bluuebunny/crossref_metadata_2025 huggingface dataset:
Menstrual Cycle Influence on COVID-19 Detection Using Machine Learning and a Wearable Medical Device [A120]
Authors: Kovacevic Vladimir , Markovic Andjela , Veen Duco , Brakenhoff Timo B. , Mitratza Marianna , Goodale Brianna M.
Published: June 2022

INTRODUCTION:

Prior research has demonstrated how immune functioning and physiological signals fluctuate across the menstrual cycle, with eumenorrheic women more likely to become ill during the luteal phase. Examining such changes during the current pandemic, we explored how the relationship between menstrual cycle phase and physiological signals impacts a wearable medical device’s ability to detect COVID-19.

METHODS:

The largest institutional review board‒approved wearable device study monitoring SARS-CoV-2’s effects on biophysiology to date, COVID-RED aims to develop a machine learning algorithm predicting an infection up to 3 days prior to symptom onset. Wearing the device nightly, participants (N=17,824) sync it with a mobile application and log SARS-CoV-2 diagnostic tests, symptoms, and menses in the app’s Daily Diary. The algorithm ingests physiological and self-reported features to provide each user with a real-time update about their likelihood of infection.

RESULTS:

Daily infection likelihood and predictions of ovulation using proprietary algorithms were generated during a 9-month period for 1,574 eumenorrheic women (n=3,281 menstrual cycles) not currently on hormonal birth control. The negative/positive ratio of predicted COVID-19 cases during the 5-day period preceding ovulation was 2.94 compared to 4.83 in the 5 days post-ovulation (chi-square (1, N=33,920)=343.34, P<.0001). Participants reported 22 SARS-CoV-2 positive test results, with five times as many confirmed infections occurring in the postovulatory period (n=10) compared to the preceding 10-day window (n=2).

CONCLUSION:

Demonstrating that machine-learning algorithms ingesting wearable data should consider menstrual cycle impact, our findings suggest that women may be more susceptible to SARS-CoV-2 during their luteal phase, with further studies needed to disentangle underlying mechanisms.
Phase 3 Study of Fezolinetant for Treatment of Moderate-to-Severe Vasomotor Symptoms Associated With Menopause [A132]
Authors: Lederman Samuel , Shapiro CM Marla , Stute Petra , Lee Misun , Wang Xuegong , Neal-Perry Genevieve
Published: June 2022

INTRODUCTION:

SKYLIGHT 1 was conducted to evaluate the efficacy and safety of the novel non-hormonal treatment, fezolinetant, versus placebo in women with moderate-to-severe vasomotor symptoms (VMS) associated with menopause.

METHODS:

This phase 3, institutional review board approved, double-blind trial (NCT04003155) randomized women aged 40–65 years with moderate-to-severe VMS (≥7 hot flashes/day) to once-daily placebo, fezolinetant 30 mg, or fezolinetant 45 mg. Co-primary efficacy endpoints were mean change from baseline to week 4 and 12 in frequency and severity of moderate-to-severe VMS. Treatment-emergent adverse events (TEAEs) were assessed.

RESULTS:

Overall, 527 women were randomized; 522 took ≥1 dose (placebo n=175, fezolinetant 30 mg n=173, fezolinetant 45 mg n=174). Both fezolinetant doses were shown to statistically reduce VMS frequency and severity at both timepoints. For VMS frequency, least squares mean (standard error) reductions versus placebo at week 4 were –1.87 (0.42), P<.001 for fezolinetant 30 mg and –2.07 (0.42), P<.001 for 45 mg. At week 12, these values were –2.39 (0.44), P<.001 for 30 mg and –2.55 (0.43), P<.001 for 45 mg. For VMS severity at week 4, reductions were –0.15 (0.06), P=.012 for 30 mg and –0.19 (0.06), P=.002 for 45 mg; at week 12, reductions were –0.24 (0.08), P=.002 for 30 mg and –0.20 (0.08), P=.007 for 45 mg. TEAEs were reported by 37.4% (fezolinetant 30 mg), 43.4% (fezolinetant 45 mg), and 44.6% (placebo) of women. Headache was the most common TEAE: 5.2% (30 mg), 6.4% (45 mg), and 7.4% (placebo).

CONCLUSION:

Fezolinetant 30 mg and 45 mg were efficacious for the treatment of moderate-to-severe VMS associated with menopause. No safety signals of concern were apparent for either fezolinetant dose.
Inclusion of Limited English Proficiency Individuals in Obstetric Randomized Controlled Trials [A161]
Authors: Mulhall Joseph C. , Zhao Zhiguo , Limperg Tobias
Published: June 2022

INTRODUCTION:

Limited English proficiency (LEP) individuals are historically underrepresented in clinical research. This study aims to quantify the inclusion of LEP individuals in high-impact obstetric studies performed in the United States, compared to the general population.

METHODS:

This literature review with a systematic search identified the 100 most cited randomized controlled trials within the field of obstetrics published from 2010 to 2019 (10 per year). Subanalyses or follow-up reports of previously published RCTs or meta-analyses were excluded. The primary outcome was the proportion of LEP individuals among trial participants compared to LEP individuals as a percentage of the U.S. population. Secondary outcomes included percentage of studies excluding LEP individuals.

RESULTS:

In Web of Science/MEDLINE, 1,227 articles were screened and 100 articles were selected for data extraction. A total of 64,179 participants were included (per-article median, 161; range, 12–2,827). The median number of citations per article was 78 (range, 14–980). A total of 66% (95% CI, 55.6–75.2%) received National Institutes of Health funding. LEP individuals were excluded in 31% (95% CI, 22.1–41.0%) of studies, as described in the article or study protocol. Inclusion was specifically allowed in 19 studies that represented 30.1% (95% CI, 30.6–31.4%) of the total study population. Only three studies reported actual inclusion of 828 LEP individuals, representing 1.3% (95% CI, 1.2–1.4%) of total participants, as compared to 8.5% of the U.S. population.

CONCLUSION:

A significant portion of high-impact obstetric studies either exclude LEP individuals or do not address inclusion, which has important implications for external validity of these studies. Future directions include surveying the investigators of identified studies to more accurately approximate included individuals.
Overview of the Rapid Antidepressant Effects Observed in the Zuranolone Clinical Development Program [A164]
Authors: Clayton Anita H. , Deligiannidis Kristina M. , Kotecha Mona , Doherty James
Published: June 2022

INTRODUCTION:

Zuranolone is an investigational oral neuroactive steroid in clinical development for once-daily, 2-week treatment of postpartum depression (PPD) and major depressive disorder (MDD) in the NEST and LANDSCAPE clinical development programs, respectively. Here we review the rapid antidepressant effects and the safety of zuranolone in four completed placebo-controlled studies in these programs.

METHODS:

ROBIN (NCT02978326; Phase 3; zuranolone 30 mg [ZRN30]; baseline 17-item Hamilton Rating Scale for Depression total score [HAMD-17] ≥26; N=153) in PPD; MDD-201B (NCT03000530; Phase 2; ZRN30; baseline HAMD-17 ≥22; N=89 [62% women]), MOUNTAIN (NCT03672175; Phase 3; zuranolone 20 mg or ZRN30; baseline HAMD-17 ≥22; N=581 [70% women]), and WATERFALL (NCT04442490; Phase 3; zuranolone 50 mg; baseline HAMD-17 ≥24; N=543 [66% women]) in MDD. All studies were institutional review board‒approved.

RESULTS:

Treatment with zuranolone led to rapid and nominally significant improvements in depressive symptoms versus placebo (as assessed by least squares mean treatment difference [SE] in change from baseline in HAMD-17) as early as Day 3 in ROBIN (−2.7 [1.19], P=.025), MOUNTAIN (ZRN30, −1.5 [0.64], P=.0160), and WATERFALL (−3.0 [0.52], P<.0001) and Day 2 in MDD-201B (−2.3 [0.99], P=.0223). Treatment-emergent adverse events (incidence ≥5% in zuranolone arms) included headache, somnolence, dizziness, nausea, sedation, diarrhea, upper respiratory tract infection, fatigue, and dry mouth (≥94% mild to moderate in severity). No loss of consciousness or excessive sedation were observed in any of the studies.

CONCLUSION:

These data from the NEST and LANDSCAPE clinical development programs demonstrate that treatment with zuranolone can lead to rapid improvement in depressive symptoms with a generally well-tolerated safety profile.
COVID-19 Vaccine Hesitancy in the California Central Valley: Why Are Pregnant Patients Saying “No”? [A201]
Authors: Franks Jennifer M. , Chavez-Sturman Taide , Kavipurapu Kiran , Lopez Juan
Published: June 2022

INTRODUCTION:

Rates of COVID-19 continue to be elevated in the California Central Valley, despite improved access to vaccination. Pregnant women are at increased risk for severe illness and preterm labor with COVID-19 infection. The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend vaccination of pregnant women. Yet, many still decline vaccination. This study is an effort to understand the rate at which patients decline vaccination and the reasons they do so.

METHODS:

Pregnant and peripartum participants were recruited from inpatient and outpatient clinical settings. We obtained demographics, history of exposure, vaccination status, intention to vaccinate, reasons for hesitancy, and knowledge of current recommendations and risks. Information was obtained using a standardized questionnaire, in English and Spanish.

RESULTS:

Of 160 surveyed, 146 participated, of whom 28% were vaccinated. Average age was 28 years; 68% Hispanic and 25% primarily Spanish-speaking. Education level was significantly associated with vaccination status (P=.03), with 53% of those with an associate’s degree or higher vaccinated, while only 22% of those with less education were vaccinated. Political party affiliation was significantly associated with vaccination status (P=.01). Having a friend or family member who had COVID-19 did not predict vaccination status. The most commonly selected reason for vaccine hesitancy was “What I have heard from the internet/media about the vaccine concerns me.”

CONCLUSION:

Our results demonstrate that level of education and political affiliation are associated with vaccination status in pregnant and peripartum patients in our population. Future counseling should be aimed at counteracting misinformation spread via internet/media sources.
CHARM 2: A Gender Synchronized Family Planning Intervention for Couples in Rural India, a Cluster Randomized Trial [A05]
Authors: Raj Anita , Ghule Mohan , Johns Nicole , Battala Madhusudana , Begum Shahina , Averbach Sarah
Published: June 2022

INTRODUCTION:

Gender synchronized family planning interventions are posited to be an important means of engaging men while supporting women’s reproductive agency and increasing modern contraceptive use, particularly in contexts where traditional gender norms prevail. The Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention counsels men, women, and couples on gender equity and family planning.

METHODS:

This is an institutional review board (IRB)-approved cluster randomized controlled trial evaluating the effect of the CHARM2 intervention on contraceptive use, communication and agency, pregnancy, and quality of care among married couples across 20 clusters in rural Maharashtra, India.

RESULTS:

We enrolled 1,201 couples. Full-couple retention at 18 months was 90.5%. Contraceptive use was higher among intervention participants at 9 but not 18 months (adjusted ratio of odds ratio [AROR] 1.5, 95% CI 1.03-2.3 and AROR 0.8, 95% CI 0.4-1.4). Communication (9-month AROR 1.9, 95% CI 1.0-3.6; 18-month AROR 2.7, 95% CI 1.5-4.8) and agency (9-month AROR 5.1, 95% CI 1.2-22.4; 18-month AROR 8.1, 95% CI 1.4-48.2) improved at both times. Intervention participants had significantly higher mean Interpersonal Quality of Family Planning scale scores at both times (9-month intervention 3.2 vs control 2.3, P<.001; 18-month intervention 3.2 vs control 2.8, P<.001). There was no significant difference in pregnancy between groups over the 18-month period (AOR 0.8, 95% CI 0.7-1.1) However, unintended pregnancy was marginally less likely among intervention participants (47% vs 19%) (P=.07).

CONCLUSION:

Broad implementation of the CHARM2 intervention has the potential to improve contraceptive use, communication, agency, and quality of care and to possibly decrease unplanned pregnancies in rural India.
Complex Family Planning Fellowship Graduates’ Practice Plans and Barriers to Practicing in Areas of Unmet Need [A42]
Authors: Pomerantz Tali S. , Creinin Mitchell D.
Published: June 2022

INTRODUCTION:

With recent changes in the political climate, complex family planning (CFP) fellowship directors have noted an increasing proportion of applicants expressing the intent to practice in areas with a dearth of abortion providers. However, data does not exist documenting fellowship graduates’ intended and post-training practice areas.

METHODS:

We anonymously surveyed 2017-2020 CFP fellowship graduates to inquire about demographics, intended and obtained post-fellowship positions, and successes and challenges in obtaining jobs. We used descriptive statistics and coded and analyzed open-ended responses for thematic content using grounded theory.

RESULTS:

One hundred (91%) of 110 invited CFP fellowship graduates responded. Most (92%) expected to practice in an academic environment. Half (49%) pursued fellowships with the intent to practice in a location with an unmet need for abortion providers. Of those, only 22 (45%) did so. When asked why they ultimately did not practice where intended, common themes included job availability, family-related concerns, safety concerns, and relationship status changes.

CONCLUSION:

CFP fellowship graduates primarily intend to practice in academic environments, with half planning to do so in underserved locations. However, the majority of those who entered fellowship hoping to fill an unmet need for abortion providers were unable to do so. While the CFP fellowship has laid the groundwork for training leaders in abortion provision, more work is needed to eliminate barriers that interfere with fellowship graduates’ willingness and ability to obtain positions in locations with unmet need.
Cost-Effectiveness of Opportunistic Salpingectomy Following Vaginal Delivery for Ovarian Cancer Prevention [A102]
Authors: Wagar Matthew K. , Forlines Grayson L. , Moellman Nicholas , Carlson Anisa , Matthews Michael , Williams Makeba
Published: June 2022

INTRODUCTION:

Opportunistic salpingectomy at the time of benign gynecologic surgery and cesarean delivery is a cost-effective strategy for ovarian cancer risk reduction. We sought to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation in the immediate postpartum period following vaginal deliveries.

METHODS:

Using two decision analytic models, we simulated a hypothetical cohort of 10,000 women undergoing bilateral salpingectomy or tubal ligation immediately following vaginal delivery. We derived probabilities of ovarian cancer risk reduction following tubal sterilization from published literature. We used institutional charge data to determine cost inputs. The primary outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Institutional review board (IRB) approval was obtained.

RESULTS:

Opportunistic salpingectomy is more cost-effective than tubal ligation following vaginal delivery in a theoretical cohort, with an ICER of $24,176/QALY. Compared to tubal ligation, opportunistic salpingectomy yields a theoretical total cost savings of $6.48 million. Discounted costs of ovarian cancer were $2.9 million lower for the salpingectomy cohort compared to tubal ligation. Opportunistic salpingectomy avoided 12 fewer ovarian cancer cases and 8 fewer ovarian cancer deaths compared to tubal ligation.

CONCLUSION:

Our analytic model demonstrates that following vaginal delivery, opportunistic salpingectomy is a cost-effective strategy for reducing risk of ovarian cancer. Compared to tubal ligation, opportunistic salpingectomy reduces ovarian cancer cases and mortality.
Renal Cell Carcinoma Subtypes and Associated Renal Malignancies: A Pictorial Review—Part I
Authors: Boora Naveenjyote S. , Michaela Perlau , Fung Christopher I.
Published: June 2022

Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies, with clear cell subtype representing the majority of these cases. In the United States, the number of new cases of kidney and renal pelvis cancers was 15.6 per 100,000 men and women per year. Although the incidence of RCC has been increasing for several years, the landscape of RCC has changed significantly due to the use of highly sensitive imaging modalities. The percentage of early-stage T1 Kidney cancers has increased from 43% to more than 60% over the past two decades, with a 5-year survival rate of more than 90% for these early-stage tumors.1 As diagnostic imaging plays a significant role in the detection and management of these cancers, a fundamental understanding of RCC and its various subtypes is essential for all medical imaging specialists.
Knowledge Retention and Clinical Skills Acquisition in Sexual and Gender Minority Health Curricula: A Systematic Review
Authors: Mains-Mason Janke B. , Ufomata Eloho , Peebles J. Klint , Dhar Cherie P. , Sequeira Gina , Miller Rebekah , Folb Barbara , Eckstrand Kristen L.
Published: June 2022

Purpose

To identify exemplary medical education curricula, operationalized as curricula evaluating knowledge retention and/or clinical skills acquisition, for health care for sexual and gender minoritized (SGM) individuals and individuals born with a difference in sex development (DSD).

Method

The authors conducted a systematic review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in PubMed/MEDLINE, The Cochrane Library, Web of Science, ERIC, Embase, PsycINFO, and the gray literature to identify studies that (1) pertained to undergraduate and/or graduate medical education, (2) addressed education on health care of SGM/DSD individuals, and (3) assessed knowledge retention and/or clinical skills acquisition in medical trainees. The final searches were run in March 2019 and rerun before final analyses in June and October 2020.

Results

Of 670 full-text articles reviewed, 7 met the inclusion criteria. Five of the 7 studies assessed trainee knowledge retention alone, 1 evaluated clinical skills acquisition alone, and 1 evaluated both outcomes. Studies covered education relevant to transgender health, endocrinology for patients born with DSDs, and HIV primary care. Only 1 study fully mapped to the Association of American Medical Colleges (AAMC) SGM/DSD competency recommendations. Six studies reported institutional funding and development support. No studies described teaching SGM/DSD health care for individuals with multiply minoritized identities or engaging the broader SGM/DSD community in medical education curriculum development and implementation.

Conclusions

Curriculum development in SGM/DSD health care should target knowledge retention and clinical skills acquisition in line with AAMC competency recommendations. Knowledge and skill sets for responsible and equitable care are those that account for structures of power and oppression and cocreate curricula with people who are SGM and/or born with DSDs.
Barriers, Challenges, and Solutions: What Can We Learn About Leadership in Academic Medicine From a Qualitative Study of Emergency Medicine Women Chairs?
Authors: Hobgood Cherri D. , Draucker Claire
Published: June 2022

Purpose

Women have made significant gains in leadership across all disciplines in academic medicine but have not yet achieved leadership parity as department chairs. The authors investigated the challenges experienced by one cohort of women department chairs in emergency medicine (EM) and the solutions they proposed to address these challenges.

Method

The authors conducted a qualitative descriptive study of 19 of 20 possible current and emeritus emergency medicine women department chairs at academic medical centers between April and December 2020. Participant interviews elicited self-reported demographic characteristics and narrative responses to a semistructured interview template that focused on the role of gender in their leadership and career trajectories. Interviews were transcribed, blinded, and iteratively coded and categorized.

Results

The analysis demonstrated 4 common challenges and 5 enacted or proposed solutions. The challenges discussed by the participants were: feeling unprepared for the role of department chair, being one of few women in leadership, inheriting unhealthy department cultures, and facing negative faculty reactions. The individual- and institutional-level solutions discussed by the participants were: gaining and maintaining confidence (individual), maintaining accountability and mission alignment (individual), facilitating teamwork (individual), supporting women’s leadership (institution), and creating safe leadership cultures (institution).

Conclusions

Women department chairs in EM were successful academic leaders despite confronting several challenges to their leadership. Considering the study findings through the lens of the concept of second-generation gender bias further illuminates the influence of gender on leadership in academic medicine. These findings suggest several possible strategies that can combat gender bias, increase gender parity among academic medicine’s leadership, and improve the leadership experience for women leaders.
Efficacy and Underlying Mechanism of Berberine Against Atherosclerosis: A Meta-Analysis in Preclinical Animal Studies
Authors: Jia Dongdong , Zhang XinYue , Guo Qianqian , Yang Rui , Yu Haitao , Zhao Mengzhu , Shi Liu , Liu Menghua , Wu Aiming , Zhang Dongmei
Published: June 2022

Atherosclerosis is the primary cause of many cardiovascular diseases, and an increasing number of studies have shown that berberine could delay plaque formation and development. Therefore, we aimed to evaluate its effects and explore its mechanisms in this meta-analysis. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP databases for original preclinical studies to conduct meta-analysis. Twelve articles (16 studies; 312 ApoE−/− mice) were included, and all the studies scored 3–5 points according to SYRCLE's risk of bias tool. Berberine could significantly decrease plaque area and plaque macrophage content (plaque area, SMD = −2.02, 95% CI: −2.80 to −1.24, P = 0.000; plaque macrophage content, SMD = −4.28, 95% CI: −7.67 to −0.88, P = 0.013); lower the levels of TC, triglyceride, and low-density lipoprotein (TC, SMD = −1.47, 95% CI: −2.20 to −0.74, P = 0.000; triglyceride, SMD = −0.77, 95% CI: −1.21 to −0.33, P = 0.000; low-density lipoprotein, SMD = −0.61, 95% CI: −1.11 to −0.11, P = 0.000), and change the secretion of inflammatory cytokines (IL-1β, SMD = −2.29, 95% CI: −3.40 to −1.18, P = 0.000; interleukin-6, SMD = −1.48, 95% CI: −2.11 to −0.85, P = 0.008; tumor necrosis factor-α, SMD = −1.98, 95% CI: −3.01 to −0.94, P = 0.000; interleukin-10, SMD = 1.78, 95% CI: 0.76 to 2.80, P = 0.015), but there were no significant differences in high-density lipoprotein levels and plaque lipid content (high-density lipoprotein, SMD = 0.02, 95% CI: −0.35 to 0.40, P = 0.021; plaque lipid content, SMD = −6.85, 95% CI: −21.09 to 7.39, P = 0.007). The results were robust across a range of sensitivity analyses. Therefore, the results indicate that berberine is a promising drug for the treatment of atherosclerosis through regulating lipid metabolism, inflammation, and plaque composition. However, some potential mechanisms remain to be further elucidated.
Augmentation Mastopexy: A Five-step Standardized Strategy Approach
Authors: Abdelkader Rasha , Raafat Sarah , Sakr Wael , Abdelaziz Mohamed , ElNoamany Sameh
Published: June 2022

Introduction:

Planning a combined procedure requires ensuring an optimal fill of the reduced breast skin envelope, which in turn requires a system to quantify skin excess to ensure that the selected implant achieves that optimal fill. This has led us to develop a five-step approach that a surgical team can use to assess patients scheduled to undergo an augmentation mastopexy and arrive at an optimal surgical strategy.

Methods:

This retrospective study included 50 consecutive cases where layered mastopexies combined with augmentation mammaplasties were performed. Step 1 entailed a preoperative examination and evaluation of the breasts. In step 2, the breast volume was assessed. The pocket plane was determined in step 3. The choice of which surgical technique to use was done in step 4, and in step 5, the horizontal skin excess was assessed.

Results:

The average implant size was 300 cm3 (range: 170–350 cm3). The overall revision rate was 4%: on average, revision surgeries were performed 24 months after the first surgery. The average implant size was 300 cm3 (range: 170–350 cm3).

Conclusions:

Early results of single-stage augmentation with mastopexy have shown that the design of this systematic five-step approach demonstrates a great potential for producing reliable results with minimal risk. Using this five-step approach will improve patient and surgeon satisfaction and help to replace the old concept of “fill and re-drape” with a new one of “plan, reduce, fill, and re-drape.”
Conchal Excision Techniques in Otoplasty: A Literature Review
Authors: Mogl Adrian Georg , Palackic Alen , Cambiaso-Daniel Janos , Duggan Robert P. , Vappiani Monica , Giraudi Camilla , Raposio Edoardo , Bertossi Dario , Gualdi Alessandro
Published: June 2022

Background:

Prominent ears are a common congenital deformity of the head and neck. Correcting concha hypertrophy is an important step in otoplasty. Despite the risk of postoperative deformity due to the sharp edges created by excision, removing a section of cartilage is sometimes the only method to obtain a satisfying and long-lasting result. Multiple conchal excision techniques have been reported in the literature, with significant differences in approach, outcome evaluation, and complication classification. The objective was to review cartilage excision-based otoplasty procedures to offer plastic surgeons’ insights into current data on outcomes and complications of conchal excision techniques.

Methods:

We conducted a literature search through the MEDLINE, EMBASE, Scopus, and Cochrane databases. Prospective and retrospective studies on otoplasty, including revision surgeries and conchal excision techniques involving concha cartilage resection, were included. Articles with no outcomes data, review articles, case reports, expert opinion or comment, and nonclinical studies were excluded.

Results:

There were a total of four manuscripts that fulfilled our criteria. Three out of four authors preferred posterior access that separates the skin excision from the cartilage excision. Following resection, cartilage edges can be approximated by placing cartilage sutures, or they can be allowed to collapse spontaneously. Although only two authors employed a systematic classification for complications, all the articles reviewed indicated a low complication rate and excellent postoperative cosmetic outcomes.

Conclusion:

Although the techniques and principles stated in the literature varied to some extent, the outcomes of all studies reviewed were comparable.
Breast Cancer Epidemiology and Contemporary Breast Cancer Care: A Review of the Literature and Clinical Applications
Authors: El Masri Jad , Phadke Sneha
Published: June 2022

Substantial progress has been made in contemporary breast cancer care, resulting in a consistently declining breast cancer mortality rate and an improvement in quality of life. Advancements include deescalation of therapy in low-risk populations and refining systemic therapy options. Research into molecular biomarkers continues to evolve and holds the promise of achieving the goal of precision medicine, while guidelines for supportive care and survivorship have been created to address the needs of an ever-increasing number of breast cancer survivors. A collaborative, multidisciplinary team approach is essential for patients and survivors to achieve optimal outcomes and enjoy productive high-quality lives. Gynecologists, in particular, play a key role in screening and survivorship care.
How Can We Get to Equitable and Effective Postpartum Pain Control?
Authors: Johnson Jasmine D. , Cooper Shontreal , Badreldin Nevert , Green Celeste
Published: June 2022

Postpartum pain is common, yet patient experiences and clinical management varies greatly. In the United States, pain-related expectations and principles of adequate pain management have been framed within established norms of Western clinical medicine and a biomedical understanding of disease processes. Unfortunately, this positioning of postpartum pain and the corresponding coping strategies and pain treatments is situated within cultural biases and systemic racism. This paper summarizes the history and existing literature that examines racial inequities in pain management to propose guiding themes and suggestions for innovation. This work is critical for advancing ethical practice and establishing more effective care for all patients.
Women's Health-Related Quality of Life Substantially Improves With Tailored Cardiac Rehabilitation
Authors: Chung Sherrie , Candelaria Dion , Gallagher Robyn
Published: June 2022

Purpose:

Exercise-based cardiac rehabilitation (EBCR) offers an opportunity to improve women's otherwise poorer outcomes from coronary heart disease compared with men. However, synthesized evidence for the benefits of EBCR for health-related quality of life (HRQL) is lacking for women. The current study addresses this gap.

Methods:

Four electronic databases (PubMed, CINAHL, SCOPUS, and Cochrane) were searched for studies reporting HRQL using validated questionnaires in women attending EBCR. Two reviewers independently screened articles and extracted data. A random effects model was used for meta-analysis, where possible.

Results:

Eleven studies (1237 women) were included, with seven suitable for meta-analyses. Participation in EBCR improved multiple domains of HRQL, with greatest improvements in Role Physical (mean differences [MD] = 19.09: 95% CI, 2.37-35.81), Physical Functioning (MD = 10.43: 95% CI, 2.60-18.27), and Vitality (MD = 9.59: 95% CI, 0.31-18.86) domains of the 12-Item Short Form Health Survey and the 36-Item Short Form Health Survey. Adding psychosocial components tailored for women to traditional EBCR produced further gains in HRQL in Bodily Pain (MD = 9.82: 95% CI, 4.43-15.21), Role Physical (MD = 8.48: 95% CI, 1.31-9.97), Vitality (MD = 8.17: 95% CI, 3.79-12.55), General Health (MD = 5.64: 95% CI, 1.31-9.97), and Physical Functioning (MD = 5.61: 95% CI, 0.83-10.40) domains.

Conclusions:

Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, with added benefits when strategies were tailored to their needs. These benefits should be highlighted to promote EBCR uptake in women.
Can β-blockers influence regular daily physical activity?
Authors: Alimento Marina Luisa , Palermo Pietro , Italiano Gianpiero , Antonioli Laura , Salvioni Elisabetta , Agostoni Piergiuseppe
Published: June 2022

Background:

In hypertension, β-blockers have a high rate of nonadherence to treatment likely because of fatigue.

Methods:

We evaluate daily physical activity and maximal exercise performance in 56 patients with hypertension (grades I–II), with and without β-blockers (bisoprolol 10 mg or atenolol 100 mg) added to standard treatment; 48 patients completed the study. Study tests were performed after 8 weeks of antihypertensive therapy without β blockers and after the following 8 weeks with β-blockers.

Results:

No significant differences between β-blockers were observed. At office measurement, β-blockers decreased heart rate (HR) from 78 ± 9 to 62 ± 7 bpm (P < 0.01) and SBP from 133 ± 13 to 125 ± 12 mmHg (P < 0.01). No significant changes were observed for DBP. Conversely, at ambulatory pressure monitoring DBP but not SBP decreased with β-blockers (mean-24-h DBP 77 ± 8 vs. 74 ± 7 mmHg, P < 0.01). An overall reduction of daily activities and of estimated kilocalories consumption was observed as measured by a portable armband device. Of note, time with activity more than 3 METS was reduced by β-blockers from 148.1 (83–201) to 117.9 (82–189) min (P < 0.01). Cardiopulmonary exercise (CPE) showed a preserved exercise performance unaffected by β-blockers.

Conclusion:

In hypertension, β-blocker treatment is associated to reduction of daily physical activity but not of maximal exercise performance.
Effect of different treatments for obstructive sleep apnoea on blood pressure
Authors: Kou Chengkun , Zhao Xu , Lin Xin , Fan Xin , Wang Qiongying , Yu Jing
Published: June 2022

Objective:

Obstructive sleep apnoea (OSA) is a common cause of secondary hypertension. This network meta-analysis (NMA) assessed the effect of different OSA treatments on lowering blood pressure.

Methods:

PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for relevant randomized controlled trials. The search strategies included the concepts of OSA, blood pressure, hypertension, and blood pressure-reducing treatments without language or data restriction (from inception to 1 June 2021). The outcomes included office SBP, office DBP, daytime SBP (dSBP) and DBP (dDBP), and night-time SBP (nSBP) and DBP (nDBP). A Bayesian network meta-analysis was performed, and mean differences with 95% credibility intervals were calculated.

Results: :

We reviewed 49 randomized controlled trials involving 4893 patients and the following interventions: continuous positive-airway pressure (CPAP), mandibular advancement devices, nocturnal supplemental oxygen, surgery, β-blocker, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), renal sympathetic denervation (RDN), mineralocorticoid receptor antagonists (MRAs), calcium channel blockers. MRAs were significantly associated with blood pressure reduction followed by ACEI/ARB. RDN could reduce office SBP, office DBP, 24-h SBP, 24-h DBP, dSBP, and dDBP. CPAP also demonstrated modest blood pressure lowering.

Conclusion:

MRAs and ACEIs/ARBs can reduce blood pressure effectively in patients with OSA. RDN is a novel hypertension treatment that lowered blood pressure in such patients. CPAP was associated with mild but stable blood pressure reduction, and it might be helpful as an adjunctive therapy in OSA patients with hypertension.

Review registration:

This systematic review and meta-analysis was registered in PROSPERO: CRD42021240891.
Inter-individual variations in response to aerobic and resistance training in hypertensive older adults
Authors: Abrahin Odilon , Abrahin Rejane Pequeno , de Sousa Evitom Corrêa , Cortinhas-Alves Erik Artur , Nascimento Dahan da Cunha , Guerreiro João Farias
Published: June 2022

Background:

Hemodynamic responses to physical training are not homogenous and uniform, and considerable inter-individual variations in the blood pressure of hypertensive individuals are noted in both aerobic and resistance training protocols. In this context, this study aimed to evaluate the effects of resistance and aerobic exercise on the blood pressure responses of hypertensive older adults.

Methods:

Groups were randomly divided into resistance training, n = 20; aerobic training, n = 20; control group, n = 21). After the first intervention period (12 weeks), individuals underwent a washout period (six detraining weeks), followed by a second intervention. This process is called the ‘cross-over’ model, where individuals who performed the aerobic exercise protocol also performed resistance training and vice-versa, constituting another 12 weeks of intervention. Blood pressure, functional performance, glycated hemoglobin and lipid profiles were evaluated preintervention and postintervention.

Results:

Varying responses to resistance training or aerobic training stimuli were observed in the hypertensive older adult participants. Both resistance training (pre 133.2 ± 14.1; post 122.4 ± 7.3; P < 0.05) and aerobic training (pre 134.2 ± 14.4; post 123 ± 9.4; P < 0.0.5) were effective in decreasing SBP, but only aerobic training (pre 9955.3 ± 1769.4; post 8800.9 ± 1316.1; P < 0.05) resulted in a decreased double product, and only the resistance training group improved functional performance.

Conclusion:

Responses to resistance training or aerobic training stimuli varied noticeably between hypertensive older adults and both resistance training and aerobic training were effective in reducing SBP. This knowledge may be useful in providing individually tailored exercise prescriptions for hypertensive older adults.
Campanumoea javanica Bl. activates the PI3K/AKT/mTOR signaling pathway and reduces sarcopenia in a T2DM rat model
Authors: Zuo Xiangyu , Yao Rongfei , Zhao Linyi , Zhang Yinjiang , Lu Binan , Pang Zongran
Published: June 2022

Objective:

Sarcopenia causes loss of skeletal muscle and function, thus seriously affecting the physical function and quality of life in the elderly. This article discusses the specific molecular mechanism and ameliorating effects of Tudangshen (TDS) on sarcopenia in elderly rats with type 2 diabetes mellitus (T2DM).

Methods:

Elderly Sprague-Dawley (SD) rats were randomly selected and fed with a high-fat diet combined with intraperitoneal injection of streptozotocin to establish T2DM model. The model rats were stratified and randomly divided into model group, metformin group, TDS high-dose group, TDS medium-dose group, and TDS low-dose group according to blood glucose combined with body weight, and the same batch of old SD rats were set as normal control group. The effects of TDS in an elderly T2DM sarcopenia rat model were evaluated by observing body positions of the rats, analyzing blood biochemistry, testing exercise capacity, and pathologically staining sectioned gastrocnemius muscle tissues. The molecular mechanisms of the effects were analyzed using quantitative real-time polymerase chain reaction and western blotting.

Results:

TDS has no statistically significant effect on blood glucose, insulin and glycosylated serum protein in aged rats with T2DM, but it can reduce levels of glycosylated serum protein, total cholesterol, triglycerides, and low-density lipoprotein; it improves pathological changes in rat gastrocnemius muscle tissues, and increases muscle cell activity in elderly rats with T2DM and sarcopenia. TDS also promoted the upregulation of the expression of mammalian target of rapamycin (mTOR)/protein kinase B (PKB/Akt)/phosphatidylinositol 3-kinase (PI3K)/ribosomal protein S6 kinase/eukaryotic initiation factor 4E binding rotein1 mRNA in rats and triggered an increase in corresponding protein levels.

Conclusions:

TDS alleviated muscle decline in elderly rats with T2DM by activating the PI3K/AKT/mTOR signaling pathway and regulating the synthesis of corresponding proteins.
The Effects of Inhalational Lavender Essential Oil Aromatherapy on Sleep Quality in Hemodialysis Patients
Authors: Beerappa Harish , GT Kavana , Chandrababu Ramesh
Published: June 2022

One of the most essential physical prerequisites for human survival is sleep. Patients undergoing hemodialysis often experience a lack of sleep, and it is one of the decisive variables in dialysis patients' quality of life. The objective of this study was to assess the effects of inhaling lavender essential oil on sleep quality in hemodialysis patients. A total of 30 patients were enrolled in the before-and-after intervention trial, which took place in a tertiary care hospital's dialysis unit. The study participants were selected using the purposive sampling technique and they received lavender oil inhalation therapy. The sleep quality was measured using the Pittsburgh Sleep Quality Index. The mean age of the participants was 55.11 (SD = 8.45) years. The mean posttherapy Pittsburgh Global Sleep Quality Index score was 8.8 ± 1.89 compared with the pretherapy score of 14.73 ± 1.53. Patients undergoing hemodialysis experienced a substantial improvement in sleep quality (P < .05). Aromatherapy using lavender oil is effective in enhancing sleep quality in hemodialysis patients.
Major Changes in Spatiotemporal Trends of US Rotavirus Laboratory Detections After Rotavirus Vaccine Introduction—2009–2021
Authors: Burnett Eleanor , Parashar Umesh D. , Winn Amber , Curns Aaron T. , Tate Jacqueline E.
Published: June 2022

For the 15 years before rotavirus vaccine introduction in 2006, annual rotavirus activity in the United States showed a distinct spatiotemporal pattern, peaking first in the Southwest and last in the Northeast. We modeled spatiotemporal trends in rotavirus laboratory detections from 2009 to 2021. Laboratories reporting to the National Respiratory and Enteric Virus Surveillance System were eligible for inclusion in a given surveillance year (July to June) if ≥1 polymerase chain reaction or enzyme immunoassay rotavirus test per week was reported during ≥26 weeks and totaling ≥100 annual tests. For each laboratory, the season peak was the week with the highest 7-week moving average of the number of rotavirus positive tests during the national season, defined as the period with a 3-week moving average of >10% rotavirus positivity lasting ≥2 consecutive weeks. We input peak week as a continuous variable and the geospatial coordinates of each laboratory into a spherical variogram model for Kriging spatial interpolation. We also created a state-level bivariate choropleth map using tertiles of the 2010–2019 average birth rates and rotavirus vaccine coverage. Following the established biennial trend, the 2010–2011, 2012–2013, 2014–2015, 2016–2017, and 2018–2019 surveillance years had >10% rotavirus positivity for ≥2 weeks and were included in the geospatial analysis. During all 5 seasons included in the geospatial analysis, the earliest peak week occurred in Oklahoma, Arkansas, and the western Gulf coast, a pattern markedly different from prevaccine seasons. These states also had the average lowest rotavirus vaccine coverage and highest birth rate, suggesting that more rapid accumulation of susceptible children drives annual rotavirus season activity. Increasing vaccine coverage remains a key tool in reducing rotavirus burden.
Incidence and Predictors of Relapse After Stopping Antiviral Therapy in Pediatric Chronic Hepatitis B
Authors: Upadhyay Piyush , Lal Bikrant Bihari , Sood Vikrant , Khanna Rajeev , Gupta Ekta , Rastogi Archana , Alam Seema
Published: June 2022

Background:

There are no definite end-points for stopping therapy in pediatric chronic hepatitis B (CHB). The study objective was to evaluate the incidence of relapse after stopping antiviral therapy and to identify its predictors.

Methods:

All hepatitis B surface antigen (HBsAg) positive children presenting to our hospital, who had been on antivirals for at least 2 years with undetectable hepatitis B virus-deoxyribonucleic acid (HBV-DNA) and normal alanine aminotransferase (ALT) on 3 consecutive occasions over last 12 months were included. Antivirals were stopped if liver biopsy showed histological activity index <5 and fibrosis (Ishak) <3. Virological relapse was defined as the elevation of HBV-DNA (>2000 IU/mL) and biochemical relapse as a rise in ALT levels to >2 times the upper limit of normal. Those having biochemical relapse were started on pegylated interferon alpha-2b-based sequential therapy.

Results:

Of the 114 children with CHB screened, 31 HBsAg-positive children fulfilled inclusion criteria and antivirals were stopped in them. Virological and biochemical relapse was seen in 12 (38.7%) and 5 (16.1%) children within 12 months of stopping antiviral treatment. On Cox regression, hepatitis B e antigen (HBeAg) positive status at the time of stopping antiviral therapy (HR: 6.208, 95% CI: 1.630–23.638) and longer time taken for HBV-DNA to become undetectable while on antivirals (HR: 1.027, 95% CI: 1.000–1.055) were the independent predictors of relapse.

Conclusion:

Discontinuation of antiviral treatment in children with CHB resulted in relapse in one-third of the patients. Relapse was frequent in those who were HBeAg-positive at the time of stopping therapy and in those who required longer therapy for HBV-DNA to become undetectable.
Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 μm topography-guided excimer regularized keratoconus corneas
Authors: Salimi Ali , Gauvin Mathieu , Harissi-Dagher Mona , Racine Louis , Cohen Mark , Wallerstein Avi
Published: June 2022

Purpose:

To investigate the efficacy and safety of phototherapeutic keratectomy (PTK) with topography-guided photorefractive keratectomy (T-PRK) corneal regularization followed by sequential hypo-osmolar riboflavin accelerated corneal crosslinking (CXL) in keratoconic (KC) eyes with <400 μm stromal bed thickness after excimer ablation.

Setting:

Multisurgeon multicenter standardized protocol practice.

Design:

Retrospective multicenter case series.

Methods:

This study included progressive KC eyes that underwent PTK and T-PRK combined with accelerated CXL and had a corneal stromal bed thickness of <400 μm after excimer ablation before administration of hypo-osmolar riboflavin. Demographics and clinical measures were reviewed at baseline and every follow-up visit.

Results:

61 consecutive eyes had a mean corneal stromal bed thickness of 367 ± 21 μm after excimer laser normalization. Postoperatively, uncorrected distance visual acuity (UDVA) improved by 0.29 logMAR (P < .0001), corrected distance visual acuity (CDVA) improved by 0.07 logMAR (P = .0012), and maximum keratometry (Kmax) decreased by 4.67 diopters (P < .0001). The safety index was favorable (1.29 ± 0.56), with stable manifest astigmatism, Kmax, and pachymetry at 12 months. 2 eyes (3%) showed evidence of keratometric progression on topography.

Conclusions:

In KC corneas thinner than 400 μm after excimer ablation, PTK epithelial removal followed by T-PRK and hypo-osmolar accelerated CXL decreases manifest astigmatism and Kmax, improves UDVA and CDVA, and halted disease progression in 97% of eyes at 12 months. These outcomes are comparable with thicker ablated corneas not requiring hypo-osmolar stromal swelling.
Medical Equipment Maintenance Management System: Review and Analysis
Authors: Khider Mohamed Omer , Hamza Alnazier Osman
Published: June 2022

Maintenance management is an orderly and systematic approach for planning, organizing, monitoring, and evaluating maintenance activities and their costs. A good maintenance management system coupled with knowledgeable and capable maintenance staff can prevent health and safety problems and environmental damage; yield longer asset life with fewer breakdowns; and result in lower operating costs and a higher quality of life. The medical equipment maintenance could be either preventive or corrective. The medical equipment management professionals ensure that equipment used in the patients care is operational, safe, and properly configured to meet the mission of the medical treatment facility and continue to function effectively in a good working condition. For example, proper maintenance can extend the life of equipment. This is essential for providing good health services and saving the scarce resources. A comprehensive review on the subject of medical device maintenance management system has been done to give an overview of the development of this system in the hospitals and to shine what could be enhanced and improved in this system to promote the patient healthcare.