bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe complications after pulmonary vein isolation for atrial fibrillation: a worldwide collaborative registry
Authors: Du Fay De Lavallaz J , Badertscher P , Reichlin T , Sticherling C , Kuehne M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss Heart Foundation

Background

Pulmonary vein isolation (PVI) is the most commonly performed electrophysiological procedure. Severe complications such as tamponade, stroke, cardiac arrest and death are believed to be uncommon but detailed assessment of these complications in very large worldwide cohorts is lacking.

Purpose

To investigate the incidence, predictors, patient characteristics, management details and outcome of severe complications (cardiac tamponade, stroke, cardiac arrest, death) after PVI in a large worldwide collaborative registry with comprehensive patient-level data.

Methods

We contacted electrophysiologists from an established PVI-collaborative network and invited further center to participate, thereby gathering individual patient-data from 23 centers worldwide. Few datapoints were collected for the overall patients and exhaustive details were entered in a dedicated database for patients experiencing a severe complication.

Results

From the 23 participating centers a total of 33,889 procedures could be collected (median age 63 y.o., 30% female, 27% cryoballoon ablations). The incidence of severe complications was low (tamponade 0.7% (7/1000 PVIs), stroke 0.089% (<1/1000 PVIs) or cardiac arrest (0.035%, <1/1000PVIs)), and death was extremely rare (1.18/10,000 PVIs), Figure panel A). Female sex (OR 1.7 95%-CI [1.3-2.2], p<0.001), a dilated left atrium (OR 1.9 95%-CI [1.4-2.8], p<0.001) and the use of radiofrequency (OR 1.8 95%-CI [1.3-2.7], p=0.002) appeared as strong predictors for the composite endpoint of all severe complications (Figure panel B). Critical steps during the ablation were transseptal puncture and energy delivery and 14% of all tamponades led to procedure abortion (Figure panel C). Among the patients experiencing a tamponade, 13% required cardiac surgery and perforations were predominantly found in the left atrial appendage and in the PVs during surgery (Figure panel D). Patient outcomes despite a severe complication were good with 93% of patients discharged directly home after a median length of stay of 5 days (IQR 3-7).

Conclusion

This very large worldwide collaborative study highlighted that tamponade, stroke, cardiac arrest or death are rare after PVI. Female sex and the use of radiofrequency catheters were associated with a higher risk of severe complications. A non-negligible percentage of patients required cardiac surgery after tamponade, where a perforation was most commonly found in the left atrial appendage and PVs.
Effectiveness of nurse-led interventions to manage hypertension and lifestyle behaviour effectively: a systematic review and meta-analysis
Authors: Bulto L , Roseleur J , Noonan S , Pinero De Plaza A , Champion S , Dafny H A , Pearson V , Nesbitt K , Gebremichael L , Beleigoli A , Schultz T , Hines S , Clark R , Hendriks J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertension is a leading risk factor in the development and worsening of cardiac arrhythmias, in particular atrial fibrillation. Practice guidelines recommend an integrated management approach which includes multidisciplinary teams.

Aim

to investigate the role of nurses in the management process, and to evaluate the effectiveness of nurse-led interventions on hypertension management, lifestyle behaviour and associated patient knowledge.

Methods

A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), Emcare (Ovid), CINAHL (EBSCO), Cochrane library and ProQuest (Ovid) were searched from inception to February 2022. Randomised controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, and full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI (Joanna Briggs Institute) tools. A statistical meta-analysis was conducted using RevMan version 5.4.1.

Results

A total of 37 RCTs and 9,731 participants were included. The overall pooled data demonstrated nurse-led interventions significantly improved systolic blood pressure (MD -5.39; 95% CI -7.59, -3.34; I2 = 81.33; 23 RCTs; moderate certainty evidence) and diastolic blood pressure (MD –1.94 95% CI -3.27, -0.60; I2 = 79.66; 22 RCTs; moderate certainty evidence) compared to usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent.

Conclusion

This review revealed beneficial effects of nurse-led interventions in hypertension management compared to usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension and conditions it may be associated with.
Does Rassi score caracterize patients with Chagas disease with complex ventricular arrhythmias?
Authors: Costa P , Moreira D , Serafim K , Habib R , Sierra Reyes C , Andalaft R , Berbert G , Fragata C , Sassaki E , Lopes H , Armaganijan L , Valdigem B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Rassi score (NYHA functional class III/IV HF [5 points], cardiomegaly [5 points], contractions abnormalities [3 points], non-sustained ventricular tachycardia [3 points], low amplitude QRS [2 points] and male sex [2 points]) is used in the clinic for risk stratification due to cardiovascular death in patients with Chagas disease (P-CD). Whether this score has any role in identifying patients at risk of complex ventricular arrhythmias has not been determined.

Objective

Assess whether there is an association between Rassi score and the presence of potentially malignant complex ventricular arrhythmias in P-CD.

Methods

79 P-CD (34 men, age 61±11 years-old), consecutively referred for 24h-Holter were divided into 2 groups: low risk Rassi score (57 P, 0-6 points) and medium-high risk (22 P, 7-20 points). The amount and complexity of ventricular arrhythmia (> 30/ h, ventricular tachycardia [VT]), LVEF, heart rate turbulence (HRT) indexes (turbulence onset [TO] and turbulence slope [TS]) and HRT category (0 [without disautonomy], 1 and/or 2 [presence of disautonomy]) were evaluated.

Results

Compared to P-CD with low risk score, those with medium-high risk had more ventricular arrhythmias, lower LVEF, worse HRT indexes and more HRT categories 1 and/or 2 (see table below).

Conclusions

1) P-CD and Rassi score of medium to high risk have a greater amount of ventricular arrhythmias; 2) These findings can be explained by the presence of greater degree of disautonomy, assessed by HRT, and by the lower LVEF; 3) Prospective studies are necessary to confirm these findings in clinical practice.
Role of periprocedural HV interval assessment to determine the risk of atrioventricular block after transcatheter aortic valve replacement
Authors: Pagnoni M , Meier D , Luca A , Fournier S , Aminfar F , Maurizi N , Cook S , Goy J J , Togni M , Pruvot E , Muller O , Pascale P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Fondation vaudoise de cardiologie interventionnelle.

Background

The identification of patients at risk of post-procedural high-grade atrio-ventricular block (HAVB) is one of the major unmet challenges in transcatheter aortic valve replacement (TAVR). Some studies have suggested that periprocedural electrophysiological (EP) testing might help to identify patients at risk, but its role is controversial.

Purpose

To determine whether the immediate postvalve deployment HV and the Delta-HV interval (difference between post- and prevalve deployment HV interval) are predictive of HAVB and pacemaker (PM) need over 1 year follow-up.

Methods

We prospectively analysed consecutive patients undergoing TAVR between August 2019 and October 2021, and without prior PM implantation. ECG and standardized HV interval measurements were performed pre- and postvalve deployment with the quadripolar catheter used for rapid pacing. The primary outcome was either documented HAVB beyond 24h after TAVR or ventricular pacing >1% in patients who underwent prophylactic PM implantation because of abnormal EP testing in the days following TAVR. Minimal follow-up was 12 months.

Results

97 patients were included. The primary outcome occurred in 8 patients (8.3%): HAVB occurred in 7 patients (5 during hospitalisation and 2 within one month of follow-up), and 1 patient underwent PM implantation because of abnormal EP testing (HV interval≥70 ms) with ventricular pacing up to 11% despite an algorithm to minimize pacing. Among ECG and EP findings, univariate predictors of the primary outcome were the pre- and postvalve deployment PR interval and both the postvalve deployment HV and Delta-HV interval (Table 1). By ROC analysis, a Delta-HV interval ≥18ms predicted HAVB with 50% sensitivity and 90% specificity (AUC=0.708, PPV 31%), and an HV interval ≥ 60ms after TAVR predicted HAVB with 63% sensitivity and 79% specificity (AUC=0.681, PPV 21%) (Figure 1).

Conclusion

The yield of the periprocedural HV interval assessment alone is limited in ruling out the risk of HAVB since about half of the patients at risk fail to be identified. However, abnormal postvalve deployment HV or Delta-HV interval may identify a subgroup at particularly higher risk, with up to one third of HAVB during follow-up.
Seasonality and competition select for variable germination behavior in perennials
Authors: ten Brink Hanna , Haaland Thomas R , Massol François , Opedal Øystein H
Published: May 2023

The occurrence of within-population variation in germination behavior and associated traits such as seed size has long fascinated evolutionary ecologists. In annuals, unpredictable environments are known to select for bet-hedging strategies causing variation in dormancy duration and germination strategies. Variation in germination timing and associated traits is also commonly observed in perennials and often tracks gradients of environmental predictability. Although bet-hedging is thought to occur less frequently in long-lived organisms, these observations suggest a role of bet-hedging strategies in perennials occupying unpredictable environments. We use complementary analytical and evolutionary simulation models of within-individual variation in germination behavior in seasonal environments to show how bet-hedging interacts with fluctuating selection, life-history traits, and competitive asymmetries among germination strategies. We reveal substantial scope for bet-hedging to produce variation in germination behavior in long-lived plants, when “false starts” to the growing season results in either competitive advantages or increased mortality risk for alternative germination strategies. Additionally, we find that lowering adult survival may, in contrast to classic bet-hedging theory, result in less spreading of germination by decreasing density-dependent competition. These models extend insights from bet-hedging theory to perennials and explore how competitive communities may be affected by ongoing changes in climate and seasonality patterns.
Episcopal entries and urban liberties in late medieval and Renaissance France, c. 1200–c. 1600
Authors: Murphy Neil
Published: May 2023

In comparison to the ceremonial entries of French kings, little work has been done on episcopal entries. Whereas royal entries underwent a period of massive elaboration during the later Middle Ages and Renaissance, there was less change to bishops’ entries during this period, especially in towns where civic administrations used these ceremonies to compel bishops to acknowledge their rights. While less susceptible to modification than royal entries, important changes did occur to the episcopal entry by the later sixteenth century because of the increased Counter-Reformation emphasis on the power of the bishop, as well as the impact of the Wars of Religion. By the seventeenth century, the requirement to confirm urban liberties at entries was far less a part of an episcopal entry than it had been during the heights of this ceremony during the later Middle Ages. Nonetheless, the episcopal entry remained an important way for towns to recruit brokers.
An efficient algebraic multi-resolution sampling approach to 3-D magnetotelluric modelling
Authors: Li Jian , Guo Rongwen , Liu Jianxin , Wang Yongfei , Wang Xulong
Published: May 2023

Since electromagnetic (EM) fields diffuse more smoothly to greater depth, it physically makes sense to apply fine discretization to model structure at near surface with an increasingly coarser grid both in horizontal and vertical directions as the depth increases for the numerical solution of EM fields. For finite-difference magnetotelluric (MT) forward modelling on regular staggered grids, this can lead to difficulties in discretizing the curl–curl equation governing the EM diffusion in the earth at regions, where the grid resolution changes. In this paper, we propose an efficient algebraic multi-resolution sampling (MRS) method for MT forward modelling. In this method, we do not require the generation of physical subgrids and merely subsample the field components. The coefficient matrix for the subsampled components can be obtained by matrix multiplication based on the initial linear system of equations and field interpolation. To guarantee divergence-free current during the iterative solution process at low frequencies, which is considered crucial for the development of efficient iterative solvers, our forward modelling is based a regularization equation obtained by augmenting the curl–curl equation with an equivalent scaled grad–div operator for electrical fields (explicitly enforcing the divergence-free condition). The correctness of our algebraic MRS algorithm is examined based on a layered model. Its stability and efficiency is exploited by comparing our results with the forward modelling on unsampled staggered grids for the Dublin Test Model 1 (DTM1) and a complex model with realistic topography, indicating a time reduction of about 42–82 per cent.
Seasonal Malaria Chemoprevention Drug Levels and Drug Resistance Markers in Children With or Without Malaria in Burkina Faso: A Case-Control Study
Authors: Roh Michelle E , Zongo Issaka , Haro Alassane , Huang Liusheng , Somé Anyirékun Fabrice , Yerbanga Rakiswendé Serge , Conrad Melissa D , Wallender Erika , Legac Jennifer , Aweeka Francesca , Ouédraogo Jean-Bosco , Rosenthal Philip J
Published: May 2023

Background

Despite scale-up of seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) in children 3–59 months of age in Burkina Faso, malaria incidence remains high, raising concerns regarding SMC effectiveness and selection of drug resistance. Using a case-control design, we determined associations between SMC drug levels, drug resistance markers, and presentation with malaria.

Methods

We enrolled 310 children presenting at health facilities in Bobo-Dioulasso. Cases were SMC-eligible children 6–59 months of age diagnosed with malaria. Two controls were enrolled per case: SMC-eligible children without malaria; and older (5–10 years old), SMC-ineligible children with malaria. We measured SP-AQ drug levels among SMC-eligible children and SP-AQ resistance markers among parasitemic children. Conditional logistic regression was used to compute odds ratios (ORs) comparing drug levels between cases and controls.

Results

Compared to SMC-eligible controls, children with malaria were less likely to have any detectable SP or AQ (OR, 0.33 [95% confidence interval, .16–.67]; P = .002) and have lower drug levels (P < .05). Prevalences of mutations mediating high-level SP resistance were rare (0%–1%) and similar between cases and SMC-ineligible controls (P > .05).

Conclusions

Incident malaria among SMC-eligible children was likely due to suboptimal levels of SP-AQ, resulting from missed cycles rather than increased antimalarial resistance to SP-AQ.
Target trial emulation to assess real-world efficacy in the Epidemiological Strategy and Medical Economics metastatic breast cancer cohort
Authors: Antoine Alison , Pérol David , Robain Mathieu , Delaloge Suzette , Lasset Christine , Drouet Youenn
Published: May 2023

Background

Real-world data studies usually consider biases related to measured confounders. We emulate a target trial implementing study design principles of randomized trials to observational studies; controlling biases related to selection, especially immortal time; and measured confounders.

Methods

This comprehensive analysis emulating a randomized clinical trial compared overall survival in patients with HER2-negative metastatic breast cancer (MBC), receiving as first-line treatment, either paclitaxel alone or combined to bevacizumab. We used data from 5538 patients extracted from the Epidemiological Strategy and Medical Economics–MBC cohort to emulate a target trial using advanced statistical adjustment techniques including stabilized inverse-probability weighting and G-computation, dealing with missing data with multiple imputation, and performing a quantitative bias analysis for residual bias due to unmeasured confounders.

Results

Emulation led to 3211 eligible patients, and overall survival estimates achieved with advanced statistical methods favored the combination therapy. Real-world effect sizes were close to that assessed in the existing E2100 randomized clinical trial (hazard ratio = 0.88, P = .16), but the increased sample size allowed to achieve a higher level of precision in real-world estimates (ie, reduced confidence intervals). Quantitative bias analysis confirmed the robustness of the results with respect to potential unmeasured confounding.

Conclusion

Target trial emulation with advanced statistical adjustment techniques is a promising approach to investigate long-term impact of innovative therapies in the French Epidemiological Strategy and Medical Economics–MBC cohort while minimizing biases and provides opportunities for comparative efficacy through the synthetic control arms provided.

Database registration

clinicaltrials.gov Identifier NCT03275311.
(007) Gendered Differences in Sexual Expectation: The Implications of Power Differentials on Condom Usage in Heterosexual Relationships
Authors: Snow G , Sampath A , Higashi K , Roberts J
Published: May 2023

Introduction

Sexuality is an important facet of every individual’s identity and overall wellbeing; despite this, gender-based discrepancies exist in relation to expectations of and experiences with sexual activity. In a longitudinal study conducted in 2013, 62% of boys reported expecting sexual pleasure from intercourse, compared with only 30% of girls (Missari, 2013). Furthermore, a 2007 study discovered that women generally prioritize their male partners’ pleasure instead of their own (Tolman, et. al).

Objective

Given an understanding of these existing trends, this study was developed to analyze contrasting attitudes about condoms and experiences with condom usage between men and women on a college campus.

Methods

A mixed-methodology approach was utilized, consisting of a survey (n=580), focus group discussions with select survey participants (n=16), and one-on-one interviews (n=30). Each element aimed to ascertain predominating student perceptions surrounding condoms and their role in sexual intercourse and to determine if these varied between men and women.

Results

Survey data revealed that 51.8% of men vs. 45.7% of women reported that they had never refused to engage in sexual activity when their partner refused to use a condom. Furthermore, women in 56.3% of focus group discussions reported that they believed men found condoms to be “uncool” or make sex “less enjoyable”, with 18.8% of focus groups involving statements that women felt guilty for diminishing their male partner’s experience. In no focus group conversations did men report feeling guilt related to their female partner’s experience. Interview data revealed that 47.8% of women reported a sense of individual responsibility to get STI tested and initiate condom use conversations, compared to only 28.6% of male respondents.

Conclusions

These data reveal discrepancies in reported self-efficacy between men and women, as well as a general tendency for women to view condoms more positively and consequently advocate for their use more often. Usage in heterosexual relationships, however, appears to be influenced by women’s deference to their male partners’ preferences. This indicates a power differential between men and women that dictates the practices adhered to within sexual relationships. Subsequent interventions should look to examine how these differing perceptions are developed, and which factors can combat the prioritization of male sexual preferences, as well as promote the comfort and pleasure of all partners during sexual intercourse.

Disclosure

No
(011) Beneficial Effects of Vaginal Prasterone (DHEA) on the Vaginal Histology of Women with GSM Beyond the Epithelium
Authors: Bouchard C , Ouellet J , Coté I , Dumas M , Dury A
Published: May 2023

Introduction

There is mounting evidence that androgens play an important role, together with estrogens, in the maintenance of genitourinary health.

Objective

Vaginal prasterone was used to characterize the histological changes associated with the dual androgen - estrogen stimulation of the vaginal wall in the treatment of the genitourinary syndrome of menopause (GSM). Since prasterone is converted to androgens which are subsequently aromatised in estrogens, a group of patients on aromatase inhibitors (AI) was included to isolate changes attributable to androgens.

Methods

Vaginal biopsies and vulvar pictures were collected before and after 12 weeks of treatment with 6.5 mg intravaginal prasterone daily (Intrarosa®). Eight women with GSM were recruited, including two breast cancer survivors on AI.

Results

Following treatment, the epithelium showed striking histological improvements, regaining thickness, ridges, active proliferation and glycogen synthesis. In the lamina propria, treatment led to increases in elastin content and nerve endings density. Visual evaluation of the vulva showed reduction of the redness and inflammation in the vestibule and the urethral meatus as well as a relaxation of the vaginal entrance. All observations were consistent between the groups with and without AI.

Conclusions

Data presented here are believed to be the first demonstration of the beneficial effects of androgens deep into the lamina propria of GSM patients both together with or independently from estrogens. Tissue changes observed could help understand some of the GSM symptomatology improvements observed before on dyspareunia and other sexual function parameters. While further studies are warranted to better understand how androgens and estrogens work synergistically in the treatment of GSM, the data presented here strongly suggest that prasterone has deep beneficial impacts on the urogenital tissue.

Disclosure

Yes, this is sponsored by industry/sponsor: Endoceutics

Clarification: Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Endoceutics
(019) Complete Sub-Epithelial Vestibulectomy: Refinement of Surgery for Neuroproliferative Vestibulodynia
Authors: Yee A , Goldstein S , Goldstein A , Goldstein I
Published: May 2023

Introduction

Complete vestibulectomy (CV) was first described by Goldstein and Marinoff, detailing an excision 3 mm cephalad to the hymen and caudad to Hart’s line. A vaginal advancement flap (VAF) to cover the defect left by excised vestibule was also described. Since neuroproliferative vestibulodynia is a field disease, The CV with VAF surgery has become widely utilized practiced by sexual medicine surgeons to treat neuroproliferative vestibulodyniaby surgeons practicing sexual medicine. However, the depth of dissection for the vestibular mucosal excision (VME) was not clearly defined. To gain a better appreciation for appropriate depth of the VME during CV with VAF, we have reviewed the results of immunohistochemical staining (IHC) of excised vestibular specimens (n=564) since 2019. In all cases, tissue depth of the excess positive CD117 and PGP9.5 staining, consistent with excess mast cells and nerves respectively, were < 600 μm (0.6 mm) from the epithelial surface.

Objective

Our objective is to describe safety and efficacy of vestibulectomy surgical technique modifications made in 2021 based on this finding.

Methods

We refined the CV and VAF surgery based on the observation that the IHC pathology resides very close to the vestibular epithelium. This modification has been termed complete subepithelial vestibulectomy (CSEV). These modifications keep the VME thickness as close as possible to 1-2 mm. Liposomal bupivicaine (20 ml) is injected subcutaneously throughout the vestibule to hydrodissect the mucosa. The lateral border at Hart’s line and medial border 3 mm cephalad to the hymen is incised. The mucosal surface of the vestibule is grasped with an atraumatic vascular clamp and dissected sharply with the tissue stretched over a finger to maintain a very thin VME. Excised specimens are sent for IHC staining. Patients who underwent CSEV with VAF surgery from 2021 onward were followed for ≥ 6 months.

Results

A total of 13 individuals (mean age 29 ± 8yrs) underwent CSEV with VAF, with a mean follow-up of 8 ± 4 months. Photomicrographs of surgical specimen confirmed the thickness to be approximately 1-2 mm (Fig 1). Blood loss was minimal, <100 ml in 11/13. Post-operative use of narcotics was minimal with all patients reporting less than 5 oxycodone 5mg tablets used. At 6 months post-op, 10/13 reported their vestibulodynia was much better/better based on PGI-I.

Conclusions

We report CSEV as a refinement of the Goldstein/Marinoff procedure. The depth of dissection and thickness of VME was 1-2 mm with this new procedure. Early results in our small case series show excellent vestibulodynia resolution and reduced pain medication requirements post-operatively. To date, the success rate of CSEV is equivalent to the outcomes from previous vestibulectomy series, ~77%, with minimal less operative blood loss.

Disclosure

No
(067) False Positive Pap Smear as The First Sign of Genitourinary Syndrome of Menopause
Authors: Dominguez-Bali A , Baqer A , Sharma R , Hassan Z , Marquez L , Dominguez-Bali C
Published: May 2023

Introduction

Around 2010, we started to realize in our centers that we were receiving an increasing number of perimenopausal women with abnormal Pap smears (cervical dysplasia), going from ASCUS to low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions with or without positive HPV. With no previous history of cervical abnormality and almost all of them in a long-term stable sexual relationship with a maximum of 1 or 2 sexual partners. After talking with our pathologist, we asked if vaginal atrophy could produce such results. He answered affirmatively and provided us with a few recent articles that describe such findings. As an advocate for hormone replacement therapy, we decided to start using local vaginal estrogen for several months and then repeat the Pap smears. We were able to confirm that inclusively with those cases diagnosed with high-grade squamous intraepithelial lesions, the next Pap smear after the treatment with local estrogens was totally normal. The situation has been repeated in more than 96% of cases in around 1500 patients in the same conditions for the last 12 years.

Objective

Describe these new findings confirmed by a few articles in the pathology field and two articles on estrogen use, in women ranging between the ages of 30-70 years.

Methods

Prospective follow-up of perimenopausal patients with positive Pap smears and very low risk for STDs placed on local and/or systemic vaginal estrogen. A Pap smear was conducted at 4 months and then 1 year after, which was followed by the regular scheme of Pap smear follow-ups.

Results

96.7% of all those patients with the described characteristics were successfully treated with local estrogens. During the study, we realized that the high number of patients who entered after the initial diagnosis of cervical dysplasia in the regular guidelines of colposcopies, biopsies, LEEP excisions, cryotherapy, and due to the persistence of the findings in more than 50% of those cases (because of the persistence of cervicovaginal atrophy) they finished having cone biopsies and/or hysterectomies.

Conclusions

We describe the early finding of another sign of genitourinary syndrome of menopause: false positive cervical dysplasias, secondary to cervicovaginal atrophy, due to the decrease in the level of estrogens that characterized the perimenopause. Also, how the management of local estrogens prevents a great number of interventions and patient procedures, saving billions of dollars per year, taking into account that the number of Pap smears in the named population is around 50-60% of all Pap smears practiced in the total population of women.

Disclosure

No
(071) Vulvo-vaginal Obliteration: Presentation of 6 Cases
Authors: Dominguez-Bali A , Sharma R , Baqer A , Hassan Z , Marquez L , Dominguez-Bali C
Published: May 2023

Introduction

Between December 2018 and July 2022, six cases of vulvovaginal fusion (obliteration) were diagnosed, evaluated, and treated at our centers. Less than 30 cases have been reported according to our reviews of the medical literature. All of the cases presented shared certain features such as more than 2 decades without sex or masturbation, no use of hormone replacement therapy, and a history of chronic urinary tract infections.

Objective

1. Present information from 6 cases of a rare genitourinary disorder, its diagnosis, medical & surgical management, follow-up, and resolution. 2. Place vulvovaginal obliteration or labial fusion as one of the most extreme late consequences of untreated genitourinary syndrome of menopause. 3. Emphasize not only the importance of the use of local estrogen in all women going through menopause but also clarify and promote the importance of the maintenance of penetrative sexual activity in the lives of older women. This can be achieved either naturally or with the use of dilators and sexual toys.

Methods

We analyzed 6 cases of patients with vulvo-vaginal obliteration that presented in our facilities.

Results

Analysis of the 6 cases showed: In 3 out of the 6 cases, the patient didn’t have a partner, while in the other 3 cases, they were not sexually active with their partner in any way. In 2 of the cases, the patient’s main complaint was the inability to urinate due to obstruction of the urethral outlet by a fused labia. In both cases, urinary leakage from overflow was present in the area of the posterior fourchette, along with urocolpos, an extremely distended urinary bladder, bilateral megaureter, and hydronephrosis. The ages of these 6 women were between 72 to 94. The most severe case involved a patient with the longest time without penetration (> 30 years).

Conclusions

Total and partial vulvovaginal obliteration is a disease that hasn’t been commonly described. By obtaining the sexual history of each patient and the practice of geriatric gynecology, we have been able to diagnose this disorder. There is no doubt that vulvovaginal obliteration, also known as labial fusion, is one of the most extreme complications of the genitourinary syndrome of menopause but has not been medically described as part of its findings up till now. The prevention and treatment include not only the local use of estrogen but also the education of the patients on the need to maintain penetrative sexual activity in order to prevent the atrophy of the genitourinary area and maintain its functional ability. This can be done with a partner, penetrative dilators, or sexual toys.

Disclosure

No
(090) Immunohistochemical Staining of Elastin in the Vestibule
Authors: Goldstein I , Yee A , Dury A , Ouellet J , Goldstein S W , Komisaruk B
Published: May 2023

Introduction

The vestibule is an external genital structure lying 90° to the vaginal canal opening. During the thrusting movements associated with penetrative sexual activity, the vestibule undergoes significant stretching during both invagination and evagination. The vestibule also undergoes extreme stretching during childbirth. The rete pegs in the non-keratinized squamous epithelium facilitate the ability of the vestibule to mechanically stretch. More importantly, however, the vestibular lamina propria, with nerves, blood vessels, glands, needs to contain a high density of extracellular matrix (ECM) proteins with stretching capabilities. In particular, the ECM protein elastin endows skin structures with the ability to stretch, recoil, and have elasticity. Elastin has previously been shown to influence mechanical stretching properties of tendons.

Objective

The objective of this study was to examine the density of elastin proteins in the vestibule in reproductive age patients as there are currently limited data.

Methods

A total of 7 reproductive age patients with normal sex steroid hormone values and complaints of entrance dyspareunia were diagnosed with neuroproliferative vestibulodynia and subsequently underwent complete vestibulectomy. Tissue blocks were created from the specimen, and 5 μm sections studied with immunohistochemical staining with primary antibody. Sections were then counterstained with Gill-modified hematoxylin.

Results

In all vestibular specimen, there was very high density of elastin underneath the epithelium in rete pegs and throughout the entire lamina propria (Fig 1). There is a density gradient with the highest density immediately deep to the basement membrane of the epithelium. Elastin fibers were arranged in all orientations: coronal (frontal), sagittal (longitudinal), and transverse (axial) planes.

Conclusions

The high density of elastin fibers in rete pegs and throughout the lamina propria in a multi-planar orientation is suggestive of extreme stretching capability in eugonadal vestibular tissues. The highest density of elastin staining was seen immediately below the basement membrane of the epithelium, which may provide tissue integrity and shear resilience to the epithelial layer. In sex steroid hormone insufficiency states such as menopause or with use of combined hormonal contraceptives, individuals may develop loss of introital elasticity and fissures due to a deficiency of the ECM protein elastin. More research is needed on elastic fiber production, organization, and integration with other cutaneous extracellular matrix proteins, and how they may be affected by sex steroid hormones.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Endoceutics, Inc.
(100) The Effect of Oral Contraceptive Pill Type on Vulvovaginal Atrophy
Authors: McMahon L N , Handy A B , Jones A G , Mijares S A , Noon A E , Meston C M
Published: May 2023

Introduction

Oral contraceptive pills (OCPs), which are used by over a quarter of reproductive-age women in the United States (Daniels et al., 2015; Jones et al., 2013), contain either both ethinylestradiol and a synthetic progestin, or solely a synthetic progestin. Through progestin-induced hepatic increases in sex hormone binding globulin (SHBG), OCPs have been found to reduce the number of bioavailable androgens within women’s bodies (Zimmerman et al., 2014). Given that androgens are essential for the maintenance of healthy vaginal tissue (I. Goldstein, 2009), reduced androgen levels may adversely impact the vaginal epithelium in OCP users. While OCPs are indeed associated with symptoms of vulvovaginal atrophy (VVA), such as vaginal pain and vaginal dryness (Battaglia et al., 2012), little is known about how these symptoms may vary based on the androgenicity of OCPs.

Objective

The aim of the present study was to compare rates of VVA among three groups of women: (1) women using OCPs containing low doses (i.e., ≤25 μg) of ethinylestradiol coupled with an androgenic progestin, (2) women using OCPs containing low doses (i.e., ≤25 μg) of ethinylestradiol coupled with an antiandrogenic progestin, and (3) naturally-cycling women (i.e., women with no history of oral contraceptive pill use).

Methods

Participants rated the severity of the following symptoms of VVA on a 4-point Likert-type scale ranging from 0 (mild) to 3 (severe): vaginal dryness, vaginal and/or vulvar irritation/itching, dysuria, and vaginal pain associated with sexual activity. Participants also dichotomously rated the presence or absence of vaginal bleeding associated with sexual activity.

Results

Women taking androgenic OCPs (n = 50) were significantly more likely to report vaginal bleeding associated with sexual activity than were women in the control group (n = 59), χ2(2, 130) = 9.759, p = .007. One participant (1.69%) in the control reported vaginal bleeding, compared to ten women (20%) in the androgenic group. Three participants (14.28%) in the antiandrogenic group endorsed vaginal bleeding, however this result was not significant. A MANOVA indicated no significant between-group differences for any of the remaining VVA items (i.e., dryness, itching/irritation, dysuria, or pain), F(2, 250) = 1.098, p = .365, and an ANOVA confirmed there were no differences between groups in the total VVA score, F(2) = 2.093, p = .127.

Conclusions

There were elevated rates of vaginal bleeding among OCP users compared to non-OCP users in this sample. This finding could be attributable a range of factors which have previously linked OCP use to vaginal bleeding, such as thinning of the vaginal tissue (Kagan & Rivera, 2018), cervical ectopy (Patil & Sharma, 2017), and thinning of the endometrium (Bright et al., 2011).

Disclosure

No
(103) Olfactory Investigation of the Male is Stimulated by Administration of Dihydrotestosterone and Blunted by Co-administration of Flutamide in Ovariectomized Rats Primed with Estradiol
Authors: Maseroli E , Filippi S , Cipriani S , Maggi M , Vignozzi L
Published: May 2023

Introduction

Although Hypoactive Sexual Desire Disorder (HSDD) is a common condition with a relevant impact on women’s quality of life, approved androgenic formulations for its treatment are lacking. In previous studies, we demonstrated that the administration of Dihydrotestosterone (DHT), a non-aromatizable androgen, in ovariectomized (OVX) Long-Evans rats primed with Estradiol Benzoate (EB), enhanced measures of sexual behavior.

Objective

To further clarify the mechanisms underlying the facilitating action of testosterone on female sexual function by investigating the effect of AR (androgen receptor) activation in a validated animal model.

Methods

After sexual training and hormonal wash-out, OVX Long-Evans rats were treated with different hormonal regimens: oil (O) + O (negative control group), 10 mcg EB+500 mcg Progesterone (P) (positive control group), 10 mcg EB+500 mcg DHT, and 10 mcg EB+500 mcg DHT+10 mg flutamide (FLU), a nonsteroidal AR antagonist (n=4 per group). EB was administered s.c. 48 h, P and DHT s.c. 4 h, and flutamide i.m. 48 and 24h prior to video-recorded sexual behavioral testing sessions. These took place in bisected unilevel pacing chambers, with sexually experienced males. Five testing sessions were conducted every 8 days. The main outcome measures were appetitive behaviors: the number of hops/darts (partial solicitation), full solicitations and olfactory investigations.

Results

A significant difference emerged among the 4 groups for all the outcome measures. Regarding solicitations, animals treated with EB+DHT displayed a higher number of hops/darts and full solicitations than the negative control group (O+O), although significantly lower than the positive control group (EB+P) for hops/darts (p=0.025). As a novel finding, we observed that the stimulating effect of EB+DHT was blunted in rats treated with EB+DHT+FLU, which showed a lower number of behaviors than EB+DHT rats (p=0.014 for hops/darts, and p=0.083, approaching statistical significance, for full solicitations). Interestingly, a significant difference was detected in the frequency of olfactory investigations, with the EB+DHT group displaying a higher frequency not only when compared with O+O rats (p=0.047), but also with EB+DHT rats (p=0.047 for both comparisons). Once again, the co-administration of FLU significantly reduced the stimulating effect (p=0.005 for olfactory investigations for EB+DHT+FLU vs. EB+DHT).

Conclusions

These data, to be confirmed in larger samples, indicate that the positive modulation exerted by androgens on appetitive behaviors, homologous to sexual interest in women, are independent of aromatization. In addition, a specific stimulating effect was detected for olfactory investigations.

Disclosure

No
(105) The Discovery of New Incredible Positive Actions of Hormone Replacement Therapy and Sex in Menopause
Authors: Dominguez-Bali A , Baqer A , Hassan Z , Sharma R , Dominguez-Bali C , Marquez L
Published: May 2023

Introduction

Every year, two or more benefits of the use of hormone replacement therapy (HRT) in menopause and andropause appear in medical literature. We present an extensive review of the literature describing the classical and novel benefits of hormonal replacement therapy and sex in menopause. Additionally, we present recent findings from our own patient population.

Objective

To contribute to the presently known benefits of the use of HRTs, and additionally to present new findings from our own practice not previously described.

Methods

We conducted an extensive literature review and described our own experience and findings within our centers.

Results

`- In the area of prevention and treatment of genitourinary syndrome of menopause, we have found: - Prevention and treatment of false positive cervical dysplasia in perimenopause. - Prevention and treatment of vulvar, labial, and vaginal occlusion in late menopause. - Prevention and treatment of recurrent urinary tract infections in geriatric patients for prevention of sepsis, secondary pneumonia, and even death. - Prevention and treatment of clitoral atrophy, phimosis, and urethral caruncles - Dermatology: We have found: - Prevention and treatment of wrinkles, alopecia related, postmenopause. - Prevention in prostrated geriatric patients of decubitus ulcers. - Internal Medicine: prevention of obesity, decreased metabolic rate, and insulin resistance. - Ophthalmology: - Prevention and treatment of macular degeneration. - Prevention of glaucoma (increased intraocular pressure), most notably in primary open- angle glaucoma. - The prevention of aging of optic nerve and neuroprotection of retinal cells. - Oncology: - Prevention of kidney cancers, and breast cancer (only estrogen hormone replacement therapy). - Enhanced visualization of the transformation zone during cervical cancer screening - Gastroenterology: protection of the gut microbiome and serum metabolome, especially in premature ovarian insufficiency - Dentistry: prevention of tooth loss through decreased gingival inflammation and periodontitis, mandibular bone loss, and oral dysesthesia. - Neurology: - Protection against intracranial aneurysm rupture in ovariectomized mice. - The prevention of Parkinson’s and Alzheimer’s disease - Rheumatology: prevention of rheumatoid arthritis.

Conclusions

To demonstrate the number of studies with the anti-aging mechanism of the use of HRT. How this knowledge, alongside our own findings of hundreds of menopausal women within our centers justify the generalized use of this therapy.

Disclosure

No
(128) Pelvic Pain in Tarlov Cyst: Pathognomony in Gender Inequality
Authors: Choucroun D , Kone Groot N
Published: May 2023

Introduction

The production of knowledge having long been the prerogative of men, scientific research and patients care are still largely unequal in the field of medecine and surgery: the construction of a weak, spontaneously painful female nature is accepted as a cause of the historical delay of 130 years in the diagnosis of endometriosis. but who knows Tarlov cysts, getting lost in a maze of protean urogenital and somatic symptoms? Pelvic pain leads always to the search for a local cause by examination, ultrasounds, sometimes MRI as well as biological explorations. At least, if nothing is found, the pain is mainly attributed to depression, whereas depression is a consequence of this chronic pain and lack of adequate care.

Objective

To be able to identify symptomatic Tarlov cysts in front of pelvic pain with or without other various symptoms. -in presence of unexplained pelvic pain, urogenital or sexual symptoms without local cause and without compatible clinical features such a Marfan syndrome, neurofibromatosis, Ehlers Danlos, other -especially if it exists urinary or sphincters disorders -knowing that Tarlov cyst can become symptomatic after childbirth -know that when discovered incidentally, an asymptomatic Tarlov cyst does not usually require treatment

Methods

Literature review on PubMed for the last ten years

Results

For the last ten years we found only eleven relevant results for the keywords Tarlov cyst and pelvic pain and Tarlov cyst and adnexal mass: in the presence of atypical or persistent pelvic pain the differential diagnosis occurs at four levels: -pain persists despite the treatment of a first etiology -a large Tarlov cyst can mimic an adnexal mass, although this is very rare, with only twelve cases described so far -gaining the patient's trust may lead her to describe the persistent genital arousal disorder, that is unwanted, intrusive and sometimes painful sensation of genital arousal, more than 60% of these patients would have a Tarlov cyst according to some authors. -Some symptoms such as early sensation of bladder filling, or urinarybladder or lumosacral symptoms might be overlooked by the patient herself, making diagnosis more difficult.

Conclusions

Tarlov cysts are extradural menigeal cysts, usually at the sacral level of the spine. their prevalence can reach up 13% of the population, and is largely female, 75 to 90% of the described cases, may be explained by thinner meninges in women compared to men and by the tilt of the pelvis, providing a stress on the spine. 1% of Tarlov cysts are symptomatic and require a specific,,usually surgical, treatment. This work has limitations in particular because of a poor literature about this subject, but highlights: - the importance of a neurological opinion in front of pleiomorphic female pelvic symptoms - the lack of scientific research for an essentially female pathology.

Disclosure

No