bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound Appearance of the Endometrium Post Radio-Frequency Ablation [A103]
Authors: Carrel-Lammert Meredith , Parikh Shivani , Patel Nima R. , Devaiah C. Ganga , Crisp Catrina 
Published: June 2022

INTRODUCTION:
Heavy and irregular menses affects 9-14% of gynecologic patients, and second-generation endometrial ablation is a treatment option when medications fail. Limited studies have been performed assessing the radiologic appearance of the endometrium post-ablation. Our study aims to describe the ultrasonographic appearance of the post-ablative endometrium to improve knowledge of its sonographic findings.

METHODS:
This was an institutional review board (IRB)-approved prospective study of patients who underwent second-generation endometrial ablation from 2016 to 2019. Patients had postoperative transvaginal ultrasounds at 2, 6, and 12 months. Ultrasound reports were analyzed for endometrial thickness, description of the endometrium and myometrium, presence of uterine fibroids, and uterine size. Statistical tests for repeated measures were utilized.

RESULTS:
There were 68 patients with an average age of 42 (standard deviation [SD] 6) and a body mass index of 32.5 (SD 8.1). Preoperatively the average endometrial thickness was 10mm, uterine length was 9.7cm, and 38.2% had leiomyoma. The average endometrial thickness decreased at each ultrasound: 8.4mm (SD 3.4), 7.2mm (SD 3.0), and 5.8mm (SD 2.5) at 2, 6, and 12 months, respectively. When comparing endometrial thickness postoperatively there was a significant difference at 2 and 12 months (P=.041) and at 6 and 12 months (P=.031). There was no change during the postoperative period in the presence of leiomyoma, hyperechoic endometrium, hypoechoic endometrium, heterogeneous endometrium, and cystic endometrium on the ultrasounds.

CONCLUSION:
After ablation with a second-generation device, the endometrial thickness on ultrasound decreases with time following surgery. Additional studies correlating these findings to clinical outcomes would be useful.
Effect of the Oral GnRH Antagonist Linzagolix on Uterine Fibroid-Related Severe Anemia [A105]
Authors: Stewart Elizabeth A. , Marsh Erica E. , Donnez Jacques , Al-Hendy Ayman , Humberstone Andrew , Garner Elizabeth 
Published: June 2022

INTRODUCTION:
Iron-deficiency anemia is common in women with uterine fibroid (UF)-related heavy menstrual bleeding. Severe anemia is defined as hemoglobin (Hb) levels <10g/dL. The effect of linzagolix, an oral GnRH antagonist, on UF-related severe anemia was assessed in two Phase 3 trials.

METHODS:
PRIMROSE 1 and 2 are randomized, double-blind, placebo-controlled Phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, with or without hormonal add-back therapy (ABT) in the treatment of UF. Subjects were considered responders if an increase of ≥2g/dL from baseline was achieved. Patients with severe anemia were given iron supplements until they reached the Hb levels >12g/dL.

RESULTS:
In PRIMROSE 1, of 165 subjects with severe anemia, 57.9%, 61.5%, 82.1% and 65.2% of patients were responders at 24 weeks, in the respective treatment groups (100 mg, 100 mg+ABT, 200 mg and 200 mg+ABT), compared to 50% in the placebo group. In PRIMROSE 2, of 93 patients with severe anemia, 62.5%, 75%, 60% and 73.7%, respectively, were responders, compared to 46.2% for placebo. Given the small sample sizes, statistical significance was not reached. Improvements were maintained at week 52: in PRIMROSE 1, 69.2%, 62.5%, 81.3% and 75% of patients were responders in the respective treatment groups, compared to 40% in placebo, in PRIMROSE 2, 66.7%, 100%, 80%, 87% were responders, respectively.

CONCLUSION:
High and low doses of linzagolix improved Hb levels in patients with UF suffering from severe anemia.
Impact of Enhanced Recovery After Surgery Implementation and COVID-19 on Hysterectomy Outcomes at a Public Hospital [A113]
Authors: Cruz Daisy A. , Saad Christina A. , DeUgarte Daniel A. , Yazdany Tajnoos , Fleischman Ross J. , Rivera-Calonje Franchesca 
Published: June 2022

INTRODUCTION:
Immediately prior to the COVID-19 pandemic, our public hospital implemented an enhanced recovery after surgery (ERAS) protocol. The purpose of this study was to evaluate ERAS outcomes for hysterectomy patients at our public hospital, given concerns about barriers to care in our underserved population.

METHODS:
A retrospective analysis was performed comparing outcomes (percent of outpatient cases, length of stay, perioperative opioids, percent of emergency department [ED] return) for hysterectomy patients for pre- and post-intervention periods (January to June in 2019 and 2021). Outcomes were compared using the Fisher exact test or t-test.

RESULTS:
A total of 192 preintervention and 120 post-intervention hysterectomy cases were analyzed. The majority of patients were Hispanic/Latinx in both groups (82% vs. 76%; P=.25). There was no significant change in the percentage of minimally-invasive procedures (71% vs 72%; P=1.0). The percentage of outpatient hysterectomies increased from 0% to 53% (P<.0001), and the mean length of stay (LOS) decreased from 1.6 days to 0.9 days (P<.0001). Peri-operative mean morphine milligram equivalents (MME) decreased from 78 to 54 (P≤.02). Mean post anesthesia care unit stay increased from 186 to 229 minutes (P<.01). There was no significant increase in returns to the ED <30 days (10% vs 13%; P=.36) or mean number of opioid pills prescribed (13 vs 13; P=.21).

CONCLUSION:
ERAS implementation for hysterectomy patients at a public hospital decreased LOS and peri-operative opioids without significantly increasing ED returns. The COVID-19 pandemic likely helped to expedite the adoption of outpatient management, which was feasible and safe in our underserved patient population.
Paraneoplastic Pityriasis Rubra Pilaris Preceding Leukemia
Authors: Vance Paul , Wyles Saranya , Alavi Afsaneh 
Published: June 2022

ABSTRACT
Pityriasis rubra pilaris (PRP) is a rare, chronic papulosquamous disorder that presents with scaling plaques, palmoplantar keratoderma, and keratotic follicular papules. Typically, there are distinctive unaffected areas referred to as “islands of sparing.” Pityriasis rubra pilaris has been associated with various immunodeficient states and malignancies.
The authors conducted a literature review using MEDLINE, PubMed, and Google Scholar, documenting all known cases of PRP associated with malignancy; 15 cases were found in the literature. They also present the case of a 49-year-old White man who, prior to referral to dermatology, was seen in urgent care for widespread pruritic rash. Physical examination in the dermatology clinic revealed confluent, scaly erythematous papules coalescing into plaques with island of sparing involving the trunk and upper and lower extremities. Bilateral palms and soles showed hyperkeratosis with fissuring. He was diagnosed with PRP after punch biopsy and began a new course of topical corticosteroid therapy. Hematology was consulted because of abnormal complete blood count results, and he was subsequently diagnosed with chronic lymphoid leukemia.
Treatment of PRP is largely based on clinical experience and may involve corticosteroids, immunomodulators, or biologic therapy. The relationship between PRP and malignancy is unknown. Current theories postulate it may be driven by tumor production of functional peptides or antigen cross-reactivity between cancer cells and the skin. This is the second reported case of PRP as a manifestation of leukemia, and the first of chronic lymphoid leukemia. Although not yet understood, the documented relationship between PRP and malignancy prompts screening for cancer in all patients with new-onset PRP.
Virtual Reality Simulated Learning Environments: A Strategy to Teach Interprofessional Students About Social Determinants of Health
Authors: Buitron de la Vega Pablo , Dimitri Noelle , Araujo Brinkerhoff Cristina , Stern Aliza , Damus Karla , Miselis Heather , Garg Priya S. , Sarfaty Suzanne , Sprague Martinez Linda 
Published: June 2022

Purpose
Physician assistants (PAs) and medical degree students (MDs) often lack training in addressing the social determinants of health (SDOH). Social work students (SWs), meanwhile, have extensive SDOH training; however, few medical professionals have opportunities to engage in interprofessional training with SWs. This study examined the feasibility, acceptability, and students’ perceptions of an interprofessional virtual reality (VR) simulated learning environment (SLE) for teaching health professions students about the SDOH.

Method
In January 2020, 15 students at Boston University School of Medicine attended web-based video conferences focused on SDOH, health equity, and team-based care. Subsequently, student dyads participated in a case-based learning activity using an immersive VR SLE to develop teamwork skills. Evaluation included a postsurvey and a focus group examining their experiences in the course to gauge feasibility and acceptability. Thematic analysis of open-ended survey responses from the postsurvey and focus group data was conducted.

Results
A total of 8 VR simulations were run. Findings indicated both MD and PA students learned patient engagement strategies from SW students, who enhanced their health care leadership capacity. Participants found the means of instruction acceptable, valued the hands-on VR interprofessional training, and expressed interest in learning more about the scope of one another’s roles and the community resources available to patients.

Conclusions
VR SLE is a feasible and acceptable means of instruction. It allowed students to connect across programmatic and geographic boundaries in a collaborative working environment mimicking the team approach to care they will use in their professional life. This experience illustrated for students the strengths a multidisciplinary team has to offer.
Intraarticular hip preservation procedures in healed Perthes disease: a systemic review and meta-analysis
Authors: Elnewishy Ahmed Awad , Mahran Mahmoud A. , El Abd Mostafa A. , Baraka Mostafa M. 
Published: June 2022

Background:
There is limited data about surgical options in treatment of healed Perthes disease. The authors conducted this systematic review and meta-analysis to compare two newly described surgical techniques: femoral head reduction osteotomy (FHRO) and relative femoral neck lengthening (RFNL) in the management of healed Perthes disease in terms of efficacy and complications.

Methods:
This systematic review and meta-analysis examined controlled and noncontrolled studies that compared FHRO and RFNL. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between January 2000 and February 2021.

Results:
Fourteen studies that assessed RFLN and five studies that assessed FHRO were examined. The FHRO group demonstrated better improvement in the Harris Hip Score (HHS) than RFLN. The RFNL group showed better improvement than the FHRO group regarding flexion and internal rotation degree. The incidence of postoperative pain and postoperative stiffness was higher in the FHRO group than in the RFNL group. In the FHRO group, 28 patients with postoperative complications were reported (59.5%) versus 72 patients in the RFNL (16.4%).

Conclusion:
FHRO and RNFL are effective and safe modalities for post-Perthes sequelae. However, the postoperative clinical outcomes were observed to be in favor of RFNL, with less incidence of postoperative complication, compared to the FHRO. Moreover, the FHRO group needed more secondary acetabular procedures than the RFNL group. On the other hand, FHRO showed observed greater improvements in radiographic coverage indices.

Level of Evidence:
Level III.
Psychological interventions targeting patients with metastatic cancer and prolonged survival expectancies: advances and challenges
Authors: Righes Sadio , Lewis Florence , Waroquier Pauline , Delevallez France , Merckaert Isabelle 
Published: June 2022

Purpose of review
The purpose of this article is to review the formats and techniques of psychological interventions designed for patients with metastatic cancer and prolonged survival expectancies.

Recent findings
Fifteen interventional studies were selected for this article. One group of psychological interventions focused primarily on patients’ adaptation by increasing their knowledge, developing patients’ stress management skills, promoting their open communication with healthcare providers, and helping them deal with existential concerns. Another group of interventions focused on patients with moderate and high levels of distress. These interventions provided specific techniques to manage anxiety, depression, fear of cancer progression, and existential distress. Interestingly, interventions targeting distressed patients are not necessarily longer or more intensive than interventions targeting adaptation. The interventions were examined in few randomized controlled trials, and incorporated a broad range of techniques, making comparison of their efficacy difficult. No intervention specifically targeted patients newly diagnosed with metastatic cancer.

Summary
On the basis of this review, we proposed suggestions according to patients’ levels of distress, which differ in intensity, format, techniques, and tools offered. These suggestions may be relevant for the future development and assessment of interventions targeting patients with newly diagnosed metastatic cancer and prolonged survival expectancies.
Complications With Noninvasive Fat and Cellulite Reduction Devices: A Cross-sectional Analysis of the US Food and Drug Administration Manufacturer and User Facility Device Experience Database
Authors: Wulkan Adam J. , Vazirnia Aria , Avram Mathew M. 
Published: June 2022

BACKGROUND AND OBJECTIVE
The US FDA mandates that manufacturers and device operators disclose medical device reports (MDRs) to monitor suspected injuries and device malfunctions by submitting information to the Manufacturer and User Facility Device Experience (MAUDE) database. Given the rapid growth in the noninvasive fat and cellulite reduction market, it is essential that physicians be aware of associated adverse events.

STUDY DESIGN/MATERIALS AND METHODS
Using the MAUDE electronic database on the FDA website, the authors performed a comprehensive search of reported complications of noninvasive fat reduction and cellulite reduction devices from January 1, 2014 to January 1, 2020 at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm. Medical device reports that likely represented medical adverse events from device use were included.

RESULTS
The search yielded 165 MDRs, a majority submitted by patients. There were 68 MDRs reported on cryolipolysis (41.2%), 34 MDRs reported on 1,060-nm laser lipolysis (20.6%), 19 MDRs reported on high-intensity focused ultrasound (11.5%), 17 MDRs reported on vacuum-assisted subcision (10.3%), 10 MDRs reported on 1,440-nm laser-assisted subcision (6.1%), 8 MDRs reported on monopolar radiofrequency (4.8%), 6 MDRs reported on focused ultrasound (3.6%), and 4 MDRs reported for a combination infrared light, bipolar radiofrequency energy, massage, and gentle suction treatment (2.4%).

CONCLUSION
It can be safely presumed that most physicians do not regularly report adverse events to the FDA; however, the MAUDE database remains the largest global repository of adverse events reported for noninvasive body contouring devices, an area that has grown tremendously over the last few years. Some MDRs may be unrelated and/or unsubstantiated, and MDRs for any given device must be correlated to the total number of procedures performed. Nevertheless, the MAUDE database allows a glimpse into potential adverse events that can occur. The authors hope that physician awareness of this database and the adverse events it reports will help improve patient safety.
Recurrent Gingival Lesions in a Pediatric Patient
Authors: Yu Jenny L. , Kapur Raj P. , Susarla Srinivas M. 
Published: June 2022

Summary:
We present the case of a 13-year-old girl who developed numerous gingival masses that recurred after two prior resections. Following the initial resection as a child, she reported that there was a period of resolution for several years before recurrence as a teenager. After the second resection, the masses recurred after 4 months. The lesions obscured the majority of her dentition and interfered with speech, eating, and oral hygiene. The patient underwent staged resection of the masses, and the wounds were allowed to heal by secondary intention. The histopathologic findings of the specimens were consistent with a diagnosis of peripheral ossifying fibroma, which is unusual as these are generally solitary lesions. We believe that this case brings attention to an underrecognized and atypical presentation of peripheral ossifying fibroma, and it should be considered in the differential diagnosis of multicentric gingival masses.
Free Your Mind, Not Your Flap
Authors: Neusner Alexander D. , Pribaz Julian J. , Guo Lifei 
Published: June 2022

Summary:
The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool. Although still requiring microsurgical skills, these flaps are of particular benefit in patients with few or poor quality recipient vessels, in those who cannot tolerate antiplatelet therapy, and in those who cannot tolerate the often-extended anesthesia time necessitated by microvascular anastomosis. Furthermore, pedicled flaps may significantly reduce total cost of a reconstruction procedure with similar outcomes. In this case series, we report challenging scenarios where microsurgical approaches may have been typical choices but were instead reconstructed by pedicled options with desired outcomes. Difficult soft tissue defects were successfully reconstructed with a variety of pedicled flaps. Soft tissue transfers to the abdomen, flank, shoulder, and back are presented. None of the reconstructions required microvascular anastomosis.
11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism: a prospective clinical trial
Authors: Puar Troy H. , Khoo Chin Meng , Tan Colin Jingxian , Tong Aaron Kian Ti , Tan Michael Chien Sheng , Teo Ada Ee Der , Ng Keng Sin , Wong Kang Min , Reilhac Anthonin , O’Doherty Jim , Gomez-Sanchez Celso E. , Kek Peng Chin , Yee Szemen , Tan Alvin W.K. , Chuah Matthew Bingfeng , Lee Daphne Hui Min , Wang Kuo Weng , Zheng Charles Qishi , Shi Luming , Robins Edward George , Foo Roger Sik Yin 
Published: June 2022

Objective:
Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.

Methods:
Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis.

Results:
All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3–94.3] and AVS was 75% (95% CI: 50.9–91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7–94.8) and 100% (95% CI: 15.8–100), and AVS was 68.2% (95% CI: 45.1–86.1) and 100% (95% CI: 15.8–100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test.

Conclusion:
In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism.

Video Abstract:

http://links.lww.com/HJH/B918.
Blood pressure variability and structural brain changes: a systematic review
Authors: Gutteridge Daria S. , Tully Phillip J. , Ghezzi Erica S. , Jamadar Sharna , Smith Ashleigh E. , Commerford Toby , Keage Hannah A.D. 
Published: June 2022

Background:
Blood pressure variability (BPV) has been linked with cognitive impairment and dementia. However, the pathophysiological mechanisms by which BPV affects cognition are unclear. This systematic review aims to assess the links between different BPV measures and white and grey matter structures.

Methods and results:
The following databases were searched from inception through to January 2021; EMBASE, MEDLINE, EMCARE and SCOPUS. Studies that reported on the relationship between within-individual BPV (short, medium or long-term variability) or a circadian blood pressure (BP) measurement and MRI assessed brain structures were included. Overall, 20 studies met the criteria and were included, of which 11 studies looked at short-term BPV, eight articles investigated visit-to-visit BPV and one study looked at a compositional BPV measurement. Due to heterogeneity in study samples, meta-analysis was not possible. Across the included studies, associations between MRI indices and BP dipping patterns were mixed; higher long-term BPV and higher sleep systolic BPV was found to be associated with lower whole brain volume and hippocampal volume.

Conclusion:
Increased BPV, in particular systolic long-term and systolic night-time BPV, appears to be associated with lower brain volume and hippocampal volume. This highlights the adverse effect that increased BPV has upon the brain, potentially contributing to cognitive decline, including dementia, in late-life.