Nevin Manimala

Plast Reconstr Surg. 2022 Sep 15. doi: 10.1097/PRS.0000000000009729. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics and weight loss is a common complaint amongst women visiting a plastic surgeon. This study sought to evaluate the utility, efficacy and safety of radiofrequency assisted lipolysis on the breast and nipple-areola complex position in women with breast ptosis.

METHODS: This was a single center (Maxwell Aesthetics) study of female desiring tightening of the breast envelope and elevation of the nipple areolar complex (NAC). Each patient underwent 1 treatment with RFAL in the operating room. RFAL was applied to each breast with a BodyTite Pro handpiece. Patients were evaluated preoperatively and postoperatively at: 6 weeks, 3 months, 6 months and 12 months via manual and 3D computer generated measurements (Vectra).

RESULTS: 10 female patients were enrolled. Ages ranged from 23-54. Follow up was 12 months. Data was captured for seven measurements from the nipple longitudinally at five time points. The sternal notch to the nipples (SN-N) distance, nipple to inframammary fold (N-IMF) and nipple to nipple (N-N), improved statistically at 6- week follow-up ,which persisted through the 12-month follow-up (p<0.05). Patient questionnaires revealed moderate to excellent satisfaction.

CONCLUSIONS: Radiofrequency assisted Lipolysis with a bipolar device to deliver RF energy to the breast is an effective modality to moderately improve breast ptosis. This study demonstrates that this treatment improves breast measurements across time, regardless of measurement type (manual versus Vectra). This modality affords a minimally-invasive, effective method to improve mild to moderate breast ptosis with minimal scarring and high patient satisfaction.

PMID:36103661 | DOI:10.1097/PRS.0000000000009729

Plast Reconstr Surg. 2022 Sep 15. doi: 10.1097/PRS.0000000000009723. Online ahead of print.

ABSTRACT

BACKGROUND: Sensory recovery of the breast is a compelling frontier in comprehensive post-mastectomy breast reconstruction. This study uses the BREAST-Q Sensation Module to evaluate the differences in women who underwent an alloplastic versus autologous breast reconstruction.

METHODS: Women with a history of breast cancer and post-mastectomy breast reconstruction were recruited through the Love Research Army, United States. Participants completed the BREAST-Q Sensation Module (3 scales: Breast Symptoms, Breast Sensation, Quality of Life Impact). Descriptive statistics and multiple linear regression analyses were used to compare outcomes between women undergoing alloplastic or autologous breast reconstruction.

RESULTS: Of 1204 respondents, 933 were included for analysis, 620 (66.5%) underwent alloplastic reconstruction and 313 (33.5%) underwent autologous reconstruction. The average age and BMI were 59.2 years (±10.1) and 26 (±5) respectively. Autologous reconstruction patients scored an average of 6.1 points (95% CI 3.9-8.4, p<0.001) and 5.3 points (95% CI 2.5-8.1, p=0.001) higher on the Breast Symptoms and Quality of Life Impact scales, respectively. No difference (0.0 points, 95% CI -2.9-3.0, p=0.75) was observed for the Breast Sensation scale. Increased time since reconstruction had a positive impact on Breast Symptoms scores. Radiotherapy negatively affected scores on both Breast Symptoms and Quality of Life Impact scales.

CONCLUSIONS: Autologous breast reconstruction may be associated with fewer abnormal breast sensations and better sensation-related quality of life in comparison to alloplastic reconstruction. This information can be incorporated during preoperative patient counseling when discussing reconstructive options.

PMID:36103650 | DOI:10.1097/PRS.0000000000009723

IISE Trans Occup Ergon Hum Factors. 2022 Sep 14:1-16. doi: 10.1080/24725838.2022.2124325. Online ahead of print.

ABSTRACT

Occupational ApplicationsMilitary personnel are at greater risk of injuries due to frequent load carriage. Novel exoskeleton technology may have benefits for soldiers, such as reduced physical burden through load carriage support that may result in decreased metabolic cost, reduced fatigue, and lower risk of injuries during walking. However, as for most assistive devices, a familiarization period is likely necessary to obtain the full potential of the device. Our results show that the metabolic cost of walking (MWC) was initially increased significantly upon provision of the passive exoskeleton, though it returned to baseline values after a 9-day familiarization period. The exoskeleton remained effective after a three-month pause, with a MCW below baseline. These results suggest that to properly assess the assistance of an exoskeleton, a sufficient familiarization period should be mandatory.Technical AbstractBackground: Military load carriage has been shown to alter gait patterns, resulting in an increased metabolic cost during walking (MCW). Soldiers’ burden could be mitigated by wearing a passive exoskeleton, but the additional payload of the device can alter movement patterns during gait, rendering it detrimental. Integrating principles of motor learning during a familiarization period could allow users to develop adaptive motor strategies, thereby decreasing MCW.Purpose: The aim of this study was to explore the influence of a familiarization period on MCW when soldiers wear a passive, load-bearing, prototype exoskeleton (Exo).Methods: Three male soldiers walked on a treadmill with a 38 kg payload at eight speeds (1.8-6.0 km/h) under five conditions: 1) no exoskeleton (NoExo); 2) exoskeleton pre-familiarization (Exo_Pre); 3) exoskeleton post-familiarization (Exo_Post); 4) no exoskeleton follow-up (NoExo_FU); and 5) exoskeleton follow-up (Exo_FU). Each experimental trial consisted of 10 minutes of standing followed by 10 minutes of walking at a constant speed. Metabolic data were normalized to walking speed (J/kg·m) to obtain the MCW. The familiarization period consisted of 9 days of activities with the exoskeleton using a standardized protocol. Differences in MCW with and without the Exo were compared at the eight walking speeds using a nonparametric analysis of Longitudinal Data.Results: There was a statistically significant decrease in MCW after familiarization with the Exo, particularly during Exo_FU with a relative treatment effect of 0.11 – 0.19. There were also significant reductions in MCW during Exo_FU when compared to NoExo_FU [participant 01 = 0.37; participant 02 = 0.27; participant 03 = 0.35].Conclusions: A first exposure to the exoskeleton increased MCW. After familiarization, however, the MCW with the Exo returned to the NoExo level or below with a payload of 38 kg among three soldiers. A familiarization period of 3 hours per day over 2 weeks of familiarization may optimize the use of an exoskeleton.

PMID:36103636 | DOI:10.1080/24725838.2022.2124325

Oral Dis. 2022 Sep 14. doi: 10.1111/odi.14378. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify and analyze the existing literature on the utility of podoplanin to predict the risk of malignancy development (MD) in patients previously diagnosed with oral leukoplakia (OL).

METHODS: A systematic review and meta-analysis (SR-MA) was performed though a search strategy using several electronic databases and a combination of keywords related to podoplanin and MD of OL, until 15 May, 2022 (PROSPERO CRD42022329326). Evaluation of the risk of bias was performed using the Quality in Prognosis Studies Tool. The meta-analyses were estimated using fixed-effect models.

RESULTS: From 421 articles, 6 studies were finally included, that enrolled 546 patients with OL, of whom 125 presented with an oral cancer during follow-up (32 to 90 months). Some limitations regarding the risk of bias were identified mostly related to small sample sizes, short follow-up times, lack of information on covariables in the included studies and lack of accuracy (including sensitivity and specificity). Meta-analysis of 6 studies revealed a pooled hazard ratio (HR) of 3.72 (95%CI, 2.40-5.76; p<0.00001) for MD without statistical heterogeneity (I² =0%, p=0.53).

CONCLUSION: The results of this SRMA support the role of podoplanin immunohistochemical expression as a potential predictive biomarker to assess the risk of malignancy development in oral leukoplakia.

PMID:36103586 | DOI:10.1111/odi.14378

Physiother Res Int. 2022 Sep 14:e1974. doi: 10.1002/pri.1974. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Ensuring access to high quality services in paediatric physiotherapy (PT) is important to respond to the diverse needs of children. The accessibility and quality of paediatric PT services has however never been explored internationally. The purpose of this study is to explore the perceived strengths, weaknesses, opportunities, and threats (SWOT) of paediatric PT services offered around the world.

METHOD: A cross-sectional survey design method was used with a subsample of physiotherapists (PTs) who had previously participated in an online survey. The survey used for this study included close- and open-ended questions about access to services and the SWOT of PT services within participants’ country. Descriptive statistics were used to summarize quantitative data and a content analysis was performed on open-ended questions.

RESULTS: Overall, 47 PTs from 47 countries completed the survey; 36% of participants reported that free access was available to all children in their country while 34% stated that a referral was always required when accessing services. Lack of direct access, insufficient specialized PT, financial and geographical issues were the main perceived barriers to access services. Access also emerged as one of the nine themes following the SWOT analysis. Other themes included education, quality of PT approaches, PT practices, communication and cooperation, teamwork, government, resources, and attitudes of PTs.

DISCUSSION: Despite variations in accessing services and how services are delivered across countries, some similar themes influencing PTs practices were found. Future opportunities for PTs working with children should aim at optimizing the initial training and professional development of PTs in paediatrics, increasing access to services for all children and advocating for sustainable and well-coordinated models of care building on best practices.

PMID:36103585 | DOI:10.1002/pri.1974

Proc Natl Acad Sci U S A. 2022 Sep 20;119(38):e2210604119. doi: 10.1073/pnas.2210604119. Epub 2022 Sep 14.

ABSTRACT

Inferring the transmission direction between linked individuals living with HIV provides unparalleled power to understand the epidemiology that determines transmission. Phylogenetic ancestral-state reconstruction approaches infer the transmission direction by identifying the individual in whom the most recent common ancestor of the virus populations originated. While these methods vary in accuracy, it is unclear why. To evaluate the performance of phylogenetic ancestral-state reconstruction to determine the transmission direction of HIV-1 infection, we inferred the transmission direction for 112 transmission pairs where transmission direction and detailed additional information were available. We then fit a statistical model to evaluate the extent to which epidemiological, sampling, genetic, and phylogenetic factors influenced the outcome of the inference. Finally, we repeated the analysis under real-life conditions with only routinely available data. We found that whether ancestral-state reconstruction correctly infers the transmission direction depends principally on the phylogeny’s topology. For example, under real-life conditions, the probability of identifying the correct transmission direction increases from 32%-when a monophyletic-monophyletic or paraphyletic-polyphyletic tree topology is observed and when the tip closest to the root does not agree with the state at the root-to 93% when a paraphyletic-monophyletic topology is observed and when the tip closest to the root agrees with the root state. Our results suggest that documenting larger differences in relative intrahost diversity increases our confidence in the transmission direction inference of linked pairs for population-level studies of HIV. These findings provide a practical starting point to determine our confidence in transmission direction inference from ancestral-state reconstruction.

PMID:36103580 | DOI:10.1073/pnas.2210604119

PLoS One. 2022 Sep 14;17(9):e0274334. doi: 10.1371/journal.pone.0274334. eCollection 2022.

ABSTRACT

OBJECTIVES: To determine the prevalence of use of complementary medicine (CM) in Switzerland in 2017, its development since the 2012 Swiss Health Survey, and to examine specific and non-specific sociodemographic, lifestyle and health-related determinants of CM use as compared to determinants of conventional health care use.

MATERIALS AND METHODS: We used data of 18,832 participants from the cross-sectional Swiss Health Survey conducted by the Swiss Federal Statistical Office in 2017 and compared these data with those from 2012. We defined four CM categories: (1) traditional Chinese medicine, including acupuncture; (2) homeopathy; (3) herbal medicine; (4) other CM therapies (shiatsu, reflexology, osteopathy, Ayurveda, naturopathy, kinesiology, Feldenkrais, autogenic training, neural therapy, bioresonance therapy, anthroposophic medicine). Independent determinants of CM use and of conventional health care use were assessed using multivariate weighted logistic regression models.

RESULTS: Prevalence of CM use significantly increased between 2012 and 2017 from 24.7% (95% CI: 23.9-25.4%) to 28.9% (95% CI: 28.1-29.7%), respectively, p<0.001). We identified the following independent specific determinants of CM use: gender, nationality, age, lifestyle and BMI. Female gender and nationality were the most specific determinants of CM use. Current smoking, being overweight and obesity were determinants of non-use of CM, while regular consumption of fruits and/or vegetables and regular physical activity were determinants of CM use.

CONCLUSION: Prevalence of CM use significantly increased in Switzerland from 2012 to 2017. Gender, nationality, age, lifestyle and BMI were independent specific determinants of CM use as compared to conventional health care use. Healthier lifestyle was associated with CM use, which may have potentially significant implications for public health and preventive medicine initiatives. The nationality of CM users underlines the role of culture in driving the choice to use CM but also raises the question of whether all populations have equal access to CM within a same country.

PMID:36103571 | DOI:10.1371/journal.pone.0274334

Clin Transl Med. 2022 Sep;12(9):e1023. doi: 10.1002/ctm2.1023.

ABSTRACT

BACKGROUND: Intrauterine infection and inflammation caused by microbial transfer from the vagina are believed to be important factors causing spontaneous preterm delivery (PTD). Multiple studies have examined the relationship between the cervicovaginal microbiome and spontaneous PTD with divergent results. Most studies have applied a DNA-based assessment, providing information on the microbial composition but not transcriptional activity. A transcriptomic approach was applied to investigate differences in the active vaginal microbiome and human transcriptome at midgestation between women delivering spontaneously preterm versus those delivering at term.

METHODS: Vaginal swabs were collected in women with a singleton pregnancy at 18 + 0 to 20 + 6 gestational weeks. For each case of spontaneous PTD (delivery <37 + 0 weeks) two term controls were randomized (39 + 0 to 40 + 6 weeks). Vaginal specimens were subject to sequencing of both human and microbial RNA. Microbial reads were taxonomically classified using Kraken2 and RefSeq as a reference. Statistical analyses were performed using DESeq2. GSEA and HUMAnN3 were used for pathway analyses.

RESULTS: We found 17 human genes to be differentially expressed (false discovery rate, FDR < 0.05) in the preterm group (n = 48) compared to the term group (n = 96). Gene expression of kallikrein-2 (KLK2), KLK3 and four isoforms of metallothioneins 1 (MT1s) was higher in the preterm group (FDR < 0.05). We found 11 individual bacterial species to be differentially expressed (FDR < 0.05), most with a low occurrence. No statistically significant differences in bacterial load, diversity or microbial community state types were found between the groups.

CONCLUSIONS: In our mainly white population, primarily bacterial species of low occurrence were differentially expressed at midgestation in women who delivered preterm versus at term. However, the expression of specific human transcripts including KLK2, KLK3 and several isoforms of MT1s was higher in preterm cases. This is of interest, because these genes may be involved in critical inflammatory pathways associated with spontaneous PTD.

PMID:36103557 | DOI:10.1002/ctm2.1023

PLoS Biol. 2022 Sep 14;20(9):e3001776. doi: 10.1371/journal.pbio.3001776. eCollection 2022 Sep.

ABSTRACT

Introgression, endosymbiosis, and gene transfer, i.e., horizontal gene flow (HGF), are primordial sources of innovation in all domains of life. Our knowledge on HGF relies on detection methods that exploit some of its signatures left on extant genomes. One of them is the effect of HGF on branch lengths of constructed phylogenies. This signature has been formalized in statistical tests for HGF detection and used for example to detect massive adaptive gene flows in malaria vectors or to order evolutionary events involved in eukaryogenesis. However, these studies rely on the assumption that ghost lineages (all unsampled extant and extinct taxa) have little influence. We demonstrate here with simulations and data reanalysis that when considering the more realistic condition that unsampled taxa are legion compared to sampled ones, the conclusion of these studies become unfounded or even reversed. This illustrates the necessity to recognize the existence of ghosts in evolutionary studies.

PMID:36103518 | DOI:10.1371/journal.pbio.3001776

PLoS One. 2022 Sep 14;17(9):e0274430. doi: 10.1371/journal.pone.0274430. eCollection 2022.

ABSTRACT

BACKGROUND: Parental support programmes aim to strengthen family functioning and the parent-child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components of the implementation process with a focus on Reach, Adaptation, and Fidelity of Ladnaan intervention.

METHOD: This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Council’s guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes and observations of the sessions. The data were then analysed using content analysis and descriptive statistics.

RESULTS: Of the 60 parents invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the parenting programme’s implementation facilitated reaching Somali-born parents. To retain the programme participants, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme and reported increased knowledge about children’s rights and the support they could seek from social services.

CONCLUSIONS: This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to attract immigrant parents to and engage them in participating in parenting support programmes.

PMID:36103499 | DOI:10.1371/journal.pone.0274430