Common Intervention Research Articles

Management and outcomes of venous thoracic outlet decompression: A transition to the infraclavicular approach

ObjectiveVenous thoracic outlet syndrome (vTOS) is caused by compression of the subclavian vein at the costoclavicular space, which may lead to vein thrombosis. Current treatment includes thoracic outlet decompression with or without venolysis. However, given its relatively low prevalence, the existing literature is limited. Here, we report our single-institution experience in the treatment of vTOS. MethodsWe performed a retrospective review of all patients who underwent rib resection for vTOS at our institution from 2007 to 2022. Demographic, procedural details, and perioperative and long-term outcomes were reviewed. ResultsA total of 76 patients were identified. The mean age was 36 years. Swelling was the most common symptom (93%), followed by pain (6.6%). Ninety percent of patients had associated deep vein thrombosis, with 99% of these patients starting anticoagulation preoperatively. A total of 91% of patients underwent rib resection via the infraclavicular approach, 2% via the paraclavicular approach (due to a neurogenic component), and 7% via the transaxillary approach. Eighty-three percent of patients had endovascular intervention before or at the time of the rib resection, with catheter-directed thrombolysis (87%), followed by angioplasty (71%) and rheolytic thrombectomy (57%) being the most common interventions. The median time from endovascular intervention to rib resection was 14 days, with 25% at the same admission. The median postoperative stay was 3 days (2-5 days). There was no perioperative mortality or nerve injury. Fourteen percent of patients had postoperative complications, with bleeding complications (12%) being the most common. Waiting more than 30 days between initial endovascular intervention and rib resection was not associated with decreased risk of bleeding complications. Patients were seen postoperatively at 1-month (physical examination) and 6-month (duplex) intervals or for any new or recurrent symptoms. Twenty-two percent of our overall patient population underwent reintervention, most commonly angioplasty (21%). At last follow-up, 97% of subclavian veins were patent, and 93% of patients were symptom free. ConclusionsOver the last decade, we have transitioned to an infraclavicular approach for isolated vTOS, with low perioperative morbidity and good patency rates. These results support the adoption of the infraclavicular approach with adjunct endovascular techniques as a safe and efficacious treatment of vTOS.

Outcomes of Mechanical Resection of Endometrial Polyps and Submucosal Fibroids Through TruClear™ Hysteroscopy.

To assess the efficacy of mechanical resection through TruClear™ hysteroscopy in patients with endometrial polyps and submucosal fibroids. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad, Pakistan, from June 2018 to 2022. Patients diagnosed with endometrial polyps and submucosal fibroids confirmed by abdominal or transvaginal ultrasonography were included. Patients having a history of congestive cardiac failure, chronic kidney disease, and bleeding diathesis were excluded from the study. Data about the complete removal of pathology (endometrial polyps and submucosal fibroids), mean operating time, and postoperative complications such as bleeding and perforation were extracted. The follow-up was set up to 6 months after the procedure. The average age of the 45 patients was 35.62 ± 7.46 years. Heavy menstrual bleeding was the most prevalent symptom, seen in 73.3% of cases, followed by irregular vaginal bleeding (IVB) in 11.1% of cases. The most frequent disease identified by sonography was a polyp in 21 (47%) instances, followed by submucosal fibroids in 12 (27%) cases, mixed pathology in 10 (22%), and malignancy in 2 (4%) cases. The overall average operative time was 36.46 ± 24.94 minutes. A hundred percent removal of lesions was observed in this study. Persistent symptoms were observed in 13% of patients after the surgery so they were treated with other interventions. The most common intervention was an intrauterine hormonal device. Intraoperative bleeding was observed in only one patient and was managed by intraoperative intrauterine balloon insertion. The recurrence rate was 8.9% (4/45). TruClear™ hysteroscopy showed a major advantage in the successful and complete removal of the pathology, low operation time, and complications. Fibroids, Hysteroscopy, Polyps, Endometrial resection, Menstrual bleeding.

Impact of Sensory Integration Therapy on Family Participation & Dynamics

Abstract Date Presented 03/21/24 Sensory integration (SI) therapy is a common intervention used by OT practitioners. This qualitative study looks beyond the impact of SI on the child to examine how SI therapy affects family dynamics as a whole. Primary Author and Speaker: Brooklyn Osborne Additional Authors and Speakers: Aimee Piller, Jessica McHugh Conlin

On the Concerning Early Failure of a Short Stem Press-Fit Humeral Component

IntroductionAnatomic total shoulder arthroplasty (TSA) is a common surgical intervention for various shoulder pathologies, predominantly glenohumeral osteoarthritis. While generally considered safe and effective, complications remain a challenge. Short stem implants, aim to preserve bone stock and reduce complications. However, concerns about a specific short stem implant (Univers Apex; Arthrex, Naples, FL, USA) have surfaced due to high reported rates relatively early aseptic loosening. MethodsThis retrospective study analyzed 116 consecutive TSA patients with Univers Apex implants from 2004 to 2022. 15 revision cases were assessed for radiographic loosening, and explanted implants were examined for damage using a 0-3 scale. Histopathological analysis evaluated cellular responses to wear debris. ResultsOf the patients, 13% (15/116) required revision at 23.2 months on average. A distinct radiographic loosening pattern was identified, with humeral component subsidence and thinning of the proximal humeral cortex. Histopathology revealed a robust inflammatory response to wear debris, with a potential association between macrophage infiltration, hinge damage, and polyethylene wear. ConclusionThis study reveals a notable rate of early aseptic humeral loosening with the Univers Apex short stem implant, emphasizing concerns raised in previous reports and providing a potential explanation for the high rate of early failure. Surgeons should exercise caution and closely monitor patients with this implant design.

Review article: Oesophageal disorders in chronic liver disease.

Oesophageal disorders and chronic liver disease are common worldwide and significantly impact quality of life. The intricate link between these conditions, including how oesophageal disorders like GERD, Barrett's oesophagus and oesophageal cancer affect and are affected by chronic liver disease, remains poorly understood. To review the relationship between oesophageal disorders and chronic liver disease, evaluating epidemiology, pathophysiology and therapeutic factors. We reviewed the literature on the relationship between oesophageal disorders and chronic liver disease, including cirrhosis, using the PubMed database RESULTS: Oesophageal disorders such as gastroesophageal reflux disease, Barrett's oesophagus, oesophageal cancer, oesophageal motor disorders and oesophageal candidiasis are prevalent among individuals with cirrhosis, exacerbating the burden of liver disease. These diseases have a multifaceted symptomatology and pathogenic basis, posing a significant challenge in cirrhotic patients that necessitates careful diagnosis and management. Additionally, therapies frequently used for these diseases, such as proton pump inhibitors, require careful consideration in cirrhotic patients due to potential adverse effects and altered pharmacokinetics. Managing oesophageal disorders in cirrhotic patients requires a cautious approach due to possible interactions with medications and the risk of adverse effects. Furthermore, symptoms associated with these conditions are often exacerbated by common interventions in patients with cirrhosis, such as band ligation for oesophageal varices. Oesophageal disorders are common in cirrhosis and increase the disease burden. These conditions require careful management due to complex symptoms and treatment risks. Proton pump inhibitors and other therapies must be used cautiously, as cirrhosis interventions can worsen symptoms.

A Contemporary Review of Blood Transfusion in Critically Ill Patients.

Blood transfusion is a common therapeutic intervention in hospitalized patients. There are numerous indications for transfusion, including anemia and coagulopathy with deficiency of single or multiple coagulation components such as platelets or coagulation factors. Nevertheless, the practice of transfusion in critically ill patients has been controversial mainly due to a lack of evidence and the need to consider the appropriate clinical context for transfusion. Further, transfusion carries many risk factors that must be balanced with benefits. Therefore, transfusion practice in ICU patients has constantly evolved, and we endeavor to present a contemporary review of transfusion practices in this population guided by clinical trials and expert guidelines.

Opioid-free anaeshtesia in gynecology, future or a step back? –systematic review

Gynecological operations are surgical procedures involving the pelvic organs of a woman. They are divided into:laparoscopic, laparotomy and from vaginal access. The first two types are performed under general anesthesiawith opioids (Opioid Based Anasthesia, OBA). However, due to many side effects of opioids, non-opioid anesthesia(Opioid Free Anasthesia, OFA) has become more widely used. The following review focuses on the comparisonof postoperative pain, analgesic consumption, recovery quality, nausea and vomiting (PONV), hypotension andbradycardia between these two therapeutic approaches. The aim of this study is to perform comparative analysis ofthe effectiveness and side effects in gynecological surgeries using the OFA or OBA procedure. Review was performedwith MEDLINE, EMBASE, AMED databeses and the Cochrane Library, between September 2023 and December 2023.Randomised controlled trials (RCTs) comparing efficacy and side effects between OFA and OBA were included. Thereview comprised 498 patients from 6 RCTs. Common interventions included laparoscopic procedures. Evidence showsa reduction in side effects in OFA. PONV frequency was reduced in OFA (RR = 0.52; 95% CI: 0.29–0.93; p = 0.004;l2 = 67.5%). The score on the recovery quality questionnaire was also significantly higher (mean difference +28.36 points/200). The difference in pain, frequency of hypotension and bradycardia slightly favors OFA, but these changeswere not statistically significant. OFA procedure is not only an effective alternative to OBA in gynecological surgery, butalso improves the outcomes after it. Although, further research in this field is required.

Timing of Off-Label Dosing of Direct Oral Anticoagulants in Three Large Health Systems.

While direct oral anticoagulants (DOACs) may be viewed as simpler to manage then warfarin, they present their own unique management challenges resulting in frequent off-label dosing. It is unknown to what extent off-label dosing occurs when a patient is started on a DOAC versus later in their treatment. We aimed to better characterize when off-label DOAC dosing is occurring and to evaluate the effectiveness of prescribing oversight using a registry-based intervention. We evaluated data from the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry, a retrospective quality-improvement process using data abstractors, from 2018 to 2022 on the number of "alerts" that are generated in response to dosing deviating from the U.S. Food and Drug Administration instructions for atrial fibrillation (AF) and venous thromboembolism (VTE). Among a sample of 789 to 1,022 annual AF patients and 381 to 484 annual VTE patients prescribed a DOAC in the MAQI2 registry, off-label dosing was relatively common. Over the 5-year period (2018-2022), there were 569 alerts for AF patients and 162 alerts for VTE patients. Alerts occurred more frequently during follow-up than at the time of initial prescribing in AF patients (78.2 vs. 21.8%), but more commonly at initial prescribing in VTE patients (59.9 vs. 40.1%). After initial review by quality-improvement abstractors, 19.3% of AF alerts and 14.8% of VTE alerts resulted in contact to the prescriber. When the prescriber was contacted, it led to an intervention about 75% of the time for both populations. The most common intervention was a change in DOAC dosing. This study demonstrates the benefit of DOAC prescribing oversight using a registry-based intervention to monitor for off-label dosing for the entirety of the time period a patient is prescribed DOAC, particularly for patients with AF, as off-label prescribing occurs frequently during the follow-up period.

An Update on Guidelines to Prevent and Manage Atrial Fibrillation After Cardiac Surgery and a Survey of Practice in the UK

ObjectivesPostoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and affects around 30% of patients. Variable guidelines from multiple organisations exist for the prevention of POAF after cardiac surgery. We conducted a survey of UK practice was conducted to define “usual care” for a platform trial of interventions to prevent POAF after cardiac surgery. To provide context for the survey, we reviewed all current guidelines for the prevention and management of AF after cardiac surgery. DesignOnline survey and literature review SettingSurvey: All 35 UK National Health Service Cardiac Surgery Centres. Literature Review: Guidelines from specialist societies and other guideline making organisations from the UK, Europe and North America. ParticipantsEstablished link network of researchers. Measurements and Main ResultsReview: Five relevant guidelines were identified. All guidelines recommend β-blockade for prevention of AF after cardiac surgery. Treatment of AF is recommended using either rate or rhythm control. Cardioversion is recommended only for the haemodynamically unstable patient. Patients who remain in AF for over 48 hours should be considered for anticoagulation. Patients should be followed up within 60 days to review the need for anti-arrhythmic and anticoagulant therapy. Survey: 31/35 (89%) of centres responded. 11 of 31 (35.5%) centres followed local guidance for prevention of POAF, 4 (13%) centres followed Society of Cardiovascular Anesthesiologists / European Association of Cardiothoracic Anaesthesia guidelines, 4 (13%) followed UK National Institute of Health and Care Excellence guidance and 4 followed “other” guidance. 8 of 31 (26%) followed no guidelines to prevent POAF. 28 of 31 (90%) centres did not risk-stratify their patients for POAF. Most centres (23/31, 74%) do not have a care-package in place to prevent POAF, but 14 of 31 (45%) try in some way to prevent AF in patients presenting in sinus rhythm. The most common interventions to prevent POAF are β-blocker use post-operatively (23/31, 74%), use of magnesium (20/31, 64.5%) and maintaining a serum K+ ≥4.5mmol/L (26/31, 84%). ConclusionsGuidance to prevent AF after cardiac surgery clusters around the use of β-blockade. Although patients in the UK do not appear to be risk-assessed for POAF, the main interventions used to prevent it are similar; β-blockade and maintenance of serum K+ and Mg2+ levels.

Evaluation of early results of diagnosis and treatment of popliteal artery injury in knee trauma at Binh Dan Hospital

Objectives:To describe the clinical and subclinical signs for early diagnosis and evaluate the short-term outcomes of surgical treatment of popliteal artery injury in knee trauma. Materials and methods: A retrospective descriptive study was conducted on 30 patients with knee trauma and popliteal artery injury who underwent surgery at Binh Dan Hospital from August 2016 to June 2021. Results: The mean age of admitted patients was 35.5±12.8 years, predominantly male (73.3%). The majority of cases were due to traffic accidents (83.4%). Peripheral pulse was absent or decreased in 76.7% of patients. Most patients (95.3%) showed loss of flow signal on ultrasound. The most common surgical intervention was venous graft repair (63.3%). After surgery, 93.3% of patients had good flow restoration. The postoperative arterial occlusion rate was 6.7%. There were two cases that required a second surgery for popliteal artery recanalisation: one case where limb salvage was achieved, and one case that resulted in amputation. Conclusion: The application of appropriate diagnostic measures, emergency management, and surgical intervention has resulted in positive treatment outcomes, helping to reduce the rate of limb amputation and other severe complications

Clinical practice of acupuncture and moxibustion in treatment of tumor-related symptoms.

Tumor and its concomitant symptoms such as pain, fatigue and nausea bring a huge physical and mental burden to the patients. Although the medication is a common intervention for these symptoms, these problems have not been solved yet due to the side effects and patients' tolerance. In modern clinical practice of anti-tumor, acupuncture-moxibustion not only inhibits the growth of tumor, but also ameliorates the related symptoms as an auxiliary therapy. The paper summarizes the application of acupuncture-moxibustion in treatment of malignant tumor and its related symptoms, systematizes the therapeutic effects on the common symptoms and analyzes the clinical value of acupuncture-moxibustion for anti-tumor.

How are nature-based interventions defined in mild cognitive impairment and dementia studies? A conceptual systematic review and novel taxonomy.

To systematically review research testing nature-based interventions for people living with mild cognitive impairment or dementia, and to report how authors have defined their interventions by presenting a taxonomy of the nature-based interventions. A conceptual systematic review of research published between 2008 and 2024 investigating nature-based interventions for people living with mild cognitive impairment or dementia was conducted. Three reviewers contributed independently. Exclusion criteria: not specifying if participants had mild cognitive impairment or dementia, only recruiting caregivers, no primary data, study protocols, abstracts, reviews, not peer-reviewed journal articles and any other grey literature. Intervention descriptions within the papers were thematically analysed. Fifty-two articles reporting fifty-one studies were included. The most common interventions were nature virtual reality (VR technology) and gardening. From the definition data, we produced a taxonomy with overarching domains of: (a) Other terms used; (b) Characteristics; (c) Activities. Subdomains included: development or approach, modes of action, location, physical features, and activities. Some interventions could be grouped. Structure and standardisation of the interventions varied, with a lack of clear reporting. This taxonomy provides conceptualisations of nature-based interventions that can be used by future researchers to guide the development, evaluation and reporting of robust interventions in this area.

Optimal content for a surgical curriculum for general practice in Rwanda: A Delphi study.

In Rwanda, a nationwide shortage of surgeons necessitates general practitioners (GPs) perform many common procedures and minor surgeries. However, GPs only receive a 1-year internship to prepare them to provide this care. We performed a Delphi survey of practicing GPs to assess essential content for a surgical curriculum for Rwandan interns to better prepare them for general practice. We invited 56 practicing GPs to participate in a two-round anonymous electronic survey in February 2023. The first round assessed demographics and solicited free-text responses to gather knowledge and procedural content suggestions for the curriculum. The second round refined these responses into key content areas. Thirty-one GPs responded to both rounds of the Delphi survey. They provided insight into the most commonly performed procedures, most important technical skills, and the top areas of surgical knowledge necessary for general practice. They expressed a need for more exposure to a variety of surgical pathologies and interventions across multiple specialties, highlighting the value of foundational skills in trauma, obstetrics and gynecology, and orthopedics, both at the beginning of their internship, as well as at the beginning of their general practice. GPs emphasized the importance of broad exposure to common acute surgical pathology and interventions across several surgical subspecialties, as well as a need for foundational technical skills and surgical knowledge. The results of our study underscore the necessity of a surgical education providing a solid basis in the foundational knowledge and techniques of surgical care.

Exploring the Gut Microbiota: Key Insights Into Its Role in Obesity, Metabolic Syndrome, and Type 2 Diabetes.

The gut microbiota (GM), comprising trillions of microorganisms in the gastrointestinal tract, is a key player in the development of obesity and related metabolic disorders, such as type 2 diabetes (T2D), metabolic syndrome (MS), and cardiovascular diseases. This mini-review delves into the intricate roles and mechanisms of the GM in these conditions, offering insights into potential therapeutic strategies targeting the microbiota. The review elucidates the diversity and development of the human GM, highlighting its pivotal functions in host physiology, including nutrient absorption, immune regulation, and energy metabolism. Studies show that GM dysbiosis is linked to increased energy extraction, altered metabolic pathways, and inflammation, contributing to obesity, MS, and T2D. The interplay between dietary habits and GM composition is explored, underscoring the influence of diet on microbial diversity and metabolic functions. Additionally, the review addresses the impact of common medications and therapeutic interventions like fecal microbiota transplantation on GM composition. The evidence so far advocates for further research to delineate the therapeutic potential of GM modulation in mitigating obesity and metabolic diseases, emphasizing the necessity of clinical trials to establish effective and sustainable treatment protocols.

Summary of Evidence on the Impact of Mindfulness Training on Anxiety Levels of Pregnant Women

Background: Mental health during pregnancy is a global health problem, the percentage of pregnant women with antenatal anxiety or mood disorders ranges from 15% and 25%, with generalized anxiety disorder as the most common factor in the illness. Most of the research findings show a relationship between mothers’ psychological distress and poor prognosis for either the mother or the infant. Low well-being during pregnancy has significant adverse impacts on both mother and infant. Therefore, it is important to focus on antenatal anxiety and psychological stress in pregnant women. Mindfulness training, defined as an intentional and non-judgmental awareness of experience in the present moment, it is the most common intervention for antenatal education. Although the impact of positive thinking interventions on antenatal maternal well-being has been increasingly examined, the results still have not been systematically evaluated. Aim: This paper aims to systematically evaluate the effects of positive thinking interventions on evidence of antenatal anxiety in pregnant women and current research methods with a population of pregnant women by evaluating five studies of Randomized Controlled Trials (RCTs) using the CASP checklist tool. Summarize the implications of the evaluation results for future studies, and finally provide practical insights and research recommendations. Methods: Firstly, the research topic is identified: patient/problem: pregnancy anxiety; intervention: intervention in positive thinking; comparison: usual care. A complete internet-based search of five databases was conducted through Academic Search Complete, Medical Line, CINAHL, Health Source: Nursing/Academic Edition and Google Scholar to identify randomized controlled trials assessing positive thinking training versus postnatal depression controls. To select higher quality and relevant articles, the author rechecked titles and abstracts exclusion criteria and manually searched five peer-reviewed RCT articles from the last five years by further evaluating reference lists, while focusing on assessing interventions, measurement scale outcomes, study sample results, strengths and limitations. Secondly, randomized controlled trials were assessed using the CASP Randomized Controlled Trial Criteria Checklist. This version has now been updated to the 2020 Access Guide. Results: This paper provides a specific review of five RCT studies by using the CASP assessment tool, and concludes that positive thinking training shows potential benefits in terms of prenatal depression, anxiety and negative affect levels. From a comparison of the five intervention modalities of the positive thinking intervention, Mindfulness-integrated Cognitive Behavior Therapy (MICBT) had the broadest range of interventions and the most comprehensive curriculum. Most of the studies had small sample sizes of participants and an increase in sample size and longer follow-up time through comparative analysis would be beneficial to generalizability, therefore a sample size of 50 people on average between the intervention and control groups was chosen as appropriate, with a follow-up time of at least one month and three months. Also, the presence of potential bias was mentioned in these studies, by comparing randomized classification methods it was found that the smaller the base difference present through computer allocation and single-blind allocation, the less systematic bias there was. The choice of measurement instruments did not conflict with the sample size, the cultural background of the population and the findings. However, positive effects on anxiety and stress during pregnancy were less consistent with the assessment tool for the intervention group. Self-report instruments are highly sensitive and idiosyncratic, coupled with the tendency of participants to interact with researchers to produce bias. Therefore, when selecting a measurement tool, the best approach is to combine a self-report instrument with a researcher’s assessment. The literature highlights the increased interest in this area in recent years. Coupled with the prevalence of methodological issues and variation between studies, the current review is timely and necessary to determine intervention effects and best practice for future research. Findings: Mindfulness training is a useful intervention for improving anxiety and stress during pregnancy, but future research recommendations must follow robust methodological criteria with expanded sample sizes and longer follow-ups to examine the effects of positive thinking interventions during pregnancy.

Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England

ObjectiveTo estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and...

Improved diet-based nutritional interventions can improve childhood obesity with the synergistic regulation of gut microbiota.

Childhood obesity is a crucial public health concern worldwide. Dietary intervention is the most common intervention for the treatment of obesity. Therefore, we tested an improved diet-based nutritional interventions to improve the childhood obesity and its gut microbiota. Thirty obese children received a 12-week intervention with the adjust-energy-restricted dietary pattern (A-CRD). Body composition was measured by bioelectrical impedance (Inbody S10) and faecal microbes were profiled by sequencing 16S rRNA. Compared to the NTB group (at 0 week), the NTA group (at 12 weeks) had a significantly greater decrease in body weight, body mass index (BMI) and percent body fat (PBF) ( P < 0.001, respectively), whereas skeletal muscle mass (SMM) and fat free mass (FFM) were not statistically significantly different ( P > 0.05). The gut microbiota was found significantly different between the NTB and NTA groups based on alpha and beta diversity. Bifidobacterium, Blautia, and Streptococcus was significantly increased, whereas Bacteroides and Megamonas was significantly decreased in the NTA group ( P < 0.05, respectively). Meanwhile, NTA group significantly increased the ability to produce short-chain fatty acids (SCFAs; e.g. acetic acid/total dietary energy) and changed he predictive metabolic functional features of the microbiota communities ( P < 0.05, respectively) than the NTB group. In conclusion, A-CRD can significantly improve childhood obesity, and the underlying mechanism may be its effect on gut microbiota and metabolism. Therefore, the diet-based nutrition intervention targeting gut microbiota will be more effective management of body weight and prevention of obesity. Chinese Clinical Trial Register: ChiCTR2300074571.

Patient-reported satisfaction and health-related quality of life after chest masculinization in transgender men using the BODY-Q Chest module and the 15D instrument

Chest masculinization is the most common surgical intervention in transgender men. Studies indicate good patient-reported postoperative satisfaction, but only recently was a patient-reported outcome instrument, BODY-Q Chest module, developed and validated for this patient group. This study aims to evaluate post-operative patient-reported satisfaction and health-related quality of life (HRQoL) using BODY-Q Chest module and the 15D after surgical chest masculinization in transgender men. The data comprised all patients receiving chest masculinization from 2005 to 2018. The patients were invited by letter to fill in the BODY-Q Chest module and the 15D questionnaire in May 2020. Of the 220 patients invited, 123 completed the survey, giving a response rate of 56%. The median chest and nipple scores were 76 and 68 out of 100, respectively. The number of secondary corrections had a negative association to the chest score (p-value<0.001). The 15D index score was lower compared to the age-standardized male population (p-value<0.001), but similar to the age-standardized female population. Psychiatric comorbidity was associated to lower 15D index scores (p-value<0.001). There was no statistically significant difference between the BODY-Q Chest module scores or the 15D index score between different surgical techniques. The postoperative satisfaction with chest masculinization is good and in line with previous literature. The HRQoL resembles that of the reference population. The periareolar technique is not associated with better satisfaction despite causing less scar burden. The negative association between the chest score and number of secondary corrections is unsettling and requires further examination in a prospective setting.

Effectiveness of pharmacological interventions for managing ADHD symptoms in individuals with autism spectrum disorder: A systematic review and meta-analysis

ObjectivesThis systematic review sought to provide evidence for the effectiveness of common pharmacological interventions used for treating attention deficit hyperactivity disorder (ADHD) symptoms in the autism spectrum disorder (ASD) population, considering studies attempting to find safe and effective drugs. MethodsWe searched for randomized controlled trials describing the effectiveness and/or safety profile of pharmacological interventions for treating ASD and ADHD or ASD with ADHD symptoms using three bibliographic databases: PubMed, Cochrane Library, and Embase. We have chosen ADHD symptoms measured by any clinical scale as the primary outcome. As additional outcomes, we have used other symptoms of aberrant behavior measured by the aberrant behavior checklist, satisfaction with treatment, and peer satisfaction. ResultsTwenty-two publications met the inclusion criteria for the systematic review and eight for the meta-analysis. In our investigation, we found a few articles using clonidine, modafinil, and bupropion as interventions when compared to methylphenidate (MPH). Our meta-analysis showed that MPH had positive changes compared to placebo in symptoms such as hyperactivity, irritability, or inattention. However, no effect was found in stereotyped symptoms, and our data's quantitative analysis revealed a large effect of MPH-induced adverse effects on the dropout rate. On the other hand, atomoxetine initiation had positive effects when compared to placebo on symptoms of hyperactivity and inattention. We have found no effect of atomoxetine on stereotypes or irritability. Furthermore, atomoxetine did not influence side effects that caused dropouts from studies. ConclusionOur results indicated that atomoxetine has a modest effect on hyperactivity and inattention symptoms, with a relatively benign profile of side effects. MPH appears to be effective in handling hyperactivity, inattention, and irritability symptoms. However, our results on atomoxetine revealed increased dropouts due to adverse effects when compared to MPH or placebo. Evidence for other substances such as guanfacine, clonidine, bupropion, or modafinil is either preliminary or nonexistent.

Emotional Dysregulation in Anorexia Nervosa: Scoping Review of Psychological Treatments.

Eating disorders are complex psychiatric disorders characterized by compensatory and restrictive behavior and a preoccupation with one's body. Eating and purging behaviors are considered dysfunctional emotional regulation strategies. Therefore, psychological treatment is essential. The most common psychological interventions are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), family therapy (FBT), multi-family group therapy (MFTG) and mentalization-based treatment (MBT). The aim of this study was to summarize the current evidence on the impact of psychological treatments on emotional regulation difficulties and psychological symptoms in patients with eating disorders, especially anorexia nervosa. A search was conducted on PubMed and Web of Science using the terms "anorexia nervosa" and "emotion dysregulation". Of the 278 initial articles, we included 15 publications. The results indicate that the acquisition of coping strategies, through DBT, leads to an improvement in anxiety and alexithymia. DBT, CBT and MBT lead to a reduction in the use of dysfunctional emotional regulation strategies too. Eating disorders involve both physical and mental health; therefore, it is desirable for future research to focus on the mutual synergy between the mental and physical components by evaluating various factors, such as biomarkers and the most appropriate therapeutic approach, with respect to the treatment setting.