Distal Level Research Articles

Prevalence and factors associated with unplanned pregnancy in a Brazilian capital in the Northeast

Abstract Objectives: to analyze the prevalence and factors associated with unplanned pregnancy in a Brazilian capital in the Northeast. Methods: a cross-sectional study nested to a hospital birth cohort with a probable sample of 5,110 puerperal women. Associated factors were analyzed using a hierarchical theoretical model in three levels: distal (women’s socioeconomic and demographic characteristics), intermediate (reproductive characteristics, maternal habits and BMI), and proximal level (partner's characteristics). Multivariate Poisson regression analysis was performed. Results: the prevalence of unplanned pregnancy was 68.1% (CI95%=66.8-69.4). Multivariate analysis showed association with black skin color/race (PR=1.03; CI95%=1.01- 1.07), mother's age group up to 19 years old (PR=1.09; CI95%=1.06-1.12) and 20 to 24 years old (PR=1.04; CI95%=1.01-1.07), not living with partner (PR=1.09; CI95%=1.07- 1.11), highest number of people in the household: 5 people (PR= 1.10; CI95%=1.08-1.13) and 3 to 4 (PR=1.08; CI95%=1.05-1.10), number of ≥4 children (PR=1.09; CI95%=1.06- 1.13) and 2 or 3 children (PR=1.03; CI95%=1.02-1.05), alcohol consumption (PR=1.03; CI95%=1.01-1.05), malnourished pre-pregnancy BMI (PR=1.03; CI95%=1.01-1.06) and partner’s low schooling (5 to 8 years) (PR=1.03; CI95%=1.01-1.07). Prior abortion was inversely associated with planned pregnancy (PR=0.95; CI95%=0.93-0.97). Conclusions: the prevalence of unplanned pregnancy was high and was associated with socioeconomic and demographic characteristics that reflect on the combination of the complex inequalities that impact women and their partners

Different Impact of Heart Rate Variability in the Deep Cerebral and Central Hemodynamics at Rest: An in silico Investigation.

Background: Heart rate variability (HRV), defined as the variability between consecutive heartbeats, is a surrogate measure of cardiac vagal tone. It is widely accepted that a decreased HRV is associated to several risk factors and cardiovascular diseases. However, a possible association between HRV and altered cerebral hemodynamics is still debated, suffering from HRV short-term measures and the paucity of high-resolution deep cerebral data. We propose a computational approach to evaluate the deep cerebral and central hemodynamics subject to physiological alterations of HRV in an ideal young healthy patient at rest.Methods: The cardiovascular-cerebral model is composed by electrical components able to reproduce the response of the different cardiovascular regions and their features. The model was validated over more than thirty studies and recently exploited to understand the hemodynamic mechanisms between cardiac arrythmia and cognitive deficit. Three configurations (baseline, increased HRV, and decreased HRV) are built based on the standard deviation (SDNN) of RR beats. For each configuration, 5,000 RR beats are simulated to investigate the occurrence of extreme values, alteration of the regular hemodynamics pattern, and variation of mean perfusion/pressure levels.Results: In the cerebral circulation, our results show that HRV has overall a stronger impact on pressure than flow rate mean values but similarly alters pressure and flow rate in terms of extreme events. By comparing reduced and increased HRV, this latter induces a higher probability of altered mean and extreme values, and is therefore more detrimental at distal cerebral level. On the contrary, at central level a decreased HRV induces a higher cardiac effort without improving the mechano-contractile performance, thus overall reducing the heart efficiency.Conclusions: Present results suggest that: (i) the increase of HRV per se does not seem to be sufficient to trigger a better cerebral hemodynamic response; (ii) by accounting for both central and cerebral circulations, the optimal HRV configuration is found at baseline. Given the relation inversely linking HRV and HR, the presence of this optimal condition can contribute to explain why the mean HR of the general population settles around the baseline value (70 bpm).

Association between perinatal factors, genetic susceptibility to obesity and age at adiposity rebound in children of the EDEN mother\u2013child cohort

BackgroundEarly adiposity rebound (AR) has been associated with increased risk of overweight or obesity in adulthood. However, little is known about early predictors of age at AR. We aimed to study the role of perinatal factors and genetic susceptibility to obesity in the kinetics of AR.MethodsBody mass index (BMI) curves were modelled by using mixed-effects cubic models, and age at AR was estimated for 1415 children of the EDEN mother–child cohort study. A combined obesity risk-allele score was calculated from genotypes for 27 variants identified by genome-wide association studies of adult BMI. Perinatal factors of interest were maternal age at delivery, parental education, parental BMI, gestational weight gain, maternal smoking during pregnancy, and newborn characteristics (sex, prematurity, and birth weight). We used a hierarchical level approach with multivariable linear regression model to investigate the association between these factors, obesity risk-allele score, and age at AR.ResultsA higher genetic susceptibility to obesity score was associated with an earlier age at AR. At the most distal level of the hierarchical model, maternal and paternal educational levels were positively associated with age at AR. Children born to parents with higher BMI were more likely to exhibit earlier age at AR. In addition, higher gestational weight gain was related to earlier age at AR. For children born small for gestational age, the average age at AR was 88 [±39] days lower than for children born appropriate for gestational age and 91 [±56] days lower than for children born large for gestational age.ConclusionThe timing of AR seems to be an early childhood manifestation of the genetic susceptibility to adult obesity. We further identified low birth weight and gestational weight gain as novel predictors of early AR, highlighting the role of the intrauterine environment in the kinetics of adiposity.

Direct visualization of epithelial microvilli biogenesis

Microvilli are actin-bundle-supported surface protrusions that play essential roles in diverse epithelial functions. To develop our understanding of microvilli biogenesis, we used live imaging to directly visualize protrusion growth at early stages of epithelial differentiation. Time-lapse data revealed that specific factors, including epidermal growth factor pathway substrate 8 (EPS8) and insulin-receptor tyrosine kinase substrate (IRTKS) (also known as BAIAP2L1), appear in diffraction-limited puncta at the cell surface and mark future sites of microvillus growth. New core actin bundles elongate from these puncta in parallel with the arrival of ezrin and subsequent plasma membrane encapsulation. In addition to de novo growth, we also observed that new microvilli emerge from pre-existing protrusions. Moreover, we found that nascent microvilli can also collapse, characterized first by loss of membrane wrapping and ezrin enrichment, followed by a sharp decrease in distal tip EPS8 and IRTKS levels, and ultimately disassembly of the core actin bundle itself. These studies are the first to offer a temporally resolved microvillus growth mechanism and highlight factors that participate in this process; they also provide important insights on the growth of apical specializations that will likely apply to diverse epithelial contexts.

Interplay between NOD1 and TLR4 Receptors in Macrophages: Nonsynergistic Activation of Signaling Pathways Results in Synergistic Induction of Proinflammatory Gene Expression.

Interactions between pattern-recognition receptors shape innate immune responses to pathogens. NOD1 and TLR4 are synergistically interacting receptors playing a pivotal role in the recognition of Gram-negative bacteria. However, mechanisms of their cooperation are poorly understood. It is unclear whether synergy is produced at the level of signaling pathways downstream of NOD1 and TLR4 or at more distal levels such as gene transcription. We analyzed sequential stages of human macrophage activation by a combination of NOD1 and TLR4 agonists (N-acetyl-d-muramyl-l-alanyl-d-isoglutamyl-meso-diaminopimelic acid [M-triDAP] and LPS, respectively). We show that events preceding or not requiring activation of transcription, such as activation of signaling kinases, rapid boost of glycolysis, and most importantly, nuclear translocation of NF-κB, are regulated nonsynergistically. However, at the output of the nucleus, the combination of M-triDAP and LPS synergistically induces expression of a subset of M-triDAP- and LPS-inducible genes, particularly those encoding proinflammatory cytokines (TNF, IL1B, IL6, IL12B, and IL23A). This synergistic response develops between 1 and 4 h of agonist treatment and requires continuous signaling through NOD1. The synergistically regulated genes have a lower basal expression and higher inducibility at 4 h than those regulated nonsynergistically. Both gene subsets include NF-κB-inducible genes. Therefore, activation of the NF-κB pathway does not explain synergistic gene induction, implying involvement of other transcription factors. Inhibition of IKKβ or p38 MAPK lowers agonist-induced TNF mRNA expression but does not abolish synergy. Thus, nonsynergistic activation of NOD1- and TLR4-dependent signaling pathways results in the synergistic induction of a proinflammatory transcriptional program.

Pre-Exposure Prophylaxis (PrEP) for HIV Infection in Cisgender and Transgender Women in the U.S.: A Narrative Review of the Literature

Using a socioecological approach, this review describes the peer-reviewed literature on oral pre-exposure prophylaxis (PrEP) among both cisgender (cis women) and transgender women (trans women) in the U.S. A search of the PubMed database and HIV-related conference abstracts generated over 2,200 articles and abstracts. Of these, 103 fulfilled review inclusion criteria. Most of the existing research presents findings on individual-level factors associated with PrEP use such as willingness and perceived barriers. There was far less investigation of factors related to PrEP at more distal ecological levels. Though trans women are at greater risk of HIV infection than cisgender women, less is known about this population group with respect to PrEP despite their inclusion in many major clinical trials. Further, the literature is characterized by a persistent conflation of sex and gender which makes it difficult to accurately assess the reviewed research on HIV prevention and PrEP apart from risk group. Informed by these findings, we highlight specific opportunities to improve access to PrEP and reduce socioecological barriers to PrEP care engagement for cisgender and transgender women.

Virtual Surgical Planning, Stereolitographic Models and CAD/CAM Titanium Mesh for Three-Dimensional Reconstruction of Fibula Flap with Iliac Crest Graft and Dental Implants.

Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.

Randomized clinical trial of zirconia and polyetheretherketone implant abutments for single-tooth implant restorations: A 5-year evaluation

Statement of problemTitanium-supported polyetheretherketone (PEEK) abutments provide an economic alternative to zirconia abutments in esthetically important areas. Research comparing the performance regarding esthetics, longevity, and biologic parameters of PEEK abutments is lacking. PurposeThe purpose of this clinical study was to determine whether PEEK implant abutments provide similar esthetic and biologic parameters and survival rates as zirconia implant abutments. Material and methodsForty participants (age 20 to 50 years) receiving maxillary anterior and premolar implants were enrolled in the study and randomly assigned into 1 of 2 groups: Group PEEK (20 titanium-supported PEEK abutments) and group ZIR (20 zirconia abutments). Both groups were restored with pressed lithium disilicate ceramic crowns. Technical, biologic, and esthetic evaluation was performed at baseline and at 1, 3, and 5 years. The probing pocket depth, plaque control record, and bleeding on probing were recorded at the abutments (test) and compared with those at the corresponding contralateral teeth (control) and also between the 2 test groups. Standardized digital radiographs of the implants were made, and the bone level was recorded with the implant shoulder as the reference on the mesial and distal sides. The color difference between the peri-implant mucosa and control teeth gingiva and the discoloration of the implant crowns were determined with a spectrophotometer. The Student unpaired t test and repeated-measure ANOVA were used to statistically analyze the data (α=.05). ResultsFrom the 5-year evaluation, both PEEK and zirconia abutments with ceramic crowns showed 100% survival rate without any fracture or restoration loss. Differences in the biologic parameters of zirconia and PEEK abutments were statistically similar: mean probing pocket depth (group ZIR: 2.32 ±0.50 mm, group PEEK: 2.13 ±0.60 mm); mean plaque control record (group ZIR: 0.19 ±0.19, group PEEK: 0.15 ±0.17); and mean bleeding on probing (group ZIR: 0.12 ±0.11, group PEEK: 0.08 ±0.12). The mean marginal bone loss at 5 years was similar for implants supporting zirconia and PEEK abutments: mean mesial bone level (group ZIR: 1.8 ±0.5 mm; group PEEK: 1.9 ±0.6 mm), and mean distal bone level (group ZIR: 1.7 ±0.6 mm, group PEEK: 1.8 ±0.3 mm). The initial color difference (ΔE) between the peri-implant mucosa and gingiva of the analogous contralateral teeth diminished over time. No discoloration of the definitive restoration supported by PEEK or zirconia was detected over 5 years. ConclusionsAt the 5-year evaluation, zirconia and PEEK abutments exhibited the same survival rate with similar biologic and esthetic outcomes.

Five‐year oncological outcomes for rectal cancer treated by upfront laparoscopic total mesorectal excision

AbstractAimThe study aimed to evaluate the long‐term recurrence rates and survival following upfront laparoscopic total mesorectal excision (TME) for rectal adenocarcinoma.Patient and MethodsThis was a retrospective cohort of 94 patients with rectal adenocarcinoma undergoing upfront radical resection in New Territories West Cluster between 2010 and 2015. Tumours with safe circumferential resection margin (>1 mm) on magnetic resonance imaging (MRI) staging were selected for upfront surgery. Demographic data, tumour characteristics, operative details, and histopathological and postoperative outcomes were collected from patients' records. The primary outcome was local recurrence. Secondary outcomes were distant recurrence and overall (OS) and disease‐free survival (DFS).ResultsA total of 224 patients were diagnosed with rectal adenocarcinoma, of which 94 received upfront surgery after a multidisciplinary team discussion by surgeons and oncologists. The median follow‐up period after surgery was 60 months (range 4.7‐60.9 months), with four patients lost to follow‐up. Six patients (6.3%) developed local recurrence (two with isolated local recurrence and four with local and distant recurrence). Twelve patients (12.8%) experienced distant recurrence. The 5‐year OS and DFS rates were 84.3% and 76.2%, respectively. Possible prognostic factors for local recurrence (including distal tumour level ≤ 5 cm, clinical nodal stage, clinical threatened margin, pathological stage, harvested lymph nodes <12, distal margin <1 cm, positive extramural venous invasion, and circumferential resection margin) were evaluated by multivariable logistic regression, and were shown to be insignificant.ConclusionUpfront laparoscopic TME for MRI‐selected rectal cancer patients can achieve favourable oncological outcomes in our centre. Routine neoadjuvant treatment for all T3 or nodal positive disease is not necessary.

An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers.

The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. Seven patients with a mean age of 35.2 years (range 17-64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8-24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.

Sizing of the hybrid stent-graft for the frozen elephant trunk procedure

Objective . The aim of study was to determine the tactics of choosing the optimal diameter of stent-graft in open hybrid repair of thoracic aorta based on the analysis of literature and the experience of Petrovsky National Research Centre of Surgery. Material and Methods. A hybrid approach using the frozen elephant trunk (FET) technique is currently the safest and most optimal approach for thoracic aorta repair in case of extended pathology of all thoracic aorta segments, including the arch and descending thoracic aorta. Despite this technique has been used for over 15 years, there is no agreement in the current literature regarding the algorithm for choosing the optimal stent-graft diameter. A total of 135 FET procedures were performed at our centre from 2013 to 2020. The average age of patients was 52.8 ± 11.5 years. We analyzed our own experience and current literature to determine the optimal tactics for sizing the hybrid stent-graft for FET procedure. Results. One of the main factors influencing the tactics of selecting the stent-graft diameter is the nature of pathology. The experience of most surgeons suggests that the size of stent-graft should not excessively exceed the diameter of a true canal in chronic dissection and the overall diameter in case of acute aortic dissection. In case of aneurysms, most authors use stent-grafts with the diameters exceeding distal landing zone diameter by 10–20%. Some authors consider it necessary to preoperatively measure the calculated diameter based on multislice computed tomography (CT) data, whereas many other authors prefer intraoperative measurements. Conclusion. The use of a stent-graft, which is too large, can result in a high risk of new fenestration at the distal end level during the postoperative period and follow-up complications, whereas stent-graft, which is too small, would not allow the adequate fit in the distal part. Therefore, the choice of optimal stent-graft size remains one of the key issues in hybrid thoracic aortic surgery.

Autologous saphenous vein and heparin-bonded expanded polytetrafluoroethylene as graft materials for below-the-knee femoro-popliteal bypass in patients with critical limb ischemia: A propensity score-matched analysis

ObjectiveTo compare the outcomes of heparin bonded expanded polytetrafluoroethylene (HePTFE) and autologous saphenous vein (ASV) in patients undergoing below-knee (BK) femoro-popliteal bypass for critical limb ischemia (CLI). DesignRetrospective single-centre matched case–control study. MethodsFrom 2003 to 2019, 275 consecutive BK bypasses for CLI were performed, 109 with the ASV and 166 with a HePTFE graft. All the baseline characteristics that were reliably measured and were potentially relevant in the decision-making process were included as confounders in a logistic regression model and the factors that were significantly different between the two groups then used to perform a propensity matching analysis. Propensity score-based matching was performed in a 1:1 ratio to compare outcomes. Arterial hypertension, hyperlipemia, the need for tibial anastomosis at the distal level and the run-off status were the covariates included in the matching. Follow-up outcomes were estimated by Kaplan–Meier methods and compared with log rank test. ResultsAfter propensity matching, 101 HePTFE bypasses were matched with 101 ASV bypasses. The median duration of follow-up was 37 months (range 1–192). The 5-year survival rate was 67.5% (standard error (SE) 0.05) in the HePTFe group and 64.5% (SE 0.06) in the ASV group (p = 0.8, log rank 0.04). Primary patency rates were 38% (SE 0.06) in the HePTFE group and 41% (SE 0.06) in the ASV group (p = 0.7, log rank 0.3). Also assisted primary patency and secondary patency rates did not differ in the two groups. Amputation-free survival was 53% (SE 0.05) in the HePTFE group and 58% (SE 0.06) in the ASF group (p = 0.6, log rank 0.2). ConclusionsHePTFE provided 5-year similar results to those obtained with use of the ASV in equivalent patients with CLI undergoing below-knee or tibial bypass.

T2 mapping of the median nerve in patients with carpal tunnel syndrome and healthy volunteers.

We investigated the changes in MRI T2 mapping values in subjects with carpal tunnel syndrome (CTS) compared to healthy controls. We enrolled 71 patients with CTS and 26 healthy controls. Median nerve T2 values were measured at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels. These were compared between patients and controls and correlated with median nerve cross-sectional area (CSA) and nerve conduction measurements. The mean T2 values at the proximal carpal tunnel levels were higher in the CTS group (56.7 ms) than in the control group (51.2 ms, P = .02) and also were higher than at the distal carpal tunnel (51.0 ms, P < .001) and forearm levels (47.6 ms, P < .001). T2 values were not significantly associated with CSA or nerve conduction measurements. T2 mapping of the carpal tunnel provides qualitative information on median nerve pathology but does not reflect CTS severity.

Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: a retrospective clinical study

BackgroundA mismatch between the femoral component and trochlear resection surface is observed in kinematically aligned total knee arthroplasty (KA-TKA) when conventional prostheses are employed. This mismatch is mainly manifested in the undercoverage of the lateral trochlear resection surface. The aim of the present study was to assess the relationship between the mismatch and the alignment parameters of the tibiofemoral joint.MethodsForty-five patients (52 knees) who underwent KA-TKA in our hospital were included. Patient-specific instrumentation was used in 16 patients (16 knees), and conventional instruments with calipers and other special tools were employed in the other 29 patients (36 knees). The widths of the exposed resection bone surface at the middle (MIDexposure) and distal (DISexposure) levels on the lateral trochlea were measured as dependent variables, whereas the hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and transepicondylar axis angle (TEAA) were measured as independent variables. Correlation analysis and subsequent linear regression were conducted among the dependent variables and various alignment parameters of the tibiofemoral joint.ResultsThe incidence of undercoverage of the lateral trochlear resection surface was 86.5 % with MIDexposure and DISexposure values of 2.3 (0–6 mm) and 2.0 (0–5 mm), respectively. The widths of the two levels of exposed bone resection were significantly correlated with mLDFA and HKAA but were not related to TEAA.ConclusionsThe undercoverage of the trochlear resection surface in KA-TKA is mainly correlated with the degree of valgus of the distal femoral joint line. The current study suggests that this correlation should be considered in the development of KA-specific prostheses.

A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis.

This was a multicentric cross-sectional descriptive study. To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity. Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated. A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16). Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb. This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.

Interventions to support autonomy, competence, and relatedness needs in organizations: A systematic review with recommendations for research and practice

Organizational research underpinned by self‐determination theory (SDT) has grown substantially over the past decade. However, the effectiveness of interventions designed to promote support for basic psychological needs in organizations remains ill documented. We thus report the results of a qualitative systematic review and synthesis of SDT‐informed studies of interventions to cultivate autonomy, competence, and relatedness needs, and in turn, autonomous motivation in organizational contexts. Studies were included in the review if they evaluated the effect of interventions to develop autonomy‐, competence‐, or relatedness‐supportive work climates or leader behaviours. A systematic search yielded ten eligible field studies for inclusion: three randomized‐controlled trials and seven non‐randomized intervention studies (combined N = 2,337). Seven studies yielded mostly favourable effects, two yielded mixed effects, and one study showed no evidence of change post‐intervention. Substantial heterogeneity in intervention format and delivery existed across studies. Studies pointed towards possible moderators of effectiveness. Interventions were more effective at spawning change at the proximal (leader) level than at the distal (subordinate) level, though few studies tracked employees over time to comprehensively evaluate long‐term transfer. Bias assessments showed that risk of bias was moderate or high across studies. We discuss overall implications of the review and suggest several recommendations for future intervention research and practice.Practitioner points Interventions to help leaders to support subordinates' basic psychological needs are effective in creating change in leader behaviour. Intervention effects for subordinate outcomes are smaller and may take time to materialize. Interventions tend to be more effective if they are aligned with organizational strategic needs, proactively consider unique work contexts, are endorsed by senior levels of management, and give preference to pedagogy that aligns with basic needs.

Dynamics of proximal and distal transport of sodium in case of bilateral gonadectomy and the efficacy of hormonal replacement therapy

Introduction. The characteristic feature of current trauma in Ukraine and in the world is the prevalence of highly energetic skeletal trauma which is followed by the appearance of combined and multiple injuries with the formation of multiorgan dysfunction and failure. Because of the increase of life duration, the high interest of current traumatology is the investigation process of trauma course in older people. Among them the high interest is given to females in postmenopausal period. The decrease of estrogen level causes very unfavorable ground for the trauma course. However, the influence of severe trauma on changes in proximal and distal transport of sodium in case of hypoestrogenic state is not fully investigated. There is no available data concerning the effectiveness of hormonal replacement therapy in this condition.The goal of the study: is to investigate the influence of cranioskeletal injury on the dynamics of proximal and distal sodium transport in rats with bilateral ovariectomy in the period of late changes of traumatic disease and evaluate the effectiveness of hormonal replacement therapy. Materials and methods. Experiments were performed on 42 non-linear white female rats with the weight of 200-220 g. The model of hypoestrogenic state was performed via surgical removal of the ovaries. 1 month after the gonadectomy in rats skeletal trauma was performed. As a treatment option in one subgroup of rats with gonadectomy and cranioskeletal injury we performed hormonal replacement therapy. The control groups were formed by intact rats and osteoporotic rats 1 month after gonadectomy which were not injured. In control groups and after 1 and 2 months of posttraumatic period we were investigating the functional state of kidneys by performing the water upload method. Afterwards we performed the laboratory checkup of creatinine and sodium levels in serum and urine and additionally calculated the values of proximal and distal sodium transport. Results and its discussion. It was found that the level of proximal and distal sodium transport depends on the estrogen level, the decrease of its secretion leads to the decrease of sodium reabsorption in tubules and the increase in secretion. These changes were more prevalent in proximal tubules. In the course of trauma 1 month after posttraumatic period the value was decreasing in both research groups. However, in rats with gonadectomy the changes were much bigger and stayed at the same level until the 2nd month of the experiment. In rats without gonadectomy these values were achieving the same levels as control group until 2nd month. The use of combined hormonal replacement therapy caused the increase of proximal and distal sodium transport in comparison to the group without receiving treatment. The results that we got though was not achieving the level of rats without gonadectomy, but it showed the perspective for the use of combined hormonal replacement therapy in case of hypoestrogenic state for the decrease of renal dysfunction. Conclusions: Bilateral ovariectomy in female rats after 1 month shows the decrease of proximal and distal sodium levels comparing to rats with preserved gonads. The cranioskeletal injury that happened 1 month after bilateral ovariectomy causes the much bigger decrease of proximal and distal sodium transport comparing to rats with preserved gonads. The use of combined hormonal replacement therapy caused lower changes in proximal and distal sodium transport comparing to rats without this treatment.

Taking the frozen elephant trunk technique to the next level by a stented side branch for a left subclavian artery connection: a feasibility study.

OBJECTIVESOur goal was to develop a modified frozen elephant trunk (FET) prosthesis with a stented left subclavian artery (LSA) side branch for LSA connection and to perform preclinical testing in a human cadaver model. METHODSWe measured aortic diameters, distance between and diameters of supra-aortic vessels and the distance from the LSA offspring to the level of the left vertebral artery offspring in 70 patients. Based on these measurements, a novel FET prosthesis was developed (Cryolife/Jotec, Hechingen, Germany) featuring a stented side branch for an intrathoracic LSA connection. The feasibility and ease of implantation were tested in 2 human cadaver models at the Anatomical Institute of the Medical University Graz. A covered stent graft (Advanta V12™ by Atrium Medical Corp., Hudson, NH, USA) was used for an LSA extension.RESULTSAccurate deployment of the novel FET prosthesis with anatomical orientation of the stented side branch towards the LSA ostium followed by consecutive stent graft deployment was feasible in both cases. Proximalizing the distal anastomosis level from zone 3 to zone 1 not only diminished the complexity of the procedure but substantially facilitated the completion of the distal anastomosis. A 2.5-cm long extension stent graft was sufficient to seal to the LSA and to maintain left vertebral artery patency in both cases.CONCLUSIONSThis initial study in human anatomical bodies could demonstrate the feasibility of implanting a newly designed FET prosthesis. This evolution of the FET technique has the potential to substantially ease total aortic arch replacement by proximalization of the distal anastomosis into zone 1 and by shortening spinal and lower body hypothermic circulatory arrest times via a stented side branch to the LSA. This direct connection enables early restoration of systemic perfusion.

How old is old for implant therapy in terms of implant survival and marginal bone levels after 5-11 years?

AimTo evaluate implant survival and marginal bone levels (MBLevel) at least 5 years after implant installation in patients ≥65 years old.MethodsPatient records were screened retrospectively for the following inclusion criteria: (1) ≥65 years of age at the time of implant installation, and (2) ≥5‐year radiographic follow‐up or registered implant loss. Association between patient‐ and implant‐related data with radiographically assessed data [i.e. implant survival, mean MBLevel (i.e. average of mesial and distal level) and maximum marginal bone loss (i.e. either mesial or distal loss; maximum MBLoss)] were statistically evaluated by mixed effects multi‐level regression models.ResultsTwo‐hundred‐eighteen implants in 74 patients were included with a mean follow‐up of 6.2 years (range: 5 to 10.7 years); four early and six late implant losses have been registered (implant survival rate: 95.4%). Mean MBLevel and maximum MBLoss was 1.24 ± 0.9 mm and 1.48 ± 1.0 mm, respectively. Maximum MBLoss < 2 mm, 2 to 5 mm and ≥5 mm was found in 70.7, 28.8 and 0.5% of the implants, respectively. For both, mean MBLevel and maximum MBLoss, age presented a slightly protective effect (mean MBLevel: Coef. −0.041, p = .016; maximum MBLoss: Coef. −0.045, p = .014).ConclusionThe high implant survival rate (95.4%), low mean MBLevel (1.24 mm) and low frequency of maximum MBLoss ≥ 5 mm (0.5%) observed herein after 5 to 11 years follow‐up suggest that older age should not be considered as a limiting factor for implant treatment.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.

PROTOCOL: Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low- and middle-income countries.