Evidence-based Research Articles

Determinants of failure to progress within 2 weeks of delivery: results of a multivariable analysis approach

ObjectiveThe incidence of cesarean section (CS) for failure to progress (FP) has progressively increased; thus, knowing the factors that increase this incidence has become of crucial importance. This study aimed to find the true determinants of CS for FP within 2 weeks of delivery, proposing strategies to reduce its incidence. Material and MethodsA group of 957 term and late preterm (≥34 weeks) singleton pregnancies with a complete gestational follow-up and an ultrasound examination within 2 weeks of delivery were included in a retrospective observational study. Epidemiological, sonographic, and perinatal data were recorded, and multivariable logistic regression analyses were applied to create models to predict the importance of different variables in the explanation of FP. ResultsInduction of labor was by far the most important modifiable factor, followed by smoking and maternal weight, while parity was the most important nonmodifiable factor, followed by maternal age and estimated fetal weight. The difference in days from the actual due date exerted no influence. ConclusionsTo reduce the incidence of CS for FP, inductions of labor should be performed only under evidence-based medicine indications and kept to a minimum. In addition, maternal overweight reduction and maternal smoking cessation should be promoted before the initiation of gestation.

Comparison of Aesthetic Results of Mercedes-Y Versus Inverted-V Incision for Umbilical Reconstruction: A Randomized Clinical Trial.

The appearance and position of navel which are considered as a marker for overall abdominal aesthetics, are important for the final results of abdominal surgeries. However, reconstructing and improving its appearance have been a challenge in plastic surgery. In this study, we aimed to compare satisfaction of the patients and the plastic surgery professors with the aesthetic results of the two methods of umbilical reconstruction: Mercedes (Y) incision versus inverted-V incision. This is a randomized clinical trial performed on umbilicoplasty patients following abdominoplasty, breast reconstruction, or abdominal flap surgery whom referred to our center. They were divided into two equal groups of twenty patients with Mercedes (Y) incision and patients with inverted-V incision. The results of surgery were compared three months after the surgery by the opinions of patients, plastic surgery professors, and unbiased observers. The average scores of patients, professors, and observers showed that Mercedes (Y) had significantly higher scores compared to inverted-V incision in terms of position, size, shape, natural appearance, and the overall satisfaction. Surgical complications including stenosis, necrosis, and wound dehiscence were not statistically different in our small sample size. In this study, Mercedes (Y) incision was preferred by all of the groups in all five parameters that were assessed including size, shape, position, natural appearance, and overall satisfaction. The simplicity of the Y incision with less visible scar makes it a suitable method for further investigations with a larger sample size. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful in preventing acute complications? A systematic review

BackgroundDiabetic ketoacidosis (DKA) is a life-threatening emergency that can result from delayed diagnosis of type 1 diabetes mellitus (T1DM). Three-quarters of Australian children with a new diagnosis of T1DM visit...

Group-Delivered Trauma-Focused CBT Integrating Racial Socialization: A Multiple Case Study

In addition to disparities in interpersonal trauma exposures, Black youth in the U.S. experience the compounding stress of racial trauma, both of which are associated with a disproportionate mental health burden. Black youth also face barriers to engaging with trauma-specific therapies to address trauma-related mental health problems, with research suggesting that they are less likely to complete trauma-specific treatment. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based therapy for trauma-related mental health problems in youth ages 3 to 18. Metzger and colleagues (2021) proposed a set of cultural considerations for Black families to address racial stressors and enhance engagement in TF-CBT. The aim of the current multiple case study was to demonstrate the utility of group-delivered TF-CBT integrating these considerations for a single telehealth group of Black adolescents and their caregivers. We describe the intervention, patient engagement and clinical outcomes, and feedback from families regarding their experience with the group model. We also outline clinical and implementation challenges and highlight directions for future research and clinical practice.

The role of single case experimental designs in evidence creation in rehabilitation.

Randomized controlled trials (RCTs) are considered the gold standard of evidence guiding intervention selection in rehabilitation. However, conduct of sufficiently powered RCTs in rehabilitation can be expensive, pose ethical and attrition concerns when participants are assigned to ineffective treatment as usual conditions, and are infeasible with low-incidence populations. Single-case experimental designs (SCEDs), including N-of-1 RCTs are causal inference studies for small numbers of participants and not necessarily one participant as the name implies. These designs are increasingly used to evaluate the effectiveness of rehabilitation interventions in diverse clinical settings and employ design features including but not limited to randomization and each participant serving as their own control. These and other internal validity enhancements can increase the confidence in study results coming from these designs. This manuscript discusses the expanded application of SCEDs in rehabilitation contexts to answer everyday clinical rehabilitation research questions with emphasis on strategies to use: 1) to maximize internal validity of this family of designs; 2) improve utility, effectiveness, and acceptability of these designs for rehabilitation end-users (clinicians, policymakers, and participants); 3) build evidence bases in areas of rehabilitation where RCTs are uncommonly used. Primary considerations for situating SCEDs within the continuum of experimental designs include increasing internal validity within designs, improving transparency in conduct and reporting of these studies, and increasing access to advanced research methods training for rehabilitation professionals.

Administration sequences in single-day chemotherapy regimens for breast cancer: a comprehensive review from a practical perspective.

Breast cancer is one of the most prevalent malignant tumors globally, posing a severe threat to human life and health. Chemotherapy, a cornerstone in the treatment of breast cancer, often overlooks the sequence of drug administration within single-day regimens. This study aims to explore the impact of drug administration order on the efficacy and toxicity of combination chemotherapy protocols for breast cancer. Through a comprehensive review and analysis based on current evidence from evidence-based medicine, we delved into how the order of drug administration affects both efficacy and toxicity. We systematically classified and analyzed commonly used combination drug regimens, providing graded recommendations and a reasoned analysis to offer valuable references for clinical decision-making. Our findings indicate that the sequence of drug administration in complex combination chemotherapy protocols is not arbitrary but necessitates multifaceted considerations. Rational drug sequencing can maximize synergistic effects between drugs, thereby augmenting therapeutic efficacy while effectively mitigating drug-related adverse effects. Additionally, some drug labels and clinical trials have explicitly highlighted the therapeutic benefits of specific drug sequences. This study underscores the importance of considering the sequence of drug administration in clinical practice. It is recommended to prioritize the sequential drug administration according to official drug product labeling, while also considering factors such as the administration sequence from large randomized controlled trials, cell proliferation kinetics specific to cancer types, drug interactions, chronopharmacology, drug irritability, clinical experiences, and patient preferences. By taking these factors into account, the goal is to maximize treatment efficacy and minimize the occurrence of adverse reactions.

Explanatory argument extraction of correct answers in resident medical exams

Developing technology to assist medical experts in their everyday decision-making is currently a hot topic in the field of Artificial Intelligence (AI). This is specially true within the framework of Evidence-Based Medicine (EBM), where the aim is to facilitate the extraction of relevant information using natural language as a tool for mediating in human–AI interaction. In this context, AI techniques can be beneficial in finding arguments for past decisions in evolution notes or patient journeys, especially when different doctors are involved in a patient’s care. In those documents the decision-making process towards treating the patient is reported. Thus, applying Natural Language Processing (NLP) techniques has the potential to assist doctors in extracting arguments for a more comprehensive understanding of the decisions made. This work focuses on the explanatory argument identification step by setting up the task in a Question Answering (QA) scenario in which clinicians ask questions to the AI model to assist them in identifying those arguments. In order to explore the capabilities of current AI-based language models, we present a new dataset which, unlike previous work: (i) includes not only explanatory arguments for the correct hypothesis, but also arguments to reason on the incorrectness of other hypotheses; (ii) the explanations are written originally in Spanish by doctors to reason over cases from the Spanish Residency Medical Exams. Furthermore, this new benchmark allows us to set up a novel extractive task by identifying the explanation written by medical doctors that supports the correct answer within an argumentative text. An additional benefit of our approach lies in its ability to evaluate the extractive performance of language models using automatic metrics, which in the Antidote CasiMedicos dataset corresponds to a 74.47 F1 score. Comprehensive experimentation shows that our novel dataset and approach is an effective technique to help practitioners in identifying relevant evidence-based explanations for medical questions.

Development of a Standardized Photo Guideline for Online Hair Transplantation Consultation.

Telemedicine has rapidly advanced in plastic and aesthetic surgery, but obtaining high-quality images during online hair transplantation consultations remains challenging, impeding doctors' visual evaluation. To investigate patients' attitude and satisfaction with online hair transplantation consultations, and to develop a standardized photo guideline to help patients capture high-quality images. We surveyed patients' attitudes and satisfaction with online hair transplantation consultations from November 23, 2023 to May 3, 2024. Meanwhile, five surgeons developed a standardized photo guideline and assessed its effectiveness by comparing image quality between two patient groups: those using the photo guideline and those not using it. We collected 570 responses to the attitude questionnaire, with 76.66% of participants expressing a willingness to undergo online hair transplantation consultations. The patient satisfaction survey yielded an overall satisfaction score of 4.44 ± 0.72 out of 5 for online hair transplantation consultations. Furthermore, all five surgeons rated photographs taken by patients following the photo guideline as higher quality compared to those taken by patients who did not use it. Patients show high satisfaction with online hair transplantation consultations. The standardized photo guideline proves effective in helping patients take high-quality photographs for online consultations. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Vasyl Yakovych Danylevskyi's lecture on health and illness (1921): annotated translation

Academician Vasyl Yakovych Danylevskyi is a world-renowned scientist, doctor, biologist, writer, teacher, author of introductory lectures for students of the medical faculty, published in 1921 in the book "The Doctor, His Vocation and Education". The article presents the second, abbreviated and annotated, lecture of Danylevsky V.Ya., dedicated to understanding the human body's ability to resist diseases, recover losses, and replenish resources. The author describes the mechanisms of morphological and physiological balance, defines the formula of human happiness (as a combination of purity of soul, enlightenment of the mind and health of the body). The lecture provides answers to the questions of what health is and whether a healthy person needs a doctor; what is a disease, and can health be restored without resorting to medicine; what role does society and the environment play in the full life of a person. In the lecture, special attention was paid to the actions and inactions of the doctor in combating the disease. It is important to advise the doctor about the purposeful use of his energies, caution against wasting these energies on secondary things unrelated to treatment, prevention and self-improvement. The author emphasizes the important role of the doctor in establishing all aspects of people's lives: lifestyle, nutrition, work and rest, hygiene (housing, clothing, personal), choice of profession, education and upbringing. The disease is considered by the author from the unexpected perspective of the natural mechanism "to remove the disease-causing substance from a person in order to preserve his life". The capacity for recovery and self-repair is described for both physical and mental health. The meaning of recovery is not only getting rid of the disease and replenishing resources, but also the return of a person to social life. The work of doctor Danylevskyi V.Ya. compares with the art of the best one’s representatives of all eras. And he considers the use of drugs permissible only if there is evidence of their reliability. Lecture by Danylevskyi V.Ya. about health and disease demonstrates the author's deep understanding of issues that have become the basis of modern evidence-based medicine, bioethics and pedagogy. Keywords: compensatory mechanisms, sanogenesis, history of medicine.

Evaluating the Role of Rectus Abdominis Fat Transfer (RAFT) in Improving Muscle Thickness: Does it Really Work? A 12-Month Follow-Up Cohort Study.

Looking for an adequate solution for those patients who desire abdominal definition, but are not candidates for liposuction alone, Danilla developed a technique, using selective fat grafting into the rectus abdominis (RAFT) to increase the muscle volume in addition to selective liposuction and abdominoplasty to provide an optimal body contouring. To determine whether intramuscular fat grafting in the rectus abdominis muscles leads to an increase in muscle thickness after one year. This is a prospective cohort study, from a single center, carried out over 24 months (October 2021-September 2023). Sixty-two patients who underwent lipoabdominoplasty and RAFT, had their rectus abdominis cross section measured by ultrasound pre- and 12 months postoperatively. To compare the muscle thickness, a paired t-test statistic was used. A p-value of 0.05 was considered statistically significant (IBM SPSS Statistics V26). After 1 year, all 62 patients showed an increase in the size of the rectus muscle cross section, although only 58 (94%) had fat identifiable in the US. Preoperatively, the mean muscle cross-sectional size was 1, 4cm. After RAFT, overall mean muscle cross section was 2, 3cm (0, 9cm/66.9% increase). When stratified into groups with and without identifiable fat, the group in which the graft remained showed greater increase than the group with no visible fat (69, 9% vs 19,6%). The RAFT provided a significant increase in the muscle cross section in most cases after 1 year. The presence of fat is related to a statistically significant increase in the muscle compartment (pack). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

UNEQUAL AGING: DISPARITIES IN GERIATRIC RESEARCH AND A CALL FOR UNIFIED ACTION

An increase in aging population poses significant challenges which are more pronounced in low- and lower middleincome countries. This editorial explores the multifaceted challenges in geriatric research such as demographic disparities, methodological complexities, ethical concern, challenges in data analysis and underrepresentation in studies with a focus on autoimmune and rheumatic diseases. To effectively address the challenges, a concerted multinational research consortia for the development of universally applicable care model is critical. Methodological advancements, increased funding at individual and institutional levels, and implementation of evidence-based healthcare policy will help in ensuring that the aged worldwide receive comprehensive care.

Managing the unmanageable: evidence-driven approaches to real-world patient prototypes of TP53-mutant myelodysplastic neoplasms and acute myeloid leukemia.

Patients with TP53 aberrations comprise the highest risk subset of all myeloid malignancies. The managerial conundrum of TP53-mutant myelodysplastic neoplasms (MDS) and acute myeloid leukemia (AML) stems from refractoriness to or relapse after conventional chemotherapy, as well as the limited translational success of investigational therapies targeting TP53-mutant cells. Thus far, no targeted therapies have been commercially approved for this mutational subset. As a result, management plans for patients with TP53-mutant MDS and AML are often driven by clinical judgment and/or physician preference rather than consensus guidelines backed by a rigorous evidence basis. This clinical case-based, evidence-driven review highlights the most salient data that guides the management of commonly encountered patient prototypes. This review discusses the therapeutic menu of first-line options that derive from multi-institutional experiences as well as from disease-centric consortia and discusses how these first-line options can be optimally tailored to heterogeneous groups of patients. The debate regarding whether allogeneic stem cell transplant should be offered to these patients is summarized. Finally, this review explores the recent unfortunate news of pauses in clinical trials for the leading investigational agents - eprenetapopt, magrolimab, sabatolimab, and idasanutlin - and offers solutions toward re-invigorating the pipeline of precision therapeutics in 2025.

Dry Liposculpture of the Calves and Ankles-A Novel Technique for Sculpting the Lower Legs.

Liposuction of the calves and ankles was historically described as a "taboo" procedure and linked with higher postoperative pain and unpleasing aesthetic results. This study presents a Novel technique for dry liposculpture of the calves and ankles using a tourniquet, as a safe and less painful procedure, which achieves better aesthetic results. This single surgeon, retrospective study included 70 women who underwent surgery based on the technique described. Details regarding the surgical outcomes and pain levels were collected, and patients completed 2 years of follow-up. A mean of 1395 cc fat was aspirated from both legs, combined, and the mean duration of surgery was 98 minutes. No major complications were observed, and postoperative pain levels were low. Pre- and post-surgery pictures were evaluated by 8 certified senior plastic surgeons for aesthetic results. The findings suggest that dry liposculpture is suitable for reshaping the calves and ankles. This technique is safe, with precise and satisfactory aesthetic results, low levels of postoperative pain, and may take less time to perform than wet liposuction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Development of a Simulation Educational Programme Within the Department of Stroke Medicine

Abstract Background Simulation has been commonly utilised in medical education as both a learning and assessment tool. Its utilisation in stroke medicine helps to facilitate learning in acute pathways, interprofessional communication, communication with family and patient and the application of evidence-based care. Methods The programme was initially developed as part of a pilot with University College Cork. The “FAST Call” scenario was seen as an opportunity to test the acute pathway. A simulation coordinator led out on the technical facilitation of simulation. Scenarios were developed to enable education in different facets of stroke. Key learning areas identified were: Quarterly feedback from all medical trainees in the department allowed qualitative assessment of the programme. Results Trainee feedback yielded positive results with all NCHDs reporting they found the programme beneficial from a clinical skills perspective. It improved confidence in dealing with acute stroke calls and provided a psychologically safe learning environment. The feedback also identified potential barriers and delays in the stroke pathway and allowed the utilisation of simulation as an educational opportunity. Conclusion The simulation programme has provided trainees within a stroke department with a psychologically safe learning environment. This has allowed the department to identify areas of physical or technical constraint when delivering care to stroke patients. The department has also gained the opportunity to discuss evidence-based medicine in a non-didactic format, along with providing NCHDs with the opportunity to manage scenarios in a safe manner. Simulation programmes and inclusion of this style of training as a core-component of training can be spread to other components of the geriatric medicine curriculum.

Advancing Reduction Mammaplasty Surgery: Advancements and Outcomes with Tumescent Local Anaesthesia.

Tumescent local anaesthesia (TLA) is a method of anaesthesia used for surgical procedures that involves the infusion of a saline solution containing lidocaine, sodium bicarbonate, and epinephrine. This anaesthetic technique is designed to achieve both vasoconstriction and anaesthesia. In this article, we present a modified TLA protocol specifically adapted for reduction mammaplasty, based on an analysis of clinical case histories collected over the past few years. During the period from 2012 to 2022, we performed a reduction mammaplasty procedure in 120 patients employing tumescent local anaesthesia (TLA). The composition of the tumescent solution included 25mL of 2% lidocaine, 8mEq of sodium bicarbonate, and 1mL of epinephrine (1mg/1mL) in 1000mL of 0.9% saline solution. The solution was injected diffusely throughout the mammary gland. The average volume of tumescent solution infiltrated during TLA was 350mL per breast. There were no cases of adrenaline or lidocaine toxicity, and no patients required conversion to general anaesthesia. No patient received sedation. Patients reported no pain or discomfort during pre-operative infiltration or during surgery. No reinterventions were necessary because of short-term complications. Among the complications, there were 4 cases of hematoma (3,3%), 3 cases of seroma (2,55%), 10 cases of wound dehiscence (8,3%), 5 cases of asymmetry (4,1%), 9 cases of T-junction breakdown (7,5%), 2 cases of (partial) nipple necrosis (1,6%), and 3 cases of liponecrosis (2,5%). No cases of infection or total nipple-areola loss were reported. The follow-up period was between 30 days and 1year. Reduction mammaplasty is a viable surgical option for women with macromastia seeking to enhance their physiognomy. It is imperative that patients fully understand the potential benefits and risks associated with the procedure and consult with healthcare professionals specialising in this field. The use of tumescent local anaesthesia (TLA) has been confirmed as a safe and effective methodology to perform reduction mammaplasty, ensuring adequate pain control with minimal post-operative complications and resulting in a high degree of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Novel Laboratory-Based Strategy for Single Adipocyte and Adipose-Derived Stem Cells Extraction for Transplantation: An Experimental Research.

Autologous fat grafting is widely used in plastic surgery. However, its main limitation is the low survival rate of fat grafts after transplantation. Transplantation of single adipocytes in combination with adipose-derived stem cells (ADSCs) could largely preserve the activity of the fat and improve graft survival. To verify the long-term survival rate of single adipocyte graft in vivo and its viable fat morphology for future fat grafting. Healthy adipose tissue was harvested and disassociated using fat dissociation solution, the Single-cell Suspension Preparation System (SSPS) was used to obtain a mixture of single adipocytes, ADSCs and stromal vascular fraction (SVF), and the structure of single adipocytes was verified by cell mask red and DAPI double staining. Nine male Balb/c nude mice were used, and three different graft volumes were established (0.05, 0.1 and 0.2ml). For each mouse, four sites were selected for transplantation, one for macrofat and the other three for single adipocytes, and different transplant volumes 30, 60 and 90days after transplantation. In each period, 3mice were selected to measure the volume of fat graft. Double staining with cell mask red and DAPI confirmed that the nucleus was identified intracellularly, which also indicated that the adipocytes in the single-cell suspension were structurally complete. When evaluating the transplantation, the groups with a volume of 0.05 ml and 0.2ml performed better in the single-cell fat group in all transplantation periods, the group with a volume of 0.1ml performed better in the single-cell group in the 30- and 60-day transplantation, and the differences were significant (P<0.05). In this study, the SSPS was used to obtain a new transplant material containing single adipocytes and ADSCs by enzymatic hydrolysis of adipose tissue and converted into single cells. It effectively improved the survival rate of fat grafting and the long-term effect of transplantation. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy and safety of dexamethasone sparing for the prevention of nausea and vomiting associated with highly emetogenic risk antineoplastic agents: a systematic review and meta-analysis of the Clinical Practice Guidelines for Antiemesis 2023 from the Japan Society of Clinical Oncology.

Chemotherapy-induced nausea and vomiting (CINV) are common side effects, classified according to timing and severity. Conventional agents such as dexamethasone are effective but have various side effects. For moderately emetogenic chemotherapy, dexamethasone-sparing antiemetic therapies have been developed to minimize these side effects. This systematic review evaluated the efficacy and safety of dexamethasone-sparing antiemetic therapy for highly emetogenic chemotherapy (HEC). We performed a thorough literature search for studies related to dexamethasone-sparing antiemetic therapy with neurokinin-1 antagonists (NK1RA) for HEC using the PubMed, Cochrane Library, and Ichushi-Web databases. A qualitative analysis of the combined data was performed and risk differences with confidence intervals were calculated. Two reviewers independently assessed the 425 records and 12 full-text articles were evaluated for eligibility. Two studies were included in the qualitative and meta-analyses. These studies included anthracycline-cyclophosphamide (AC) regimens and cisplatin-based regimens, with palonosetron as the serotonin receptor antagonist. In the two studies, no difference was found in the prevention of vomiting (delayed complete response). However, non-inferiority was not demonstrated in the subgroup that received cisplatin-containing regimens. Delayed complete control showed different results for nausea prevention; however, there was no significant difference in the meta-analysis. Only one report has shown non-inferiority for delayed total control. Although the strength of evidence for individual outcomes varied, there was no difference in the duration of dexamethasone administration. This systematic review and meta-analysis revealed that dexamethasone-sparing antiemetic therapy with NK1RA and palonosetron can be used to prevent CINV in HEC, limited to AC combination therapy.

Breast Cancer-Related Chemical Exposures in Firefighters.

To fill a research gap on firefighter exposures and breast cancer risk, and guide exposure reduction, we aimed to identify firefighter occupational exposures linked to breast cancer. We conducted a systematic search and review to identify firefighter chemical exposures and then identified the subset that was associated with breast cancer. To do this, we compared the firefighter exposures with chemicals that have been shown to increase breast cancer risk in epidemiological studies or increase mammary gland tumors in experimental toxicology studies. For each exposure, we assigned a strength of evidence for the association with firefighter occupation and for the association with breast cancer risk. We identified twelve chemicals or chemical groups that were both linked to breast cancer and were firefighter occupational exposures, including polycyclic aromatic hydrocarbons, volatile aromatics, per- and polyfluoroalkyl substances, persistent organohalogens, and halogenated organophosphate flame retardants. Many of these were found at elevated levels in firefighting environments and were statistically significantly higher in firefighters after firefighting or when compared to the general population. Common exposure sources included combustion byproducts, diesel fuel and exhaust, firefighting foams, and flame retardants. Our findings highlight breast-cancer-related chemical exposures in the firefighting profession to guide equitable worker's compensation policies and exposure reduction.

Enhanced Transconjunctival Lower Blepharoplasty: A Novel Method for Intraorbital Fat Transposition and Stabilization.

The evolution of lower blepharoplasty has shifted from simply removing of orbital septum fat to smoothing of the lid-cheek junction through fat repositioning. This paper adopts a novel technique to transpose and stabilize intraorbital fat during transconjunctival lower blepharoplasty. The tear trough and nasal alar base were filled to correct the pouch while ensuring the blood supply of the fat flap. Between September 2019 and June 2022, 104 patients aged between 22 and 49 who underwent bilateral fat flap transposition-nasal alar base filling lower blepharoplasty were selected. The surgical results were assessed by non-operative plastic surgeons according to the Hirmand grading system. Moreover, a self-satisfaction survey was conducted and patients were followed up for at least 6months to evaluate any complications and surgical outcomes. A high-frequency ultrasound imaging system was used to assess the degree of filling of the tear trough and nasal alar base. All 104 patients were followed up for at least 6months. The postoperative Hirmand grade was 0 for 96 out of 104 (92.3%) patients. In terms of self-satisfaction assessment, there were 92 out of 104 (88.5%) patients reported satisfaction. Dermatologic ultrasound showed no obvious gaps 6months after surgery. Transconjunctival fat flap transposition combined with nasal alar base filling during lower blepharoplasty has been shown to have a positive postoperative effect and high patient satisfaction. This procedure can preserve the blood supply of the fat flap, reduce the rates of fat absorption and denaturation, and improve facial contour, resulting in a satisfactory repairing effect. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diagnostic value of serum human epididymal secretory protein 4 for endometrial cancer: a systematic review and meta analysis

ObjectiveThe diagnostic value of serum human epididymal secretory protein 4 (HE4) for endometrial cancer (EC) was assessed via evidence-based medicine (EBM) and systematic review (SR) methodologies.MethodsThe Cochrane Library, PubMed, Web of Science, Embase, CBM, CNKI, and Wan Fang databases were searched up to April 1st, 2024, to identify relevant literature. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was utilized to evaluate the quality of the selected studies. The meta-analysis was conducted via RevMan 5.3, STATA 16.1, and Meta-disc software.ResultsA total of 22 studies comprising 9036 cases (3776 cases in the case group and 5260 cases in the control group) were included. The results revealed that HE4 exhibited a pooled sensitivity of 0.59 [95% CI (0.53, 0.64)], specificity of 0.93 [95% CI (0.88, 0.96)], positive likelihood ratio (PLR) of 6.87 [95% CI (4.57, 10.33)], negative likelihood ratio (NLR) of 0.46 [95% CI (0.39, 0.54)], diagnostic odds ratio (DOR) of 14.36 [95% CI (9.37, 21.17)], and area under the receiver operating characteristic curve (AUC) of 0.78 [95% CI (0.75, 0.82)].ConclusionsSerum HE4 demonstrates high specificity and moderate sensitivity for diagnosing EC, thus serving as a valuable biomarker for clinicians either alone or in conjunction with other tumour markers.