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Journal of Obstetrics and Gynaecology... Apr 2016Surgical ovarian wedge resection was the first established treatment for women with anovulatory polycystic ovary syndrome (PCOS) but was largely abandoned both due to...
Surgical ovarian wedge resection was the first established treatment for women with anovulatory polycystic ovary syndrome (PCOS) but was largely abandoned both due to the risk of postsurgical adhesions and the introduction of medical ovulation induction. Laparoscopic ovarian drilling (LOD) is an alternative method to induce ovulation in PCOS patients with clomiphene citrate resistance instead of gonadotropins. Surgical therapy with LOD may avoid or reduce the need for gonadotropins or may facilitate their use. However, the procedure, though effective, can be traumatic on the ovaries, which may cause postoperative adhesions and/or diminished ovarian reserve. In over-enthusiastic hands, this day-care procedure might lead to iatrogenic premature ovarian failure in young women. Some trials have compared LOD with gonadotropins, but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies. Today, evidence-based reviews conclude that there is no evidence of a significant difference in rates of clinical pregnancy, live birth or miscarriage in women with clomiphene-resistant PCOS undergoing LOD compared to other medical treatments. The reduction in multiple pregnancy rates in women undergoing LOD is the only pro-LOD argument. However, there are ongoing serious concerns about the long-term effects of LOD on ovarian function.
PubMed: 27046958
DOI: 10.1007/s13224-015-0799-1 -
Orthopaedics & Traumatology, Surgery &... Feb 2017Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament... (Review)
Review
Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament reconstruction stabilizes the joint. Exhaustive preoperative clinical and paraclinical work-up is essential. The present article classifies, presents and criticizes the main techniques in terms of long-term stabilization and reduction of osteoarthritis risk. Anatomic ligament repair with reinforcement (mainly extensor retinaculum) or anatomic ligament reconstruction are the two recommended options. Non-anatomic reconstructions using the peroneus brevis should be abandoned. Arthroscopy is increasingly being developed, but results need assessment on longer follow-up than presently available. Postoperative neuromuscular reprogramming is fundamental to optimal recovery. Finally, the concept of complex ankle instability is discussed from the diagnostic and therapeutic points of view. The various forms of ligament reconstruction failure and corresponding treatments are reported.
Topics: Ankle Injuries; Arthroscopy; Decision Support Techniques; Humans; Joint Instability; Lateral Ligament, Ankle; Plastic Surgery Procedures
PubMed: 27871968
DOI: 10.1016/j.otsr.2016.06.026 -
Animals : An Open Access Journal From... Feb 2024The historical relationship between humans and dogs has involved selective breeding for various purposes, such as hunting, guarding, and service roles. However, over... (Review)
Review
The historical relationship between humans and dogs has involved selective breeding for various purposes, such as hunting, guarding, and service roles. However, over time, there has been a shift in preferences from functionality to aesthetics, which has influenced the diverse sizes, shapes, and coats of dog breeds. This review looks at fashionable dog breeding and questions the ethics of prioritising looks over health and behaviour. It aims to alert potential owners, breeders, and regulators to the importance of considering a dog's overall well-being, not just its appearance, which has resulted in fad breeding, leading to genetic disorders, health issues, and a loss of biodiversity. Ethical concerns arise from breeding brachycephalic breeds with respiratory conditions, inbreeding causing inherited disorders, and overbreeding popular breeds while shelter dogs remain unadopted. Additionally, the impact of cosmetic surgeries on popular dog breeds, as well as the neglect of behavioural traits in favour of physical characteristics and strict breeding practices are also considered. The current breeding model can have a negative impact on the emotional and cognitive well-being of dogs, resulting in issues such as aggression, anxiety, and other behavioural problems that can significantly reduce their overall quality of life. Unregulated breeding practices and the demand for rare breeds can lead to illegal breeding, compromising animal welfare. Prospective owners, veterinarians, kennel clubs, and legislators all need to play a responsible role in protecting animals.
PubMed: 38473141
DOI: 10.3390/ani14050756 -
Frontiers in Research Metrics and... 2023Patent protection typically lasts about 20 years from the filing date and is in exchange for sufficiently disclosing the invention. The disclosure aims to enrich... (Review)
Review
Patent protection typically lasts about 20 years from the filing date and is in exchange for sufficiently disclosing the invention. The disclosure aims to enrich technical knowledge globally, promote creativity and technological innovation and contribute to sustainable socio-economic development. After this protection period, the patent expires, and in principle, any person may begin practicing the specific subject matter previously protected by the patent. Since the invention originally met all the patentability requirements, it was disclosed sufficiently to stimulate further innovation by others through a thorough understanding of existing developments in the patent literature. Thus, in addition to scholarly research articles, this makes patents potentially valuable sources of technical information in research and academia, unlocking new technology opportunities. We use the exploratory research method to study a potentially genuine and vital research stream that uncovers the overlooked yet valuable scientific and technical information sources that higher education institutions could utilize to complement academic research articles. This work establishes a necessary research agenda that critically challenges researchers to tap into the immediately available and promising technology opportunities presented by patents in the public domain. Using case studies to gain in-depth, multi-faceted explorations about the impact of these patents, we find that technologies contained in expired patents, abandoned patents, and technologies not protected by IPRs, resulting in improved research quality and increased collaboration with industry, if adequately exploited and integrated with other technologies. Moreover, this could lead to increased academic patenting and commercialization with support from the university's Technology Transfer Office.
PubMed: 37008286
DOI: 10.3389/frma.2023.1115457 -
Journal of Arrhythmia Apr 2022Along with the incremental cases of cardiac implantable electronic devices implantation or upgrade, the lead-related complications are also in rise year after year. The...
Along with the incremental cases of cardiac implantable electronic devices implantation or upgrade, the lead-related complications are also in rise year after year. The most common and serious lead-related complication is infection that needs a transvenous lead extraction (TLE) as the first-line therapy. TLE is also performed for abandoned leads in case of lead failure or device upgrade, and for lead-related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty of radiation therapy. This registration has been performed by the Japanese Heart Rhythm Society and started in July 2018. The first reported data of the Japanese Lead Extraction (J-LEX) from July 2018 to December 2019 were underestimated since the number of patients and hospitals increased gradually because of the approval process of each hospital's IRB. The TLE procedure was attempted to 1253 leads among 661 patients. Complete removal was achieved in 96.7% of the target leads and the clinical success was obtained in 98.9% of the patients. Perioperative complications were observed in 4.1% of the patients. The annual J-LEX report reflects a real-world TLE medicine in Japan and demonstrates that the clinical outcome is similar to former reports from high-volume centers in North America and European countries.
PubMed: 35387141
DOI: 10.1002/joa3.12678 -
Netherlands Heart Journal : Monthly... Sep 2023The introduction of dedicated tools for pacing and defibrillator lead extraction has resulted in relatively high success and low complication rates. The confidence this... (Review)
Review
The introduction of dedicated tools for pacing and defibrillator lead extraction has resulted in relatively high success and low complication rates. The confidence this elicits has broadened the indications from device infections to non-functional or redundant leads and the latter make up an increasing share of extraction procedures. Proponents of extracting these leads point to the higher complication burden of lead extraction in patients with longstanding abandoned leads when compared one-to-one with extraction when these leads become redundant. However, this does not translate into better patient outcomes on a population level: complications are rare with properly abandoned leads and thus most patients will never be subjected to an extraction procedure and the ensuing complications. Therefore, not extracting redundant leads minimises the risk for the patients and avoids many expensive procedures.
PubMed: 37010738
DOI: 10.1007/s12471-023-01770-7 -
BMJ Case Reports Mar 2022Laryngoceles are rare dilated laryngeal saccules that can present as acute airway obstruction and lead to airway emergencies. A man, presented to the emergency room,...
Laryngoceles are rare dilated laryngeal saccules that can present as acute airway obstruction and lead to airway emergencies. A man, presented to the emergency room, with difficulty in breathing and change in voice. An unevaluated pulsatile swelling was present on the left side of neck. Since, the patient was in stridor, an awake fiberoptic bronchoscopy (FOB)-guided intubation was planned with readiness for emergency tracheostomy, if needed. On FOB, an edematous supraglottic area with a narrowed glottic opening was observed. The procedure was abandoned and a surgical tracheostomy was performed to secure the airway. Postoperative contrast-enhanced CT neck revealed a huge laryngocele in left cervical region. We recommend that a high index of suspicion for presence of laryngocele should be kept in mind when a patient presents with stridor with pulsatile neck swelling. Timely aspiration of laryngocele may help in amelioration of the respiratory distress avoiding emergency tracheostomy.
Topics: Airway Obstruction; Dilatation, Pathologic; Humans; Laryngocele; Larynx; Male; Tomography, X-Ray Computed
PubMed: 35272990
DOI: 10.1136/bcr-2021-248126 -
Anales de Pediatria Sep 2021Prenatal alcohol exposure is the leading preventable cause of cognitive deficit in developed countries and can lead to fetal alcohol spectrum disorder (FASD). This term... (Review)
Review
Prenatal alcohol exposure is the leading preventable cause of cognitive deficit in developed countries and can lead to fetal alcohol spectrum disorder (FASD). This term encompasses a wide range of physical, mental, behavioral, and cognitive effects that result from damage caused by exposure to alcohol during intrauterine life. Alcohol consumption among the general population is common in Eastern European countries and especially among women at risk of social exclusion, who are the ones who lose or give up custody of their children. A high number of these children are adopted in Spain and many of them present neurocognitive and behavioral disorders, causing FASD to be a public health problem in our country. In many occasions this clinical spectrum is delayed or under-diagnosed due to the overlapping of neuropsychological symptoms caused by the abandonment. A neurocognitive and behavioral profile specific for FASD has not been defined and all the symptoms are common to other etiologies. The aim of this work is to review the neuropsychological profile in the diagnosis of FASD.
Topics: Alcohol Drinking; Child; Ethanol; Female; Fetal Alcohol Spectrum Disorders; Humans; Pregnancy; Prenatal Exposure Delayed Effects; Spain
PubMed: 34456169
DOI: 10.1016/j.anpede.2020.12.012 -
The American Journal of Managed Care Nov 2022Nonmedical switching (NMS) is a change in a patient's treatment regimen for reasons other than lack of efficacy, intolerance, adverse effects, or poor adherence. We... (Review)
Review
OBJECTIVES
Nonmedical switching (NMS) is a change in a patient's treatment regimen for reasons other than lack of efficacy, intolerance, adverse effects, or poor adherence. We describe the impact of NMS on patients, health care workers, and health systems, focusing on NMS to in-class biologic alternatives in US patients with chronic, immune-mediated rheumatic and dermatologic conditions. Additionally, we evaluate the ways in which the COVID-19 pandemic may exacerbate the physical, psychological, and economic impacts of NMS.
STUDY DESIGN
Narrative review.
METHODS
We performed a search of MEDLINE's PubMed database from October 2015 to October 2020, with a repeat search in October 2021. Search terms included relevant keywords pertaining to NMS, biologics, and disease areas. Results were supplemented by a search of key congress abstracts from 2015 to 2021 and a targeted internet search.
RESULTS
NMS increases medication abandonment, errors, and adverse effects, and it can lead to longer patient visits, increased follow-up visits, additional laboratory tests and procedures, and greater overall health care resource utilization (HCRU). The increased HCRU associated with NMS increases patients' financial burden due to additional co-pays and out-of-pocket costs.
CONCLUSIONS
The decision to switch treatments should result from shared decision-making between health care providers (HCPs) and patients to achieve the best clinical outcomes and optimal HCRU. The issues related to NMS may be compounded by the financial and psychosocial stress on HCPs and patients created by the COVID-19 pandemic. HCPs should advocate for continuous patient treatment and be familiar with continuity of care legislation, appeals processes, and manufacturer assistance programs.
Topics: Humans; COVID-19; Pandemics; Health Expenditures; Delivery of Health Care; Health Personnel
PubMed: 36374660
DOI: 10.37765/ajmc.2022.89246 -
Heliyon Sep 2020The "problem of e-books" is defined as the difficulty improving the adoption rates of e-books by students. The adoption rates of e-books for academic use remain low, and...
The "problem of e-books" is defined as the difficulty improving the adoption rates of e-books by students. The adoption rates of e-books for academic use remain low, and research into the reasons for this have resulted in inconclusive findings. Factors such as student perception, and variations in experimental methodology and technology, contribute to difficulties in generalising findings and establishing conclusive causes for this problem. To better understand the causal factors for low adoption rates and the student's experience with ereaders and digital text, an investigation was conducted by the lead researcher as a student enrolled in a postgraduate course. The experiment was designed using e-book and digital text documents on an ereader for academic study and the results analysed with the framework of Activity Theory. This methodology allowed exploration of the problem within the authentic experience of a student to examine the effects of this social environment on ereader and e-book use. Analysis of the work domain was conducted and a comparative assessment of the observed effect of using the digital documents on an ereader compared with the paper book. Findings show that attempts to apply self-regulation and metacognitive learning techniques within the activity using the ereader were abandoned due to breakdowns in operations, and that this resulted in a perceived lower quality of achievement. The effect on the processes used by the student were extreme and were observed to be highly dependent on the student's use of specific learning strategies. The experimental methodology employed in this investigation enabled identification of the role of the social environment in the use of course documents on an ereader for academic study. The functionality of the ereader was such an extremely poor fit with the observed academic processes that a redesign approach for ereader and e-book technology is proposed as a solution to the low adoption rates of e-books.
PubMed: 32995643
DOI: 10.1016/j.heliyon.2020.e04982