Vaginal Stenosis After Gender-affirming Vaginoplasty: A Systematic Review.

OBJECTIVE: To review the literature and report the incidence of vaginal stenosis (VS) after vaginoplasty and compare the incidence rates by surgical technique and follow-up duration. METHODS: We performed a systematic literature review according to PRISMA guidelines. Original research on primary vaginoplasty was included. Exclusion criteria included non-English studies, mixed cohorts without subgroup analysis, revision vaginoplasty, and papers without stenosis rates. The search was ran in Pubmed, Embase, Scopus, and Cochrane on September 9, 2022. Stenosis rates were compared with descriptive statistics using SPSS. RESULTS: Fifty-nine studies with a cumulative 7338 subjects were included. The overall incidence of VS was 5.83% (range 0%-34.2%). Combining VS with introital stenosis (IS) and contracture results in a cumulative incidence of 9.68%. The rate of VS in the penile inversion vaginoplasty subgroup (PIV) was 5.70%, compared to 0.20% in primary intestinal vaginoplasty. The rate of IS in the PIV group was 3.13% and 4.7% in the intestinal vaginoplasty subgroup. CONCLUSION: The overall rate of VS was 5.83%, which is lower than previously documented. This may be related to the inclusion of more recent studies and analysis limited to primary vaginoplasty. The similar rate of IS in PIV and intestinal vaginoplasty subgroups may be secondary to multiple suture lines and the need for dilation through this anastomosis. Our research demonstrates a need for a standardized definition of VS.

Exploring late Pleistocene bioturbation on Yermak Plateau to assess sea-ice conditions and primary productivity through the Ethological Ichno Quotient.

Central Arctic, interglacial intervals have traditionally been associated with diverse and intense bioturbation, and abundant foraminifera, interpreted as indicating relatively low sea-ice concentrations and productive surface waters, while glacial intervals, typically barren, support the inverse. In this respect, the Yermak Plateau is anomalous. Biomarker studies suggest that glacial intervals were characterized by comparatively open water, while interglacials are marked by severe sea-ice conditions. Here we study downcore Ethological Ichno Quotient (EIQ) variations in trace fossils and bioturbation to test the hypothesis that different ethological classes vary in accordance with late Pleistocene changes in sea-ice extent, with deposit feeders increasing during reduced sea-ice cover and chemosymbiotic traces increasing during periods of thick perennial sea-ice conditions. Our results generally demonstrate that the abundance of traces like Planolites, Scolicia, and burrows produced by deposit feeders increase during episodes of seasonal sea-ice cover. In contrast, intervals with more severe sea-ice conditions are characterized by chemosymbiotic traces such as Chondrites and Trichichnus/Mycellia, suggesting lower food delivery and poorly ventilated bottom water conditions. The study thus confirms previous reconstructions of sea-ice conditions on the Yermak Plateau during interglacials, demonstrating that bioturbation variation provides insights into bentho-pelagic coupling under variable sea ice regimes in the Arctic Ocean.

Remobilization of dormant carbon from Siberian-Arctic permafrost during three past warming events.

Carbon cycle models suggest that past warming events in the Arctic may have caused large-scale permafrost thaw and carbon remobilization, thus affecting atmospheric CO2 levels. However, observational records are sparse, preventing spatially extensive and time-continuous reconstructions of permafrost carbon release during the late Pleistocene and early Holocene. Using carbon isotopes and biomarkers, we demonstrate that the three most recent warming events recorded in Greenland ice cores-(i) Dansgaard-Oeschger event 3 (~28 ka B.P.), (ii) Bølling-Allerød (14.7 to 12.9 ka B.P.), and (iii) early Holocene (~11.7 ka B.P.)-caused massive remobilization and carbon degradation from permafrost across northeast Siberia. This amplified permafrost carbon release by one order of magnitude, particularly during the last deglaciation when global sea-level rise caused rapid flooding of the land area thereafter constituting the vast East Siberian Arctic Shelf. Demonstration of past warming-induced release of permafrost carbon provides a benchmark for the sensitivity of these large carbon pools to changing climate.

Benthic phosphorus cycling within the Eurasian marginal sea ice zone.

The Arctic Ocean region is currently undergoing dramatic changes, which will likely alter the nutrient cycles that underpin Arctic marine ecosystems. Phosphate is a key limiting nutrient for marine life but gaps in our understanding of the Arctic phosphorus (P) cycle persist. In this study, we investigate the benthic burial and recycling of phosphorus using sediments and pore waters from the Eurasian Arctic margin, including the Barents Sea slope and the Yermak Plateau. Our results highlight that P is generally lost from sediments with depth during organic matter respiration. On the Yermak Plateau, remobilization of P results in a diffusive flux of P to the seafloor of between 96 and 261 µmol m-2 yr-1. On the Barents Sea slope, diffusive fluxes of P are much larger (1736-2449 µmol m-2 yr-1), but these fluxes are into near-surface sediments rather than to the bottom waters. The difference in cycling on the Barents Sea slope is controlled by higher fluxes of fresh organic matter and active iron cycling. As changes in primary productivity, ocean circulation and glacial melt continue, benthic P cycling is likely to be altered with implications for P imported into the Arctic Ocean Basin. This article is part of the theme issue 'The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.

Examining the Reach and Impact of a Systematic Review Service.

This case study describes the process librarians at a large research university used to evaluate a systematic review searching service. PubMed, Embase, CINAHL, and Scopus were searched for studies with a local, health sciences author. Data on librarian involvement, search quality, and standards adherence were recorded. Results of the assessment indicate a gradual increase in librarian authorship or acknowledgement over time, a moderate improvement in adherence to reporting standards over time, and insight into which departments better adhere to standards. Ideas for improving the quality and reach of the service while ensuring sustainability are discussed.

Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review.

BACKGROUND: Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as "asymptomatic," "incidental," or "clinically silent/occult" VTE. OBJECTIVE: To understand the epidemiology, management, and outcomes of uVTE in children. METHODS: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years). RESULTS: Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval [CI]: 13%-24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non-CVL settings included post-spinal surgery, post-splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long-term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor-associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management. CONCLUSION: Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and thromboprophylaxis. Prospective research is needed to clarify the optimal management of iVTE.

Arctic closure as a trigger for Atlantic overturning at the Eocene-Oligocene Transition.

The Eocene-Oligocene Transition (EOT), approximately 34 Ma ago, marks a period of major global cooling and inception of the Antarctic ice sheet. Proxies of deep circulation suggest a contemporaneous onset or strengthening of the Atlantic meridional overturning circulation (AMOC). Proxy evidence of gradual salinification of the North Atlantic and tectonically driven isolation of the Arctic suggest that closing the Arctic-Atlantic gateway could have triggered the AMOC at the EOT. We demonstrate this trigger of the AMOC using a new paleoclimate model with late Eocene boundary conditions. The control simulation reproduces Eocene observations of low Arctic salinities. Subsequent closure of the Arctic-Atlantic gateway triggers the AMOC by blocking freshwater inflow from the Arctic. Salt advection feedbacks then lead to cessation of overturning in the North Pacific. These circulation changes imply major warming of the North Atlantic Ocean, and simultaneous cooling of the North Pacific, but no interhemispheric change in temperatures.

Remobilization of Old Permafrost Carbon to Chukchi Sea Sediments During the End of the Last Deglaciation.

Climate warming is expected to destabilize permafrost carbon (PF-C) by thaw-erosion and deepening of the seasonally thawed active layer and thereby promote PF-C mineralization to CO2 and CH4. A similar PF-C remobilization might have contributed to the increase in atmospheric CO2 during deglacial warming after the last glacial maximum. Using carbon isotopes and terrestrial biomarkers (Δ14C, δ13C, and lignin phenols), this study quantifies deposition of terrestrial carbon originating from permafrost in sediments from the Chukchi Sea (core SWERUS-L2-4-PC1). The sediment core reconstructs remobilization of permafrost carbon during the late Allerød warm period starting at 13,000 cal years before present (BP), the Younger Dryas, and the early Holocene warming until 11,000 cal years BP and compares this period with the late Holocene, from 3,650 years BP until present. Dual-carbon-isotope-based source apportionment demonstrates that Ice Complex Deposit-ice- and carbon-rich permafrost from the late Pleistocene (also referred to as Yedoma)-was the dominant source of organic carbon (66 ± 8%; mean ± standard deviation) to sediments during the end of the deglaciation, with fluxes more than twice as high (8.0 ± 4.6 g·m-2·year-1) as in the late Holocene (3.1 ± 1.0 g·m-2·year-1). These results are consistent with late deglacial PF-C remobilization observed in a Laptev Sea record, yet in contrast with PF-C sources, which at that location were dominated by active layer material from the Lena River watershed. Release of dormant PF-C from erosion of coastal permafrost during the end of the last deglaciation indicates vulnerability of Ice Complex Deposit in response to future warming and sea level changes.

Erosion of organic carbon in the Arctic as a geological carbon dioxide sink.

Soils of the northern high latitudes store carbon over millennial timescales (thousands of years) and contain approximately double the carbon stock of the atmosphere. Warming and associated permafrost thaw can expose soil organic carbon and result in mineralization and carbon dioxide (CO2) release. However, some of this soil organic carbon may be eroded and transferred to rivers. If it escapes degradation during river transport and is buried in marine sediments, then it can contribute to a longer-term (more than ten thousand years), geological CO2 sink. Despite this recognition, the erosional flux and fate of particulate organic carbon (POC) in large rivers at high latitudes remains poorly constrained. Here, we quantify the source of POC in the Mackenzie River, the main sediment supplier to the Arctic Ocean, and assess its flux and fate. We combine measurements of radiocarbon, stable carbon isotopes and element ratios to correct for rock-derived POC. Our samples reveal that the eroded biospheric POC has resided in the basin for millennia, with a mean radiocarbon age of 5,800 ± 800 years, much older than the POC in large tropical rivers. From the measured biospheric POC content and variability in annual sediment yield, we calculate a biospheric POC flux of 2.2(+1.3)(-0.9) teragrams of carbon per year from the Mackenzie River, which is three times the CO2 drawdown by silicate weathering in this basin. Offshore, we find evidence for efficient terrestrial organic carbon burial over the Holocene period, suggesting that erosion of organic carbon-rich, high-latitude soils may result in an important geological CO2 sink.