Genital Self-Image and Body Dysmorphic Disorder Symptoms in Patients Undergoing Central Wedge vs. Linear Resection Labiaplasty: A Randomized Clinical Trial.

BACKGROUND: Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder. Brazil stands as the global leader in the prevalence of labiaplasty procedures. OBJECTIVE: This study aimed to assess alterations in genital self-image and symptoms of body dysmorphic disorder in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty. METHODS: A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with two parallel groups. Allocation ratio was 1:1. The Study Group (SG) underwent wedge labiaplasty, while the Control Group (CG) underwent trim labiaplasty. Genital self-image and symptoms of body dysmorphic disorder were assessed both preoperatively and six months postoperatively, using validated tools. RESULTS: After a six-month intervention period, a statistically significant improvement in genital self-image was observed (p<0.001), alongside a marked decrease in the score of symptoms related to body dysmorphic disorder (p<0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique employed. CONCLUSION: The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of body dysmorphic disorder, evident in both the wedge and linear labiaplasty groups at the six-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes.

Systemic White supremacy: U.S. state policy, policing, discrimination, and suicidality across race and sexual identity.

Although suicide rates are stable or decreasing among White communities, rates are increasing among Black communities, a trend that appears to be disproportionately affecting Black lesbian, gay, bisexual, and queer (LGBQ) people. To understand the structural drivers and mechanisms of these trends, we examined associations between U.S. state-level racist and heterosexist criminal legal policies and policing, discrimination, and suicidality among White and Black, heterosexual and LGBQ, communities. We recruited 5,064 participants in 2021 using online census-driven quota sampling. Structural equation modeling estimated associations from objective indicators of racist and heterosexist criminal legal policies to self-reported police stops, discrimination, and suicidal ideation and behavior. For White heterosexual participants, racist (ß = -.22, SE = 0.03, p < .001) and heterosexist (ß = -.26, SE = 0.03, p < .001) policies were negatively associated with police stops. For White LGBQ participants, racist and heterosexist policies were not significantly associated with police stops. For Black heterosexual participants, racist (ß = .30, SE = 0.11, p = .005), but not heterosexist, policies were positively associated with police stops. For Black LGBQ participants, racist (ß = .57, SE = 0.08, p < .001) and heterosexist (ß = .65, SE = 0.09, p < .001) policies were positively associated with police stops which, in turn, were positively associated with discrimination and suicidal ideation and behavior. Results provide evidence that racist and heterosexist state policies are linked to policing and interpersonal drivers of suicide inequities and suggest that repealing/preventing oppressive policies should be a suicide prevention imperative. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Congenital and acquired symmastia: a novel correction technique.

BACKGROUND: Symmastia, first defined by Spence in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach, preoperative, and postoperative care for the correction of symmastia. METHODS: Between January 2014 and December 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. RESULTS: All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. CONCLUSION: The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes.

Performance of a Real-Time PCR Assay for the Detection of Five Candida Species in Blood Samples from ICU Patients at Risk of Candidemia.

The gold standard for diagnosing invasive candidiasis still relies on blood cultures, which are inefficient and time-consuming to analyze. We developed an in-house qPCR assay to identify the 5 major Candida species in 78 peripheral blood (PB) samples from ICU patients at risk of candidemia. Blood cultures and (1,3)-ß-D-glucan (BDG) testing were performed concurrently to evaluate the performance of the qPCR. The qPCR was positive for DNA samples from all 20 patients with proven candidemia (positive PB cultures), showing complete concordance with Candida species identification in blood cultures, except for detection of dual candidemia in 4 patients, which was missed by blood cultures. Additionally, the qPCR detected Candida species in six DNA samples from patients with positive central venous catheters blood (CB) but negative PB cultures. BDG values were similarly high in these six samples and the ones with proven candidemia, strongly suggesting the diagnosis of a true candidemia episode despite the negative PB cultures. Samples from patients neither infected nor colonized yielded negative results in both the qPCR and BDG testing. Our qPCR assay was at least as sensitive as blood cultures, but with a shorter turnaround time. Furthermore, negative results from the qPCR provided strong evidence for the absence of candidemia caused by the five major Candida species.

Milky secretion after late breast reconstruction with latissimus dorsi musculocutaneous flap with implant / Produção de secreção leitosa após reconstrução mamária tardia com retalho musculocutâneo de latíssimo do dorso com implante

We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast.

Apresentamos um caso raro de uma paciente de 28 anos com carcinoma ductal invasivo submetida a quimioterapia neoadjuvante, mastectomia radical modificada, radioterapia e reconstrução mamária tardia com retalho de latíssimo do dorso associado a implante. Um ano depois, foi submetida a reconstrução do complexo areolopapilar sobre a ilha cutânea do retalho do grande dorsal com enxerto de pele total da coxa e enxerto da porção caudal da papila contralateral. Ela engravidou seis meses após a reconstrução do complexo areolopapilar e, inesperadamente, apresentou produção de leite pela mama reconstruída.

Feasibility, Acceptability, and Preliminary HIV Care and Psychological Health Effects of iTHRIVE 365 for Black Same Gender Loving Men.

OBJECTIVES: This uncontrolled pilot study examined the feasibility, acceptability, and preliminary HIV and psychological health effects of iTHRIVE 365, a multicomponent intervention designed by and for Black same gender loving men (SGLM) to promote: health knowledge and motivation, Black SGLM social support, affirming health care, and housing and other economic resources. DESIGN METHODS: We conducted a 14-day daily diary study with 32 Black SGLM living with HIV connected to THRIVE SS in Atlanta, GA. Daily surveys assessed intervention engagement, antiretroviral medication (ART) use, depressive symptoms, anxiety symptoms, and emotion regulation difficulties. App paradata (ie, process data detailing app usage) assessed amount of intervention engagement via page access. Participants began receiving access to the intervention on day 7. After the 14-day daily diary period, participants responded to follow-up items on the user-friendliness, usefulness, helpfulness, and whether they would recommend iTHRIVE 365 to others. Chi-square analyses examined associations between intervention engagement and ART use, and dynamic structural equation modelling assessed longitudinal associations from intervention engagement to next-day psychological health. This intervention trial is registered on ClinicalTrials.gov (NCT05376397). RESULTS: On average, participants engaged with iTHRIVE 365 over once every other day and accessed intervention pages 4.65 times per day. Among participants who engaged with the intervention, 78% reported it was helpful to extremely helpful, 83% reported it was moderately to extremely useful, and 88% reported it was user-friendly and they would recommend it to others. On intervention engagement days, participants had higher odds of ART use, χ 2 (1) = 4.09, P = 0.04, than intervention nonengagement days. On days after intervention engagement, participants showed non-null decreases in depressive symptoms (τ = -0.14; 95% CI : = [-0.23, -0.05]) and emotion regulation difficulties (τ = -0.16; 95% CI : = [-0.24, -0.02]). CONCLUSIONS: Findings suggest iTHRIVE 365 is feasible, acceptable, and positively affects daily ART use, depressive symptoms, and emotion regulation difficulties.

EPIDEMIOLOGICAL DISTRIBUTION OF SOFT PART TUMORS IN A TERTIARY HOSPITAL.

Objective: To evaluate cases of soft tissue tumors at the Orthopedic Oncology service of the PUC-Campinas Hospital and determine the epidemiological profile in the period from February 2012 to November 2019, associating the participation of a non-reference hospital in the approach and treatment of the pathology. Methods: This study evaluated 72 patients aged 18 to 81 years, of both sexes and diagnosed with soft tissue tumor and divided into two groups: (I) primary etiology and (II) metastatic etiology. Results: Of 146 patients admitted, 22 resulted in deaths, with 9 patients from Group I, and 13 from Group II. For all patients with soft tissue tumor, aged between 51 and 58 years, admitted in the period, the probability of survival after 46 months was 71.84%, Group I's was 22.7% and Group II's 91.43%. Conclusion: Despite the scarcity of epidemiological data related to soft tissue tumor, the data appreciated in the hospital's service, not a reference in treating this type of condition, are compatible with the data presented in specialized hospitals in Brazil, thus, in confluence with the literature. Level of Evidence III, Comparative, Prognostic and Retrospective Study.

Objetivo: Avaliar casos de tumores de partes moles do Serviço de Oncologia Ortopédica do Hospital PUC-Campinas e determinar o perfil epidemiológico no período de fevereiro de 2012 a novembro de 2019, associando à participação de um hospital que não é referência na abordagem e tratamento da patologia. Métodos: Foi realizada uma análise exploratória de dados com 72 pacientes entre 18 e 81 anos, de ambos os sexos e com diagnóstico de tumor de partes moles. Eles foram avaliados e divididos em dois grupos: (I) de etiologia primária e (II) de etiologia metastática. Resultados: Do total de 146 pacientes admitidos, 22 vieram a óbito, sendo 9 pacientes do Grupo I, e 13 do Grupo II. Para todos os pacientes com tumor de partes moles, com idade entre 51 e 58 anos, admitidos no período, a probabilidade de sobrevida após 46 meses foi de 71,84%, enquanto do Grupo I foi de 22,7%, e do Grupo II foi de 91,43%. Conclusão: Apesar da escassez de dados epidemiológicos relacionados ao tumor de partes moles, os dados apreciados no serviço do hospital, que não é referência no tratamento dessa condição, são compatíveis com os dados apresentados em hospitais especializados no Brasil, assim, corroborando a literatura. Nível de Evidência III, Estudo Retrospectivo Comparativo Prognóstico.

Hierarchical compound topology uncovers complex structure of species interaction networks.

Nestedness and modularity have been found in many species interaction networks. Despite being conceptually distinct, negatively correlated and having different causes, these patterns often co-occur. A realistic but seldom investigated alternative to these simple topologies is hierarchical compound networks, in which the entire network is modular, and modules are internally nested. In compound networks, nestedness is suppressed by modularity at higher network hierarchical levels, but prevails at lower levels, within modules. The aims of this study are (i) to evaluate the prevalence of simple and hierarchical compound topologies in binary and weighted networks describing different kinds of species interactions and (ii) to probe the relationships between modularity and nestedness at different network hierarchical levels. With a procedure that discriminates between simple and compound structures, we re-analysed the topology of 142 well-studied binary networks including seed dispersal, host-parasite, pollination and plant-herbivore interactions; 68 of these also had quantitative information. Additionally, we tested the relationship between robustness and topology of binary networks and compared the robustness of networks with compound topologies to different sequences of species removals. Compound topologies were detected in 34% of binary and 71% of weighted networks of all interaction kinds. These results establish the hierarchical compound topology as a widespread network architecture, often undetected without quantitative data. Furthermore, they disentangle an apparent paradox: despite conflicting with overall nestedness, modularity usually co-occurs with high values of low-level nestedness. Nestedness progressively decreased, while modularity increased, from seed dispersal to host-parasite, pollination and plant-herbivore networks. There were no consistent differences in the robustness of networks with nested and compound topologies. However, compound topologies were especially vulnerable to removal sequences that accelerate the exclusion of entire modules. Compound topologies improve the depiction of ecological networks and differentiate ecological and evolutionary processes that operate at different hierarchical levels, with the potential to advance our understanding of network dynamics, stability and response to species loss or change. Quantitative data often reveal specialization patterns that are indistinguishable in binary networks, strongly improving the detection of modular and compound topologies.

Epidemiological distribution of soft part tumors in a tertiary hospital / Distribuição epidemiológica de tumores de partes moles em um hospital terciário

ABSTRACT Objective: To evaluate cases of soft tissue tumors at the Orthopedic Oncology service of the PUC-Campinas Hospital and determine the epidemiological profile in the period from February 2012 to November 2019, associating the participation of a non-reference hospital in the approach and treatment of the pathology. Methods: This study evaluated 72 patients aged 18 to 81 years, of both sexes and diagnosed with soft tissue tumor and divided into two groups: (I) primary etiology and (II) metastatic etiology. Results: Of 146 patients admitted, 22 resulted in deaths, with 9 patients from Group I, and 13 from Group II. For all patients with soft tissue tumor, aged between 51 and 58 years, admitted in the period, the probability of survival after 46 months was 71.84%, Group I's was 22.7% and Group II's 91.43%. Conclusion: Despite the scarcity of epidemiological data related to soft tissue tumor, the data appreciated in the hospital's service, not a reference in treating this type of condition, are compatible with the data presented in specialized hospitals in Brazil, thus, in confluence with the literature. Level of Evidence III, Comparative, Prognostic and Retrospective Study.

RESUMO Objetivo: Avaliar casos de tumores de partes moles do Serviço de Oncologia Ortopédica do Hospital PUC-Campinas e determinar o perfil epidemiológico no período de fevereiro de 2012 a novembro de 2019, associando à participação de um hospital que não é referência na abordagem e tratamento da patologia. Métodos: Foi realizada uma análise exploratória de dados com 72 pacientes entre 18 e 81 anos, de ambos os sexos e com diagnóstico de tumor de partes moles. Eles foram avaliados e divididos em dois grupos: (I) de etiologia primária e (II) de etiologia metastática Resultados: Do total de 146 pacientes admitidos, 22 vieram a óbito, sendo 9 pacientes do Grupo I, e 13 do Grupo II. Para todos os pacientes com tumor de partes moles, com idade entre 51 e 58 anos, admitidos no período, a probabilidade de sobrevida após 46 meses foi de 71,84%, enquanto do Grupo I foi de 22,7%, e do Grupo II foi de 91,43%. Conclusão: Apesar da escassez de dados epidemiológicos relacionados ao tumor de partes moles, os dados apreciados no serviço do hospital, que não é referência no tratamento dessa condição, são compatíveis com os dados apresentados em hospitais especializados no Brasil, assim, corroborando a literatura. Nível de Evidência III, Estudo Retrospectivo Comparativo Prognóstico.

Host migration and environmental temperature influence avian haemosporidians prevalence: a molecular survey in a Brazilian Atlantic rainforest.

Avian haemosporidians are parasites with great capacity to spread to new environments and new hosts, being considered a good model to host-parasite interactions studies. Here, we examine avian haemosporidian parasites in a protected area covered by Restinga vegetation in northeastern Brazil, to test the hypothesis that haemosporidian prevalence is related to individual-level traits (age and breeding season), species-specific traits (diet, foraging strata, period of activity, species body weight, migratory status, and nest shape), and climate factors (temperature and rainfall). We screened DNA from 1,466 birds of 70 species captured monthly from April 2013 to March 2015. We detected an overall prevalence (Plasmodium/Haemoproteus infection) of 22% (44 host species) and parasite's lineages were identified by mitochondrial cyt b gene. Our results showed that migration can be an important factor predicting the prevalence of Haemoproteus (Parahaemoproteus), but not Plasmodium, in hosts. Besides, the temperature, but not rainfall, seems to predict the prevalence of Plasmodium in this bird community. Neither individual-level traits analyzed nor the other species-specific traits tested were related to the probability of a bird becoming infected by haemosporidians. Our results point the importance of conducting local studies in particular environments to understand the degree of generality of factors impacting parasite prevalence in bird communities. Despite our attempts to find patterns of infection in this bird community, we should be aware that an avian haemosporidian community organization is highly complex and this complexity can be attributed to an intricate net of factors, some of which were not observed in this study and should be evaluated in future studies. We evidence the importance of looking to host-parasite relationships in a more close scale, to assure that some effects may not be obfuscated by differences in host life-history.

The resilient frugivorous fauna of an urban forest fragment and its potential role in vegetation enrichment.

Anthropocentric defaunation affects critical ecological processes, such as seed dispersal, putting ecosystems and biomes at risk, and leading to habitat impoverishment. Diverse restoration techniques could reverse the process of habitat impoverishment. However, in most of the restoration efforts, only vegetation cover is targeted. Fauna and flora are treated as isolated components, neglecting a key component of ecosystems' functioning, the ecological interactions. We tested whether the resilient frugivorous generalist fauna can improve habitat quality by dispersing native plant species through the use of fruit feeders as in a semideciduous seasonal urban forest fragment. A total of 32 sampling points was selected at a heavily degraded 251-ha urban forest fragment, with feeders installed at two heights monitored by camera-traps. Variable quantities of native fruits of 27 zoochorous species were offered alternately in the feeders. Based on more than 36,000 h of video records, Turdus leucomelas (Class Aves), Sapajus nigritus (Class Mammalia), and Salvator merianae (Class Reptilia) were recorded ingesting the highest fruit species richness. Didelphis albiventris (Class Mammalia) was the most frequent visitor but consumed only pulp in most of the visits. The frugivorous birds were recorded at a high visitation rate and consumed a wider variety of fruits. Our study opens a new avenue to combine the traditional approach of ecosystems recovery and ecological interactions restauration in an urban forest fragment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11252-020-01080-5.

Aesthetic Contouring of the Chest wall with Rib Resection.

BACKGROUND: In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes. METHODS: A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details. CONCLUSIONS: Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes. LEVEL OF EVIDENCE III: 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 .

Insights into the assembly rules of a continent-wide multilayer network.

How are ecological systems assembled? Identifying common structural patterns within complex networks of interacting species has been a major challenge in ecology, but researchers have focused primarily on single interaction types aggregating in space or time. Here, we shed light on the assembly rules of a multilayer network formed by frugivory and nectarivory interactions between bats and plants in the Neotropics. By harnessing a conceptual framework known as the integrative hypothesis of specialization, our results suggest that phylogenetic constraints separate species into different layers and shape the network's modules. Then, the network shifts to a nested structure within its modules where interactions are mainly structured by geographic co-occurrence. Finally, organismal traits related to consuming fruits or nectar determine which bat species are central or peripheral to the network. Our results provide insights into how different processes contribute to the assemblage of ecological systems at different levels of organization, resulting in a compound network topology.

A new model explaining the origin of different topologies in interaction networks.

Nestedness and modularity have been recurrently observed in species interaction networks. Some studies argue that those topologies result from selection against unstable networks, and others propose that they likely emerge from processes driving the interactions between pairs of species. Here we present a model that simulates the evolution of consumer species using resource species following simple rules derived from the integrative hypothesis of specialization (IHS). Without any selection on stability, our model reproduced all commonly observed network topologies. Our simulations demonstrate that resource heterogeneity drives network topology. On the one hand, systems containing only homogeneous resources form generalized nested networks, in which generalist consumers have higher performance on each resource than specialists. On the other hand, heterogeneous systems tend to have a compound topology: modular with internally nested modules, in which generalists that divide their interactions between modules have low performance. Our results demonstrate that all real-world topologies likely emerge through processes driving interactions between pairs of species. Additionally, our simulations suggest that networks containing similar species differ from heterogeneous networks and that modules may not present the topology of entire networks.

Addressing the Absence of Black Men in Medicine.

There is a profound absence of Black men in medicine. Addressing this issue requires a concerted and holistic effort that includes learning from the current generation of medical students. This article summarizes three medical student perspectives presented as posters at the National Academies of Science, Engineering, and Medicine inaugural workshop on the growing absence of Black men in medicine. These posters present perspectives from men of color each from one of the three historically Black medical colleges in the country. The authors provide narratives on the importance of early access to resources and adequate inter-generational mentorship in preparing Black men for a career in medicine. Popular culture is also discussed as a means of facilitating further engagement of premedical Black students. Black men interested in medicine face unique challenges in the United States, and initiatives to improve the declining matriculation rate into medical schools need to be well-designed, relevant, and facilitating of early mentorship.