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Background and objective: Most trans women are requesting a gender affirming genital surgery by vulvovaginoplasty. However, long-term complications such as genital prolapse are unknown. Through this systematic review, our objective was to provide an overview of the published outcomes related to genital prolapse after vaginoplasty in male-to-female transgender individuals, including prevalence, identified risk factors, and treatment. Methods: We included all studies reporting genital prolapse rates following vulvovaginoplasty from 1995 to the present. Only studies that focused on the transgender population were included. The primary outcome was the genital prolapse rate. The secondary outcomes included risk factors and treatment of genital prolapse after vulvovaginoplasty. Article selection was performed by two independent reviewers. Key findings and limitations: Twenty-four studies, involving 3166 patients, that presented sufficient data were analyzed. The mean age at the time of vulvovaginoplasty was 37.7 yr. The mean follow-up time was 22.5 mo. Most of the studies were retrospective case series of low to intermediate quality. The penile skin inversion technique was the most frequently employed method (in 85% of the 3166 patients). The prevalence of prolapse ranged from 0% to 7% with the penile skin inversion technique and from 1.6% to 22.7% with intestinal vaginoplasty. Upon consolidating the results, an overall rate of 2.7% was observed. Specifically, the prolapse rate within the penile inversion technique subgroup was 2.5%, while the rate for the intestinal-derived neovagina subgroup was 3.5%. The only significant risk factor identified was a high body mass index at the time of surgery. The most employed intraoperative technique to prevent neovaginal prolapse involves fixation to the sacrospinous ligament, coupled with systematic vaginal packing. Few case reports addressed the surgical treatment of neovaginal prolapse, predominantly using open abdominal or laparoscopic approaches. None of these considered transvaginal or perineal approaches. No recommendation exists about the use of vaginal prosthesis. Conclusions and clinical implications: Neovaginal prolapse in male-to-female transgender patients remains a rare complication, but its significance is growing as the transgender population ages. Scarce information is available regarding preventative techniques and treatments, necessitating further exploration, hampered by its infrequent occurrence. Patient summary: Neovaginal prolapse in male-to-female transgender patients is a rare complication, with the only recognized risk factor being a high body mass index. However, its importance is growing with the aging of the transgender population. Long-term complications, preventive techniques, and management of these prolapses need to be explored through further research.

IntroductionOptimizing care for young adults with cerebral palsy is crucial for their physical and psychological well-being. The inadequacy of proximal environment may play a role in the provision of health services. The aim of this study is to explore the association between unmet environmental needs in the physical, social and attitudinal domains and unmet healthcare needs in four interventions: physiotherapy, occupational therapy, speech therapy and psychological counselling.MethodsYoung adults with cerebral palsy were recruited in the SPARCLE3 European multicenter cross-sectional study. Healthcare needs and coverages were assessed using the Youth Health Care, Satisfaction, Utilization and Needs questionnaire. The need and availability of environmental factors in physical, social and attitudinal domains were collected using the European Adult Environment Questionnaire. Logistic regressions were conducted separately for each intervention to measure associations between unmet environmental needs and unmet healthcare needs.ResultsWe studied 310 young adults with cerebral palsy, with a mean age of 24.3 years; 37.4% could not walk independently, 51.5% had an IQ below 70, 34.2% had severe communication difficulties. The most commonly expressed need was physiotherapy (81.6% of participants). Unmet healthcare needs were reported by 20.9%, 32.4%, 40.3% and 49.0% of participants requiring physiotherapy, occupational therapy, psychological counselling and speech therapy, respectively. The physical environment was never significantly associated with unmet healthcare needs. In contrast, the social environment was significantly associated with unmet healthcare needs across all interventions, with odds ratios over 2.5, depending on the number of unmet needs and the nature of intervention needed. With regard to the attitudinal environment, when at least one unmet attitudinal environmental need was reported, the odds of also reporting an unmet healthcare need were of 3.68 for speech therapy and 3.77 for physiotherapy. The latter association was significant only for individuals with severe motor impairment.DiscussionOur results highlight the importance of the social and attitudinal environment in meeting healthcare needs in young adults with cerebral palsy. The lack of correlation between unmet healthcare needs and the physical environment suggests that it can be partly compensated for by social support.

1. Una teoría del ambiente, inducida a partir de reiteradas contemplaciones e interpretaciones puntuales de ambientes concretos, debe comenzar por un ejercicio de pulcritud semántica.

Introduction For young people with disabilities, access to higher education and employment should lead to improved personal self-esteem and well-being and, in the long run, to increased inclusion in society. Our aims were to describe the education and employment status of young adults with cerebral palsy (CP), to investigate the personal and contextual factors, including prior mainstream education, that most influence these statuses, and to study to what extent employment affects the quality of life (QoL).Methods We used data from the SPARCLE3 cross-sectional study, collected in 2018–2020 in five European regions. Eligible participants were adults with CP, 22–27 years, without moderate to profound intellectual disability. Outcomes were education and employment statuses. Unconditional logistic regressions were performed to test the association with impairments, comorbidities, personal and family characteristics and environmental factors. QoL scores (WHOQOL-bref score 0–100) were compared using linear regressions.Results Of the 227 participants, 21.6% had a tertiary degree, 35.2% were employed. The likelihood of being employed or of having a tertiary degree was reduced by more than 75% for those with more severe gross motor limitations or communication/speech difficulties. Those with a tertiary degree were more likely to be employed (OR 9.37 (95% CI 2.87 to 30.64)) while accessible car parking was the only associated environmental factor (OR 2.92 (95% CI 1.19 to 7.18)). Prior mainstream schooling increased the odds of being employed 16-fold. Individuals who were employed reported an 8-point increase in the physical and psychological well-being domains of QoL compared with those who were unemployed.Conclusions The employment situation of young adults with CP can still be improved, but our findings encourage the implementation of inclusive policies from an early age.

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary studies using robotic techniques have shown promising results, but only one small study has compared robotic to open procedures. This study aims to compare the outcomes of robotic and open artificial urinary sphincter implantation in women with stress urinary incontinence due to intrinsic sphincter deficiency in a large multicenter cohort. Methods: Data were collected retrospectively from female patients who underwent open or robot-assisted artificial urinary sphincter implantation from 2006 to 2020 at 12 urology departments. The primary outcome was the rate of complications within 30 days after surgery, graded using the Clavien-Dindo Classification. Perioperative and functional outcomes were compared between the two groups. Results: A total of 135 patients were included, with 71 in the robotic group and 64 in the open group. The open group had a higher rate of intraoperative complications (27.4% vs. 12.7%; p = 0.03) and postoperative complications (46.8% vs. 15.5%; p < 0.0001). More patients in the robotic group achieved full continence (83.3% vs. 62.3%; p = 0.01). The open group had higher explantation (27.4% vs. 1.4%; p < 0.0001) and revision rates (17.5% vs. 5.6%; p = 0.02). The estimated 1-year explantation-free survival rate was higher in the robotic group. (98.6% vs. 78.3%; p = 0.001). Conclusions: Robot-assisted implantation may reduce perioperative morbidity and improve functional outcomes compared to open implantation in women with stress urinary incontinence. [ABSTRACT FROM AUTHOR]

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications. [ABSTRACT FROM AUTHOR]

Abstract Background While evidence concerning Quality of Life (QoL) in youth with cerebral palsy (CP) in comparison to the general population has been accumulating, there is a lack of studies exploring differences on a wider range of positive and negative mental health outcomes in emerging adults. Methods This binational case control study is part of the SPARCLE cohort study on QoL and participation of youth with CP. QoL (WHOQOL-BREF), depression (PHQ-9), anxiety (GAD-7) and self-efficacy (GSE) were assessed in 198 emerging adults with CP and 593 emerging adults from the general population, matched for country of residence, age and gender. ANCOVAs with impairment and pain as covariates were run. Results Similar levels of QoL were found in both samples, except for the environmental domain, with better QoL for emerging adults with CP compared to the general population. There were significant descriptive differences regarding depression with worse levels in the CP sample, however, also worse levels of self-efficacy. Pain as a covariate had a significant negative impact on all measures, leading to poorer self-efficacy while worsening depression and anxiety; impairment had a significant worsening impact on physical QoL and self-efficacy only. Conclusion Similar expressions of mental health outcomes in emerging adults with CP and the general population indicate the high adaptive capability of emerging adults with CP.

We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of non-thyroidal illness syndrome (NTIS) in critically ill patients. We included studies that assessed thyroid function by measuring the serum thyroid hormone (TH) level and in-hospital mortality in adult septic patients. Reviews, case reports, editorials, letters, animal studies, duplicate studies, and studies with irrelevant populations and inappropriate controls were excluded. A total of 6869 patients from 25 studies were included. The median prevalence rate of NTIS was 58% (IQR 33.2–63.7). In univariate analysis, triiodothyronine (T3) and free T3 (FT3) levels in non-survivors were relatively lower than that of survivors (8 studies for T3; stan dardized mean difference (SMD) 1.16; 95% CI, 0.41–1.92; I2 = 97%; P < 0.01). Free thyroxine (FT4) levels in non-survivors were also lower than that of survivors (12 studies; SMD 0.54; 95% CI, 0.31–0.78; I2 = 83%; P < 0.01). There were no statistically significant differences in thyrotropin levels between non-survivors and survivors. NTIS was independently associated with increased risk of mortality in critically ill patients (odds ratio (OR) = 2.21, 95% CI, 1.64–2.97, I2 = 65% P < 0.01). The results favor the concept that decreased thyroid function might be associated with a worse outcome in critically ill patients. Hence, the measurement of TH could provide prognostic information on mortality in adult patients admitted to ICU.

According to Plotinus, the conversion of the soul is both the movement which consists in converting towards itself and the one which makes it turn towards the Intellect, but they have different directions and therefore different requirements. This paper deals with the link between these movements of the soul. When the soul converts towards itself, it only finds inactive prints coming from the intelligible realities: it has to turn towards the latter in order to reactivate them. This process of reactivation enables the soul to appropriate its own content.

Elections are still about shaking hands and kissing babies, for the time being. Maria Vidart explores the first experience with social media campaigning in Colombia.