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Approaches to Psychological Assessment Prior to Multidisciplinary Chronic Pain Management
Published in Michael E. Schatman, Alexandra Campbell, John D. Loeser, Chronic Pain Management, 2007
In clinical practice, the mental-health specialist needs to evaluate for these factors and use them together with his or her own judgment in deciding whether to allow or exclude a patient from treatment. Sometimes the recommendation might be to delay implantation until a severe depression can be better controlled. Other times, a patient’s level of motivation to return to work might be so impressively high that it would mitigate the presence of some of the above-delineated exclusion criteria. Patient expectations about the success of the device is a very important area of evaluation (40). An unrealistically high expectation, such as complete “cure” of their pain, is a red flag for problems. Additionally, patients who are very concerned about body image, such as commonly found in young women, need to be assessed regarding their willingness to accept the body protrusion brought about by the stimulator implantation.
Mother and Embryo Cross Communication during Conception
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Anna Idelevich, Andrea Peralta, Felipe Vilella
The implantation of the embryo in the uterus is among the most finely tuned processes, and two ovarian hormones, estrogen (E2) and progesterone (P4) are placed at the top of the hierarchy of factors regulating the chronological transition between events, supporting continuous interaction between the mother and the developing baby [10,27]. Ovarian E2 and P4 are crucial for the series of events from uterine receptivity, implantation, decidualization, placentation, and finally birth. Both hormones affect a plethora of growth factors, cytokines, transcription factors, lipid mediators, and cell cycle regulators involved during the course of pregnancy [9,37]. In mice, ovariectomy on day 4 before preimplantation causes an estrogen surge, and continued P4 treatment places the uterus in a state of quiescence, while maintaining implantation competency which is resumed when estrogen levels peak. This “delayed implantation” model is commonly used in research [38]. Interestingly, although P4 is an absolute requirement for implantation in many species, ovarian estrogen increase is not crucial in subhuman primates [10]. In humans, the 28-to 30-day menstrual cycle begins with menses. The proliferative (follicular) phase is under the influence of rising E2 levels from the growing ovarian follicles, leading to the proliferation of epithelium, stroma, and vascular endothelium to regenerate the endometrium. At midcycle, there is a surge of gonadotropins, namely follicle-stimulating hormone (FSH) and luteinizing hormone (LH), leading to ovulation on day 14. The early secretory (luteal) phase is characterized by thickening of the endometrium and the formation of the corpus luteum from the ruptured follicle and subsequent P4 upsurge in preparation for implantation. Increasing E2 levels, superimposed on rising P4 concentrations, define the window of receptivity. In the absence of a viable embryo, hormone withdrawal and menstruation occur. Conversely, an implanting blastocyst secretes chorionic gonadotropin (hCG) to maintain the corpus luteum, and pregnancy ensues [10].
Eicosanoids and Blastocyst Implantation
Published in Murray D. Mitchell, Eicosanoids in Reproduction, 2020
Endometrial responsiveness to PGs may be related to changes in endometrial receptors for PGs. Endometrial membrane preparations from sensitized rat uteri and from pig and human uteri have specific, saturable, high-affinity binding sites for E-series PGs,85,86,88–90 but not, at least in the rat and human, for PGF2α.87,88 In the rat, the endometrial concentrations of PGE binding sites are controlled primarily by progesterone and seem to be located in the stroma, but not in the luminal epithelium.86 Using autoradiography, Chegini et al.89 have demonstrated that [3H]PGE2 binds to stromal cells, glandular epithelium, arterioles, and erythrocytes of the human endometrium. Endocrine regulation of the binding sites in human and pig endometrium has been less well investigated. Although in the rat the onset of uterine sensitization is temporally correlated with the appearance of detectable concentrations of PGE binding sites,85 no simple relationship exists between their endometrial concentrations and uterine sensitization for the decidual cell reaction.86 For example, in ovariectomized rats treated with various combinations of progesterone and estrogen to produce uteri differentially sensitized for the decidual cell reaction, the highest concentrations of endometrial PGE binding sites are found in the preparations from rats which received progesterone only.86 However, this treatment regimen produces the prereceptive or neutral state10 analogous to that which occurs in the rat during delayed implantation. Blastocyst implantation will not occur in such animals, and decidualization will only occur in response to overtly traumatic stimuli.4 Also, there is no difference in the concentrations of endometrial PGE binding sites in membrane preparations from rats treated with progesterone and estrogen so that they are at the receptive or postreceptive phase for the induction of decidualization.86 Yet when PGE2 is injected into the uterine lumen of animals treated with indomethacin to inhibit endogenous PG production, the uteri of receptive rats are more responsive, in terms of changes in endometrial vascular permeability, than those of neutral or postreceptive animals.43,44 These data indicate that changes in the concentrations of PGE binding sites cannot, by themselves, offer an explanation for changes in uterine sensitization for the decidual cell reaction.
Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series
Published in Journal of Investigative Surgery, 2022
Burak Sercan Erçin, Fatih Kabakaş, Burak Ergün Tatar, Musa Kemal Keleş, Ismail Bülent Özçelik, Berkan Mensa, Pedro C. Cavadas
Various opinions have been suggested regarding ectopic banking duration [15]. In their study, Godina et al. kept the amputated hand on the thoracic wall for 66 days [3]. They indicated that the long implantation time allowed the proximal stump to recover entirely and reduced hypertrophic scarring [3]. However, Graf et al. argued that delayed implantation increases joint stiffness and causes tendon shortening [16]. Wang et al. reported that when they performed ectopic banking procedures for two different hands. As a result, functional recovery was worse in a hand with a longer implantation time (319 days) than in a hand with a shorter implantation time (81 days) [17]. Higgins et al. suggested that the ectopic amputated part should be implanted as soon as the recipient site is available [4]. They argued that early implantation is more advantageous in terms of nerve, tendon, and bone healing, as well as patient morbidity. In addition, Higgins et al. stated that while the delayed transfer approach is a three-stage reconstruction (ectopic transfer–stump coverage–orthotopic transfer), early reconstruction generally involves a two-stage reconstruction (ectopic banking and soft tissue coverage with simultaneous delayed replantation).
Surgical outcomes of testicular prostheses implantation in transgender men with a history of prosthesis extrusion or infection
Published in International Journal of Transgender Health, 2021
Catherine M. Legemate, Freek P. W. de Rooij, Mark-Bram Bouman, Garry L. Pigot, Wouter B. van der Sluis
A former study of our research group reported an explantation rate of 13% after primary prostheses implantation and also found a history of smoking as a predictor for explantation (Pigot et al., 2019). The explantation rate in our population (i.e. after previous explantation due to infection or extrusion) is twice as high. This is most likely the result of the selection of patients who already had complicated healing because of patient-related factors. Furthermore, a lack of enough (good quality) soft tissue to protect the prosthesis during the primary procedure or after infection may be the cause of the higher infection and extrusion rates after reimplantation. The former study also concluded that a trend can be seen toward delayed implantation (Pigot et al., 2019). A mid-scrotal vertical or horizontal incision is made at the scrotophallic transition to create two separate pockets for implantation of the prostheses in case of delayed implantation. Prostheses are closer to the newly created wound if a mid-scrotal incision is used, which might result in higher extrusion rates. During the past years, our scrotoplasty technique has changed requiring more tissue dissection. This could hypothetically lead to a more wound problems. Therefore, testicular prostheses are now implanted at least 6 months after gGAS. Nevertheless, groups in our data were too small to support this hypothesis.
Urethral instillation of chlorhexidine gel is an effective method of sterilisation
Published in Arab Journal of Urology, 2021
Osama Shaeer, Amr Abdel- Raheem, Haitham Elfeky, Ahmad Seif, Tarek M. Abdel-Raheem, Amgad Elsegeiny, May Sherif Soliman, Emad B. Basalious, Kamal Shaeer
However, this approach has the disadvantage that a delayed implantation procedure can be challenging due to penile fibrosis, which has a major impact on clinical outcomes and patient satisfaction [1]. This has led some authors to recently suggest primary repair of distal, mid and corporotomy related urethral injuries with simultaneous implantation. Such injuries are often identified during dilatation or irrigation of the corpora and can be accessed, depending on the location, through the same incision or by making a counter subcoronal incision with penile degloving or by performing a meatotomy [5,6].