Effectiveness of bespoke or customised orthotic treatment in plantar pressure reduction of the central metatarsals: A systematic review and meta-analysis.

Background: Conservative treatment is the first therapeutical option for central heads metatarsalgia, a common foot condition. However, to our best knowledge, systematic review and meta-analysis of its effectiveness in terms of plantar pressure improvement have not been yet carried out. Our aim was to answer the following research question: Is bespoke or customized orthotic treatment effective for plantar pressure reduction in patients with mechanical metatarsalgia in the central metatarsal heads? Methods: A systematic review and meta-analysis of the effectiveness of bespoke or customised orthotic treatment in terms of plantar pressure reduction beneath the central -2nd to 4th - metatarsal heads in mechanical metatarsalgia patients were carried out. Pubmed database was searched from September to November 2022. All type of related-topic studies were included. Cochrane Collaboration tool was used to assess the risk of bias of each study. Descriptive and frequency analyses were performed with SPSS 25.0 software. Review Manager v5.4.1 software was used to analyse the data using the inverse variance method for continuous outcomes according to a fixed or random effects model. Results: A total of 5 studies met our inclusion criteria, with 158 participants. Bespoke or customised orthotic treatment is effective for the improvement of plantar pressure under 2nd to 4th metatarsal heads in mechanical metatarsalgia patients (MD -37.54 [95 % CI -65.84, -9.24], p = 0.009). Customised orthotic treatment is more effective than no treatment in terms of reducing plantar pressure (MD -78.63 [95 % CI -119.70, -39.16], p = 0.0002), but its effectiveness is similar to standardised footwear, standardised foot orthoses and isolated metatarsal domes. Conclusions: We found conservative bespoke or customised orthotic treatment to be effective for the improvement of plantar pressure under the central metatarsal heads.

Post-operative care for patients following surgical treatment of lymphedema.

Surgical treatments are promising for the treatment of lymphedema. It is important for patients, healthcare providers, and lymphedema community to understand that surgical treatments currently are not a cure for lymphedema but have provided promising options for patients. Post-operative care for patients following surgical treatment of lymphedema is vital to optimize and sustain patient outcomes. This expert-consensus statement addresses current practice and research needs for standardized post-operative care, a core set of outcome measures, quality of care, and training of healthcare providers. Current research and clinical practice support non-surgical lymphedema therapy, also known as conservative therapy of lymphedema (e.g., compression therapy, or manual lymph drainage, or Complete Decongestive Therapy) as an essential part of post-operative care. Importantly, patient education should focus on patients' understanding that surgery is not a cure and the importance to adhere to post-operative care and life-long self-monitoring to sustain surgical results of limb volume reduction, relief of symptoms, and mitigate known or ongoing risk factors for recurrence of lymphedema. To optimize patient outcomes, it is crucial to have a multidisciplinary professional team consisting of well-qualified and credentialed healthcare providers participating in ongoing training and education. The essentials recommended by this expert-consensus are an initial and foundational step to build clinical standards for best practice and provide directions for future research.

[Translated article] Rehabilitation and orthopaedic management of osteoporotic vertebral compression fractures. / Manejo rehabilitador y ortopédico de las fracturas por compresión vertebral osteoporótica.

Osteoporosis represents a public health problem that can be prevented and treated early through health education. Over time, screening techniques, diagnosis and treatments even conservative and surgical, have improved.Through this publication we want to highlight the importance of the medical and orthopedic management of these fractures, describing the benefit of diet and physical exercise as the protagonists of conservative treatment but above all its indications and contraindications, emphasizing the limitations of exercise in a vertebral osteoporotic fracture. The different orthoses prescriptions are also highlighted.

Endodontic Access Cavity Design and Fracture Resistance: A Systematic Review and Meta-Analysis of Conventional vs. Newer Access Cavity.

The era of minimally invasive dentistry has led to the development of new access cavity designs. The impact of various access cavity designs on the fracture resistance of teeth has been extensively studied. The primary aim of this systematic review and meta-analysis is to evaluate and compare the effects of recent modifications in endodontic access cavity design- specifically, conventional, conservative, and truss designs on tooth fracture resistance. Three independent reviewers searched studies across six different databases (PubMed, Scopus, EBSCOhost, BVS, Wiley, and Google Scholar) from January 2000 to July 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were then screened using strict inclusion and exclusion criteria. A quality assessment was performed using a modified version of the quality assessment of in-vitro studies according to the QUIN (Quality Assessment Tool For In Vitro Studies) tool, categorizing the selected articles into low, moderate, and high risk of bias. Quantitative data synthesis was conducted to combine equivalent results using STATA. Forest plots were created with the level of significance set at 0.05 (p = 0.05). Out of 243 articles, 14 met the strict inclusion criteria. Among the selected articles, 11 showed a low risk of bias and three showed a moderate risk. The meta-analysis revealed that fracture resistance of conservative and truss access designs is significantly higher than that of conventional endodontic access, with a standardized mean difference (SMD) of 2.61 (95% 1.47 to 3.74; p-values <0.001) and SMD = -1.26 (95% confidence interval (CI): -1.81 to 0-0.71; p<0.001). The heterogeneity (I²) values for these comparisons were 92% and 65.6%, respectively. The extent of the access cavity has a substantial impact on tooth fracture resistance. Newer conservative and truss endodontic access designs offer better fracture resistance compared to conventional endodontic access.

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial.

PURPOSE: This study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. METHODS: In this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. RESULTS: At all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). CONCLUSION: Ultrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy.

INTRODUCTION: Anal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period. METHODS: A survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic). RESULTS: Analysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66-75% of patients in cases of acute AF and 63-67% for chronic AF, while 10-15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time. CONCLUSIONS: This study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.

The value evaluation of Nomogram prediction model based on CTA imaging features for selecting treatment methods for isolated superior mesenteric artery dissection.

OBJECTIVE: To evaluate value of Nomogram prediction model based on CTA imaging features for selecting treatment methods for isolated superior mesenteric artery dissection (ISMAD). METHODS: Symptomatic ISMAD patients were randomly divided into a training set and a validation set in a 7:3 ratio. In the training set, relevant risk factors for conservative treatment failure in ISMAD patients were analyzed, and a Nomogram prediction model for treatment outcome of ISMAD was constructed with risk factors. The predictive value of the model was evaluated. RESULTS: Low true lumen residual ratio (TLRR), long dissection length, and large arterial angle (superior mesenteric artery [SMA]/abdominal aorta [AA]) were identified as independent high-risk factors for conservative treatment failure (P < 0.05). The receiver operating characteristic curve (ROC) results showed that the area under curve (AUC) of Nomogram prediction model was 0.826 (95% CI: 0.740-0.912), indicating good discrimination. The Hosmer-Lemeshow goodness-of-fit test showed good consistency between the predicted curve and the ideal curve of the Nomogram prediction model. The decision curve analysis (DCA) analysis results showed that when probability threshold for the occurrence of conservative treatment failure predicted was 0.05-0.98, patients could obtain more net benefits. Similar results were obtained for the predictive value in the validation set. CONCLUSION: Low TLRR, long dissection length, and large arterial angle (SMA/AA) are independent high-risk factors for conservative treatment failure in ISMAD. The Nomogram model constructed with independent high-risk factors has good clinical effectiveness in predicting the failure.

Conservative treatment of corpus callosum hemorrhage due to a falling coconut in Indonesia: a case report.

The potential for traumatic brain injury resulting from falling coconuts is frequently overlooked. These incidents can cause focal lesions in the form of brain hemorrhage. Corpus callosum hemorrhage due to blunt trauma from a falling object is rare and typically associated with poor prognosis. The purpose of this report is to detail a case of corpus callosum hemorrhage caused by a coconut fall and to discuss the conservative management approach employed. We report the case of a 54-year-old woman who was admitted to the hospital with symptoms of unconsciousness, headache, and expressive aphasia after being struck by a falling coconut. Notably, hemorrhage was detected within the body of the corpus callosum, as revealed by imaging findings. The patient received intensive monitoring and treatment in the intensive care unit, including oxygen therapy, saline infusion, an osmotic diuretic, analgesics, and medication to prevent stress ulcers. The patient demonstrated marked clinical improvement while undergoing conservative treatment. Despite the typically unfavorable prognosis of these rare injuries, our patient exhibited meaningful clinical improvement with conservative treatment. Timely diagnosis and appropriate interventions were crucial in managing the patient's condition. This report emphasizes the importance of considering traumatic brain injury caused by falling coconuts and highlights the need for further research and awareness in this area.

Age Is a Key Factor Influencing the Choice of Treatment for Primary Patellar Dislocation: A Systematic Review and Meta-analysis.

Primary patellar dislocation has a certain recurrence rate after either conservative or surgical treatment, and the optimal treatment for patients with primary patellar dislocation of different ages remains unclear. This study aims to compare the clinical efficacy of surgical and conservative treatments for primary patellar dislocation across different age groups. According to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist, we conducted a systematic search for randomized controlled trials. We searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases for randomized controlled trials of primary patellar dislocation treated surgically or conservatively up to January 2023. Data searching, extraction, analysis, and quality assessment were carried out in accordance with the Cochrane Collaboration guidelines. A total of nine studies with 433 patients were included in our study. There was no statistically significant difference between the two treatment modalities in terms of Kujala score, pain score, patient satisfaction, reoperation, and Tegner score. The rate of re-dislocation after surgical treatment is lower than that after conservative treatment. Subgroup analysis based on mean age showed that when the age was >20 years, Kujala scores were higher after surgical treatment than after conservative treatment (p < 0.0001, 95% confidence interval [CI] = 10.41-21.30). When the age was ≤20 years, the difference in Kujala scores between the two treatment modalities was not statistically significant. When the age was >20 years, the recurrence rate of patellar dislocation was lower after surgical treatment than after conservative treatment (p = 0.009, 95% CI = 0.08-0.70). When the age was ≤20 years, the difference in the recurrence rate of patellar dislocation between the two treatment modalities was not statistically significant. When the age of patients with primary patellar dislocation is ≤20 years, both surgical and conservative treatments result in similar clinical outcomes. When the age is >20 years, better clinical outcomes can be achieved by opting for surgical treatment. Therefore, surgery may be a better option for patients with primary patellar dislocation whose age is >20 years.

Comparison of surgical and conservative therapy in older patients with distal radius fracture: a prospective randomized clinic al trial.

INTRODUCTION: The distal radius fracture is considered the most common fracture in humans. For fractures classified as Arbeitsgemeinschaft für Osteosynthese (AO) 23-C1 + C2, there is no consensus on treatment in older patients due to inconsistent study results. The aim of this study was to compare conservative and surgical treatment in relation to wrist function and satisfaction in patients older than 65 years. METHODS: In this prospective randomized clinical trial, patients aged older than 65 years who suffered an isolated AO-classified C1 or C2 distal radius fracture were randomized to surgical treatment using palmar plate osteosynthesis or conservative treatment. Patient-rated wrist evaluation (PRWE) score and disabilities of arm, shoulder, and hand (DASH) was assessed 3, 6 and 12 months post-interventionally. Satisfaction, range of motion (ROM) and pain scores were evaluated at 6 weeks and 3, 6 and 12 months post-interventionally. RESULTS: A total of 80 patients with a mean age of 77.3 years (± 6.1 years) in the conservative group and 72.5 years (± 5.3 years) in the surgery group were included. Both the PRWE score, and the DASH score showed a statistically significant difference between the two groups after 3 months, 6 months and 12 months (p < 0.001). Patients in the surgical cohort showed a statistically significant higher satisfaction at the 6-week, 6-month and 12-month follow-up (p < 0.001 6 weeks + 12 months; p = 0.004 6 months). CONCLUSION: In this prospective randomized study, surgical treatment proved to be superior to conservative treatment in terms of the primary outcome variable PRWE score. Satisfaction was significantly better in the surgical group.

Conservative treatment in uterine perivascular epithelioid cell tumor of uncertain malignant potential: a case report.

INTRODUCTION: Perivascular epithelioid cell tumors are uncommon mesenchymal tumors. The genital tract is the most common extrarenal location. Preoperative diagnosis is rarely achieved owing to non-specific symptoms and imaging features. Consensus on treatment strategies remains elusive. Case presentation We report the case a 38 year-old north African woman with a primary sterility, who was diagnosed with a uterine Perivascular epithelioid cell tumor of uncertain malignant potential on a resection specimen of an intracavity polypoid mass. Immunohistochemistry confirmed the diagnosis and we opted for conservative surgery to preserve the patient's fertility desires. CONCLUSION: Uterine perivascular epithelioid cell tumor is a rare entity that warrants consideration in the differential diagnosis of uterine tumors. Treatment modalities, follow-up protocols, and prognosis remain ambiguous. Given their unpredictable behavior, accurate diagnosis and long-term monitoring are imperative.

Cystic dysplasia of the rete testis in adulthood: a case report and review of the literature.

Background: Rete testis dysplasia is a cystic anomaly arising from the rete testis presenting normally in the pediatric population. These cases usually regress spontaneously without the need for surgical intervention. There are rare, reported cases of rete testis dysplasia in adulthood, which have been managed surgically. Case presentation: A 58-year-old man presented with lower urinary tracts symptoms and found to have a slightly larger right testicle namely in the lower pole near the epididymis. Investigation was done using ultrasound of the testicles with Doppler showing an 8 mm cyst contained in 16.5×12.1 mm cystic dysplasia near the rete testis. MRI of the testicles revealed a small intratesticular cyst with adjacent band-like signals, in keeping with rete testis dysplasia. This patient was placed under surveillance and the rete testis dysplasia is stable after 6 months and will not be operated on unless progression on ultrasound is encountered. Clinical discussion: The management of cystic dysplasia of the rete testis has been evolving with time. While there have never been clear-cut guidelines on the treatment of this condition, a radical orchiectomy of the affected testicle had traditionally been the preferred treatment option. There have only been three case reports of cystic dysplasia of the rete testis in adults, none of which are known to have been managed by observation. Conclusion: In conclusion, the authors report a unique case of rete testis dysplasia being managed conservatively showing the benign features of such a pathology, which may be actively surveyed through sequential imaging.

Patient preferences for conservative treatment of shoulder pain: a discrete choice experiment.

BACKGROUND: Shoulder pain is common amongst adults, but little is known about patients' preferences. OBJECTIVE: The aim of this study was to determine patients' preferences for treatment options offered for shoulder pain in primary care. METHODS: A discrete choice experiment was used to investigate these preferences. Adults with shoulder pain were asked to make 12 choices between two treatment options, or to opt-out. The attributes of the 12 treatment options were presented as varying in: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), prevention of relapse (yes/no), requiring injection (yes/no), and including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model. RESULTS: Three hundred and twelve participants completed the questionnaire with mean age of 52 ±â€…15.2 years. Latent class analysis revealed three groups. Group 1 preferred to opt-out, unless the attributes were highly favorable (90% effectiveness). Group 2 preferred treatment, but not an injection. Group 3 preferred to opt-out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again. CONCLUSION: This study showed that most patients with shoulder pain prefer to opt-out, unless treatment attributes are highly favorable. Characteristics of influence on this decision was whether the patient had received an injection or physiotherapy before.

Conservative management of brain arteriovenous malformations: results of the prospective observation registry of a pragmatic trial.

OBJECTIVE: Many patients recruited in the Treatment of Brain Arteriovenous Malformations Study (TOBAS) are managed conservatively. The aim of this study was to monitor what happened to those patients. METHODS: TOBAS comprises two randomized controlled trials and multiple prospective registries. All patients with brain arteriovenous malformations (AVMs) can participate. This report concerns patients selected for conservative management. The primary trial outcome measure is related death or dependency (modified Rankin Scale [mRS] score > 2) at 10 years. Secondary outcomes include intracranial hemorrhages, nonhemorrhagic neurological events, and serious adverse events (SAEs). For this report, outcome results are presented using patient-years, Kaplan-Meier survival curves, and Cox log-rank tests. There was no blinding. RESULTS: From June 2014 to May 2021, 1010 patients were recruited, of whom 498 (49%) were proposed the prospective observation registry. After exclusions, 434 (87%) patients remained for analysis. The majority of patients had unruptured AVMs (378/434 [87%]), of which 195 (52%) were low grade (Spetzler-Martin grade I or II). During a mean follow-up period of 3.2 years (total 1368 patient-years), the primary outcome occurred in 23 of 434 (5%) patients, corresponding to an incidence of 1.7 (95% CI 1.1-2.5) per 100 patient-years. For unruptured AVMs the incidence was 1.1 (95% CI 0.7-1.9) per 100 patient-years, and for low-grade unruptured AVMs it was 0.6 (95% CI 0.2-1.7) per 100 patient-years. Poor outcomes were more frequent in patients with a history of rupture (HR 5.6 [95% CI 2.4-13.0], p < 0.001), infratentorial AVMs (HR 2.9 [95% CI 1.1-7.3], p = 0.027), and age ≥ 55 years (HR 3.2 [95% CI 1.4-7.6], p = 0.007). Major intracranial hemorrhage occurred in 35 of 434 (8%) patients (incidence of 2.6 [95% CI 1.9-3.6] per 100 patient-years; 2.0 [95% CI 1.3-2.9] per 100 patient-years for unruptured AVMs and 1.3 [95% CI 0.6-2.6] per 100 patient-years for low-grade unruptured AVMs). Major AVM hemorrhages were more frequent in ruptured (HR 4.4 [95% CI 2.1-8.9], p < 0.001), large (HR 2.6 [95% CI 1.1-6.6], p = 0.039), and high-grade (HR 2.5 [95% CI 1.2-5.3], p = 0.013) AVMs and those with deep venous drainage (HR 2.1 [95% CI 1.1-4.2], p = 0.032). SAEs occurred in 48 of 434 (11%) patients (incidence of 3.6 [95% CI 2.7-4.8] per 100 patient-years). For unruptured AVMs the incidence was 2.8 (95% CI 2.0-4.0) per 100 patient-years, and for low-grade unruptured AVMs it was 1.8 (95% CI 1.0-3.2) per 100 patient-years. CONCLUSIONS: Nearly half of TOBAS participants were observed. Rates of untoward neurological events were within expected boundaries.

Rehabilitation and orthopedic management of osteoporotic vertebral compression fractures. / Manejo rehabilitador y ortopédico de las fracturas por compresión vertebral osteoporótica.

Osteoporosis represents a public health problem that can be prevented and treated early through health education. Over time, screening techniques, diagnosis and treatments even conservative and surgical, have improved. Through this publication we want to highlight the importance of the medical and orthopedic management of these fractures, describing the benefit of diet and physical exercise as the protagonists of conservative treatment but above all its indications and contraindications, emphasizing the limitations of exercise in a vertebral osteoporotic fracture. The different orthoses prescriptions are also highlighted.

Spontaneous regression of a petroclival meningioma: illustrative case.

BACKGROUND: Spontaneous regression is relatively rare in meningiomas. Since meningiomas are known to have a relationship with sex-related hormones, spontaneous regression cases related to sex hormones have been reported. OBSERVATIONS: A 66-year-old man with a petroclival meningioma was radiologically followed up for 13 years. The tumor initially measured 2.535 cm3 and 2.521 cm3 on gadolinium-enhanced magnetic resonance imaging (MRI) and fast imaging employing steady-state acquisition MRI, respectively. However, the measurements decreased in the follow-up period to 0.977 cm3 and 0.98 cm3, respectively, demonstrating spontaneous regression of an asymptomatic meningioma located in a petroclival area. Continuous meticulous long-term follow-up revealed this phenomenon. LESSONS: It is important to retain the option of conservative treatment for patients ineligible for surgery for reasons such as advanced age and coexisting diseases. https://thejns.org/doi/10.3171/CASE24416.

A choice experiment of older patients' preferences for kidney failure treatments.

Most older people with kidney failure choose between treatment with dialysis or conservative kidney management. The preferences underlying these decisions are poorly understood. Here, we performed a choice experiment, informed by qualitative research, to examine preferences for the characteristics of dialysis and conservative management among over-65-year-olds with eGFR of 20 mls or under/min/1.73m2. Mixed logit and latent class analyses quantified the trade-offs between frequency and location of treatments, survival, and capability (the ability to do important activities), accounting for participants' characteristics. Overall, 327 United Kingdom participants across 23 centers (median age 77 years, eGFR 14 mls/min/1.73m 2) needed 8%-59% absolute survival benefit two years after starting treatment to accept dialysis, with preferences for less frequent treatment and treatment at home. Significantly higher preferences for survival were seen amongst partnered participants (effect size 0.04, 95% confidence interval 0.02-0.06) and if better levels of capability were depicted (effect size 0.02, 0.01-0.03). Three latent classes were identified with divergent preferences for survival, capability, and location of care. Stated preferences indicated participants favored higher survival probabilities, but only if their capability was preserved and the location and frequency of care were acceptable. Subgroups may prioritize survival, hospital avoidance, or in-center care. Clinicians supporting people making kidney failure treatment decisions must explore their goals and values. Thus, investment in services that prioritize capability and ensure treatment is delivered at a frequency acceptable to people in their preferred location would enable provision of preference sensitive care.

Global Ecosystem Nitrogen Cycling Reciprocates Between Land-Use Conversion and Its Reversal.

Anthropogenic land-use practices influence ecosystem functions and the environment. Yet, the effect of global land-use change on ecosystem nitrogen (N) cycling remains unquantified despite that ecosystem N cycling plays a critical role in maintaining food security. Here, we analysed 2430 paired observations globally to show that converting natural to managed ecosystems increases ratios of autotrophic nitrification to ammonium immobilisation and nitrate to ammonium, but decreases soil immobilisation of mineral N, causing increased N losses via leaching and gaseous N emissions, such as nitrous oxide (e.g., via denitrification), resulting in a leaky N cycle. Changing land use from intensively managed to one that resembles natural ecosystems reversed N losses by 108% on average, resulting in a more conservative N cycle. Structural equation modelling revealed that changes in soil organic carbon, pH and carbon to N ratio were more important than changes in soil moisture content and temperature in predicting ecosystem N retention capacities following land-use conversion and its reversion. The hotspots of leaky N cycles were mostly in equatorial and tropical regions, as well as in Western Europe, the United States and China. Our results suggest that whether an ecosystem exhibits a conservative N cycle after land-use reversion depends on management practices.

Pelvic floor muscle training for urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life after hysterectomy: a systematic review with meta-analyses.

BACKGROUND: After hysterectomy, women could experience pelvic floor dysfunction and negative impact on quality of life, which could be improved by pelvic floor muscle training. OBJECTIVE: To investigate effects of pelvic floor muscle training on urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life after hysterectomy. METHODS: Systematic review with meta-analyses of randomized controlled trials. Trials with pelvic floor muscle training in women after hysterectomy were included. The outcomes measures were urinary symptoms, vaginal prolapse, sexual function, pelvic floor muscle strength, and quality of life. Quality of evidence was assessed by adopting the GRADE approach. RESULTS: Six trials, involving 776 participants, were included. The mean PEDro score of trials was 5.5. Moderate-quality evidence suggested that pelvic floor muscle training improves sexual function by 5 points (95% CI: 4, 6) on the Female Sexual Function Index, compared with no intervention. It might affect strength (SMD 0.5; 95% CI: -0.4, 1.3), quality of life (SMD 0.5 points out of 108, 95% CI: -0.1, 0.9), urinary symptoms (RD -0.02; 95% CI: -0.06, 0.1); however, the estimates were too imprecise. In addition, it produces no or negligible effects on vaginal prolapse (RD 0; 95% CI: -0.1, 0.1). Long-term effects remain uncertain. CONCLUSION: This systematic review provides moderate-quality evidence that pelvic floor muscle training is effective for improving women's sexual function after hysterectomy, in comparison with no intervention. Benefits on urinary symptoms, pelvic floor muscle strength, quality of life, and vaginal prolapse remains unclear. Also, the effects beyond the intervention period remains uncertain.

Omental incarceration secondary to uterine perforation after dilatation curettage: Conservative approach in sub-saharan Africa.

Key Clinical Message: Complications of uterine perforation and herniation of intra-abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Abstract: Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002-1.7. A 30-year-old multiparous case with a 7-week 4-day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.