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Risk management has reduced vulnerability to floods and droughts globally 1,2 , yet their impacts are still increasing 3 . An improved understanding of the causes of changing impacts is therefore needed, but has been hampered by a lack of empirical data 4,5 . On the basis of a global dataset of 45 pairs of events that occurred within the same area, we show that risk management generally reduces the impacts of floods and droughts but faces difficulties in reducing the impacts of unprecedented events of a magnitude not previously experienced. If the second event was much more hazardous than the first, its impact was almost always higher. This is because management was not designed to deal with such extreme events: for example, they exceeded the design levels of levees and reservoirs. In two success stories, the impact of the second, more hazardous, event was lower, as a result of improved risk management governance and high investment in integrated management. The observed difficulty of managing unprecedented events is alarming, given that more extreme hydrological events are projected owing to climate change 3 ., (© 2022. The Author(s).)

Background: The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis., Methods: This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients' data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN., Results: The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%., Conclusions: The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.

Laparoscopic pectopexy has been described recently for pelvic organ prolapse (POP) and it could be an alternative surgery to sacrohysteropexy. A 36-year-old parity 3 women was operated cause of POP, and on her history, she had performed one sacrospinous ligament fixation with colporrhaphy anterior and one abdominal sacrohysteropexy because of POP. After 6-month follow-up, anatomic and functional cures were provided. Laparoscopic pectopexy could be an alternative procedure for recurrent POP surgery with promising results., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Gynecology and Minimally Invasive Therapy.)

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, β-hCG level, the type of scar pregnancy and the clinical status of the patient. IMPACT STATEMENT What is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity. What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies. What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP.

The aim of this study was to evaluate the morphometric and immunohistochemistry in umbilical cords from patients with severe pre-eclampsia with and without haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. The patient and control groups were similar according to baseline obstetric characteristics. White blood cell count in patients with HELLP syndrome and the control group was significantly increased among patients with HELLP syndrome ( p < 0.001). Morphometric examination and endothelial core length were significantly different between the groups. In the umbilical cord cross-section of the HELLP group, endothelial cell degeneration in the vessel wall and basement membrane thickening were observed. In the muscle layer of blood vessels, the following disorders were found: increased collagen fibres in the muscle cell, hyperplasia and separation of muscle fibres as well as edema in the intermediate connective tissue. Immunohistochemical analysis showed that endothelial cells, basal membrane and fibroblast cells in the HELLP group expressed high levels of CD44. Vessel wall and amniotic epithelial basement membrane thickening were observed in the HELLP group. Matrix metalloproteinase 9 (MMP9) was expressed. Fibroblast and smooth muscle cells were fusiform and showed a positive reaction to immunohistochemical staining of α -actin smooth muscle.

Objectives: The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long-term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse., Methods: PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence Questionnaire-Vaginal Symptoms before and after operation., Results: The average follow-up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively)., Conclusion: PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly., (© 2012 Wiley Publishing Asia Pty Ltd.)