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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. [ABSTRACT FROM AUTHOR]

This is Part 3 of a trio of papers that unify in a natural way the two historically distinct parallel discrete event synchronization paradigms, optimistic and conservative, combining the best properties of both into a single framework called Unified Virtual Time (UVT). In this part, we survey the synchronization effects that can be achieved by restricting to corner cases the relationships permitted among the control variables, GVT, CVT, TVT, and LVT, which were defined in Part 1. We also survey various throttling policies from the literature and describe how they can be implemented in UVT by controlling the value of TVT, including policies that can take advantage of rollback in addition to LP blocking. A significant result is a new category of efficient and higher precision throttling algorithms for optimistic execution that are based on optimistic lookahead, defined in a way that is symmetric to what we now call the conservative lookahead information that is traditionally used for conservative synchronization. Finally, we present a novel algorithm allowing the choice between lazy and aggressive cancellation to be made on a message-by-message basis using either external logic expressed in the model code, or policy code internal to the simulator, or a mixture of both. [ABSTRACT FROM AUTHOR]

Background: Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment. Methods: Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes. Result: A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I2 = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I2 = 0%). Conclusion: Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications. [ABSTRACT FROM AUTHOR]

Emphysematous pyelonephritis (EPN) is a severe, life-endangering, necrotising, gas-producing infection affecting the kidney and perinephric tissue. It is associated with renal loss, high morbidity, and mortality. Diabetes, obstructive uropathy, female gender and hypertension are the most common risk factors. Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are the most common pathogens causing Emphysematous pyelonephritis. EPN presents as a clinical triad of fever, flank pain, and nausea. Non-contrast CT scan is the mainstay of early diagnosis of EPN. It is diagnosed by demonstrating gas in renal parenchyma and perinephric tissue. Huang and Sang's classification is used for the classification and management of EPN. Treatment of EPN progressed from early nephrectomy to minimally invasive treatments including newer and advanced antibiotics and percutaneous drainage along with Percutaneous nephrostomy and DJ stenting. Early nephrectomy was the treatment of choice in the last century however newer studies suggest conservative treatment is associated with renal preservation, decreased morbidity and mortality. The initial use of broad-spectrum antibiotics such as Third-or fourth generation cephalosporins and carbapenems is recommended. Emergency drainage is indicated with a larger-sized pigtail catheter as pus is thick and frequent blockage of tubes is common. Nephrectomy should be done for those patients who fail to respond to conservative therapy i.e., antibiotics and percutaneous drainage. This review aims to provide comprehensive, evidence-based recommendations for the diagnosis and management of this life-threatening urological infection Emphysematous pyelonephritis. [ABSTRACT FROM AUTHOR]

Self‐service technologies are widely used in business, and retailers and service firms invest significant resources to obtain and improve their Self‐Service Technology capabilities. To allocate resources efficiently, it is crucial for firms to predict Self‐Service Technology usage by their customers. However, predictors in the extant literature (e.g., customers' perceptions and personality traits) are not easy to objectively measure or obtain secondary data about. This research proposes and examines political ideology, for which fairly accurate and objective data can be obtained, as a novel predictor of customer Self‐Service Technology usage. In four studies in different contexts, the authors consistently find that political ideology is significantly related to customers' intention to use and actual use of Self‐Service Technologies; Liberals, on average, are found to be significantly more likely to use Self‐Service Technologies compared to conservatives. Moreover, process complexity is identified as a moderator of this effect. In addition, two mediators, customers' need for interaction and customers' perceived control, through which political ideology affects intention to use Self‐Service Technologies are uncovered. The manuscript concludes with a discussion of contributions and practical implications for managers and practitioners as well as avenues for future research. [ABSTRACT FROM AUTHOR]

Spontaneous pneumothorax is an increasingly common clinical presentation, the management of which, until recent years, had remained unchanged for decades. A recent surge in pneumothorax research has produced the largest randomised controlled trials in the field yet and has revolutionised the management of spontaneous pneumothorax. The body of evidence supporting the introduction of conservative and ambulatory care in appropriate patients in recent guidelines now allows these patients, many of whom would otherwise have been admitted to hospital, to be managed in the outpatient setting and reduces their risk of complications compared to conventional chest drain insertion. In this review, we discuss recent advances in the management of pneumothorax and the evidence underpinning contemporary guidelines. We aim to equip physicians with the knowledge to engage their patients in the decision-making process regarding their pneumothorax, whilst keeping patient safety and patients' own preferences at the centre of their care. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups. Methods: A prospectively registered (ISRCTN95922938) randomized parallel group trial will be conducted. Elderly patients meeting the inclusion criteria with a dorsally displaced distal radius facture will be randomized (1:1 ratio) to either conservative management (cast without further manipulation) or surgery. Patients will be assessed at six, 12, 26 weeks, and 52 weeks post intervention. The primary outcome measure and endpoint will be the Patient-Rated Wrist Evaluation (PRWE) at 52 weeks. In addition, the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH), EuroQol five-dimension questionnaire, pain score (visual analogue scale 1 to 10), complications, grip strength (dynamometer), range of motion (goniometer), and radiological assessments will be undertaken. A cost-utility analysis will be performed to assess the cost-effectiveness of surgery. We aim to recruit 89 subjects per arm (total sample size 178). Discussion: The results of this study will help guide treatment of dorsally displaced distal radial fractures in the elderly and assess whether surgery offers functional benefit to patients. This is an important finding, as the number of elderly distal radial fractures is estimated to increase in the future due to the ageing population. Evidence-based management strategies are therefore required to ensure the best outcome for the patient and to optimize the use of increasingly scarce healthcare resources. Cite this article: Bone Jt Open 2024;5(10):920–928.

Abstract Background Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment. Methods Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes. Result A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I2 = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I2 = 0%). Conclusion Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.

Abstract Background Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures. Methods This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate. Result Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%). Conclusion

Introduction: Acute appendicitis (AA) represents the most frequent surgical emergency. Perforation was long considered the ultimate outcome of AA, prompting appendectomy; which remains the standard treatment. New data have clarified the role of the appendix, justifying conservative treatment. This narrative review aims to summarize the evidence regarding the non-operative treatment (NOT) of AA in adults. Methods: The literature search was performed via the PubMed Medline database. Our criteria-based selection resulted in a total of 48 articles for review. Results: Recent trials and meta-analyses have assessed NOT, which support primary antibiotic treatment of uncomplicated AA. Although it has a significant recurrence and failure rate, NOT does not appear to increase the risk of appendicular perforation. Moreover, NOT compared with appendectomy, seems to be associated with less morbidity, lower cost of care and preserved quality of life. Conclusion: First-line NOT seems to be a reasonable approach for the treatment of uncomplicated CT-confirmed AA. Careful patient screening would definitely enhance the success rate.

Introduction: Treatment of proximal humerus fractures remains controversial. Understanding the factors that can affect the long-term functional outcomes can aid with management choices. This primary aim of this paper is to evaluate the association of radiographic parameters with functional outcomes. Methods: Radiographic parameters [Caput-collum-diaphyseal (CCD) angles, Y-scapular angles, and humeral head height (HHH)] were studied. The patients were split into varus and valgus groups based on the CCD angles and retroverted and anteverted groups based on Y-scapular angles. Functional outcome was measured by Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), and quick Disabilities of Arm, Shoulder and Hand score at 1 year follow-up. Intra- and interrater reliability were measured with the intraclass correlation coefficients (ICCs). Receiver operator curve (ROC) analysis and logistic regression analysis defined the optimal value for abnormalities on radiographic evaluation as an outcome predictor. Results: 111 patients were recruited (mean age 69, 78% female). Median final radiographic assessment was at 7 months. Mean initial/final CCD was 119o /111o (varus, n = 36) and 153o/140o (valgus, n = 75). Mean initial/final Y-scapula angle was 27o/27o (retroversion, n = 101) and 70o/40o (anteversion, n = 9). There was a significant relationship between OSS and final Y-scapular angle in the retroverted group (adj coeff 0.034, p = 0.009) with optimum predictive retroversion angulation of 25o predicting poor functional outcome (OSS < 40), area under the ROC curve of 0.614. Higher initial valgus and retroversion significantly predicted more change in the final angle (adj coeff − 0.349, p = 0.002, adj coeff − 0.527, p < 0.001 respectively). Both intra-rater and inter-rater reliability for the radiographic parameters were excellent (ICC > 0.9). Conclusion: Radiographic parameters whilst having excellent reliability, have a limited ability to predict short-term functional recovery. The extent of retroversion is the most important predictor for functional recovery with 25o a cut-off guide. Fractures with a higher initial valgus and retroversion tend to displace more. [ABSTRACT FROM AUTHOR]

Introduction: Non-operative treatment (NOT) of proximal humerus fractures (PHF) has regained significance due to recent evidence. Additionally, positive outcomes of plate osteosynthesis and fracture arthroplasty prompt a reassessment of the role of intramedullary nailing (IMN). While favorable short and medium-term results have been documented following IMN, little is known regarding functional outcomes and quality of life in the long-term. Methods: Data from 180 patients with dislocated PHF of Neer types III, IV and V, treated at our level-I trauma center between 2004 and 2014 using IMN or NOT therapy, were scanned. Patients were re-evaluated after a minimum of 5 years to assess functional outcomes (age- and sex-adapted Constant Score, QuickDASH), quality of life (SF12), and complications or reoperations. Results: Out of the initially identified 180 patients, 51 were unavailable for follow-up (FU) and 71 had deceased during the FU period. Functional outcomes and quality of life was, therefore, assessed in 58 patients (30 IMN, 28 NOT) with an average age at injury of 68 years after a mean FU time of 10.3 ± 3.4 years. Epidemiological patient characteristics did not exhibit significant differences between the two groups (p >.05). The functional outcome assessed by age- and sex-adapted Constant Score (NOT: 74 ± 28; IMN: 68 ± 24; p =.438), QuickDASH (NOT: 25 ± 27; IMN: 31 ± 23; p =.374) or quality of life using the SF12 (p >.05) revealed no significant disparities in long-term outcomes between the treatment groups. 10 of 30 patients in the IMN group underwent surgical revision to address complications, exceeding mere implant removal. Conversely, no patient in the NOT group underwent a revision surgery during the FU period. Conclusions: In the long-term, functional and quality of life-related outcomes of IMN did not diverge significantly from those of NOT, while causing a higher incidence of follow-up interventions. Highlights: • Comparing intramedullary nailing to non-operative treatment of Neer type III - V proximal humerus fractures, there was no significant difference in long-term functional outcome. • Revision rates were significantly higher in the surgically treated patient group. • Irrespective of the treatment modality long-term functional outcomes were significantly worse in fractures with more than two key fragments according to the Codman Classification. [ABSTRACT FROM AUTHOR]

This article focuses on the finite‐time mixed ℋ∞$$ {\mathscr{H}}_{\infty } $$ and passive filtering problem for discrete‐time singular systems with randomly occurring nonlinear perturbations. The main purpose is to design a filter, which ensures the singular error system is stochastically finite‐time bounded and satisfies mixed ℋ∞$$ {\mathscr{H}}_{\infty } $$ and passive performance. By constructing an augmented matrix, the properties of matrix determinant and rank are used to prove that the singular system is regular and causal, Finsler's lemma and Projection lemma are used in the design process to acquire additional slack variable matrices, thereby enhancing the solution space with extra degrees of freedom. Then, the unknown parameters of the filter are obtained by solving the less conservative linear matrix inequalities. Finally, the feasibility of the proposed method is verified through a common numerical example and by controlling a DC motor for an inverted pendulum. [ABSTRACT FROM AUTHOR]

Aim: Hallux valgus is a common foot deformity that causes significant pain and functional impairment. This study aimed to compare the effectiveness of prolotherapy and dry needling in treating mild to moderate hallux valgus pain. Material and Methods: Patients with hallux valgus deformity experiencing refractory pain after orthotic and analgesic treatment, and treated with prolotherapy (52 patients, 68 feet) or dry needling (49 patients, 57 feet) methods were included in the study. Each group received three treatment sessions at 3-week intervals. Clinical assessments were performed using the visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores at baseline, in the third month, and twelfth month. Results: Both groups showed significant improvement in VAS and AOFAS scores after treatment (p<0.001). In the prolotherapy group, the VAS score decreased from 6 (range, 4-8) in the pre-treatment period to 2 (range, 1-5) both in the third and twelfth months (p<0.001). In the dry needling group, the VAS score decreased from 6 (range, 4-7) in the pre-treatment period to 4 (range, 2-7) both in the third and twelfth months (p<0.001). While the AOFAS scores improved to 75 (range, 63-85) in the third month and 76 (range, 60-80) in the twelfth month in the prolotherapy group (p<0.001), improved to 56 (range, 44-75) in the third month and 50 (range, 36-75) in the twelfth month in the dry needling group (p<0.001). Conclusion: Both prolotherapy and dry needling effectively treat hallux valgus pain and improve foot function, with prolotherapy showing superior effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the remineralization effect of NaF, NaF with TCP, NaF with CPP‐ACP and NaF with CXP varnishes on newly erupted first permanent molars using laser fluorescence (LF) method. The study was a randomized, double‐blind, controlled trial with four parallel groups. Methods: The study was carried out in 48 high caries‐risk children (DMFS >8), aged 6–7 years with newly erupted permanent first molars (initial lesion with 13 < LF value<30). A total of 140 teeth were divided randomly into four groups (n = 35): G1.Duraphat Varnish containing 5% NaF, G2. Clinpro™ White Varnish containing 5% NaF with TCP, G3.Embrace™ Varnish containing 5% NaF with CXP, G4. MI Varnish containing 5% NaF with CPP‐ACP. All dental treatments of the patients were completed before the varnish application. The varnishes were applied to the targeted teeth at baseline, 1 and 3 months. Patients were called for follow‐up appointments at 1, 3 and 6 months, and LF scanning was used to monitor mineralization changes. Data were analysed statistically by Wilcoxon signed‐rank and Mann–Whitney U‐tests. Results: In total, 40 children (122 teeth) completed the trial. At the end of 6 months, the amount of reduction in LF values (indicating remineralization) are as follows: NaF with CXP(6.87 ± 4.32) < NaF with TCP(7.36 ± 7.05) < NaF(7.40 ± 7.03) < NaF with CPP‐ACP(8.33 ± 4.90). All of the varnishes resulted in significant decrease in LF measurements and there was no significant difference between control (NaF alone) group and other groups. Only MI varnish had a significantly greater remineralization effect than Embrace™ Varnish (p < 0.05). Conclusion: As a non‐invasive approach, CPP‐ACP, TCP and CXP containing NaF varnishes have the potential to remineralize initial caries lesions on permanent first molars in high caries‐risk children. [ABSTRACT FROM AUTHOR]

Background and Aims A routine invasive strategy is recommended in the management of higher risk patients with non-ST-elevation acute coronary syndromes (NSTE-ACSs). However, patients with previous coronary artery bypass graft (CABG) surgery were excluded from key trials that informed these guidelines. Thus, the benefit of a routine invasive strategy is less certain in this specific subgroup. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. A comprehensive search was performed of PubMed, EMBASE, Cochrane, and ClinicalTrials.gov. Eligible studies were RCTs of routine invasive vs. a conservative or selective invasive strategy in patients presenting with NSTE-ACS that included patients with previous CABG. Summary data were collected from the authors of each trial if not previously published. Outcomes assessed were all-cause mortality, cardiac mortality, myocardial infarction, and cardiac-related hospitalization. Using a random-effects model, risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results Summary data were obtained from 11 RCTs, including previously unpublished subgroup outcomes of nine trials, comprising 897 patients with previous CABG (477 routine invasive, 420 conservative/selective invasive) followed up for a weighted mean of 2.0 (range 0.5–10) years. A routine invasive strategy did not reduce all-cause mortality (RR 1.12, 95% CI 0.97–1.29), cardiac mortality (RR 1.05, 95% CI 0.70–1.58), myocardial infarction (RR 0.90, 95% CI 0.65–1.23), or cardiac-related hospitalization (RR 1.05, 95% CI 0.78–1.40). Conclusions This is the first meta-analysis assessing the effect of a routine invasive strategy in patients with prior CABG who present with NSTE-ACS. The results confirm the under-representation of this patient group in RCTs of invasive management in NSTE-ACS and suggest that there is no benefit to a routine invasive strategy compared to a conservative approach with regard to major adverse cardiac events. These findings should be validated in an adequately powered RCT. [ABSTRACT FROM AUTHOR]

Objective: Chronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment. Methods: Data were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment. Results: In this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n = 5, 6%), 1 (n = 43, 52%), and 2 (n = 35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10 mL; 95% confidence interval [CI] 0.64–0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61–6.69). Conclusions: Three quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices. [ABSTRACT FROM AUTHOR]

Background: Renal abscess (RA) is rarely seen in the paediatric age group. The proposed management protocols are mainly derived from the adult series which may not be appropriate in children. Objective: In this retrospective analysis of cases with renal and perinephric abscesses, the objective is to correlate the clinical presentation, radiological findings and treatment options and also to propose a paediatric-specific practical management algorithm. Study design: This is a retrospective study of cases with renal and perinephric abscesses admitted between March 2012 and February 2020. The patients were reviewed for demographics, presentation, predisposing factors, laboratory investigations, imaging, management and outcome. Results: Analysis of 12 paediatric patients (13 renal units) with RA (median age 4 years) was done. Organisms were isolated in 8 of 12 (66.6%) patients with Gram-negative organisms being the commonest. On admission, all patients were started on empirical broad-spectrum antibiotics. Except for two patients who were critically ill with frank sepsis and had a tender renal lump, the rest of them were initially offered conservative management with intravenous antibiotics, and the response was reviewed after 48–72 hours. Of five units with abscess size of ⩽3 cm, two units (40%) responded to conservative management, while three units (60%) required intervention, and of eight units of size >3 cm, three units (37.5%) responded to conservative management and five units (62.5%) required intervention. None of the abscesses with perinephric collection (30.7%) responded to antibiotics and required intervention. Conclusion: A protocol based on the size of RA as recommended in most of the adult series may not be appropriate in the paediatric age group because of the differences in clinical presentation, predisposing factors and immune response. The clinical condition on presentation, response to antibiotic therapy and the presence of perinephric collection should be considered as an important determinant in deciding the need for intervention. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

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Background: Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures. Methods: This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate. Result: Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%). Conclusion: [ABSTRACT FROM AUTHOR]

Background: Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods: A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results: Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p < 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT‐scan groups, respectively (p < 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT‐scan (4.1%) (p < 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4–6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). Conclusion: The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low‐resource settings worldwide. CT‐scan association may improve the detection of patients who may potentially be submitted to conservative treatment. [ABSTRACT FROM AUTHOR]

Acute appendicitis (AA) represents the most frequent surgical emergency. Perforation was long considered the ultimate outcome of AA, prompting appendectomy; which remains the standard treatment. New data have clarified the role of the appendix, justifying conservative treatment. This narrative review aims to summarize the evidence regarding the non-operative treatment (NOT) of AA in adults. The literature search was performed via the PubMed Medline database. Our criteria-based selection resulted in a total of 48 articles for review. Recent trials and meta-analyses have assessed NOT, which support primary antibiotic treatment of uncomplicated AA. Although it has a significant recurrence and failure rate, NOT does not appear to increase the risk of appendicular perforation. Moreover, NOT compared with appendectomy, seems to be associated with less morbidity, lower cost of care and preserved quality of life. First-line NOT seems to be a reasonable approach for the treatment of uncomplicated CT-confirmed AA. Careful patient screening would definitely enhance the success rate. [ABSTRACT FROM AUTHOR]

Non-operative management (NOM) of simple appendicitis is becoming an increasingly researched treatment option. This systematic review aims to describe the short and long-term failure rates of NOM and the complication rate of appendicectomy in children with simple appendicitis. The systematic review was registered a priori (CRD42022322149). Study inclusion criteria are: participants aged ≤ 18 years of age; groups undergoing both NOM and appendicectomy for simple appendicitis; outcomes including one or more of: NOM failure rate at 30 days or 1 year and beyond; study design: RCT or case control study. Four databases were searched and 3 reviewers determined study eligibility and data extraction. Risk of bias was assessed and meta-analysis was performed using Stata. The database search identified 2731 articles, 14 studies met the inclusion criteria; 4 RCTs and 10 case controlled studies. All studies had moderate-serious risk of bias. There were no deaths in either group in any study. Meta-analysis demonstrated a 30 day failure rate of 20 % (95 % CI 11–29 %) and 11 studies reported failure rate at 1 year or beyond at 32 % (95 % CI 25–38 %). Rates of significant complications of appendicectomy was 1 % (95 % CI 0–1 %). Non-operative management of simple appendicitis in children is safe, with moderate early success. The failure rate increases over time, resulting in eventual appendicectomy in a third of the children diagnosed with appendicitis. These data will enable clinicians to have an informed discussion with children and their parents about their treatment options for simple appendicitis. II. [ABSTRACT FROM AUTHOR]

Background: There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The aim of our randomized controlled trial was to compare ORIF and PA for displaced Lisfranc injuries. Methods: This study was a national multicenter randomized controlled trial. Altogether 43 displaced Lisfranc injuries were enrolled in this trial. The primary outcome measure was Visual Analogue Scale Foot and Ankle (VAS-FA) at a 24-months follow-up. The secondary outcome measures were VAS-FA pain, function, and other complaints subscales and the American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6, 12, and 24 months. We were unable to reach the planned sample size of 60 patients; thus, the study remains underpowered. Results: The mean VAS-FA Overall score in the ORIF group was 86.5 (95% CI 77.9, 95.1) and 80.1 (95% CI 72.0, 88.1) in the PA group at the 24-month follow-up. We did not find eligible evidence of a difference in VAS-FA Overall scores (mean between-group difference 6.5 [95% CI −5.3, 18.2], Cohen d = 0.100). Conclusion: We did not find evidence of a difference in VAS-FA between ORIF and PA in patients with displaced Lisfranc injuries, and thus both are viable options for the initial surgical method. The trial is underpowered; however, the data may be included in a meta-analysis of similarly designed randomized controlled trials. ClinicalTrials.gov identifier: NCT02953067 24 October 2016. [ABSTRACT FROM AUTHOR]

The reliable exchange of data is a crucial issue for the loose coupling of computational fluid dynamics (CFD) and computational structural mechanics (CSM) modules in fluid–structure interaction (FSI) applications. This paper presents a comparison between two methods for mapping the traction field across mismatching grids, namely the RIBES method and the preCICE algorithm, both based on radial basis function (RBF) interpolation. The two methods demonstrate different degrees of control over balance preservation during mapping, with the RIBES algorithm exhibiting greater efficacy. Test benches are a parametric double curved geometry and a wind tunnel mock-up. In this second case, forces from mapping are used to load a CSM model to retrieve stress and displacement fields. Differences in FEM results are appreciable although not significant, showing a correlation between the accuracy of balance preservation during data mapping and the structural output. [ABSTRACT FROM AUTHOR]

This study investigates how family values can create finance and growth challenges for family-owned businesses in emerging economies. Specifically, it explores the interplay between family values, debt financing, and firm growth, while also considering the moderating role of self-enhancement and self-transcendence in this relationship. The paper uses Schwartz's theory of human values to illustrate how incorporating indigenous ontologies based on Ubuntu can lead to sustainable growth in family businesses in Ghana and the African continent. A sample of 295 Small and Medium-sized family businesses in Accra, Ghana, was selected using purposive sampling, and multiple regression modeling was used to test the study's hypotheses. The study employed Cronbach's alpha and factor analysis to assess the reliability, validity, and variations between observed and correlated variables. The results suggest that family businesses with conservation, openness-to-change, and self-enhancement values may not be inclined to utilize debt financing, and conservation values have a negative effect on family business growth. The study also found that self-enhancement, conservation, and self-transcendence values positively moderated the relationship between debt financing and family business growth, with self-transcendence values playing a more significant role. These findings contribute to a better understanding of the complex relationship among family values, debt finance, and business growth in emerging economies, and lay a foundation for future research. [ABSTRACT FROM AUTHOR]

Ecological theory posits that temporal stability patterns in plant populations are associated with differences in species ecological strategies. However, empirical evidence is lacking about which traits, or trade-offs, underlie species stability, especially across different biomes. We compiled a worldwide collection of long-term permanent vegetation records (greater than 7000 plots from 78 datasets) from a large range of habitats which we combined with existing trait databases. We tested whether the observed inter-annual variability in species abundance (coefficient of variation) was related to multiple individual traits. We found that populations with greater leaf dry matter content and seed mass were more stable over time. Despite the variability explained by these traits being low, their effect was consistent across different datasets. Other traits played a significant, albeit weaker, role in species stability, and the inclusion of multi-variate axes or phylogeny did not substantially modify nor improve predictions. These results provide empirical evidence and highlight the relevance of specific ecological trade-offs, i.e. in different resource-use and dispersal strategies, for plant populations stability across multiple biomes. Further research is, however, necessary to integrate and evaluate the role of other specific traits, often not available in databases, and intraspecific trait variability in modulating species stability.

Background and Aims: Traumatic bilateral brachial plexus injuries in adults are rare and present unique challenges in management. We report a case of a 21-year-old veterinary student who sustained bilateral brachial plexus injuries following a fall from a moving two-wheeler. Case Presentation: The patient suffered a C5,6 brachial plexus injury on the right side and a C5–7 injury on the left side. Remarkably, the right-sided injury showed signs of recovery after four months, while the left-sided injury took seven months to resolve completely. Despite the severity of the injuries, the patient underwent a conservative approach and did not undergo any surgical intervention. Results: Following months of dedicated rehabilitation, the patient achieved significant recovery and was able to return to her veterinary studies. This case highlights the potential for recovery in traumatic bilateral brachial plexus injuries with conservative management, emphasising the importance of patient-specific treatment strategies and rehabilitation protocols. Conclusion: Conservative management can lead to significant recovery in traumatic bilateral brachial plexus injuries. Patient-specific treatment strategies and dedicated rehabilitation are crucial components of successful outcomes in such cases. [ABSTRACT FROM AUTHOR]

Abstract Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Abstract Background Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners’ identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. Methods Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. Results The mean score of SA1 was significantly higher than that of FA1 (p

Background: Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. Methods: Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. Results: The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001). Conclusion: SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry. [ABSTRACT FROM AUTHOR]

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis was conducted to compare the benefits of adrenalectomy and conservative treatment for comorbidities associated with mild autonomous cortisol secretion (MACS) in patients diagnosed with MACS. Background: MACS is the most common benign hormone-secreting functional adrenal incidentaloma. Overproduction of cortisol is observed in MACS patients, resulting in a variety of long-term health issues, including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and osteoporosis; however, the classic clinical manifestations of Cushing’s syndrome (CS) are not present. Methods: A systematic search was conducted using MEDLINE, Embase, Web of Sciences, and Scopus databases on December, 2023. Two reviewers independently extracted data and assessed the quality of the included articles. A meta-analysis was performed to compare the beneficial effects of adrenalectomy versus conservative management for MACS-related comorbidities. Results: Fifteen articles were included in this study, which evaluated 933 MACS patients (384 Adrenalectomy and 501 Conservative treatment, and 48 excluded due to incomplete follow-up duration). MACS diagnosis criteria were different among the included articles. All studies, however, stated that there must be no overt CS symptoms. Meta-analysis demonstrates the overall advantage of adrenalectomy over conservative treatment for MACS-related comorbidities (Cohen’s d = -0.49, 95% CI [-0.64, -0.34], p = 0.00). Subgroup analysis indicated that the systolic blood pressure (pooled effect size = -0.81, 95% CI [-1.19, -0.42], p = 0.03), diastolic blood pressure (pooled effect size = -0.63, 95% CI [-1.05, -0.21], p = 0.01), and BMD (pooled effect size = -0.40, 95% CI [-0.73,-0.07], p = 0.02) were significantly in favor of adrenalectomy group rather than conservative treatment but no significant differences between the two treatment groups in other MACS-related comorbidities were reported. Conclusion: Despite the limited and diverse data, this study demonstrates the advantage of adrenalectomy over conservative treatment for MACS-related comorbidities. [ABSTRACT FROM AUTHOR]

This study aims to systematically review the current literature on pediatric cerebral venous sinus thrombosis (CVST) following closed head injury and to evaluate the clinical management of these patients. Systemic review of the literature was conducted using the following databases: PubMed, Google Scholar, Microsoft Academic, Clinical Trials, Cochrane Library, and Web of Science. All databases were searched from their date of inception to June 2022. Inclusion criteria were applied to identify articles reporting on pediatric patients with CVST following closed head injury. Out of the articles screened, 23 met the inclusion criteria, reporting on 23 pediatric patients with CVST. Falls were the most common cause of traumatic CVST (52.2%), followed by motor vehicle accidents (30.4%). Nausea and vomiting were the most common presenting symptoms (71.4%), and magnetic resonance venogram was the most common diagnostic method (43.5%). Multisinus involvement was noted in 52.2% of cases. Patients with falls from height were more likely to receive conservative management than those with nonfall mechanisms of injury (p < 0.05). Pediatric CVST following closed head injury is a rare condition, with only case reports available in the literature. Prompt diagnosis and early treatment can lead to good survival and neurological outcomes. In severe cases, neurosurgical intervention may be necessary to prevent mortality and severe morbidity. This review highlights the need for further research to establish evidence-based management guidelines for this rare but potentially serious condition in the pediatric population. [ABSTRACT FROM AUTHOR]

Aim: We aim to observe the clinical outcomes of our patients with distal radius fractures treated conservatively with cast immobilization. Materials and Methods: This is a retrospective observational study of 52 (13 males and 39 females) patients with distal end radius fractures who were treated with cast immobilization. We noticed there were three different groups of patients with different periods of cast immobilization and the onset of rehabilitation. The first group (n=18) was undergone 4 weeks of cast immobilization, the second group (n=17) underwent 5 weeks, whereas the third group of patients (n=17) completed 6 weeks of cast immobilization. Wrist and affected hand rehabilitation were started soon after the discontinuation of the cast. All patients were assessed using a visual analog scale (VAS) for pain, Beck Depression Inventory (BDI) for emotional status, and the Disabilities of the Arm, Shoulder, and Hand(DASH) Score for overall hand function. All patients have also been evaluated for pain-free grip strength, and joints Range of Motion (ROM). The assessments were done right after removing the cast(pre-rehabilitation) and after completing rehabilitation(post-rehabilitation). Results: The VAS score, grip strength, BDI, and DASH scores showed significant differences among all groups before rehabilitation (p<0.01). The ROM and the grip strength were found to be insufficient, while the BDI and DASH scores were not significantly improved with long-term immobilization when compared to short-term immobilization. All scores showed a statistically significant difference in all groups after the 6th month (p<0.01). Conclusion: Short-term immobilization is a more effective functional outcomes and safer treatment modality before and after rehabilitation compared to long-term immobilization in the conservative treatment of distal radius fractures. [ABSTRACT FROM AUTHOR]

Nature is a valuable resource, supplying remedies for the treatment of all diseases. Plant kingdom stands for a plethora of natural compounds that are well known for their utilization in therapeutic applications. They may pave the way for the development of new mediators with appropriate efficacy in many pathological disorders in the future. In India and throughout the world, herbs have become a principle and popular medicine. Recognized green medicines are better than synthetic ones and have fewer side effects. Since ancient times, plants have been intended for their medicinal properties for treating various diseases owing to their fewer side effects, availability of the agent, cost-efficiency, and potential effectiveness. The medicinal value of plants stems from various vegetative parts of the plant, including flowers, fruit, bark, roots, leaves, seeds, and its modified parts. The Indian forests are the major repository of remedial and aromatic medicinal plants, which can be used for the production of a plethora of remedies against various diseases. Butea monosperma is one of the traditional Ayurvedic medicinal plants considered a rich source of ingredients that can be used in drug development as home remedies to treat various diseases, such as diarrhea, constipation, hypertension, dehydration, bronchial asthma, leucorrhea, cancer, infection, as well as liver and stomach disorders. The seed powder is known for its notable medicinal, pharmaceutical, and insecticidal activities. This study highlights the traditional Ayurvedic importance of an eminent medicinal plant, B. monosperma, with its active chemical constituents, as well as pharmacological, environmental, ecological, economical, and agricultural significance. This plant can be planted everywhere to take advantage of its versatile applications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Low-flow vascular lesions are commonly encountered in the oral cavity and may require removal due to aesthetic concerns, repeated bleeding or a cluttering sensation. Laser devices represent an excellent aid due to their affinity with blood and to their biostimulating properties and have been substituting traditional excision in selected cases. Materials and Methods: In this study, 30 patients presenting with low-flow oral vascular lesions were included. The lesions were clinically evaluated as follows: lesion's site, reason for treatment, lesion's dimensions, confirmation of positive diascopy via compression with a glass slide and photograph. The lesions were treated with laser forced dehydration (LFD) and then followed-up after 3 weeks, 6 months and 1 year. The laser source was a K-Laser Blu Derma (Eltech, K-Laser S.r.l., Via Castagnole, 20/H, Treviso, Italy). In the case of incomplete healing, a further protocol was performed at the three-week follow-up, and a further follow-up was scheduled for three weeks after. The following aspects were evaluated at each appointment: pain, using a Numeric Rating Scale (NRS) from 0 to 10 (0 = no pain, 10 = worst pain ever); the need to take painkillers (day of intervention and during follow-up); bleeding (yes/no); scar formation. Results: Complete regression was obtained in all patients, with no side effects. Only one patient required a second LFD protocol. NRS was 0 for all patients for the whole duration of the follow-up. None of the patients took painkillers on the day of the intervention and during the follow-up. One patient declared slight bleeding the day of the intervention, which she easily managed at home. One patient showed a small non-retracting and non-painful scar at the three-week follow-up. No recurrences were found after six months and one year. Conclusions: LFD targets endogenous chromophores, minimizing damage to adjacent tissue and limiting side effects. LFD is effective and could be considered a conservative alternative to traditional excision in low-flow lesions. [ABSTRACT FROM AUTHOR]

Aim: The safety of nonoperative treatment for patients with transplanted kidneys who develop acute diverticulitis is unclear. Our primary aim was to examine the long‐term sequelae of nonoperative management in this group. Method: We performed a population‐based retrospective cohort study using linked administrative databases housed at ICES in Ontario, Canada. We included adult (≥18 years) patients admitted with acute diverticulitis between April 2002 and December 2019. Patients with a functioning kidney transplant were compared with those without a transplant. The primary outcome was failure of conservative management (operation, drainage procedure or death due to acute diverticulitis) beyond 30 days. The cumulative incidence function and a Fine–Grey subdistribution hazard model were used to evaluate this outcome accounting for competing risks. Results: We examined 165 patients with transplanted kidneys and 74 095 without. Patients with transplanted kidneys were managed conservatively 81% of the time at the index event versus 86% in nontransplant patients. Short‐term outcomes were comparable, but cumulative failure of conservative management at 5 years occurred in 5.6% (95% CI 2.3%–11.1%) of patients with transplanted kidneys versus 2.1% (95% CI 2.0%–2.3%) in those without. Readmission for acute diverticulitis was also higher in transplanted patients at 5 years at 16.7% (95% CI 10.1%–24.7%) versus 11.6% (95% CI 11.3%–11.9%). Adjusted analyses showed increased failure of conservative management [subdistribution hazard ratio (sHR) 3.24, 95% CI 1.69–6.22] and readmissions (sHR 1.55, 95% CI 1.02–2.36) for patients with transplanted kidneys. Conclusion: Most patients with transplanted kidneys are managed conservatively for acute diverticulitis. Although long‐term readmission and failure of conservative management is higher for this group than the nontransplant population, serious outcomes are infrequent, substantiating the safety of this approach. [ABSTRACT FROM AUTHOR]

Background: An anterior cruciate ligament (ACL) tear is a risk factor for early osteoarthritis (OA) onset. Generally, ACL reconstruction (ACLR) is associated with better outcomes. However, there is a lack of evidence regarding the effect of operative versus nonoperative treatment for preventing premature knee OA in isolated ACL tears while achieving good functional outcomes. Purpose/Hypothesis: The purpose of the study was to compare the outcomes of ACLR to primarily nonoperative management of isolated ACL tears. It was hypothesized that the outcomes between treatment types would be similar. Study Design: Systematic review; Level of evidence, 3. Methods: This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registration No. CRD42021285901) and was conducted according to the Cochrane Handbook guidelines. We systematically searched for randomized and nonrandomized studies that compared ACLR with nonoperative treatments in isolated ACL tears in 3 databases until October 25, 2021. The risk of bias and quality of evidence of the included studies was assessed in accordance with the Cochrane guidelines. The primary outcome was radiologic signs of OA, and the secondary outcomes were functional parameters. Using the common effects model, we calculated pooled mean differences (MDs) and odds ratios (ORs) with 95% CIs. Results: Five studies—2 randomized controlled trials (RCTs) and 3 retrospective non-RCTs—were included. There was a moderate risk of bias in 2 studies and a serious risk of bias in 1 study. The quality of evidence was rated low because of the higher risk of bias and inconsistency. Nonoperatively treated knees showed a trend toward lower odds of developing radiological signs of OA (OR, 1.84 [95% CI, 0.90 to 3.75]); however, surgically reconstructed knees had significantly better stability (MD, –2.44 [95% CI, –3.21 to −1.66 ]) and a trend toward better but clinically not meaningful Lysholm scores (MD, 2.88 [95% CI, –1.09 to 6.85]). The qualitative synthesis showed that surgical reconstruction was protective against subsequent injuries but not superior when returning to previous activity levels or various functional tests. Conclusion: Findings indicated that there is no certain evidence that ACLR for an isolated ACL tear is superior to nonoperative treatment. Clinicians should consider nonoperative treatments with a well-designed rehabilitative program as a primary option. However, these findings must be interpreted with caution because of low study quality and high risk of bias. [ABSTRACT FROM AUTHOR]

Droughts are predicted to become more frequent and intense in many tropical regions, which may cause shifts in plant community composition. Especially in diverse tropical communities, understanding how traits mediate demographic responses to drought can help provide insight into the effects of climate change on these ecosystems. To understand tropical tree responses to reduced soil moisture, we grew seedlings of eight species across an experimental soil moisture gradient at the Luquillo Experimental Forest, Puerto Rico. We quantified survival and growth over an 8‐month period and characterized demographic responses in terms of tolerance to low soil moisture—defined as survival and growth rates under low soil moisture conditions—and sensitivity to variation in soil moisture—defined as more pronounced changes in demographic rates across the observed range of soil moisture. We then compared demographic responses with interspecific variation in a suite of 11 (root, stem, and leaf) functional traits, measured on individuals that survived the experiment. Lower soil moisture was associated with reduced survival and growth but traits mediated species‐specific responses. Species with relatively conservative traits (e.g., high leaf mass per area), had higher survival at low soil moisture whereas species with more extensive root systems were more sensitive to soil moisture, in that they exhibited more pronounced changes in growth across the experimental soil moisture gradient. Our results suggest that increasing drought will favor species with more conservative traits that confer greater survival in low soil moisture conditions. [ABSTRACT FROM AUTHOR]

In 1970, the Canadian government amended the Criminal Code to include the nation's first provisions banning hate propaganda. This article examines the parliamentary debates over these provisions, from their introduction to their adoption, to assess how members of the two mainstream political right and right-of-center parties responded to the proposed amendments to the Criminal Code. It considers what this response—and the way in which it was articulated—reveals about how self-identified conservatives understood rights and freedoms, and how they conceived of the role of the state in securing these rights and freedoms in the context of Canada's expanding legislative human rights framework. I argue that these debates over hate speech are illustrative of a coherent form of conservative rights-talk in 1960s Canada, one that varied from, and in some respects was in opposition to, a more dominant liberal discourse of rights. [ABSTRACT FROM AUTHOR]