Conservative Treatment Research Articles

Restoring with flowables: An injection moulding technique – A report of two cases

This case report showcases the conservative management of aesthetic anterior restorations for patients seeking to enhance their smiles using the highly filled flowable composite resin injectable moulding technique. This efficient method resulted in optimal, aesthetically pleasing outcomes, leading to high patient and dentist satisfaction. Direct veneers made from injectable flowable resin composites provide a minimally invasive treatment option, given that the case selection criteria are appropriately followed. Furthermore, this approach can be viewed as a more cost-effective alternative. However, additional follow-ups are essential to thoroughly assess the clinical longevity of both the restorations and the materials utilised.

Emphysematous pancreatitis: Diagnosis, treatment, and prognosis

BACKGROUND Emphysematous pancreatitis (EP) is a rare, severe form of acute necrotizing pancreatitis characterized by gas in pancreatic or peripancreatic tissue, with a high mortality rate. AIM To assess the diagnosis, treatment, and outcomes of EP through a series of case studies. METHODS This case series was conducted in intensive care units at the Second Affiliated Hospital of Anhui Medical University. Patients were included if they were diagnosed with pancreatic necrosis and gas via computed tomography from June 2018 to June 2024. Patients were categorized into early and late EP groups based on the timing of the appearance of the bubble sign and into extensive and common types based on the distribution range of the bubble sign. The data recorded included sex, age, aetiology, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, Bedside Index for Severity in Acute Pancreatitis score, subtype, gas distribution extent, aetiological diagnostic basis, pathogen categories, intervention measures, and prognosis. RESULTS Among the 15 patients, 66.7% had a biliary aetiology and extensive type of EP, 47.1% had early-onset EP, and 73.3% had confirmed aetiological evidence [6 based on bacterial culture, 4 based on both routine culture and next-generation sequencing (NGS), and 1 solely based on NGS]. The common pathogens were Escherichia coli and Klebsiella pneumoniae . Six patients survived. Among the 2 patients who did not undergo percutaneous drainage or surgical treatment, 1 survived. Of the 6 patients who underwent percutaneous drainage, 2 survived, 2 survived after subsequent surgery, and 2 died without surgery. Among the 6 patients who underwent surgery alone, 5 died and 1 survived. Among the early-onset EP patients, 4 survived; among the late-onset EP patients, 2 survived. Among the common EP types, 4 survived; among the extensive EP types, only 1 survived. CONCLUSION The mortality rate among patients with EP is considerable, and NGS enhances pathogen identification accuracy. Despite the debate on conservative vs surgical management, the STEP-UP strategy remains viable. Aggressive antimicrobial therapy, early percutaneous catheter drainage, and other minimally invasive interventions, along with delayed surgical intervention, may improve patient prognosis.

Elbow arthritis

Most patients with primary osteoarthritis of the elbow report a history of heavy lifting work with the affected upper limb. Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drug (NSAID) intake, and intra-articular injections can provide sufficient pain relief in the early stages when used in combination. If surgery is required, many patients experience significant pain relief from joint-preserving procedures despite existing cartilage damage. Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has become established as the preferred surgical procedure. The ulnar nerve should be assessed during surgery and treated if necessary. Total elbow arthroplasty (TEP) is successful in terms of pain relief and function; however, it is recommended for older patients with advanced osteoarthritis or for whom joint-preserving procedures have failed.

Operative management of penoscrotal elephantiasis

Enormous oedema of the male genitals, such as penoscrotal elephantiasis, is a very rare condition. It is usually a result of recurrent inflammation, trauma or malignancy, although the main cause is lymphatic filariasis. Furthermore, it is a challenging condition for both patient as well as the attending healthcare team. By elongation of the lymphatic channels, local oedema is initially created. In the further course, through fibrosis and thus deterioration of the lymphatic drainage, recurrent infections with irreversible elephantiac hard swelling and skin changes are evident. Depending upon the clinical stage, conservative or surgical treatment are suggested. Unfortunately, up to date, no evidence-based therapeutic protocol exists. Interdisciplinary cooperation among doctors, physiotherapists with active cooperation of the patient decide the success of the therapeutic outcome.

Modern surgical treatments for lymphedema.

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.

A Novel Approach to Aplasia Cutis Congenita With PolyNovo BTM.

Aplasia cutis congenita (ACC) is a rare congenital condition characterized by the absence of skin and subcutaneous tissue, typically affecting the scalp. This case report presents a female infant born at 38+3 weeks with a posterior midline scalp defect measuring 15×12.5mm, involving skin, subcutaneous tissue, and calvarium. The defect was managed with NovoSorb Biodegradable Temporising Matrix (BTM). Initially, the plan involved a subsequent skin graft; however, the defect epithelized without grafting. By 2 months, the wound had healed completely, and by 6 months, the underlying bone had ossified. ACC presents with significant variability, and management strategies range from conservative treatment to surgical intervention depending on defect size. This case demonstrates the successful use of a fully synthetic dermal substitute in managing full-thickness scalp defects, providing a novel, effective option for treating ACC without requiring grafting.

Treatment of blunt splenic injury in children in China

IntroductionNonoperative management (NOM) is recognized as a viable treatment for pediatric closed splenic trauma. However, clinical guidelines are applied inconsistently, resulting in different treatment strategies in different regions. This study aimed to investigate the independent risk factors influencing the length of stay in pediatric closed splenic injuries and to analyze the key determinants in the choice of surgical treatment to optimize inpatient management and patient care and improve outcomes.MethodsA retrospective evaluation of medical records of pediatric patients with blunt splenic injury (BSI) admitted to Wuhan Children's Hospital from 2020 to 2024 was conducted. The dataset included demographics, mechanism of injury, injury grade, associated injuries, therapeutic measures, and outcomes, which were subjected to statistical analysis. Factors influencing length of hospital stay and treatment regimen were also analyzed.ResultsA total of 88.5% of patients underwent NOM, with 11% requiring splenic embolization due to hemodynamic instability or arterial hemorrhage. Surgery was required in 11.5% of patients, primarily for combined gastrointestinal perforation, or peritonitis. One patient died due to brain injury. Trauma scores and transfusion requirements were higher in the surgical group (37.7 ± 16.1 vs. 17.2 ± 13.1, p < 0.001; 21.7% vs. 100%, p < 0.001). Multivariate logistic regression showed that gastrointestinal complications significantly influenced the decision to operate (p = 0.0087). A generalized additive model showed a corresponding increase in length of stay with increasing injury severity, with the curve flattening in the mid to high ISS range (40–60).ConclusionNOM remains an effective and preferred treatment strategy for pediatric BSI, particularly in the setting of stable hemodynamic parameters. This approach reduces the need for surgical intervention and associated complications while preserving splenic function. The study highlights that gastrointestinal complications are important determinants of surgical management. Further research into long-term outcomes and advancements in conservative management are needed.

Development of a spectral repository for the identification of western Himalayan medicinal plants using machine learning techniques

The identification of medicinal plant species is a crucial task for assessing the status of our bioresources. Conventional methods primarily rely on taxonomy and laboratory-based instruments, which are time-consuming and require the requisite expertise. Thus, there is an escalating demand for efficient techniques that can quickly identify these precious species. The advent of Hyperspectral Remote Sensing (HRS) with artificial intelligence has significantly increased the scope of HRS techniques by offering rapid and precise plant identification. This study utilised non-imaging HRS handheld sensors to build a spectral repository for 10 important medicinal plant species from diverse locations across Indian Himalayan states, representing varying altitudinal and ecological conditions. The spectral repository encompasses 1237 distinct spectral signatures obtained from the leaves and canopies of the targeted plant species. Subsequently, an identification model has been developed using Random Forest (RF) with several feature selection methods, and it has been revealed that the RF model, coupled with wrapper-based feature selection, is an effective combination for classifying the targeted plant species. The calibration and test datasets accounted for accuracies of 87.87% and 91.39%, respectively, with corresponding kappa coefficients of 0.85 and 0.89. Furthermore, the developed RF model was applied to ‘PRISMA’ satellite data to identify Saussurea costus crops in farmers' croplands, achieving a classification accuracy of 81.31% and a kappa coefficient of 0.76. Therefore, the study highlights the potential of integrating RF, in-situ HRS, and satellite HRS for the non-destructive, precise, and accurate identification of medicinal plants that can significantly contribute to biodiversity conservation and sustainable resource management.

Phylogeography, taxonomy, and conservation of the endangered brown howler monkey, Alouatta guariba (Primates, Atelidae), of the Atlantic Forest

The brown howler, Alouatta guariba, endemic to the Atlantic Forest of Brazil and Argentina, is threatened by habitat loss and fragmentation, hunting, and its susceptibility to yellow fever. Two subspecies have been recognized, but their names, validity, and geographic ranges have been controversial. We obtained samples covering the species' entire distribution in Brazil and Argentina to clarify these issues by investigating their genetic diversity and structure and assessing their evolutionary history. We analyzed, for the first time, a set of ten microsatellite markers (N = 153), plus mitochondrial DNA (mtDNA) segments of the control region (N = 207) and cytochrome b gene (N = 116). The microsatellite data support two to three genetic clusters with biological significance. The southern populations (Argentina, Santa Catarina, and Rio Grande do Sul) presented a homogeneous genetic component, and populations from São Paulo (SP) to the north presented another component, although most presented ∼20% of the southern component. With K = 3, SP emerged as a third component while sharing some ancestry with Rio de Janeiro and Argentina. The mtDNA phylogenies revealed three main clades that diverged almost simultaneously around 250 thousand years ago (kya). Clades A and B are from central SP to the north and east, while clade C is from SP to the south and southwest. Samples from SP presented haplotypes in all three clades, sometimes in the same population. The demographic history of the species estimated with the Bayesian skyline plot of the mtDNA showed a strong expansion ∼40–20 kya and a strong reduction over the last ∼4–2 kya. Although the genetic clusters identified here deserve appropriate management strategies as conservation units, the absence of (i) concordance between the mtDNA and microsatellite data, (ii) reciprocal monophyly in the mtDNA, and (iii) clear-cut non-genetic diagnostic characters advises against considering them as different taxonomic entities. None of the previous taxonomic proposals were corroborated by our data. Our results elucidate the taxonomy of the Atlantic Forest brown howler, indicating it should be considered a monotypic species, A. guariba. We also clarify the evolutionary history of the species regarding its intraspecific genetic diversity, which is crucial information for its conservation and population management.

Soil ecosystem services valuation in a priority terrestrial region for biodiversity conservation in Mexico, from ecological economics and the local community perspective

Soils, often perceived as merely the surface layer of Earth, play a crucial role as the foundation for terrestrial life and are deeply integrated into the worldviews, livelihoods and cultural practices of communities in Mexico. Mexican soils and the ecosystem services that provide are essential for food security and ecological resilience, especially amidst environmental challenges like climate change, desertification and biodiversity loss. Their conservation, restoration and sustainable management are essential to maintain the country's natural environment and to ensure the integral wellbeing of its inhabitants. This study evaluates the ecosystem services provided by soils in a priority area for biodiversity conservation in Mexico, adopting an approach that merges ecological economics perspectives with local community views. By understanding how residents of this region value their soils, this research highlights the ecological and economical significance of soils and their intrinsic cultural and social value within communities that have coexisted with these ecosystems for generations.

Preserving tororaro’s legacy: conservation genetics of in-situ and ex-situ populations of Muehlenbeckia astonii (Polygonaceae)

ABSTRACT Tororaro, a Threatened Nationally Endangered species in eastern South Island and southern North Island, New Zealand, is primarily found in coastal or lowland droughty habitats with small, isolated populations, notably the largest on Kaitōrete Spit, Canterbury. Due to recent issues with the conservation management of the Kaitōrete Spit population, the importance of protecting this species has been highlighted. While widely cultivated in gardens for its horticultural appeal and resilience, recruitment failure in wild populations and the genetic structure and variation within wild and cultivated populations is unknown, which raises questions about in-situ and ex-situ conservation strategies. Microsatellite markers were developed to assess the level of natural variation present in wild populations and that of cultivated material present throughout New Zealand. The results reveal natural populations can be grouped into three clusters with a low to medium level of diversity for each cluster (Na = 1.647–3.647, Ho = 0.194–0.457, He = 0.181–0.478), and the diversity of each group is captured in cultivation (Na = 2.471–3.588, Ho = 0.207–0.511, He = 0.173–0.519). Cultivated material largely follows ecosourcing guidelines whereby cultivated plants in Wellington, Marlborough and Canterbury are often sourced from the regional meta-population, however, there are some exceptions that have implications for management of this species. In Otago, where M. astonii does not naturally occur, cultivated populations comprise representatives of all regional populations. An interesting outcome is that we recovered from among the cultivated plants several individuals that are likely to be putative intraspecific hybrids between plants from Wellington populations and those from either Marlborough or Canterbury; these hybrid genotypes are unknown in wild populations. Clonal plants were also represented among the wild and cultivated populations by individual plants having identical genotypes. We also demonstrate the utility of these markers across other Muehlenbeckia species.

The clinical effects of pulsed electromagnetic field therapy for the management of chronic ankle instability: a study protocol for a double-blind randomized controlled trial

BackgroundChronic ankle instability is associated with long-term neuromuscular deficits involving poor postural control and peroneal muscular impairment. Symptoms of chronic ankle instability hinder engagement in physical activity and undermine the patient’s quality of life. Despite the existence of various treatment modalities, none has conclusively provided evidence of clinical effectiveness in counteracting neuromuscular deficits, such as arthrogenic muscle inhibition of the peroneal longus (PL). Pulse electromagnetic field therapy employed as an adjunct biophysical therapy can potentially improve stability by mitigating peroneal muscle weakness and by activating the peroneal muscle. We postulate that by combining standard care (muscle strengthening, balance training, and range of motion exercise) with pulse electromagnetic field therapy, postural control stability and peroneal muscle weakness will significantly improve.MethodsThis is a prospective, randomized, double-blind, placebo-controlled trial. A total of 48 adults with chronic ankle instability will be recruited and randomly allocated into either the intervention or control groups. The intervention group (n = 24) will receive active pulse electromagnetic field therapy and standard exercise training, while the control group (n = 24) will receive sham pulse electromagnetic field therapy and standard exercise training for 8 weeks. Primary and secondary outcomes will be evaluated at baseline, week 4, 8 as well as at 3-, 6-, and 12-month follow-up visits.DiscussionChronic ankle instability is a common debilitating condition without a curative conservative treatment. Investigating different treatment modalities will be essential for improving rehabilitation outcomes in this clinical population. This study will investigate the effectiveness of pulsed electromagnetic field therapy on the functional and clinical outcomes in the chronic ankle instability population. This trial may demonstrate this non-invasive biophysical therapy to be an effective measure to help patients with CAI.Trial registrationClinicalTrials.gov NCT05500885. Registered on August 13, 2022.

Invasive vs conservative management in elderly patients with NSTEMI- insights from the SENIOR-RITA trial

Invasive vs conservative management in elderly patients with NSTEMI- insights from the SENIOR-RITA trial

Uncommon presentation of left main congenital coronary aneurysm: a rare case report

Coronary aneurysm, a dilated segment of the coronary artery, is a rare condition with a prevalence ranging from 0.02% to 0.2%. According to the current literature, reports of large aneurysms in the left main artery are extremely rare. We present a case of a 43-year-old male patient presenting with cough, wheezing, and dyspnea after a cold. Initial examinations suggested viral myocarditis, but further evaluation revealed a giant aneurysm in the left main coronary artery. Due to the high surgical risk, conservative treatment was chosen. Follow-up assessments showed no significant changes in the coronary aneurysm, with slight improvement in dyspnea. This rare case of a left main congenital coronary aneurysm suggests that treatment should consider the patient's overall condition, thrombosis presence, suitability for anticoagulant therapy, and aneurysm location and size.

Assessing the impact of environmental education in a critical orangutan landscape in West Kalimantan, Indonesia.

Gunung Palung National Park (GPNP) and the surrounding region in West Kalimantan, Indonesia, host a significant population of Critically Endangered Bornean orangutans (Pongo pygmaeus wurmbii) amidst various conservation challenges, including habitat destruction, the illegal pet trade, and human-wildlife conflict. The Gunung Palung Orangutan Conservation Program (GPOCP) employs diverse strategies, including environmental education, to address these challenges. Environmental education helps to connect local students with conservation efforts, educate them about endangered endemic species, and highlight the relationship between human behavior and ecosystem health. Environmental education is critical in fostering sustainable behaviors and raising awareness about conservation issues, particularly in areas where human activities threaten primate biodiversity. Such programs can promote long-term conservation outcomes by engaging communities and empowering individuals to take action. Here, we review the effectiveness of GPOCP's environmental education initiatives, focusing on school visits conducted between 2016 and 2023 that concentrated on orangutan conservation. We analyze data from standardized pre- and post-activity surveys administered to students participating in puppet shows and lectures. Results indicate a substantial increase in knowledge and positive shifts in attitudes toward orangutan conservation among students. However, challenges remain in evaluating long-term behavioral changes and the relative contribution of different conservation interventions. Future efforts will explore tailored educational approaches and impact assessments to enhance conservation outcomes and foster community engagement in safeguarding Bornean orangutans and their habitat.

Spatial Heterogeneity and Seasonality of Phytoplankton Responses to Marine Heatwaves in the Northeast Pacific

Abstract Marine heatwaves (MHWs) have emerged as a recurrent phenomenon in the Northeast Pacific (NEP) since 2013, with significant ecological and economic consequences. However, our understanding of the impacts of these events on phytoplankton, the primary producers in the marine food web, remains incomplete. In this study, we elucidated the phytoplankton responses during MHWs in the NEP between 1998 and 2022 and revealed contrasting phytoplankton chlorophyll anomalies between the north and south of the Transition Zone Chlorophyll Front (TZCF). Specifically, chlorophyll shows a marked increase north of the TZCF but a decrease south of it, with the most pronounced negative anomalies centered on the TZCF. Additionally, this chlorophyll response exhibits remarkable seasonal variation in space and time, consistent with the seasonal migration of the TZCF. Weakened subpolar southward Ekman transport, which may have resulted in reduced phytoplankton nutrient supply, is likely to be the major contributor to the negative chlorophyll response in this frontal region. Our results highlight the importance of previously unrecognized spatial and temporal heterogeneity of phytoplankton responses to MHWs in the NEP, which may provide insights for future ecosystem conservation and fisheries management in the NEP under MHWs. 



Use of a bioactive matrix glove in the treatment of paediatric hand burns: a case series.

Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove. A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient. The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints. Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients.

Eksplorasi Sejarah, Arsitektur, dan Konservasi Candi Tebing Tegallinggah sebagai Warisan Budaya di Gianyar, Bali

The objective of this research is to critically evaluate the historical significance, architectural features, and conservation techniques associated with the Tegalinggah Cliff Temple, a major cultural heritage site in Gianyar, Bali. The inquiry used a qualitative research technique, collecting primary data through field observations and interviews with historians, local community stakeholders, and conservation specialists, supported with secondary material from relevant academic literature. Data was analyzed using qualitative descriptive approaches, supplemented by focus group discussions, to offer a thorough knowledge of the temple's historical background, architectural elements, and contemporary conservation efforts. The research results show that, despite Tegalinggah Cliff Temple's historical and architectural significance, it faces serious preservation issues such as natural degradation and limited community participation. The report emphasizes the importance of enhanced local engagement and the establishment of stronger conservation management structures to protect the site. In conclusion, the Tegalinggah Cliff Temple is an important cultural asset that requires increased preservation measures to maintain the long-term protection and development of Balinese cultural heritage.

Larval dispersal predictions are highly sensitive to hydrodynamic modelling choices

AbstractLarval dispersal is a critical ecological process in marine ecosystems, responsible for connecting and replenishing populations in patchy habitat. Because empirical measurements of larval dispersal are very challenging, coupled biological and oceanographic simulations (“biophysical models”) of larval dispersal are commonly used to answer ecological questions and support conservation management decisions. In the process of creating biophysical models, a series of choices must be made that do not have a single correct answer—sometimes because the oceanographic or ecological processes are uncertain; sometimes because trade-offs are required between different goals (e.g. computational time versus spatial resolution). In this paper, we demonstrate that larval dispersal estimates at management scales are strongly affected by these choices. Using three different hydrodynamic models of the Great Barrier Reef, we estimated the dispersal of crown-of-thorns starfish larvae in the spawning seasons between 2018 and 2021. Despite sharing similar physical forcings and using similar models of larval behaviour, we find that the different hydrodynamic models produce divergent predictions of larval dispersal between the reefs. If used to support crown-of-thorns starfish control decisions, these different predictions would recommend different priority reefs. Our results caution against the use of single models of larval dispersal, and suggest that multi-model ensembles may offer a valuable new perspective on dispersal patterns in marine environments.

Minimally invasive treatment of talar neck fractures using the calcaneal distractor - a technical note

Talar neck fractures, though rare, pose significant challenges in treatment due to their complex nature and potential for severe complications. Despite the fact that most of talar fractures are treated operatively, there is scarcity of clear recommendations concerning appropriate surgical technique and care. Historically, conservative management was favored, but open reduction and internal fixation (ORIF) have become the standard of care. However, merely restoring rotation, axis, and length is insufficient; restoring the articulating surface in an anatomical manner is essential for long-term joint health. Surgical access to the fracture site via anteromedial and anterolateral approaches provides visualization, but risks compromising the sensitive, partly retrograde blood supply to the talar body. While being biomechanically superior, screws inserted from a posterior to anterior direction pose challenges in soft tissue preservation and accurate placement. Despite widespread usage of this technique, postoperative outcomes remain suboptimal with considerable rates of malunion, osteonecrosis and osteoarthritis. An overlooked technique in the literature is the use of a distractor, commonly employed in minimally-invasive surgical calcaneal fracture treatment in order to maintain length, alignment and joint reposition during fixation. With the potential to reduce soft tissue damage and preserve the blood supply minimally invasive techniques present a promising advancement in fracture management of talar neck fractures.