Conservative Group Research Articles

Compared with other methods, cyanoacrylate and lauromacrogol in treating esophagogastric varices did not increase the risk of postoperative infection.

Patients with cirrhosis commonly undergo endoscopic cyanoacrylate injection for gastric and esophageal variceal bleeding. However, postoperative infections can increase the risk of rebleeding and mortality. This study aimed to determine the risk of postoperative infections and its associated factors following cyanoacrylate injection treatment in these patients. A retrospective analysis was conducted on 57 patients treated with ligation (ligation group), 66 patients treated with cyanoacrylate injection (injection group), and 91 patients treated with conservative treatment (control group) at the Nanchong Central Hospital. The rate of postoperative infection was similar among the cyanoacrylate, ligation, and conservative treatment groups, with no significant statistical difference observed ( P = 0.97). Multivariate analysis identified postoperative Child-Pugh score and renal insufficiency as two independent risk factors for postoperative infection. The rebleeding rate in the injection group was significantly lower than in the other groups ( P = 0.01). Mortality was significantly higher in the control group compared with the ligation and injection groups ( P = 0.01). Cyanoacrylate combined with lauromacrogol injection did not significantly increase the risk of infection compared with ligation and conservative treatments, and it was more effective in reducing the risk of rebleeding. This method is safe, effective, and holds clinical value for broader application.

Effect of tonsillectomy combined with steroid pulse therapy upon IgA nephropathy depending on proteinuria status at diagnosis: a nationwide multicenter cohort study in Japan.

The effects of tonsillectomy combined with steroid pulse (TSP) therapy for IgA nephropathy (IgAN) are little known. Therefore, we examined the effects of TSP therapy on the kidney outcomes of IgAN in a large, nationwide cohort study in Japan. Between 2002 and 2004, 632 IgAN patients with ≥ 0.5g/day proteinuria at diagnosis were divided into three groups with mild (0.50-0.99g/day; n = 264), moderate (1.00-1.99g/day, n = 216), or severe (≥ 2.00g/day; n = 153). Decline in kidney function and urinary remission were compared among the three groups after TSP therapy, corticosteroid (ST) therapy, or conservative therapy during a mean follow-up of 6.2 ± 3.3years. 10.6% and 5.9% of patients in the ST and conservative therapy group underwent tonsillectomy. The rate of urinary remission at the final observation was significantly higher in the TSP therapy group than in the ST or conservative therapy groups (mild proteinuria: 64%, 43%, and 41%; moderate proteinuria: 51%, 45%, and 28%; severe proteinuria: 48%, 30%, and 22%, respectively). In contrast, the rate of a 50% increase in serum creatinine was lower in groups TSP therapy, than ST or conservative therapy (mild proteinuria: 2.1%, 10.1% and 16.7%; moderate proteinuria: 4.8%, 8.8% and 27.7%; severe proteinuria: 12.0%, 28.9% and 43.1%, respectively). In multivariate analysis, TSP therapy significantly prevented a 50% increase in serum creatinine levels compared with conservative therapy in groups with moderate and severe proteinuria (hazard ratio, 0.12 and 0.22, respectively). TSP significantly increased the rate of proteinuria disappearance and urinary remission in IgAN patients with mild-to-moderate urinary protein levels. It may also reduce the decline in kidney function in patients with moderate-to-severe urinary protein levels.

Treatment for appendicitis in cancer patients on chemotherapy: a retrospective cohort study.

Whether to perform surgery or conservatively manage appendicitis in immunosuppressed patients is a concern for clinicians. This study aimed to compare the outcomes of these 2 treatment options for appendicitis in patients with cancer undergoing chemotherapy. This retrospective study included 206 patients with cancer who were diagnosed with acute appendicitis between August 2001 and December 2021. Among them, patients who received chemotherapy within 1 month were divided into surgical and conservative groups. We evaluated the outcomes, including treatment success within 1 year, 1-year recurrence, and the number of days from the diagnosis of appendicitis to chemotherapy restart, between the 2 groups. Among the 206 patients with cancer who were diagnosed with acute appendicitis, 78 received chemotherapy within 1 month. The patients were divided into surgery (n = 63) and conservative (n = 15) groups. In the surgery group, the duration of antibiotic therapy (7.0 days vs. 16.0 days, P < 0.001) and length of hospital stay (8.0 days vs. 27.5 days, P = 0.002) were significantly shorter than conservative groups. The duration from the diagnosis of appendicitis to the restart of chemotherapy was shorter in the surgery group (20.8 ± 15.1 days vs. 35.2 ± 28.2 days, P = 0.028). The treatment success rate within 1 year was higher in the surgery group (100% vs. 33.3%, P < 0.001). Surgical treatment showed a significantly higher success rate than conservative treatment for appendicitis in patients less than 1 month after chemotherapy. Further prospective studies will be needed to clinically determine treatment options.

Predictive value of the C-reactive protein to albumin ratio in the treatment of septic arthritis in young children: a retrospective study

IntroductionSeptic arthritis (SA) can cause lifelong disability in children due to joint dysfunction but there is controversy regarding the timing of surgery in SA. The C-reactive protein to albumin ratio (CAR) has emerged as a novel marker of inflammation and has been extensively used in predicting inflammatory bowel disease, arthritis, and systemic inflammation. Despite advancements, few studies have evaluated the role of CAR in SA. Therefore, the present study was aimed to investigate whether CAR could serve as predictive indicators for determining whether patients under four years old with SA should be managed conservatively or require surgical intervention, and to analyze its predictive accuracy. HypothesisAn increase in CAR values among patients under four years old with SA indicates the requirement of surgical intervention. Materials and methodsThis retrospective study enrolled SA children under four years old and divided them into two groups, the surgery and conservative groups. The clinical data between the two groups were compared and multivariate logistic regression was performed to assess the independent predictors of SA requiring surgery. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to determine the predictive ability of CAR in SA requiring surgery. ResultsA total of 82 SA children were included, with 42 children (51.3%) in the surgery group and 40 children (48.7%) in the conservative group. CAR ≥ 1.165 [OR = 12.641, 95% CI (4.264–37.479), p < 0.001] was an independent predictive indicator for surgery in SA children under four years old, with a predicted sensitivity of 0.714, specificity of 0.850, and AUC of 0.793 [95% (0.694−0.893)] indicating good predictive accuracy. DiscussionCAR to be an independent predictive indicator patients under four years old with SA. And a CAR value ≥ 1.165 upon admission in these patients suggests the necessity for surgical intervention. Level of evidenceIV, Retrospective study.

Risk Factors and Treatment of Chylothorax After Minimally Invasive Esophagectomy for Esophageal Cancer.

Background Postoperative chylothorax is a rare but life-threatening complication of esophagectomy. However, due to its rarity, researching the risk factors and selecting appropriate treatment options has been limited. Methods This study included 727 patients with esophageal cancer who underwent minimally invasive esophagectomy at our hospital. To detect the risk factors for chylothorax, we divided the patients into two groups, with and without postoperative chylothorax. We then compared patient characteristics, tumor-specific variables, and operative details. Subsequently, we analyzed the peri-treatment characteristics and outcomes for the three distinct treatment options we had chosen: surgery, conversion (the group that finally underwent surgery after unsuccessful conservative treatment), andconservative. Results Of the 727 patients, 18 (2.5%) developed a chylothorax. The mean BMI was lower (20.3 vs. 21.9, p=0.057), and more cases of thoracic duct resection were found in the chylothorax group (33.3% vs. 6.2%, p=0.001), with statistical significance. Multivariate analysis identified thoracic duct resection as a risk factor (adjusted odds ratio, 6.83). The drainage volume two days after chylothorax was higher in the surgery group, although the difference was not statistically significant (surgery group, 1,405 ml vs. conversion group, 260 ml vs. conservative group, 310 ml; p=0.073). The surgery group had the shortest median postoperative hospital days among these groups (21.5 as compared to 102 and 25.0 days in the conversion and conservative groups, respectively; p<0.001). None of the patients died during their hospital stays. Conclusion Thoracic duct resection during the initial minimally invasive esophagectomy was an independent risk factor for chylothorax. If drainage volume does not decrease on the second day, early surgery may lead to earlier discharge.

Long-Term Outcomes of Conservative versus Surgical Management of Dental Caries

ABSTRACT Introduction: The management of dental caries presents challenges for oral health professionals, with options including conservative and surgical interventions. However, debate persists regarding the long-term efficacy of these strategies. Methods: This retrospective cohort research involved 500 subjects diagnosed with dental caries at the University Dental Clinic between January 1, 2018, and December 31, 2020. Data on demographics, dental history, treatments, and follow-up were collected from patient records. Subjects were categorized into conservative and surgical groups based on treatment received. Outcome measures included tooth survival, caries recurrence, and patient satisfaction. Results: The research included 300 subjects, with 60% under conservative management and 40% under surgical management. Demographics were comparable between groups, and both groups showed similar outcomes in tooth survival, caries recurrence, and patient satisfaction. Statistical analysis revealed no significant differences in these outcomes between groups. Conclusion: Conservative and surgical management approaches demonstrate comparable long-term outcomes in treating dental caries, emphasizing the importance of personalized treatment decisions. Further research with larger samples and prospective designs is needed to validate these findings and guide evidence-based practice in dental caries management.

Decision-Making for Preventive Interventions in Asymptomatic Patients.

The decision to treat an incidental finding in an asymptomatic patient results from careful risk-benefit consideration and is often challenging. One of the main aspects is after how many years the group who underwent the intervention and faced the immediate treatment complications will gain a treatment benefit over the conservatively managed group, which maintains a lower but ongoing risk. We identify a common error in decision-making. We illustrate how a risk-based approach using the classical break-even point at the Kaplan-Meier curves can be misleading and advocate for using an outcome-based approach, counting the cumulative number of lost quality-adjusted life years instead. In clinical practice, we often add together the yearly risk of the natural course up to the time point where the number equals the risk of the intervention and assume that the patient will benefit from an intervention beyond this point in time. It corresponds to the crossing of the Kaplan-Meier curves. However, because treatment-related poor outcome occurs at the time of the intervention, while the poor outcome in the conservative group occurs over a given time period, the true benefit of retaining more quality-adjusted life years in the interventional group emerges at a much later time. To avoid overtreatment of patients with asymptomatic diseases, decision-making should be outcome-based with counting the cumulative loss of quality-adjusted life years, rather than risk-based, comparing the interventional risk with the ongoing yearly risk of the natural course.

The Most Iniquitous Lobby: The Committee for Constitutional Government and the Shaping of American Politics, 1937–1955

AbstractThis article examines the Committee for Constitutional Government, a conservative organization that spearheaded a novel form of mass-based mobilization and direct-mail propaganda to counter New Deal reforms from 1937 to the late 1950s. I argue that the members of the committee offered a supple and variegated response to New Deal liberalism, one with deep roots in the American past. Organizationally, the committee differed from other conservative groups of the period in the vastly greater reach of its propaganda, the small-donor financial base of its operations, and its extensive cultivation of a grassroots movement committed to right-wing reform. The committee was a critical political actor from 1937 to 1955, systematically shaping legislation and countering the trend toward social democracy in America. The ultimate result of its campaigns was to retard the growth of the administrative state and help formulate a cogent conservative critique of reformist liberalism.

Fiqh Contestation on Women's Public Leadership in Indonesia and Malaysia: Reproducing Qur'anic and Hadith Interpretations

This paper discusses the contestation of women's public leadership discourse among feminist activists in Indonesia and Malaysia and how the reproduction of fiqh on women's public leadership in both countries takes place. This research is a field study with data collection through interviews and direct interaction with women activists in both countries and documenting their works. Using the Islamic activism approach, it was found that: 1) The issue of women leaders in Indonesia and Malaysia is complex. Women are often held back by culture, religion and politics. Muslim feminist groups face resistance from conservative groups when they try to challenge gender inequality. Furthermore, some sharia law make it harder for women to get legal protection and justice. More legal rights and support for women are therefore required to make politics more equal. 2) Feminist activists in Indonesia and Malaysia have reinterpreted Islamic texts to promote gender equality. They offer gender-responsive interpretation of the Qur'an and Hadith deemed to be fairer while supporting support social justice and gender equality. 3) The fiqh product of leadership concludes that the moral ideal in the Qur'an and hadith is for leaders to be competent (qawwām). People who fit this profile are well-suited to lead, particularly in a country that adheres to democratic principles.

기업의 사회적 책임에 내재된 개념적 한계와 대안 모색: 기업의 사회적 책임을 넘어 기업의 지구적 책임으로

기업의 사회적 책임에 내재된 개념적 한계와 대안 모색: 기업의 사회적 책임을 넘어 기업의 지구적 책임으로

Generation in the Dimension of Growing Responsibility

Purpose. The article is devoted to the study of the phenomenon of generation, which is a necessary condition for the birth of the modern open society, taking into account the risks that accompany this process. Theoretical basis. The research covers a wide range of concepts (K. Mannheim, J. Ortega y Gasset, M. McLuhan, B. Anderson, P. Connerton, etc.), which reveal the temporal aspect of the analysed phenomenon, in particular, the insecurity of its constitution (the risk of a "lost generation") in the horizon of modernity as an unfinished project (J. Habermas), and the growing degree of responsibility associated with the formation of the creative social class. Originality. For the first time in the research literature, the author analyses the connection between the study of the phenomenon of generation and the establishment of a consensus in the modern world on the observance of the rules of win-win games as the value foundation of Western civilization. One of the key points of this process is the processing of the traumas of modernization. The omission of this task in the agenda of the transition society, despite the warnings evident in retrospect, releases the element of resentment, with consequences that can be qualified as an anthropological catastrophe. Conclusions. Ukrainian society, opening up to the world and working through the traumas of modernisation (Chornobyl, the Holodomor, the Fall of Lenin), which has become a kind of hermeneutical cycle of healing the "humanitarian aura of the nation" (L. Kostenko), in the process of which new layers such as the creative class appeared on the public scene, has demonstrated the European identity of the Ukrainian community. In the new horizon after 02/24, when, according to A. Yermolenko, it is no longer possible to talk about the postmodern situation, the Ukrainian agenda irreversibly acquires globality and should be rethought in the dimension of the "big time" and its global responsibility. This affects, in particular, the entire legacy of Russian-Soviet modernisation, to the extent that it has become an integral part of modern Ukrainian identity, including such controversial pages as the "Afghan" trauma.

Is there a change in the view of treatment for primary spontaneous pneumothorax?: The effect of thoracic CT and autologous blood pleurodesis: a retrospective cohort study.

This study investigated recurrence rates and treatment efficacy based on tomographic findings during a long-term follow-up after primary spontaneous pneumothorax (PSP) treatment. We retrospectively analyzed patients with PSP treated at our hospital between 2003 and 2020. Patients were categorized into 2 groups based on computed tomography (CT) findings: group 1 (no bulla/bleb) and group 2 (bullae-bleb <3 cm). Data on demographics, recurrence, treatment methods, and outcomes were also collected and compared. A total of 251 PSP cases were evaluated, predominantly male (93.6%) with a mean age of 29.23 ± 1.14 years. Most cases (57%) occurred on the right side. Recurrence rates were highest within the first year (77.8%), with the first and second recurrences occurring at rates of 26% and 27.3%, respectively. In group 1 (n = 117), conservative treatment was applied in 15 cases, tube thoracostomy in 81, autologous blood pleurodesis (ABP) in 19, and surgery in 12. Recurrence rates were 46.6%, 21%, 5.3%, and 8.3%, respectively. In group 2 (n = 134), the recurrence rates were 50%, 32.7%, 20%, and 3.1%, respectively (P < .001). No mortality was observed for any patient. The treatment groups included conservative (n = 19), thoracostomy (n = 179), ABP (n = 34), and surgical (n = 44) groups. Recurrence rates were 47.3%, 27.4%, 11.8% (group 1: 5.3%, group 2: 20%, P = .035), and 4.5% (0% vs 6.3%), respectively. ABP effectively reduced recurrence in group 1 PSP patients without bullae or blebs on CT, potentially avoiding surgery. Video-assisted thoracoscopic surgery should be preferred in group 2 cases with bullae or blebs to minimize recurrence. These results underscore the importance of tailoring treatment strategies based on CT findings to optimize PSP management outcomes.

Nursing students' conceptualization of environmental problems: a descriptive cross-sectional study

BackgroundThe significant challenges of the twenty-first century revolve around environmental issues. Knowing individuals' environmental attitudes and what they see as environmental problems is crucial to mobilizing them to action. Nurses hold a significant responsibility in addressing and combating environmental challenges. Research aimThis study had two objectives: understanding how nursing students classify environmental issues and examining the effects of gender, economic status, school district, family environmental awareness, and perception of global responsibility on their conceptualization of environmental issues. DesignA descriptive cross-sectional study using a questionnaire. Setting and participantsThe sample consisted of 1466 nursing students from four faculties of two public universities in Turkiye. The study was conducted between January and April 2023. MethodsData were collected using a form that included 19 issues ranging from ecological problems to social problems related to the environment, as well as the Global Social Responsibility Scale (GSRS). The data were analyzed using explanatory factor analysis, multiple regression, and mediator analysis. ResultsParticipants classified the environmental issues as eco-social-oriented and human-oriented. First-year students (B = -0.201), male students (B = -0.263), those studying in rural schools (B = -0.123), and those who rarely discuss environmental issues in the family (B = -0.197) describe the problems in the eco-social oriented dimension as less “environmental.” The increase in the action-oriented responsibility (B = 0.014) and ecological responsibility (B = 0.077) scores of The Global Social Responsibility Scale leads to an increase in recognizing the problems in this area as environmental issues. Similarly, first-year students (B = -0.340), male students (B = -0.293), and those who rarely discussed environmental issues in the family (B = -0.243) led to a decrease in recognizing problems as environmental in the human-oriented issues dimension. In contrast, poor socioeconomic perception (B = 0.245), negative perception of the future (B = 0.145), and increased action-oriented responsibility (B = 0.024) and ecological responsibility (B = 0.042) led to an increase in recognition of human-oriented issues. The increase in the national responsibility score decreased the score of environmental assessment of the problems in this area (B = -0.017). In addition, the perception of global responsibility partially mediates between students' sociodemographic characteristics and environmental issues recognition scores in both sub-dimensions. ConclusionThis study presents results that point to individual differences among nursing students in addressing environmental issues, reveal the impact of family on these differences, and finally show the importance of curricula to increase students' global social responsibility during their education.

Advancing Multicultural Education in Indonesia: Insights from Amin Abdullah’s Perspective

This article examines multicultural education through the lens of Amin Abdullah, a notable Indonesian Muslim scholar. Using a descriptive-qualitative approach, it reviews his works to elucidate his perspective. Abdullah’s ideas address Indonesia’s diverse social and cultural landscape, emphasizing intercultural understanding and tolerance, particularly in the post-Suharto era, marked by the resurgence of ethnic and religious identities. The article defines multicultural education and its goals, explores the influence of organizations like Muhammadiyah and Nahdlatul Ulama on Abdullah’s thought, and discusses the implications for Indonesian education. It advocates for inclusive curricula, tolerance promotion, teacher training, and multicultural materials, while addressing challenges such as resistance from conservative groups. Integrating perspectives from other scholars, it offers a comparative analysis within the broader discourse on multicultural education, enhancing understanding of integrating cultural and religious diversity into Indonesian education, while noting potential limitations and practical application difficulties

Recommendations for the Prevention and Management of Deep Brain Stimulation Infections Based on 26-Year Single-Center Experience

Introduction: Infections related to deep brain stimulation (DBS) can lead to discontinuation of the treatment and increased morbidity. Various measures of reducing infection rates have been proposed in the literature, but scientific consensus is lacking. The aim of this study was to report a 26-year single center experience of DBS infections and provide recommendations for the prevention and management of them. Methods: The retrospective analysis consisted of 978 DBS surgeries performed at Oulu University Hospital (OUH) from 1997 to 2022. This included 342 primary or reimplantations of DBS electrodes and 559 primary or reimplantations of implantable pulse generator (IPG). Infections within approximately 1 year after the surgery without secondary cause were considered surgical-site infections (SSIs). χ2 test was used to compare infection rates before and after 2013, when the systematic implementation of infection prevention measures was started. Results: A total of 35 DBS implants were found to be infected. The number of SSIs was 30, of which 29 were originally operated in OUH leading to a center-specific infection rate of 3.1%. Of the SSIs, 17.2% occurred after IPG replacement. Staphylococcus aureus was found in 75.0% of cultures and 32.1% were mixed infections. The treatment of SSIs included aggressive surgical revision combined with cefuroxime and vancomycin antibiotics, as most patients in the initial conservative treatment group eventually required surgical revision. A statistically significant difference in infection rates before and after the implementation of preventative measures was not observed (risk ratio 2.20, 95% confidence interval 0.94–5.75, p = 0.051), despite over two-fold difference in the incidence of SSIs. Conclusion: Our findings show that the rates of surgical infections are low in modern DBS, but due to their serious consequences, preventative measures should be implemented. We highlight that mixed infections should be accounted for in the antibiotic selection. Furthermore, our treatment recommendation includes aggressive surgical revision combined with antibiotic treatment.

Delayed Perforation After Endoscopic Resection of Upper Gastrointestinal Tumors: CT Findings to Identify Patients Requiring Surgery.

To determine the clinical and imaging factors associated with surgical treatment in patients with delayed perforation after endoscopic resection of upper gastrointestinal tumors. We retrospectively included patients with delayed perforation after endoscopic tumor resection for gastric or duodenal tumors between January 2007 and December 2021 in a tertiary hospital. We compared the clinical, endoscopic, and CT findings of the surgical and conservative treatment groups. Univariable and multivariable analyses were performed to identify significant factors associated with surgery. Among 10,423 patients who had undergone endoscopic tumor resection, 52 (0.50%) experienced delayed perforation, with 20 patients (35.5%) treated surgically and 32 patients (64.5%) treated conservatively. The CT findings of gross perforation (adjusted odds ratio [OR]=6.75, 95% confidence interval [CI], 1.04-43.89; P=0.045) and presence of peritonitis (OR=34.26, 95% CI, 5.52-212.50; P<0.001) were significantly associated with surgical treatment. Other clinical factors as well as CT-measured amount of pneumoperitoneum were not significant factors. CT findings of gross perforation and peritonitis are significant factors associated with surgery in delayed perforation after endoscopic tumor resection. These factors can aid in guiding the patients towards an appropriate treatment plan.

Early Postoperative Rapid Rehabilitation Yields More Favorable Short-term Outcomes in Patients Undergoing Patellar Realignment Surgery for Recurrent Patellar Dislocation: A Prospective Randomized Controlled Study.

Use of a rapid rehabilitation protocol for postoperative recovery after recurrent patellar dislocation (RPD) has gradually gained attention; nonetheless, evidence of its safety and effectiveness is lacking. To compare the short-term postoperative outcomes of early rapid rehabilitation with those of conservative rehabilitation in patients with RPD. Randomized controlled trial; Level of evidence, 2. A total of 50 patients with RPD who underwent tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction were enrolled between January 2018 and February 2019. Postoperatively, the patients were randomly assigned to either the early rapid group (rapid group; n = 25 patients) or the conservative group (control group; n = 25 patients) for rehabilitation training. The rapid group underwent faster progression in weightbearing and range of motion (ROM) training. Knee joint functional scores, ROM, bilateral thigh circumference differences, and imaging data were recorded preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively for comparison. Postoperative complications were recorded over the 24-month follow-up period. The baseline data did not significantly differ between the 2 groups. Postoperatively, compared with the control group, the rapid group had higher Tegner scores at 6 weeks and 3 months; higher Lysholm scores at 3 and 6 months; higher International Knee Documentation Committee scores at 6 weeks, 3 months, and 12 months; better ROM; and smaller bilateral thigh circumference differences at 24 months (P < .05 for all). However, no differences were observed in the Tegner, Lysholm, and International Knee Documentation Committee scores at 24 months postoperatively. At the 6-week and subsequent follow-up visits, the Caton and Insall indices were lower in the control group than in the rapid group (P < .01 for all). Moreover, compared with the control group, the rapid group had a lower incidence of patella baja at 24 months (0% vs 17%) and fewer complications during the whole follow-up period (P < .01). Early rapid postoperative rehabilitation appears to be safe and effective for patients who undergo tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction to treat RPD. In the short term, this approach was shown to be more advantageous than conservative rehabilitation in improving functional scores, allowing an earlier return to daily activities, although the lack of difference at 24 months implies no long-term benefits. In addition, it potentially helped to prevent the occurrence of complications, including patella baja. ChiCTR1800014648 (ClinicalTrials.gov identifier).

Diastasis Recti Abdominis: A Practical and Effective Width-Length Classification Based on Ultrasound Measurements and its Clinical Validation.

This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility. We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment. The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%. This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.

Pituitary apoplexy in cushing's disease: a single center study and systematic literature review.

Pituitary apoplexy (PA) in Cushing's disease (CD) is rare with data limited to case reports/series. We retrospectively reviewed case records of PA in CD managed at our center from 1987 to 2023 and performed a systematic literature review. We identified 58 patients (44 females), including twelve from our center (12/315 CD, yielding a PA prevalence in CD of 3.8%) and forty six from systematic review. The median age at PA diagnosis was 35 years. The most common presentation was type A (79.3%) and symptom was headache (89.6%), with a median Pituitary Apoplexy Score (PAS) of 2. Median cortisol and ACTH levels were 24.9µg/dl and 94.1 pg/ml, respectively. Apoplexy was the first manifestation of underlying CD in 55.2% of cases, with 31.1% (14/45) presenting with hypocortisolemia (serum cortisol ≤ 5.0µg/dl), underscoring the importance of recognizing clinical signs/symptoms of hypercortisolism. The median largest tumor dimension was 1.7cm (53/58 were macroadenomas). PA was managed surgically in 57.8% of cases, with the remainder conservatively managed. All five PA cases in CD with microadenoma achieved remission through conservative management, though two later relapsed. Among treatment-naïve CD patients with macroadenoma, PA-related neuro-deficit improvement was comparable between surgical and conservative groups. However, a greater proportion of surgically managed patients remained in remission longer (70% vs. 38.5%; p = 0.07), for an average of 31 vs. 10.5 months. PA in CD is more commonly associated with macroadenomas, may present with hypocortisolemia, and surgical treatment tends towards higher and longer-lasting remission rates.

Accelerated demographic and economic transition calls for resolute socioeconomic policies

Population management seemed to have gotten underway quite well in 1970. But no sooner had the program gained traction than the Roman Catholic hierarchy and conservative groups voiced their strong opposition to family planning, which President Marcos, Sr. accommodated for political expediency. Thus, with a failed family planning program, declining fertility – a necessary condition for demographic transition towards faster economic growth, higher employment, and poverty reduction could not be achieved. A hugely missed opportunity graphically illustrated when comparing the Philippines and Thailand in particular, which had virtually identical key demographic-economic indicators in 1970 but drastically diverged by 2020. Apparently, the former ‘sowed the wind and is reaping the whirlwind’ – a cogent motivation moving forward for overcoming failures and balancing population and the economy better by adopting judiciously chosen policy options.