Conservative Procedures Research Articles

The wisdom behind the third molars removal: A prospective study of 106 cases

PurposeThis paper aims to evaluate the decision-making of wisdom teeth extractions (M3s extraction) and the epidemiological profile in the targeted population. Materials and methodThis was a prospective analysis study of 106 patients at our hospital august 20, 1953 specialist hospital, which is a referral center between January 1, 2020 and January 1, 2021. The patients are divided into 2 groups according decision-making of wisdom teeth removal based on scientific evidence if it's right or wrong. ResultsThere was no statistically significant difference between the groups regarding sex (P = 0.478), educational level (P = 0.718), or working status (P = 0.606). Furthermore, there was no statistically significant difference between the groups regarding general co-morbidity (P = 1.00) or oral history (P = 0.28). The mean age of the sample was 32.12 years (SD = 11.337 years, range = 17–70 years, median = 30 -years). We reported that only 28% of the third molars were surgically extracted. We included in Group (I), 81 patients who were treated for third molars removal which the decision-making was justified. In Group (II), 25 patients were treated for third molars removal which the decision-making was unjustified. Group (I) comprised 30 men and 51 women with a mean age of 30 years. Group (II) comprised 7 men and 18 women with a mean age of 27 years. The assessment of surgical outcomes (operating time, blood loss, hospital stay) showed no difference between groups. DiscussionMonitoring asymptomatic wisdom teeth appears to be an appropriate strategy. Regarding retention versus prophylactic extraction of asymptomatic wisdom teeth, decision-making should be based on the best evidence combined with clinical experience.76.4% had a reason for extraction that was justified. The reasons why extraction of the wisdom tooth was not justified in our study population was either: extraction for prophylaxis or in the case of asymptomatic non-pathological third molars; without scientific evidence. ConclusionThis subject, which is perpetually debated, requires updating dental health authorities by evaluating new conservative procedures.

Management of the Oral Health of Children During the COVID-19 Pandemic in Poland.

Managing the oral health of children during the time of a health emergency linked to the current COVID-19 pandemic presents specific problems. A high number of non-specific effective infection control protocols are available in dental settings. It is of fundamental importance to implement specific protocols relating to those clinical situations that normally do not represent an emergency but which now fall into that category. The aim of this study was the comparison of data obtained from the Regional National Health Fund (NFZ) relating to the number and the type of procedures in the oral health management of children aged 0–18 years from the Wielkopolska region, with the months of March and April of 2019 being compared with those of the, respective, pandemic period of 2020. The results showed statistical differences in the number of performed procedures when comparing 2019 and 2020; especially in April (n = 53,077 in 2019 but only n = 2,287 in 2020), when lockdown restrictions reached their highest level and when only 30% of the dental clinics for children were open for patients in the Wielkopolska region of Poland. Regarding surgical cases, there were no differences in percentage frequency between April 2019 and 2020 in terms of extractions. However, an increase was observed in abscess incisions (3.5–17.8%) and surgical dressings (1.5–10.07%). There was a decrease in the total number of performed conservative dentistry procedures in April 2020, but temporary fillings in primary and permanent teeth showed a prominent increase: from 6.4% in 2019 to 19.3% in 2020; and 5.8–11.4%, respectively. Pulp treatment and mucosal lesions therapy fall into the dental emergency category during this COVID-19 pandemic. These cases have shown an increase from 3.2% in 2019 to 12.8% in 2020 for pulp treatment, and from 2.3 to 4.3% for the treatment of oral mucosal lesions. As suspected, after the lockdown was implemented, the number of pediatric dental cases were low. Moreover, the analysis revealed differences in the profile of clinical situations that represented the emergency cases and the pandemic treatment protocols. Future implications suggest that dental prophylactic procedures be included in pandemic protocols with even dental services being limited to a form of urgent treatment. New approaches and treatment models should be implemented in the control of the infectious spread of the disease in the management of the oral health of children in this pandemic period.

A Unified Computational Framework to Compare Direct and Sequential False Discovery Rate Algorithms for Exploratory DNA Microarray Studies

The problem of detecting differential gene expression with mi croarray data has led to further innovative approaches to controlling false positives in multiple testing. False discovery rate (FDR) has been widely used as a measure of error in this multiple testing context. Direct estima tion of FDR was recently proposed by Storey (2002, Journal of the Royal Statistical Society, Series B 64, 479-498) as a substantially more powerful al ternative to the traditional sequential FDR controlling procedure, pioneered by Benjamini and Hochberg (1995, Journal of the Royal Statistical Society, Series B 57, 289-300). Direct estimation to FDR requires fixing a rejection region of interest and then conservatively estimating the associated FDR. On the other hand, sequential FDR procedure requires fixing a FDR control level and then estimating the rejection region. Thus, sequential and direct approaches to FDR control appear very different. In this paper, we intro duce a unified computational framework for sequential FDR methods and propose a class of more powerful sequential FDR algorithms, that link the direct and sequential approaches. Under the proposed unified compuational framework, both approaches simply approximate the least conservative (op timal) sequential FDR procedure. We illustrate the FDR algorithms and concepts with some numerical studies (simulations) and with two real ex ploratory DNA microarray studies, one on the detection of molecular signa tures in BRCA-mutation breast cancer patients and another on the detection of genetic signatures during colon cancer initiation and progression in the rat.

Value supported decision-making in paper conservation

This research announcement outlines the fundamentals, initial reflections, objectives, and methodology of a research project developed jointly by the University of West Attica, Greece, and the Federal University of Minas Gerais, Brazil. It presents the variability of the concept of value in the context of the preservation of cultural assets, the diversity of the terminology and the scarcity of specific discussions in the area of paper conservation. It outlines the conceptual contribution based on the relationship between values, historical evidence, and layers of data in cultural objects, as well as on the impact of conservation procedures on their interconnections. Finally, this article supports both the societal and material approach to decision-making in preservation and conservation through the interdisciplinary investigation of paper-based objects to understand them as complex artefacts.

BMAC and Adipose-Derived MSCs Treatment for Knee Osteoarthritis: A Systematic Review

Background: Knee osteoarthritis is the most common musculoskeletal progressive disorder that affects nearly 303 million people worldwide. This condition prevails in 10% males and 13% females among the elders above 60. Although there is conventional nonsurgical and surgical treatment available for knee osteoarthritis, there is a fascinating interest in bone marrow aspirate concentrate (BMAC) as well as adipose-derived mesenchymal stem cells (AD-MSC), including enzymatically treated stromal vascular fraction (SVF) and mechanically treated (microfat/nanofat) injections among physicians. Hence, this systematic review aims to determine the efficacy of BMAC and AD-MSCs (enzyme and mechanically treated) injections for knee osteoarthritis treatment. Methods: A systematic review was performed on the following data sources (PubMed, Scopus, Google Scholar, EMBASE, and Cochrane Library) published on March 31, 2021. The keywords or MeSH terms include 'Knee Osteoarthritis with 'Bone marrow aspirate concentrate' OR 'BMAC' or with 'Adipose-derived mesenchymal stem cells (AD-MSC)' or with 'Stromal vascular fraction' OR 'SVF' or 'Mechanically treated AD-MSC (mfat/nanofat)'. In addition, the retrieved articles were further reviewed to identify relevant research studies. Results: The authors reviewed and tabulated data based on the year of study, study type, therapy protocol, patient population, outcome measures, and interpretation. Among the 382 records screened, 43 studies (16 on BMAC and 27 on AD-MSCs) were included in the systematic review study. Among them, only 5 were randomized controlled trials. These selected studies demonstrated short-term positive outcomes such as improvement in knee pain and function with no adverse side effects. Moreover, researchers reported varied administration methods of BMAC or AD-MSC either as standalone or in combination with other conservative procedures such as PRP (Platelets Rich Plasma), HA (Hyaluronic acid), or surgery. Conclusions: BMAC and AD-MSC (enzymatically and mechanically treated) injections prove safer and more efficacious in patients with knee osteoarthritis for a shorter duration of 2 years. However, the available literature lacks high-quality studies with no varied clinical settings and long-term follow-up of more than two years.

Functional and/or hygienic surgery of the hypertonic upper limb

Neuro-orthopedic complications of the upper limb affect all of its joints and lead to a multitude of clinical pictures. The clinical assessment, which should be multidisciplinary, will have to answer basic questions to define the goal(s) and the appropriate surgical strategy. What is the patient’s and family’s complaint? What is the possible utility of the deformities? What is the type of deformity? Is it reducible or not? What is the contribution of the upper limb deformities versus that of any associated injuries to the discomfort? Several difficulties exist in the clinical assessment: evaluation of the antagonists especially the wrist extensor muscles; the intrinsic deformity component, which can be masked by the extrinsic component when retracted, the muscles responsible for a wrist flexion contracture and the complex shoulder deformities. Many patients have multiple deformities, which creates a problem for the hierarchy of corrections depending on the objectives. The answer to these questions helps to define a clear objective that will be formalized in a contract with the patient and subsequently to define the surgical strategy. Surgery is based on a simple principle: relax the muscles on the side of the deformity, either by selective neurotomy if there is a simple hypertonia, or by a tendon procedure if the muscle is retracted; compensate for the antagonists if they are deficient, and potentially stabilize the joint. Conservative procedures are preferred to preserve the possibility of functional recovery in the future. The wide range of medical and surgical solutions allows the patient’s care to be personalized. In the upper limb, the results are better for hygienic, positioning, and analgesic objectives. They remain more difficult to obtain for functional objectives, due to the biomechanical complexity of gripping.

Laparoscopic radical and conservative surgery of hydatid liver echinococcosis. PSM based comparative analysis of immediate and long-term outcomes

The diffusion of laparoscopic radical surgery of hydatid liver echinococcosis remains limited. There no published data on a comparative analysis of the immediate and long-term results of radical and conservative laparoscopic surgery for liver hydatid cysts. Comparison of the immediate and long-term outcomes after laparoscopic radical and conservative cystectomies was aimed. HPB center (center 1) and general surgery hospital in endemic area (center 2) participated in retrospective study. Radical surgery included total, subtotal pericystectomy and liver resection. Conservative surgery comprised cystectomy without/with partial pericystectomy. The total number of patients was 204. Laparoscopic cystectomy was performed in 97 (47%) patients. Radical (n-40) and conservative (n-61) laparoscopic procedures were performed in center 1 and center 2, respectively. Twenty-five pairs of patients were matched. The length of hospital stay and time of abdominal drainage were significantly shorter after radical surgery before and after PSM. The rate of severe morbidity did not differ. The mean follow-up length was 34 and 45 months in center 1 and center 2, respectively. No differences were found in the disease recurrence rate. Laparoscopic radical surgery leads to a reduction in the treatment time and can be recommended as the preferred treatment option in a specialized HPB center.

\u201cHow to measure the outcome in the surgical treatment of vertebral compression fractures? A systematic literature review of highly cited level-I studies\u201d

BackgroundThe economic burden of vertebral compression fractures (VCF) caused by osteoporosis was estimated at 37 billion euros in the European Union in 2010. In addition, the incidence is expected to increase by 25% in 2025. The recommendations for the therapy of VCFs (conservative treatment versus cement augmentation procedures) are controversial, what could be partly explained by the lack of standardized outcomes for measuring the success of both treatments. Consensus on outcome parameters may improve the relevance of a study and for further comparisons in meta-analyses. The aim of this study was to analyze outcome measures from frequently cited randomized controlled trials (RCTs) about VCF treatments in order to provide guidance for future studies.Material and methodsWe carried out a systematic search of all implemented databases from 1973 to 2019 using the Web of Science database. The terms “spine” and “random” were used for the search. We included: Level I RCTs, conservative treatment or cement augmentation of osteoporotic vertebral fractures, cited ≥50 times. The outcome parameters of each study were extracted and sorted according to the frequency of use.ResultsNine studies met the inclusion criteria. In total, 23 different outcome parameters were used in the nine analyzed studies. Overall, the five most frequently used outcome parameters (≥ 4 times used) were the visual analogue scale (VAS) for pain (n = 9), European Quality of Life–5 Dimensions (EQ-5D; n = 4) and Roland–Morris Disability Questionnaire (RMDQ, n = 4).ConclusionWith our study, we demonstrated that a large inconsistency exists between outcome measures in highly cited Level I studies of VCF treatment. Pain (VAS), followed by HrQoL (EQ-5D) and disability and function (RMDQ), opioid use, and radiological outcome (kyphotic angle, VBH, and new VCFs) were the most commonly used outcome parameters.

Osteoarthritis Related Pain: Which Procedure is the Optimal Choice?

Osteoarthritis (OA) is not simply a matter of mechanical damage and several risk factors are involved in the manifestation of the OA phenotype. OA-related pain management needs a multidisciplinary approach involving various treatment options including nonpharmacological and pharmacological ones. Due to the low number of high-quality studies related to OA related pain treatment, which conservative or non-conservative procedure should be chosen?

Clinical features and treatment of bronchial rupture of pulmonary hydatid cyst in children: a retrospective study of 36 patients.

The aim of this study was to review the clinical symptoms, radiological data, surgical techniques, and postoperative complications associated with bronchial rupture of pulmonary hydatid cysts in children and evaluate the results of surgical treatment. A retrospective study of 40 surgical procedures performed for pulmonary hydatid cyst ruptured in the bronchial tree in 36 children (22 boys and 14 girls), aged between 7 and 18 from January 2009 to December 2019. The study included 36 patients with a mean age of 14.7. Most symptoms were cough (63.9%), chest pain (38.9%), hemoptysis (33.3%), and hydatid vomiting (22.2%). Chest X-ray, chest CT scan and abdominal echography was performed in all cases. Surgical approach was posterolateral thoracotomy in all cases. Conservative treatment was possible in 35 patients (97.2%) through cystotomy in 25 cases, pericystectomy in 11 cases, and lobar resection in 1 case (2.8%). Average operative time was 103min (range: 53 and 185min) and mean postoperative hospital stay was 5.9days. The postoperative complications occurred in 4 (11.1%): atelectasis (N = 2), wound site infection (N = 1), and prolonged air leak (N = 1). There was no postoperative mortality. After an average follow-up of 39months there was no recurrence. Ruptured hydatid cyst of the lung into the bronchus. Must be surgically treated and carefully due to the risk of per-operative bronchial flooding. Conservative surgical procedures with precise closure of the bronchial fistulas and capitonnage can complete removal of the cyst with low complications.

Legal support for the restoration of lands disturbed by mining operations: Experience in the Russian Federation

The effectiveness of the restoration of lands disturbed by mining operations largely depends on the perfection of the legislation regulating this process. The purpose of the study is to identify evolutionary changes in the legal framework for reclamation and bottlenecks that require the improvement of legal acts. Research methods – scientific generalization, comparisons, analogy method, comparative and evolutionary analysis. Результаты. The relevance of reclamation in modern conditions has been substantiated, which is confirmed by the basic requirements of sustainable subsoil use and the Sustainable Development Goals (SDGs). The information concerning the legal support of reclamation is generalized and analyzed, the stages of this process are determined; setting back by a decade in the formation of legal support for reclamation in Russia of the Soviet period from foreign countries is identified. In Russia, the initial stage is attributed to the period of the 1950s– 1970s, when legislative documents were sporadic and did not practised on such a systematic basis. The period of the 1970s–1980s was defined as the main one, during which there was the approval of the “Basic provisions on the reclamation of lands disturbed during the development of mineral deposits and peat, conducting geological exploration, construction and other works” (1977), which have been successfully used for almost 20 years. At the same time, GOSTs and standards regulating reclamation began to operate. The following were subject to regulation: financing, accounting for the costs of reclamation work, compensation for any damage caused by the recipient, transfer of reclamation lands to land users, etc. Since the 1990s, there has been a certain decline in research focused on reclamation, although this period is characterized by the approval of quite important legislative acts, including the “Basic Provisions on Land Reclamation, removal, conservation and rational use of the fertile soil layer” (1995). Reclamation provisions are reflected in a number of federal laws and strategic documents. The highly anticipated government act defining the procedure for land reclamation and conservation was adopted in 2018. Deficiencies in the existing legislation regulating reclamation were identified, requiring amendments and additions to the latter. First of all, this concerns the Federal Law called “On Subsoil”, as well as the regulation of the financing of reclamation. Conclusion. Improving the legal framework for reclamation work will undoubtedly help to increase the efficiency of this process.

Long-term results of corneal collagen crosslinking for recurrent corneal erosion

BACKGROUND: Recurrent corneal erosion (RCE) is characterized by excacerbation and remission episodes, reduced patients quality of life affecting their daily and professional activities. In case of conservative therapy inefficacy surgical procedures are used (Bowmans membrane polishing with diamond drill, excimer laser phototherapeutic keratectomy, anterior stromal puncture, and amniotic membrane transplantation). All methods have their advantages and weak points, as well as a certain percent of recurrence. In this regard the use of corneal collagen cross-linking is of the interest as an alternative method of the RCE surgical treatment.
 MATERIALS AND METHODS: 18 patients (20 eyes) with RCE without central corneal stroma scars, aged from 30 to 66 (average 49,5 10,6, all women), after conservative treatment failure (more than 6 months) underwent cross-linking according to the Dresden protocol with the UVX device, version 1000, by IROC INNOCROSS (Switzerland).
 RESULTS: All patients were asymptomatic and had no recurrence during the observation period (from 1 to 6 years, in average 2,6 1,6). There was a slight but statistically significant BCVA improvement (from 0,93 0,09 at baseline to 0,97 0,07 after intervention).
 CONCLUSIONS: Crosslinking may be an additional and effective treatment in a number of RCE cases when there is no central corneal stromal scars present. To reduce stromal keratocytes alteration during the procedure modified protocols may be used.

Mid-term Outcome of the Edge-To-Edge Mitral Valve Repair Via Aortic Outflow Tract in High-Risk Patients

The edge-to-edge mitral valve repair technique, invented by Alfieri and colleagues, introduced valve repair as a treatment option for patients with complex diseases where standard annuloplasty and related repair techniques are insufficient, due to annular calcification and patient frailty. We retrospectively evaluated the results of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) in high-risk patients who were undergoing aortic valve replacement. From February, 2012 to December, 2017, 43 patients underwent transaortic edge-to-edge mitral valve repair with concomitant aortic valve replacement at a single institution. Preoperative and postoperative echocardiograms were compared. Home telephone follow up was conducted and postoperative morbidity was examined, including the need for reoperation, stroke and cardiac arrhythmia. 30-day and long-term survival rates were also determined. Mitral regurgitation (MR) was graded semi-quantitatively as 0 (trace and/or none), mild (1), moderate (2) or moderate to severe (3-4). The patients were 74 ± 7.8 years old. 65% of the patients were male. Mean cardiopulmonary bypass time was 115 ± 37 minutes and mean cross-clamp time was 71 ± 23 minutes. There was a significant improvement in preoperative vs postoperative median MR grade (2 (IQR 2-3) vs 0 (IQR 0-1); P = 0.05). Follow-up transthoracic echocardiograms in 29 patients obtained at a median of 9 months' (range 3 - 19 months') and in 16 patients at a median of 34 months' postoperatively (range 21 - 53 months') showed mild (1 (IQR 1-2)) grade of mitral regurgitation. 30-day survival was 98%. Long term survival at 12 and 24 months' were 88% and 81% respectively. Mitral valve reoperation was conducted in 1 patient (2%), who was suffering of endocarditis. Stroke occurred in 2 patients (7%). Cardiac arrhythmia was observed in 15 patients (35%). 8 patients (19%) suffered from atrial fibrillation and 7 patients (16%) displayed atrioventricular blockage. 10 patients (23%) could be treated conservatively and 5 patients (12%) needed implantation of a pacemaker. Transaortic edge-to-edge mitral valve repair can be safely performed during aortic valve replacement in high-risk patients and improves even long-term MR grade. Postoperative cardiac arrhythmia occurs frequently. 66% of them could be treated successfully by conservative procedures.

An outline of the problem of pelvic organ prolapse, including dietary and physical activity prophylaxis

Abstract Introduction. In gynecology, the proper selection of diagnostic and therapeutic methods, including conservative and/or surgical procedures, plays an important role. An outline of these issues is presented in the context of static disorders of female genital organs. The period of a woman’s life predisposing to pelvic organ prolapse is menopause, especially the period of senium, which is associated with hypoestrogenism. An analysis of the factors affecting the risk of disorders of genital statics indicates that pelvic floor exercises and a proper diet, which does not lead to constipation or obesity, are important in the prevention of genital static disorders. Aim. The aim of the study is to analyze the problem of disorders of the statics of genital organs, which is significant in nursing and medicine, in the light of the literature data.

Effect of water in color changes of historical paintings

AbstractIn conservation and cleaning of historical paintings, the use of water was discouraged because of its effects in terms of swelling and leaching of pictorial materials and of color modification. Nevertheless, water can represent a good substitute of organic solvents and of other tools recently employed for cleaning and restoration. The research article assesses the wetting characteristics and to quantifies the effect of the water absorption on the color changes for historical paintings. For these purposes, different typologies of painting mock‐ups have been prepared in the laboratory to reproduce the main antique pictorial techniques. The results highlighted that the binder played an important function in the wetting properties assessed by contact angle measurement. The water absorption tests underlined that the topography of the painting surface strongly influenced the water absorption. The data have been correlated to colorimetric measurements to quantify the color alteration induced by water. This quantification is important to define the role of water‐based products in cleaning and conservation procedures. The water, in fact, could be a good tool of green chemistry to save the health of the restorer and the environment.

Sub-Tissue Localization of Phytochemicals in Cinnamomum camphora (L.) J. Presl. Growing in Northern Italy.

In the present paper, we focused our attention on Cinnamomum camphora (L.) J. Presl. (Lauraceae), studied at three levels: (i) micromorphological, with the analysis of the secretory structures and a novel in-depth histochemical characterization of the secreted compounds; (ii) phytochemical, with the characterization of the essential oils from young stems, fruits, and leaves, subjected to different conservation procedures (fresh, dried, stored at −20 °C, stored at −80 °C) and collected in two different years; (iii) bioactive, consisting of a study of the potential antibacterial activity of the essential oils. The micromorphological investigation proved the presence of secretory cells characterized by a multi-layered wall in the young stems and leaves. They resulted in two different types: mucilage cells producing muco-polysaccharides and oil cells with an exclusive terpene production. The phytochemical investigations showed a predominance of monoterpenes over sesquiterpene derivatives; among them, the main components retrieved in all samples were 1,8-cineole followed by α-terpineol and sabinene. Conservation procedures seem to only influence the amounts of specific components, i.e., 1,8-cineole and α-terpineol, while analyses on each plant part revealed the presence of some peculiar secondary constituents for each of them. Finally, the evaluation of the antibacterial activity of the essential oil showed a promising activity against various microorganisms, as Listeria monocytogenes, Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa. In conclusion, we combined a micromorphological and phytochemical approach of the study on different plant parts of C. camphora, linking the occurrence of secretory cells to the production of essential oils. We compared, for the first time, the composition of essential oils derived from different plant matrices conserved with different procedures, allowing us to highlight a relation between the conservation technique and the main components of the profiles. Moreover, the preliminary antibacterial studies evidenced the potential activity of the essential oils against various microorganisms potentially dangerous for plants and humans.

Use of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery

BackgroundChronic rhinosinusitis with nasal polyps recurs frequently after functional endoscopic sinus surgery (FESS), with resultant poor quality of life with persistence of nasal obstruction, sinus aches, and discharge as well anosmia and dysgysia; revision FESS is usually the treatment of choice referred to relief patients’ suffering, yet it is not always the case, patients preference as well as fitness for general hypotensive anesthesia, patients age, cardiopulmonary status, and concurrent bronchial asthma might render unfit for an elective procedure. The aim of this study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery.ResultsThirty patients suffering from recurrent sinonasal polyposis after single or multiple FESS procedures were selected; all patients were subjected to intranasal application of gelfoam soaked with triamcinolone as a conservative medical office procedure using triamcinolone-soaked absorbable gelatin foam (gelfoam) weekly for a period of 8 weeks followed by intranasal steroid nasal spray for maintenance and as anti-recurrence measure. Patients were followed up for 4 months post-intervention; Meltzer Clinical Scoring System was used to analyze the patients’ pre- and post-intervention via office endoscopy (0° 4-mm Hopkins endoscope). All patients tolerated the procedure well. The study group showed no statistical significance pre-intervention which comprised 17 (56.7%) patients with grade 4 sinonasal polyposis extent and 13 (43.3%) patients with grade 3 sinonasal polyposis extent (P=0.795), denoting no difference between patients pending treatment option. Post-treatment, both groups showed a significant reduction in the extent of polyposis (P<0.001) where post-treatment showed 21 (70%) patients with grades 0 no polyps and 9 (30%) patients with grade 1 sinonasal polyposis extent.ConclusionTriamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent sinonasal polyposis after FESS. Intervention contributed to a successful result, decreased the need for surgery in poor candidates for hypotensive anesthesia, and could be used as a sole treatment of recurrent sinonasal polypsis in elderly patients whose general condition could not tolerate invasive procedures.

Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis.

BackgroundIn patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy.MethodsA systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732).ResultsOf 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9–23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5–13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6–9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8–1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1–6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years.ConclusionEndocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.

Conservation officer perceptions of search authority

ABSTRACT To date, a great deal of confusion and misinformation surrounds the authority (and therefore potentially wider discretion) that conservation officers possess to search private property, vehicles, and residences. Utilizing a survey of approximately 1,600 officers employed in 15 state-level conservation agencies in the United States, the current inquiry examines conservation officer perceptions of their search authority. Findings indicate there is substantial state-level variation in statutory authority granted to conservation officers relative to their search and seizure capabilities. A substantial percentage of conservation officers believe that they possess authority to search private property beyond that granted to other law enforcement officers. Findings indicate that this perception is less common for vehicles or private residences. The findings from this study have implications for conservation officer training, policy, and procedure.

Cervical spondylosis: An ayurvedic review

Introduction: In this period of modernization and fast life, people undergo many unwanted practices like improper sitting posture for long time in offices, continuous work in one posture, over exertion, lack of physical exercise, excessive loads to bearing movements during travelling and sports, all these factors create undue pressure and compressive injury to the spine, that play an important role in producing disease like Cervical Spondylosis. Modern medicine has limited conservative and surgical procedures which provide only temporary symptomatic relief and many times have hazardous side effects. In Ayurveda through its sign and symptoms it can be correlated with Prishtagraha. There is need to explore the Ayurvedic perspective of cervical spondylosis by which we can cure and prevent this disease. Aim & Objective: To study the clinical manifestations, etiological factors, pathogenesis and management of cervical spondylosis through Ayurvedic perspective. Materials and Methods: For this study Ayurveda Samhitas like Charak Samhita, Sushruta Samhita etc, authentic publications, internet and modern medical literature have been reviewed. Conclusion: It is concluded that, on the basis of clinical manifestation, pathogenesis and complication cervical spondylosis can be correlated with Pristha (back of neck) Graha (stiffness or obstruction) and the Ayurvedic treatment modalities can be used as an effective management in cervical spondylosis.