Conservative Treatment Strategies Research Articles

Fluoroscopy: Taking a closer look at joint motion in osteoarthritis

BackgroundKnowledge of joint biomechanics is crucial for understanding the pathophysiology of osteoarthritis (OA). Biomechanical changes, especially in early-stage OA, are subtle and therefore require highly accurate and precise ways of measuring joint loading (i.e., forces) and kinematics (i.e., motion). Most OA research investigating kinematics to date using conventional measurement methods, has been restricted either to measures of functional, weight-bearing activities with limited precision, or to highly precise measures of non-functional activities. X-ray fluoroscopy, however, is a medical imaging modality that can be used to precisely measure high-speed dynamic human movement in vivo under weight-bearing conditions. ObjectiveTo illustrate the potential of fluoroscopy to measure human movement and study joint biomechanics in OA by highlighting several exemplary applications in studies on knee OA. DesignWe searched PubMed to identify a selection of relevant studies with fluoroscopic evaluation of joint mechanics in individuals with, or at risk of developing, knee OA. ResultsFluoroscopy has been utilized in biomechanical studies in populations with early stages of knee OA or at risk of developing knee OA, as well as in studies evaluating conservative treatment strategies for knee OA. Due to its ability to capture highly accurate and precise kinematic measures, fluoroscopy holds great promise in providing new insights in the role of biomechanics in OA pathogenesis. ConclusionsThe use of fluoroscopy in larger cohorts and longitudinal (interventional) studies may lead to more robust and generalizable results and could clarify the mediation pathways of joint biomechanics in the onset and progression of OA.

PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONGENITAL HEART DISEASE: RATIONALE FOR MANAGEMENT ALGORITHM BASED ON A LITERATURE REVIEW

The substantial progress achieved in cardiology and paediatric cardiac surgery has led to a considerable increase of life expectancy of patients with congenital heart disease (CHD), and at the same time to growing number of adult patients developing pulmonary arterial hypertension (PAH) associated with congenital heart defects. Nowadays guidelines were developed and updated for PAH, but no expert recommendations exist for effective management of PAH associated with CHD. Thus, it is important to develop an algorithm for managing these patients, based on international standards and a comprehensive understanding of prognostic markers of worsening the course of pulmonary arterial hypertension (PAH), considering local cardiac tertiary hospitals' capabilities.
 The aim. To highlight the pathophysiology and clinical characteristics of PAH-CHD patients, identify prognostic markers for its onset and progression, and develop a management algorithm for patients.
 Results. The article presents the pathophysiology of PAH-CHD, the mechanisms of right ventricle adaptation to pressure overload, which determine the functional abilities of patients and prognosis, PAH formation, and progression after defects correction. The accurate identification of stages in PAH-CHD (volume overload, mixed, stage of pulmonary vascular disease) is essential for the timely determination of surgical intervention, selecting conservative treatment strategies, and predicting the outcomes of surgical defect correction. The type of defect, its size, and the volume of blood flow through the defect influence the onset and progression of PH-CHD. We review the pathophysiology and clinical features of PAH-CHD, as well as the reasons for the late diagnosis of heart failure at the stage of severe decompensation and irreversible remodelling of the lung vessels when diuretic therapy is not effective enough and inotropic support, circulatory mechanical support and heart / lung complex transplantation are required. The necessity of developing new scales for stratifying the risk of PAH-CHD is justified considering the particularities of the disease course and cardiac hemodynamic in different anatomical types of the defects. Based on this literature review, at the Municipal Enterprise «Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment» of the Dnipropetrovsk Regional Council» the algorithm for managing patients with PAH-CHD was devised and implemented into clinical practice.
 Conclusions. PAH is a common complication of CHD. The prevalence of PAH-CHD is substantial and it can manifest and progress even in patients with previously corrected heart defects. To effectively manage patients with PAH-CHD, an algorithm has been devised and implemented in clinical practice. It includes factors that have demonstrated associations with poor prognosis which are more than two hospitalizations for HF in the last year, pulmonary vascular resistance (PVR) (or index of PVR), mean pressure in the pulmonary artery, pulmonary capillary wedge pressure, left ventricular ejection fraction, heart failure with a reduced ejection fraction, right ventricle heart failure, NYHA FC, high risk of atrial fibrillation or flutter, 6-minute walking test distance, NTproBNP, highly sensitive C-reactive protein, B-lines on lung ultrasound, glomerular filtration rate, haemoglobin, platelet count, sodium, Model for End-Stage Liver Disease scale.

Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction

The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior. ClinicalTrials.gov Identifier: NCT03208153.

Treatment strategies for simple elbow dislocation - a systematic review

BackgroundCurrent treatment concepts for simple elbow dislocation involve conservative and surgical approaches. The aim of this systematic review was to identify the superiority of one treatment strategy over the other by a qualitative analysis in adult patients who suffered simple elbow luxation.Study designA systematic review in accordance with the PRISMA guidelines and following the suggestions for reporting on qualitative summaries was performed. A literature search was conducted using PubMed and Scopus, including variations and combinations of the following keywords: elbow, radiohumeral, ulnohumeral, radioulnar, luxation, and therapy. Seventeen studies that performed a randomized controlled trial to compare treatment strategies as conservative or surgical procedures were included. Reviews are not selected for further qualitative analysis. The following outcome parameters were compared: range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand outcome measure (Quick-DASH), recurrent instability, pain measured by visual analog scale (VAS) and time to return to work (RW).ResultsEarly mobilization after conservative treatment strategies showed improved ROM compared to immobilization for up to 3 weeks after surgery with less extension deficit in the early mobilization group (16° ± 13°. vs. 19.5° ± 3°, p < 0.05), as well as excellent clinical outcome scores. Surgical approaches showed similar results compared to conservative treatment, leading to improved ROM (115 vs. 118 ± 2.8) and MEPS: 95 ± 7 vs. 92 ± 4.ConclusionConservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. The surgical procedure provides similar outcomes compared to conservative treatment regarding MEPS and ROM for patients with slight initial instability in physical examination and radiographs. People with red flags for persistent instability, such as severe bilateral ligament injuries and moderate to severe instability during initial physical examination, should be considered for a primary surgical approach to prevent recurrent posterolateral and valgus instability. Postoperative early mobilization and early mobilization for conservatively treated patients is beneficial to improve patient outcome and ROM.

Nitisinone attenuates cartilage degeneration and subchondral osteoclastogenesis in osteoarthritis and concomitantly inhibits the cGAS/STING/NF-κB pathway

Osteoarthritis (OA) is a chronic degenerative joint disease characterized by cartilage degeneration and subchondral bone remodelling. Currently, conservative treatment strategies cannot effectively alleviate the progression of OA. In this study, we used computer network analysis to show that Nitisinone (NTBC) is closely related to extracellular matrix degradation in OA and mainly interferes with the TNF-α signaling pathway. NTBC is an orphan drug used to treat hereditary type I tyrosinemia by altering phenylalanine/tyrosine metabolic flow. In this study, we found that NTBC effectively reduced chondrocyte inflammation and extracellular matrix degradation induced by TNF-α. Mechanistically, NTBC inhibited the cGAS/STING signaling pathway and reduced activation of the STING-dependent NF-κB pathway to alleviate inflammation. In addition, NTBC inhibited osteoclastogenesis and delayed the occurrence of subchondral bone remodelling. In mice with ACLT-induced osteoarthritis, intra-articular injection of NTBC significantly reduced cartilage degradation and subchondral bone remodelling. NTBC showed impressive therapeutic efficacy as a potential pharmaceutical intervention for the treatment of OA.

Xylazine-Associated Wounds and Related Health Concerns Among People Who Use Drugs: Reports From Front-Line Health Workers in 7 US States.

Xylazine, an adrenergic alpha-2 agonist increasingly present in the US drug supply, is associated with severe skin ulcers and other harms. Expert knowledge from front-line harm reduction and healthcare professionals is an essential component of evidence-based practice. The purpose of this study is to describe the progression and treatment of xylazine-associated wounds, other xylazine-related health concerns, and the most urgent research priorities as reported by front-line harm reduction and healthcare professionals serving people who use drugs. A convenience sample of 17 healthcare and harm reduction professionals who serve people who use drugs in the US states of Maryland, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, and Texas participated in semi-structured interviews. Participants were asked about the appearance and progression of xylazine-associated wounds; preferred treatment strategies; other xylazine-related harms experienced by people who use drugs; and the most urgent priorities for xylazine-related research. Xylazine-associated wounds were broadly described as small lesions appearing mostly on extremities both at and away from injection sites, often within hours or days of exposure, that quickly developed into large, complex, chronic wounds. Reported risk of secondary infection was generally low but appeared more common among unhoused populations. Most participants preferred conservative treatment strategies that included regular wound care, enzymatic debridement, and hygiene. Xylazine-associated wounds and xylazine withdrawal reportedly act as significant barriers to care, including addiction treatment. Participants reported urgent need for scientific research and evidence-based guidance on the management of xylazine-associated wounds and withdrawal. High-quality scientific evidence on risk factors for xylazine-associated wounds and on their biologic mechanisms is needed. Such studies could inform new strategies for the prevention and treatment of these wounds. Efforts to improve the management of xylazine withdrawal and to reduce stigma by incorporating harm reduction professionals into healthcare settings may improve access to and retention in care.

Steven-Johnson Syndrome/ Toxic Epidermal Necrolysis Overlap Complications

ABSTRACT Steven–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) overlap is a life-threatening disorder which can lead to mortality because of systemic complications. Here, we present a case of a 22-year-old female referred to the hospital with generalized epidermal detachment and necrolysis covering approximately 25% body surface area, and unstable vital signs were found. Laboratory examination results showed acute renal failure (ARF), anemia, and hypoalbuminemia. Comprehensive treatment of skin and systemic conditions must be carried out to avoid mortality and improve the outcome. This case highlights a case of SJS overlap TEN with shock, ARF, anemia, and hypoalbuminemia safely treated by a conservative treatment strategy.

Non-surgical management of chronic subdural hematoma: insights and future perspectives from an international survey including neurosurgeons from 90 countries worldwide

Background Chronic subdural hematoma (cSDH) is one of the most common neurosurgical conditions. Although surgical evacuation is still the gold standard for treatment, recent advances have led to the development of other management strategies, such as medical therapies and endovascular middle meningeal artery (MMA) embolization. Through this international survey, we investigated the global trends in cSDH management, focusing on medical and endovascular treatments. Design and participants A 14-question, web-based, anonymous survey was distributed to neurosurgeons worldwide. Results Most responders do not perform MMA embolization (69.5%) unless for specific indications (29.6%). These indications include residual cSDH after surgical evacuation (58.9%) or cSDH in patients on antiplatelet medications to avoid surgical evacuation (44.8%). Survey participants from teaching versus non-teaching hospitals (p = 0.002), public versus private hospitals (p = 0.022), and Europe versus other continents (p < 0.001) are the most users of MMA embolization. A large number of participants (51%) declare they use a conservative/medical approach, mainly to avoid surgery in patients with small cSDH (74.8%). Conclusions This survey highlights the current trends of cSDH management, focusing on conservative and MMA embolization treatment strategies. Most responders prefer a conservative approach for patients with small cSDHs not requiring surgical evacuation. However, in higher-risk scenarios such as residual hematomas after surgery or patients on antiplatelet medications, MMA embolization is regarded as a reasonable option by participants. Future studies should clarify the indications of MMA embolization, including appropriate patient selection and efficacy as a stand-alone procedure.

Advances in Endoscopic Diagnosis and Treatment of Gastric Neuroendocrine Neoplasms.

Gastric neuroendocrine neoplasms refer to a group of diseases that are relatively rare. They can be classified into three subtypes based on their clinical and histopathological features, and there are significant differences in diagnosis, treatment, and prognosis among the different subtypes. The incidence of gastric neuroendocrine neoplasms has been increasing globally in recent years with the localized disease being particularly evident. Gastrointestinal endoscopy is of irreplaceable importance for the diagnosis and management of g-NENs. Endoscopy with biopsy is the gold standard for the diagnosis of g-NENs. Ultrasound endoscopy can assess the depth of tumor invasion and the presence of lymphatic metastases, which is important for the development of treatment strategies. Meanwhile, for some small and low-risk lesions, endoscopic surveillance or endoscopic resection has satisfactory therapeutic results and prognosis. This means that even though the incidence has increased, advances in endoscopic techniques have allowed more patients to adopt a relatively conservative treatment strategy. However, the criteria for patients suitable for endoscopic surveillance or endoscopic resection remain controversial.

Treatment of hard-to-heal wound after huge scalp tumor resection and reconstruction: a case report

Introduction and importance: Free skin flap transplantation and titanium mesh reconstruction can effectively repair the scalp and skull defects caused by massive scalp tumour resection. Postoperative flap infection is a common complication. Due to the presence of titanium mesh, once infection occurs, a second operation is required to remove the titanium mesh, which brings a great physical and economic burden to the patient. Case presentation: In this case of postoperative infection, the authors used a conservative treatment based on dressing change, preserved the titanium mesh and flap, avoided secondary surgery, and successfully controlled the infection. Clinical discussion: The treatment strategy is mainly divided into three steps: the first stage is to control infection, the authors use complexed iodine to repeatedly disinfect wounds, subcutaneous dead space, exposed titanium mesh, and antibiotic treatment for bacterial culture results; the second stage is to promote granulation growth, After infection control, the authors remove old granulation after each wound disinfection, and then instill fibroblast growth factor to promote subcutaneous granulation growth to fill dead space, and also provide a base platform for epidermal growth; the third stage is mainly epidermal healing, Change the dressing every day to observe the growth of the epidermis. Conclusion: This case suggests that conservative treatment strategy based on dressing change is also a potential treatment option for postoperative infection of the flap with exposure of the titanium plate.

Proportional troponin changes and risk for outcomes with intervention strategies in non-ST-elevation acute coronary syndrome across kidney function.

This analysis evaluates whether proportional serial cardiac troponin (cTn) change predicts benefit from an early versus delayed invasive, or conservative treatment strategies across kidney function in non-ST-elevation acute coronary syndrome (NSTE-ACS). Patients diagnosed with NSTE-ACS in the Veterans Health Administration between 1999 and 2022 were categorized into terciles (<20%, 20 to ≤80%, >80%) of proportional change in serial cTn. Primary outcome included mortality or rehospitalization for myocardial infarction at 6 and 12 months, in survivors of index admission. Adjusted hazard ratio (HR) with 95% confidence Intervals (95% confidence interval [CI]) were calculated for the primary outcome for an early invasive (≤24 h of the index admission), delayed invasive (>24 h of index admission to 90-days postdischarge), or a conservative management. Chronic kidney disease (CKD) was more prevalent (45.3%) in the lowest versus 42.2% and 43% in middle and highest terciles, respectively (p < 0.001). Primary outcome is more likely for conservative versus early invasive strategy at 6 (HR: 1.44, 95% CI: 1.37-1.50) and 12 months (HR: 1.44, 95% CI: 1.39-1.50). A >80% proportional change demonstrated HR (95% CI): 0.90 (0.83-0.97) and 0.93 (0.88-1.00; p = 0.041) for primary outcome at 6 and 12 months, respectively, when an early versus delayed invasive strategy was used, across CKD stages. Overall, the invasive strategy was safe and associated with improved outcomes across kidney function in NSTE-ACS. Additionally, >80% proportional change in serial troponin in NSTE-ACS is associated with benefit from an early versus a delayed invasive strategy regardless of kidney function. These findings deserve confirmation in randomized controlled trials.

Botulinum toxin and conservative treatment strategies in people with cervical dystonia: an online survey

Isolated cervical dystonia is a focal, idiopathic dystonia affecting the neck muscles. Treatment usually consists of botulinum neurotoxin (BoNT) injections into the dystonic muscles. Our aim is to investigate the use of BoNT treatment and conservative treatments by people living with cervical dystonia. An online survey in English was conducted between June and August 2022. Participants were eligible to participate if they were living with cervical dystonia, were over 18 years old and could read and understand English. The survey consisted of demographic questions, characteristics of dystonia, questions relating to BoNT use and the perceived utility of conservative treatments. The data were analysed descriptively, and open-ended questions were grouped into similar topics represented by direct quotes. We received 128 responses from people with cervical dystonia, with an average age of 59 years and 77% women. Most participants (52%) described their cervical dystonia as mild to moderate with an average pain score of 5/10. Eighty-two (64%) participants were having regular BoNT injections, with overall positive perceived effects. Common activities reported to improve the symptoms were the use of heat packs, massage, relaxation, physiotherapy and participation in general exercise. Common coping strategies reported were getting sufficient rest, having the support of friends and family, and remaining engaged in enjoyable hobbies. We found that most participants received regular BoNT injections and that heat packs, exercise, massage, physiotherapy and relaxation were mostly perceived as effective in reducing the symptoms of cervical dystonia.

Photoreceptor Damage in Terson Syndrome.

To describe photoreceptor damage in patients with Terson syndrome as a potential cause for inconsistent clinical outcomes. Clinical evaluation and retinal imaging in six patients. Four patients were female and two male, with an average age of 46.8 years (SD 8.9). Four patients suffered aneurysmal subarachnoid haemorrhage, one vertebral artery dissection, and one superior sagittal sinus thrombosis. In 11 eyes, we observed a consistent pattern of outer retinal damage within the central macula affecting the ellipsoid zone and the outer nuclear layer, indicating photoreceptor damage. Areas of photoreceptor damage showed poor spatial correlation with intraocular haemorrhage, particularly sub-internal limiting membrane haemorrhage. The observed retinal abnormalities demonstrated incomplete recovery over long-term follow-up 3.5 to 8 years post-haemorrhage, irrespective of surgical or conservative treatment strategy, and had variable impact on the patients' visual function. The observations suggest that photoreceptor damage in Terson syndrome likely represents a distinct manifestation of this condition, which could be caused by transient ischaemia resulting from disturbed choroidal perfusion secondary to acute rise in intracranial pressure.

Current trends in non-surgical management of Peyronie's disease-A narrative review.

Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.

3D imaging of left atrial dissection: a case report

BackgroundLeft atrial dissection (LAD) is an uncommon but potentially devastating complication of cardiac surgery. Though surgical and conservative treatment strategies have been reported, the choice depends on each clinical situation. Especially in sensitive cases, the decision could be difficult, where the detailed assessment of the multiple imaging modalities is mandatory.Case presentationOpen surgical total arch replacement (TAR) was performed on a male patient aged 79 years old, who had severe chronic obstructive pulmonary disease (COPD) and a history of aortofemoral bypass for abdominal aortic aneurysm and arteriosclerosis obliterans (ASO). During the weaning off the cardiopulmonary bypass (CPB), LAD was detected on intraoperative transesophageal echocardiography (TEE). It was 18 × 26 mm and full of hematoma with the TEE. Due to the patient’s frailty and not to elongate the CPB duration, we selected a conservative strategy. The patient was extubated on postoperative day (POD) 1 and transferred from ICU to the ward on POD 3. On POD 7, ECG-gated 3D-CT was performed, on which LAD occupied 26% of the left atrial volume. It also revealed the opening of the pulmonary veins and the proximity of the LAD and the coronary sinus (CS). The cause of the LAD was considered to be the CS perforation with a retrograde cardioplegic cannula. A follow-up 3D-TEE was performed on POD 15, where the hematoma inside the LAD was absorbed. He was discharged home at POD 23. With transthoracic echocardiography, LAD itself disappeared after 3 months.Conclusion3D imaging, such as 3D-TEE and 3D-CT, is valuable in the assessment of the volume and quality of LAD. Furthermore, it clarifies the exact position and configuration of LAD, which help in assessing the etiology, predicting the hemodynamic disturbance, and determining the treatment strategy. They are potent tools, especially in complex cases.

Genome-wide CRISPR screening reveals ADCK3 as a key regulator in sensitizing endometrial carcinoma cells to MPA therapy

BackgroundThe effectiveness of conservative treatment of endometrial carcinoma (EC) with oral progesterone therapy, such as medroxyprogesterone acetate (MPA), can be blunted due to primary or acquired resistance, but the underlying mechanisms remain incompletely defined.MethodsGenome-wide CRISPR screening was performed to identify potential regulators in response to MPA in Ishikawa cells. Crystal violet staining, RT–qPCR, western blotting, ChIP–qPCR and luciferase assays were employed to elucidate the p53-AarF domain-containing kinase 3 (ADCK3) regulatory axis and its roles in sensitizing EC cells to MPA treatment.ResultsADCK3 is identified as a previously unrecognized regulator in response to MPA in EC cells. Loss of ADCK3 in EC cells markedly alleviated MPA-induced cell death. Mechanistically, loss of ADCK3 primarily suppresses MPA-mediated ferroptosis by abrogating arachidonate 15-lipoxygenase (ALOX15) transcriptional activation. Moreover, we validated ADCK3 as a direct downstream target of the tumor suppressor p53 in EC cells. By stimulating the p53-ADCK3 axis, the small-molecule compound Nutlin3A synergized with MPA to efficiently inhibit EC cell growth.ConclusionsOur findings reveal ADCK3 as a key regulator of EC cells in response to MPA and shed light on a potential strategy for conservative EC treatment by activating the p53-ADCK3 axis to sensitize MPA-mediated cell death.

Adhesive Capsulitis Secondary to COVID-19 Vaccination - A Case Series.

Shoulder injury related to vaccine administration (SIRVA) is a group of pathologies defined by pain and stiffness after intramuscular administration of vaccine to the upper arm and has been reported after COVID-19 vaccination. We aim to discuss its pathophysiology, clinical presentation, treatment and outcomes. We retrospectively identified patients presenting with adhesive capsulitis within four weeks of administration of COVID-19 vaccine to the affected arm at our tertiary institution from March 2021 to December 2022. Based on the above criteria, we identified seven cases of adhesive capsulitis, comprising one male and six female patients, with average age of 60 years. We present initial symptoms, signs and the duration from when the vaccine was administered. We have highlighted our treatment strategies as well as the clinical and functional outcomes reported by these patients after treatment. We have reported improvement in both Visual Analogue Scale (VAS) and range of motion (ROM) in all our patients after non-surgical management which included physiotherapy and, in some cases, hydrodilatation. SIRVA related adhesive capsulitis is rare and under-reported with limited information in current literature. This study highlights that adhesive capsulitis is a potential complication arising from improper COVID-19 vaccine administration and reinforces traditional wisdom of administering vaccinations on the non-dominant arm. Conservative treatment strategies appear to be effective, particularly hydrodilatation combined with physiotherapy, and patients are expected to have a good return of function.

Dental implants in growing patients: A systematic review and meta-analysis.

Dental implants provide a suitable and reliable treatment for the replacement of missing teeth. Very few studies have been reported in the literature regarding the application of dental implants in growing and developing patients. This systematic review with meta-analysis aimed to systematically review the available literature regarding the application of dental implants in growing and developing patients. A detailed search in the literature was performed with the help of keywords such as dental implants, treatment planning, children, adolescents, growing patients, and developing jaws. PubMed, Scopus, Web of Sciences, and Ovidsp databases were searched for papers published between 1980 and 2021. The papers focused on children, adolescents, developing jaws, and implants. In this systemic review, the dataset concerned with the type of study, aim, number of patients and specimens included, age of patients, total number of implants placed, total number of implants evaluated, medical history of developmental disorders of teeth such as ectodermal dysplasia, congenital absence of teeth, were evaluated. Out of the total literature searched, 33.45% of studies and case reports documented no complications in any implant treatment. In 47.21% of studies and case reports, there was both success and failure of implants while in 13.21% of studies and case reports there was a complete failure of implants. The most common cause for loss of permanent teeth in growing children and adolescent patients was dental trauma (73.13%) followed by congenital developmental disturbance of teeth (18.19%). It can be concluded from this systematic review that the use of implants in edentulous growing patients is determined by several parameters, including the patient's overall health, the stage of jaw growth, the number of teeth to be replaced, and soft and hard tissue anatomic features. Still, the use of a conservative treatment strategy for missing teeth management in patients with developing jaws is common and recommended until the patient's growth is completed, as there are chances of changes in the position of dental implants placed in the developing and growing jaws due to the continuous changes taking place in their body. However, placement of implants can be done in these patients successfully with proper treatment planning and taking into account the phase of growth with proper follow-up.

The The Observed Pre and Post-Intervention Changes to Movement Potentiation Scale (MPS) Scores and How That Impacts Pain, Balance &amp; Coordination - A Case Series

Musculoskeletal (MSK) injuries are a major leading burden of disease worldwide, making up 77% of all injury healthcare visits, totaling around 65.8 million people annually in the US alone. There is a clear demand to optimize conservative treatment strategies for improved clinical outcomes. Three Case Reports were conducted with three different female participants (of whom each presented with different primary complaints). Each participant was scored pre and post-intervention using the Movement Potentiation Scale™ (MPS), designed by Williams &amp; Horschig (2022). Additionally, a Visual Analog Pain Scale (VAS) was used to determine each participant’s pain levels, and a comprehensive history was conducted prior to the commencement of the program. The MPS model consists of 6 fundamental movement challenges worth a total value of 26 points. Following the MPS assessment, each participant underwent a consecutive 5-day Functional Movement Training Program. The program prioritized movement Quality over Quantity, an inherent characteristic of Movement Therapy, focusing on proprioception, balance, coordination, and proper biomechanics under tolerable loads. Primary provocative movements and day-to-day activities were identified. Each participant was educated about spinal hygiene, postural stress, and safe movement strategies such as hip hinging, squats, lifting overhead, and the coordination of the core and bracing. On day 6, post-intervention data was collected. Each participant displayed a drastic improvement in pain and MPS score, reflecting increased Movement Quality and joint stability. Improvements in strength, neural control, and connective tissue integrity were observed with reduced nociception and inflammation. Participant 1, awaiting surgery for ongoing chronic Low Back Pain (LBP), scored a low MPS score of 5/26 on day 1. Post-intervention on Day 6, she presented with 0/10 pain and a 15/26 MPS score. It was noted that “for the first time in years,” she had pain-free sleep and zero pain. Participant 2 entered the study with a low MPS score of 7/26 and chronic ongoing shoulder pain and paresthesia down the left arm. On day 6, she presented with 0/10 pain, no paresthesia, and an improved 14/26 MPS score. Participant 3 presented an MPS score of 8/26 and a primary complaint of Urinary Incontinence (UI). Referrals were made from her doctor (GP) to multiple physiotherapists, including postpartum specialists. However, they were unsuccessful. On day 6, she presented an improved MPS score of 18/26 with a 10-day follow-up of zero urinary incontinence issues. This case series is a small step in the right direction; however, further high-caliber studies are required to add further validation to the utility of The MPS Model and Movement Quality focused Rehabilitation – Functional Movement Therapy.

Conservative treatment strategies for endometrioid ovarian cysts: A review

Endometriosis remains one of the most topical diseases in current gynecology and is a multifactorial condition with an overgrowth of tissue morphologically and functionally similar to the endometrium outside the uterine cavity. One of the most frequently diagnosed forms of endometriosis is endometrioid ovarian cysts. An important feature of the clinical course of ovarian endometriosis is its negative impact on reproductive function and the recurrent nature of the disease, which may require repeated surgeries with even greater damage to the ovarian tissue. Therefore, the development of a long-term drug treatment strategy for patients with a history of endometrioid cysts aimed at preventing recurrences is urgently needed. According to domestic and foreign clinical guidelines, progestagen hormone therapy is recommended as first-line therapy for such patients. One of the most clinically studied drugs with a favorable efficacy and safety profile proven in numerous studies is dienogest. The paper presents the experience of foreign and domestic authors in conservative therapy in patients with a history of endometrioid cysts using dienogest in terms of recurrence prophylaxis.