Efficacy and safety of resistance training for knee osteoarthritis and subsequent knee replacement: A systematic review and meta-analysis.

Scoliosis is a three-dimensional spinal deformity that may affect musculoskeletal alignment, respiratory mechanics, and neuromotor control. Rigid thoraco-lumbo-sacral orthoses (TLSOs) remain the primary conservative treatment during skeletal growth. Most brace systems rely on three-point pressure mechanisms that primarily generate lateral compression forces, while the contribution of shear components to corrective biomechanics has been insufficiently quantified. This study presents the experimental and analytical validation of the Canali Front-Push Orthopedic Brace, a rigid orthotic system designed to generate controlled compressive and shear forces through a frontal thrust mechanism and anterior rib cage engagement. By applying anterior force, the device reduces the frontal-plane lever arm, thereby limiting the mechanical moment that contributes to transverse plane rotation. An instrumented four-segment torso model derived from the internal CAD geometry of the brace was developed to independently measure upper compression, lower compression, and intersegmental shear forces. Controlled misalignment conditions (0 mm, 2 mm, and 4 mm) were introduced to simulate asymmetric engagement of the orthosis. Three load cell configurations (200 N and 500 N capacity) were tested. Mechanical endurance of the rack–latch fastening system was also evaluated. A predictive shear–misalignment relationship was derived and experimentally validated. Peak compressive forces reached approximately 370 N, while shear forces increased from less than 40 N under symmetric alignment (D0) to approximately 170 N under maximal misalignment (D4). Shear activation demonstrated near-linear proportionality to imposed geometric asymmetry (R2 > 0.94). Following cyclic loading, the fastening system stabilized mechanically around 300 N. Measurement repeatability showed a coefficient of variation below 5%. These findings demonstrate that the brace produces predictable and controllable shear activation while maintaining high mechanical repeatability. The results provide a quantitative biomechanical framework for understanding shear-induced corrective mechanics in scoliosis bracing and support future studies integrating computational modeling and clinical validation. The proposed mechanical framework may contribute to the development of next-generation orthotic strategies aimed at controlling spinal rotation through vector modulation rather than purely compressive correction.

Background and Aim. Urinary incontinence (UI) affects up to one in three adults over 50 and is closely associated with stigma, embarrassment, and delayed help‑seeking. Its impact includes psychological distress, social withdrawal, and reduced daily functioning. Although pelvic floor muscle training is an effective conservative treatment, many older adults face barriers related to awareness, guidance, and motivation. Digital health tools may help address these challenges by offering anonymity, structured support, reducing waiting lists and lowering healthcare costs. Evidence from mobile and web‑based UI interventions shows improvements in symptoms and engagement. This study, part of the multinational KOKU Bladder project, explored the needs, expectations, and preferences of a pelvic‑floor digital intervention. Methods. Focus groups were conducted in Spain, the United Kingdom, and Lithuania with adults aged ≥50 (both men and women). Participants completed sociodemographic and ICIQ‑SF questionnaires via REDCap during face-to-face interviews. Qualitative data were analysed using Reflexive Thematic Analysis. Results. Thirty-one potential end users (mean age 62.3 years; 71% women) contributed to the focus groups. UI severity varied widely (ICIQ‑SF 0–16, with a mean of 8.3), and many reported multiple comorbidities. Across countries, Spanish participants emphasised very simple navigation and strong anonymity needs, UK participants showed higher digital confidence and greater openness to optional engagement features, while Lithuanian participants expressed mixed digital skills but a pronounced preference for privacy and clear guidance to ensure exercises were performed correctly. Participants supported reminders and personalised feedback, while views on gamification and virtual communities were mixed. Conclusions. Older adults view a pelvic‑floor digital intervention as acceptable when it is simple, evidence‑based, personalised, and integrated with professional guidance to ensure long-term adherence and effectiveness. Findings directly informed the co‑creation of the KOKU Bladder platform, shaping its educational content, exercise library, and motivational features. Keywords: Urinary incontinence; digital health; eHealth solutions; pelvic floor exercises

This study explored experiences of Relational Accommodation (RA) for caregivers and significant others living with an adult with Body Dysmorphic Disorder (BDD) and how they respond to BDD symptoms. BDD is under-researched. In paediatric and/or obsessive-compulsive populations, RA has been found to negatively impact the lives of caregivers. To date, very little is understood about RA in caregivers for adults with BDD and how this impacts the phenomenology of BDD. Given the high suicidality rates in BDD populations, and somewhat conservative treatment outcomes, a greater understanding is needed. Eight caregivers, recruited from a BDD research conference and online support groups, were interviewed online about their experiences cohabiting with a loved one with BDD. Interviews were transcribed and subject to Interpretative Phenomenological Analysis (IPA). Four Group Experiential Themes were interpreted from participants' accounts: RA occurs in the context of Distress; RA and Self-concept are intertwined; Relational Gains and Losses; and Understanding of RA and BDD changes over time. Participant experiences of RA mirrored the OCD and/or paediatric BDD literature confirming the importance of this experience in BDD and extended existing knowledge by highlighting nuanced differences specific to being a caregiver of an adult with BDD. Improved parent- and clinician-specific guidance around RA and parent peer support groups should be considered. Future research should seek to recruit a more diverse representation of the adult caregiver experience, including that beyond the parent-child dynamic.

Test the hypothesis that conservative fluid management with active deresuscitation would not adversely affect tissue perfusion or kidney injury and would be associated with reduced vascular injury compared with usual care. Secondary analysis of the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) trial. ICUs. Critically ill patients enrolled in the RADAR-2 trial. Conservative fluid management with active deresuscitation vs. usual care. Measures of tissue hypoperfusion (whole blood lactate), acute kidney injury (AKIRisk score and urinary cystatin-C), and vascular injury (plasma hyaluronan, syndecan-1, and angiopoietin-2) were compared between groups. For each analyte, change from baseline was compared between groups and the median inter-group difference at each timepoint was estimated with bootstrapped CIs. Exploratory logistic regression examined associations between plasma biomarker levels (including N-terminal pro-B-type natriuretic peptide [NT-proBNP]), 28-day mortality, and treatment allocation. Whole blood lactate levels were similar between groups at all timepoints. Using change from baseline comparisons, no statistically detectable between-group differences were observed in AKIRisk scores or urinary cystatin-C levels. Plasma vascular injury biomarkers showed no statistically detectable between-group differences at any timepoint. High baseline hyaluronan (adjusted odds ratio [aOR], 5.75; 95% CI, 1.94-17.02; p = 0.002), syndecan-1 (aOR, 8.82; 95% CI, 2.67-29.15; p < 0.001), and NT-proBNP greater than 2500 pg/mL (aOR, 21.48; 95% CI, 3.57-129.41; p < 0.001) were independently associated with increased 28-day mortality. There was no evidence of differential treatment response based on these biomarker levels. Conservative fluid management and active deresuscitation were not associated with worsening tissue perfusion or acute kidney injury. A reduction in vascular injury markers was not observed. Given the modest sample size and resultant imprecision, clinically important effects cannot be excluded.

Controversy persists regarding flow-augmentation bypass for steno-occlusive atherosclerotic cerebrovascular disease (ACVD), especially after the divisive Carotid Occlusion Surgery Study (COSS) and Middle Cerebral Artery Occlusion Surgery Study (CMOSS) trials. High complication rates (COSS) and the selection of patients with stable disease under conservative management (CMOSS) yielded conflicting results. Despite conflicting evidence, some authors argue for the procedure's continued relevance, supported by reduced perioperative complication rates and a distinct contemporary patient cohort. This study contributes to the ongoing discourse by presenting our centre's experience. We analysed data (2007-2023) from our extracranial-intracranial bypass registry. Included were patients with ACVD, reduced cerebrovascular reserve and recurrent minor strokes/transient ischaemic attacks (TIAs) or progressive stroke despite maximal conservative therapy. A total of 98 procedures were performed in 89 patients (mean age 61 years, median follow-up 27.4 months). Internal carotid artery (ICA) occlusion was most common (88.8%), with 27.6% showing additional intracranial stenoses. Isolated middle cerebral artery (MCA) and anterior cerebral artery (ACA) stenosis were rare. Presentations included single TIA (14.3%), multiple TIAs (44.9%), recurrent strokes (26.5%) and progressive stroke (14.3%). Preoperatively, 62.2% had unilateral and 37.8% bilateral cerebrovascular reserve capacity impairment. ICA stenosis with additional intracranial disease was more often linked to bilateral impairment. Postoperative bypass patency was 96.9% at 30 days; perioperative stroke occurred in 4.1%. Long-term patency was 96.3%, with 3.7% experiencing recurrent TIAs. Flow-augmentation bypass remains a valuable option in carefully selected ACVD patients with progressive disease, offering low perioperative risk and reduced stroke recurrence.

Objective This case report presents a rare case of C5 nerve root palsy following corrective surgery for severe congenital cervicothoracic scoliosis in a child, and explores its distinctive pathogenesis and treatment strategy. Methods This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (PJ-2021-100), and informed consent was obtained from the patient's guardian. The clinical data of a 9-year-old boy with congenital cervicothoracic scoliosis (Cobb angle of 99°) who underwent posterior corrective instrumentation and fusion were retrospectively analyzed. Typical C5 palsy developed on postoperative day 7. Imaging studies and the clinical course were used to identify the responsible mechanism. Results Postoperatively, left deltoid strength decreased to grade II/III. CT excluded direct implant impingement, and no laminectomy had been performed, thus excluding the classic “posterior cord drift” hypothesis. Comparative imaging revealed a significant reduction in the vertical diameter of the C4–C5 foramen. We concluded that reduction maneuvers had transmitted excessive traction through the C5 pedicle screw, producing dynamic foraminal stenosis and nerve root stretching. Conservative management (with cervical traction and hyperbaric oxygen) was instituted, and complete neurological recovery was documented at 3 months. Conclusion In cervical deformity surgeries performed without decompression, iatrogenic alteration of the foramina’s geometry, produced by corrective forces, is an important and frequently overlooked mechanism of postoperative C5 palsy. Surgeons should avoid overtightening a single screw during rod reduction; once the complication occurs, systematic conservative treatment usually yields a favorable outcome.

Spontaneous intracranial hypotension (SIH) with ventral dural tears is associated with spinal longitudinal extradural collections (SLECs). Direct fluoroscopic characterization of the anterior epidural compartment and SLEC morphology in vivo remains limited. We describe wire-catheter epidural navigation and imaging in patients with SIH and SLECs. Between June 2023 and December 2025, 20 consecutive patients with type 1 SIH and MRI-confirmed SLECs underwent attempted wire-catheter epidural navigation from a lumbar interlaminar approach. Using a hydrophilic guidewire and 4 French catheter, a controlled dorsoventral transition was performed to access the anterior epidural space. Feasibility of anterior epidural and SLEC cannulation was assessed. Therapeutic outcomes were not evaluated. Anterior epidural and/or SLEC opacification was successfully obtained in 15/20 cases (75%, 95% CI 51% to 91%). Anterior epidural injections demonstrated a segmental pattern with radiolucent septations and periradicular extensions, whereas SLEC injections produced homogeneous ventral opacification without segmental organization. Navigation failed in 5 cases due to dense epidural scarring (n=2) or early procedural discontinuation related to concern for dural violation (n=3). Venous entry occurred in approximately 15-25% of procedures. One early case of subarachnoid opacification resulted in transient symptoms that resolved with conservative management. Epidural navigation enables fluoroscopic access to the anterior epidural space and SLECs in patients with SIH. Imaging patterns, metameric septations in the anterior epidural space, and homogeneous opacification in SLECs correspond to anatomical structures and distinguish between different compartments. These technical and anatomical observations provide a foundation for therapeutic applications.

Deep neck space infections are potentially life-threatening conditions due to their proximity to vital structures such as the airway, major blood vessels, and cranial nerves. These infections may spread rapidly and lead to severe complications, including airway obstruction and sepsis. This study aims to describe a rare case of concurrent intratonsillar, peritonsillar, and retropharyngeal abscesses, as well as to evaluate the effectiveness of conservative management using intravenous antibiotics. This research employed a descriptive qualitative case report approach involving a 32-year-old male patient presenting with progressive throat pain, dysphagia, neck swelling, and a muffled voice. Data were collected through clinical examination, laboratory tests, and radiological imaging, followed by continuous observation during hospitalization. The findings revealed elevated leukocyte levels and radiographic evidence of retropharyngeal space widening. The patient was treated with intravenous cefotaxime and metronidazole, along with supportive therapy. Significant clinical improvement was observed within 48 hours, with resolution of symptoms by the fifth day without surgical intervention. In conclusion, early diagnosis and prompt antibiotic therapy can effectively manage selected cases of multiple deep neck abscesses. Conservative treatment may be considered in stable patients, potentially avoiding invasive procedures while ensuring favorable clinical outcomes

This study critically evaluates conventional, reduced, and zero tillage systems with a focus on soil and water conservation, residue management, and sustainability in global agriculture and the Indo-Gangetic Plains. A systematic narrative review approach was used, synthesizing peer-reviewed literature (1990-2025) from major scientific databases. Results indicate that zero tillage systems, particularly Happy Seeder-based practices, can enhance soil aggregation, increase infiltration, and improve moisture retention through residue mulching. Quantitative evidence suggests yield gains of 6.8-17%, cost reductions of up to 29%, irrigation savings of 20-30%, and greenhouse gas emission reductions exceeding 50% compared to conventional systems. However, outcomes vary across soil types, climatic conditions, and management practices. Key limitations include herbicide dependence, weed resistance, and socio-economic constraints affecting adoption. The study concludes that conservation tillage offers significant potential for climate-smart agriculture, but its effectiveness depends on region-specific adaptation, integrated nutrient and weed management, and supportive policy frameworks.

We report an uncommon presentation and conservative management of Aplasia Cutis Congenita (ACC), a rare congenital defect of the skin in a newborn. The skin defects was located on the abdominal region, irregularly shaped, symmetrical, each measuring about 5 x 3 cm. There was no discharge, bleeding, bullae or anomalies on clinical examination. The child was managed conservatively with antibiotics and wound dressing. The wound granulated well, there were no local or systemic complications. By the 8th day of admission, defect had almost completely healed leaving a hypo-pigmented scar. At 2 weeks on follow-up the scar had become hyper-pigmented.

Open excision of the anterior process of the calcaneus for degan classification type II fracture non-union: A retrospective analysis of patient-reported outcomes.

Distal radius fractures are among the most frequent musculoskeletal injuries, with a significant impact on upper limb function. Their incidence has increased in recent decades, particularly in older adults, making them clinically important. The objective of this study was to analyze and compare the functional outcomes of surgical management versus conservative treatment in patients with distal radius fractures. A systematic literature review was conducted using a qualitative approach, following the PRISMA guidelines. Relevant studies were selected according to pre-established inclusion and exclusion criteria, prioritizing recent evidence of high methodological quality. Study evaluation was performed using the Johns Hopkins Hospital model. The findings show that surgical treatment, especially with volar plate repair, offers better functional outcomes in the short and medium term, including less pain, greater range of motion, and improved grip strength. However, in the long term, the differences compared to conservative treatment tend to diminish, achieving similar functional results, especially in older adults. Surgical management does not demonstrate sustained superiority over conservative treatment in the long term. The therapeutic choice should be based on a comprehensive patient assessment, prioritizing functionality and quality of life over isolated anatomical correction.

Caroli disease is a rare congenital hepatobiliary disorder characterized by non-obstructive dilatation of the intrahepatic bile ducts and classified as Todani type V choledochal cyst. Although congenital in origin, the disease is often diagnosed in adulthood due to its indolent course and nonspecific symptoms, frequently after complications such as recurrent cholangitis have occurred. We report a case of a 46-year-old male presenting with recurrent epigastric pain, abdominal distension, fever, jaundice, nausea, vomiting, and bowel movement disturbance. Laboratory findings revealed leukocytosis, direct hyperbilirubinemia, and cholestatic liver enzyme elevation consistent with acute cholangitis. Abdominal radiography demonstrated features of partial small bowel obstruction. Magnetic resonance cholangiopancreatography (MRCP) with contrast revealed multifocal cystic dilatation of the intrahepatic bile ducts without extrahepatic obstruction, consistent with Caroli disease. The patient was managed conservatively with intravenous antibiotics, ursodeoxycholic acid, bowel decompression, and supportive care, resulting in gradual clinical improvement. This case highlights the diagnostic value of MRCP and demonstrates that conservative management can be effective in adult Caroli disease complicated by recurrent cholangitis and secondary small bowel obstruction.

Background: Posterior ankle pain has varied etiologies, with sural nerve (SN) entrapment contributing to posterolateral ankle discomfort. The SN is a pure sensory nerve that innervates the lateral ankle and foot up to the fifth metatarsal. Although SN pathologies are known, specific clinical features and management of neuropathy affecting the lateral calcaneal branch of the sural nerve (LCBSN), which supplies the lateral heel, are less defined. This condition is often exacerbated by repetitive ankle dorsiflexion in sports or external compression from tight footwear. We hypothesized that LCBSN lesions cause a distinct pattern of heel pain that is uniquely aggravated by ankle dorsiflexion or shoe contact, thereby distinguishing this entity from other causes of posterior ankle pain. Methods: This retrospective case series included 23 patients. We reviewed records of 23 patients presenting with posterolateral ankle pain and localized LCBSN tenderness. Key diagnostic features included pain aggravation with ankle dorsiflexion or shoe contact, lacking motor deficits. Diagnosis was primarily confirmed by immediate, significant pain relief after local anesthetic injection around the LCBSN. Symptom severity (0-4 scale) and American Orthopaedic Foot &amp; Ankle Society (AOFAS)-hindfoot scores were assessed at 1 month and 1 year post-treatment. Surgical intervention was performed for recurrent pain after 6 months of conservative management. Results: Improvement ( P &lt; .05) in both symptoms and AOFAS-hindfoot scores was observed at 1-month and 1-year follow-ups. Six patients required surgical treatment for recurrent symptoms. Pathologic findings included arterial wall thickening with dense perineural adhesions and scarring (3 cases), neuroma formation (2 cases), and nerve entrapment due to adhesions (1 case). Conservative treatment was effective for the remaining patients. Conclusion: Accurate and timely diagnosis of LCBSN lesions is crucial for effective treatment and enabling prompt return to sports activities. A diagnostic, small volume local anesthetic injection may serve as a practical diagnostic adjunct and an initial therapeutic measure for this clinically significant condition.

Aims Implantable tibial nerve neuromodulation (ITNM) represents a minimally invasive intervention for urgency urinary incontinence (UUI). This study evaluated the 3-year cost-utility of ITNM with an external wearable battery (Revi System) versus conservative treatments (behavioral ± pharmacotherapy) from a US payer perspective. Materials and methods A cohort state-transition (Markov) model with annual cycles compared ITNM to conservative treatment modalities (behavioral ± pharmacotherapy). ITNM clinical parameters were derived from the OASIS pivotal trial (N = 150); parameter uncertainty was propagated via 20,000 Monte Carlo simulations. Health states captured responder and non-responder status with permitted transitions, rescue interventions (onabotulinumtoxinA, sacral neuromodulation, percutaneous tibial nerve stimulation), and downstream event modules (falls, urinary tract infection, incontinence-associated dermatitis, depression, cognitive decline/dementia, and nursing-home entry). Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually and expressed in 2025 US dollars. Parameter uncertainty was assessed using probabilistic sensitivity analysis (PSA; 20,000 simulations) and tornado analysis. Results ITNM was both more effective and less costly than behavioral ± pharmacotherapy. Mean 3-year costs were $39,308 versus $43,737 (ΔCost = –$4,428), with mean QALYs of 2.188 and 1.940, respectively (ΔQALY = +0.249). The incremental cost-effectiveness ratio was –$17,818/QALY (dominant). Incremental net monetary benefit at $40,000/QALY was $14,369, with 100% probability of cost-effectiveness across thresholds from $20,000–$150,000/QALY. Key value drivers were responder utility and fall-related parameters. Limitations The analysis adopts a US payer perspective with direct medical costs only. Some event risks were applied from population-level sources and may not fully capture patient-level heterogeneity. The 3-year base-case horizon may miss longer-term durability effects, though extended-horizon scenarios support consistent findings. Conclusions Over 3 years, ITNM with an external wearable battery improves quality-adjusted survival and lowers overall payer costs compared with conservative therapies for UUI, supporting its inclusion as a value-consistent minimally invasive therapy.

Pain, decreased quality of life, and functional impairment are common symptoms of knee osteoarthritis (KOA), a degenerative joint disease. Surgery is reserved for advanced cases, and conservative treatment is primarily palliative. Although platelet-rich plasma (PRP) therapy is a novel regenerative strategy, the influence of PRP composition on its effectiveness remains unclear. The aim of this review is to determine whether PRP activation and platelet and leukocyte enrichment are associated with improved pain and functional outcomes in KOA at 6 and 12 months. The systematic review included 56 randomized controlled trials (RCTs), involving a total of 5251 patients. Of these, 53 RCTs involving 5031 participants were included in the network meta-analysis. PRP treatments were compared with other nonsurgical interventions and placebo. Primary outcomes included Western Ontario and McMaster Universities Arthritis Index Score (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS), while International Knee Documentation Committee Score (IKDC), Lequesne Index, and EuroQol (EQ)-VAS were assessed as secondary outcomes. PRP formulations were categorized on the basis of activation status and Mishra's classification system. Both direct and indirect comparisons were performed using a frequentist network meta-analysis approach. Comparing PRP with different activation states at 6 and 12 months revealed that PRP activation exerted significant benefits in specific KOOS domains at 12 months (KOOS Activities of Daily Living, KOOS Sport and Recreation Function, and KOOS Knee-Related Quality of Life). Generally, the performance of high-platelet PRP was not statistically different from that of low-platelet PRP in most of the assisted questionnaires and domains. Considering activated PRP, no significant variation was detected between Mishra's categories, indicating that increased leukocyte and platelet enrichment ratios confer no additional benefit. Overall, the data suggest that PRP activation could play a key role in the treatment outcomes of KOA and could compensate for variation in both platelet and leukocyte enrichment. There is a need for RCTs to assess the effect of platelet composition and activation status in the clinical performance of PRP in KOA. Level I, systematic review and network meta-analysis.

The conservation and sustainable management of natural resources have become a vital part of development programmes globally. Nutrient and sediment losses from watersheds are strongly influenced by morphometry, land use, and hydrological characteristics. This study evaluates spatial patterns of water quality and nutrient transport across different reaches of the Sillahalla watershed. The watershed was stratified into three elevation-based reaches viz., lower (&lt;2200 m), middle (2200–2400 m) and upper (2400–2630 m), and integrated grab samples were collected thrice during the monsoon period (June–August 2016). A total of 14 physicochemical parameters, including major ions and nutrient indicators, were analysed using standard laboratory procedures. Analysis of 14 physicochemical parameters revealed that most water quality indicators, including pH, electrical conductivity, total dissolved solids, and major ions, were within permissible limits for irrigation use. However, nitrate concentrations showed a progressive increase from upper (23.5 mg L⁻¹) to lower reaches (55.5 mg L⁻¹), with the lower reach exceeding the recommended limit, indicating potential risks for water quality. Elevated Biological Oxygen Demand (BOD) in the lower reach further suggested contamination from organic and anthropogenic sources. The (Nutrient Pollution Index) NPI for Nitrogen in the lower reach is 1.23 and exceeds the NPI limit of 1 indicating the potential water pollution, and the NPI for P indicates no pollution. However, the combined NPI also indicates the nutrient pollution in Lower reaches. Further, Agricultural Non-Point Source (AGNPS) model was employed to simulate nutrient losses under different management scenarios, including existing farmer practices, 25% and 50% reductions in fertilizer application, and a land-use change scenario involving partial conversion to tea plantations. Based on this result, ready reckoner for fertilizer recommendation was developed for potato and carrot with the STCR equations. This can be readily utilized by the Sillahalla watershed farmers. The study underscores the need for integrated approaches involving farmers, researchers, and policymakers to prioritise soil erosion control and sustainable land management practices. Adoption of site-specific, cost-effective, and climate-resilient soil and water conservation measures, supported by appropriate incentives, can significantly enhance on-field implementation. Overall, the research advocates for a participatory and sustainable watershed management framework to minimise nutrient losses, protect water resources, and ensure long-term agricultural sustainability in hilly regions.

Background: Vocal cord lesions are a common cause of dysphonia and functional impairment, often requiring surgical intervention when conservative management fails. Conventional microlaryngeal techniques, including cold instrumentation and CO₂ laser, are effective but may be associated with thermal injury and suboptimal tissue preservation. Coblation-assisted microlaryngeal excision has emerged as a minimally invasive alternative that enables precise tissue ablation at lower temperatures, potentially improving functional outcomes. Objective: To evaluate the feasibility, safety, and early functional outcomes of coblation-assisted microlaryngeal excision in patients with vocal cord lesions. Methods: A descriptive case series was conducted in a tertiary care center involving two male patients aged 60 and 73 years presenting with persistent hoarseness of voice. Preoperative evaluation included videolaryngoendoscopy and clinical assessment. Both patients underwent coblation-assisted microlaryngeal excision under general anesthesia. Operative parameters, histopathological findings, mucosal healing, and postoperative voice outcomes were analyzed. Results: Two patients with unilateral vocal cord lesions (polyp and leukoplakia) underwent successful excision. Lesion sizes ranged from 0.8 × 0.5 cm to 1.0 × 0.6 cm. Operative duration was 20–25 minutes, with minimal intraoperative blood loss (&lt;5 mL) and no perioperative complications. Histopathology revealed a benign polyp in one case and hyperkeratosis with mild dysplasia in the other. Follow-up at 4–6 weeks demonstrated complete mucosal healing with no evidence of recurrence. Both patients showed significant subjective improvement in voice quality. Conclusion: Coblation-assisted microlaryngeal excision provides effective lesion removal with minimal thermal injury and excellent early functional outcomes. Its ability to preserve the vibratory layer of the vocal folds, combined with low complication rates and rapid recovery, supports its role as a promising minimally invasive technique in the management of vocal cord lesions. Larger studies are required to validate its long-term efficacy and comparative advantage over conventional modalities.

The global decline in biodiversity, driven by habitat loss, overexploitation, climate change, biological invasions, and illegal trade, poses significant challenges for conservation management. Although many South African ecosystems and species are under threat, effective conservation efforts are hindered by incomplete foundational biodiversity data and assessments, caused by taxonomic gaps and unverified distributions. DNA barcoding has emerged as an invaluable tool for species identification and classification of biodiversity. While substantial barcoding progress has been made, for many taxa, others remain underrepresented in sequence databases. This study evaluates the status and progress of DNA barcoding in South Africa through a gap analysis, comparing verified species checklists with barcoded sequences from the Barcode of Life Database (BOLD) and GenBank to assess taxonomic and geographic representation. A literature review (2003-2023) highlights applications across terrestrial, freshwater, and marine habitats. Of the 931,476 South African species barcode records, 52% were publicly available. Although the insects dominated with the highest number of records and BINs, reptiles had the highest taxonomic representation. Plants and fungi were underrepresented (16.1% and 2.8%, respectively). Regionally, Mpumalanga and Limpopo provinces showed the highest BIN counts, while North-West and Free State provinces had the lowest. The majority of barcode records were for mtDNA genes such as cytochrome c oxidase subunit I (COI) and were contributed by both local and international institutions. Discrepancies between GenBank records and those mined by BOLD indicated that many GenBank sequences for South Africa have poor quality metadata, including geographic sampling locality information. While significant progress has been made across taxa, further efforts are needed to expand species and geographic coverage, enhance sequence quality, improve species metadata, and resolve inconsistencies in BIN assignments, particularly for underrepresented groups such as plants and fungi. These advances would strengthen biodiversity assessments and support conservation efforts in South Africa.