When removing beach wrack, synergies between services should be used, i.e., use of biomass as material or further processing. However, trade-offs prevail between cultural services and the overall provision of beach ecosystem services (i.e., coastal protection and biodiversity). We recommend developing new and innovative beach cleaning techniques and procedures, i.e., different spatio-temporal patterns, e.g., mechanical vs. manually, daily vs. on-demand, whole beach width vs. patches. Our fast and easy-to-apply assessment approach can support decision-making processes within sustainable coastal management allowing us to show and compare the impacts of measures from a holistic ecosystem services perspective.
To evaluate the evidence for operative and non-operative management of isolated posterior cruciate ligament (PCL) injuries.
Using Pubmed, EMBASE and Cochrane databases, a systematic review was conducted of studies investigating the treatment of isolated PCL injuries published until July 2020. Quality assessment was performed with the Cochrane risk of bias tool (level I), the Newcastle-Ottowa Scale (level II-III) and the National Institute of Health quality assessment tool (level IV). Clinical outcome measures included residual laxity, return to sports, patient-reported outcome measures, subsequent articular degeneration and complications.
Twenty-seven studies [23 case series, 2 case-control, 1 cohort study and 1 randomized controlled trial (RCT)] including 5197 patients (5199 knees) with a mean age of 29.5 ± 3.6years (range 15-68) fulfilled the study requirements. Significantly less residual laxity was found after posterior cruciate ligament reconstruction (PCLR) compared to non-operative management (3.43 vs. 5.47mm, CI 1.84-2.23, p < 0.001). Both treatment modalities yielded satisfying functional outcomes and a high return to sports (64-77%, mean 70.3, CI 67.8-72.2). Osteoarthritis (OA) occurred less frequently following PCLR (21.5 vs. 44.1%, p < 0.001).
In the absence of level I RCTs, this systematic review suggests that surgical management for selected isolated PCL injuries is a reasonable option to consider, especially when the surgeon aims at minimizing residual laxity and presumably secondary osteoarthritis.
IV.
IV.
To determine factors significantly correlated with the failure of macular reattachment by pars plana vitrectomy (PPV) without laser photocoagulation of the optic disc margin to treat optic disc pit (ODP) maculopathy.
Retrospective, interventional case series.
We reviewed the medical records of 35 consecutive patients with ODP maculopathy who underwent PPV without laser photocoagulation. PPV with the creation of a posterior vitreous detachment (PVD) was performed in 34 eyes. An epiretinal membrane and internal limiting membrane present in the other eye with a PVD were removed. Patients were followed for 12-193months (mean 58months) after surgery. The main outcome measures were the postoperative rate of retinal reattachment and best-corrected visual acuity. The preoperative clinical characteristics of the successful cases were compared to those of the unsuccessful cases.
A complete retinal reattachment was attained in 31 of 35 eyes and it required about one year. The 4 other eyes that did not achieve a macular reattachment after the primary PPV underwent additional therapies. The factors that were significantly associated with a failure of a retinal reattachment after primary PPV were the presence of a retinal detachment connected to the optic disc (P < 0.001) and the presence of preoperative headaches (P = 0.030).
Clinicians should be aware that the presence of a preoperative macular detachment connected to the optic disc margin and preoperative headaches are indicators for an unsuccessful outcome of PPV without laser photocoagulationin eyes with ODP maculopathy.
Clinicians should be aware that the presence of a preoperative macular detachment connected to the optic disc margin and preoperative headaches are indicators for an unsuccessful outcome of PPV without laser photocoagulation in eyes with ODP maculopathy.
N-3 polyunsaturated fatty acids (n-3 PUFAs), which are an important nutrient for humans, are particularly essential to the growth and development of the central nervous system (CNS) in fetuses and infants. Consequently, sufficient n-3 PUFA intake by mothers during pregnancy is considered to contribute to CNS development in their infants. CNS development is known to be associated with sleep, but no large epidemiological studies have yet confirmed that n-3 PUFA intake during pregnancy is associated with infants' sleep.
After exclusion and multiple imputation from a dataset comprising 104 065 records from the Japan Environment and Children's Study (JECS), we examined 87 337 mother-child pairs for the association between mothers' fish and n-3 PUFA intakes and risk of their infants sleeping less than 11h at 1year of age.
Multiple logistic regression analysis with the lowest quintile used as a reference revealed odds ratios for the second through fifth quintiles of 0.81 (95% confidence interval [95% CI] 0.76-0.87), 0.81 (95% CI 0.76-0.87), 0.78 (95% CI 0.72-0.84), and 0.82 (95% CI 0.76-0.88) for fish intake (p for trend < 0.001) and 0.90 (95% CI 0.84-0.97), 0.88 (95% CI 0.81-0.94), 0.88 (95% CI 0.82-0.95), and 0.93 (95% CI 0.86-0.998) for n-3 PUFA intake(p for trend =0.04).
Low fish intake during pregnancy may increase the risk of infants sleeping less than 11h at 1year of age. This relationship may have been mediated by maternal n-3 PUFA intake and infant neurodevelopment, but further evidence from interventional and other studies is needed to determine the appropriate level of fish intake during pregnancy.
The Japan Environment and Children's Study, https//upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035091 (Registration no. UMIN000030786).
The Japan Environment and Children's Study, https//upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035091 (Registration no. UMIN000030786).Assessment of image noise is a relevant issue in computed tomography (CT). Noise is routinely measured by the standard deviation of density values (Hounsfield units, HU) within a circular region of interest (ROI). We explored the effect of a spherical volume of interest (VOI) on noise measurements. Forty-nine chronic obstructive pulmonary disease patients underwent CT with clinical protocol (regular dose [RD], volumetric CT dose index [CTDIvol] 3.04 mGy, 64-slice unit), and ultra-low dose (ULD) protocol (median CTDIvol 0.38 mGy, dual-source unit). Noise was measured in 27 1-cm2 ROIs and 27 0.75-cm3 VOIs inside the trachea. Median true noise was 21 HU (range 17-29) for RD-CT and 33 HU (26-39) for ULD-CT. https://www.selleckchem.com/products/Cyclopamine.html The VOI approach resulted in a lower mean distance between limits of agreement compared to ROI 5.9 versus 10.0 HU for RD-CT (-40%); 4.7 versus 9.9 HU for ULD-CT (-53%). Mean systematic bias barely changed -1.6 versus -0.9HU for RD-CT; 0.0 to 0.4HU for ULD-CT. The average measurement time was 6.8 s (ROI) versus 9.7 (VOI), independent of dose level. For chest CT, measuring noise with a VOI-based instead of a ROI-based approach reduces variability by 40-53%, without a relevant effect on systematic bias and measurement time.
To conduct a multi-centered randomized trial evaluating stress urinary incontinence (SUI) treatment based on the Patient Global Impression of Improvement score after 4weeks using a continence pessary (CP) or a disposable intravaginal continence device (DICD). The null hypothesis is no difference in treatment success between cohorts.
This parallel group, active treatment comparative effectiveness trial randomized women with SUI to either CP or DICD for 4weeks in a 11 allocation ratio. Exclusion criteria included pregnancy, UTI, postmenopausal bleeding, neurogenic bladder, urinary retention, prolapse, contraindication to or prior treatment with CP/DICD, and prior SUI surgery. Assuming an80% power, an alpha of 5% and 20% dropout, we needed 138 participants to detect 50% success with CP versus 25% with DICD. Due to slow enrollment, the study was stopped after 16months with 50 participants enrolled.
Of the 50 women enrolled, 25 (50%) were randomized to CP and 25 (50%) to DICD. Thirty-five of 50 (70%) completed a fitting, and 22/50 (44%) completed 4-week and 17/50 (34%) completed 6-month follow-up. Baseline characteristics were similar, and there was high treatment success in each cohort [80% (8/10) CP vs. 75% (9/12) DICD; p= 1.0]. DICD patients showed improvement on all questionnaires but had higher use of other therapies over 6months. CP patients showed improvements except for lower sexual function scores at 4weeks. No serious adverse events occurred.
Most women fitted with a CP/DICD experienced treatment success after 4weeks without serious adverse events.
Most women fitted with a CP/DICD experienced treatment success after 4 weeks without serious adverse events.The age-related decline in muscle function, particularly muscle power, is associated with increased risk of important clinical outcomes. Physical activity is an important determinant of muscle function, and different types of physical activity e.g. power-based versus endurance-based exercise appear to have differential effects on muscle power. Cross-sectional studies suggest that participation in power-based exercise is associated with greater muscle power across adulthood but this has not been investigated longitudinally. We recruited eighty-nine male and female power and endurance master athletes (sprint and distance runners respectively, baseline age 35-90y). Using jumping mechanography, we measured lower limb muscle function during a vertical jump including at least two testing sessions longitudinally over 4.5 ± 2.4y. We examined effects of time, discipline (power/endurance) and sex in addition to two- and three-way interactions using linear mixed-effects models. Peak relative power, relative force and jump height, but not Esslingen Fitness Index (indicating peak power relative to sex and age-matched reference data) declined with time. Peak power, force, height and EFI were greater in power than endurance athletes. There were no sex, discipline or sex*discipline interactions with time for any variable, suggesting that changes were similar over time for athletes of both sexes and disciplines. Advantages in lower limb muscle function in power athletes were maintained with time, in line with previous cross-sectional studies. These results suggest that improvements in lower limb function in less active older individuals following power-based training persist with continued adherence, although this requires further investigation in interventional studies.
In congenital diaphragmatic hernia (CDH), ultrasound (U/S) measurements of the contralateral lung commonly provide the observed-to-expected lung-to-head ratio (O/E LHR) and are used to determine the severity of pulmonary hypoplasia. Fetal magnetic resonance imaging (MRI) measurement of the observed-to-expected total lung volume (O/E TLV) has been used as an adjunct to O/E LHR in predicting outcomes. Since O/E LHR only measures the contralateral lung, we sought to investigate if MRI measurements of the contralateral lung volume (O/E CLV) can accurately predict outcomes in CDH. We hypothesize that O/E CLV is a better predictor of CDH outcomes than O/E LHR.
We identified all infants with a prenatal diagnosis of CDH at our fetal center who had both MRI and U/S measurements. Using lung volume ratios of right-left 5545, we calculated O/E CLV from O/E TLV. We used receiver-operating characteristic (ROC) curves to calculate the area under the curve (AUC) to compare the predictive accuracy of O/E CLV to O/E LHR for ECMO support, as well as survival to both discharge and 1 year.