Placenta Accreta Spectrum:Conservative Management and Its Impact on Future Fertility

Placenta accreta spectrum is a complication of pregnancy,which poses a great risk on maternal health.Historically,hysterectomy was the modality of treatment of such condition,but an approach towards a more conservative management has been in the light recently.This includes several methods with varying rates of success and complications.Expectant management is effective in up to 78%–80%of the cases.The extirpative method is associated with a high risk of postpartum hemorrhage.The success of the onestep conservative procedure depends on the degree of placental invasion,and the triple-P procedure appears to be successful but requires and interdisciplinary approach.Adjuvant treatment options can be tailored according to individual cases,and these include methotrexate injection,uterine devascularization and hysteroscopic resection of retained placental tissues.Follow up after conservative management is crucial to detect complications early,and it can be done by ultrasound,Doppler examination,and trending b human chorionic gonadotropin levels.Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications.In the future,more research should be directed to achieve clear guidelines regarding this topic.

Identifying priority protection areas of key food resources of the giant panda

Animals that live in seasonal environments adjust their reproduction cycle to optimize seasonal forage quality.Giant pandas(Ailuropoda melanoleuca)are seasonal altitudinal migrants that feed on bamboo shoots and leaves with different nutritional quality.However,the importance of bamboo shoots to giant pandas,especially small and isolated populations,is not fully appreciated.Here,we explored whether mating time of giant pandas is shaped by bamboo shoot phenology.We also assessed the intensity of ongoing bamboo shoot harvesting by local communities in 42 giant panda reserves based on questionnaire surveys.Varying intensity and protection levels of bamboo shoot harvesting were found.From these data,we developed a priority ranking scheme of protection areas for this key food resource.Our study showed that pandas time their mating behavior to coincide with bamboo shoot phenology due to the high nutritional demands associated with mating and pregnancy.We also found that bamboo shoots were not well protected in many places.Liangshan,Daxiangling,and Xiaoxiangling,containing the most isolated panda populations,were identified as the areas with the most urgent need of protection.Furthermore,equal attention should be paid to the Qiong L-B population,as this region holds considerable potential to serve as a corridor between the Minshan and Qionglai populations.To address the challenges posed by bamboo shoot harvesting,we recommend establishing more practical bamboo shoot management policies,increasing public awareness of bamboo shoot protection,and providing alternative sources of income for local communities.

Contemporary approach to active surveillance for favorable risk prostate cancer

The approach to favorable risk prostate cancer known as“active surveillance”was first described explicitly in 2002.This was a report of 250 patients managed with a strategy of expectant management,with serial prostate-specific antigen and periodic biopsy,and radical intervention advised for patients who were re-classified as higher risk.This was initiated as a prospective clinical trial,complete with informed consent,beginning in 2007.Thus,there are now 20 years of experience with this approach,which has become widely adopted around the world.In this chapter,we will summarize the biological basis for active surveillance,review the experience to date of the Toronto and Hopkins groups which have reported 15-year outcomes,describe the current approach to active surveillance in patients with Gleason score 3þ3 or selected patients with Gleason score 3þ4 with a low percentage of Gleason pattern 4 who may also be candidates,enhanced by the use of magnetic resonance imaging,and forecast future directions.

Viable Second Trimester Cervical Ectopic Pregnancy Managed Successfully with Uterine Preservation: Case Report

Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5% of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were misleading. Several weeks later, a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.

Chylothorax following posterior low lumbar fusion surgery:A case report

BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery.The etiology,diagnosis,and treatment were analyzed and discussed.CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain.She was diagnosed with L4 degenerative spondylolisthesis,L4/L5 and L5/S1 intervertebral disc herniation and L5 instability,and underwent successful posterior L4-S1 instrumentation and fusion surgery.Unfortunately,thoracic effusion was identified 2 d after operation.The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests.The patient was discharged after 12-d persisting drainage,3-d total parenteral nutrition and fasting,and other supportive treatments.No recurring symptoms were observed within 12 mo follow-up.CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion.Comprehensive diagnosis and treatment of chylothorax are necessary.Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.

An alveolate kidney:A case report of emphysema pyelonephritis

Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:Emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.

Rare Case of Spontaneous Perinephric Hematoma with Two-Year Follow-Up

Background: Spontaneous perinephric hematoma with no associated pathology or provocation is a rare clinical phenomenon. The hematoma requires a two-year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. Aims: Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2-year follow up. Case Presentation: A previously healthy 38-year-old woman, presented with a sudden onset of left flank pain, associated with fatigue and pallor. The patient remained hemodynamically stable with no significant history or associated provocations identified. Conclusion: The acute management strategy is favorable in such condition, as the hematoma remains under tamponade in the retroperitoneal space, regardless of the size and organ displacement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.

A Rare Presentation of Partial Segmental Thrombosis of the Corpus Cavernosum Secondary to Sickle Cell Anemia

Background: Partial segmental thrombosis of the corpus cavernosum, known as partial priapism, is an uncommon urological condition which predominantly affects young men in which the proximal part of one corpus cavernosum is thrombosed. Many risk factors have been described in the literature, however, the exact etiology of penile thrombosis and its pathogenesis remains unclear. Several treatment options are available ranging from conservative medical treatment, surgical intervention, or simple follow-up observation without treatment. Aim: In this study, we describe a patient with sickle cell anemia who presented with pain and a perineal swelling that was eventually diagnosed as partial priapism utilizing MRI scan and was treated conservatively with a successful outcome. We then performed a literature search of similar cases highlighting incidence, risk factors and management of this rare presentation. Case Presentation: A 23-year-old male who is known with sickle cell anemia presented to casualty with a 1-day history of perineal pain of a sudden onset associated with perineal swelling and vomiting. Genitourinary exam findings confirmed the absence of classic priapism. Careful examination of his perineal area revealed the presence of a fixed, hard, and tender mass at the proximal part of the penis. It was not attached to the overlying skin and no enlarged pelvic lymph nodes were felt. Once stabilized, MRI of the pelvis was performed showing right intra-tunical corpus cavernosum features suggestive of hematoma in keeping with partial segmental thrombosis of the corpus cavernosum. Conservative treatment was initiated, and the patient was managed expectantly in which he improved gradually with eventual disappearance of the perineal mass. Conclusion: Partial segmental thrombosis of the corpus cavernosum is a rare urological condition. Pathogenesis and etiologies are poorly understood but risk factors have been advocated of which sickle cell anemia is one of them. MRI has a crucial role in the diagnosis under this condition. Conservative treatment appears to be a reliable initial therapeutic option.

Can Necrosis and Ovarian Vein Thrombus Be a Serious Complication in Morbidly Adherent Placenta?

We report a case of a 40-year-old woman, second pregnancy, previous cesarean section due to intrauterine growth restriction and placenta accreta spectrum disorders. She was 25 weeks gestational age, admitted to the hospital 25 weeks gestational age, diagnosed with fetal death. Initial conservative management attempt with uterine preservation progresses to complications requiring total hysterectomy followed by a rare outcome: pelvic thrombi with uterine necrosis, with its associated clinical complications.

Comparative population genetic analyses suggest hybrid origin of Rhododendron pubicostatum,an endangered plant species with extremely small populations endemic to Yunnan,China

Gene flow between sympatric congeneric plants is thought to be very common and may pose serious threats to endangered species.In the present study,we evaluate the genetic diversity and divergence of three sympatric Rhododendron species in Jiaozi Mountain using newly developed microsatellites through the Illumina MiSeq sequencing approach.Genetic diversity of all three Rhododendron species studied was moderate in comparison to genetic parameters previously reported from species of this genus.Interestingly,genetic structure analysis of the three species identified a possible hybrid origin of the threatened Rh.pubicostatum.This sympatry should be considered a unimodal hybrid zone,since Rh.pubicostatum is predominant here.Unimodal hybrid zones are uncommon in Rhododendron,despite the fact that hybridization frequently occurs in the genus.Issues pertaining to the conservation of Rh.pubicostatum resulting from admixture of genetic material from its parental species are discussed.

Conservation utility of botanic garden living collections:Setting a strategy and appropriate methodology

In the realities of the modern world, when the natural habitat is rapidly disappearing and the number of imperiled plants is constantly growing, ex situ conservation is gaining importance. To meet this challenge, botanic gardens need to revise both their strategic goals and their methodologies to achieve the new goals. This paper proposes a strategy for the management of threatened plants in living collections,which includes setting regional conservation priorities for the species, creation of genetically representative collections for the high priority species, and usage of these collections in in situ actions. In this strategy, the value of existing and future species living collections for conservation is determined by the species' conservation status and how well the accessions represent their natural genetic variation.

Benefits of conservation-driven mowing for the EU policy species Gladiolus palustris Gaudin in mountain fen meadows:a case-study in the European Alps

The sword lily Gladiolus palustris Gaudin is protected on European level and listed in Annexes II and IV of the EC Habitat Directive 92/43/EEC.It grows in nutrient-poor,calcareous meadows in central and eastern Europe.Tree encroachment in montane meadows of the European Alps as a result of recent land use changes and the abandonment of traditional farming practices threaten the survival of this species.Conservation-driven mowing is considered a feasible conservation measure for maintaining high species diversity in abandoned semi-natural grasslands.To assess the effects of tenyears of biennial mowing on a grassland community in the Dolomiti Bellunesi National Park,Italy(Site of Community Importance,Natura 2000 network),ten25 m2 plots were established whereby four plots were placed in the mowed area,four in the non-mowed area and two in a small non-mowed patch of grassland inside the mowed area.In each plot the following variables were recorded,total percentage of plant cover,percentage cover of woody species,percentage cover of herbaceous species,percentage cover and number of flowering ramets of G.palustris and a complete list of species and their percentage abundance.Mowed plots showed a higher species richness than non-mowed plots.The number of G.palustris flowering ramets and percentage cover increased manifold in mowed plots compared to nonmowed plots.The resumption of mowing forconservation purposes undertaken by the managing authority halted the process of tree encroachment and avoided a drastic change in plant composition.Periodic mowing(every second or third year)was demonstrated to be a cost-effective conservation measure in non-productive grasslands to keep grasses at bay in favour of forbs of high conversation value.

Distribution pattern and ecological determinants of an invasive plant Parthenium hysterophorus L., in Malakand division of Pakistan

After habitat loss,drastic effects of biological invasion caused by alien invasive species to the native biodiversity have been acknowledged worldwide by the agriculturists,ecologists,and governments as it is more overwhelming than pollution,harvest and disease combined.One such example of biological invasion is P.hysterophorus which is considered to be one of the topmost noxious weeds threatening ecosystems diversity in the world,particularly in Pakistan due to its invasive success and generalist nature.Yet no studies have explored the pattern and determinants of plant biodiversity in the Parthenium dominated landscapes.Here we explored the current distribution pattern of this species with relation to environmental variables in the Malakand division of northern Pakistan.Twenty-three sites dominated by P.hysterophorus were identified through a participatory mapping process combined with traditional ecological knowledge and quantitative inventories were made.In total,we found 62 plant species in 55 genera and 32 families,predominately from Asteraceae,Poaceae,and Solanaceae.Ward’s agglomerative clustering procedure showed three well-differentiated,and ecologically meaningful but overlapping vegetation communities.P.hysterophorus was found to be the leading species with an average Importance value ranging from 33.28%to 65.59%.Based on our criteria,surprisingly we found significantly less to be fully(30%)or partially invaded(21%)than the less invaded(47%)plots,indicating the gradual invasive success of the species across the landscape.Canonical Correspondence Analysis(CCA-ordination)has explained 36.9%of the cumulative variance by the first three axes and identified elevation(r=-0.526),slope(r=0.438)and percent sand(r=-0.474)to be the major environmental factors affecting the distribution of P.hysterophorus and associated vegetation.These results suggested that elevation and percent sand negatively affect Parthenium distribution whereas slope has a positive relationship thereby promoting its populations in the region.The generalist nature of this invasive species is likely to have an overall adverse negative effect on the ecosystem functioning and cannot be ignored.Therefore,quick actions should be taken for the management of this noxious weed to avoid economic consequences and potential threats to fragile ecosystems such as that in Malakand division.

Fish Species Diversity in Upstream and Downstream of Sittaung River,Bago Region,Myanmar

This research was conducted to generate a primary database on ichthyofauna,distribution and diversities in the upstream and downstream segments of Sittaung River in Bago Region of Myanmar.This study contributes to the information needed on the distribution of river fish in Myanmar.Fish diversities are assessed by calculating the various diversities indices between December,2018 and November,2019.A total of 65 fish species belonging to 9 orders,23 families and 49 genera were recorded.All 65 fish species were found in upstream segment but only 60 species of them were found in downstream segment of the river.In all study sites,Shannon diversity index had value above 3 indicating that the structure of habitat was stable and balanced.Simpson’s index values were close to 1 in all sites indicating that the species richness in the region was satisfactory.The abundance all of above 5%of total catch of Mystus vittatus,M.pulcher,M.cavasius and Erethistes pusillus in their feeding habitat suggested that their upstream and downstream habitats provided suitable feeding conditions.Anguilla bengalensis,Tenualosa ilisha,Mystus gulio,Rita rita and Silonia silondia were least abundant all below 0.1%of total catch showing they could be impacted by unwise anthropogenic activities.Assessing fish species diversity is thus very important to conserve and manage and promote the health of river ecosystem that is necessary for the migration of fish species.

Peoples’ Perception and Conservation of Dactylorhiza hatagirea (D. Don) Soóin Manaslu Conservation Area, Central Nepal

The present study analyzes the information and perception of the local community of Samagaun VDC, Manaslu Conservation Area Project (MCAP) regarding Dactylorhiza hatagirea (D. Don) Soó (Orchidaceae). We assessed the local peoples’ perception on its population status, its availability, factors causing its decline and management practices of this terrestrial orchids. A pre-designed questionnaire was used to gather information targeting the age group between 25 and 60 years (n = 75, 45 male and 30 female). Most of the informants (76%) believe that the abundance of this orchid is declining. Over grazing of domestic animals, over harvesting and lack of awareness among the local community were determined to be the major causes of decline of D. hatagirea in the study area. Protection measures as prescribed by the informants were control grazing, raising awareness among the individuals and sustainable harvestings for the long-term conservation of the species. Systematic management plans that incorporate the participation of local individuals and prioritization of their views will be applicable for the proper conservation of the species.

The Importance of Spatiotemporal Heterogeneity for Biodiversity in Forest—Heathland Mosaics and Implications for Heathland Conservation

In biodiversity management, spatio-temporal heterogeneity is important to consider conserving high levels of habitat diversity and ecosystems. In this study, we investigated the relationship between landscape spatio-temporal heterogeneity and biodiversity in a mosaic-landscape, located in the Fontainebleau forest (France). The diversity of successional stages along a gradient from heathland to forest as well as the persistence of Calluna vulgaris (L.) Hull in different forest stands was examined in order to find how the numerous patches of European Heathland habitat embedded in this area should be maintained. The results indicated that in the areas of high spatio-temporal heterogeneity, a general increase is observed in species richness, in particular for vascular plants, bryophytes and carabids. C. vulgaris persisted in coniferous stands and young mixed stand but decreased under deciduous trees and old mixed stands. The Ellenberg’s values for light, nutrients and acidity, show the persistence of favorable enviromental conditions for heathland vegetation under coniferous stands and young mixed stands. These results enable us to offer recommendations to better manage mosaic-landscape biodiversity, and in particular, the heathland semi-natural habitats in the Fontainebleau forest and elsewhere in Europe.

Analysis of Ecotourism, Culture and Local Community Empower­ment: Case Study of Wasur National Park - Indonesia

The focus of this research lies in community empowerment based on culture and local communities as well as sustainable ecotourism,which is directed at a complicated mechanism of empowerment elements,local culture that is thick in ecotourism to get added value for the novelty of ecotourism research.The object of research is Wasur National Park(WNP),Papua,Indonesia.Qualitative methods have been used to obtain accurate data and information,i.e.,in-depth interviews with indigenous people to find out the benefits or functions of their culture that can be developed in ecotourism,interviews with leaders and staff of WNP and the Department of Culture and Tourism to find out the potential and processes empowerment and existing tourism potential.As a result,from the perspective of empowerment,local people will easily follow the empowerment process provided that they use methods that are culturally appropriate which is from the viewpoints from the culture of sasi,totem and sacred places.The culture adopted by the community is in accordance with the principles of ecotourism that supports sustainability,environmental conservation,protection of environmental resources and increases economic value.However,it is recommended to carry out modified socialization in accordance with the current conditions.Hence,tourists who visit WNP do not become afraid of the very rigid sanctions which are applied to them who violate the existing cultural and environmental customs.Moreover,to get added economic value in the tourism business within WNP,it is necessary to explore the potential of cultural wealth,natural and biological wealth so that it becomes the main attraction in carrying out the economic empowerment of local communities in the field of ecotourism.

Intra-abdominal aortic balloon occlusion in the management of placenta percreta

Background:Massive bleeding is the main concern for the management of placenta percreta(PP).Intra-abdominal aortic balloon occlusion(IABO)is one method for pelvic devascularization,but the efficacy of IABO is uncertain.This study aims to investigate the outcomes of IABO in PP patients.Methods:We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015.PP cases with/without the use of IABO were analyzed.Propensity score matching analysis was performed to reduce the effect of selection bias.Postpartum hemorrhage(PPH)and the rate of hysterectomy,as well as neonatal outcomes,were analyzed.Results:One hundred and thirty-two matched pairs of patients were included in the final analysis.Compared with the control group,maternal outcomes,including PPH(68.9%vs.87.9%,χ^(2)=13.984,P<0.001),hysterectomy(8.3%vs.65.2%,χ^(2)=91.672,P<0.001),and repeated surgery(1.5%vs.12.1%,χ^(2)=11.686,P=0.001)were significantly reduced in the IABO group.For neonatal outcomes,Apgar scores at 1 minute(8.67±1.79vs.8.53±1.68,t=-0.638,P=0.947)and 5 minutes(9.43±1.55vs.9.53±1.26,t=0.566,P=0.293)were not significantly different between the two groups.Conclusions:IABO can significantly reduce blood loss,hysterectomies,and repeated surgeries.This procedure has not shown harmful effects on neonatal outcomes.

Wetland loss in Turkey over a hundred years:implications for conservation and management

The aims of this study were to provide a complete inventory of wetlands in Turkey including their past status(1910-1930)in comparison to the present time(2014).The types of wetlands and their area sizes were determined by using cartographical maps of 1/200,000 in scale made between 1910s and 1920s vs.2006 CORINE Land Cover data,which were updated with Landsat 8 satellite images in 2014.The effect of possible climate change on wetlands sizes various local,national and regional rainfall datasets were analysed by correlation and regression analysis.A hundred years ago,the total number of natural wetlands was 1299 with a total surface area of 1,376,505 hectares.In 2014,the total number of natural wetlands had decreased to 900,with a total surface area of 1,085,936 hectares,so that 21.2%of the original wetlands were lost(291,339 hectares).The observed changes in the number of wetlands and their relative sizes cannot be attributed directly to changes in climate.Wetland drainage was largely responsible for observed wetland losses,but local changes in precipitation regimes partially contributed to this loss.Urgent conservation and restoration of wetlands are recommended to avoid further loss of wetlands in Turkey.

Habitat suitability response to sea-level height changes: Implications for Ommastrephid squid conservation and management

Sea level rise,amplified by anthropogenic climate change,causes visible impacts on wildlife habitats in low-lying coastal areas.However,the potential consequences of sea level height(SLH)changes for pelagic fish habitats in the open oceans are poorly understood,especially for climate-sensitive Ommastrephid squid.In this study,the impacts of SLH changes were estimated under three different SLH change scenarios(5 cm,20 cm,and 35 cm)for the western stock of winter-spring neon flying squid Ommastrephes bartramii,an ecologically-and commercially-important species in the northwest Pacific Ocean(NWPO).A habitat suitability index(HSI)modeling approach was applied to predict the habitat suitability of O.bartramii,using data from 2006 to 2014 for model construction and data from 2015 for model validation.Results showed that the decreasing catch-per-unit-effort(CPUE)of O.bartramii from 2006 to 2015 was highly correlated with the increases in sea level height(SLH).Significant positive relationships were found between the HSI values for latitudinal centers of gravity(LATGHSI)and SLH.The monthly-averaged HSI of O.bartramii was negatively correlated with the SLH,except in July and November.SLH scenarios revealed that the predicted suitable habitat(areas with HSI≥0.6)exhibited a decreasing trend with increasing SLH from August to October.In July and November,the suitable habitat initially increased in the+5 cm and+20 cm scenarios,but largely declined under the+35 cm scenario.The poor habitat(areas with HSI≤0.2)significantly increased under all SLH scenarios.A poleward shift of LATGHSI was observed under all scenarios.These findings suggest that the O.bartramii habitats in the NWPO are at risk to SLH changes and have important implications for better conservation and fishery management regarding pelagic short-lived Ommastrephid squid in global oceans.