The Minimal Length of a Lagrangian Cobordism between Legendrians

To investigate the rigidity and flexibility of Lagrangian cobordisms between Legendrian submanifolds, we investigate the minimal length of such a cobordism, which is a $1$-dimensional measurement of the non-cylindrical portion of the cobordism. Our primary tool is a set of real-valued capacities for a Legendrian submanifold, which are derived from a filtered version of Legendrian Contact Homology. Relationships between capacities of Legendrians at the ends of a Lagrangian cobordism yield lower bounds on the length of the cobordism. We apply the capacities to Lagrangian cobordisms realizing vertical dilations (which may be arbitrarily short) and contractions (whose lengths are bounded below). We also study the interaction between length and the linking of multiple cobordisms as well as the lengths of cobordisms derived from non-trivial loops of Legendrian isotopies.Comment: 33 pages, 9 figures. v2: Minor corrections in response to referee comments. More general statement in Proposition 3.3 and some reorganization at the end of Section

Definition and criteria for diagnosing cesarean scar disorder.

IMPORTANCE: Approximately 60% of women develop a uterine niche after a cesarean delivery (CD). A niche is associated with various gynecological symptoms including abnormal uterine bleeding, pain, and infertility, but there is little consensus in the literature on the distinction between the sonographic finding of a niche and the constellation of associated symptoms. OBJECTIVE: To achieve consensus on defining the clinical condition that constitutes a symptomatic uterine niche and agree upon diagnostic criteria and uniform nomenclature for this condition. DESIGN, SETTING, AND PARTICIPANTS: A consensus based modified electronic Delphi (eDelphi) study, with a predefined Rate of Agreement (RoA) of 70% or higher. Experts were selected according to their expertise with niche-related consultations, publications, and participation in expert groups and received online questionnaires between November 2021 and May 2022. MAIN OUTCOMES AND MEASURES: Definition, nomenclature, symptoms, conditions to exclude, and diagnostic criteria of an illness caused by a symptomatic uterine niche. RESULTS: In total, 31 of the 60 invited experts (51.7%) participated, of whom the majority worked in university-affiliated hospitals (28 of 31 [90.3%]), specialized in benign gynecology (20 of 31 [64.5%]), and worked in Europe (24 of 31 [77.4%]). Three rounds were required to achieve consensus on all items. All participants underlined the relevance of a new term for a condition caused by a symptomatic niche and its differentiation from a sonographic finding only. Experts agreed to name this condition cesarean scar disorder, defined as a uterine niche in combination with at least 1 primary or 2 secondary symptoms (RoA, 77.8%). Defined primary symptoms were postmenstrual spotting, pain during uterine bleeding, technical issues with catheter insertion during embryo transfer, and secondary unexplained infertility combined with intrauterine fluid. Secondary symptoms were dyspareunia, abnormal vaginal discharge, chronic pelvic pain, avoiding sexual intercourse, odor associated with abnormal blood loss, secondary unexplained infertility, secondary infertility despite assisted reproductive technology, negative self-image, and discomfort during participation in leisure activities. Consensus was also achieved on certain criteria that should be met and conditions that should be excluded before making the diagnosis. CONCLUSIONS AND RELEVANCE: In this modified Delphi study, a panel of 31 international niche experts reached consensus for the constellation of symptoms secondary to a uterine niche and named it cesarean scar disorder

The clinical features of the piriformis syndrome: a systematic review

Piriformis syndrome, sciatica caused by compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years; yet, it remains controversial. The literature consists mainly of case series and narrative reviews. The objectives of the study were: first, to make the best use of existing evidence to estimate the frequencies of clinical features in patients reported to have PS; second, to identify future research questions. A systematic review was conducted of any study type that reported extractable data relevant to diagnosis. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase and Medline. Screening, data extraction and analysis were all performed independently by two reviewers. A total of 55 studies were included: 51 individual and 3 aggregated data studies, and 1 combined study. The most common features found were: buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with manoeuvres that increase piriformis muscle tension. Future research could start with comparing the frequencies of these features in sciatica patients with and without disc herniation or spinal stenosis

Ambiguous publicities: Cultivating doubt at the intersection of competing genres of risk evaluation in Catalan Prisons

Policymakers in Canada and across Europe have largely embraced the creation of post-disciplinary systems of punishment. In the autonomous region of Catalonia, Spain, this meant expanding connections between prisons and communities, expanding the publics a prison serves. At the same time, in part driven by austerity policies, incarceration in Spain and Catalonia has become more punitive and bureaucratic. Actuarial risk assessments introduced in Catalan prisons in 2009 are an example of this type of reform—designed to facilitate the release of low-risk inmates earlier and to control mobility. Drawing on ethnographic research conducted in Catalan prisons from 2012 to 2014, I show how both actuarial and clinical risk evaluation involved therapists’ anticipation of future aggressive acts on the part of inmates. Analyzing risk assessment as a practice and as an ideological frame, I argue that the short-term focus of risk assessments reinforced existing forms of interpreting inmates’ actions that therapists attempted to hold at bay. Risk as an ideological frame in the context of austerity contributes to a form of publicity that can further isolate inmates rather than facilitating the construction of community inside and outside of a rehabilitative prison

Does sport participation (including level of performance and previous injury) increase risk of osteoarthritis? A systematic review and meta-analysis

Background: To assess the relationship between sport and osteoarthritis, and specifically to determine whether previous participation, in terms of level (elite or non-elite), type of sport, intensity or previous injury were associated with osteoarthritis. Methods: This systematic review was developed using PRISMA guidelines. Databases were searched (to May 2016). Narrative review and meta-analysis (with risk ratio (RR) and 95% confidence intervals (CI)) approaches were undertaken where appropriate. Study quality was assessed using GRADE. Results: Forty-six studies were included. Narratively, 31 studies reported an increased risk of osteoarthritis, with 19 demonstrating an increased risk in elite athletes. There was an increased risk after sports exposure (irrespective of type) (RR:1.37; 95% CI:1.14, 1.64; 21 studies). It remained uncertain whether there was a difference in risk of osteoarthritis between elite and non-elite athletes (RR:1.37; 95% CI:0.84, 2.22; 17 studies). Risk was higher in soccer (RR:1.42; 95% CI:1.14, 1.77; 15 studies), but lower runners (RR:0.86; 95% CI:0.53, 1.41; 12 studies). Nine studies showed an association with the intensity of sport undertaken and osteoarthritis. Five studies demonstrated a higher prevalence of osteoarthritis following meniscectomies and anterior cruciate ligament tears. Overall the evidence was of GRADE 'very low' quality. Conclusions: There was very low quality evidence to support an increased relationship between sports participation and osteoarthritis in elite participants. It is unclear whether there is a difference in risk between elite and non-elite participants with further prospective studies needed to evaluate this. Pooled findings suggested significant injuries were associated with OA in soccer players

First-trimester cesarean scar pregnancy: a comparative analysis of treatment options from the international registry

Background: A cesarean scar pregnancy is an iatrogenic consequence of a previous cesarean delivery. The gestational sac implants into a niche created by the incision of the previous cesarean delivery, and this carries a substantial risk for major maternal complications. The aim of this study was to report, analyze, and compare the effectiveness and safety of different treatments options for cesarean scar pregnancies managed in the first trimester through a registry. Objective: This study aimed to evaluated the ultrasound findings, disease behavior, and management of first-trimester cesarean scar pregnancies. Study design: We created an international registry of cesarean scar pregnancy cases to study the ultrasound findings, disease behavior, and management of cesarean scar pregnancies. The Cesarean Scar Pregnancy Registry collects anonymized ultrasound and clinical data of individual patients with a cesarean scar pregnancy on a secure, digital information platform. Cases were uploaded by 31 participating centers across 19 countries. In this study, we only included live and failing cesarean scar pregnancies (with or without a positive fetal heart beat) that received active treatment (medical or surgical) before 12+6 weeks' gestation to evaluate the effectiveness and safety of the different management options. Patients managed expectantly were not included in this study and will be reported separately. Treatment was classified as successful if it led to a complete resolution of the pregnancy without the need for any additional medical interventions. Results: Between August 29, 2018, and February 28, 2023, we recorded 460 patients with cesarean scar pregnancies (281 live, 179 failing cesarean scar pregnancy) who fulfilled the inclusion criteria and were registered. A total of 270 of 460 (58.7%) patients were managed surgically, 123 of 460 (26.7%) patients underwent medical management, 46 of 460 (10%) patients underwent balloon management, and 21 of 460 (4.6%) patients received other, less frequently used treatment options. Suction evacuation was very effective with a success rate of 202 of 221 (91.5%; 95% confidence interval, 87.8-95.2), whereas systemic methotrexate was least effective with only 38 of 64 (59.4%; 95% confidence interval, 48.4-70.4) patients not requiring additional treatment. Overall, surgical treatment of cesarean scar pregnancies was successful in 236 of 258 (91.5%, 95% confidence interval, 88.4-94.5) patients and complications were observed in 24 of 258 patients (9.3%; 95% confidence interval, 6.6-11.9). Conclusion: A cesarean scar pregnancy can be managed effectively in the first trimester of pregnancy in more than 90% of cases with either suction evacuation, balloon treatment, or surgical excision. The effectiveness of all treatment options decreases with advancing gestational age, and cesarean scar pregnancies should be treated as early as possible after confirmation of the diagnosis. Local medical treatment with potassium chloride or methotrexate is less efficient and has higher rates of complications than the other treatment options. Systemic methotrexate has a substantial risk of failing and a higher complication rate and should not be recommended as first-line treatment

Sport et arthrose. [Sports and arthrosis]

Recent changes in lifestyle have considerably reduced the loads that joints have to bear through occupational stresses. It is now essentially during leisure time that most people use somewhat intensely their locomotive systems, mostly as sustained bouts of physical exercise. The physician is therefore led to examining critically these sports activities and their consequences. One has to be aware of the fact that some sports may bring about an articular overuse, partly through trauma and partly through microtrauma. Nevertheless, when reviewing recent literature on the implied relation between exercise and degenerative joint disease, one is amazed in observing how contradictory the current opinions are. This article intends to be both a review and a synthesis of the various factors which are commonly accepted as playing a role in the etiology of degenerative joint disease consecutive to exercise. We take into account by the same token the well-known advantages of physical activity such as prevention of cardiovascular disease and atherosclerosis, the enhancement of psychic well-being and the delaying of the onset of ageing. Thus, knowing which sports may promote degenerative joint disease under given conditions, the physician will be able to counsel people with an identified proneness to joint disease into undertaking more healthful physical workouts