This case report describes an exceptionally late mesh-related complication occurring 16 years after transobturator tape placement for stress urinary incontinence. The patient developed a recurrent vaginocutaneous fistula and abscess 9 years after partial mesh removal, highlighting the long-term risks associated with retained synthetic material. Clinical presentation included persistent purulent discharge and inguinal abscess, with MRI confirming infection of the remaining sling arm and fistulization to the thigh. Complete surgical excision led to full recovery. This case emphasizes the potential for delayed mesh complications, even after prolonged asymptomatic periods. It underscores the importance of considering mesh-related pathology in patients with atypical infections and a remote surgical history, the key role of imaging in diagnosis, and the need for individualized, multidisciplinary management. Long-term vigilance and thorough patient counseling remain essential.
Background/Objectives The Government indicator evaluates national policies and strategies for child and adolescent physical activity, supporting country reporting and international comparisons within the Global Matrix initiative. To grade this indicator, countries/jurisdictions apply either the original method or, in recent editions, an alternative approach. The alternative approach was proposed by the Welsh team, who derived six criteria from the World Health Organization’s Health-enhancing Physical Activity Policy Audit Tool v2 and developed an accompanying scoring rubric. This study aimed to evaluate the Welsh approach in comparison with the original method to guide recommendations for future applications. Methods The study employed a mixed-methods design, including: 1) inductive content analysis of feedback collected via survey from 17 researchers and policy professionals from various countries, and 2) descriptive and Wilcoxon signed-rank analysis of Government indicator grades from Global Matrices 3.0 and 4.0 in 6 countries that transitioned to the Welsh approach and 28 countries/jurisdictions that retained the original method. Results User feedback on the Welsh approach was predominantly positive, noting its structure, transparency, and comprehensiveness as strengths, and indicating greater utility and suitability than the original method. Concerns included limited consideration of policy implementation and feasibility aspects. No statistically significant group-level temporal grade differences were found for both methods. Conclusion The Welsh approach adds structure and transparency to the Government indicator assessment. Further refinements to the Welsh approach may improve comparability and policy relevance, while both the Welsh and original methods remain acceptable for interim use within the Global Matrix, with potential applicability beyond it.
OBJECTIVE:To evaluate the effectiveness and tolerability of dienogest in patients with endometriosis in real-world clinical practice. METHODS:This cross-sectional observational study was based on a self-administered questionnaire in which patients retrospectively reported their symptoms and quality of life before dienogest initiation, as well as perceived treatment effectiveness and tolerability. The questionnaire was distributed to patients followed for endometriosis within a regional endometriosis care network (April 2024-September 2025). Participants assessed symptom improvement, overall quality of life before and during treatment, the frequency of adverse events, and treatment continuation or discontinuation. Changes in quality of life before and after treatment were analysed using the Wilcoxon test. RESULTS:A total of 146 patients were included. Complete resolution of dysmenorrhea was reported by 44.7% of patients with baseline dysmenorrhea (55/123). Overall quality of life significantly improved under treatment (4.4 ± 2.3 vs 5.5 ± 2.6; p<0.001). All patients reported at least one adverse event; the most frequent were fatigue (63.0%), decreased libido (58.3%), and mood disturbances (50.7%). Treatment was discontinued by 40.4% of patients, mainly due to adverse events. Some symptom improvements and adverse events varied according to treatment duration. CONCLUSIONS:In this real-world patient-reported study, patients reported improvement under dienogest treatment, particularly for dysmenorrhea and overall quality of life. However, frequent adverse events and treatment discontinuation suggest that tolerability may limit long-term adherence.
INTRODUCTION:Postpartum perineal pain is a common condition that may interfere with functional recovery. This study aimed to characterize its temporal evolution, anatomical distribution and functional impact during the first 90 days after vaginal birth. METHODS:Prospective cohort study including 106 women following vaginal delivery. Participants were assessed using structured digital questionnaires at eight time points (1, 2, 7, 15, 21, 30, 60 and 90 days postpartum). Pain intensity was measured using a numerical rating scale (PNRS), and location was recorded using a standardized neuroanatomical perineal map. Pain triggers, treatments and functional limitations were also documented. RESULTS:Perineal pain was highly prevalent in the immediate postpartum period and declined over time, but remained clinically relevant. At 15 days, 78% of women reported pain, decreasing to 50% at one month and 25% at two months. At 90 days, 13.3% still reported persistent pain, generally mild to moderate. Pain was most frequently localized in the lower vulvar and vulvoanal regions, with a modest right-sided predominance. Approximately one-third of women reported limitations in sitting, standing or walking. Women reporting persistent pain were less likely to have resumed sexual activity and more frequently reported continued analgesic use during follow-up. CONCLUSIONS:Postpartum perineal pain is common, functionally relevant and may persist for months after vaginal birth. Recognition of its temporal evolution, anatomical distribution and functional impact may facilitate a more comprehensive clinical assessment during the postpartum period.
Objective To evaluate the feasibility and effectiveness of vaginal ethanol sclerotherapy (EST) for ovarian endometriomas, with a focus on recurrence and subsequent fertility outcomes. Materials and Methods We conducted a retrospective study including all patients who underwent vaginal EST at the Strasbourg University Hospitals from January 2015 to March 2024. Diagnosis was based on transvaginal ultrasound, with MRI confirmation in selected cases. The primary endpoint was recurrence, defined as reappearance of an endometrioma >30 mm at least one month after treatment. Secondary outcomes were postoperative complications and fertility outcomes. Results Among 129 procedures scheduled, 118 were performed and analyzed. Three cases required conversion to laparoscopy. The mean patient age was 32 years, and 87% had a history of infertility. Endometriomas had a mean diameter of 50 mm; 28% of treated ovaries had a prior surgical history. The recurrence rate was 12.7% (15/118), with a mean time to recurrence of 3 months and mean cyst diameter of 55 mm. Perioperative complications included three alcohol leaks (2.5%) and one hemoperitoneum (0.8%). Postoperative complications occurred in 1.6% of cases, including one infected hematoma and one peritonitis. Among patients desiring pregnancy (n=86), 41.9% conceived, 69.4% of which resulted in live births. Most pregnancies (83.3%) were achieved through assisted reproductive technology. Conclusion Vaginal EST appears to be a feasible and safe alternative to cystectomy, with a low recurrence rate and a favorable impact on fertility outcomes. It may represent a promising fertility-preserving option for women with endometriomas and diminished ovarian reserve.
Background/Objectives Adequate physical literacy (PL) in children is a potential preventive measure against non-communicable diseases. Direct measurement of PL is often absent in population-wide studies, particularly in East and Southeast Asia. We assessed PL and associated individual- and environmental-level factors in Singapore children. Methods 726 participants (373 boys, 353 girls; age: 11.0±0.2 years) from a birth cohort study (GUSTO) completed a self-administered questionnaire in the Canadian Assessment of Physical Literacy Second Edition (CAPL-2) to assess affective and cognitive domains of PL. A subset of 360 children (187 boys, 173 girls) completed a modified fitness test-battery to assess physical competence. Chi-square tests of independence compared sex and ethnicity differences in PL scores. A modified three-domain composite Overall PL score was derived. Pearson’s correlation assessed PL scores against self-reported moderate-to-vigorous physical activity (MVPA) duration. Regression analysis examined associations of socio-economic status (SES) with PL, adjusting for sex, ethnicity, and MVPA. Results 72.8% of children were classified within the lower category bins of the modified Overall PL scoring framework. Self-reported MVPA duration was positively associated with modified Overall PL score (r(358)=0.13, p=0.01). After adjustment, the regression model revealed that household income was not associated with modified Overall PL scores (all p>0.05), while higher maternal education remained associated with higher scores (all p<0.01). Conclusion Low levels of PL observed in Singapore school children warrant concern for public health and disease prevention. These findings, alongside similarities in educational systems, cultural influences, and socioeconomic factors shared with countries within the region, highlight an urgent need to prioritize physical activity and PL in children across Asian contexts.
Background /Objective: Compression garments (CGs) with localized stiffness alterations are marketed to enhance athletic performance, yet evidence for benefits in jumping remains limited. This study aimed to evaluate the effects of stiffness-altered CGs on lower-limb angular kinematics and force-time characteristics in countermovement jumps (CMJs). Methods 62 physically active adults (31 female, 31 male) performed CMJs under four conditions: control (shorts only), knee sleeves with stiffness components, compression leggings without stiffness alterations, and stiffness-altered compression leggings. Sagittal-plane angles were recorded via motion capture, and vertical ground reaction forces via force platforms. Two-way (sex*condition) ANOVA were performed for derived variables, employing both discrete and one-dimensional statistical parametric mapping (SPM) analyses. Results Both leggings conditions significantly restricted hip range of motion (81-82˚vs. non-leggings 85˚, p=0.001) and peak extension velocity (455-461˚/s vs. non-leggings 512˚/s, p<0.001) relative to non-leggings conditions. SPM further revealed phase-specific effects, such as slower hip flexion during early unweighing phase (p<0.001) in stiffness-altered leggings. Knee and ankle kinematics were not affected. In addition, stiffness-altered leggings reduced countermovement speed (1.37 m/s vs. control 1.43 m/s, p=0.018) and braking impulse (1.37 N s/kg vs. control 1.43 N s/kg, p=0.017) but did not impair jumping height (∼0.3 m) and propulsive impulse (∼2.5 N s/kg). No sex-by-condition interactions were observed. No significant differences were found between the two non-leggings conditions, nor between the two leggings conditions. Conclusion Despite no detectable performance decline, compression leggings primarily restricted hip motion and altered eccentric phase characteristics in CMJs, likely diminishing stretch-shortening cycle efficiency. To promote beneficial effects of stiffness-altered CGs, future study designs shall control for garment fitting via compression and stiffness measurements, as well as individual variations in skill levels via more specific and representative sampling.
OBJECTIVE:To examine the association between socioeconomic status (SES) on long-acting reversible contraception (LARC) discontinuation. METHODS:We analyzed a national cohort of women born between 1980-1984 in the National Longitudinal Survey of Youth (NLSY97). We used 2005-2021 NSLY97 cycles, including the first cycle respondents were ≥18 years, sexually active, and using LARC. Respondents were tracked until they either reported using non-LARC contraception, were not using any contraceptives, became pregnant, or were lost to follow-up. SES characteristics were ascertained at respondents' first eligible cycle, including: Family income relative to the Federal Poverty Level (FPL), insurance, education, and employment. LARC discontinuation was categorized as stopping contraception, switching to non-LARC contraception, pregnancy, or continuing LARC throughout the study. Mixed-effects multinomial logistic regression with cluster-robust standard errors modeled continued LARC use as a function of SES. RESULTS:Our cohort contained 435 women contributing 893 interviews. At the last interview, 23% of respondents still used LARC, 19% stopped contraception, 20% switched to another contraceptive, and 38% became pregnant. On multivariable regression, respondents between 300-399% FPL had an increased likelihood of stopping LARC (relative risk ratio [RRR]: 7.65; 95% confidence interval [CI]: 1.72, 33.93; p=0.007) while respondents between 100-199% FPL had a decreased likelihood of becoming pregnant (RRR: 0.28; 95% CI: 0.13, 0.61; p=0.001). There were no other significant associations between SES and LARC discontinuation. CONCLUSIONS:Our analysis found no consistent relationship between SES and LARC discontinuation. While SES may influence the decision to initiate LARC, SES may not influence the decision to discontinue LARC.
Traditional resistance training requires prolonged continuous sessions, which may limit participation among time-constrained individuals. Fragmented resistance training (FRT), derived from ‘exercise snacking,’ may offer a more flexible alternative, but comparative evidence with traditional resistance training (TRT) remains limited. This study examined the effects of 8 weeks of FRT and TRT on muscular fitness and exercise enjoyment in 45 recreationally trained male students (18–25 years, ≥6 months training). Participants were randomised to FRT (three daily short bouts, 1×20 squats each), TRT (one continuous session, 3×20 squats), or a time-matched control group. Training was performed three times/week for 8 weeks using Smith-machine squats, with volume matched and intensity progressing from 40% to 55% of 1RM. Outcomes included 1RM strength, isometric squat force, relative muscular endurance (repetitions at 40% of current 1RM), and PACES enjoyment. Both FRT and TRT significantly outperformed the control in 1RM strength (FRT: +20.59 kg [8.69–32.49], p<0.001; TRT: +28.93 kg [17.05–40.82], p<0.001), isometric squat force (FRT: +27.89 kgf [12.15–43.64], p<0.001; TRT: +35.24 kgf [19.48–51.00], p<0.001) and relative muscular endurance (FRT: +9.97 repetitions [1.68–18.27], p=0.020; TRT: +14.11 repetitions [5.84–22.38], p<0.001), with no significant differences between FRT and TRT group (p=0.164, 0.353 and 0.320). FRT reported significantly higher enjoyment than TRT (p=0.034). These findings suggest FRT and TRT produce comparable improvements in strength and endurance under volume-matched conditions, both superior to control. FRT was more enjoyable, indicating it may serve as a practical alternative for time-constrained young adults, though further research on long-term adherence is warranted.Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR2500115052.
In recent years, the fertility and parenthood of transgender men have emerged as significant medical and societal subjects. Since the 2016 french legal reform, transgender men have been able to retain their reproductive organs, opening the door to discussions regarding their fertility and pathways to parenthood. To evaluate the medical, legal, and ethical issues associated with the fertility of transgender men in France, we have analysed three scenarios adapted from real clinical cases and contrasted them with the existing literature: a termination of pregnancy (abortion), a medical termination of pregnancy (TOP), and a continued pregnancy. These cases illustrate the specific challenges encountered in practice: lack of awareness regarding reproductive risks, legal hurdles in accessing abortion and medical termination of pregnancy, the impact of bodily dysphoria during pregnancy, issues surrounding legal parentage, and the still-limited utilization of oocyte cryopreservation. The literature confirms that testosterone does not constitute a reliable method of contraception and that parenthood for transgender men remains hindered by medical, social, and legal barriers. The management of fertility in transgender men must be multidisciplinary, inclusive, and tailored to legislative developments in order to meet growing needs in contraception, oocyte preservation, and parenthood.
OBJECTIVE:To investigate the association between air travel during early pregnancy and the risk of spontaneous miscarriage. SETTING:This population-based retrospective cohort study included completed singleton pregnancies ending in either a first-trimester spontaneous miscarriage or a live birth between 2010 and 2019. Only pregnancies with a confirmed last menstrual period (LMP) date were included to ensure accurate temporal assessment of air travel in relation to pregnancy outcome. METHODS:Singleton pregnancies resulting in live birth were compared with those ending in spontaneous miscarriage during the first trimester. Air travel between 4 + 0 and 13+6 weeks of gestation was defined as the primary exposure. Spontaneous miscarriage was identified using ICD-9 codes. Multivariable logistic regression was performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS:A total of 439,990 pregnancies were analyzed, including 427,727 live births (97.2%) and 12,263 miscarriages (2.8%). Air travel during the first trimester was more common among women who experienced miscarriage compared to those with live births (0.01% vs. 0.00,014 %, P < 0.001). After adjustment for potential confounders, air travel was associated with more than fivefold higher odds of miscarriage (aOR 5.20, 95% CI 4.38-6.33). CONCLUSION:Air travel during the first trimester was associated with an increased risk of spontaneous miscarriage. While causality cannot be established, these findings may have implications for counseling women considering air travel during early pregnancy.
INTRODUCTION:Operative hysteroscopy is widely used for intrauterine pathologies, but the impact of hysteroscope diameter on intraoperative safety remains under-evaluated. This study compared intraoperative complications using 18 Fr versus 26 Fr operative hysteroscopes. MATERIAL AND METHODS:We conducted a prospective single-center observational study in a French university hospital. Women undergoing operative hysteroscopy for polypectomy, myomectomy, or endometrial resection between June 2023 and May 2024 were included without exclusion criteria. Procedures were performed by four senior surgeons who regularly used both systems. Hysteroscope selection (18 Fr vs 26 Fr) was at the surgeon's discretion based on clinical and technical considerations. The primary outcome was intraoperative complications. Secondary outcomes included procedure completeness, operative time, postoperative pain, and distension fluid deficit. RESULTS:A total of 117 procedures were analyzed (18 Fr, n=89; 26 Fr, n=28). Intraoperative complications occurred in 11 cases (9.4%), including 9 cervical lacerations and 2 uterine perforations. Complications were less frequent with the 18 Fr hysteroscope (5.6% vs 21.4%; OR 0.22; 95% CI, 0.06-0.78). Procedure completeness (89.8% vs 85.2%; p=0.51), operative time (18.2 ± 9.1 vs 23.0 ± 11.8 min; p=0.09), and postoperative pain (4.5% vs 3.6%; p=0.88) were similar. A fluid deficit ≥1500 mL occurred less frequently with 18 Fr (2.2% vs 14.3%; OR 0.14; 95% CI, 0.02-0.80). DISCUSSION:Smaller diameter hysteroscopes were associated with fewer intraoperative complications, particularly cervical trauma, without compromising procedural outcomes. CONCLUSION:Use of an 18 Fr operative hysteroscope was associated with improved intraoperative safety without loss of effectiveness or efficiency.
Objectives:This study examined the associations of different physical activity patterns with mortality risk and life expectancy among individuals with cardiometabolic multimorbidity (CMM). Design:We analyzed data from adults with CMM in the National Health Interview Survey (1997-2018), linked to mortality records through December 31, 2019. CMM was defined as the coexistence of at least two of heart disease, diabetes, and stroke. Methods:Physical activity was categorized as Inactive, Insufficiently Active, Weekend Warrior (≥150 min/week in 1-2 sessions), or Regularly Active (≥150 min/week in ≥3 sessions). Relative mortality risks were estimated using Cox proportional hazards models, absolute mortality rate differences using Poisson regression, and differences in life expectancy at ages 45 and 65 using flexible parametric survival models. Subgroup and sensitivity analyses assessed robustness. Results:The analytic sample included 15,079 adults with CMM, of whom 8299 (55.0%) were women. Over a mean follow-up of 10.1 years, 6932 deaths occurred. Compared with Inactive participants, mortality risk was 19% lower among the Insufficiently Active (HR = 0.81, 95% CI: 0.75-0.89), 36% lower among Weekend Warriors (HR = 0.64, 95% CI: 0.49-0.83), and 40% lower among the Regularly Active (HR = 0.60, 95% CI: 0.55-0.65). At age 45, estimated differences in life expectancy were 2.24, 4.60, and 4.94 years across these groups, respectively; corresponding differences at age 65 were 1.46, 3.04, and 3.27 years. Conclusions:Among individuals with CMM, recommended levels of physical activity, whether accumulated in 1-2 weekly sessions or more frequent exercise, were associated with lower mortality risk and longer life expectancy. Weekend Warrior and regular activity patterns showed comparable associations with survival-related outcomes.
Objective:(1) Compare Functional Gait Assessment (FGA) scores between knee osteoarthritis (KOA) patients and healthy older adults; (2) assess FGA inter-rater/test-retest reliability in people with KOA; (3) examine the correlations between FGA scores and knee function measures; (4) identify the optimal FGA cutoff score for distinguishing people with KOA from healthy controls. Methods:This cross-sectional study included 63 individuals with KOA (mean age = 66.6 years) and 30 healthy older adults (mean age = 68.1 years). The participants were assessed by FGA, knee flexion/extension strength, Limit of Stability (LOS), Berg Balance Scale (BBS), Timed Up and Go (TUG), Five Times Sit to Stand (5STS), Activity-specific balance confidence (ABC) scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), Falls Efficacy Scale-International (FES-I), and Oxford Participation and Activities Questionnaire (Ox-PAQ). The KOA group was assessed on Day 1 and Day 2 (7 days apart), whereas the healthy group was assessed on Day 1 only. Inter-rater and test-retest reliability of the FGA in the KOA group were evaluated using the Intraclass Correlation Coefficient (ICC). Correlations between FGA performance and other outcome measures were analyzed using Pearson's r or Spearman's rho. The optimal FGA cutoff score for differentiating between the KOA and healthy groups was determined using the Receiver Operating Characteristic curve. Results:People with KOA (mean ± standard deviation (SD) = 23.49 ± 3.87) had significantly lower(p < 0.001) FGA scores than healthy older adults (mean ± SD = 27.03 ± 2.51). The FGA demonstrated excellent inter-rater reliability (ICC = 0.986) and good test-retest reliability (ICC = 0.897). FGA scores showed moderate-to-strong positive correlations with affected knee strength, LOS, BBS, KOOS, and ABC (r = 0.36-0.70), and significant negative correlations with TUG, 5STS, FES-I, and Ox-PAQ scores (r = -0.32 to -0.69). The optimal FGA cutoff score was 25.5 (Area Under the Curve = 0.795-0.798, sensitivity = 0.867, specificity = 0.651-0.667) as a threshold to distinguish performance of people with KOA from healthy controls. Conclusion:The FGA showed promising overall reliability and selected validity evidence in this sample, while further confirmation in larger, more diverse cohorts is required.
OBJECTIVES:To estimate the probability of histologically confirmed cervical high-grade intraepithelial lesions and cancer (HGIL+) among women referred for colposcopy after ASCH cytology, and to determine whether this probability differs when ASCH is reported as triage after a positive primary HPV test. METHODS:We conducted a retrospective two-center study including women referred for colposcopy following ASCH cytology between 2018 and 2024. ASCH was classified as either a primary screening result or triage after positive HPV testing. Clinical, cytological, colposcopic, and histological data were extracted. The primary outcome was histologically confirmed HGIL+, defined as high-grade cervical or vaginal intraepithelial lesion and/or cervical cancer diagnosed on biopsy and/or LLETZ specimen. RESULTS:Overall, 421 colposcopies performed after ASCH cytology were included. ASCH was reported as a primary screening result in 185 cases (43.9%) and as triage after positive HPV testing in 236 cases (56.1%). HGIL+ was diagnosed in 213 women (50.6%), including 202 cervical HGIL, five vaginal HGIL, and six cervical cancers. The HGIL+ rate did not differ significantly between primary cytology and HPV-positive triage: 102/185 (55.1%) versus 111/236 (47.0%) (p = 0.099). The HGIL+ rate varied significantly with age and was the lowest in women older than 50 years: 45.5% before 30 years, 56.3% between 30 and 50 years, and 40.5% after 50 years (p = 0.017). CONCLUSION:The probability of HGIL+ among women referred after ASCH cytology was approximately 50%. This probability was not significantly modified by HPV-positive triage context but appeared lower in women older than 50 years.
Recurrent implantation failure (RIF) remains a major challenge in assisted reproductive technology (ART), reflecting multifactorial and incompletely understood etiologies. Although embryonic competence is widely regarded as the primary determinant of implantation success, increasing attention has been directed toward endometrial and immunological factors that may contribute to repeated failure in selected patient populations. Among proposed immunomodulatory interventions, intravenous lipid emulsions (intralipids) have been investigated as a strategy to modulate uterine immune responses, particularly natural killer (NK) cell activity, in women undergoing in vitro fertilization (IVF). The biological rationale for intralipid therapy derives from observations that uterine NK (uNK) cells play essential roles in early placentation, including regulation of angiogenesis, trophoblast invasion, and cytokine balance. However, the clinical significance of altered NK cell numbers or function in RIF remains debated, and evidence linking immune modulation to improved live birth rates is inconsistent. Variability across studies is further compounded by heterogeneity in diagnostic criteria, immune testing methodologies, and treatment protocols. This narrative review aims to critically evaluate the available mechanistic and clinical evidence regarding intravenous intralipid infusion in IVF patients, with emphasis on recurrent implantation failure. We examine proposed mechanisms of action, summarize randomized controlled trials and meta-analyses, assess methodological limitations, and consider current professional society recommendations. Although some reports describe improvements in clinical pregnancy rates, conflicting findings and the absence of large, adequately powered trials preclude definitive conclusions. Current guidelines do not recommend routine intralipid use outside research settings. Future investigations should prioritize immune assessment and live birth as the primary endpoint.
Background/objective:Korean youth experience academic, social, and environmental pressures that shape opportunities for play. Using nationally representative data, this study examined gender- and school-level differences in play-related factors (e.g., preference, autonomy, opportunities, support, access, and policy needs) to describe the status of play in Korea. Methods:Data from a nationally representative, self-administered survey of 2992 Korean youth, conducted by the NYPI in 2021 was used. The survey employed a modified proportional stratified multi-stage cluster sampling method. Logistic regression models were conducted after adjusting for household economic status and academic achievement. Results:Boys favored active and outdoor play, while girls preferred indoor, sedentary, or culturally oriented activities. With increasing school-level, active play, autonomy, and supportive environments declined, and academic demands grew. Parental support was most consistent, while teacher and community support decreased. Boys reported better access to programs and play spaces, while girls expressed greater need for adult-facilitated support and policy-driven improvements. Environmental constraints, including limited availability, accessibility, and proximity of play spaces, were most pronounced for older students and girls. Policy needs for play were the greatest among middle and high school students, in the domains of play spaces, program availability, and support for self-directed activities. Conclusions:Patterns of play among Korean youth appear to be shaped by gender and school-level, showing a clear trajectory of declining active, outdoor, and self-directed play with increasing school-level, and gendered differences in activity type, location, and support. Findings highlight the importance of youth-centered, gender- and developmentally-tailored strategies to foster meaningful play participation for Korean youth.
Uterine fibroids are the most common benign uterine tumors and may require surgical management in symptomatic patients desiring uterine preservation. Robot-assisted laparoscopic myomectomy has emerged as a minimally invasive alternative to open surgery, offering reduced intraoperative blood loss and faster postoperative recovery. We describe our surgical technique as performed at Bichat-Claude Bernard University Hospital (AP-HP), with particular emphasis on intraoperative hemostatic strategies: uterine artery clamping with Bulldog MicroClamp clips, pericervical tourniquet using a Foley catheter, and multilayer myometrial closure with V-Loc barbed sutures. Preoperative prehabilitation, including GnRH agonist therapy and iron supplementation, is considered to optimize hemoglobin levels prior to surgery. Trocar placement, robotic docking configuration, and contained morcellation technique are also detailed. This standardized approach seems to yield excellent functional outcomes while minimizing hemorrhagic complications.
Accurate staging of cervical cancer is essential for guiding treatment selection and determining prognosis. Physical examination, although fundamental for assessing vaginal extension and obtaining biopsies, shows important limitations for evaluating parametrial invasion and overall FIGO staging. Pelvic MRI provides higher diagnostic performance, particularly when diffusion-weighted imaging is incorporated, improving assessment of tumour size, parametrial involvement and residual disease after chemoradiotherapy. Contrast-enhanced sequences offer additional value for detecting small lesions and characterizing stromal invasion. Functional MRI parameters, including ADC changes and dynamic enhancement patterns, show promise for early prediction of treatment response, although standardisation remains insufficient for routine clinical application. After conization, MRI demonstrates good sensitivity and excellent specificity for detecting residual tumour, but postoperative inflammatory changes may reduce accuracy when performed too early. For nodal staging, 18F-FDG PET-CT offers whole-body evaluation, with diagnostic sensitivity strongly influenced by tumour stage and nodal prevalence. PET-CT rarely influences management in IA1-IA2 and has limited impact in IB1 but becomes relevant in IB2-IIB and IIIA-IVA disease, particularly when positive nodal uptake may obviate lymphadenectomy. PET-derived metabolic parameters also correlate with recurrence and survival, though no validated thresholds allow direct clinical use. Serum SCC-Ag is associated with recurrence and survival in observational studies, but its clinical utility remains unproven due to heterogeneity of thresholds and absence of evidence that testing improves outcomes. Future research integrating modern MRI protocols, digital PET-CT technology and validated imaging biomarkers is needed to refine staging algorithms and optimize personalized management.
