This observational longitudinal study utilized the Global Burden of Disease (GBD) 2023 database to comprehensively analyze and project the burden of uterine prolapse (UP) in China and G20 countries from 1990 to 2050. Incidence, deaths, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were assessed, including their age-standardized rates (ASRs). Trends from 1990 to 2023 were analyzed using Joinpoint regression (calculating the average annual percentage change, AAPC), along with their respective 95% confidence intervals (CI), and decomposition analysis. The future burden to 2050 was projected using autoregressive integrated moving average (ARIMA) and Bayesian age-period-cohort (BAPC) models. From 1990 to 2023, the ASRs for incidence, prevalence, DALYs, and YLDs of UP in China showed a declining trend, with AAPCs of -0.47 (95% CI -0.51 to -0.44), -0.52 (95% CI -0.56 to -0.47), -0.50(95% CI -0.54 to -0.46), and -0.52 (95% CI -0.55 to -0.48), respectively. A transient increase was observed between 2010 and 2015. The ASR for deaths remained near zero, while the ASR for YLLs increased (AAPC = 2.12, 95% CI 1.32-2.93). The G20 countries showed similar declining trends for non-fatal burdens, with reductions more pronounced than in China. Projections indicate that from 2023 to 2050, the ASRs for incidence, prevalence, DALYs, and YLDs will continue to decline in both China and G20 countries, with a faster decrease anticipated in China. Consequently, the age-standardized burden among Chinese women is expected to remain lower than the G20 average. In conclusion, while China's age-standardized UP burden is historically and prospectively lower than the G20 aggregate, rising absolute numbers due to population aging indicate a substantial future healthcare burden. This underscores the need for China to develop targeted, age-group-specific prevention and control strategies.

This article presents a clinical case of staged surgical rehabilitation of a child with severe combined contusion of the eye, adnexa and orbit, which occurred as a result of a gunshot wound with a rubber bullet from a traumatic pistol. The stages of reconstructive treatment are described step by step: removal of a foreign body from the right orbit, restoration of the orbital bone walls using a polytetrafluoroethylene (PTFE) implant (manufactured by Ekoflon, Russia), evisceration of the right eye with the formation of a musculoskeletal stump using a PTFE graft, individual ocular prosthetics, correction of ptosis of the upper eyelid on the side of the anophthalmic orbit. Assessment of treatment outcomes after three years showed that an anatomically adequate conjunctival cavity had been formed, the integrity and mobility of the upper eyelid had been restored, and symmetry of the palpebral fissure relative to the healthy side had been achieved. The use of modern ophthalmic surgical technologies ensured maximum restoration of damaged structures of the ocular adnexa and made it possible to achieve significant cosmetic and functional results.

Mitral valve (MV) disease, particularly MV prolapse (MVP) and mitral regurgitation (MR), affects 2 to 5% of the population and poses a substantial arrhythmogenic risk, with 43% of MVP patients developing arrhythmias. Although less common in children, the absence of comorbidities can uniquely isolate early electromechanical alterations that may elucidate mechanisms later contributing to arrhythmic risk and devastating effects such as sudden cardiac death. Conventional echocardiography lacks sensitivity for MV electromechanics, motivating advanced approaches. We introduce Electromechanical Wave Imaging (EWI), a high-frame-rate echocardiography modality, to map MV-complex activation and diastolic recovery in N = 21 MVP, MR, and control pediatric subjects (13.10 ± 4.51 y old, 43% male). A preclinical canine study (n = 3) established EWI's ability to observe temporally coupled electromechanical wave propagation across the atrioventricular junction through the closed MV-following atrial and preceding ventricular activation (73.0 ms, 60 BPM). MVP patients exhibited significantly delayed left ventricular (LV) activation (76.04 ± 12.51 ms vs. 47.64 ± 2.57 ms in controls, P = 0.0013), primarily in papillary muscles. Both MVP and MR-only subjects exhibited prolonged LV recovery, with MR-only patients showing significantly longer recovery intervals (MR-only: 277.0 ± 27.61 ms, Control: 248.7 ± 10.43 ms, MVP vs. Control: MR-only vs. Control: P = 0.0395). In two arrhythmogenic MVP cases, EWI localized arrhythmic exit sites adjacent to LV papillary muscles, coinciding with regional delayed sinus activation, aligning with invasive electrophysiology. This study demonstrates that atrioventricular valve function dictates cardiac electromechanical function and establishes full-cycle EWI as a transformative tool for diagnosing MV disease electromechanical effects, assessing arrhythmic risk, guiding interventions, and advancing noninvasive cardiac imaging.

Innovation in pelvic organ prolapse surgery depends on early, iterative collaboration among clinicians, engineers, companies, universities, and professional societies. After past device-related harms, many organizations adopted restrictive rules to prevent undue influence, but these can unintentionally exclude the physician innovators best positioned to guide safe progress. We propose a proportional governance framework that scales with technological maturity (technology readiness level, TRL), clinical validation (clinical readiness level, CRL), and physician financial or decisional influence (level of involvement, LOI) across four stages: discovery, translational innovation, clinical validation, and commercial deployment. A practical governance scorecard and a standardized research lexicon (completed, ongoing, planned) support management rather than exclusion, preserving transparency and patient protection while enabling responsible innovation.

Complex bileaflet and Barlow-type degenerative disease is among the most demanding substrates in reconstructive mitral surgery, where durable repair-preserving the subvalvular apparatus and left ventricular geometry-remains the goal [1]. Through a right mini-thoracotomy, limited exposure amplifies every source of intraoperative variability. Two pitfalls in bileaflet repair may compromise durability: leaving excessive height of the posterior leaflet, which displaces the coaptation line anteriorly and drives residual regurgitation and systolic anterior motion; and inappropriately sized anterior chordae, in which a small error in length may produce residual prolapse, restriction or recurrence. RE-LOCK and TRACK is a two-component, posterior-first protocol designed to control both, reproducibly, in the minimally invasive field (Fig. 1).

Introduction Spinal cord injury (SCI) results in profound neurological deficits, including bladder dysfunction that significantly impairs quality of life. Non-traumatic SCI, arising from spinal stenosis, tumours, or disc prolapse, accounts for a growing proportion of SCI cases globally. Neurogenic bladder dysfunction, manifesting as urgency, incontinence, or retention, remains one of the most debilitating sequelae. Pelvic floor neurodynamics (PFN), integrating neural mobilisation techniques with targeted pelvic floor rehabilitation, represents a novel therapeutic approach. However, its efficacy in the post-operative non-traumatic SCI population has not been formally evaluated. Method A randomised controlled trial was conducted at Krishna College of Physiotherapy in Karad, Maharashtra, India. Twenty-four participants (aged 30-60 years) with non-traumatic SCI and neurogenic bladder dysfunction were randomly allocated into two groups (n = 12 each). Group A (experimental) received PFN combined with conventional physiotherapy; group B (control) received conventional physiotherapy alone. Both protocols were delivered over two weeks. Outcome measures were the International Consultation on Incontinence Questionnaire (ICIQ) and the Spinal Cord Independence Measure (SCIM), assessed pre- and post-intervention using paired and independent samples t-tests. Result Group A showed a mean ICIQ reduction of 7.50 points (16.75 to 9.25; p < 0.001) and a mean SCIM gain of 21.08 points (46.25 to 67.33; p < 0.001). Group B showed a mean ICIQ reduction of 3.42 points (p < 0.01) and a SCIM gain of 10.25 points (p < 0.001). Between-group comparisons confirmed significantly superior outcomes in group A on both ICIQ (p < 0.01) and SCIM (p < 0.05), with improvements more than double those in the control group. Conclusion The addition of PFN to conventional physiotherapy significantly enhances bladder control and functional independence in non-traumatic post-operative SCI. These findings support the integration of neurodynamic techniques into standard SCI rehabilitation protocols.

Aggressive angiomyxoma (AAM) is a rare, slow-growing, locally infiltrative mesenchymal tumor of the pelvis and perineum, most often affecting women. Its nonspecific presentation and tendency to mimic more common vaginal or periurethral masses frequently delay diagnosis. Early recognition is critical to guide appropriate surgical planning, optimize resection, and reduce recurrence risk. In this case, a 61-year-old woman with prior vaginal hysterectomy presented with symptoms of pelvic organ prolapse, urinary incontinence, and occasional bleeding. Examination revealed a 10 × 3-cm protruding anterior vaginal wall mass with a spongy texture. MRI demonstrated a well-defined tubular lesion in the left distal vaginal wall extending towards the vulva. Intraoperative evaluation, including cystourethroscopy, diagnostic laparoscopy, and general surgery consultation, ruled out bowel involvement. The mass was excised via vaginal approach with preservation of surrounding structures. Histopathology confirmed AAM. Margins could not be assessed due to specimen disruption. At 6-week follow-up, the patient was asymptomatic with well-healed incisions, and ongoing surveillance with gynecologic oncology was arranged. This case highlights the importance of including AAM in the differential diagnosis of anterior vaginal wall masses. Multidisciplinary collaboration and advanced imaging are essential for accurate diagnosis and surgical planning. Given the tumor's locally infiltrative nature and high recurrence rate, long-term follow-up is warranted. Awareness of this rare pathology can aid timely recognition and improve patient outcomes.