A key factor in evolution is reproduction, which is also a major concern in medicine. Evolutionists have proposed many theories and hypotheses to explain the low fertility rates of modern industrial societies, which are contrary to maximization of biological fitness. Given that childbirth is the most significant factor affecting re-productive fitness, it is likely that a variety of psychological modules related to childbirth behavior and intentionevolved over time. Several evolutionary psychological modules have been proposed in relation to reproduction, including sexual desire, status-seeking, a need for nurturing, and the desire for children. Previously adaptive psychological modules may now be expressed maladaptively due to the discrepancy between the Environment of Evolutionary Adaptedness (EEA) and the environment of modern industrial society. Several evolutionary ecological factors influence childbirth intention in modern society, including individual personality factors, childhood life his-tory experiences, and socioecological factors throughout reproductive life. By focusing on mental, social, and ecological factors, this review examines several hypothetical models relating to evolutionary psychological factors and childbirth decisions in modern industrial society, as well as a possible explanation for the low birth rate.

Purpose: Suprascapular neuropathy can be caused by a solid mass, transverse scapular ligament hypertrophy, paralabral cyst, or dilatation of a suprascapular vein. Studies have measured the size of the cyst and veins using magnetic resonance imaging (MRI) to aid diagnosis of suprascapular neuropathy. However, it is often difficult to determine the size of a cyst and vein. we measured cyst and vein size as potential diagnostic markers for suprascapular neuropathy. Methods: This study retrospectively enrolled 118 patients diagnosed with a paralabral cyst in a clinic from January 2016 to December 2019. After excluding other neuropathies and cysts not related to the course of the suprascapular nerve, a total of 67 patients were analyzed. The cyst diameter, cyst volume, and vein diameter were measured engorgement by MRI in axial, coronal, and sagittal T2-weighted images. Cutoff values were established based on Youden’s index. Results: There was no significant difference between the neuropathy and control groups in cyst coronal diameter, but the neuropathy group had greater sagittal (p=0.001), axial (p=0.001), and maximum cyst diameters (p=0.005), cyst volume (p=0.003), and coronal (p=0.002), axial (p=0.001), and maximum vein diameters (p=0.001). Conclusion In suprascapular neuropathy symptomatic patients, electromyographyerve conduction velocity tests are eventually needed when in doubt. However, measuring cyst diameter, volume, and suprascapular vein diameter as a screening test could be considered.

STUDY DESIGN: Data of 22 patients with congenital scoliosis who underwent single stage posterior hemivertebrectomies and short segment fixation with a minimum follow-up of 2 years in our centre were studied retrospectively. PURPOSE: To report the efficacy of posterior hemivertebrectomy in single vs multiple level hemivertebra and compare their results. OVERVIEW OF LITERATURE: Single stage hemivertebrectomy is a standard procedure for single level hemivertebra. Results of multiple level hemivertebrectomies have not been reported. METHODS: Twenty-two patients (9 male and 13 female) with the mean age of 11.2 years (range, 2 years 4 months to 24 years 10 months) and a mean follow up of 32 months (range, 4 to 73 months) were studied retrospectively and their results were compared. RESULTS: Average number of hemivertebrae removed was 1.46 (range, 1 to 3). Mean preoperative and postoperative coronal cob angle was 48.7° (range, 22° to 80°) and 24.2° (range, 7° to 41°), respectively (p<0.001). Mean preoperative and postoperative sagittal cobb angle was 32.1° (range, 7° to 76°) and 13.6° (range, 0° to 23°), respectively (p<0.005). Mean coronal and sagittal cob correction percentage achieved was 50.2% and 51.8% respectively. Mean follow-up was 49 months (range, 30 to 84 months). Mean loss of coronal and sagittal correction at final follow-up was 4% (0% to 13.6%) degrees and 3.5% (0% to 20%), respectively. CONCLUSIONS: Posterior hemivertebrectomy in congenital scoliosis is a safe treatment option for up to 3-level hemivertebrae. Excision of thoracolumbar hemivertebrae results in better correction than thoracic and lumbar hemivertebrae.
Congenital Abnormalities ; Follow-Up Studies* ; Humans ; Kyphosis ; Male ; Retrospective Studies ; Scoliosis ; Spinal Curvatures ; Spine

STUDY DESIGN: Data of 22 patients with congenital scoliosis who underwent single stage posterior hemivertebrectomies and short segment fixation with a minimum follow-up of 2 years in our centre were studied retrospectively. PURPOSE: To report the efficacy of posterior hemivertebrectomy in single vs multiple level hemivertebra and compare their results. OVERVIEW OF LITERATURE: Single stage hemivertebrectomy is a standard procedure for single level hemivertebra. Results of multiple level hemivertebrectomies have not been reported. METHODS: Twenty-two patients (9 male and 13 female) with the mean age of 11.2 years (range, 2 years 4 months to 24 years 10 months) and a mean follow up of 32 months (range, 4 to 73 months) were studied retrospectively and their results were compared. RESULTS: Average number of hemivertebrae removed was 1.46 (range, 1 to 3). Mean preoperative and postoperative coronal cob angle was 48.7° (range, 22° to 80°) and 24.2° (range, 7° to 41°), respectively (p<0.001). Mean preoperative and postoperative sagittal cobb angle was 32.1° (range, 7° to 76°) and 13.6° (range, 0° to 23°), respectively (p<0.005). Mean coronal and sagittal cob correction percentage achieved was 50.2% and 51.8% respectively. Mean follow-up was 49 months (range, 30 to 84 months). Mean loss of coronal and sagittal correction at final follow-up was 4% (0% to 13.6%) degrees and 3.5% (0% to 20%), respectively. CONCLUSIONS: Posterior hemivertebrectomy in congenital scoliosis is a safe treatment option for up to 3-level hemivertebrae. Excision of thoracolumbar hemivertebrae results in better correction than thoracic and lumbar hemivertebrae.
Congenital Abnormalities ; Follow-Up Studies* ; Humans ; Kyphosis ; Male ; Retrospective Studies ; Scoliosis ; Spinal Curvatures ; Spine

Several cases of photodynamic therapy (PDT) for the curative treatment of early gastric cancer have recently been reported. However, PDT has been performed in only limited cases because it is impossible to determine the pathologic subtype or stage of the malignant lesion after the procedure. Nevertheless, PDT combined with endoscopic submucosal dissection (ESD) is expected to enhance the accuracy of the pathologic assessment and enable more effective, safe treatment for early gastric cancer. Furthermore, PDT may exert a complementary and synergetic effect on ESD for the atypical forms of early gastric cancer. From this background, we report here on a case of early gastric cancer that mimicked submucosal tumor, and this was removed by ESD, and then this was followed by adjuvant PDT. The patient had a high risk for operation due to his old age and comorbidity. After the procedure, he achieved complete remission and he is currently under follow up: he is without recurrence of tumor one year after ESD.
Comorbidity ; Humans ; Photochemotherapy ; Recurrence ; Stomach Neoplasms ; Triazenes

Gene therapy holds a great promise and has been extensively investigated to improve bone formation and regeneration therapies in bone tissue engineering. A variety of osteogenic genes can be delivered by combining different vectors (viral or non-viral), scaffolds and delivery methodologies. Ex vivo & in vivo gene enhanced tissue engineering approaches have led to successful osteogenic differentiation and bone formation. In this article, we review recent advances of gene therapy-based bone tissue engineering discussing strengths and weaknesses of various strategies as well as general overview of gene therapy.
Bone and Bones* ; Bone Morphogenetic Proteins ; Genetic Therapy* ; Osteogenesis ; Regeneration ; Tissue Engineering

BACKGROUND/AIMS: The use of self-expandable metallic stents (SEMS) is an established palliative treatment for malignant stenosis in the gastrointestinal tract; therefore, its application to benign stenosis is expected to be beneficial because of the more gradual and sustained dilatation in the stenotic portion. We aimed in this prospective observational study to evaluate the efficacy and safety of temporary SEMS placement in benign pyloric stenosis. METHODS: Twenty-two patients with benign stenosis of the prepylorus, pylorus, and duodenal bulb were enrolled and underwent SEMS placement. We assessed symptom improvement, defined as an increase of at least 1 degree in the gastric-outlet-obstruction scoring system after stent insertion. RESULTS: No major complications were observed during the procedures. After stent placement, early symptom improvement was achieved in 18 of 22 patients (81.8%). During the follow-up period (mean 10.2 months), the stents remained in place successfully for 6 to 8 weeks in seven patients (31.8%). Among the 15 patients (62.5%) with stent migration, seven (46.6%) showed continued symptomatic improvement without recurrence of obstructive symptoms. CONCLUSIONS: Despite the symptomatic improvement, temporary SEMS placement is premature as an effective therapeutic tool for benign pyloric stenosis unless a novel stent is developed to prevent migration.
Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Palliative Care ; Prospective Studies ; Pyloric Stenosis ; Pylorus ; Recurrence ; Stents