Our understanding of the hydrological processes in cocoa agroforests is extremely limited. Most work has focused on characterising throughfall and transpiration processes under various management approaches and climate change scenarios. However, little is currently understood about the soil hydrological processes which serve as a link to throughfall and transpiration. We monitored the soil properties, soil water repellency and hydraulic conductivity in a 5, 12 and >30 year old cocoa plantation in the wet and dry seasons. During the wet season repellent conditions were absent in all stands while the hydraulic conductivity showed no significant differences among them. This suggests that stand age has little effect on water movement during the wet period. During the dry season, the soil at the 5 and 12 year old stands became extremely repellent and was twice as severe as that of the >30 year old plantation. It was expected that the extreme repellency in the younger stands would reduce infiltration rates; however, higher rates were recorded in the 5 and 12 year old stands. This was likely due to the combination of a repellent soil matrix and the presence of large, deep soil cracks which enhanced preferential flow. As the repellency was not significantly correlated with soil properties, we hypothesised that the high grass/sedge cover and temperatures in the 5 and 12 year old stands enhanced it. While further research is needed to investigate the role that grass and sedges play in developing repellent conditions, managing their cover may prove beneficial for the growth and survival of young cocoa trees.

Title: Atopic sensitization in childhood depends on the type of green area around the home in infancy Tiia Voor1,2*, Meelis Pärtel3*, Aleksandr Peet1,2, Liisa Saare1,2, Heikki Hyöty4,5, Mikael Knip6,7, John Davison3, Martin Zobel3#, Vallo Tillmann1,2#1 Children´s Clinic of Tartu University Hospital, Estonia2 Institute of Clinical Medicine, University of Tartu, Estonia3 Institute of Ecology and Earth Sciences, University of Tartu, Estonia4 Faculty of Medicine and Health Technology, Tampere University, Finland5 Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland6 Pediatric Research Center, New Children’s Hospital, Helsinki University Hospital, Helsinki, Finland7 Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, FinlandTo the editor,The prevalence of allergy has increased worldwide (1) and a green environment is essential in developing immune responses and may protect against allergy (2, 3). However, previous studies have not distinguished the effects of different green area types.Here we tested how the type and spatial scale of green area around the infancy home are associated with atopic sensitization up to the age of 9 years.The study group comprised 280 children from the Estonian DIABIMMUNE project birth cohort (4) whose sera were measured for different allergen-specific IgE (sIgE) antibodies at the ages 0.5, 1.5, 3, and 9 years. Subjects were divided into 3 groups by sIgE results. 86 children who had at least one sIgE ≥0.7 kU/L were categorized into the group of definite atopic sensitization (Group I); 44 children had some sIgE between 0.35-0.69 kU/L and were classified as uncertain sensitization (Group II); 150 children had all measured sIgE below 0.35 KU/L, and they formed the control group (Group III). The types of surrounding green areas during the first six months of life were obtained from digital maps of Estonia. The land was divided into agricultural fields, forests, grasslands and wetlands (Figure 1A).The combination of various green area types at a radius of 1-10 km around homes in infancy was related to signs of atopy by ordinal regressions, and model weights were compared.This is the first study addressing the correlation between the land-use intensity around child homes and the development of atopic sensitization. A model with the green areas within 8 km had the highest protective weight (Fig. 1B). Among the various types of green areas, the impact of forests was the largest (Fig. 1C), but the best model also included grasslands and wetlands. Agricultural fields had an impact only at 1-2 km scales, and their weight declined strongly at larger scales (Table 1). We used the best model (area of forest, grasslands and wetlands within 8 km) and examined how it predicts atopic sensitization groups (Fig. 1D). The model predicted a decrease in Group I and an increase in control Group III. The uncertain Group II showed a slightly decreasing tendency. The protective effect of forests, grasslands and wetlands against sensitization was evident for both inhaled and food allergens.The world is urbanizing, and the isolation of humans from biodiverse green areas leads to reduced contact with beneficial environmental microbes (5). Ruokalainen et al (2) showed that the greenness around homes was negatively associated with the risk of atopy in children. Contact with natural soil enriched microbiota enhanced immune regulation and may reduce the risk of development of immune-mediated diseases (6). Our results reveal considerable differences in how various green area types might prevent atopic sensitization. The area of biodiverse land (forests, grasslands, wetlands) showed a strong protective effect, while the agricultural land did not. The positive effect of forests, grasslands and wetlands became clearer with increasing spatial scale. The relatively large distance of influence indicates that the biodiversity of beneficial microbes might need a large area.Our study has some limitations. First, we could not study the microbiota of the participants and determine whether the spatial environmental model explained microbiota composition. Secondly, we studied only atopic sensitization and did not diagnose allergic disease. This was because the data were collected using questionnaires completed by parents and were of variable quality.In conclusion, the current results indicate that biodiverse land – such as forests, grasslands, and wetlands – around homes during infancy elicits a strong protective effect against the development of atopy later in childhood. At the same time, intensive croplands have only a very weak effect.

Background: Recognition of specific allergens triggering immune response is key for the appropriate prescription of allergen-specific immunotherapy (SIT). This study aimed at evaluating the impact of using the commercially available microarray ImmunoCAP TM ISAC 112 (Thermo Fisher Scientific) on the etiological diagnosis and SIT prescription compared to the conventional diagnostic methods in patients with allergic rhinitis/rhinoconjunctivitis and/or asthma. Methods: 300 patients with respiratory allergic disease, sensitized to three or more pollen aeroallergens from different species, as assessed by skin prick-test (SPT) and specific IgE assays (sIgE), were included in this multicentric, prospective observational study. SPT and a blood test were performed to all patients. Total serum IgE, sIgE (ImmunoCAP TM) for allergens found positive in the SPT and sIgE allergen components (ImmunoCAP TM ISAC 112) were measured. Results: According to SPT results, the most prevalent pollen sensitizers in our population were Olea europaea followed by grass, Platanus acerifolia and Parietaria judaica. The molecular diagnosis (MD) revealed Ole e 1 as the most prevalent pollen sensitizer, followed by Cup a 1, Phl p 1, Cyn d 1, Par j 2, Pla a 1, 2, and 3 and Phl p 5. Immunotherapy prescription changed, due to MD testing, in 51% of the cases, with an increase of prescription of SIT from 39% to 65%. Conclusion: The identification of the allergen eliciting the respiratory disease is essential for a correct immunotherapy prescription. The advances in allergen characterization using methods such as the commercial microarray ImmunoCAP TM ISAC 112 can help clinicians to improve SIT prescription.

The two cases we present are the first to demonstrate novel manifestations of COVID-19- related interaction between the liver and the immune system in pediatric patients. Written informed consent was obtained from the parent/guardian to publish this report in accordance with the journal’s patient consent policy.

In this paper, general one-dimensional difference equations (DE) are studied. In fact, the asymptotic behaviour of such DE's will be studied via an algebraic closed-form condition plus a linear DE. Some examples are presented including the Collatz sequence, proving the existence of at most one invariant set surrounding the number 1: {1, 2, 4}. Some conclusions will be also depicted.

Objective To explore whether a previous late miscarriage(LM) has a prognostic impact on the subsequent pregnancy outcomes in in-vitro fertilization(IVF) women. Design Retrospective cohort study. Setting Reproductive medicine centre at a tertiary hospital Population 1072 infertile women who had a LM following first embryo transfer. Methods Women were grouped by the causes of LM, 458 women with unexplained factor(unLM), 146 women with fetal factor(feLM), 412 women with cervical factor(ceLM), 56 women with trauma factor(trLM). Subgroup analysis and binary logistic regression were performed to evaluate the associations between LMs with different causes and subsequent pregnancy outcomes. Main outcome measures The frequency of live birth and miscarriage following the subsequent embryo transfer after LM. Results Compared with general IVF population, the early miscarriage rate was significantly higher in unLM group(8.28% vs. 13.47%,P=0.003, rate ratio(RR)=1.725,95% confidence interval(CI)1.204-2.470). Further, women with a unLM or ceLM had a dramatically elevated risk of recurrent LM(for unLM:4.24% vs. 9.43%,P=0.000,RR=2.348,95%CI 1.527-3.610; for ceLM: 4.24% vs. 15.53%,P=0.000,RR=4.147,95%CI 2.836-6.064) and a consequently reduced frequency of live birth(for unLM: 49.96% vs. 43.01%,P=0.005, RR=0.756,95%CI 0.622-0.918; for ceLM: 49.96% vs. 38.59%,P=0.000,RR=0.629,95%CI 0.512-0.774). Conclusions Only one previous LM resulted from unexplained factor or cervical factor was significantly associated with a higher risk of miscarriage and a lower live birth rate after the subsequent embryo transfer. Keywords Late Miscarriage/Live Birth/Early Miscarriage/Cervical Incompetence/In Vitro Fertilization Tweetable abstract Women who had a LM for unexplained factor or cervical factor following the first embryo transfer had a significantly poor pregnancy prognosis after the subsequent transfer.

A modular multilevel converter (MMC) based four-port power electronic transformer (PET) based on is proposed in this paper. Medium-voltage AC(MVAC) and medium-voltage DC(MVDC) ports provided by MMC, adopts the MMC SMs of upper and lower arms with symmetric structure to build the low-voltage port, in each phase, the first submodule of the upper bridge arm and the last submodule of the lower bridge arm are used to build low-voltage DC(LVDC) port, and the last submodule of the upper bridge arm and the first sub-module of the lower bridge arm are used to build low-voltage AC(LVAC) port. They are cascaded with DAB for step-down and power isolation. The working principle and control strategy of the four-port are introduced respectively, a voltage fluctuation compensation control strategy for low-voltage terminal module is proposed to reduce capacitor voltage fluctuation effectively. It has the advantage of using fewer switching devices and transformers (56.8% lower cost compared with the existing traditional PET). The feasibility of the proposed PET and the effectiveness of the overall control strategy are verified by simulation.

Objective: To evaluate the efficacy of an exercise intervention, in addition to usual care, to prevent or delay insulin prescription in women with gestational diabetes mellitus (GDM). Design: Randomised controlled trial Setting: University hospital Population: Women at 25-35 weeks pregnancy upon diagnosis of GDM. Methods: In the intervention arm, women had weekly, supervised, 30-45 min long exercise sessions and were encouraged to accumulate more than 5000 steps per day, monitored by a pedometer, in addition to usual care. Women in the control group had usual care only. Main outcome measure: Insulin prescription. Results: From February 2008 through April 2013, 109 women were randomized into intervention (n=57) or usual care (n=52). Two women, both in the intervention group, were excluded from the analysis (one randomised in error and one lost to follow-up). Six women never attended the exercise sessions and two women participated to less than two sessions, while two-third of women were considered as compliant to the intervention. Incidence of insulin prescription was not significantly different between groups: 31 (56%) in the intervention and 24 (46%) in the control group (RR 1.22, 95% CI 0.84 to 1.78); the median time between randomization and insulin prescription was not different between groups (14 and 13 days, respectively). Conclusion: We were unable to show that an exercise program reduces or delays insulin prescription. Low compliance with the intervention, small sample size and the short duration of the program may explain the apparent lack of benefit.

Objective: To determine whether health care providers (HCPs) would find an interactive digital 3D application (webapp) showing pelvic and genital anatomy to be helpful in patient consultations about female genital mutilation or cutting (FGM/C). Design: Qualitative study using semi-structured interviews. Setting: Recorded audio/video calls with HCPs in migration-destination countries of USA, UK, Sweden, France, Belgium, and Switzerland. Sample: Seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Methods: Audio- and video-recorded usability testing with semi-structured interview protocol, transcribed manually and analysed thematically. Main outcome measures: Contextualised data regarding HCP’s willingness to use a 3D webapp visualising anatomy in FGM/C in consultations with patients. Results: All but one of the seven HCPs interviewed expressed keen interest in using this webapp and its 3D visuals of anatomy after FGM/C in consultations with patients. In their feedback, participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to reinforce. Participating HCPs also highlighted the need for visuals that patients can relate to, as well as features that would adapt to and improve the continuum of care for women and girls with FGM/C. Conclusions: Digital applications with interactive 3D models of pelvic and genital anatomy that are accessible, accurate, and adaptable are likely to aid HCPs in communicating clinical information about FGM/C to patients in consultations. Funding: N/A Keywords: FGM/C, FGM, FGC, 3D, pelvis, interactive, patients, consultations, application, webapp, genital, vulva, anatomy, female genital cutting

A document by Ann Moore. Click on the document to view its contents.

Rare cystic variant of adenomatoid tumor of the uterus: a case reportPrasanna D. Tati D.O.1, Muhammad O. Afridi D.O.1, Victoria Petty M.D.2, Monika Mansmann PA-C2, Joyce Varughese M.D.3

Neuroschistosomiasis is a rare entity, it can cause cerebral or spinal cord involvement. high clinical suspicion is needed to diagnose it and rapid treatment is needed to prevent complications.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic neoplasm derived from plasmacytoid dendritic cell precursors. The malignancy was characterized by cutaneous and bone marrow involvement and leukemic spread，predominantly involving elderly patients. Pediatric cases of BPDCN are much fewer reported in the literature, making the management of pediatric BPDCN challenging. We report a congenital BPDCN patient who manifested with neutropenia and nodular skin lesions. Whole-exome sequencing suggests the presence of kmt2c gene duplication. She died four months after diagnosis. This case report reminds clinicians, especially neonatologists, to consider the possibility of BPCDN when finding neonates present with rash(such as purplish nodules, bruiselike macules) and a cytopenia. In addition, this study suggests that the KMTC2 gene may play a vital role in the pathogenesis of BPDCN.

Introduction: Case definitions are used to guide clinical practice, surveillance, and research protocols. However, how they identify COVID-19-hospitalised patients is not fully understood. We analysed the proportion of hospitalised patients with laboratory-confirmed COVID-19, in the ISARIC prospective cohort study database, meeting widely used case definitions. Methods: Patients were assessed using the CDC, ECDC, WHO, and UKHSA case definitions by age, region, and time. Case fatality ratios (CFR) and symptoms of those who did and who did not meet the case definitions were evaluated. Patients with incomplete data and non-laboratory-confirmed test-result were excluded. Results: 263,218 of the patients (42%) in the ISARIC database were included. Most patients (90.4%) were from Europe and Central Asia. The proportions of patients meeting the case definitions were 56.8% (WHO), 74.4% (UKHSA), 81.6% (ECDC), and 82.3% (CDC). For each case definition, patients at the extremes of age distribution met the criteria less frequently than those aged 30 to 70 years; geographical and time variations were also observed. Estimated CFRs were similar for the patients that met the case definitions. However, when more patients did not meet the case definition, the CFR increased. Conclusions: The performance of case definitions might be different in different regions and may change over time. Similarly concerning is the fact that older patients often did not meet case definitions. While epidemiologists must balance their analytics with field applicability, ongoing revision of case definitions is necessary to improve patient care through early diagnosis and limit potential nosocomial spread.

Major depressive disorder (MDD) is one of the most prevalent mental diseases. The first monoamine-based antidepressants were designed for treating MDD. Ketamine and its analogues were recently launched as fast-acting antidepressants. Unfortunately, the present therapeutic alternatives are insufficient; their lack of effectiveness, hazards and unwanted effects and patients with few therapy options. Efforts are currently being directed at understanding the genesis of depression and discovering new pharmaceutical therapy. In this review, we examine possible new pharmaceutical targets for the treatment of major depressive illness. Antidepressant effects may be obtained by targeting receptors such as peroxisome proliferator-activated receptors, G-protein-coupled receptors, opioid receptors and galanin receptors. This study highlights the anti-inflammatory activity of SNRIs & SSRIs anti-depression therapy, as well as the specific issues for each medication. In addition, we present outline of the depression theory and underlying processes. Furthermore, natural goods such as herbs, plants and fatty acids alleviated depression behaviours and symptoms. This review will present a brief history of medically accessible antidepressants, with a special focus on innovative pharmacological methods that have shown potential antidepressant activity in clinical and preclinical research. As a conclude SSRIs and SNRIs have an Anti-inflammatory role which might contribute the Anti-depressant activity.

Introduction: Management of gestational supraventricular tachycardia (SVT) is challenging and requires a multidisciplinary approach for optimal management. Antiarrhythmic pharmacologic therapy has variable efficacy and carries potential risks to both mother and fetus. Catheter ablation during pregnancy has traditionally been considered a last option due to procedural safety and ionizing radiation risks. Recent advances including intracardiac echocardiography and multi-electrode electroanatomic mapping have greatly enhanced the safety and efficacy profile to successfully perform ablations with minimal to no fluoroscopy even during pregnancy; however, most of the literature publications are case reports. Though the use of fluoroscopy-guided catheter ablations for refractory cardiac arrhythmias in pregnancy have been extensively studied, there are still a paucity of data about the efficacy, safety, and aggregate outcomes of purely zero-fluoroscopic ablations in comparison to minimal fluoroscopic approaches. Methods: A literature search was performed for catheter ablations in the past fifteen years for gestational arrhythmias that used minimal or no fluoroscopy. Sixteen cases describing catheter ablations with zero-fluoroscopy were compared to twenty-four cases using minimal fluoroscopy, defined as total documented exposure time of less than 10 minutes. Baseline characteristics, techniques, and outcomes of both groups were compared. Results: Analysis of both groups demonstrated that zero-fluoroscopic approaches for treatment of gestational SVT, though underutilized, have comparable successful outcomes without additional risk compared to minimally fluoroscopic procedures. Utilization of electroanatomic mapping with or without concomitant intracardiac echocardiography in the zero-fluoroscopy group further demonstrated equal efficacy rates of successful ablation when compared to the control group. Furthermore, there were no reported immediate or long term periprocedural complications in either group, including delivery outcomes. Conclusions: Zero-fluoroscopy catheter ablation for SVT in pregnancy appears to be as effective and safe when compared to minimal fluoroscopy ablations while eliminating the theoretical risks of ionizing radiation.

This editorial discusses the report titled “Cardiac Resynchronization Therapy Response in Cardiac Sarcoidosis” by Shabtaie et al.

Climate change is often associated with increasing vapor pressure deficit (VPD) and decreasing soil moisture (SM). While atmospheric and soil drying often co-occurs, their differential effects on plant functioning and productivity remain uncertain. We aimed to elaborate on the divergent effects and underlying mechanisms of soil and atmospheric drought, based on continuous, in situ measurements of branch gas exchange, with automated chambers, in a mature semiarid Aleppo pine forest. We investigated the response of control trees exposed to combined soil-atmosphere drought (low SM, high VPD) during the rainless Mediterranean summer, and that of trees experimentally unconstrained by soil dryness (high SM; using supplementary dry season water supply) but subjected to atmospheric drought (high VPD). During the seasonal dry period, branch conductance (g br), the rates of transpiration (E) and net photosynthesis (A net) decreased in low-SM trees but greatly increased in high-SM trees. The response of E and g br to the massive rise in VPD (to a maximum of 7 kPa) was negative in low-SM trees and positive in high-SM trees. These observations were consistent with predictions based on a simple plant hydraulic model showing that plant water potential is a good predictor of the g br and E response to VPD. These results demonstrate that the release from drought on the supply-side, in combination with plant hydraulic regulation, eliminates the effect of atmospheric demand (VPD) as a stressor and on canopy gas exchange in mature, drought-adapted pine trees.

Smooth-coated otters (Lutrogale perspicillata) and Malayan water monitor lizards (Varanus salvator) occupy similar habitats and and interact regularly in Singapore’s waterways. These interactions have a range of potential outcomes and are sometimes lethal. Few formal behavioral studies exist for either species. We analyzed interactions between otters and monitor lizards by gleaning data from publicly available videos from citizen scientists to examine what factors influence aggressive and defensive behaviors, and what influences vigilance in otters. Behavioral sequence analysis revealed no obvious monitor lizard behavior that predicted otter aggression towards monitors. We found that the presence and number of otter pups is positively associated with otter aggression. Otters also tended to be more vigilant in groups with more pups, and more vigilant on land than water. Monitor lizards displayed aggressive and defensive behaviors more frequently than did otters, regardless of whether the otters were aggressive towards lizards. These observations suggests that otters vary their aggression and vigilance levels depending on the context of each interaction.

This paper settles event-triggered synchronization and H∞ synchronization matters for two types of coupled delayed reaction-diffusion memristive neural networks (CDRDMNNs). First of all, several synchronization and H∞ synchronization conditions are acquired for CDRDMNNs with state coupling in virtue of exploiting Lyapunov stability theory in combination with proper controllers of the triggering event. Then, for CDRDMNNs with spatial diffusion coupling, event-triggered synchronization and H∞ synchronization are investigated as well. Finally, the correctness of the deduced synchronization and H∞synchronization results is verified by two given numerical examples.

In Freeman-Burian syndrome (formerly, Freeman-Sheldon syndrome), correcting visual obstruction and strabismus, when present, is the operative priority and is not outweighed by anesthesia challenges; operative delay risks vision loss and developmental delay.

Background. Oral immunotherapy (OIT) is an emerging method for treating food allergy in children. However, data regarding adults undergoing this process is lacking. Methods. We retrospectively analyzed the medical records of patients with food allergy aged ≥17 years who completed OIT treatment between April 2010 to December 2020 at Shamir medical Center. Data was compared to that of children aged 4 to <11 years and adolescents aged ≥11 to 17 treated during the same time period. Results. A total of 96 adults at a median age of 22.3 years who underwent OIT for milk (n=53), peanut (n=18), sesame (n=7), egg (n=5) and tree nuts (n=13) were analyzed and compared to 1299 children and 309 adolescents. Adults experienced more adverse reactions requiring injectable epinephrine, both during in-clinic up-dosing (49% vs. 15.9% and 26.5% for children and adolescents respectively, p<0.0001) and during home treatment (22.9% vs. 10.5%, p=0.001 for children, and 14.2%, p=0.06 for adolescents). Most adults (61.5%) were fully desensitized, but rates of full desensitization were significantly lower compared to children (73.4%, p=0.013). Significantly more adults (28.3%) undergoing milk OIT failed treatment compared to children (14.3%, p=0.015) and adolescents (14.1%, p=0.022), while failure rates in adults undergoing OIT for other foods were low (9.3%) and comparable to children and adolescents. Conclusions. OIT is successful in desensitizing most adults with IgE-mediated food allergy. Adults undergoing milk OIT are at increased risk for severe reactions and for OIT failure while failure rates in adults undergoing OIT for other foods are low.

Objective: To explore the audiological characteristics of infant auditory neuropathy (AN) patients with cochlear microphonic (CM) recorded but no otoacoustic emission (OAE) response and clinically reduce the rate of missed diagnosis of AN. Design: Retrospective clinical study of medical data from 2003 to 2020. Setting: Otolaryngology head and neck surgery clinical hearing center. Participants: Eighteen infant AN patients with CM present and distortion product otoacoustic emission (DPOAE) absent in both ears were OAE absent group. Forty-four infant AN patients with CM and DPOAE present in both ears were OAE present group. Main outcome measures: Audiological characteristics. Results: 1. The age of onset in OAE absent group was 0.9 (0.02) years old, which was less than 1.11 (1.63) years old in OAE present group (P=0.041). 2. The CM threshold of OAE absent group was 80 (10) dB nHL, which was significantly higher (P<0.001) than OAE present group. CM amplitude were smaller (P<0.05), and CM duration were shorter (P<0.05) in OAE absent group. 3. The thresholds of auditory steady-state response (ASSR) at 0.5, 1, 2 and 4 kHz were 94 (10), 94 (10), 87 (20) and 81 (10) dB HL cg respectively in OAE absent group, which were higher than those in OAE present group (P<0.01). Conclusions: Infant AN patients with CM present and OAE absent showed earlier onset, worse hearing level and worse CM performance. The influencing factors and value of CM in AN patients still need to be explored in the future.

Background Uterine artery embolization (UAE) and myomectomy are uterus-sparing treatments for uterine fibroids. Each carries a different risk and efficacy profile. Despite this there is a lack of direct comparison between the two techniques making treatment choice decisions difficult. Objectives To compare the therapeutic efficacy and complications of UAE versus myomectomy. Search strategy A systematic search of The Cochrane Library, Medline, and EMBASE databases was conducted using a pre-defined search strategy. The review was prospectively registered on PROSPERO (CRD42021259347). Selection Criteria All randomised controlled trials and cohort studies published between January 1995 and August 2021 directly comparing UAE and myomectomy were included. Data Collection and Analysis Meta-synthesis of raw data was performed using Review Manager 5.4.1 from the Cochrane Collaboration. A pooled estimate of efficacy was established using a fixed-effect model. Main results 8 studies were identified. UAE was associated with lower complication rates (OR 0.56; 95% CI 0.40-0.79), increased improvement in bleeding (OR 1.61 95% CI 1.07-2.43) and a shorter total recovery time (7.72 days versus 36.63 days). Whilst myomectomy was associated with a higher post-procedure quality of life (mean difference -10.56; 95% CI -15.34 - -5.79) and lower re-intervention rate (OR 5.16; 95% CI 2.41-11.04). No significant difference in procedural failure rate was seen (OR 0.67; 95% CI 0.30-1.50). Given concerns with UAE and future fertility limited post-procedure fertility outcomes were identified. Conclusions: Given differences in efficacy profiles a personalised approach to treatment discussions should be maintained. Funding: None Keywords: Uterine artery embolization, myomectomy, uterine fibroid