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The Cochrane Database of Systematic... May 2018Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms.
OBJECTIVES
To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
SEARCH METHODS
We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017.
SELECTION CRITERIA
We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions.
DATA COLLECTION AND ANALYSIS
Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods.
MAIN RESULTS
We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture may result in little to no difference in adverse events (low QoE). Acupuncture may not reduce sexual dysfunction when compared with sham procedure (MD in the International Index of Erectile Function (IIEF) Scale -0.50, 95% CI -3.46 to 2.46, low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). We found no information regarding quality of life, depression or anxiety.2. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.3. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). This programme may not reduce anxiety or depression (low QoE). We found no information regarding adverse events, sexual dysfunction or quality of life.4. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.5. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). This treatment probably improves sexual dysfunction (MD in the IIEF Scale MD 3.34, 95% CI 2.68 to 4.00, one study, 60 participants, moderate QoE). We found no information regarding quality of life, depression or anxiety.6. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. We found no information regarding sexual dysfunction, quality of life, depression or anxiety.7. Other interventions: there is uncertainty about the effects of most of the other interventions included in this review. We found no information regarding psychological support or prostatic surgery.
AUTHORS' CONCLUSIONS
Based on the findings of moderate quality evidence, this review found that some non-pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Topics: Acupuncture Therapy; Adult; Chronic Disease; Chronic Pain; Circumcision, Male; Electromagnetic Radiation; Exercise; Extracorporeal Shockwave Therapy; Humans; Hyperthermia, Induced; Life Style; Male; Massage; Pelvic Pain; Prostatitis; Randomized Controlled Trials as Topic
PubMed: 29757454
DOI: 10.1002/14651858.CD012551.pub3 -
Acta Obstetricia Et Gynecologica... Aug 2013Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for... (Review)
Review
Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain. To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP. We searched until July 2012: the Cochrane Library, EMBASE (1980-2012), Medline (1950-2012), Web of knowledge (1900-2012), LILACS (1982-2012) and SIGLE (1990-2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society. Randomized and prospective quasi-randomized controlled studies vs. sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms. Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There were no reported data for sacral nerve stimulation. There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi-centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost-analysis of this treatment is recommended.
Topics: Chronic Pain; Cystitis, Interstitial; Electric Stimulation Therapy; Humans; Pain Measurement; Pelvic Pain; Quality of Life; Research Design
PubMed: 23710833
DOI: 10.1111/aogs.12184 -
Medicina (Kaunas, Lithuania) Aug 2022: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles... (Review)
Review
: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. : An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were "malunion" AND "pelvic" OR "pelvis". Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. : Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.
Topics: Fractures, Bone; Fractures, Malunited; Humans; Pelvic Bones
PubMed: 36013565
DOI: 10.3390/medicina58081098 -
Women's Health (London, England) 2023Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dysmenorrhea (painful menstrual cramps) is one of the most common gynecological complaints in women and girls. Dysmenorrhea may be a condition itself or a result of another medical condition, including endometriosis and chronic pelvic pain. Research examining the relationship between menstrual pain ratings and catastrophizing has produced mixed results.
OBJECTIVE
To review and meta-analyze the relationship between catastrophizing and pain ratings of chronic cyclical pelvic pain.
DESIGN
Cross-sectional, longitudinal, and intervention studies that reported the relationship between menstrual/pelvic pain and catastrophizing were included. Study populations had to include healthy menstruating persons or persons with a condition associated with cyclical pelvic pain including primary dysmenorrhea, endometriosis, and/or chronic pelvic pain.
DATA SOURCES AND METHODS
A systematic search of articles published since 2012 on PubMed, PsychInfo, CINHAL, and Medline was conducted in January and rerun in November of 2022. Search terms included cyclical pelvic pain, dysmenorrhea, endometriosis, pelvic pain, and catastrophizing. Data extraction was completed independently by two extractors and cross-checked for errors. A random-effects meta-regression was used to synthesize the data using restricted maximum likelihood.
RESULTS
Twenty-five studies examining 4,540 participants were included. A random effects model found a meta-correlation between catastrophizing and pain of = .31 (95% confidence interval: .23-.40) < .001. Heterogeneity was large and significant ( = 84.5%, (24) = 155.16, < .001). Studies that measured general pelvic pain rather than cyclical pelvic pain specifically and those that used multi-item rather than single-item measures of pain had significantly higher correlations. Age and depression did not moderate the relationship between catastrophizing and pain.
CONCLUSION
A systematic review and meta-analysis found that catastrophizing had a small but significant positive association with pain ratings. Patients experiencing cyclical pelvic pain may benefit from interventions targeting the psychological management of pain.
REGISTRATION
This meta-analysis was registered in PROSPERO on 14 January 2022. Registration number: CRD42022295328.
Topics: Female; Humans; Dysmenorrhea; Endometriosis; Cross-Sectional Studies; Pelvic Pain; Chronic Pain; Catastrophization
PubMed: 37752879
DOI: 10.1177/17455057231199949 -
European Urology Open Science Oct 2023Radiotherapy of the pelvis is a widely used method for the treatment of malignancies, and local complications including pain following pelvic radiation therapy are... (Review)
Review
The Benefits and Harms of Pharmacological Treatment for Postradiation Pelvic Pain: A Systematic Review by the European Association of Urology Chronic Pelvic Pain Panel with Recommendations for Clinical Practice.
CONTEXT
Radiotherapy of the pelvis is a widely used method for the treatment of malignancies, and local complications including pain following pelvic radiation therapy are acknowledged complications.
OBJECTIVE
The primary objective is to assess the clinical effectiveness and safety of pharmacological therapies on postradiation pelvic pain.
EVIDENCE ACQUISITION
A systematic review of the use of different pharmacological treatments in the management of post-radiation pelvic pain was conducted (PROSPERO-ID: CRD42021249026). Comprehensive searches of EMBASE, Medline, and Cochrane library were performed for publications between January 1980 and April 2021. The primary outcomes were improvement in pain and adverse events following treatment. The secondary outcomes included quality of life, bowel function, and urinary function.
EVIDENCE SYNTHESIS
After screening 1514 abstracts, four randomised controlled trials were identified, enrolling 355 patients with bladder and anorectal subtypes of postradiotherapy chronic pelvic pain (CPP). A narrative synthesis was performed as heterogeneity of included studies precluded a meta-analysis. A single study reported a significant reduction in pain after 6 mo in patients with bladder pain syndrome treated with hyaluronic acid or hyperbaric oxygen. Anorectal pain was reported to be reduced by the application of 4% formalin, but the use of hyperbaric oxygen in postradiotherapy anorectal pain remains controversial. Adverse event reporting was generally poor. Studies looking at medications used routinely in guidelines for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, and duloxetine, were absent or of poor quality when it came to postradiation pelvic pain.
CONCLUSIONS
Beneficial effects of hyperbaric oxygen or formalin on pain, quality of life, and functional symptoms were seen in patients with certain CPP subtypes, but the current evidence level is too weak to allow recommendations about the use of any pharmacological treatment for postradiation pelvic pain.
PATIENT SUMMARY
Different pharmacological treatments are used to treat pain after radiotherapy, but current studies are of insufficient quality to determine whether these should be recommended and many chronic pelvic pain subtypes are not covered. Further research is needed.
PubMed: 37711669
DOI: 10.1016/j.euros.2023.08.009 -
Journal of Physiotherapy Mar 2014In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality... (Meta-Analysis)
Meta-Analysis Review
QUESTION
In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life?
DESIGN
Systematic review of randomised trials with meta-analysis.
PARTICIPANTS
Women with primary dysmenorrhea.
INTERVENTION
Any form of physiotherapy treatment.
OUTCOME MEASURES
The primary outcome was menstrual pain intensity and the secondary outcome was quality of life.
RESULTS
The search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0-10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0-10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life.
CONCLUSION
Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects.
Topics: Acupressure; Acupuncture; Adolescent; Adult; Dysmenorrhea; Electric Stimulation Therapy; Female; Hot Temperature; Humans; Outcome Assessment, Health Care; Physical Therapy Modalities; Quality of Life; Treatment Outcome; Yoga; Young Adult
PubMed: 24856936
DOI: 10.1016/j.jphys.2013.12.003 -
International Urogynecology Journal May 2021Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population.
METHODS
This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the "Critical Review Form for quantitative studies" (McMaster University).
RESULTS
From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain.
CONCLUSIONS
Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.
Topics: Adult; Female; Humans; Male; Pelvic Girdle Pain; Urinary Incontinence; Urinary Incontinence, Stress; Urinary Incontinence, Urge
PubMed: 33620534
DOI: 10.1007/s00192-020-04670-1 -
Acta Obstetricia Et Gynecologica... Sep 2021Endometriosis is challenging to treat. It is a painful and chronic inflammatory disorder that impacts up to 10% of women of reproductive age. Despite available surgical...
INTRODUCTION
Endometriosis is challenging to treat. It is a painful and chronic inflammatory disorder that impacts up to 10% of women of reproductive age. Despite available surgical and medical treatment options, recurrence of symptoms is common. Available studies suggest that exercise may have a therapeutic effect on chronic inflammation and thereby on pain perception. This review evaluates whether exercise can decrease pain perception in women with symptomatic endometriosis.
MATERIAL AND METHODS
This systematic review was conducted according to PRISMA by searching databases Medline and Embase to locate randomized controlled trials and observational studies. Risk of bias was investigated using the Cochrane Collaboration Tool for the Evaluation of Randomized Controlled Trials and the ROBINS-I quality assessment scale. Inclusion criteria were women of reproductive age, laparoscopically confirmed diagnosis of endometriosis, and intervention of any type of exercise. All manuscripts were evaluated by two of the authors and when in doubt a third author was consulted. This review was registered in PROSPERO on November 14, 2020 (CRD42020212309).
RESULTS
Six articles fulfilled the inclusion criteria and were included in this systematic review. Concerning exercise, two studies showed significant decrease in pain relief but the remaining studies showed either negative or no impact on pain relief. A meta-analysis could not be conducted because of the considerable heterogeneity among the included studies.
CONCLUSIONS
The present review does not indicate any beneficial effect of exercise on pain in women with endometriosis. There is a need for randomized controlled trials with correct power calculation, well-defined study groups and training programs to be able to answer the question of whether exercise can improve the pain experience in patients with endometriosis.
Topics: Endometriosis; Exercise Therapy; Female; Humans; Pain Perception; Pelvic Pain
PubMed: 33999412
DOI: 10.1111/aogs.14169 -
AJOG Global Reports Feb 2022While widely used for the treatment of chronic pelvic pain, limited data exists on efficacy of gabapentin, especially in the subgroup of women suffering from chronic...
BACKGROUND
While widely used for the treatment of chronic pelvic pain, limited data exists on efficacy of gabapentin, especially in the subgroup of women suffering from chronic pelvic pain without a known diagnosis, such as endometriosis.
OBJECTIVE
This study aimed to assess the efficacy of gabapentin when administered to women with chronic pelvic pain without another diagnosis.
STUDY DESIGN
We performed a Systematic Review and Meta Analysis including all controlled clinical trials addressing the use of gabapentin for the treatment of chronic pelvic pain without another diagnosis. We searched PubMed, Scopus, Web of Science, ClinicalTrials.Gov, MEDLINE, and The Cochrane Library from inception of each database to April 30, 2021. We included all the studies that fulfilled the following criteria: (1) population: women suffering from chronic pelvic pain without another identified diagnosis (such as endometriosis); (2) intervention: gabapentin (regardless of the dosage); (3) comparator:placebo; (4) outcomes: pain score (visual analog scale) after 3 months and pain score (visual analog scale) after 6 months as primary outcomes; and (5) study design: we only included randomized or controlled clinical trials. Our exclusion criteria included (1) uncontrolled clinical trials, (2) studies that did not report data or measures for any of our selected outcomes, (3) studies that included patients with surgically or clinically diagnosed endometriosis, or (4) studies with no full-text manuscript available. Risk of bias assessment was performed using the Cochrane risk of bias tool. We analyzed dichotomous outcomes as percentages and totals, whereas continuous outcomes were analyzed using mean difference, standard deviations, and relative 95% confidence intervals using the inverse variance method.
RESULTS
We included 4 placebo-controlled randomized controlled trials. Analysis was hindered because half of the studies (n=2) used the visual analog scale pain score and the other half (n=2) used the numerical rating scale. The analysis showed that when compared with the placebo, gabapentin significantly lowered the visual analog scale pain score at 3 months (mean difference, 0.79; 1.23 to 0.35; =.005) and 6 months (mean difference, 1.68; 2.30 to 1.05; =.001) and the numerical rating scale pain score at 3 months (mean difference, 0.20; 0.25 to 0.15; =.001). However, in terms of the numerical rating scale pain score after 6 months, the 2 groups showed no significant difference (mean difference, 0.27; 0.80 to 0.26; =.32).
CONCLUSION
Gabapentin may hold benefit for the management of chronic pelvic pain, with significant improvement in pain seen in both scales at 3 months when compared with the placebo, but only in the visual analog scale group at 6 months of usage. Secondary to the differences in the nature of the 2 scales, a further weighted combined analysis was not possible.
PubMed: 36274967
DOI: 10.1016/j.xagr.2021.100042 -
Prostate Cancer and Prostatic Diseases Sep 2023We performed this systematic review and meta-analysis to investigate the efficacy and safety of Li-ESWT combined with or without medications for patients with Chronic... (Meta-Analysis)
Meta-Analysis Review
The efficacy and safety of low-intensity extracorporeal shock wave treatment combined with or without medications in Chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis.
BACKGROUND
We performed this systematic review and meta-analysis to investigate the efficacy and safety of Li-ESWT combined with or without medications for patients with Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS).
METHODS
A comprehensive search was conducted of PUBMED, Cochrane Library, and Web of Science databases from inception to February 2022 for randomized controlled trials (RCTs) assessing the efficacy and safety of Li-ESWT with or without the combination of medications compared with the control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Visual Analogue Scale/Score (VAS), International Index of Erectile Function (IIEF), and International prostate symptom score (IPSS) were used to assess the improvements of symptoms in CP/CPPS patients.
RESULTS
651 patients from 12 randomized controlled studies were included in this study. The total NIH-CPSI scores, pain domain scores, and quality of life (QOL) scores were significantly lower in the Li-ESWT group than those in the control group at the termination of treatment, and 1, 4, 12, and 24 weeks after treatment. And these scores were significantly reduced in the Li-ESWT group than in baselines. In the subgroup analysis, reductions of these scores lasted longer and were greater in Li-ESWT combined with medications than in Li-ESWT alone. In the Li-ESWT group, the VAS score; IIEF score; and IPSS score were significant improvements than those in control group at the termination of treatment, and 1, 4, and 12 weeks after treatment; 4, 12, and 24 weeks after treatment; and 1, 4, and 12 weeks after treatment, respectively.
CONCLUSIONS
Li-ESWT is a safe, non-invasive, and effective option for patients with CP/CPPS, whether combined with medications or not, should be recommended for widespread use in clinical practice.
Topics: Male; Humans; Prostatitis; Prostatic Neoplasms; Chronic Disease; Pelvic Pain; Databases, Factual; Chronic Pain
PubMed: 35798855
DOI: 10.1038/s41391-022-00571-0