Gradual Improvement Research Articles

The Research on the Influence of Swarovski Brand Image on Chinese College Students Purchase Intention

With the gradual improvement of China's overall economic level, the per capita disposable income of Chinese families has also increased. This article hopes to take the luxury brand Swarovski as an entry point, and study its influence on Chinese college students' purchase intentions from the perspective of its brand image. And this paper results of the elements of "luxury brand", in order to summarize the influence of the elements of luxury brand on consumers, and provide theoretical guidance for the future research direction of luxury goods. This article is based on the use of a questionnaire survey, the authors found that 68% students positioned Swarovski as a luxury brand, and nearly half of students believe that Swarovski`s strength lies in the variety of styles. This article believes that Swarovski's brand image has a positive correlation with the consumption behavior of university students, that is, the higher the brand image, the more consumption behavior of university students. However, due to the limited economic strength of university students, the premise of the above conclusion is that Swarovski still maintains relatively low prices for the public. At the same time, as a brand, Swarovski should have a reasonable and effective product marketing strategy, but while establishing a brand image, it should also control the quality of its products and let consumers know whether the products they purchase are truly what they want.

A Comparative Study of Business Strategies Between 24-Hour Gyms and Traditional Gyms Based on the SWOT Model -- Take LeFit as an Example

With the development of sports in China, gyms of various operation models are gradually emerging. Today, traditional gyms still occupy a large share of the market in China, but 24-hour gyms are developing rapidly at a rate that cannot be ignored. This paper will analyze the current situation and problems of the 24-hour gym model in China today by observing and summarizing the competitive strategies and advantages of LeFit. It is found that LeFit has already fully satisfied the diversified needs of customers through its benefits and expands the brand value with its special communication channels. At the same time, this paper will also point out the problems and some drawbacks of LeFit at this stage and proposes practical construction for the gradual improvement of 24-hour gyms. Although there are still certain problems in its model that need to be optimized and adjusted, LeFit provides a new solution for the development of gyms in today's era.

Mastermind with a linear number of queries

AbstractSince the 1960s Mastermind has been studied for the combinatorial and information-theoretical interest the game has to offer. Many results have been discovered starting with Erdős and Rényi determining the optimal number of queries needed for two colours. For $k$ colours and $n$ positions, Chvátal found asymptotically optimal bounds when $k \le n^{1-\varepsilon }$ . Following a sequence of gradual improvements for $k\geq n$ colours, the central open question is to resolve the gap between $\Omega (n)$ and $\mathcal{O}(n\log \log n)$ for $k=n$ . In this paper, we resolve this gap by presenting the first algorithm for solving $k=n$ Mastermind with a linear number of queries. As a consequence, we are able to determine the query complexity of Mastermind for any parameters $k$ and $n$ .

Abstract 13651: Pembrolizumab Associated Myocarditis, Myasthenia Gravis, and Myositis

Case: A 71 year old man presented with acute generalized muscle weakness, double vision, sagging eye lids, weakness with swallowing, shortness of breath, and dark urine. History was notable for stage IV non-small cell lung cancer with second dose of pembrolizumab therapy completed 12 days earlier. Exam showed bilateral ptosis and muffled speech. He had increased work of breathing, tachypnea, 3/5 strength in the bilateral lower extremities, and 5/5 strength in the upper extremities. His initial NIF was -25. Labs were notable for troponin of 1532, CK 16229, ESR 100, CRP 8.8, ALT 225, and AST 648. EKG revealed a new right bundle branch block and left posterior fascicular block. TTE showed EF of 65% without regional wall motion abnormalities. Cardiac MRI showed mildly elevated T1 and T2 relaxation times, suggestive of diffuse myocardial edema and inflammation without delayed gadolinium enhancement. He was treated with high dose steroids, fluid resuscitation, IVIG, and briefly pyridostigmine. On hospital day 8, he was found to have complete AV block with junctional escape rhythm. He had urgent placement of a temporary pacemaker. He was started on abatacept, ruxolitinib, and oral prednisone. Over the next 14 days he made gradual improvement. Discussion: While ICI-associated myocarditis is rare, it is worth investigating due to the high mortality. The clinical presentation can range from asymptomatic troponin elevations to cardiogenic shock and ventricular arrhythmias/AV block. Diagnosis requires a high index of suspicion and multiple diagnostic modalities, including ECG, echocardiography, serum biomarkers, and often cardiac MRI and endomyocardial biopsy. There is a large overlap between myocarditis and myositis. The mainstay treatments of ICI-induced myocarditis include holding the offending immune-checkpoint inhibitor, high-dose corticosteroids, and guideline-directed medical therapy for associated heart failure or arrhythmias. Abatacept, a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) immunoglobulin fusion protein, and ruxolitinib, a JAK 1/2 inhibitor, have recently been suggested as a novel combination to reduce mortality from ICI-associated myocarditis with concomitant myositis.

Extrapyramidal Symptoms and Insulin Resistance in a Patient on Multiple Antipsychotics Therapy

Background/Objective: Multiple Antipsychotics Therapy promote obesity and insulin resistance. This study aimed to describe a T2DM patient with extrapyramidal symptoms and hyperglycemia who was also on several antipsychotic therapies and to determine whether omission of all antipsychotics along with modification of antidiabetic therapy led to better glycemic control. Case Report: An uncontrolled T2DM female subject presented with tremor in both hands as well as in the right corner of her lips. She also having comorbid hypertension and hypothyroidism. On examination, she showed no signs of pallor, icterus, clubbing, cyanosis or edema. Central nervous system examination revealed a GCS of 15 and neurological examinations including motor and sensory responses were unremarkable in Nerve Conduction Study and MRI. her blood glucose levels showed poorly controlled diabetes (HbA1C – 9.5%, FBS – 278mg/dl, PPBS – 234mg/dl) in spite of taking OHAs. Her initial treatment plan included omission of all antipsychotics and reduction in dose of glimepiride to 4mg. This led to a drastic fall in the blood glucose levels. Her CBG levels were between 100mg/dl- 150 mg/dl. Soon after this, the dose of metformin was reduced to 1000mg, vildagliptin was omitted and a SGLT-2 inhibitor was added. This caused gradual improvement in her symptoms and subsequently the blood sugar levels and blood pressure were also within acceptable limits. Discussion: Diabetes and hyperglycaemic emergencies are linked to APDs. There may be several processes that mediate this. In insulin-sensitive cells such muscle cells, hepatocytes, and adipocytes, APDs can block the insulin signalling pathway, resulting in insulin resistance. When choosing a course of treatment, one must consider this elevated risk. Conclusion: Patients receiving multiple antipsychotics therapy are more likely to experience negative metabolic alterations. This case findings also highlight the importance of glycemic control in patients with acute or subacute onset movement disorders, irrespective of their past glycemic status. Keywords: Multiple Antipsychotics Therapy, insulin resistance, T2DM patient, extrapyramidal symptoms, hyperglycemia.

Clinical case of 9-month observation of orbital venous varicose with intraluminal thrombus using radiologic methods

A rare clinical case of thrombosis of varicose superior ophthalmic vein in combination with a unilateral venous anomaly of the subcortical region of the brain with successful antithrombotic therapy is presented. Varicose veins of the superior ophthalmic vein are rare (2% of all orbital formations) and are a risk factor for thrombosis.Material and methods. A 41-year-old patient with verified thrombosis of unilateral orbital venous varicose veins was observed for 9 months. Initially, MSCT of the brain and MSCT angiography were performed, then dynamic monitoring was carried out by performing MRI of the brain and MR venography, and finally an ultrasound examination of the orbit was performed.Description of a clinical case. The clinical presentation consisted of a slight non-pulsatile unilateral exophthalmos, mild ptosis, periorbital soft tissue edema, subconjunctival hemorrhage, paraorbital hematoma, and venous dysfunction in the fundus. MSCT and MSCT angiography revealed a thrombus inside the sac of orbital venous varicose veins. The disease was probably secondary in nature, given that it was combined with venous angioma of the subcortical region on the same side. During 9 months of observation, to monitor the effectiveness of therapy, MRI was performed three times before and after contrast enhancement, which showed a gradual decrease in exophthalmos, the size of the thrombus and the varicocele sac, which was accompanied by a gradual improvement in the clinical picture until subjective recovery.Conclusion. MRI was as good an imaging modality as MSCT, and, in our opinion, more preferable due to the absence of radiation exposure and the need for iodine contrast agent.

Frequency and Outcomes of Obinutuzumab-Induced Thrombocytopenia

Introduction Obinutuzumab (Obi) is a third-generation anti-CD20 monoclonal antibody widely used in the treatment of B-lymphoproliferative disorders (B-LPD) including follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL). It is infrequently associated with severe thrombocytopenia which can be life-threatening. The pathophysiology is unclear, but platelet clearance can be extremely rapid (<24 hours). Methods After obtaining local ethics review, we collected the total number of patients who received Obi as part of multi-agent chemotherapy for the following hematological diseases from 01/01/2015 -01/01/2023: FL (Obi-bendamustine +/- Obi maintenance; Obi-cyclophosphamide/vincristine/prednisone +/-doxorubicin +/- Obi maintenance, Obi-Zanubrutinib (Rosewood trial) and CLL (Obi-venetoclax; Obi-chlorambucil). All cases of clinically suspected Obi-induced thrombocytopenia were reviewed and presented below. All suspected cases were confirmed by evidence of temporal relationship with Obi, spontaneous resolution off Obi, and recapitulation with Obi rechallenge. Results Four out of 147 patients receiving Obi-based multi-agent chemotherapy were found to have Obi-induced thrombocytopenia (frequency 2.7%). Two patients were females (50%), and the median age was 78 (range, 72-82) years. Figure 1 demonstrates the trend of platelet and neutrophils in a patient who received Obi and venetoclax (Ven). Ven was postulated as the cause of the thrombocytopenia, but Ven cessation had no effect on the thrombocytopenia. After suspending Obi, there was a steady increase in the platelet count to 104 x 10 9/L. Obi was re-commenced at cycle 7 (eighth dose) which was followed by a prompt relapse to 4 x 10 9/L 48 hours later. A steady recovery in the platelet count was again seen after ceasing Obi. The other 3 patients received Obi-bendamustine for FL. For the first patient, thrombocytopenia occurred on day 7 of first cycle (41 x 10 9/L) with a nadir of 14 x 10 9/L on day 11. She received intravenous immunoglobulin (IVIg) and oral corticosteroids due to associated bleeding. The second patient had thrombocytopenia on day 28 of the first cycle (71 x 10 9/L) which decreased to a nadir 13 x 10 9/L while receiving Obi-maintenance. There was no bleeding and Obi was ceased followed by a gradual improvement in thrombocytopenia. For the third patient, thrombocytopenia (41 x 10 9/L) occurred on day 18 of first cycle without bleeding. Obi was changed to rituximab. Discussion This is the first known study on the frequency of Obi-induced thrombocytopenia (2.7%). Obi-associated thromboctopenia is severe, sudden-onset, not exclusive to the first cycle of therapy, and the mechanism remains unknown. The diagnosis may be challenging as patients are often receiving other myelosuppressive therapies. Various strategies may help to elucidate the cause, including correlation with timing of exposure and single agent elimination. Suspension of Obi on suspicion is both an important diagnostic and therapeutic strategy. Obi rechallenge can be considered however thorough patient discussion is required with close monitoring and strategies to manage thrombocytopenia. In multi-agent chemotherapy studies containing Obi, severe thrombocytopenia of any cause occurred in up to 13% of cases including fatal hemorrhage. The optimal management is unclear. As our cases demonstrate, thrombocytopenia may resolve spontaneously after withdrawing Obi. Analogous to ITP, steroids, and intravenous immunoglobulin (IVIg) have been associated with response whereas platelet transfusions may be ineffective. Two recent cases with severe thrombocytopenia were treated with thrombopoietin receptor agonist (TPO-RA). Other important considerations are regular blood count monitoring and withholding medications which may increase bleeding risk (e.g., anticoagulants) especially during the first cycle. Summary Obi is prevalent in the treatment of B-LPD, being used in 6 different regimens in local guidelines. However, clinicians need to be aware of the risk of thrombocytopenia which may be severe. The frequency was 2.7% in this single-center retrospective audit. Correlation with timing of exposure is important. The optimal management is unclear. It may be self-limiting whereas some cases have been treated with steroids, IVIg, and TPO-RA. Further studies are required to delineate the incidence, pathophysiology, diagnosis, and management.

The high genetic yield of Xinjiang cotton is associated with improvements in boll-leaf system photosynthesis

ContextDespite significant advancements in cotton breeding, there is ongoing debate regarding the mechanism of the yield increase in early-maturing cotton (Gossypium hirsutum L.) through photosynthesis of single leaves in Xinjiang, China. ObjectiveThis study aims to investigate the role of the boll-leaf system (BLS) involving the main-stem leaf, the sympodial leaf, and the boll, in cotton yield formation. Our hypothesis was that genetic breeding enhances cotton yield by improving BLS photosynthesis. MethodsTo examine the relationship between BLS photosynthesis and yield, we conducted a comprehensive literature review spanning 70 years to assess yield changes in the Xinjiang cotton-growing region. We also conducted a series of field experiments in 2020 and 2021 using main cultivars to further investigate the connection between BLS photosynthesis and yield. ResultsLiterature data analysis revealed a consistent increase in boll density, boll weight, and yield of the main cotton cultivars in Xinjiang since the 1950s, particularly after the 1990s. The succession of cultivars showed greater improvements in boll density than boll weight. Our experiments supported these findings by demonstrating that the gradual genetic enhancement in cotton cultivars also led to increased photosynthetic area (PA) and photosynthetic rate (Pn) of the boll-leaf system (BLS). When the BLS was isolated by stem girding, we observed a significant rise in PA, Pn, and boll weight during the genetic improvement. Notably, the boll weight of the cultivars from the 2010s showed the least impact from girdling. These results highlight the prominent enhancement of BLS photosynthesis and subsequent boll growth throughout the succession of Xinjiang cotton cultivars. Further analysis revealed that genetic breeding improved the PA and Pn of both the main-stem leaf and sympodial leaf within the BLS. Specifically, the Pn of the main-stem leaf exhibited a stronger association with boll density than boll weight. Conversely, the Pn of the sympodial leaf showed a significant association with boll weight but not with boll density. ConclusionsThe gradual genetic improvement of cotton cultivars significantly enhanced BLS photosynthesis, resulting to improvements in both boll density and boll weight. The improvement in photosynthesis of the main-stem leaf contributed to enhanced boll density, while the improvement in photosynthesis of the sympodial leaf promoted greater boll weight.

Guillain-Barré syndrome following varicella-zoster virus infection: a case report and systematic review.

Guillain-Barré syndrome (GBS) is an acute inflammatory disease of the peripheral nervous system, rarely following Varicella-zoster virus (VZV) infection. The authors aimed to review all cases in the English literature of GBS that occurred after primary VZV infection to investigate the clinical features, diagnostic workup, treatment, and outcome of patients with GBS following VZV. PubMed, Scopus, and Embase are systematically searched from their inception to 9 May 2022 to collect all cases of GBS following varicella-zoster infection. Patients with GBS following VZV reactivation were excluded. Among the 29 patients, the age of presentation ranged from 1.5 to 70 years with a median of 37, with a yield for males (81.5%). Most of the patients presented with sensory-motor symptoms (65.4%) and suffered from tetraparesis (81.5%). Cranial nerve palsy was present in (84%) of patients, and the seventh cranial nerve was the most commonly affected nerve (75%). Lumbar puncture showed albuminocytological dissociation in (80%) of patients. The dominant nerve conduction study subtype was acute inflammatory demyelinating polyneuropathy (65.3%). in addition, the magnetic resonance imaging showed pathological findings in only (47.5%) of the patients. Intravenous immunoglobulin is now the drug of choice for all cases of GBS following VZV infection. GBS is a rare neurological complication of primary infection with VZV. However, the authors should suspect this syndrome when a patient develops ascending weakness, regardless of the absence of areflexia and albuminocytological dissociation. Drug therapy with IIVIg ensures a gradual improvement for the patient over a period of weeks to several months.

Effectiveness of Low Dose D-Penicillamine Therapy in Neurologic Wilson Disease - A Prospective Observational Study

Background: Wilson disease is an inherited disorder of copper metabolism that mostly manifests as hepatic and neurologic symptoms. Chelation therapy specially penicillamine is given as first line treatment in children with symptomatic Neurologic Wilson disease. Objective: Objective of the study was to assess the safety & the clinical outcome of treatment with low dose penicillamine in Neurologic Wilson disease. Methods: A longitudinal observational study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, a tertiary care Premier Postgraduate Medical Institution of Bangladesh. Thirty-nine (39) patients of Neurologic Wilson disease who fulfill the inclusion and exclusion criteria were evaluated at In-patient Department of Paediatric Neurology, during the period of January 2015 to December 2019. All study children were treated with low dose penicillamine (Cap Artamin 250 mg) rather with conventional dose penicillamine (Cap Artamin 500 mg or 20 mg/kg/day). Subsequent follow up examination was performed at 2 weeks, 1, 3 and 6 months. Follow up was done by global assessment scoring (GAS) and slit lamp examination to see the clinical improvement after treatment with low dose penicillamine therapy. Results: Total number of studied cases were 39. Mean age was 10.2 ± 3.1 year and male to female ratio was 2:1. Most of the patients (66.67%) were arrived from rural area and 20.51% children had history of consanguineous mating parents. Common presenting features were progressive deterioration of school performance (89.74%), gait disturbance (92.31%), dysarthria (92.31%) and dystonia (82.06%) of our studied children. Ophthalmological manifestations like KF ring (100%) found in all patients. Neuroimaging showed bilateral basal ganglia involvement in (63.63%) children followed by hyperintense signal changes (18.18%) and ventricular dilatation in (18.18%) of cases. Majority of the children (74.36%) were improved with low penicillamine therapy clinically and KF ring disappeared in (5.12%) cases after drug therapy on follow up. Commonest side effects were worsening of neurological symptoms in (25.64%) and rash & thrombocytopenia in (5.1%) cases after penicillamine therapy. Conclusion: About three-fourth children of studied Neurologic Wilson disease showed gradual improvement with low-dose penicillamine therapy. Moreover, one-fourth of cases experienced neurological deterioration, which was lower than previously used high dose penicillamine therapy. Therefore, low dose penicillamine may be beneficial as an initial therapy for Wilson disease with neurological manifestations.

GLIOMA-16 EARLY NEUROCOGNITIVE OUTCOME POST RESECTION OF ADULT SUPRATENTORIAL GLIOMAS AT THE KENYATTA NATIONAL HOSPITAL

Abstract Gliomas are the commonest brain tumors in our setting. Traditionally; Overall Survival, progression free survival and Extent of resection are used to define oncologic outcome in gliomas. These measures don’t reflect the complete patient status and hence the need for functional outcome determination. Cognitive outcome, is a key functional measure in gliomas. This was a prospective Cohort Study whose objective was to determine the Early Neurocognitive outcome post-resection of adult supratentorial gliomas at the Kenyatta National Hospital. Our study population was adult patients with supratentorial gliomas. We examined twenty patients who met the inclusion criteria. Data collection was by an interviewer-based questionnaire incorporating the ACE III (Addenbrooke Cognitive Examination III) tool administered at three instances as follows: - Within two weeks Preoperatively (T0), at one week postoperatively (T1) and at four weeks postoperatively (T2). The pre and post operative cognitive scores were then analyzed to determine the cognitive outcome. Statistical significance was considered where the p-value was <0.05. Ninety five percent of patients had cognitive impairment at baseline. Mean age of presentation was 34.3 years for Low grade glioma (LGG) and 43.8 years for High Grade Glioma (HGG). 55% of patients had LGG while 45% had HGG. Overall, there was transient decline in cognition from T0-T1 and a gradual improvement beyond the baseline from T1-T2. This improvement was across all domains but was significant in the total ACE score, memory and fluency. LGG showed the greatest improvement in cognition especially in the fluency domain. Sixty percent of the tumors were subtotally resected and showed significant cognitive change in the domains of Attention, fluency and Visuospatial association. Glioma surgery in our setting results in a transient decline in cognition one week postoperatively after which improvement in cognition beyond baseline is noted one month post operatively.

Cyclosporine A improves ulcerative colitis complicated with deep vein thrombosis with coagulation abnormalities

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon and rectum. UC patients are at increased risk of deep vein thrombosis. Cyclosporine A (CyA) is an immunosuppressant drug that is used to treat severe UC. A 49-year-old man with UC complicated by DVT was treated with CyA. The patient presented with severe bloody diarrhea, lower extremity edema, and a clinical activity index of 16. The patient's coagulation test results were also abnormal. After CyA administration, the patient's leg pain and swelling improved. In addition, the extrinsic coagulation abnormalities improved first after CyA administration, followed by a gradual improvement in the intrinsic coagulation abnormalities. CyA may be effective in correcting coagulation abnormalities that contribute to DVT in UC patients.

Bickerstaff’s brainstem encephalitis: a rare case of neurologic complication in Ulcerative Colitis

Bickerstaff’s brainstem encephalitis is a rare autoimmune disorder that presents with ataxia, ophthalmoplegia, disturbance of consciousness and quadriplegia. A 45-year-old man with a history of ulcerative colitis (UC) taking mesalazine (5-aminosalicylic acid) visited the emergency room presenting with ataxia, ophthalmoplegia and a progressively worsening cognitive impairment. Cerebrospinal fluid analysis showed mild elevation in protein and white blood cell count and increased intracranial pressure. Anti-GQ1b autoantibodies were found positive in the patient’s serum and contrast-enhanced brain magnetic resonance imaging showed diffuse leptomeningeal enhancement and pontine lesions. Based on these findings and the patient’s clinical course and history, he was diagnosed with Bickerstaff’s brainstem encephalitis. Mesalazine was discontinued and high-dose steroid pulse therapy was started, followed by intravenous immunoglobulin, which resulted in gradual improvement of the neurologic symptoms. When an ulcerative colitis patient presents with progressive cognitive impairment, quadriplegia and disturbance of consciousness and gait, Bickerstaff brainstem encephalitis should be considered in the differential diagnosis and prompt immunotherapy may lead to favorable prognosis.

Performance of Vegetable Based Cropping Sequence under INM in Protected Conditions

The field experiment was conducted in a naturally ventilated arched saw teeth polyhouse department of vegetable science, faculty of horticulture, BCKV, Kolkata, West Bengal. Vegetable crops were produced in appropriate cropping rotations under integrated nutrient management with acceptable cultural methods in the current study. Four different cropping sequences and five various levels of nutrition supplies were used in the experiment. With four replications, the experiment was set up in a Split plot design. Plant height [at first harvesting], number of leaves, number of primary branches, days required for first harvesting, fruit yield per plant and yield per square metre of component crops did not show any significant variation over the two-year cropping cycle, but observed a gradual improvement in consecutive years of cropping. All growth and reproductive characters of component crops in the cropping sequence differed statistically from the first to the second year cropping under the influence of different levels of combined nutrient management, with the highest values for these characters obtained under L1 (100 percent Recommended dose of fertilizer (R.D.) through inorganic source), but results are statistically comparable to L2 (application of 50 percent R.D. of NPK + Vermicompost) and L3 (application of 50 percent R.D of NPK + FYM). However, there was no substantial variation in growth and yield parameters when cropping sequence and nutrient management were combined. It can be concluded Supplementation of organic fertilisers along suitable cropping sequences with short duration vegetable crops would be beneficial for long term soil fertility and crop vigour point of view.

Pelvic exenteration for late complications of radiation-induced pelvic injury: a preliminary study

Objective: To investigate the safety and efficacy of total pelvic exenteration (TPE) for treating late complications of radiation-induced pelvic injury. Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) confirmed radiation-induced pelvic injury after radiotherapy for pelvic malignancies; (2) late complications of radiation-induced pelvic injury, such as bleeding, perforation, fistula, and obstruction, involving multiple pelvic organs; (3) TPE recommended by a multidisciplinary team; (4) patient in good preoperative condition and considered fit enough to tolerate TPE; and (5) patient extremely willing to undergo the procedure and accept the associated risks. The exclusion criteria were as follows: (1) preoperative or intraoperative diagnosis of tumor recurrence or metastasis; (2) had only undergone diversion or bypass surgery after laparoscopic exploration; and (3) incomplete medical records. Clinical and follow-up data of patients who had undergone TPE for late complications of radiation-induced pelvic injury between March 2020 and September 2022 at the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed. Perioperative recovery, postoperative complications, perioperative deaths, and quality of life 1 year postoperatively were recorded. Results: The study cohort comprised 14 women, nine of whom had recto-vagino-vesical fistulas, two vesicovaginal fistulas, one ileo-vesical fistula and rectal necrosis, one ileo-vesical and rectovaginal fistulas, and one rectal ulcer and bilateral ureteral stenosis. The mean duration of surgery was 592.1±167.6 minutes and the median blood loss 550 (100-6000) mL. Ten patients underwent intestinal reconstruction, and four the Hartmann procedure. Ten patients underwent urinary reconstruction using Bricker's procedure and 7 underwent pelvic floor reconstruction. The mean postoperative hospital stay was 23.6±14.9 days. Seven patients (7/14) had serious postoperative complications (Clavien-Dindo IIIa to IVb), including surgical site infections in eight, abdominopelvic abscesses in five, pulmonary infections in five, intestinal obstruction in four, and urinary leakage in two. Empty pelvis syndrome (EPS) was diagnosed in five patients, none of whom had undergone pelvic floor reconstruction. Five of the seven patients who had not undergone pelvic floor reconstruction developed EPS, compared with none of those who had undergone pelvic floor reconstruction. One patient with EPS underwent reoperation because of a pelvic abscess, pelvic hemorrhage, and intestinal obstruction. There were no perioperative deaths. During 18.9±10.1 months of follow-up, three patients died, two of renal failure, which was a preoperative comorbidity, and one of COVID-19. The remaining patients had gradual and significant relief of symptoms during follow-up. QLQ-C30 assessment of postoperative quality of life showed gradual improvement in all functional domains and general health at 1, 3, and 6 months postoperatively (all P<0.05). Conclusions: TPE is a feasible procedure for treating late complications of radiation-induced pelvic injury combined with complex pelvic fistulas. TPE is effective in alleviating symptoms and improving quality of life. However, the indications for this procedure should be strictly controlled and the surgery carried out only by experienced surgeons.

Autism Spectrum Disorder and Role of the Inflammatory Theory: A Case Report

In this case study, an 8-year-old child from a consanguineous marriage with a complicated pregnancy due to maternal preeclampsia and a normal delivery experienced developmental delays, language problems, social challenges, and other autism spectrum disorder (ASD) symptoms. The child underwent various diagnostic tests, including the M-CHAT, ADI, and ADOS, which all supported an ASD diagnosis. Despite receiving psychomotor, speech, and ABA therapy, the child showed gradual improvement in language skills but continued to exhibit behavioral issues such as irritability, anger outbursts, and sleep disturbances. After experiencing a febrile episode with tonsillitis, followed by knee pain, walking difficulties, chest pain, and shortness of breath, the child was diagnosed with acute rheumatic fever and received corticosteroid therapy, resulting in significant clinical improvement in language, facial expressions, social interactions, and a renewed ASD assessment. The discussion focuses on the potential environmental factors contributing to ASD, emphasizing the role of shared environmental factors in twin studies and genetic factors. The study explores the inflammatory response as a possible common pathway for ASD development, particularly in cases where preeclampsia during pregnancy and its associated inflammation affect the mother and, subsequently, the placenta or fetus. Abnormal angiogenesis and elevated levels of soluble tyrosine kinase 1 (sFlt-1) are discussed as potential factors contributing to fetal neurodevelopmental abnormalities. The text also highlights the role of corticosteroid therapy in improving ASD symptoms, with references to previous studies showing positive responses to corticosteroid treatment in ASD patients. The impact of medications like prednisone and pregnenolone on ASD symptoms and their mechanisms of action, including potential modulation of GABA A receptors, is mentioned. In conclusion, the case study suggests a potential link between ........

Kaposiform hemangioendotheliomas and tufted angiomas: Sirolimus for treating children

Introduction. Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are extremely rare vascular tumors characterized by pathologically progressive angiogenesis and lymphangiogenesis. They are also associated with the development of the KazabachMerritt Phenomenon (KMP; Kasabach-Merritt Phenomenon).Material and methods. 8 patients (5 boys, 3 girls) with kaposiform hemangioendothelioma (two out of them with Kazabakh-Merritt syndrome) and 4 patients (3 boys, 1 girl) with tufted angioma were treated at the Russian Children's Clinical Hospital of Pirogov Russian National Research Medical University (Moscow, Russia) . All patients were prescribed Sirolimus therapy for antiproliferative purpose.Results. In all children, positive changes were registered: reduction of vascular tumor volume, gradual improvement of clinical picture and control of complications: pain syndrome, KMP, improvement or restoration of functions in affected organs /systems (increase/restoration of movement volume in joints, compensation for length discrepancy in lower legs). Complete resorption of vascular tumors and clinical symptoms were registered in 3 patients.Conclusion. The obtained encouraging results after Sirolimus therapy prescribed for treating KME and TA allow the authors to recommend this therapy to patients with KME with or without KMP and TA. However, further researches with a large sample of participants is required to confirm the obtained results.

Amiodaron-induced skin lesion: focus on blue man syndrome

Amiodarone has been used in clinical practice since 1964. The 2020 European guidelines note that amiodarone is recommended for long-term rhythm control in all patients with atrial fibrillation. However, due to its extracardiac toxicity, other antiarrhythmic drugs should be considered first. Information databases were searched for descriptions of amiodarone-induced blue man syndrome. Its pathogenesis is associated with accelerated physiological aging of dermal cells, leading to the accumulation of lipofuscin in lysosomes, or occurs as a result of the direct accumulation of amiodarone and its metabolites in the skin. As part of the review, brief descriptions of the 32 clinical cases found of the blue man syndrome are given. Most publications refer to various countries in Europe and the United States, which suggests that this syndrome develops more often in Caucasians. This syndrome is more common in people over 60 years of age, males predominate among patients. The development of the blue man syndrome is preceded by long-term use of amiodarone and the achievement of a certain cumulative dose. After the abolition of amiodarone, a gradual improvement is noted for 1 year or more. Other side effects of amiodarone are often detected in the presence of the blue man syndrome. Most publications describing the blue man syndrome belong to cardiologists and dermatologists. Given the variety of side effects of amiodarone, pulmonologists, endocrinologists, neurologists, ophthalmologists, gastroenterologists and doctors of other specialties may encounter a blue-gray skin color change.

Allocation scheme selection for transportation carbon allowance -evidence from China's top ten economic regions

Establishing a scientific allocation scheme for transportation carbon allowance (TCA) is an inevitable requirement of China's sustainable development. Previous studies on the allocation problems of TCA considered the single goal, but this study constructs an allocation model of TCA under the framework of zero-sum gains data envelopment analysis and a spatial simultaneous panel. Furthermore, a profit maximization function model is used to measure the allocative efficiency and the differences in regional abatement costs of three different transport allocation mechanisms in China's top 10 economic regions from 1998 to 2019. Empirical results revealed four key results. (1) The efficient scheme is beneficial to regions with a high level of economic development and high-carbon emission efficiency, but it is easy to cause widening regional wealth disparities. (2) The equitable scheme is beneficial to regions with low transportation carbon emission efficiency, immature transportation structures, and green transportation technology, but it is easy to cause an unsuitable punishment effect. (3) Compared with the above two schemes, the comprehensive scheme is beneficial to more regions because it can both minimize the average marginal abatement costs and mitigate regional development inequalities. (4) With the gradual improvement of the national transportation carbon trading market, the comprehensive scheme is more sustainable and should be used more in the future. This study contributes to the formulation and implementation of energy allocation policies in the transportation sector.

Prediction of survival in patients with infected pancreatic necrosis: a prospective cohort study.

Infected pancreatic necrosis (IPN) is a severe complication of acute pancreatitis, with mortality rates ranging from 15 to 35%. However, limited studies exist to predict the survival of IPN patients and nomogram has never been built. This study aimed to identify predictors of mortality, estimate conditional survival (CS), and develop a CS nomogram and logistic regression nomogram for real-time prediction of survival in IPN patients. A prospective cohort study was performed in 335 IPN patients consecutively enrolled at a large Chinese tertiary hospital from January 2011 to December 2022. The random survival forest method was first employed to identify the most significant predictors and capture clinically relevant nonlinear threshold effects. Instantaneous death risk and CS was first utilized to reveal the dynamic changes in the survival of IPN patients. A Cox model-based nomogram incorporating CS and a logistic regression-based nomogram were first developed and internally validated with a bootstrap method. The random survival forest model identified seven foremost predictors of mortality, including the number of organ failures, duration of organ failure, age, time from onset to first intervention, hemorrhage, bloodstream infection, and severity classification. Duration of organ failure and time from onset to first intervention showed distinct thresholds and nonlinear relationships with mortality. Instantaneous death risk reduced progressively within the first 30 days, and CS analysis indicated gradual improvement in real-time survival since diagnosis, with 90-day survival rates gradually increasing from 0.778 to 0.838, 0.881, 0.974, and 0.992 after surviving 15, 30, 45, 60, and 75 days, respectively. After further variables selection using step regression, five predictors (age, number of organ failures, hemorrhage, time from onset to first intervention, and bloodstream infection) were utilized to construct both the CS nomogram and logistic regression nomogram, both of which demonstrated excellent performance with 1000 bootstrap. Number of organ failures, duration of organ failure, age, time from onset to first intervention, hemorrhage, bloodstream infection, and severity classification were the most crucial predictors of mortality of IPN patients. The CS nomogram and logistic regression nomogram constructed by these predictors could help clinicians to predict real-time survival and optimize clinical decisions.