Optimal Management Strategy Research Articles

Beyond the discomfort: understanding and managing sexual pain in women, a comprehensive case-based discussion.

Sexual pain has a profound impact on individuals, regardless of their sexual orientation or gender identity, and affects women more often than men. It adversely affects both sexual function and interpersonal relationships. Despite its prevalence, sexual pain in women often remains unaddressed and untreated. Various underlying causes contribute to sexual pain, sometimes involving multiple factors. We explore treatment options and offer clinical insights into the evaluation and management of 4 common conditions which cause sexual pain in women. In this article, we use the term "women" to indicate cisgender women. Our aim is to highlight the most common clinical scenarios of sexual pain and provide comprehensive discussions on each, to improve patient care and outcomes in the management of sexual pain. We conducted a comprehensive review of literature and clinical cases to explore the various causes and management strategies for sexual pain in women. We systematically searched databases such as PubMed, Google Scholar, and relevant medical journals. We included peer-reviewed articles, case studies, and clinical trials published between 2000 and 2023. Additionally, we analyzed real-life cases from our clinical practice at our academic institution. Our review identified various factors contributing to sexual pain in women, ranging from hormonal imbalances to neuroproliferative and inflammatory conditions affecting the genitourinary system. Each case should be approached individually to offer optimal management strategies accordingly. The management of sexual pain in women requires a comprehensive approach that addresses the multifactorial nature of the condition. Patient education and counseling play a crucial role in the management of sexual pain, empowering individuals to advocate for their own health and well-being. The collaboration between healthcare providers and patients can improve our understanding and management of this complex condition.

Effects of water quality and nitrogen on wheat productivity: Experimental and modelling study using the SALTMED model

AbstractThe effects of different water qualities and nitrogen doses need to be investigated for wheat growth to determine the optimal management strategy for sustaining wheat production potential to ensure human food security. Therefore, a 2‐year study (2020–2021 to 2021–2022) was conducted on wheat irrigated with different water qualities, including canal water (Ca), tubewell water (Tu) and mixed Ca‐Tu water (Mx), each fertilized with two nitrogen doses, that is, N75 = 75 kgN.ha−1 and N100 = 100 kgN.ha−1. Ca⨯N100 performed best, with 5.12 t.ha−1 grain yield, 11.60 t.ha−1 biomass, 102.83 cm plant height and 1.32 kg.m−3 water productivity. The best values of the root mean square error (RMSE), normalized root mean square error (NRMSE), coefficient of determination (R2) and coefficient of residual mass (CRM) were 0.11, 0.12, 0.93 and −0.004, respectively, for calibration and 0.13, 0.15, 0.87 and ±0.01, respectively, for validation of the SALTMED model. The scenario simulation was performed for additional levels of water salinity (electrical conductivity [EC] = 8 and 12 dS.m−1) and nitrogen doses (50, 125, 150 and 175 kgN.ha−1). The results revealed improvements in wheat grain yield of 107%, 16% and −6% at EC = 8 dS.m−1 and 125%, 31% and 5% at EC = 12 dS.m−1, while the improvements in biomass were 113%, 22% and −2% at EC = 8 dS.m−1 and 137%, 29% and 8% at EC = 12 dS.m−1 with increasing nitrogen doses from 50–125 kg.ha−1, 125–150 kg.ha−1 and 150–175 kg.ha−1, respectively. It is recommended that high‐quality water with the lowest possible EC and nitrogen applications of up to 150 kgN.ha−1 be adopted for wheat production in semi‐arid areas of Punjab, Pakistan.

Continuous Catheter Techniques Versus Single-Injection Nerve Blocks: A Comprehensive Review of Postoperative Pain Management Strategies.

Effective postoperative pain management is crucial for optimizing patient recovery and enhancing surgical outcomes. This review compares two prominent regional anesthesia techniques, continuous catheter techniques and single-injection nerve blocks, focusing on their efficacy, safety, and impact on patient outcomes. Single-injection nerve blocks involve administering a one-time anesthetic dose to a specific nerve or plexus, offering immediate but transient pain relief. In contrast, continuous catheter techniques utilize a catheter to deliver a continuous infusion of anesthetic, providing extended analgesia. The review synthesizes current evidence on the effectiveness of each method, highlighting that single-injection blocks are advantageous for their simplicity and rapid onset but may require supplementary pain management for longer procedures. Continuous catheter techniques, while offering prolonged pain relief, carry risks such as infection and catheter displacement. The comparative analysis of these techniques reveals that both have distinct roles in postoperative care, with choice depending on the surgical procedure and patient needs. Patient satisfaction, recovery times, and overall outcomes are critical factors in determining the optimal pain management strategy. Future research should focus on refining these techniques and exploring innovations to improve patient care and pain management outcomes. This review provides insights for clinicians to make informed decisions about postoperative pain management to enhance patient comfort and recovery.

Fast rehabilitation does not worsen clinical, radiological, and arthroscopic outcomes after medial meniscus posterior root repair: A retrospective comparative study

Background/ObjectiveThe main surgical treatment for medial meniscus posterior root tear (MMPRT) has shifted from meniscectomy to meniscus repair; however, there is no clear consensus regarding the optimal postoperative management strategy after MMPRT repair. This study aimed to perform a comparative analysis of patients who received conventional rehabilitation or fast rehabilitation following MMPRT repair. MethodsThe current retrospective cohort study compared clinical, radiological, and arthroscopic outcomes after conventional rehabilitation (group A, January 2020 to April 2020, 24 patients) with those after fast rehabilitation (group B, May 2020 to August 2020, 24 patients) in patients who underwent pullout repair for MMPRT. Partial weight-bearing and range of motion exercises were allowed 2 weeks postoperatively in group A and 1 week postoperatively in group B. In patients with an average weight of approximately 60 kg, full weight bearing was allowed 4 weeks postoperatively in group A and 3 weeks postoperatively in group B. ResultsAt 12 months postoperatively, the clinical scores, including International Knee Documentation Committee and Japanese Knee Injury and Osteoarthritis Outcome Score, significantly improved in both groups (p < 0.01). Although meniscus healing was achieved in both groups, medial meniscus extrusion significantly progressed by 0.9 mm in group A and 0.8 mm in group B (p < 0.01, compared with preoperative extrusion). There were no significant differences in clinical scores, arthroscopic meniscal healing status, or medial meniscus extrusion progression on magnetic resonance images between the groups. ConclusionA fast rehabilitation protocol can be safely implemented without compromising patient outcomes after pullout repair for MMPRT.

Navigating discreetly: Spatial ecology of urban wild boar in Bordeaux City's landscape of fear, France

An exemplary urban adapter, the wild boar (Sus scrofa) has successfully colonized urban ecological niches worldwide. Improvement of strategies for optimal management of urban wild boar need to gather more empirical evidence of their spatial ecology. This study is based on GPS tracking and capture-mark-recapture (CMR) of 10 and 59 wild boar, respectively, captured in Bordeaux Metropolis (France). It shows that wild boar have become urban dwellers, with intra-urban home ranges varying from 1.3 to 64.6 km2 (MCP 100 %) and from 0.5 to 9.6 km2 (KDE 95 %), depending on urban conditions. CMR results confirm the low propensity to move away from urban areas (with a mean distance of 2 km between capture and recapture sites), despite a relatively low one-year survival rate since capture (47.5 %), primarily attributable to removal efforts. Wild boar strongly depended on urban woods, mostly during daytime resting, and highly frequented urban meadows during night foraging. Their use of urban agricultural areas was minimal, but they were mostly monitored following corn and grape harvests. Wild boar mitigated the risk associated with close proximity to humans by: a nocturnal activity (72.2 % of active locations registered from sunset to sunrise), which could also be partially attributed to their sensitivity to heat; a strong use of covered habitats, especially during daytime resting and when close to buildings and roads; and a low mobility during night-time foraging (1974 m average daily distance travelled). Moreover, we demonstrate high inter- and intra-individual variability in the spatio-temporal behaviour of urban wild boar. Finally, we discuss the gap between these results and the narratives surrounding the spatial ecology of urban wild boar. Our results not only confirm the species' ability to adapt to urban environments, but also highlight their behavioural flexibility, underscoring the relevance of significant changes in representations and management activities to mitigate human-urban wild boar conflicts.

Abstract C067: Immune thrombocytopenia induced by PD-1/PD-L1 inhibitors in a patient with non-small cell lung adenocarcinoma: A case report and literature review

Abstract Introduction: The introduction of immunotherapy, particularly programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitors, has transformed the treatment paradigm for non-small cell lung adenocarcinoma (NSCLC), significantly improving patient survival rates. However, alongside their immune-activating effects, these agents can also lead to immune-related adverse events (irAEs), affecting various organ systems. Among these, immune thrombocytopenia (ITP) is a rare but potentially life-threatening complication characterized by the destruction of platelets by autoantibodies, resulting in decreased platelet counts and an increased risk of bleeding. While ITP has been identified as a complication of immunotherapy, particularly PD-1 or PD-L1 inhibitors, its incidence, clinical presentation, and management remain poorly understood. Case Presentation: The 73-year-old female with stage IIIA poorly differentiated NSCLC who received chemotherapy with Taxol/Carboplatin and concurrent radiation therapy followed by a right upper lobectomy, initiated on immunotherapy with durvalumab, a PD-L1 inhibitor, developed severe thrombocytopenia (grade 4) after receiving two cycles of durvalumab. Despite steroid treatment, her condition persisted, indicating immune-related adverse events (irAEs). After confirming the diagnosis through further investigation, including molecular analysis, the patient was treated with intravenous immunoglobulin (IVIG), which significantly increased her platelet counts. Durvalumab was discontinued, and fostamatinib, a spleen tyrosine kinase (SYK) inhibitor, was initiated to manage the irAEs effectively. Discussion: ITP is recognized as an immune-related adverse event (irAE) associated with PD-1 or PD-L1 inhibitors, although it remains rare and poorly understood. Several case reports have highlighted the occurrence of ITP induced by these inhibitors, demonstrating varied clinical presentations and responses to treatment. Mechanisms underlying ITP induction by PD-1/PD-L1 inhibitors are not fully elucidated but may involve immune dysregulation, including CD4+ and CD8+ T cell activation, production of antiplatelet antibodies, and increased expression of PD-L1 on platelets. Management strategies for ITP induced by PD-1/PD-L1 inhibitors include steroids, intravenous immunoglobulin (IVIG) therapy, recombinant human thrombopoietin (TPO), interleukin-6 (IL-6) receptor antagonists, and immunosuppressive agents. However, the effectiveness of these treatments varies among patients, highlighting the need for individualized approaches and further research to optimize management strategies. Conclusion: The prompt recognition and management of ITP induced by PD-1/PD-L1 inhibitors are essential for ensuring favorable patient outcomes. Further research is needed to understand the underlying mechanisms and develop effective prevention and management strategies for this rare but serious immune-related adverse event. Citation Format: Aliya M Khan, Richa Dawar. Immune thrombocytopenia induced by PD-1/PD-L1 inhibitors in a patient with non-small cell lung adenocarcinoma: A case report and literature review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C067.

Management of Otogenic Meningitis: A Proposal for Practical Guidelines from a Multicenter Experience with a Systematic Review.

Background: Otogenic meningitis represents the most common and life-threatening complication of infective middle ear diseases. However, no guidelines are available to describe the optimal management strategy and the role of surgical intervention. Methods: A six-year multicenter retrospective study on consecutive patients treated for otogenic meningitis caused by acute otitis and re-exacerbation of chronic otitis at the University Hospital of Verona and Modena was performed, and a systematic review regarding acute otitis media-related meningitis in accordance with the PRISMA 2020 statement was then conducted. Results: From the clinical chart analysis, 16 patients with surgical indications according to our decision-making flow chart were reviewed, with most of them undergoing surgery within 7 days of admission (n = 13, 81%). The systematic review ultimately utilized 24 studies (16 case reports and 8 case series) published between 1990 and 2023, with the overall analysis involving a total of 181 patients. Conclusion: The primary treatment for acute bacterial meningitis relies on antibiotic therapy, with surgical intervention being employed in the event of complications and when the initial treatment is not effective within 48 h. The objective of surgery is to sterilize the tympanic and mastoid cavity, thereby eradicating the suspected infective foci and managing any eventual intracranial complications.

Squamous Cell Carcinoma of the Gallbladder Masquerading as Complicated Cholecystitis: A Case Report and Review

In summary, squamous cell carcinoma (SCC) of the gallbladder, although rare, poses significant diagnostic and therapeutic challenges. We report the case of a 51-year-old woman with no previous medical history, with SCC discovered during complicated cholecystitis with cholangitis, treated by palliative chemotherapy, underscoring the difficulty in early detection and the poor prognosis associated with advanced-stage diagnosis. Treatment options are limited, with palliative chemotherapy often being the primary recourse for unresectable tumors. Gallbladder cancers, including SCC, share risk factors with adenocarcinomas, but their distinct histopathological features and clinical presentations warrant careful consideration. Despite recent advancements in treatment modalities, including adjuvant therapy, optimal management strategies remain elusive, highlighting the need for further research to improve outcomes for patients with this aggressive malignancy.

Impact of plant nutrients and organic substances on growth, yield, and quality attributes of Anna apple cultivar under semi-arid conditions

The unique challenges posed by semi-arid climates, including soil nutrient limitations and organic matter decline, underscore the importance of effective nutrient and organic substance management to ensure optimal yields, quality, and environmental sustainability. A field experiment was conducted at Horticulture Farm of Chaudhary Charan Singh Haryana Agricultural University, Hisar during two succeeding years, 2020–21 and 2021–22, to identify optimal nutrient management strategies of different plant nutrients and organic substances on growth, flowering, quality, and yield attributes of the “Anna” apple cultivar. The experiment consisted of nineteen treatments in an RBD system. The plant growth parameters [leaf area (33.64 cm2) and trunk girth (13.16 cm)] when applied 2.0% Urea (N) + 15% Cow urine-T12. Whereas, the number of flower buds (232.83/m2) and flowering duration (39.00 days) were found better with T6. Similarly, [fruit volume (158.95 cm3), number of fruit (63.33/tree) and fruit drop (70.54%)] and [TSS: acid ratio (22.60), reducing sugars (7.17%), non-reducing sugars (2.83%), total protein (0.97 g 100 g−1), starch index (3.59)] were superior with the application of treatment T6. Higher content of boron (80.09 ppm) was estimated in treatment T6, zinc (24.69 ppm) in T9, iron (134.67 ppm) in T1, and manganese (59.94 ppm) in T12 during the experimentation. Therefore, it was concluded that treatment T12 was most effective for enhancing plant growth while treatment T6 was found superior for flowering, high yield, and quality of apple cv. Anna fruit under semi-arid conditions.

Assessment of Functional outcomes Following Arthroscopy-Assisted Anterior Cruciate Ligament Reconstruction Utilizing Autograft Bone-Patellar Tendon-Bone

Anterior cruciate ligament (ACL) injuries are prevalent in athletes and active individuals, necessitating effective surgical interventions for restoring knee stability and function. This study evaluates the outcomes of Arthroscopic ACL reconstruction using bone-patellar tendon-bone (BPTB). This prospective study conducted from March 2022 to August 2023 evaluated the functional outcomes of 21 patients undergoing ACL reconstruction with BPTB autografts. Clinical assessments, including the Lachman and Lysholm scores, were utilized to assess knee stability and function preoperatively and postoperatively. Significant improvements were observed postoperatively in clinical assessments, with mean Lysholm scores increasing from 51.74 preoperatively to 91.64 at the 12-month follow-up (p &lt; 0.001). The study also highlighted the prevalence of associated meniscal injuries and postoperative complications. Despite study limitations, including sample size constraints, our findings support the efficacy of ACL reconstruction with BPTB autografts in restoring knee function and stability. Evidence-based decision-making and comprehensive patient care are crucial for optimizing surgical outcomes in ACL injuries. Further research with larger cohorts and long-term follow-up is warranted to validate these results and explore optimal management strategies.

Functional Outcome of Perpendicular Plating Versus Parallel Plating In The Management Of Distal Humerus Fractures- A Comparative Study

Distal humerus fractures are quite uncommon but pose significant challenges in management due to their complex anatomy and varied fracture patterns. Surgical intervention, particularly using plate fixation, is often necessary to achieve stable fracture union and restore functional elbow mobility. This prospective comparative study aimed to analyse the outcomes of distal humeral fracture management using perpendicular and parallel plating techniques. Thirty patients with distal humeral fractures underwent osteosynthesis with either perpendicular or parallel plating between November 2020 and October 2022 at Saveetha Medical College and Hospital in Chennai. The Mayo Elbow Performance Score has been utilized to measure the following assessment parameters: pain, radiological, stiffness and clinical union, and functional elbow ability at 6 weeks, 3 months, 6 months, and 1 year after the surgery.Both techniques yielded satisfactory outcomes in terms of fracture union and functional recovery. However, complications and biomechanical properties differed significantly between the two methods. Parallel plating demonstrated superior stability and resistance to plastic deformation, particularly in osteoporotic bone, suggesting potential advantages in managing comminuted distal humerus fractures with an intraarticular component. This study contributes valuable insights into the optimal management strategies for distal humeral fractures and highlights the importance of considering individual patient factors and fracture characteristics when selecting the most suitable surgical approach. Additional investigation is necessary to verify these results and improve methods of treatment for this difficult kind of fracture.

Occurrence of Ectoparasites on Tilapia zillii (Red Belly Tilapia) Gervais 1848 in The Tono Reservoir, Navrongo, Ghana

This study was carried out to assess the occurrence of endoparasites in (Tilapia zillii (Gervais, 1848)) from Tono reservoir, Navrongo Ghana. A total of 120 fish samples were collected from the upstream, midstream and downstream regions of the reservoir using cast nets. All the collected fish samples were transported to the research laboratory in the University for Development Studies and examined for ectoparasites during January 2022 to August 2022. Five ectoparasites namely Trichodina sp. of Protozoans ciliates, Dactyolgyrus sp. of Monogenean, Argulus sp. and Lernaea sp. of Crustaceans and the Diplostomum sp were identified. Overall prevalence of the fish parasites was 52.32 %. Intensity of the parasites observed ranged between 1.58% to 3.52%. Highest prevalence 70 % was reported in dry season while lowest (31.67%) was reported in the rainy season. Female fish samples had higher prevalence (64.47 %) than males (27.27 %). Fishes of downstream had highest prevalence (92.5 %) than upstream (17.5 %). Fish samples with maximum length and weight were highly (65.15 %) infected than small sized fish with low body length and weight (33.33 %). It is debatable if the degree of ectoparasite activity found in this study will constitute a serious danger to the local fish population. Yet, in order to stop disease outbreaks brought on by an increase in ectoparasites, the reservoir must be given significant attention by using optimum management strategies. This study shows that dry season affects the fish business and result in poor quality fish meat with risk of diseases infection.

Mathematical model for managing marine ecosystem risks

The article presents the results of the research aimed at developing and verifying a mathematical model for managing the ecosystem risks of marine areas. The main purpose of the research is to create an effective tool for assessing and managing the risks arising from anthropogenic influence, climate change and other natural factors. The proposed model is based on the existing theory of sea ecosystem risks management and takes into account the relationship between natural and anthropogenic factors, condition of marine ecosystems, their vulnerability and ecosystem services. The model uses mathematical methods, in particular, differential equations, statistical analyses, simulation modeling and network analysis, allowing creation of detailed models that reflect marine ecosystems' dynamics and their response to external influence. Numerous experiments were conducted in order to verify the model. They demonstrate its ability to predict changes in the condition of marine ecosystems under influence of various factors. The results of the research show that the proposed model can be an effective tool for optimizing management strategies, minimizing ecosystem risks and improving sustainability of marine ecosystems. Practical recommendations developed on the basis of the results of the research include strategies for preventing, minimizing and adapting to potential threats, taking into consideration each region's and ecosystem's specifics. The proposed model helps to optimize management decisions, reducing risks and improving the condition of marine ecosystems affected by anthropogenic impact and climate change. It is a reliable tool for ensuring sustainability and preservation of marine ecosystems. This approach allows for evidence-based risk management that increases sustainability of marine ecosystems and their preservation for future generations. The model also considers key factors influencing marine ecosystems, including biological diversity, water quality, industrial fisheries, tourism and recreation, and allows evaluation of effectiveness of various management decisions in the context of such factors. The application of this model in ecosystem management practices allows making more informed decisions regarding protection and preservation of marine resources. It contributes to their sustainable development and provision of ecosystem services having critical importance for society.

Prevalence, Management, and Outcomes of Atrial Fibrillation in Paediatric Patients: Insights from a Tertiary Cardiology Centre.

Background and Objectives: Atrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. Materials and Methods: A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023. The study focused on demographic details, clinical presentations, treatments, and outcomes. Descriptive statistics were employed to assess treatment efficacy, recurrence rates, and complications. Results: The study included 36 paediatric patients (median age: 15 years, IQR: 13-17; 58% male). Of these, 52.8% had acquired heart disease, 16.7% had congenital heart anomalies, and 16.7% presented with lone AF. The initial management strategies involved electrical cardioversion in 53.3% of patients and pharmacological conversion with amiodarone in 46.7%. Rhythm control therapy was administered to over 80% of the cohort, and 63.9% were placed on oral anticoagulation, predominantly for rheumatic and congenital heart diseases. The overall success rate of rhythm control was 96.2%, with an AF recurrence rate of 3.8%. Ischemic stroke was the most common complication, occurring in three patients, all with underlying rheumatic heart disease. Conclusions: AF in paediatric patients is predominantly associated with rheumatic and congenital heart diseases, though a significant proportion of patients present with lone AF. Despite effective rhythm control in most cases, neurological complications, particularly ischemic strokes in patients with underlying heart disease, remain a critical concern. These findings underscore the need for more comprehensive studies to better understand the aetiology, risk factors, and optimal management strategies for paediatric AF.

511 Assessing the carry-over effects of precision livestock technology on steer performance and carcass characteristics

Abstract Our objective was to evaluate how virtual fencing grazing management during the stocker phase influences steer growth performance, carcass traits, and enteric emissions during the finishing phase. Angus steers [n = 96; initial body weight (BW) = 375 ± 7.2 kg) grazed native rangeland from 07 June 2023 to 31 August 2023 in Cottonwood, SD at South Dakota State University’s Cottonwood Field Station. Following summer grazing, steers were transported to Brookings, SD and fed for 130-d at the South Dakota State University Cow-Calf Education and Research Facility. During the summer grazing season, steers were assigned to different stocking rates (Light, Moderate, and Heavy, at 0.32, 0.42, and 0.72 animal unit months, respectively), and grazing strategies [continuous (CG) or virtual fencing rotational (RG)] in a 2 × 3 factorial design. Steers were transitioned from a 30% roughage to a 10% roughage diet over 21-d. The finishing diet (13.7% CP, 17.2% NDF, 1.36 Mcal/kg NEg, and 30 g/907-kg monensin sodium) was manufactured twice daily and provided ad libitum. Feed consumption was tracked using precision monitoring equipment (Insentec, The Hague, Netherlands). Steers were individually weighed on d 1 (entry BW), 21, 63, 90, and 130 and administered a steroidal implant (200 mg trenbolone acetate and 20 mg estradiol; Revalor-200, Merck Animal Health, DeSoto, KS) on d 21. Enteric emissions, including methane and carbon dioxide, were monitored using the GreenFeed trailer system (C-Lock Inc., Rapid City, SD), growth performance, carcass traits, and categorical carcass traits were analyzed in a factorial design using a randomized complete block design with individual steer considered the experimental unit. Final BW was determined from hot carcass weight divided by 0.625. Steers from heavy-CG had greater feedlot entry BW (P ≤ 0.05) compared with all treatments except light-CG and light-RG. Light-CG and light-RG had greater entry BW compared with heavy-RG (P ≤ 0.05). Gain efficiency was greater for light-CG compared with light-RG, moderate-CG, and heavy-CG (P ≤ 0.05), while moderate-RG and heavy-RG were intermediate (P ≤ 0.05). Steers from moderate-RG had greater marbling scores compared with heavy-RG (P = 0.05), and all other treatments were intermediate. Neither stocking density (P ≥ 0.15) nor grazing management strategy (P ≥ 0.13) had any influence on other measures of growth performance, emissions (CH4 and CO2) production rate, or carcass traits. These findings suggest that stocking density and grazing-management strategy (CG vs. virtual fencing-RG) influence gains on pasture and alter feedlot entry BW, highlighting the need for further investigation into their implications for greenhouse gas emissions, as well as for determining optimal stocking densities and management strategies for ranchers

Management strategies and outcomes in pregnancy-related acute aortic dissection: a multicentre cohort study in China

BackgroundAcute aortic dissection (AD) in pregnancy poses a lethal risk to both mother and fetus. However, well-established therapeutic guidelines are lacking. This study aimed to investigate clinical features, outcomes and...

Stress-induced hyperglycemia and mortality in patients with traumatic brain injury without preexisting diabetes: A meta-analysis.

Stress-induced hyperglycemia (SIH) is common in patients with traumatic brain injury (TBI) and has been suggested to influence mortality rates. This meta-analysis aims to evaluate the impact of SIH on the mortality of TBI patients without preexisting diabetes mellitus (DM). A comprehensive search was performed in Medline, Web of Science, Embase, Wanfang, and CNKI databases up to May 15, 2024, to retrieve relevant studies. Observational studies reporting the incidence of all-cause mortality among TBI patients without preexisting DM, comparing those with and without SIH, were included. The association between SIH and all-cause mortality was analyzed using risk ratios (RR) and 95% confidence intervals (CI) with a random-effects model. Twelve cohort studies comprising 15 datasets with 16,387 TBI patients were included. The pooled analysis showed that SIH was associated with a higher risk of all-cause mortality (RR: 2.00, 95% CI: 1.72-2.33, p < 0.001), with mild heterogeneity (I² = 25%). Sensitivity analysis confirmed the robustness of these findings. Subgroup analyses indicated no significant differences based on study design, patient age, gender proportion, SIH definition, or follow-up duration. However, the association was slightly weaker but still significant in studies using multivariate analyses (RR: 1.76) compared to univariate analyses (RR: 2.69). In conclusion, SIH was associated with a higher risk of all-cause mortality in TBI patients without preexisting DM. Further research should explore the underlying mechanisms and optimal management strategies for SIH in this population.

Paradoxical Reaction to Tuberculosis Therapy among HIV-Negative Children: A Systematic Review and Meta-Analysis.

Tuberculosis treatment is sometimes associated with clinical deterioration, referred to as paradoxical reaction (PR), especially in those with HIV coinfection. However, the burden and characteristics of PR in children without HIV coinfection are unclear. We undertook a systematic review to estimate the burden and clinical characteristics of PR in HIV-negative children. We searched PubMed, Embase, Web of Science, CINAHL, Scopus, Cochrane Library, ProQuest, and OpenGrey for studies reporting PR in HIV-negative children (<18 years old). We included observational studies including case series with at least five cases. Data on incidence/prevalence, clinical features, risk factors, management strategies, and outcome of PR were extracted. Risk of bias in the included studies was assessed using the NIH's quality assessment and Joanna Briggs Institute critical appraisal tools. We pooled the prevalence data using random effects meta-analysis. We identified 1,673 studies, of which 10 were eligible for inclusion. They described PR in 133 HIV-negative children. The pooled prevalence was 8.8% (95% CI: 2.9%, 14.6%). Owing to heterogeneity among studies, risk factors for the development of PR could not be identified. Limited data suggested that children developing PR were younger and had neurological or lymph node tuberculosis more often. Most children were treated with corticosteroids, but data were insufficient to identify the optimal management strategy. The review showed that PR affects nearly 1 in 12 HIV-negative children receiving tuberculosis treatment. The paucity of studies emphasizes the need for surveillance/studies to better characterize clinical features, risk factors, appropriate management strategies, and outcome.

Straw Returning With No‐Tillage Alleviates Microbial Metabolic Carbon Limitation and Improves Soil Multifunctionality in the Northeast Plain

ABSTRACTStraw returning has been broadly recognized as an agronomic strategy to manage soil quality and has great potential to enhance soil fertility. However, soil microbial metabolism and ecosystem multifunctionality in response to various straw returning strategies in the black soil remain poorly understood. Here, a 5‐year field trial was conducted to discover the effects of four straw management strategies (SIDP, straw incorporation by deep ploughing; SIRT, straw incorporation by rotary tillage; SM, straw mulching with no‐tillage; SR, straw removal with no‐tillage) on the soil biochemical properties in the topsoil (0–20 cm) and subsoil (20–40 cm). SM maintained soil fertility, as evidenced by increases in soil organic carbon, total nitrogen, dissolved organic carbon, and nitrogen, compared with SIDP and SR. Additionally, this strategy promoted microbial biomass. It also stimulated nutrient cycling through increased enzyme activity. Meanwhile, SM alleviated microbial carbon limitation and promoted the shift of soil microbial metabolism from P limitation to N limitation compared to other treatments, especially in the subsoil. This shift was directly influenced by soil available nutrients and microbial properties, as revealed by the partial least‐squares path modeling analysis. Besides, SM promoted soil ecosystem multifunctionality by 29%–37% in both soil layers compared to SIDP and SR. Random forest analysis indicated that soil microbial biomass and activity were the main drivers of this increase in multifunctionality. In conclusion, straw returning with no‐tillage is an optimal straw management strategy for improving the soil biochemical properties, stimulating enzyme activities, alleviating microbial carbon limitation, and increasing ecosystem multifunctionality in the Northeast Plain.

Dynamical and optimal control analysis of lymphatic filariasis and buruli ulcer co-infection

This study delves into the dynamics of lymphatic filariasis and buruli ulcer coinfection, two overlooked yet impactful tropical diseases. With lymphatic filariasis, commonly referred to as elephantiasis, and buruli ulcer, a chronic affliction caused by mycobacterium ulcerans, both posing significant health challenges, understanding their interaction is crucial. Utilizing a mathematical model, this research aims to analyze the dynamics of this coinfection, elucidating its complexities. The study establishes the local asymptotic stability of the disease-free equilibrium and calculates the basic reproduction number using the next generation matrix. It uncovers transcritical and backward bifurcation phenomena within the model. Additionally, the integration of time-dependent controls enables the exploration of optimal disease management strategies. Numerical simulations highlight the efficacy of employing a comprehensive approach, utilizing all available controls simultaneously, as the most effective strategy for disease control. These findings underscore the importance of integrated interventions in combating lymphatic filariasis and buruli ulcer coinfection, offering valuable insights for public health policymakers and practitioners.