Optimal Management Research Articles

Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions.

The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence. This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables. No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates. For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.

Lithium battery SOC estimation based on improved sparrow search algorithm and backpropagation neural network

Accurate state-of-charge (SOC) estimation is crucial for optimal battery management. This paper proposes a novel method, the Improved Sparrow Search Algorithm-Backpropagation (ISSA-BP) neural network, to address the issue of low estimation accuracy encountered with a single BP neural network. ISSA is used to optimize the initial weights and thresholds of the BP neural network, effectively overcoming its tendency to get stuck in local minima. Compared to the single BP neural network, ISSA-BP demonstrates significantly improved accuracy under two conditions (DST and BJDST), with reductions in root mean square error by 64.0% and 50.9% and mean absolute error by 69.8% and 51.1%, respectively. These results highlight the superior robustness and accuracy of the ISSA-BP algorithm for SOC estimation in lithium batteries.

No benefit from the addition of low-dose ketamine infusion to standard evidence-based care of patients with multiple rib fractures.

Multiple rib fractures from blunt thoracic trauma cause significant morbidity. Optimal current management includes multimodal analgesia, pulmonary hygiene, and early mobilization. Low-dose ketamine infusion (LDKI) has been proposed as an adjunctive analgesic in this setting. A prior study reported decreased pain scores with LDKI in patients with multiple rib fractures. We hypothesized that LDKI would decrease morphine milligram equivalents (MMEs) in patients with multiple rib fractures. A prospective randomized placebo-controlled trial was performed in adult (18 years or older) patients with three or more rib fractures. A prestudy power analysis calculated an 80% chance of identifying a 15% decrease in MMEs with 50 subjects. The study was approved by the institutional review board and informed consent obtained in all subjects. Demographic (age, sex) and injury specific information (Injury Severity Score, number of rib fractures) were obtained. Subjects were randomized 1:1 to receive continuous LDKI (0.1 mg/kg/h) or placebo infusion (0.9% NaCl) for ≤48 hours. All patients received a standard evidence-based multidisciplinary protocol for rib fractures management. Primary outcome measure was MME use or pulmonary complications. Statistical comparison of LDKI versus placebo was performed using the Mann-Whitney U test. All 50 enrolled subjects (placebo, 25; LDKI, 25) received study drug infusion. The two groups were well matched for age, Injury Severity Score, and number of rib fractures. We observed no differences in the Day 1 (p = 0.961), Day 2 (p = 0.373), or total MMEs (p = 0.946) between groups. Similar total MME use was observed when subjects who received ≥40 hours of study drug and were compared (p = 0.924). Use of LDKI did not alter subsequent need for opiate analgesics postinfusion, hospital length of stay, pulmonary complications, or need for readmission. The addition of LDKI to an established multimodal, evidence-based protocol for management of multiple rib fractures did not decrease opiate usage or impact pulmonary complications. Therapeutic/Care Managaement; Level I.

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exists a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomical variations, disparity in healthcare resources and infrastructure and the lack of consensus on the optimal management of aortic stenosis in the Asia-Pacific region. Hence, an Asian Pacific Society of Cardiology (APSC) working group, including a multidisciplinary group of general and interventional cardiologists, cardiac surgeons and imaging specialists, developed a position statement on the recommendations for TAVI in the management of aortic stenosis. The APSC expert panel reviewed and appraised the available evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Recommendations were developed and put to an online vote. Consensus was reached when 80% of votes for a given recommendation were in support of ‘agree’ or ‘neutral.’ The resulting 28 statements provide guidance for clinical practitioners in the region on the use of TAVI in the treatment of patients with aortic stenosis.

Concordance of ChatGPT With American Burn Association Guidelines on Acute Burns.

Burn injuries often require immediate assistance and specialized care for optimal management and outcomes. The emergence of accessible artificial intelligence technology has just recently started being applied to healthcare decision making and patient education. However, its role in clinical recommendations is still under scrutiny. This study aims to evaluate ChatGPT's outputs and the appropriateness of its responses to commonly asked questions regarding acute burn care when compared to the American Burn Association Guidelines. Twelve commonly asked questions were formulated by a fellowship-trained burn surgeon to address the American Burn Association's recommendations on burn injuries, management, and patient referral. These questions were prompted into ChatGPT, and each response was compared with the aforementioned guidelines, the gold standard for accurate and evidence-based burn care recommendations. Three burn surgeons independently evaluated the appropriateness and comprehensiveness of each ChatGPT response based on the guidelines according to the modified Global Quality Score scale. The average score for ChatGPT-generated responses was 4.56 ± 0.65, indicating the responses were exceptional quality with the most important topics covered and in high concordance with the guidelines. This initial comparison of ChatGPT-generated responses and the American Burn Association guidelines demonstrates that ChatGPT can accurately and comprehensibly describe appropriate treatment and management plans for acute burn injuries. We foresee that ChatGPT may play a role as a complementary tool in medical decision making and patient education, having a profound impact on clinical practice, research, and education.

Dynamics of soluble salts in cooling systems of circulating water supply

A model of the dynamics of soluble salts in the water of cooling systems of circulating water supply was developed based on mass balance principles. The proposed model is expressed in a general form under the assumption of a constant volume of circulating water and non-stationary input and output flows. The model accounts for scenarios where the concentration of soluble salts exceeds their concentration in the circulating water, thereby considering the technological necessity to change the system's power source in the event of an emergency at the feedwater treatment facilities. The developed model enables accurate prediction of the water-chemical regime in both existing and new recirculating cooling systems, sufficient for engineering calculations. It also facilitates the selection of optimal management strategies for such systems, including stabilization methods for recirculating water, feedwater preparation, blowdown volumes, etc. The model was validated under laboratory conditions for cases of concentration and dilution of highly soluble NaCl salt, with an observed error margin not exceeding 2%, attributed to experimental and instrumental factors. The variation in the concentration factor was analyzed for different blowdown rates, assuming initial equality of soluble salt concentrations in feedwater and circulation water. It was shown that establishing dynamic equilibrium between the circulation and feed waters can require dozens or even hundreds of circulation cycles for blowdown rates of 1–4%, and this system inertia must be considered during operation and when forecasting the performance of cooling systems with circulating water supply.

Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study.

The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF). We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded. A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences. In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.

Precommercial Thinning but Not Commercial Thinning Increases the Merchantable and Large Sawlog Volume Production of Lodgepole Pine on Fair Sites

Abstract The effect of thinning on stand structure and volume production is well studied. However, the effect of combinations of precommercial (PCT) and commercial thinning (CT) on the production of different log grades and differential growth responses is less understood, although it is crucial for forest managers to choose an optimal management regime. Starting with actual operational field data from a lodgepole pine (Pinus contorta var.latifolia) PCT trial on fair quality sites (site index: 16–18 m at 50 years), we used an individual tree growth model to forecast development over the entire rotation. We found thinning changed the structure (density, quadratic mean diameter) of the stands but not the total volume production. However, in terms of merchantable volume and large sawlog volume, stands with only PCT provided the largest volume, more than either CT or a combination of PCT and CT, or the unthinned control. Moreover, our study findings also showed that, by doing only PCT, stands reached maximum merchantable or large sawlog mean annual increment earlier than other thinned or unthinned stands. This indicates that PCT might shorten the rotation length and contribute to an enhanced supply of timber. Study Implications: The effect of commercial thinning (CT) on stand structure and volume production is well studied. However, the effect of combinations of precommercial (PCT) and commercial thinning (CT) on the production of different log grades and differential growth responses is less studied, although it is crucial for forest managers to choose a management option. Starting with actual operational field data from a lodgepole pine (Pinus contorta var.latifolia) PCT trial in a fair-quality site (site index [SI]: 16–18), we used an individual tree growth model to develop the stands over the entire rotation. We found thinning changed the structure (density, quadratic mean diameter) of the stands but not the total volume production. However, in terms of merchantable volume and large sawlog volume, stands with only PCT provided the largest volume, more than either CT or a combination of PCT and CT, or the unthinned control. Moreover, our study findings also showed that, by doing only PCT, stands reached maximum merchantable or large sawlog MAI earlier than other thinned or unthinned stands. This indicates that PCT might shorten the rotation length and contribute to the continuous supply of timber production.

(Re)conceptualising Good Care in Hospital Settings From the Perspectives of Older Persons: A Concept Analysis Using Pragmatic Utility.

To understand good care from the perspective of hospitalised older persons. Older persons are the largest group of hospital users, and numbers will increase in the next decades. Hospital organisations are attempting to transform traditional care models to meet the specialised needs of hospitalised older persons. To achieve this, healthcare providers including nurses and administrators need to understand the perspectives of hospitalised older persons on what constitutes good care. This knowledge is critical to nursing to ensure that care aligns with the perceived needs of hospitalised older persons. However, good care from the viewpoints of hospitalised older persons remains ambiguous and poorly delineated in the literature. We conducted a concept analysis using the pragmatic utility method. To identify peer-reviewed articles, we searched CINAHL, MedLine, PsycINFO, Scopus and Embase databases for related literature using the keywords and related terms to 'good care', 'hospital or acute care' and 'older persons'. Twenty-two peer-reviewed articles out of 2144 search results were included. The heterogeneity of older persons' perspectives and limitations in the literature on good care led to a tentative understanding. Good care, a partially mature concept, is the provision of person-centred, culturally sensitive, holistic and integrated care that fosters autonomy, control and participation, resulting in a sense of belonging, smooth transitions, optimal management of clinical conditions, satisfaction in care and informed older persons and family caregivers. Older persons are a heterogeneous group with diverse perceptions of good care. Instead of seeking a common understanding of good care, efforts should be focused on identifying individual preferences, values and goals of hospitalised older persons. The components of good care are important for many hospitalised older persons and can serve as a starting point for improvements in practice settings. However, this understanding is tentative and may overlook critical aspects of care at an individual level. Hospital organisations, healthcare providers and nurses should be cognizant of this limitation and cultivate adaptability for an individualised approach to care.

Giant cystic lymphangioma as a rare cause of acute abdomen in infancy: a case report and literature review

Lymphangioma, a benign mass of lymphatic origin, primarily affects the head, neck, and oral cavity, with the abdomen being an uncommon location. Clinical presentation is defined by site of origin and size. We present the case of a 10-month-old male infant with no previous medical history, admitted to our department with diffuse abdominal pain and distension. Physical examination revealed a huge, palpable mass arising from the left abdomen, abdominal tenderness, guarding, and rigidity. Abdominal ultrasound revealed a multilocular, non-measurable mass with both cystic and solid components that were suggestive of a giant cystic lymphangioma. Multidetector computed tomography and magnetic resonance imaging were performed to estimate the size and extension of the tumor for preoperative planning. Moreover, an elevated alpha-fetoprotein level further supported the neoplastic origin of the tumor. Exploratory laparotomy was performed, and a mass measuring approximately 13.9×16.7×15.4 cm was identified and completely excised in negative margins. Histopathological findings confirmed the initial diagnosis. Our patient had an uncomplicated postoperative course and recovery, with no signs of recurrence on a 6-month follow-up. Giant abdominal lymphangiomas in infants are extremely rare and close attention for complications is vital. Surgical intervention with complete resection is considered the optimal management.

Enhancing wind erosion risk assessment through remote sensing techniques.

Preventing wind erosion and dust storms has always been a major concern in arid and semi-arid areas because of their negative effects on the environment. This study aims to utilize remote sensing and machine learning techniques to model, monitor, and predict the risk of wind erosion in Northeast Iran. Through an examination of relevant studies, a comprehensive review was conducted, leading to the identification of eight remote sensing indicators that exhibited the highest correlation with field data. These indicators were subsequently employed to model the risk of wind erosion in the study area. Various methods including Random Forest (RF), Support Vector Machine (SVM), Gradient Boosting Machine (GBM), and Generalized Linear Models (GLM) were employed to carry out the modeling process. The final method utilized a weighted average of the model, and the SDM statistical package was used to combine different approaches to decrease uncertainty when modeling and monitoring wind erosion in the area. The modeling results indicated that in 2008, the RF model performed the best (AUC = 0.92, TSS = 0.82, and Kappa = 0.96), while in 2023, the GBM model showed superior performance (AUC = 0.95, TSS = 0.79, and Kappa = 0.95). Therefore, the utilization of an ensemble model emerged as an effective approach to reduce uncertainty during the modeling process. By employing the ensemble model, the outcomes obtained accurately depicted an elevated intensity of wind erosion in the northeastern regions of the study area by 2023. Furthermore, considering the climatic scenarios and projected land use changes, it is anticipated that wind erosion intensity will experience a 23% increase in the central and southern parts of the study area by 2038. By taking into account the reliable results of the ensemble model, which offers reduced uncertainty, it becomes feasible to implement effective planning, optimal management, and appropriate measures to mitigate the progression of wind erosion.

The path to individualization of infusion therapy for emergency conditions according to the ROSE concept

The article is devoted to the role of intravenous fluid therapy in conditions of impaired fluid homeostasis, which often occur during major surgical interventions and critical conditions, such as sepsis and trauma. The importance of adequate fluid administration to maintain cellular homeostasis, as well as the management of conditions associated with hypovolemia and hemodynamic disturbances, is described. It is noted that, despite numerous studies, the topic of optimal fluid management strategies remains controversial, with potential risks of adverse effects of excessive fluid administration on clinical outcomes. The concept of liquid resuscitation ROSE is presented, which includes four stages: resuscitation, optimization, stabilization and evacuation. This concept will assist physicians in making decisions about fluid therapy management. Different types of fluids are reviewed, including balanced solutions and the multifunctional hyperosmolar solution Reosorbilact, and the importance of individualizing therapy based on the needs of each patient is emphasized. The importance of the need for careful monitoring and control of fluid balance is emphasized to avoid complications and ensure improved clinical outcomes

The Impact of ESG Ratings on Investment Decisions in the Energy Sector During Uncertain Times

With increasing global awareness of sustainability, the financial sector must inevitably adapt. Our research investigates the role of Environmental, Social, and Governance (ESG) ratings in investment decision-making, particularly in the energy sector, by examining their impact on portfolio performance. The study aims to assess the impact of ESG integration on portfolio risk and returns. Using data from the SP500 index, econometric models and Monte Carlo simulations are employed to evaluate how ESG considerations influence portfolio optimization and risk management. The study reveals that integrating ESG criteria into investment strategies, especially during market volatility, may not always directly affect returns, they provide significant benefits in terms of risk mitigation and ethical investment alignment.

Current Trends in the Treatment of Pediatric Hydrocephalus: A Narrative Review Centered on the Indications, Safety, Efficacy, and Long-Term Outcomes of Available Treatment Modalities

The pathophysiologic substrate of pediatric hydrocephalus has not been thoroughly elucidated. Valve-based shunt systems have constituted the main therapeutic option since the late 1950s. The initially used systems were concerning the ventricular system and the atrium. In the 1970s, VA shunts were not the main stay of treatment as the preferred option for the terminal end of the drainage system was the peritoneum. Our review analyzes these valve types and attempts a comparison, based on their functional characteristics. Nowadays, the only available surgical alternative for the treatment of hydrocephalus is ETV. This technique is associated with lower infection rates as well as, on average, a lower re-operation rate. Another term that deserves special mention is related to the outcome of ETV in children who had a medical history of previously incorporated shunts and who were subsequently suffering from shunt malfunction. Well-recognized predictive factors associated with secondary ETV failure include age, early onset of hydrocephalus, and prematurity. Although several attempts have been made in order to establish the optimum surgical treatment management in the different subgroups of patientswho are suffering from shunt dysfunction, there is no universal agreement. Therefore, this review attempts to identify the specific subpopulations of patients in whom the insertion of a drainage system as the preferred treatment modality is associated with an optimum long-term prognosis, compared to ETV, and vice versa. The objective of our study is to analyze the safety, efficacy, and outcomes of drainage devices and ETV in pediatric hydrocephalus patients.

Submacular hemorrhage: My personal journey to the goal.

Acute submacular hemorrhage (SMH) can be caused by various diseases including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and retinal arterial microaneurysm (RAM). The natural course of submacular hemorrhage is generally poor. Animal studies have suggested that the removal of subretinal hemorrhage may effectively reduce retinal damage caused by hemorrhage in humans and removal of submacular hemorrhage have been performed with limited visual outcomes. Pneumatic displacement involving intravitreal expansile gas with or without adjunctive intravitreal injection of tissue plasminogen activator (tPA) has demonstrated effective displacement of SMH and improvement in visual acuity in the majority of cases. Although tPA may not be indispensable, its use may facilitate displacement. Combining pneumatic displacement with vitrectomy and subretinal injection of tPA may achieve superior displacement of SMH compared to pneumatic displacement of SMH, implying that pneumatic displacement of SMH with vitrectomy and subretinal injection may offer enhanced effectiveness in SMH displacement,while noobvious different was found in visual outcomes between the two treatments.Complications associated with these procedures encompass breakthrough hemorrhage, retinal detachment and macular hole formation. Breakthrough hemorrhage is more commonly observed following pneumatic displacement whereas retinal detachment appears to be more prevalent following vitrectomy. Macular hole formation subsequent to vitrectomy represents a significant complication, particularly in eyes with SMH attributed to ruptured retinal arterial microaneurysm. Both pneumatic displacement and vitrectomy present advantages and disadvantages, and the superiority between the two remains undetermined. Sequential strategy for the treatment of submacular hemorrhage is another option. As the initial step, pneumatic displacement of SMH should be attempted, and if displacement is insufficient, pneumatic displacement following vitrectomy with subretinal injection of tPA may be pursued. Further investigations are warranted to ascertain optimal management strategies for SMH leading to improved outcomes. KEY MESSAGES: What is known • Pneumatic displacement with/without intravitreal tPA injection, and vitrectomy with subretinal tPA injection and gas are the two major treatments for submacular hemorrhage. What is new • No obvious different was found in visual outcomes between vitrectomy, subretinal tPA injection and gas, and intravitreal tPA injection and gas while vitrectomy with subretinal tPA injection and gas may achieve better displacement of submacular hemorrhage. • Macular hole formation is a specific complication for submacular hemorrhage due to ruptured retinal arterial macroaneurysm.

A Systematic Review of Comparative Effectiveness of Interventions for Low Anterior Resection Syndrome: Impacts on Bowel Function and Quality of Life.

Low anterior resection syndrome (LARS) is a common complication following sphincter-preserving surgical resection for rectal cancer, characterized by symptoms such as fecal incontinence, urgency, and altered bowel habits, which significantly affect patients' quality of life. This cluster of symptoms not only limits their day-to-day physical activity but also has a debilitating effect on their emotional and mental well-being, undermining their integration and overall psychological health. This systematic review aimed to evaluate the effectiveness of invasive and non-invasive interventions for LARS, including pelvic floor rehabilitation, transanal irrigation, and various surgical options such as sacral neuromodulation and stoma formation, either as part of primary surgery or as a definitive treatment option for refractory cases. We systematically searched relevant databases for studies published in the last decade, focusing on adult patients diagnosed with LARS post-low anterior resection (LAR), with outcomes assessed through bowel function and quality of life metrics. The review identified six studies that met our eligibility criteria; a pooled cohort of 794 patients was identified, with sample sizes ranging from 37 to 430 participants. Our analysis revealed that pelvic floor rehabilitation significantly improves bowel function and quality of life in patients with LARS; yet, the optimal management approach remains unclear due to variability in patient responses. These findings highlight the inherent complexity and heterogeneity of LARS management, underscoring the necessity for multifaceted and individualized treatment strategies. Although pelvic floor rehabilitation shows promise, especially among motivated patients, its long-term sustainability remains uncertain. Surgical options are typically reserved for severe cases and carry significant risks and psychological impacts. For patients identified as being at high risk for LARS, treatment options must be considered and discussed at an earlier phase of their care. Our review concludes with the need for a tailored, patient-centered approach to managing LARS, highlighting the importance of ongoing research to fill existing evidence gaps. There is a need for translational research across various treatment modalities, comparing their effects, cost-effectiveness, implementation strategies, and the consequent effects on patients' quality of life and mental health.

Risk Factor Analysis and Algorithmic Approach for Managing Deep Brain Stimulation Device-Related Wound Complications

Background: Although implanting deep brain stimulation (DBS) devices carries up to a 15% risk of complications, optimal management strategies remain poorly understood. This study aimed to review the risk factors for wound complications of DBS device implantation and develop an algorithm for proper management.Methods: Patients with Parkinson disease who underwent bilateral subthalamic nucleus DBS device implantation between 2005 and 2022 were retrospectively reviewed. All DBS-related wound complications such as infection, dehiscence, erosion, and displacement were recorded, and factors associated with device explantation were also assessed.Results: A total of 398 patients underwent DBS device implantation using 796 electrodes and implantable pulse generators. During the mean follow-up of 9.8 ± 5.5 years, 28 patients (7.0%) experienced wound complications that required reoperation, including 14 infection (50.0%), 22 dehiscence (78.6%), five skin erosion (17.9%), and two device displacement (7.1%). Complications were resolved with a single reoperation in 13 patients (46.4%), while nine patients underwent 2–3 surgical procedures (32.2%), and six patients in 6–8 operations (21.4%). The device was salvaged in 16 patients (57.1%) and removed in 12 (42.9%). Infection (P = 0.010), shorter time interval from device implantation to complications (P = 0.022), higher C-reactive protein levels (P = 0.026), methicillin-resistant <i>Staphylococcus aureus</i> growth (P = 0.044), and history of multiple previous revisions (P < 0.001) were associated with device removal.Conclusion: To maximize the therapeutic benefit of DBS and minimize the time, effort, and cost required for revision, temporary explantation in early stages followed by reimplantation of the device after the wound subsides should be considered in high-risk cases.

Laboratory Management; Challenges and Opportunities in FkipUhamka

This study aims to analyze the management of basic physics laboratories at UniversitasMuhammadiyah Prof DR HAMKA and its impact on user performance and satisfaction. Optimal management of basic physics laboratories is very important to support the learning process and student practicums. This study uses a descriptive method with a quantitative approach, where data is collected through questionnaires distributed to lecturers and students who use the laboratory. The results of the study indicate that the management of basic physics laboratories at UniversitasMuhammadiyah Prof DR HAMKA has been running well, but there are still several aspects that need to be improved, such as equipment maintenance, additional facilities, and improving work safety. Data analysis shows that there is a significant relationship between laboratory management and user performance and satisfaction. Good management will improve the efficiency of laboratory use, which in turn will improve academic performance and user satisfaction. Based on the findings, several suggestions are given for further improvement, including planning for periodic maintenance, adding facilities, improving laboratory technician skills, and regular monitoring and evaluation. The implementation of these suggestions is expected to improve the quality of basic physics laboratory management at UniversitasMuhammadiyah Prof. DR HAMKA.

A Delphi consensus project to capture experts' opinion on hyperkalaemia management across the cardiorenal spectrum.

The main purpose of this project was to capture experts' opinion on hyperkalaemia management and form best practice recommendations for cardiorenal patients in Greece. A steering committee of nephrologists and cardiologists developed 37 statements. An online questionnaire completed by 32 experts in cardiorenal management in Greece. Median score used to determine the level of agreement and disagreement index (DI) used to determine the level of consensus for each statement. Statements divided in four sectors: hyperkalaemia risk management, preventative measures, treatment and collaboration between specialties. The rate of the first round of the consensus was 94.6%. Median score was >7 for 36 of 37 statements and DI≤1 for 35 of 37. Among other statements, consensus reached for recognizing levels K+>5.0mEq/L as associated with elevated mortality risk; retaining renin-angiotensin-aldosterone system inhibitors (RAASi) on maximum recommended dose for cardiorenal patients; and using novel K+ binders to help enabling guideline-recommended doses of RAASi therapy. Cardiologists compared to nephrologists showed higher reluctance to discontinue down-titrate RAASi and MRA in patients with K+ levels above 5mEq/L. Additionally, 88.9% of nephrologists and 71.4% of cardiologists agreed that cross-specialty alignment on a serum K+ concentration level (K>5.5mEq/L) is needed to initiate hyperkalaemia treatment. Both cardiologists and nephrologists showed disagreement with the statement on keeping titration in cardiorenal patients with K+>5.5mEq/L or preserving fruit and vegetable consumption when moderate or severe hyperkalaemia exhibits. This Delphi project pointed out nephrologists' and cardiologists' agreement on hyperkalaemia management in cardiorenal patients; thus, it can help a cross-specialty optimal management of cardiorenal patients, with hyperkalaemia not being an obstacle for disease-optimizing therapy. Novel potassium binding agents can enable guideline-recommended doses of potassium-sparing medication.

Age-Dependent Enhancement in Fecundity and Ova Diameter of <i>Schizopyge niger</i> (Heckel, 1838) in Dal Lake, Kashmir

Understanding the reproduction and recruitment pattern is essential for successful conservation of a species. Accurate estimates of fecundity plays acrucial role in comprehending fish population dynamics. The snowtrout, Schizopyge niger, is a Cyprinid fish widely distributed throughout the lakes of Kashmir valley and is one of the most important commercial fish species. In this study, we examined the age-dependent reproductive perfor-mance of female S. niger, aiming to gain insights into its breeding characteristics for the development of an optimal brood-stock management plan. The study involved 78 female S. niger specimens collected from Dal Lake during the spawning season, representing age groups of 2+, 3+, 4+, 5+, and 6+ years. Fecundity and ova diameter showed an increasing trend from age 2+ (3,971 eggs; 1.45 mm) to age 6+ (10,501 eggs; 2.00 mm). Total fecundity exhibited positive correlations with age, total weight, ovary weight, and ova diameter. Additionally, there was a positive correlation between ova diameter and fish age, with the highest fecundity and largest ova diameter observed in the 6+ years age group. Among each age group, fecundity and ova diameter varied significantly (p <0.05). Based onthese findings, for optimal broodstock management of S. niger, it is recommended to use females of the6+ years age group after assessing the quality of eggs.