Optimal Management Strategy Research Articles

Intralesional steroid injection in keloid ear — a prospective observational study

BackgroundKeloid is a fibro-proliferative dermal benign growth affecting the Asian population. In India, ear keloids are common, often resulting from ear piercing, a prevalent cultural practice. The resultant ear keloids pose aesthetic concerns, leading to significant psychological distress, and necessitating effective treatment. While various treatment options are available, their outcomes and recurrence rates vary, highlighting the need for individualized and optimal management strategies. Our study aimed to observe the combined effect of intralesional triamcinolone with hyaluronidase on keloid regression.MethodsThis prospective observational study was conducted at our tertiary care institute over 1 and a half years. Fifty patients who met the inclusion criteria were enrolled and received intralesional triamcinolone injection with hyaluronidase. Keloid regression was assessed using the Vancouver Scar Scale (VSS), while the visual analogue score (VAS) and patient satisfaction score (PSS) provided subjective evaluations of symptom relief. All patients underwent compression therapy. Patients were evaluated at every visit and then at 1 year for symptom relief, keloid regression, and complications if any.ResultsDemographic data of all patients were recorded. Ear keloids were predominantly observed in females, with a male-to-female ratio of 18:32. The most common etiology was trauma following ear piercing, accounting for 46% of cases. All patients showed improvement in VSS, VAS, and PSS scores in the follow-up visits. A total of 98% of patients demonstrated a complete treatment response, with only a single instance of recurrence.ConclusionIntralesional triamcinolone with hyaluronidase provides satisfactory symptomatic relief and has lower recurrence rates. All patients showed improvement in the Vancouver Scar Scale and had enhanced VAS and PSS scores.

Obesity and Different Effect Between Exercise and Diet for Weight Loss

The worldwide increase in obesity has become a significant public health issue, linked to a range of chronic illnesses, including diabetes, heart disease, and some types of cancer. This study investigates the effectiveness of combined dietary and exercise interventions in promoting weight loss, drawing on a systematic literature review and case analysis of recent peer-reviewed research. By examining various dietary approachesincluding low-carbohydrate, Mediterranean, and calorie-restricted dietsalongside different exercise modalities such as aerobic training and high-intensity interval training (HIIT), this research aims to identify the optimal strategies for weight management. Findings indicate that individuals participating in combined interventions experience significantly greater weight loss and improvements in metabolic health compared to those following diet or exercise regimens alone. Moreover, the study emphasizes the importance of personalized interventions that consider individual preferences and psychological factors, suggesting that integrating social support mechanisms and technological tools can enhance adherence and long-term success. The results emphasize the need for comprehensive weight management strategies that address the interplay of dietary and exercise components, psychological support, and social influences to effectively combat obesity and promote overall health.

Diagnostic modalities for ischemic heart disease: evaluating the role of stress echocardiography, cardiac CT, and myocardial perfusion scintigraphy in guiding coronary angiography

Cardiovascular diseases, particularly ischemic heart disease (IHD), are the leading cause of mortality globally, accounting for 16% of deaths. Effective management of ischemic cardiomyopathy (ICM) is crucial, as outlined in the latest European Society of Cardiology (ESC) guidelines for chronic coronary syndrome (CCS). The guidelines emphasize a structured approach comprising four key steps: a general clinical evaluation to exclude non-cardiac causes, cardiac examination, and likelihood estimation using echocardiography, diagnostic testing such as stress echocardiography and coronary CT angiography, and treatment involving lifestyle changes and medication, alongside potential revascularization. The review underscores the importance of coronary angiography and functional assessments in diagnosing ischemic heart failure (IHF) and guiding treatment strategies. Non-invasive imaging techniques, including stress echocardiography and myocardial perfusion scintigraphy, are valuable for assessing ischemia and myocardial viability while reducing unnecessary invasive procedures. Coronary CT angiography is also examined for its procedural advantages and risks. A comparative analysis of diagnostic modalities highlights the strengths and limitations of each technique, emphasizing the need for individualized approaches based on patient characteristics. The ESC 2024 guidelines advocate for a patient-centered imaging strategy based on the likelihood of coronary artery disease (CAD) while addressing the economic and environmental impacts of imaging practices. Overall, implementing these guidelines and leveraging diverse imaging modalities can optimize management strategies for IHD, ultimately improving patient outcomes.

Hyperacute silicosis after bronchoscopy-induced melanoptysis in a lung transplant patient. A first report in literature.

Silicosis, a fibrotic lung disease caused by crystalline silica inhalation, presents unique challenges in lung transplantation. This case reports an unprecedented complication in a lung transplant recipient with chronic silicosis. A man in his 60 s, post left single-lung transplantation for silica-induced pneumoconiosis, developed acute respiratory deterioration following routine bronchoscopy. Melanoptysis, followed by imaging showing extensive inflammatory involvement in the transplanted lung, required intubation and prone positioning. This case highlights the potential for residual silicotic material to trigger acute post-transplant complications. It underscores the importance of comprehensive pretransplant evaluation of occupational exposures and heightened awareness of silica-related complications in post-transplant care. The report emphasizes gaps in understanding long-term outcomes and optimal management strategies for lung transplant recipients with silicosis.

Impact of preoperative stenting in management of bilateral ureteral stones.

This study aims to evaluate the impact of preoperative stenting on surgical outcomes and complications in patients with bilateral ureteric stones, specifically assessing its role in reducing the need for subsequent interventions. A retrospective analysis was conducted at a tertiary center over eight years, involving 82 patients with bilateral ureteric stones. Patients were divided into two groups: Group 1 (no preoperative stenting) and Group 2 (preoperative stenting). Key data collected included demographics, preoperative stone sizes, preoperative serum creatinine levels, operative details, postoperative complications, and stone-free rates (SFR) at two weeks post-surgery. Statistical analyses were performed using SPSS 25.0. Of the 54 patients analyzed (27 in each group), the mean age was 48.8 ± 12.7 for Group 1 and 52.3 ± 15.2 for Group 2. Group 2 exhibited significantly higher preoperative serum creatinine levels (p = 0.016). Secondary interventions were needed for 8 patients in Group 1 versus 3 in Group 2 (p = 0.042). The SFR was 67% in Group 1 and 78% in Group 2 (p = 0.361), indicating no statistically significant difference. Preoperative stenting may enhance the success of surgical interventions for bilateral ureteric stones, potentially reducing the need for further procedures. Further prospective studies are needed to validate these findings and optimize management strategies.

Distal augmentation in unstable distal clavicle fractures: a retrospective cohort study of 101 cases.

The optimal management strategy for unstable distal clavicular fractures remains controversial. Recent studies on plate techniques have reported good-to-excellent outcomes with no serious complications. The questions are that: (1) Does the use of wire augmentation with locking plate in distal part (distal wire augmentation) reduce radiographic loss of reduction (RLOR) and get earlier bony union in distal clavicular fractures? (2) Which fixation methods are associated with a higher incidence of acromioclavicular (AC) joints arthritis or subluxation? We collected and analyzed clinical studies on different plate fixation methods for unstable fractures to identify the best surgical modality. This retrospective case-control study included 101 patients with Neer types IIB and V unstable distal clavicle fractures treated using plate techniques. The patients were divided into four groups according to the surgical procedure: hook plate (HP group) (n = 13), lateral locking plate alone (LP group) (n = 41), locking plate with coracoclavicular (CC) ligament suture repair (LPC group) (n = 26), and locking plate with distal wire augmentation (LPA group) without CC repair (n = 21). The clinical outcomes of shoulder function were the mean Constant score and the University of California-Los Angeles (UCLA) shoulder scale. The bony union time, loss of CC distance reduction, and AC joint condition were used to evaluate the radiographic results. One-way ANOVA, Kruskal-Wallis test, and chi-square test were performed to compare differences between groups. Multiple p-value comparison corrections were calculated using the Bonferroni method. There were no significant differences in the mean Constant and UCLA scores among the groups after 1 year of follow-up. All fractures healed. The LPA and HP groups achieved earlier bone union (LPA 8.4 weeks, HP 8.9 weeks, LP 12.6 weeks, and LPC 13.4 weeks, P = 0.000); however, the HP group had the highest complication rate and required bone removal (LPA 4.0%, HP 23.1%, LP 0.0%, LPC 0.0%, P = 0.003). A low rate of RLOR was observed in the LPA group (LPA 9.5%, HP 23.1%, LP 22.0%, LPC 30.8%, P = 0.362). The incidence of AC joint subluxation was higher in the Neer type V group and was unrelated to surgical methods. Hook plate and locking plate with distal wire augmentation in distal clavicle fractures result in an earlier time to bone union when compared with CC suture repair or non-CC suture repair techniques. However, HP may have the higher complication rate and require subsequent implant removal. The incorporation of distal wire augmentation appears to be beneficial in maintaining fracture reduction. In the future, larger prospective studies are needed to confirm these findings. Level III, therapeutic study.

What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients.

Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population. We conducted a literature search in PubMed up to April 2024, focusing on CMV infection and disease in patients with overt immunosuppression (hematopoietic stem cell and solid organ transplantation, solid or hematologic malignancies, HIV infection, immunosuppressive drugs, including corticosteroids, and primary immunodeficiencies) admitted to the intensive care unit (ICU). As there is limited ICU-specific data on CMV in immunosuppressed patients, many of the findings were extrapolated from the general literature. CMV infection and disease in immunocompromised critically ill patients is associated with increased mortality and presents significant management challenges. Clinical manifestations are diverse, shaped by the underlying immune deficiency and primary disease. Pneumonia and encephalitis are among the most severe CMV end-organ diseases. CMV infection may also increase the risk of secondary infections and induce life-threatening conditions, such as thrombotic microangiopathy. Importantly, CMV reactivation is not synonymous with CMV disease, and qPCR testing of body fluids cannot reliably differentiate between viral shedding and tissue-invasive infection, which requires histopathological confirmation. Ganciclovir is commonly the first-line anti-viral, though maribavir shows potential for patients unresponsive to other antivirals. Identifying patients who require prophylactic or preemptive antiviral therapy is essential. CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV's pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.

Proteinuria's Influence on Clinical Outcomes and Prognostic Accuracy in Acute Ischaemic Stroke Patients Undergoing Reperfusion Therapy: A Comprehensive Meta-Analysis.

Proteinuria commonly accompanies acute ischaemic stroke (AIS) patients undergoing reperfusion therapies such as intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Understanding its influence on outcomes is crucial for prognosis and optimising management strategies. This study aims to elucidate proteinuria's role in mediating outcomes among reperfusion-treated patients. Through a random-effects meta-analysis, we analysed data to assess the association of proteinuria with functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. A total of 33 140 patients were included in the meta-analysis. Proteinuria demonstrated a pooled prognostic sensitivity of 58% (95% CI: [48%; 67%]; p < 0.001) for poor functional outcomes at 90 days. It was linked with increased odds of unfavourable functional outcome at 90 days in both IVT (OR 2.27; 95% CI: [1.95; 2.66]; p < 0.001) and EVT (OR 2.57; 95% CI: [2.16; 3.05]; p < 0.001) groups. Furthermore, it was associated with increased odds of 90-day mortality in IVT-treated patients (OR 2.31; 95% CI: [1.76; 3.02]; p < 0.001), while EVT-treated patients exhibited increased odds of in-hospital mortality (OR 2.71; 95% CI: [1.22; 6.04]; p < 0.05). The clinical significance of proteinuria is underscored by its impact on outcomes for AIS patients receiving reperfusion treatments. This awareness may guide individualised treatment by considering the intricate interplay between kidney function and its correlation with stroke. Consequently, this has the potential to improve prognosis and overall outcomes in AIS therapy.

Point shear wave elastography application in assessment pancreas tissue stiffness: A pilot study.

Recent advancements in medical imaging, such as point shear wave elastography (pSWE), offer non-invasive methods to assess tissue stiffness and structural changes. This study explores the use of pSWE to evaluate pancreatic stiffness and dimensions in three different pancreas parts. This study was conducted at diagnostic radiology department, King Abdulaziz University Hospital, Jeddah, between June 2022 and November,2022. Thirty-one diabetic patients and thirty-one healthy controls were included. Ultrasound pSWE examination was performed using a ultrasound system (Philips Elite Epic 7) to measure stiffness across different pancreatic parts. Pancreatic stiffness was quantified in meters per second (m/s), and the dimensions of each pancreatic part were recorded. Different parameters, including age, sex, height, weight, body mass index (BMI), and comorbidities, were collected and analyzed. Diabetic patients exhibited significantly higher shear wave velocities (SWVs) compared to healthy controls, indicating increased pancreatic stiffness. The mean shear wave velocity was 1.7m/s in diabetic versus 0.6m/s in controls (p<0.001). Additionally, the pancreatic head dimensions were significantly large in diabetic patients (2.1cm vs. 1.8cm; p=0.003), while the body and tail part showed no significant differences. A positive correlation was found between SWVs and BMI. The findings underscore the potential of pSWE as a non-invasive diagnostic tool for early detection and monitoring of diabetes-related pancreatic alterations. Assessing pancreatic stiffness and dimensions through pSWE can help in identify patients at risk for pancreatic complications and optimize management strategies. Point shear wave elastography (pSWE) could be a useful, non-invasive tool for early detection of pancreatic changes in diabetic patients, identifying those at risk for complications. Integrating pSWE into routine diabetes check may enhance early interventions and improve outcomes.

Research on the optimal control strategy of voltage management in distributed photovoltaic grid-connected station area

Research on the optimal control strategy of voltage management in distributed photovoltaic grid-connected station area

Optimal energy management strategy for distributed solar-powered UAV with multiple propellers

Optimal energy management strategy for distributed solar-powered UAV with multiple propellers

The impact of the war in Ukraine on the prevalence of MDR/RR-TB in Poland.

The 2022 invasion of Ukraine by the Russian Federation triggered a refugee crisis, affecting the multidrug-/rifampicin-resistant TB (MDR/RR-TB) prevalence in neighbouring countries. This study examines the epidemiological trends and characteristics of MDR/RR-TB patients in Poland, focusing on the relative contribution of Ukrainian refugees. Data from the Polish National Tuberculosis Registry and EPIC Project database, covering MDR/RR-TB cases reported between 2010 and Q1 2024, were analysed. The study included 794 MDR/RR-TB cases, showing a demographic shift post-2022. During the 10-year period up to 2021, a median of 48 MDR/RR-TB cases were reported annually in Poland. After 2022, these numbers doubled: 104 cases were reported in 2022 and 101 cases in 2023. Simultaneously, the number of Ukrainian MDR/RR-TB patients increased from 77 (13%) during 2010-2021 to 127 (58%) from 2022 to Q1 2024. Poland is observing an increased number of cases of MDR/RR-TB associated with the large number of displaced Ukrainian citizens who are now residing in Poland. There is a need to monitor the epidemiology of MDR/RR-TB and seek optimal screening and management strategies for TB among refugees from countries with high MDR/RR-TB incidence in Poland and Europe.

Epidural analgesia versus systemic opioids for postoperative pain management after VATS: Protocol for a systematic review.

Postoperative pain following video-assisted thoracoscopic surgery (VATS) remains a significant challenge. While epidural analgesia is still the gold standard, other types of regional analgesia are gaining popularity because of perceived less risk of complications. The efficacy of systemic opioids as an alternative to epidural analgesia has not been thoroughly explored. This systematic review and meta-analysis aims to evaluate and compare the efficacy of systemic opioids versus epidural analgesia in managing postoperative pain after VATS. We will conduct a systematic review and meta-analysis in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. A comprehensive search will be conducted in MEDLINE, EMBASE, and the Cochrane Library supplemented with Scopus citation searches, search for gray literature using Google Scholar and a search for ongoing studies. We will include studies based on the PICO methodology without restrictions regarding study type. Two independent reviewers will screen studies, extract data, and assess study quality using the Cochrane Risk of Bias tools. The primary outcomes will be postoperative pain intensity at rest and during activity at 24, 48, and 72 h. Secondary outcomes will include use of "rescue" opioids, hospital length of stay, and adverse events. If feasible, a meta-analysis will be done, otherwise we will perform a descriptive analysis. The results will provide a comparative analysis of the effectiveness of systemic opioids versus epidural analgesia in managing postoperative pain in VATS patients. Data synthesis will include pooled estimates for pain scores, opioid consumption, and adverse events, possibly with subgroup and sensitivity analyses conducted to explore heterogeneity across studies. This systematic review will offer valuable insights into the optimal pain management strategy for patients undergoing VATS. The findings may guide clinical practice in selecting the most effective and safe analgesic approach, improving postoperative recovery, and patient outcomes.

A Three-Stage Optimal Energy Management Strategy for Co-Phase Power Supply Systems with Integration of Renewable Energy

A Three-Stage Optimal Energy Management Strategy for Co-Phase Power Supply Systems with Integration of Renewable Energy

Stroma-derived neoplasms and pseudoneoplastic lesions of the spleen: a select review of pathologic and CT/MRI findings.

A wide spectrum of benign and malignant primary mesenchymal tumors and tumor-like lesions of the spleen has been recently included under the umbrella term 'stroma-derived' neoplasms and tumor-like lesions. These include dendritic cell neoplasms such as follicular dendritic cell sarcoma, EBV-positive inflammatory follicular dendritic cell sarcoma, and fibroblastic reticular cell tumor; smooth muscle and myofibroblastic lesions such as inflammatory pseudotumor, EBV-associated smooth muscle tumor and undifferentiated pleomorphic sarcoma as well as a diverse spectrum of vascular and vascular-stromal tumors and tumor-like lesions. While some tumor and tumor-like lesions are unique to the spleen, others may also occur in diverse extra-splenic viscera. These tumors and tumor-like lesions demonstrate characteristic histopathology, immunocytochemistry and biological behavior. While cross-sectional imaging studies allow detection, staging and limited characterization of these splenic lesions, histopathological confirmation permits optimal management and surveillance strategies.

European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma.

The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular trauma with the aim of assisting physicians in selecting the optimal management strategy. The guidelines are based on scientific evidence completed with expert opinion. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to the ESVS evidence grading system, where the strength (class) of each recommendation is graded from I to III, and the letters A to C mark the level of evidence. A total of 105 recommendations have been issued on the following topics: general principles for vascular trauma care and resuscitation including technical skill sets, bleeding control and restoration of perfusion, graft materials, and imaging; management of vascular trauma in the neck, thoracic aorta and thoracic outlet, abdomen, and upper and lower extremities; post-operative considerations after vascular trauma; and paediatric vascular trauma. In addition, unresolved vascular trauma issues and the patients' perspectives are discussed. The ESVS clinical practice guidelines provide the most comprehensive, up to date, evidence based advice to clinicians on the management of vascular trauma.

Active power loss reduction for optimal photovoltaic distributed generators allocation in hybrid medium-voltage AC-DC electrical distribution system

Due to improvements in PV technology, electrical distribution networks are increasingly integrating PV-based distributed generation (PVDG) systems to reduce reliance on a single power source and the greenhouse gas emissions produced by conventional power plants. However, reverse power flow created by high power output from intermittent PVDG can increase system power losses and distort the voltage profile. Proper positioning and size are required to inject a PVDG during peak hours. The principal contribution of this paper is the application of a new efficient and reliable algorithm known as the equilibrium optimizer algorithm (EOA) to solve the optimal allocation of multiple PVDG units in hybrid medium-voltage AC-DC distribution networks. Comparing the EOA technique to the light spectrum optimizer (LSO), the energy valley optimizer (EVO), and the Archimedes optimization algorithm (AOA), the convergence characteristics and results show that the EOA approach was the quickest and best strategy to obtain the best solutions. The results from the simulation demonstrate that higher performance in terms of reducing power loss and improving voltage profile can be obtained by achieving the ideal size and positioning of the PVDG sources via an optimum energy management strategy.

Coronary Plaque Characteristics Assessed by Optical Coherence Tomography and Plasma Lipoprotein(a) Levels in Patients With Acute Coronary Syndrome.

Lipoprotein(a) [Lp(a)] is associated with increased cardiovascular risk, but its influence on plaque characteristics at optical coherence tomography (OCT) evaluation is not fully understood. This study seeks to explore the impact of Lp(a) levels on plaque morphology as assessed by OCT in a very high-risk subset of patients. Consecutive patients admitted for acute coronary syndrome (ACS) and undergoing OCT-guided percutaneous coronary intervention (PCI) at a large tertiary care center between 2019 and 2022 were deemed eligible for the current analysis. The overall population was categorized into two subgroups according to baseline Lp(a) levels: (1) lower Lp(a) (Lp(a) ≤ 300 mg/L) and (2) elevated Lp(a) (Lp(a) 300 mg/L). Predictors of lipid-rich plaques were identified using multivariable logistic regression with stepwise selection of candidate covariates. A total of 202 patients were included in this study. OCT findings revealed that patients with elevated Lp(a) had a higher prevalence of lipid-rich plaques, a significantly greater mean lipid arc, along with increased macrophage infiltration and thin-cap fibroatheroma (TCFA). In contrast, calcific plaque prevalence was higher in the lower Lp(a) group. Multivariable regression analysis identified low-density lipoprotein cholesterol ≥ 70 mg/dL, and elevated Lp(a) as strong predictors of lipid-rich plaques at OCT. In this observational study including ACS patients undergoing OCT-guided PCI, those with elevated Lp(a) levels exhibited a higher prevalence of lipid-rich plaques, increased macrophage infiltration, and TCFA, thereby indicating a more vulnerable plaque phenotype. Additionally, elevated Lp(a) levels and LDL-C levels ≥ 70 mg/dL were each independently associated with lipid enrichment of coronary plaques. These findings suggest Lp(a), beyond other well-known risk factors, as a key marker for risk stratification, potentially informing optimal medical management strategies.

Диагностика устойчивого развития экономики Китая на основе методов статистического анализа

The article presents the results of diagnosing the sustainable economic development of China through the application of correlation-regression analysis. The methodology proposed by the authors encompasses five stages: defining objectives, data collection and preparation, performing correlation and regression analysis, interpreting results, and assessing economic sustainability. The aim of diagnosing the sustainable development of the national economy is to identify optimal management strategies and facilitate informed economic decisions under conditions of limited resources. The indicators of sustainability utilized in this analysis consist of static indicators spanning the years 2010 to 2022, identified based on the sustainable development model formulated by the International Commission on Environment and Development. In accordance with the criteria of correlation-regression analysis, 23 single-factor linear regression models were selected. Elasticity coefficients were calculated to assess the impact of the factor on the stability of the economy. Based on the results of the analysis, two distinct groups of factors were delineated: those that strengthen and those that undermine the sustainability of China’s economy. Moreover, measures for optimizing sustainable development strategies are proposed, aimed at strengthening the resilience and adaptive capacity of the economic system in the face of evolving challenges.

Tradeoffs between thinning treatments and rotation periods of planted Larix olgensis forests: a perspective from carbon balance

IntroudctionThe current CO2 levels are higher than ever in the past two million years. Forests, as one of the climate change mitigation solutions, are becoming increasingly technically feasible and cost-effective. However, limited research comprehensively considers thinning in the context of optimizing the rotation period for carbon sequestration.MethodsThis study utilizes stand-level growth models and diameter distribution models to simulate the carbon balance dynamics of Larch (Larix olgensis) plantations under various thinning scenarios. The effects of different initial planting densities (N0∈{2,500, 3,333, 4,444} tree ha−1) and site class index (SCI∈[14–20] m) on the optimal forest management measures are also quantified.ResultsThe results reveal that the overall trend of carbon balance gradually increases and then decreases over time under the baseline scenario (3,333 tree ha−1 of N0, 16 m of SCI, 5% of discount rate, 100 CNY ton−1 C of carbon price); the carbon balances of all thinning forests were less than that of the unthinned forest before until 56th year. The optimal rotation period and net present value (NPV) increase with increasing thinning frequency and intensity. The sensitivity of NPV to thinning frequency increases with higher thinning intensities, SCI, and carbon prices.DiscussionThis study further expands the scope of forest management strategies, providing optimal forest management plans for all 21 combinations of different SCIs and N0. The optimal forest management strategy in the baseline scenario is 3 thinnings, with the first thinning at 20% intensity in the 15th year, the second thinning at 30% intensity in the 18th year, and the third thinning at 30% intensity at 21 years, with a rotation period of 26 years, resulting in an NPV of 37,180 CNY ha−1.