Optimal Management Strategy Research Articles

Applied equilibrium optimizer algorithm for optimal planning multiple photovoltaic distributed generators in hybrid AC-DC distribution networks

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. This paper's main contribution is the application of a brand-new, dependable, and efficient algorithm called the equilibrium optimizer algorithm (EOA) to solve the problem of linking different numbers of PVDG units optimally in order 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 various technical parameters can be obtained by achieving the ideal size and positioning of the PVDG sources via an optimum energy management strategy.

Dynamic optimal lane management strategy for multi-lane urban expressway with bi-class connected vehicles

Traffic flow mobility on expressway plays an important role in urban development. With the emergent technologies, connected vehicles, including both connected automated vehicles (CAVs) and connected regular vehicles (CRVs), are equipped with connectivity features to improve efficiency of urban expressway in a mixed traffic scenario. Existing research indicates that without targeted management, the integration of CAVs and CRVs into regular vehicles (RVs) traffic can lead to a series of congestion issues. A potential solution lies in the implementation of dedicated lanes, each designated for specific vehicle types, which could alleviate traffic flow complications. Therefore, this paper proposes a dynamic optimal lane management strategy for multi-lane mixed traffic urban expressway, aimed at maximizing the whole discharge flow. To begin with, we present an analytical method to mathematically derive discharge flow of each lane type including mixed traffic lane, CAV/CRV dedicated lane, and RV dedicated lane, from the perspective of both traffic demand and traffic capacity. Then, taking a three-lane mixed traffic urban expressway as an application, we conduct a numerical analysis of the dynamic optimal lane management strategy, based on comparisons among eight distinct strategies, under varying factors of traffic demands, penetration rates of CAVs and CRVs, and allocation proportions of vehicles upstream assigned to mixed traffic lanes. The results validate the effectiveness of the analytical method proposed for lane management strategies. It also indicates that the aforementioned system factors have significant impacts on the dynamic optimal lane management strategy.

Spatial transcriptome profiling identifies DTX3L and BST2 as key biomarkers in esophageal squamous cell carcinoma tumorigenesis

BackgroundUnderstanding the stepwise progression of esophageal squamous cell carcinoma (ESCC) is crucial for developing customized strategies for early detection and optimal clinical management. Herein, we aimed to unravel the transcriptional and immunologic alterations occurring during malignant transformation and identify clinically significant biomarkers of ESCC.MethodsDigital spatial profiling (DSP) was performed on 11 patients with early-stage ESCC (pT1) to explore the transcriptional alterations in epithelial, immune cell, and non-immune cell stromal compartments across regions of distinct histology, including normal tissues, low- and high-grade dysplasia, and cancerous tissues. Furthermore, single-cell spatial transcriptomics was performed using the CosMx Spatial Molecular Imaging (SMI) system on 4 additional patients with pT1 ESCC. Immunohistochemical (IHC) analysis was performed on consecutive histological sections of 20 pT1 ESCCs. Additionally, public bulk and single-cell RNA-sequencing (scRNA-seq) datasets were analyzed, and in vitro and in vivo functional studies were conducted.ResultsSpatial transcriptional reprogramming and dynamic cell signaling pathways that determined ESCC progression were delineated. Increased infiltration of macrophages from normal tissues through dysplasia to cancerous tissues occurred. Macrophage subtypes were characterized using the scRNA-seq dataset. Cell–cell communication analysis of scRNA-seq and SMI data indicated that the migration inhibitory factor (MIF)-CD74 axis may exhibit pro-tumor interactions between macrophages and epithelial cells. DSP, SMI, and IHC data demonstrated that DTX3L expression in epithelial cells and BST2 expression in stromal cells increased gradually with ESCC progression. Functional studies demonstrated that DTX3L or BST2 knockdown inhibited ESCC proliferation and migration and decreased M2 polarization of tumor-associated macrophages.ConclusionsSpatial profiling comprehensively characterized the molecular and immunological hallmarks from normal tissue to ESCC, guiding the way to a deeper understanding of the tumorigenesis and progression of this disease and contributing to the prevention of ESCC. Within this exploration, we uncovered biomarkers that exhibit a robust correlation with ESCC progression, offering potential new avenues for insightful therapeutic approaches.

Sustainability Strategy and Development of Village Breeding Center: Evaluation of Morphometric Characteristics of Female Peranakan Ongole Cattle in Napis Village

This study evaluates the morphometric characteristics of female Peranakan Ongole (PO) cattle in Napis Village, Bojonegoro Regency, East Java, as part of a strategy for developing sustainable village breeding centers. The selection of the research location was conducted through purposive sampling, and the material in this study consists of female Peranakan Ongole cattle with age criteria (PI) based on the SNI for Peranakan Ongole cattle, namely PI0 (aged <1 year), PI2 (1 – 1.5 years), PI4 (1.5 - 2 years), PI6 (2 – 3 years), PI8 (aged > 3.5 years). Measurements include body height, body length, hip height, chest depth, chest circumference, ossa cervical vertebrae, ossa thoracic vertebrae, ossa vertebrae lumbar, ossa scapula, hip width, head length, head width and body weight, as well as morphometric indices such as head index, height slope, body index, index of compression, conformation index, length index, body ratio, proportionality and thoracic development on 206 female cattle grouped by age (PI0-PI8). Data were analyzed using multivariate analysis of variance (MANOVA) and post hoc tests, as well as key indices to identify growth patterns and body size stability. The research results show a significant increase in body size in the young-to-adult age group, where adult cows reach size stability. The morphometric index reveals consistent proportional development in the body of cattle as they age, reflecting structural maturity. Evaluation based on the Indonesian National Standard (SNI) shows that most cattle are in Class II and III, indicating excellent body quality in the productive age group. This research emphasizes that morphometric characteristics are important indicators in determining optimal management strategies to support the sustainability of local PO cattle development. These findings provide a foundation for the maintenance and development programs of the PO cattle population by prioritizing quality livestock management, supporting the conservation of local genetic resources, and enhancing cattle productivity in Indonesia.

Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis.

Systematic Review and Network-Meta-analysis. This study aimed to systematically review the literature on management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations. Primary osteomyelitis discitis is a challenging condition with varying management strategies. A comprehensive literature search was conducted. Studies reporting outcomes for treatment of primary osteomyelitis discitis were included. A random-effects network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4-8 weeks, 8-12 weeks, and 12-16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness. Sixty-three articles with 4,233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4-8 week antibiotic duration ranked highest across fixed-effect and random-effects models (SUCRA 0.8207 and 0.8343). The 12-16 week duration ranked highest in the fixed-effect model (SUCRA 0.8460) but dropped substantially in the random-effects model (SUCRA 0.3067). The <4 week duration showed mixed results. The 8-12 week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief. Antibiotic therapy for 4-8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.

Key challenges of post-liver transplant weight management.

Liver transplantation serves as a life-saving intervention for patients with end-stage liver disease, yet long-term survival remains a challenge. Post-liver transplant obesity seems to have a significant contribution to this challenge and it emerges as a significant risk factor for graft steatosis, metabolic syndrome and de-novo malignancy development. This review synthesizes current literature on prevalence, risk factors and management strategies for post-liver transplant obesity, emphasizing its impact on graft and patient survival. Literature review consultation was conducted in Medline/PubMed, SciELO and EMBASE, with the combination of the following keywords: Weight management, liver transplantation, immunosuppressive therapy, lifestyle interventions, bariatric surgery. Immunosuppressive therapy has a significant influence on long-term survival of liver transplant patients, yet it seems to have lesser effect on post-transplant obesity development than previously thought. However, it significantly contributes to the development of other components of metabolic syndrome. Key predisposing factors for post-transplant obesity development encompass elevated recipient and donor body mass index, a history of alcoholic liver disease, hepatocellular carcinoma, male gender, the absence of cellular rejection and the marital status of the recipient. Tailored immunosuppressive regimens, pharmacotherapy, lifestyle interventions and bariatric surgery represent key components in mitigating post-transplant obesity and improving long-term survival and quality of life in this group of patients. Timely identification and intervention thus hold paramount importance. Further research is warranted to refine optimal management strategies and enhance outcomes in this patient population.

Effect of vermicompost, intercropping, and seedbed types on Striga hermonthica infestation and sorghum production in East Hararghe, Ethiopia

AbstractStriga hermonthica is the most devastating parasitic weed affecting the productivity of cereal crops in Sub‐Saharan Africa. The key challenge for controlling this weed is identifying the optimal management strategies that simultaneously reduce Striga infection while boosting crop productivity. This study aimed to evaluate the potential role of intercropping, vermicompost, and seedbed types on the level of S. hermonthica infestation and sorghum productivity in 2021 and 2022 years. The treatments consisted of three factors: (i) three sowing methods (sole‐cropped sorghum (SS), intercropped sorghum with Babile‐1 (SB1), and Babile‐2 (SB2) groundnut varieties); (ii) four levels of vermicompost (0, 1.5, 3.0, and 4.5 t/ha); and (iii) two seedbed types (open‐furrow and tied‐ridge). The results indicated that pure‐stand sorghum in open‐furrow planting without fertilizer had the tallest height (60 cm), the heaviest dry weight (39 g) as well as the highest Area under Striga Number Progress Curve (ASNPC) (&gt;1200) in the first year with substantial reduction in successive year. The combination of 4.5 t/ha vermicompost, tied‐ridge, and groundnut intercropping gave the maximum sorghum panicle weight (151 g/plant), stover yield (14.21 t/ha), and grain yield (6.01 t/ha) in the year 2022. The greatest grain yield observed at 4.5 t/ha vermicompost under tied‐ridge with SB2 was nearly three times higher than the plot without vermicompost application. This treatment combination significantly suppresses S. hermonthica infestation while improving sorghum yield attributes. Thus, it could reduce food insecurity in the lowlands of Ethiopia via improving sorghum productivity, resources use efficiency, and soil health.

Relationship between Fibrinogen Values and Sensitivity and Specificity of STS Score, Euroscore for Patients Undergoing Open Heart Surgery

Background/Aim: Cardiovascular diseases are a leading cause of mortality worldwide, with surgical interventions playing a crucial role in outcomes. Despite technological advancements and improved operator experience, perioperative and postoperative risks remain significant, particularly for high-risk patients. Fibrinogen, an acute-phase reactant, increases during inflammation and plays a role in coagulation. This study investigates the prognostic impact of fibrinogen levels on the outcomes of cardiac surgery and evaluates its relationship with established risk classification systems. Materials and Methods: This observational cohort study included 105 patients who underwent cardiac surgery between May 2018 and December 2023. Patients with coronary bypass grafting and valve surgery were included, while those with transplantation, congenital heart surgery, or other significant conditions were excluded. Patient data, including demographic information, comorbidities, laboratory parameters, and surgical details, were collected. The fibrinogen cutoff value was determined using the Youden index. Statistical analyses were performed using SPSS 23.0, with p-values &lt; 0.05 considered significant. Results: Of the 116 individuals screened, 105 were included in the study. The HighFib group (&gt;3.8 g/dL) showed higher rates of complications, such as low cardiac output, prolonged mechanical ventilation, and atrial fibrillation, compared to the LowFib group (&lt;3.8 g/dL). The HighFib group also had lower preoperative hemoglobin levels and higher Euroscore values. Logistic regression analysis demonstrated that both fibrinogen levels and established risk scores were significant predictors of postoperative complications. Conclusion: Elevated fibrinogen levels are associated with increased postoperative complications in cardiac surgery patients. Fibrinogen, alongside traditional risk scores, can be a valuable predictor of adverse outcomes. Prospective studies are needed to further validate these findings and establish optimal fibrinogen management strategies in cardiac surgery.

Axillary lymph node management strategies in cN + breast cancer patients after neoadjuvant chemotherapy.

With the widespread use of neoadjuvant chemotherapy (NAC), the optimal management strategy for axillary lymph nodes following chemotherapy has become a hot topic of discussion. For patients with clinically positive axillary lymph nodes (cN +) (defined as axillary lymph nodes confirmed positive by pathology before NAC), axillary lymph node dissection (ALND) remains the current standard treatment. However, there is still no consensus on whether sentinel lymph node biopsy (SLNB) and other local axillary treatments following NAC can safely replace ALND to reduce injury and complications. This article provides a narrative review of strategies for managing axillary lymph nodes in this patient population.

Efficacy of muscle energy technique with stretching versus muscle energy technique with myofascial release in upper cross syndrome

INTRODUCTION: Cervical pain represents one of the most prevalent musculoskeletal disorders, with the potential for secondary complications if left untreated. The primary causes of neck pain are cervical spine and soft tissue disorders, while neck pain due to postural abnormalities is known as upper cross syndrome (UCS). Epidemiological studies indicate that neck pain is prevalent in the general population but is significantly more common among office workers. Optimal management strategies require further investigation to improve treatment outcomes. This study aims to evaluate and compare two therapeutic approaches for managing Upper Cross Syndrome (UCS): Muscle Energy Technique (MET) combined with Myofascial Release Therapy (MFR), and MET combined with Muscle Stretching Exercises. MATERIAL AND METHODS: This non-randomized, active-controlled trial enrolled 40 patients with neck pain, assigned to two intervention groups of 20 participants each: Muscle Energy Technique (MET) with Myofascial Release Therapy (MFR), and MET with Muscle Stretching Exercises. The study assessed pain intensity using the Visual Analogue Scale (VAS) and forward head posture using the Craniovertebral Angle (CVA) at baseline and three weeks post-treatment. RESULTS: VAS score for pain showed a mean change of 1.7 and 1.8 in the MET with MFR group and MET with the Muscle Stretching Exercises group after 11 sessions. The CVA increased by 2.08° in the MET with MFR group and by 1.78° in the MET with the Muscle Stretching Exercises group. Both groups showed significant improvements in pain and forward head posture (p&lt;0.001), with no significant difference between the interventions. CONCLUSION: Both MET combined with MFR and MET with Muscle Stretching Exercises demonstrate improvement in pain and CVA.

Methane Oxidation Rates and Efficiencies Across Four Distinct Soil Environments: Implications for Greenhouse Gas Mitigation

Methane oxidation by soil microorganisms is crucial in mitigating greenhouse gas emissions. This study investigated methane oxidation potential across four distinct soil environments through standardized laboratory enrichment cultures. Soil samples were collected from landfill-cover soils, rice fields, cattle farms, and pond sediments, with environmental parameters monitored to understand their influence on oxidation rates and efficiencies. Using gas chromatography analysis, we quantified methane oxidation under controlled conditions. Statistical analysis revealed significant differences in oxidation rates across soil types. Landfill cover soils exhibited the highest oxidation rate of 0.39 μmol-CH₄/g-soil dry weight/h and efficiency of 66.5 %. Pond sediments, cattle farm soils, and rice field soils followed with rates of 0.29, 0.28, and 0.27 μmol-CH₄/g-soil dry weight/h, respectively. Oxidation efficiencies for these environments ranged from 46.1% to 48.4%. pH and organic matter content showed strong positive correlations with oxidation rates across all soil types, while environmental moisture content effects varied. The superior performance of landfill soils was attributed to optimal environmental conditions and stable substrate availability. This analysis revealed significant potential for enhancing oxidation efficiencies: landfill soils from 66.5% to 75-85%, rice fields from 46.1% to 60-70%, cattle farms from 47.0% to 55-65%, and pond sediments from 48.4% to 60-75%. Implementing optimized management strategies could reduce methane emissions by 70-90% in landfills, 30-50% in agricultural systems, and 40-60% in aquatic environments compared to current practices. This study highlights the substantial potential for enhancing biological methane oxidation across diverse ecosystems and emphasizes the need for targeted management approaches to optimize methane mitigation strategies.

Optimizing management strategies for malunion and nonunion of Hoffa fractures: a detailed case series with a proposed treatment algorithm.

This study aims to refine management strategies for malunion and nonunion of Hoffa fractures, as these rare complications present significant clinical challenges. We conducted a case series involving seven patients with Hoffa fracture complications, including four cases of malunion and three cases of nonunion. Each patient underwent individualized surgical treatment, depending on the nature of their complication. Treatment strategies varied from intra-articular osteotomies for malunions to revision surgery or total knee arthroplasty for nonunions. Postoperative outcomes were monitored, with follow-up ranging from 1 to 15years (mean follow-up time was 6.7years). In all malunion cases, intra-articular osteotomies restored the articular surface, leading to improved function and bone healing. In nonunion cases, two patients with non-reconstructible nonunions underwent total knee arthroplasty, while one patient achieved union with surgical revision. Overall, six out of seven patients showed significant functional improvements post-surgery, although some experienced mild residual pain or deformities. The management of malunion and nonunion in Hoffa fractures remains challenging, but the individualized strategy based on fracture type and patient-specific factors leads to favourable outcomes. The proposed treatment algorithm provides a useful framework for orthopaedic trauma surgeons in addressing these complications, with emphasis on stable fixation, early intervention, and personalized surgical planning.

Sensor management method based on TD3 in multi-target tracking

Abstract This paper proposes an innovative sensor management method utilizing deep reinforcement learning to optimize the performances of multi-target filters based on random finite sets. Within the theoretical framework of partially observable Markov decision processes, the twin delayed deep deterministic policy gradient reinforcement learning algorithm is employed to decide optimal sensor management strategies in continuous space. For each control command, predicted ideal measurement set is generated to update posterior multi-target density. The divergence between the predicted multi-target posterior density and the updated posterior multi-target density is used as a reward function to guide the decision of sensor management strategies. The simulation results demonstrate that, compared to other algorithms, the proposed method is more effective in enhancing the performance of multi-target tracking.

Changes in reproduction mediate the effects of climate change and grassland management on plant population dynamics.

Climate change is one of the largest threats to grassland plant species, which can be modified by land management. Although climate change and land management are expected to separately and interactively influence plant demography, this has been rarely considered in climate change experiments. We used a large-scale experiment in central Germany to quantify the effects of grassland management, climate change, and their joint effect on the demography and population growth rate of 11 plant species all native to this temperate grassland ecosystem. We parameterized integral projection models with five years of demographic data to project population growth rate. We hypothesized that plant populations perform better in the ambient than in the future climate treatment that creates hotter and drier summer conditions. Further, we hypothesized that plant performance interactively responds to climate and land management in a species-specific manner based on the drought, mowing, and grazing tolerances as well as the flowering phenology of each species. Due to extreme drought events, over half of our study species went quasi extinct, which highlights how extreme climate events can influence long-term experimental results. We found no consistent support for our expectation that plants perform better in ambient compared with future climate conditions. However, several species showed interactive responses to the treatments, indicating that optimal management strategies for plant performance are expected to shift with climate change. Changes in population growth rates of these species across treatments were mostly due to changes in plant reproduction. Experiments combined with measuring plant demographic responses provide a way to isolate the effects of different drivers on the long-term persistence of species and to identify the demographic vital rates that are critical to manage in the future. Our study suggests that it will become increasingly difficult to maintain species with preferences for moister soil conditions, and that climate and land use can interactively alter demographic responses of the remaining grassland species.

Non-restraint in pediatric ankle sprain: a non-inferiority randomized clinical trial

Ankle sprains are common injuries in pediatric populations, yet current literature lacks consensus on optimal management strategies. This study aimed to compare the effectiveness of non-restraint treatment versus bandaging in children with mild ankle sprains, focusing on functional recovery and pain management.A single-center, open-label, non-inferiority randomized clinical trial was conducted at a pediatric emergency service. Patients aged 5–16 years with mild ankle sprains were included. Participants were randomized in a 1:1 ratio to receive either a standardized functional bandage or only general measures with non-restraint. The primary endpoints were a 10-point difference in the OXAFQ-C and a 2-point difference in pain intensity at day 5 after discharge. A total of 113 participants were randomly assigned to receive a functional bandage (n = 51) or non-restraint measures (n = 62). At day 5, the OXAFQ-C score in the non-restraint group was 76.59 (SD 15.51) and 69.71 (SD 15.24) in the restraint group, with a mean difference of 6.295 (90% CI − 0.058 to 12.647). The mean difference in pain intensity was 0.048 (90% CI − 0.741 to 0.838). No differences were observed in the OXAFQ-C scores or pain intensity at 14 and 30 days. Conclusions: This single-center, randomized clinical trial demonstrates that non-restraint is non-inferior to bandaging for functional recovery and short- to medium-term pain management in pediatric patients with mild ankle sprains. The treatment was very well accepted among patients and no adverse effects were reported.Trial registration: Retrospectively registered in January 2024 on clinicaltrials.org with identifier: NCT06189625.What is Known• Current literature lacks consensus on optimal ankle sprain management, with no evidence supporting non-restraint approaches. Guidelines recommend immobilization despite insufficient comparative data on different restraint systems. Some studies seem to demonstrate that early mobilization may offer better outcomes.What is New•This study contributes novel evidence by demonstrating the non-inferiority of non-restraint treatment compared to bandaging in pediatric ankle sprains. It highlights the safety and efficacy of early mobilization without restraint, suggesting a potential shift in standard management practices.

Risk Factors of Marginal Cord Insertion in Singleton Pregnancies: A Systematic Review and Meta-Analysis.

Background: Marginal cord insertion (MCI) is increasingly recognized as a pathological variation that necessitates early diagnosis. Identifying the risk factors associated with MCI is essential for improving prenatal screening and optimizing management strategies. Our meta-analysis systematically and quantitatively synthesizes the current evidence on various potential risk factors for MCI. Methods: This systematic review and meta-analysis adhered to the PRISMA and MOOSE guidelines. Comprehensive searches were performed in three databases up until 6 May 2024, identifying observational cohort and case-control studies that examined risk factors for MCI in singleton pregnancies compared with central or eccentric cord insertion. Quality and risk of bias assessment were performed using the Newcastle-Ottawa Scale and the Quality In Prognosis Studies tool, respectively. Statistical analyses employed random-effects models to calculate relative risks (RR) and mean differences with their 95% confidence intervals (95% CI). Heterogeneity was assessed via Cochran's Q and I2 statistics. Results: A total of 18 studies (14 cohort and 4 case-control), encompassing 51,463 MCI cases and 901,020 control cases, were included. The meta-analysis revealed a prevalence of MCI at 5.71% among singleton pregnancies. Significant risk factors for MCI included the use of assisted reproductive technology (RR = 1.55; 95% CI: 1.34-1.78), chronic hypertension (RR = 1.47; 95% CI: 1.11-1.95), placenta previa (RR = 1.83; 95% CI: 1.62-2.08), and nulliparity (RR = 1.18; 95% CI: 1.08-1.30). No significant associations were found for smoking, maternal age, prior Cesarean section, preexisting diabetes, or Caucasian ethnicity. Sensitivity analyses corroborated the robustness of these findings. Conclusions: This meta-analysis identified assisted reproductive technology, chronic hypertension, placenta previa, and nulliparity as significant risk factors for marginal cord insertion in singleton pregnancies. These findings can inform the development of prenatal screening protocols and enable targeted screenings for high-risk populations.

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.

Management of twin-reversed arterial perfusion (TRAP) sequence: a systematic review and meta-analysis.

Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic twin pregnancies characterized by placental anastomoses between a normally developed twin and an acardiac mass. Though several treatment modalities exist, the optimal management strategy is unclear. This study aims to compare the various treatment strategies for TRAP sequence. A systematic review of the literature was performed using PRISMA guidelines including PubMed, Scopus, Web of Science and the Cochrane Library. Studies were imported into Covidence, where they were independently screened by two authors. Studies included described interventions for TRAP sequence. Those excluded were unavailable in English and lacked differentiation between intervention strategies for TRAP and other monochorionic twin pregnancies. Fisher's exact test and random effects modeling were used for statistical analysis. 2340 abstracts were screened, of which 218 articles progressed to full review and 120 qualified for data extraction. 757 twin pregnancies were described. Most were treated with radiofrequency ablation (RFA) (n=363, 47.95%) and laser ablation (n=220, 29.06%). Statistically significant differences amongst the modalities were seen in technical success (p = 0.005), gestational age at presentation (p < 0.01), intervention (p = 0.01), and delivery (p = 0.01), respectively, and time between treatment and delivery (p < 0.01). Notably, pump twin survival did not differ based on treatment modality used (p = 0.196). Overall, complication rates were low with no differences in preterm premature rupture of membranes (PPROM) (p = 0.66), preterm labor (p = 0.58) or maternal hemorrhage between modalities (p = 0.28). Suture cord ligation, however, had a greater hemorrhage rate than RFA (p = 0.03). This embodies the first meta-analysis comparing treatment modalities for TRAP sequence with outcomes and complications. RFA is the most technically successful strategy. Prospective data is required to further understand the optimal modality and gestational age at treatment to ensure best overall outcomes. .

Pyrexia of Unknown Origin in a Patient with Ankylosing Spondylitis: A Rare Case of Concurrent Adult-Onset Still's Disease

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton, with systemic symptoms such as fever being uncommon. Adult-onset Still’s disease (AOSD) is an autoinflammatory condition characterized by high-grade fever, rash, and polyarthritis. The co-occurrence of AS and AOSD is extremely rare and presents significant diagnostic challenges. This case report outlines the complexities involved in identifying and managing such an overlap. Case Presentation: A 37-year-old male with a history of AS presented with pyrexia of unknown origin (PUO), bilateral asymmetric polyarthritis, and a transient skin rash. Laboratory findings showed elevated inflammatory markers (CRP: 322 mg/L, ESR: 82 mm/hr), hyperferritinemia (&gt;10,000 ng/mL), hyperleukocytosis (16,000/mm³) with neutrophil predominance, and normocytic normochromic anemia (hemoglobin: 9 g/dL). Extensive infectious and immunological investigations were negative, while PET CT revealed metabolically active lymphadenopathy. Biopsies excluded malignancy and macrophage activation syndrome. A diagnosis of AOSD was established based on Fautrel and Yamaguchi criteria. The patient’s treatment was shifted from NSAIDs to corticosteroids (prednisone 1 mg/kg/day), leading to significant improvement, followed by maintenance therapy with DMARDs to sustain remission. Conclusion: This case highlights the importance of considering AOSD in AS patients presenting with PUO and systemic inflammation. Timely diagnosis and appropriate treatment can reduce complications. Further studies are needed to explore the pathophysiological links and optimize management strategies.

Real-Time Global Optimal Energy Management Strategy for Connected PHEVs Based on Traffic Flow Information

Real-Time Global Optimal Energy Management Strategy for Connected PHEVs Based on Traffic Flow Information