BACKGROUND Emphysematous gastritis(EG)is a rare and serious condition that has fatal consequences.Although its clinical presentation is not specific,radiological imaging is characterized by intramural gastric gas.Defe...BACKGROUND Emphysematous gastritis(EG)is a rare and serious condition that has fatal consequences.Although its clinical presentation is not specific,radiological imaging is characterized by intramural gastric gas.Defects in the stomach mucosal barrier and invasion of gas-producing organisms are believed to be the cause.CASE SUMMARY An 88-year-old male with multiple comorbidities presented to our center with abdominal pain and increased stoma output as chief complaints.Upon further investigation he was found to have EG.Despite the high mortality risk without intervention,the patient and family declined operative intervention.CONCLUSION This case report underscored the challenges of managing a critically ill elderly patient with a history of multiple comorbidities and extensive abdominal surgeries and highlighted the successful use of conservative measures in treating EG.展开更多
This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions,telerehabilitation,dry n...This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions,telerehabilitation,dry needling,and kinesiology taping.The study demonstrated significant pain reduction and functional improvement,highlighting the feasibility of hybrid care models.However,limitations include short-term follow-up,lack of post-treatment imaging,and single-case design restricting generalizability.Future research should prioritize longitudinal studies,anatomical correlation via imaging,and randomized trials to validate efficacy across diverse populations.While the framework offers promising clinical utility,further investigation is critical to optimize protocols and elucidate biomechanical mechanisms underlying symptom resolution.展开更多
Iatrogenic aortic dissection （IAD） is a rare complication of percutaneous coronary intervention （PCI） with an estimated incidence of 0.02%--0.04%. lAD occurs more frequently in the setting of urgent PCI for acute ...Iatrogenic aortic dissection （IAD） is a rare complication of percutaneous coronary intervention （PCI） with an estimated incidence of 0.02%--0.04%. lAD occurs more frequently in the setting of urgent PCI for acute myocardial infarction （AMI） （0.19%） than for elective procedures （0.01%）.[11 The mortality risk associated with IAD is high （16%） and is comparable to that for spontaneous aortic dissection （16%）.Urgent surgery is the treatment of choice for extensive dissection or hemodynamic instability. In this report, we present a case of severe IAD that was managed conservatively with good clinical outcome.展开更多
Spontaneous coronary artery dissection is a non-atherosclerotic cause of acute coronary syndrome,particularly among young women.A 46-year-old female without a family history of cardiac disease and traditional atherosc...Spontaneous coronary artery dissection is a non-atherosclerotic cause of acute coronary syndrome,particularly among young women.A 46-year-old female without a family history of cardiac disease and traditional atherosclerotic risk factors presented to hospital with non-ST-segment elevation myocardial infarction.Diagnostic coronary angiography revealed moderate stenosis of the left main coronary artery and the left anterior descending artery with blood flow thrombolysis in myocardial infarction grade 3.The left circumflex artery was observed hypoplastic without significant stenosis.Intravascular ultrasound revealed an extensive intramural hematoma from the middle of the left anterior descending branch to the left main trunk and a compressed lumen with intact intima.The patient underwent conservative treatment and remained asymptomatic 11 months after discharge.Repeat coronary computed tomography angiography showed haematoma absorption with stenosis relief.Spontaneous coronary artery dissection of the left main coronary artery is relatively rare.Its management is based on the patient’s clinical condition and lesion characteristics.展开更多
Placenta accreta spectrum is a complication of pregnancy,which poses a great risk on maternal health.Historically,hysterectomy was the modality of treatment of such condition,but an approach towards a more conservativ...Placenta accreta spectrum is a complication of pregnancy,which poses a great risk on maternal health.Historically,hysterectomy was the modality of treatment of such condition,but an approach towards a more conservative management has been in the light recently.This includes several methods with varying rates of success and complications.Expectant management is effective in up to 78%–80%of the cases.The extirpative method is associated with a high risk of postpartum hemorrhage.The success of the onestep conservative procedure depends on the degree of placental invasion,and the triple-P procedure appears to be successful but requires and interdisciplinary approach.Adjuvant treatment options can be tailored according to individual cases,and these include methotrexate injection,uterine devascularization and hysteroscopic resection of retained placental tissues.Follow up after conservative management is crucial to detect complications early,and it can be done by ultrasound,Doppler examination,and trending b human chorionic gonadotropin levels.Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications.In the future,more research should be directed to achieve clear guidelines regarding this topic.展开更多
Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively i...Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.展开更多
Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down’s syndrome and black babies. If diagnosed early and treated properly,...Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down’s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of non syndromic congenital bilateral severe upper eyelid eversion in otherwise normal 3 days old neonate of African descent (Tanzanian), born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching. We report this case because from the best of our knowledge it has never been documented here at our hospital and Tanzania before.展开更多
The Himalayan Yew (Taxus baccata subsp. wallichiana) is an endangered native high value medicinal plant of the Himalayan Region. The several medicinal properties of the bark and leaves of this species have increased i...The Himalayan Yew (Taxus baccata subsp. wallichiana) is an endangered native high value medicinal plant of the Himalayan Region. The several medicinal properties of the bark and leaves of this species have increased its risk of extinction due to pressures for utilization. It is also subjected to harvest for fuelwood. The species does not regenerate well from seed and that is another risk factor. The objective of this research was to investigate the population ecology of the species as a foundation for its conservation. Six forest communities in the Khokhan Wildlife Sanctuary where the species is present were sampled. The abundance of the species, impacts of harvesting and its current regeneration patterns indicate that it may soon be extirpated from the Sanctuary. A plan for conserving the remaining sub-populations is presented. It could provide a template for conservation in other locations where the species is at risk.展开更多
The modernization of water conservancy project management is a complicated engineering system involving a management system, a management method, management personnel, the exertion of social, economic, and ecological ...The modernization of water conservancy project management is a complicated engineering system involving a management system, a management method, management personnel, the exertion of social, economic, and ecological effects, and so on. However, indices for evaluating the modernization of water conservancy project management are usually unobtainable in practical applications. Conducting appropriate extension of the classical rough set theory and then applying it to an incomplete information system are the key to the application of the rough set theory Based on analysis of some extended rough set models in incomplete information systems, a rough set model based on the θ-improved limited tolerance relation is put forward. At the same time, upper approximation and lower approximation are defined under this improved relation. According to the evaluation index system and management practices, the threshold for θ is defined. An example study indicates the practicability and maneuverability of the model.展开更多
Background：Conceptual models of forest dynamics are powerful cognitive tools,which are indispensable for communicating ecological ideas and knowledge,and in developing strategic approaches and setting targets for for...Background：Conceptual models of forest dynamics are powerful cognitive tools,which are indispensable for communicating ecological ideas and knowledge,and in developing strategic approaches and setting targets for forest conservation,restoration and sustainable management.Forest development through time is conventionally described as a directional,or ＂linear＂,and predictable sequence of stages from ＂bare ground＂ to old forest representing the ＂climax-state＂.However,this simple view is incompatible with the current knowledge and understanding of intrinsic variability of forest dynamics.Hypothesis：Overly simple conceptual models of forest dynamics easily become transformed into biased mental models of how forests naturally develop and what kind of structures they display.To be able to communicate the essential features and diversity of forest dynamics,comprehensive conceptual models are needed.For this end,Kuuluvainen（2009） suggested a relatively simple conceptual model of forest dynamics,which separates three major modes of forest dynamics,and incorporates state changes and transitions between the forest dynamics modes depending on changes in disturbance regime.Conclusions：Conceptual models of forest dynamics should be comprehensive enough to incorporate both longterm directional change and short-term cyclic forest dynamics,as well as transitions from one dynamics mode to another depending on changes in the driving disturbance regime type.Models that capture such essential features of forest dynamics are indispensable for educational purposes,in setting reference conditions and in developing methods in forest conservation,restoration and ecosystem management.展开更多
In the process of agricultural production, the relationship between land consolidation and irrigation and water conservancy is very close. Irrigation and water conservancy design is more scientific and reasonable, so ...In the process of agricultural production, the relationship between land consolidation and irrigation and water conservancy is very close. Irrigation and water conservancy design is more scientific and reasonable, so the efficiency of agricultural production is likely to be improved. In land consolidation, the design and arrangement of irrigation and water conservancy has played a vital role. So the irrigation and water conservancy project construction from the early design to use to strictly check, every link should be accurate after put into use also want to strengthen maintenance and maintenance, to ensure the normal operation of water conservancy projects.展开更多
In recent years, due to the increase of urban population and the imbalance of natural environment rainfall, China has appeared in the urban flood, drought and water shortage and other problems. The construction techno...In recent years, due to the increase of urban population and the imbalance of natural environment rainfall, China has appeared in the urban flood, drought and water shortage and other problems. The construction technology and management of water conservancy and hydropower engineering is an effective platform for the mutual conversion of facilities and equipment that convert water energy into electric energy. This paper mainly introduces the characteristics of water resources conservation and hydropower construction, puts forward the problems existing in the process of water resources conservation and hydropower construction and puts forward the improvement measures.展开更多
BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investig...BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.展开更多
The East China Sea(ECS)off the Coast of Zhoushan Archipelago,Zhejiang(ECS-CZA)is home to abundant fishery resources and an important spawning,feeding,and nursing ground for a variety of fish species.Due to long-term o...The East China Sea(ECS)off the Coast of Zhoushan Archipelago,Zhejiang(ECS-CZA)is home to abundant fishery resources and an important spawning,feeding,and nursing ground for a variety of fish species.Due to long-term overfishing,the ichthyoplankton structure has been dramatically altered.Understanding the species composition and distribution of fish eggs and larvae is one of the most essential tasks to accurately regulate fishery resources and formulate effective management policies;however,little is known about the ichthyoplankton in this region.In this study,an integrated strategy of morphology identification(MI)and mitochondrial COI DNA barcoding was used to identify species of fish eggs and larvae collected from the ECSCZA.MI revealed 15 fish egg species belonging to 12 families and 12 fish larva species belonging to 12 families;in contrast,DNA barcoding altogether identified 30 species,including 18 fish egg species and 13 fish larva species.One species was shared between the egg and larva samples.Our study offers useful tools and critical scientific information for further understanding the diversity,distribution,and conservation management of various ichthyoplankton species in the marine environment.展开更多
Wetlands offer important ecological functions and values.Wetland functional zoning provides a reference and basis for sustainable fulfilment and management.In this study,two coastal urban agglomerations in South China...Wetlands offer important ecological functions and values.Wetland functional zoning provides a reference and basis for sustainable fulfilment and management.In this study,two coastal urban agglomerations in South China were taken as study areas,namely,the Guangxi Beibu Gulf(GBG)and Guangdong-Hong Kong-Macao Greater Bay Area(GBA).Based on multisource information data,a wetland functional zoning system was constructed with the four levels of zoning concept,zoning principle,zoning basis,and zoning scheme.The functional zoning and dynamic analysis of wetlands from 1990 to 2020 were carried out from multiple perspectives of wetland ecological functions,wetland management and conservation functions.The results showed that:1)in terms of wetland ecological functions,the two coastal urban agglomerations were dominated by hydrological regulation and purification of environmental functional areas.The coastal region was largely characterized by the main functional areas of climate regulation and biodiversity maintenance.2)Regarding wetland management and conservation functions,two coastal urban agglomerations exhibited similar trends in terms of the sizes of their conservation and buffer zones from 1990 to 2020.Prevention and control zones were mainly located in core cities in a concentrated manner.Conservation zones largely comprised mountainous woodlands and important wetlands.3)The two coastal urban agglomerations could be divided into 21 wetland functional zones.The central river area has remained the main prevention and control zone for many years.Regarding conservation zones,ecological protection and restoration should be the main focus.Regarding buffer zones,the construction of wetlands and surrounding complex systems should be strengthened or enhanced.Regarding prevention and control zones,activities that do not affect wetland functions should be allowed,provided that they comply with existing laws and regulations.This study could provide technical support and practical application guidance for wetland regulation and management.展开更多
The approach to favorable risk prostate cancer known as“active surveillance”was first described explicitly in 2002.This was a report of 250 patients managed with a strategy of expectant management,with serial prosta...The approach to favorable risk prostate cancer known as“active surveillance”was first described explicitly in 2002.This was a report of 250 patients managed with a strategy of expectant management,with serial prostate-specific antigen and periodic biopsy,and radical intervention advised for patients who were re-classified as higher risk.This was initiated as a prospective clinical trial,complete with informed consent,beginning in 2007.Thus,there are now 20 years of experience with this approach,which has become widely adopted around the world.In this chapter,we will summarize the biological basis for active surveillance,review the experience to date of the Toronto and Hopkins groups which have reported 15-year outcomes,describe the current approach to active surveillance in patients with Gleason score 3þ3 or selected patients with Gleason score 3þ4 with a low percentage of Gleason pattern 4 who may also be candidates,enhanced by the use of magnetic resonance imaging,and forecast future directions.展开更多
BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female p...BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery.The etiology,diagnosis,and treatment were analyzed and discussed.CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain.She was diagnosed with L4 degenerative spondylolisthesis,L4/L5 and L5/S1 intervertebral disc herniation and L5 instability,and underwent successful posterior L4-S1 instrumentation and fusion surgery.Unfortunately,thoracic effusion was identified 2 d after operation.The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests.The patient was discharged after 12-d persisting drainage,3-d total parenteral nutrition and fasting,and other supportive treatments.No recurring symptoms were observed within 12 mo follow-up.CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion.Comprehensive diagnosis and treatment of chylothorax are necessary.Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.展开更多
Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although...Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5%<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>misleading. Several weeks later,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.</span></span></span>展开更多
Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s ...Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:Emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.展开更多
<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Spontaneous perinephric...<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Spontaneous perinephric hematoma with no associated pa</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">thology or provocation is a rare clinical phenomenon. The hematoma requires a two</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. </span><b><span style="font-family:Verdana;"><strong></strong></span><strong><span style="font-family:Verdana;">Aims:</span><span style="font-family:Verdana;"></span></strong></b></span><b> </b><span style="font-family:Verdana;">Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">year follow up. </span><b><span style="font-family:Verdana;"><strong></strong></span><strong><span style="font-family:Verdana;">Case Presentation:</span><span style="font-family:Verdana;"></span></strong></b></span><span style="font-family:Verdana;"> A previously healthy 38-year-old woman, presented with a sudden onset of left flank pain, associated with fatigue and pallor. The patient remained hemodynamically stable with no significant history or associated provocations identified. </span><b><span style="font-family:Verdana;"><strong></strong></span><strong><span style="font-family:Verdana;">Conclusion:</span><span style="font-family:Verdana;"></span></strong></b></span><b> </b><span style="font-family:Verdana;">The acute management strategy is favorable in such condition, as the hematoma remains under tam</span><span style="font-family:Verdana;">ponade in the retroperitoneal space, regardless of the size and organ dis</span><span style="font-family:Verdana;">placement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.</span></span>展开更多
文摘BACKGROUND Emphysematous gastritis(EG)is a rare and serious condition that has fatal consequences.Although its clinical presentation is not specific,radiological imaging is characterized by intramural gastric gas.Defects in the stomach mucosal barrier and invasion of gas-producing organisms are believed to be the cause.CASE SUMMARY An 88-year-old male with multiple comorbidities presented to our center with abdominal pain and increased stoma output as chief complaints.Upon further investigation he was found to have EG.Despite the high mortality risk without intervention,the patient and family declined operative intervention.CONCLUSION This case report underscored the challenges of managing a critically ill elderly patient with a history of multiple comorbidities and extensive abdominal surgeries and highlighted the successful use of conservative measures in treating EG.
文摘This commentary evaluates the case report by Mohammed et al on conservative management of ischiofemoral impingement through a multimodal physical therapy program integrating in-person sessions,telerehabilitation,dry needling,and kinesiology taping.The study demonstrated significant pain reduction and functional improvement,highlighting the feasibility of hybrid care models.However,limitations include short-term follow-up,lack of post-treatment imaging,and single-case design restricting generalizability.Future research should prioritize longitudinal studies,anatomical correlation via imaging,and randomized trials to validate efficacy across diverse populations.While the framework offers promising clinical utility,further investigation is critical to optimize protocols and elucidate biomechanical mechanisms underlying symptom resolution.
文摘Iatrogenic aortic dissection （IAD） is a rare complication of percutaneous coronary intervention （PCI） with an estimated incidence of 0.02%--0.04%. lAD occurs more frequently in the setting of urgent PCI for acute myocardial infarction （AMI） （0.19%） than for elective procedures （0.01%）.[11 The mortality risk associated with IAD is high （16%） and is comparable to that for spontaneous aortic dissection （16%）.Urgent surgery is the treatment of choice for extensive dissection or hemodynamic instability. In this report, we present a case of severe IAD that was managed conservatively with good clinical outcome.
基金financially supported by the Qingdao Medical and Health Research Program(2021-WJZD004).
文摘Spontaneous coronary artery dissection is a non-atherosclerotic cause of acute coronary syndrome,particularly among young women.A 46-year-old female without a family history of cardiac disease and traditional atherosclerotic risk factors presented to hospital with non-ST-segment elevation myocardial infarction.Diagnostic coronary angiography revealed moderate stenosis of the left main coronary artery and the left anterior descending artery with blood flow thrombolysis in myocardial infarction grade 3.The left circumflex artery was observed hypoplastic without significant stenosis.Intravascular ultrasound revealed an extensive intramural hematoma from the middle of the left anterior descending branch to the left main trunk and a compressed lumen with intact intima.The patient underwent conservative treatment and remained asymptomatic 11 months after discharge.Repeat coronary computed tomography angiography showed haematoma absorption with stenosis relief.Spontaneous coronary artery dissection of the left main coronary artery is relatively rare.Its management is based on the patient’s clinical condition and lesion characteristics.
文摘Placenta accreta spectrum is a complication of pregnancy,which poses a great risk on maternal health.Historically,hysterectomy was the modality of treatment of such condition,but an approach towards a more conservative management has been in the light recently.This includes several methods with varying rates of success and complications.Expectant management is effective in up to 78%–80%of the cases.The extirpative method is associated with a high risk of postpartum hemorrhage.The success of the onestep conservative procedure depends on the degree of placental invasion,and the triple-P procedure appears to be successful but requires and interdisciplinary approach.Adjuvant treatment options can be tailored according to individual cases,and these include methotrexate injection,uterine devascularization and hysteroscopic resection of retained placental tissues.Follow up after conservative management is crucial to detect complications early,and it can be done by ultrasound,Doppler examination,and trending b human chorionic gonadotropin levels.Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications.In the future,more research should be directed to achieve clear guidelines regarding this topic.
文摘Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.
文摘Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down’s syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of non syndromic congenital bilateral severe upper eyelid eversion in otherwise normal 3 days old neonate of African descent (Tanzanian), born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching. We report this case because from the best of our knowledge it has never been documented here at our hospital and Tanzania before.
文摘The Himalayan Yew (Taxus baccata subsp. wallichiana) is an endangered native high value medicinal plant of the Himalayan Region. The several medicinal properties of the bark and leaves of this species have increased its risk of extinction due to pressures for utilization. It is also subjected to harvest for fuelwood. The species does not regenerate well from seed and that is another risk factor. The objective of this research was to investigate the population ecology of the species as a foundation for its conservation. Six forest communities in the Khokhan Wildlife Sanctuary where the species is present were sampled. The abundance of the species, impacts of harvesting and its current regeneration patterns indicate that it may soon be extirpated from the Sanctuary. A plan for conserving the remaining sub-populations is presented. It could provide a template for conservation in other locations where the species is at risk.
基金supported by the Fundamental Research Funds for the Central Universities(Grant No.2013B102008)the Open Fund of the Yellow River Committee(Grant No.2011535012)
文摘The modernization of water conservancy project management is a complicated engineering system involving a management system, a management method, management personnel, the exertion of social, economic, and ecological effects, and so on. However, indices for evaluating the modernization of water conservancy project management are usually unobtainable in practical applications. Conducting appropriate extension of the classical rough set theory and then applying it to an incomplete information system are the key to the application of the rough set theory Based on analysis of some extended rough set models in incomplete information systems, a rough set model based on the θ-improved limited tolerance relation is put forward. At the same time, upper approximation and lower approximation are defined under this improved relation. According to the evaluation index system and management practices, the threshold for θ is defined. An example study indicates the practicability and maneuverability of the model.
文摘Background：Conceptual models of forest dynamics are powerful cognitive tools,which are indispensable for communicating ecological ideas and knowledge,and in developing strategic approaches and setting targets for forest conservation,restoration and sustainable management.Forest development through time is conventionally described as a directional,or ＂linear＂,and predictable sequence of stages from ＂bare ground＂ to old forest representing the ＂climax-state＂.However,this simple view is incompatible with the current knowledge and understanding of intrinsic variability of forest dynamics.Hypothesis：Overly simple conceptual models of forest dynamics easily become transformed into biased mental models of how forests naturally develop and what kind of structures they display.To be able to communicate the essential features and diversity of forest dynamics,comprehensive conceptual models are needed.For this end,Kuuluvainen（2009） suggested a relatively simple conceptual model of forest dynamics,which separates three major modes of forest dynamics,and incorporates state changes and transitions between the forest dynamics modes depending on changes in disturbance regime.Conclusions：Conceptual models of forest dynamics should be comprehensive enough to incorporate both longterm directional change and short-term cyclic forest dynamics,as well as transitions from one dynamics mode to another depending on changes in the driving disturbance regime type.Models that capture such essential features of forest dynamics are indispensable for educational purposes,in setting reference conditions and in developing methods in forest conservation,restoration and ecosystem management.
文摘In the process of agricultural production, the relationship between land consolidation and irrigation and water conservancy is very close. Irrigation and water conservancy design is more scientific and reasonable, so the efficiency of agricultural production is likely to be improved. In land consolidation, the design and arrangement of irrigation and water conservancy has played a vital role. So the irrigation and water conservancy project construction from the early design to use to strictly check, every link should be accurate after put into use also want to strengthen maintenance and maintenance, to ensure the normal operation of water conservancy projects.
文摘In recent years, due to the increase of urban population and the imbalance of natural environment rainfall, China has appeared in the urban flood, drought and water shortage and other problems. The construction technology and management of water conservancy and hydropower engineering is an effective platform for the mutual conversion of facilities and equipment that convert water energy into electric energy. This paper mainly introduces the characteristics of water resources conservation and hydropower construction, puts forward the problems existing in the process of water resources conservation and hydropower construction and puts forward the improvement measures.
文摘BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.
文摘The East China Sea(ECS)off the Coast of Zhoushan Archipelago,Zhejiang(ECS-CZA)is home to abundant fishery resources and an important spawning,feeding,and nursing ground for a variety of fish species.Due to long-term overfishing,the ichthyoplankton structure has been dramatically altered.Understanding the species composition and distribution of fish eggs and larvae is one of the most essential tasks to accurately regulate fishery resources and formulate effective management policies;however,little is known about the ichthyoplankton in this region.In this study,an integrated strategy of morphology identification(MI)and mitochondrial COI DNA barcoding was used to identify species of fish eggs and larvae collected from the ECSCZA.MI revealed 15 fish egg species belonging to 12 families and 12 fish larva species belonging to 12 families;in contrast,DNA barcoding altogether identified 30 species,including 18 fish egg species and 13 fish larva species.One species was shared between the egg and larva samples.Our study offers useful tools and critical scientific information for further understanding the diversity,distribution,and conservation management of various ichthyoplankton species in the marine environment.
基金Under the auspices of National Natural Science Foundation of China(No.U21A2022,U1901219,42101369)National Key Research and Development Program of China(No.2023YFF0807204)。
文摘Wetlands offer important ecological functions and values.Wetland functional zoning provides a reference and basis for sustainable fulfilment and management.In this study,two coastal urban agglomerations in South China were taken as study areas,namely,the Guangxi Beibu Gulf(GBG)and Guangdong-Hong Kong-Macao Greater Bay Area(GBA).Based on multisource information data,a wetland functional zoning system was constructed with the four levels of zoning concept,zoning principle,zoning basis,and zoning scheme.The functional zoning and dynamic analysis of wetlands from 1990 to 2020 were carried out from multiple perspectives of wetland ecological functions,wetland management and conservation functions.The results showed that:1)in terms of wetland ecological functions,the two coastal urban agglomerations were dominated by hydrological regulation and purification of environmental functional areas.The coastal region was largely characterized by the main functional areas of climate regulation and biodiversity maintenance.2)Regarding wetland management and conservation functions,two coastal urban agglomerations exhibited similar trends in terms of the sizes of their conservation and buffer zones from 1990 to 2020.Prevention and control zones were mainly located in core cities in a concentrated manner.Conservation zones largely comprised mountainous woodlands and important wetlands.3)The two coastal urban agglomerations could be divided into 21 wetland functional zones.The central river area has remained the main prevention and control zone for many years.Regarding conservation zones,ecological protection and restoration should be the main focus.Regarding buffer zones,the construction of wetlands and surrounding complex systems should be strengthened or enhanced.Regarding prevention and control zones,activities that do not affect wetland functions should be allowed,provided that they comply with existing laws and regulations.This study could provide technical support and practical application guidance for wetland regulation and management.
文摘The approach to favorable risk prostate cancer known as“active surveillance”was first described explicitly in 2002.This was a report of 250 patients managed with a strategy of expectant management,with serial prostate-specific antigen and periodic biopsy,and radical intervention advised for patients who were re-classified as higher risk.This was initiated as a prospective clinical trial,complete with informed consent,beginning in 2007.Thus,there are now 20 years of experience with this approach,which has become widely adopted around the world.In this chapter,we will summarize the biological basis for active surveillance,review the experience to date of the Toronto and Hopkins groups which have reported 15-year outcomes,describe the current approach to active surveillance in patients with Gleason score 3þ3 or selected patients with Gleason score 3þ4 with a low percentage of Gleason pattern 4 who may also be candidates,enhanced by the use of magnetic resonance imaging,and forecast future directions.
基金Supported by National Natural Science Foundation of China,No.81874027.
文摘BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery;however,it is one of the rare complications in orthopedic surgery.This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery.The etiology,diagnosis,and treatment were analyzed and discussed.CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain.She was diagnosed with L4 degenerative spondylolisthesis,L4/L5 and L5/S1 intervertebral disc herniation and L5 instability,and underwent successful posterior L4-S1 instrumentation and fusion surgery.Unfortunately,thoracic effusion was identified 2 d after operation.The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests.The patient was discharged after 12-d persisting drainage,3-d total parenteral nutrition and fasting,and other supportive treatments.No recurring symptoms were observed within 12 mo follow-up.CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion.Comprehensive diagnosis and treatment of chylothorax are necessary.Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.
文摘Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5%<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>misleading. Several weeks later,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.</span></span></span>
文摘Rationale:Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment.The disease is often misdiagnosed due to its diversity of clinical manifestations.Patient’s concern:A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea.Physical examination showed percussion pain on the right costovertebral angle.Besides,she had a history of diabetes mellitus and urinary calculus.Diagnosis:Emphysematous pyelonephritis.Intervention:The patient accepted antishock therapy,tight glucose control,and broad-spectrum anti-infective therapy.After stabilization of the general condition,an ultrasound-guided percutaneous nephrostomy was performed.Outcome:Her conditions became stable over the following days.She presented a favorable clinical course,with normalization of renal function and positive improvements in imaging findings in a month.Lessons:Early diagnosis and rapid medical management are the keys to successful treatment.CT is an important method for the diagnosis of emphysematous pyelonephritis.For patients with severe lesions,percutaneous renal drainage combined with active anti-infection should be given in time.
文摘<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Spontaneous perinephric hematoma with no associated pa</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">thology or provocation is a rare clinical phenomenon. The hematoma requires a two</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. </span><b><span style="font-family:Verdana;"><strong></strong></span><strong><span style="font-family:Verdana;">Aims:</span><span style="font-family:Verdana;"></span></strong></b></span><b> </b><span style="font-family:Verdana;">Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">year follow up. </span><b><span style="font-family:Verdana;"><strong></strong></span><strong><span style="font-family:Verdana;">Case Presentation:</span><span style="font-family:Verdana;"></span></strong></b></span><span style="font-family:Verdana;"> A previously healthy 38-year-old woman, presented with a sudden onset of left flank pain, associated with fatigue and pallor. The patient remained hemodynamically stable with no significant history or associated provocations identified. </span><b><span style="font-family:Verdana;"><strong></strong></span><strong><span style="font-family:Verdana;">Conclusion:</span><span style="font-family:Verdana;"></span></strong></b></span><b> </b><span style="font-family:Verdana;">The acute management strategy is favorable in such condition, as the hematoma remains under tam</span><span style="font-family:Verdana;">ponade in the retroperitoneal space, regardless of the size and organ dis</span><span style="font-family:Verdana;">placement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.</span></span>
