Successful conservative management of Class III iatrogenic aortic dissection

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.

Bilateral Congenital Upper Eyelid Eversion (Ectropion): A Rare Presentation Responded Well to Conservative Treatment at Temeke Regional Referral Hospital-Tanzania

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.

Placenta Accreta Spectrum:Conservative Management and Its Impact on Future Fertility

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.

Population Ecology of the Endangered Himalayan Yew in Khokhan Wildlife Sanctuary of North Western Himalaya for Conservation Management

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.

θ-improved limited tolerance relation model of incomplete information system for evaluation of water conservancy project management modernization

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.

Conceptual models of forest dynamics in environmental education and management:keep it as simple as possible,but no simpler

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.

Identifying priority protection areas of key food resources of the giant panda

Animals that live in seasonal environments adjust their reproduction cycle to optimize seasonal forage quality.Giant pandas(Ailuropoda melanoleuca)are seasonal altitudinal migrants that feed on bamboo shoots and leaves with different nutritional quality.However,the importance of bamboo shoots to giant pandas,especially small and isolated populations,is not fully appreciated.Here,we explored whether mating time of giant pandas is shaped by bamboo shoot phenology.We also assessed the intensity of ongoing bamboo shoot harvesting by local communities in 42 giant panda reserves based on questionnaire surveys.Varying intensity and protection levels of bamboo shoot harvesting were found.From these data,we developed a priority ranking scheme of protection areas for this key food resource.Our study showed that pandas time their mating behavior to coincide with bamboo shoot phenology due to the high nutritional demands associated with mating and pregnancy.We also found that bamboo shoots were not well protected in many places.Liangshan,Daxiangling,and Xiaoxiangling,containing the most isolated panda populations,were identified as the areas with the most urgent need of protection.Furthermore,equal attention should be paid to the Qiong L-B population,as this region holds considerable potential to serve as a corridor between the Minshan and Qionglai populations.To address the challenges posed by bamboo shoot harvesting,we recommend establishing more practical bamboo shoot management policies,increasing public awareness of bamboo shoot protection,and providing alternative sources of income for local communities.

Contemporary approach to active surveillance for favorable risk prostate cancer

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.

Viable Second Trimester Cervical Ectopic Pregnancy Managed Successfully with Uterine Preservation: Case Report

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% 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 woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were misleading. Several weeks later, a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.

Chylothorax following posterior low lumbar fusion surgery:A case report

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.

An alveolate kidney:A case report of emphysema pyelonephritis

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.

Rare Case of Spontaneous Perinephric Hematoma with Two-Year Follow-Up

Background: Spontaneous perinephric hematoma with no associated pathology or provocation is a rare clinical phenomenon. The hematoma requires a two-year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. Aims: Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2-year follow up. Case Presentation: 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. Conclusion: The acute management strategy is favorable in such condition, as the hematoma remains under tamponade in the retroperitoneal space, regardless of the size and organ displacement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.

A Rare Presentation of Partial Segmental Thrombosis of the Corpus Cavernosum Secondary to Sickle Cell Anemia

Background: Partial segmental thrombosis of the corpus cavernosum, known as partial priapism, is an uncommon urological condition which predominantly affects young men in which the proximal part of one corpus cavernosum is thrombosed. Many risk factors have been described in the literature, however, the exact etiology of penile thrombosis and its pathogenesis remains unclear. Several treatment options are available ranging from conservative medical treatment, surgical intervention, or simple follow-up observation without treatment. Aim: In this study, we describe a patient with sickle cell anemia who presented with pain and a perineal swelling that was eventually diagnosed as partial priapism utilizing MRI scan and was treated conservatively with a successful outcome. We then performed a literature search of similar cases highlighting incidence, risk factors and management of this rare presentation. Case Presentation: A 23-year-old male who is known with sickle cell anemia presented to casualty with a 1-day history of perineal pain of a sudden onset associated with perineal swelling and vomiting. Genitourinary exam findings confirmed the absence of classic priapism. Careful examination of his perineal area revealed the presence of a fixed, hard, and tender mass at the proximal part of the penis. It was not attached to the overlying skin and no enlarged pelvic lymph nodes were felt. Once stabilized, MRI of the pelvis was performed showing right intra-tunical corpus cavernosum features suggestive of hematoma in keeping with partial segmental thrombosis of the corpus cavernosum. Conservative treatment was initiated, and the patient was managed expectantly in which he improved gradually with eventual disappearance of the perineal mass. Conclusion: Partial segmental thrombosis of the corpus cavernosum is a rare urological condition. Pathogenesis and etiologies are poorly understood but risk factors have been advocated of which sickle cell anemia is one of them. MRI has a crucial role in the diagnosis under this condition. Conservative treatment appears to be a reliable initial therapeutic option.

Can Necrosis and Ovarian Vein Thrombus Be a Serious Complication in Morbidly Adherent Placenta?

We report a case of a 40-year-old woman, second pregnancy, previous cesarean section due to intrauterine growth restriction and placenta accreta spectrum disorders. She was 25 weeks gestational age, admitted to the hospital 25 weeks gestational age, diagnosed with fetal death. Initial conservative management attempt with uterine preservation progresses to complications requiring total hysterectomy followed by a rare outcome: pelvic thrombi with uterine necrosis, with its associated clinical complications.

Comparative population genetic analyses suggest hybrid origin of Rhododendron pubicostatum,an endangered plant species with extremely small populations endemic to Yunnan,China

Gene flow between sympatric congeneric plants is thought to be very common and may pose serious threats to endangered species.In the present study,we evaluate the genetic diversity and divergence of three sympatric Rhododendron species in Jiaozi Mountain using newly developed microsatellites through the Illumina MiSeq sequencing approach.Genetic diversity of all three Rhododendron species studied was moderate in comparison to genetic parameters previously reported from species of this genus.Interestingly,genetic structure analysis of the three species identified a possible hybrid origin of the threatened Rh.pubicostatum.This sympatry should be considered a unimodal hybrid zone,since Rh.pubicostatum is predominant here.Unimodal hybrid zones are uncommon in Rhododendron,despite the fact that hybridization frequently occurs in the genus.Issues pertaining to the conservation of Rh.pubicostatum resulting from admixture of genetic material from its parental species are discussed.

Seasonal variations in the plant diet of the Chinese Monal revealed by fecal DNA metabarcoding analysis

The Chinese Monal(Lophophorus thuysii)is an alpine-obligate galliform species of global conservation priority.It has been listed as a first class protected wildlife species in China,requiring conservation actions during the 14 th Five-Year Plan period.However,the diet composition of Chinese Monal and its seasonal variations have rarely been studied,constraining the effective conservation of the species.Here,we investigated the plant diet composition of the Chinese Monal and its seasonal variations using a DNA metabarcoding approach on fecal samples.We collected 190 fecal samples of the Chinese Monals from the central Qionglai Mountains located in China,and analyzed the plant diet of this species using a DNA metabarcoding approach.Taxonomic profiling of higher plants in the fecal samples was performed using the second internal transcribed spacer(ITS2)amplicon.Downstream analyses,including rarefaction curves,nonmetric multidimensional scaling(NMDS)and permutational multivariate analysis of variance(PERMANOVA),were used to explore the seasonal variations in diet composition.The Chinese Monal foraged a wide range of plant recipes composed of 35 families and 83 genera throughout the year,with Brassicaceae,Apiaceae,and Poaceae as the dominant families,and Cardamine as the dominant genus.The species consumed plants from 62 genera from 28 families during the breeding season(n=81)and 66 genera from 31 families during the non-breeding season(n=109).Further,the plant diet composition significantly varied between the breeding and non-breeding seasons,especially for the frequency of occurrence and relative read abundances at genus level.Our study analyzed the plant diet of the Chinese Monal at a high resolution for the first time,and the results revealed that the seasonal variations in its plant diet composition was adapted to plant phenology and foraging strategy.Fritillaria species,a previously confirmed important food resource for the Chinese Monal,were not detected in any fecal samples,potentially due to overharvesting of Fritillaria bulbs for Traditional Chinese Medicine.Therefore,we highly recommend further restriction of herb gathering in Chinese Monal habitats to facilitate the conservation of this endangered species.Altogether,our study enriches essential ecological information for the Chinese Monal and also provides insights into conservation management for this endangered species.

Conservation utility of botanic garden living collections:Setting a strategy and appropriate methodology

In the realities of the modern world, when the natural habitat is rapidly disappearing and the number of imperiled plants is constantly growing, ex situ conservation is gaining importance. To meet this challenge, botanic gardens need to revise both their strategic goals and their methodologies to achieve the new goals. This paper proposes a strategy for the management of threatened plants in living collections,which includes setting regional conservation priorities for the species, creation of genetically representative collections for the high priority species, and usage of these collections in in situ actions. In this strategy, the value of existing and future species living collections for conservation is determined by the species' conservation status and how well the accessions represent their natural genetic variation.

Benefits of conservation-driven mowing for the EU policy species Gladiolus palustris Gaudin in mountain fen meadows:a case-study in the European Alps

The sword lily Gladiolus palustris Gaudin is protected on European level and listed in Annexes II and IV of the EC Habitat Directive 92/43/EEC.It grows in nutrient-poor,calcareous meadows in central and eastern Europe.Tree encroachment in montane meadows of the European Alps as a result of recent land use changes and the abandonment of traditional farming practices threaten the survival of this species.Conservation-driven mowing is considered a feasible conservation measure for maintaining high species diversity in abandoned semi-natural grasslands.To assess the effects of tenyears of biennial mowing on a grassland community in the Dolomiti Bellunesi National Park,Italy(Site of Community Importance,Natura 2000 network),ten25 m2 plots were established whereby four plots were placed in the mowed area,four in the non-mowed area and two in a small non-mowed patch of grassland inside the mowed area.In each plot the following variables were recorded,total percentage of plant cover,percentage cover of woody species,percentage cover of herbaceous species,percentage cover and number of flowering ramets of G.palustris and a complete list of species and their percentage abundance.Mowed plots showed a higher species richness than non-mowed plots.The number of G.palustris flowering ramets and percentage cover increased manifold in mowed plots compared to nonmowed plots.The resumption of mowing forconservation purposes undertaken by the managing authority halted the process of tree encroachment and avoided a drastic change in plant composition.Periodic mowing(every second or third year)was demonstrated to be a cost-effective conservation measure in non-productive grasslands to keep grasses at bay in favour of forbs of high conversation value.

Distribution pattern and ecological determinants of an invasive plant Parthenium hysterophorus L., in Malakand division of Pakistan

After habitat loss,drastic effects of biological invasion caused by alien invasive species to the native biodiversity have been acknowledged worldwide by the agriculturists,ecologists,and governments as it is more overwhelming than pollution,harvest and disease combined.One such example of biological invasion is P.hysterophorus which is considered to be one of the topmost noxious weeds threatening ecosystems diversity in the world,particularly in Pakistan due to its invasive success and generalist nature.Yet no studies have explored the pattern and determinants of plant biodiversity in the Parthenium dominated landscapes.Here we explored the current distribution pattern of this species with relation to environmental variables in the Malakand division of northern Pakistan.Twenty-three sites dominated by P.hysterophorus were identified through a participatory mapping process combined with traditional ecological knowledge and quantitative inventories were made.In total,we found 62 plant species in 55 genera and 32 families,predominately from Asteraceae,Poaceae,and Solanaceae.Ward’s agglomerative clustering procedure showed three well-differentiated,and ecologically meaningful but overlapping vegetation communities.P.hysterophorus was found to be the leading species with an average Importance value ranging from 33.28%to 65.59%.Based on our criteria,surprisingly we found significantly less to be fully(30%)or partially invaded(21%)than the less invaded(47%)plots,indicating the gradual invasive success of the species across the landscape.Canonical Correspondence Analysis(CCA-ordination)has explained 36.9%of the cumulative variance by the first three axes and identified elevation(r=-0.526),slope(r=0.438)and percent sand(r=-0.474)to be the major environmental factors affecting the distribution of P.hysterophorus and associated vegetation.These results suggested that elevation and percent sand negatively affect Parthenium distribution whereas slope has a positive relationship thereby promoting its populations in the region.The generalist nature of this invasive species is likely to have an overall adverse negative effect on the ecosystem functioning and cannot be ignored.Therefore,quick actions should be taken for the management of this noxious weed to avoid economic consequences and potential threats to fragile ecosystems such as that in Malakand division.

Fish Species Diversity in Upstream and Downstream of Sittaung River,Bago Region,Myanmar

This research was conducted to generate a primary database on ichthyofauna,distribution and diversities in the upstream and downstream segments of Sittaung River in Bago Region of Myanmar.This study contributes to the information needed on the distribution of river fish in Myanmar.Fish diversities are assessed by calculating the various diversities indices between December,2018 and November,2019.A total of 65 fish species belonging to 9 orders,23 families and 49 genera were recorded.All 65 fish species were found in upstream segment but only 60 species of them were found in downstream segment of the river.In all study sites,Shannon diversity index had value above 3 indicating that the structure of habitat was stable and balanced.Simpson’s index values were close to 1 in all sites indicating that the species richness in the region was satisfactory.The abundance all of above 5%of total catch of Mystus vittatus,M.pulcher,M.cavasius and Erethistes pusillus in their feeding habitat suggested that their upstream and downstream habitats provided suitable feeding conditions.Anguilla bengalensis,Tenualosa ilisha,Mystus gulio,Rita rita and Silonia silondia were least abundant all below 0.1%of total catch showing they could be impacted by unwise anthropogenic activities.Assessing fish species diversity is thus very important to conserve and manage and promote the health of river ecosystem that is necessary for the migration of fish species.