Comparable results of surgical versus non-surgical management for patients with malignant bowel obstruction-a lesson from S1316 study

We had the pleasure to read the paper published online by Krouse et al.in August 2023 in the Lancet Gastroenterology and Hepatology(1).The study labeled as S1316 was a prospective pragmatic comparative effectiveness trial evaluating the surgical versus non-surgical management for patients with malignant small intestinal bowel obstruction(MIO)and having an intra-abdominal or retroperitoneal primary cancer and were aged 18 years or older with a Zubrod performance status 0-2 within 1 week before admission;had a surgical indication;and treatment equipoise.The patients were divided in two pathways.Those who accepted the randomization were randomly assigned to surgical and non-surgical treatment groups.Those who declined consent for random assignment were offered a prospective observational patient choice pathway where the patients with their caring team decide upon the treatment option.

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Enhancing perianal disease management with integrated physical and psychological approaches

This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

Solid Waste Management:A MADM Approach Using Fuzzy Parameterized Possibility Single-Valued Neutrosophic Hypersoft Expert Settings

The dramatic rise in the number of people living in cities has made many environmental and social problems worse.The search for a productive method for disposing of solid waste is the most notable of these problems.Many scholars have referred to it as a fuzzy multi-attribute or multi-criteria decision-making problem using various fuzzy set-like approaches because of the inclusion of criteria and anticipated ambiguity.The goal of the current study is to use an innovative methodology to address the expected uncertainties in the problem of solid waste site selection.The characteristics(or sub-attributes)that decision-makers select and the degree of approximation they accept for various options can both be indicators of these uncertainties.To tackle these problems,a novel mathematical structure known as the fuzzy parameterized possibility single valued neutrosophic hypersoft expert set(ρˆ-set),which is initially described,is integrated with a modified version of Sanchez’s method.Following this,an intelligent algorithm is suggested.The steps of the suggested algorithm are explained with an example that explains itself.The compatibility of solid waste management sites and systems is discussed,and rankings are established along with detailed justifications for their viability.This study’s strengths lie in its application of fuzzy parameterization and possibility grading to effectively handle the uncertainties embodied in the parameters’nature and alternative approximations,respectively.It uses specific mathematical formulations to compute the fuzzy parameterized degrees and possibility grades that are missing from the prior literature.It is simpler for the decisionmakers to look at each option separately because the decision is uncertain.Comparing the computed results,it is discovered that they are consistent and dependable because of their preferred properties.

Addressing functional constipation in children:A call for comprehensive and collaborative management

Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.

Management of chylous ascites after liver cirrhosis: A case report

BACKGROUND Chylous ascites is an uncommon condition,occurring in less than 1%of ascites cases.It results from traumatic or obstructive disruption of the lymphatic system,causing the leakage of thoracic or intestinal lymph into the abdominal cavity.This leads to the accumulation of a milky,triglyceride-rich fluid.In adults,malignancy and cirrhosis are the primary causes of chylous ascites.Notably,chylous ascites accounts for only 0.5%to 1%of all cirrhosis-related ascites cases.At present,there is a limited understanding of this condition,and effective timely management in clinical practice remains challenging.CASE SUMMARY This case report presents a patient with hepatic cirrhosis complicated by chylous ascites,who had experienced multiple hospitalizations due to abdominal distension.Upon admission,comprehensive examinations and assessments were conducted.The treatment strategy focused on nutritional optimization through a low-sodium,low-fat,and high-protein diet supplemented with medium-chain triglycerides,therapeutic paracentesis,and diuretics.Following a multidiscip-linary discussion and thorough evaluation of the patient’s condition,surgical indications were confirmed.After informing the patient about the benefits and risks,and obtaining consent,a transjugular intrahepatic portosystemic shunt procedure was performed,successfully alleviating the abdominal swelling symptoms.This article details the clinical characteristics and treatment approach for this uncommon case,summarizing current management methods for hepatic cirrhosis complicated by chylous ascites.The aim is to provide valuable insights for clinicians encountering similar situations.CONCLUSION Optimizing nutrition and addressing the underlying cause are essential in the treatment of chylous ascites.When conservative approaches prove ineffective,alternative interventions such as transjugular intrahepatic portosystemic shunt may be considered.

Early identification and multidisciplinary management of immune checkpoint inhibitors associated colitis can improve patient outcomes

Currently,the use of immune checkpoint inhibitors(ICIs)has shown notable clinical efficacy in treating various malignant tumors,significantly improving patient prognosis.However,while ICIs enhance the body’s anti-tumor effects,they can also trigger immune-related adverse events(irAEs),with ICI-associated colitis being one of the more prevalent forms.This condition can disrupt treatment,necessitate drug discontinuation,and adversely affect therapeutic outcomes.In severe cases,irAEs may even become life-threatening.A recent case report by Hong et al highlights the importance of vigilance for ICI-associated colitis in patients experiencing symptoms such as diarrhea and abdominal pain,which can arise both during and even after completion of ICI treatment.Early identification,multidisciplinary management,and continuous monitoring of patients are essential steps to further improve outcomes.

Ultra-Dense LEO Satellite-Aircraft Access and Service Management in Civil Aviation

With the deployment of ultra-dense low earth orbit(LEO)satellite constellations,LEO satellite access network(LEO-SAN)is envisioned to achieve global Internet coverage.Meanwhile,the civil aviation communications have increased dramatically,especially for providing airborne Internet services.However,due to dynamic service demands and onboard LEO resources over time and space,it poses huge challenges in satellite-aircraft access and service management in ultra-dense LEO satellite networks(UDLSN).In this paper,we propose a deep reinforcement learning-based approach for ultra-dense LEO satellite-aircraft access and service management.Firstly,we develop an airborne Internet architecture based on UDLSN and design a management mechanism including medium earth orbit satellites to guarantee lightweight management.Secondly,considering latency-sensitive and latency-tolerant services,we formulate the problem of satellite-aircraft access and service management for civil aviation to ensure service continuity.Finally,we propose a proximal policy optimization-based access and service management algorithm to solve the formulated problem.Simulation results demonstrate the convergence and effectiveness of the proposed algorithm with satisfying the service continuity when applying to the UDLSN.

The Effectiveness of Non-Surgical Weight Management Interventions for Obesity in the UK: A Review and Meta-Regression Analysis

Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority aiming to reduce the burden of obesity and co-morbidities. Therefore this review aims to assess the effectiveness of non-surgical weight management interventions for obesity in the UK. Method: Thirty one databases were searched that identified 20 articles for inclusion. Articles were screened and quality scored using the “Effective Public Health Practice Project Quality Assessment Tool”. Meta-regression analysis (MRA) was undertaken on seven studies that allowed for effect size calculations. Results: In adult populations, lifestyle interventions that targeted both diet and physical activity, delivered in the private sector were most effective in reducing weight and/or BMI, and were more cost-effective. In children the most successful interventions mirrored adult interventions, but were family-orientated. MRA supported these findings. Most frequent intervention duration was 12 weeks. Discussion: The results provide evidence to support policy makers for the effective delivery of weight management interventions. Findings suggest that weight management interventions in the UK are effective in reducing weight and/or BMI for both children and adults. Interventions delivered in the private sector (e.g. Weight Watchers), targeting diet and physical activity levels, demonstrated the highest levels of effectiveness. However, compared to these models, NHS programmes are less well defined in the research literature and may not have been optimised. For children, effectiveness is improved by family-level programmes incorporating children and their parents.

Assessment and management of immature facial scars by non-surgical methods

Background:Scar quality is affected by patients’wound healing conditions,trauma type,and skin features that differ due to ethnicity.Despite tremendous improvements in scar remodeling techniques,conspicuous scars can still remain postoperatively.Non-surgical methods used for handling scars include the use of topical corticosteroids,pressure therapy,lasers,and platelet-rich plasma(PRP).This study aimed to assess and evaluate different non-surgical modalities for treating immature facial scars.Methods:Fifteen patients with scars were included for non-surgical management.They received one or more of 5 treatments:corticosteroid injection,topical silicone gel application with or without bandage,pressure therapy,lasers,or PRP injection.Scars were assessed using the Patient and Observer Scar Assessment Scale(POSAS)and serial photographs.Results:There were no significant differences in the results obtained using POSAS.None of the patients required a secondary intervention or sought a second opinion.The rate of complications associated with the treatments were very minor.Conclusion:Good assessment of patient characteristics,proper planning,and appropriate treatment lead to favorable outcomes.

Personal Thermal Management by Radiative Cooling and Heating

Maintaining thermal comfort within the human body is crucial for optimal health and overall well-being.By merely broadening the setpoint of indoor temperatures,we could significantly slash energy usage in building heating,ventilation,and air-conditioning systems.In recent years,there has been a surge in advancements in personal thermal management(PTM),aiming to regulate heat and moisture transfer within our immediate surroundings,clothing,and skin.The advent of PTM is driven by the rapid development in nano/micro-materials and energy science and engineering.An emerging research area in PTM is personal radiative thermal management(PRTM),which demonstrates immense potential with its high radiative heat transfer efficiency and ease of regulation.However,it is less taken into account in traditional textiles,and there currently lies a gap in our knowledge and understanding of PRTM.In this review,we aim to present a thorough analysis of advanced textile materials and technologies for PRTM.Specifically,we will introduce and discuss the underlying radiation heat transfer mechanisms,fabrication methods of textiles,and various indoor/outdoor applications in light of their different regulation functionalities,including radiative cooling,radiative heating,and dual-mode thermoregulation.Furthermore,we will shine a light on the current hurdles,propose potential strategies,and delve into future technology trends for PRTM with an emphasis on functionalities and applications.

Etiology and management of urethral calculi:A systematic review of contemporary series

Objective:To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology,investigation,and management patterns.Methods:A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials(CENTRAL)databases was performed.Articles,including case reports and case series on urethral calculi published between January 2000 and December 2019,were included.Full-text manuscripts were reviewed for clinical parameters including symptomatology,etiology,medical history,investigations,treatment,and outcomes.Data were collated and analyzed with univariate methods.Results:Seventy-four publications met inclusion criteria,reporting on 95 cases.Voiding symptoms(41.1%),pain(40.0%),and acute urinary retention(32.6%)were common presenting features.Urethral calculi were most often initially investigated using plain X-ray(63.2%),with almost all radio-opaque(98.3%).Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi(16.8%)and underlying urethral pathology(53.7%)including diverticulum(33.7%)or stricture(13.7%).Urethral calculi were most commonly managed with external urethrolithotomy(31.6%),retrograde manipulation(22.1%),and endoscopic in situ lithotripsy(17.9%).Conclusion:This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm.Management in contemporary urological practice should be according to calculus size,shape,anatomical location,and presence of urethral pathology.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Self‑Healing Dynamic Hydrogel Microparticles with Structural Color for Wound Management

Chronic diabetic wounds confront a significant medical challenge because of increasing prevalence and difficult-healing circumstances.It is vital to develop multifunctional hydrogel dressings,with well-designed morphology and structure to enhance flexibility and effectiveness in wound management.To achieve these,we propose a self-healing hydrogel dressing based on structural color microspheres for wound management.The microsphere comprised a photothermal-responsive inverse opal framework,which was constructed by hyaluronic acid methacryloyl,silk fibroin methacryloyl and black phosphorus quantum dots(BPQDs),and was further re-filled with a dynamic hydrogel.The dynamic hydrogel filler was formed by Knoevenagel condensation reaction between cyanoacetate and benzaldehyde-functionalized dextran(DEX-CA and DEX-BA).Notably,the composite microspheres can be applied arbitrarily,and they can adhere together upon near-infrared irradiation by leveraging the BPQDs-mediated photothermal effect and the thermoreversible stiffness change of dynamic hydrogel.Additionally,eumenitin and vascular endothelial growth factor were co-loaded in the microspheres and their release behavior can be regulated by the same mechanism.Moreover,effective monitoring of the drug release process can be achieved through visual color variations.The microsphere system has demonstrated desired capabilities of controllable drug release and efficient wound management.These characteristics suggest broad prospects for the proposed composite microspheres in clinical applications.

Sustainable land management in Mali

This study uses logistic and Poisson regression models to examine the factors influencing the adoption of sustain-able land management(SLM)practices in Mali using two rounds of the nationally representative survey Enquête Agricole de Conjoncture Intégrée aux Conditions de Vie des Ménages.The SLMs considered include the applica-tion of organic fertilizers,the application of inorganic fertilizers,the use of improved seeds,and the practice of intercropping.On average the application of organic fertilizers(39.2%),and inorganic fertilizers(28.7%)are the most frequent SLM practices among Malian farmers,and between 2014 and 2017,we observe a decline in the practice of intercropping.The regression results show that farmers’adoption of different SLMs is significantly associated with biophysical factors(average temperature,climate type,plot size,plot shape,and location),de-mographic factors(age,gender,education,household size),and socioeconomic factors(number of cultivated plots,livelihood diversification,type of crop grown,market access,credit access,economic shocks,and social capital).Our findings suggest that policymakers and agricultural development agencies in Mali need to adopt a multidimensional policy framework to unlock the untapped potential of SLM practices in promoting sustainable agriculture and food security.

Security Monitoring and Management for the Network Services in the Orchestration of SDN-NFV Environment Using Machine Learning Techniques

Software Defined Network(SDN)and Network Function Virtualization(NFV)technology promote several benefits to network operators,including reduced maintenance costs,increased network operational performance,simplified network lifecycle,and policies management.Network vulnerabilities try to modify services provided by Network Function Virtualization MANagement and Orchestration(NFV MANO),and malicious attacks in different scenarios disrupt the NFV Orchestrator(NFVO)and Virtualized Infrastructure Manager(VIM)lifecycle management related to network services or individual Virtualized Network Function(VNF).This paper proposes an anomaly detection mechanism that monitors threats in NFV MANO and manages promptly and adaptively to implement and handle security functions in order to enhance the quality of experience for end users.An anomaly detector investigates these identified risks and provides secure network services.It enables virtual network security functions and identifies anomalies in Kubernetes(a cloud-based platform).For training and testing purpose of the proposed approach,an intrusion-containing dataset is used that hold multiple malicious activities like a Smurf,Neptune,Teardrop,Pod,Land,IPsweep,etc.,categorized as Probing(Prob),Denial of Service(DoS),User to Root(U2R),and Remote to User(R2L)attacks.An anomaly detector is anticipated with the capabilities of a Machine Learning(ML)technique,making use of supervised learning techniques like Logistic Regression(LR),Support Vector Machine(SVM),Random Forest(RF),Naïve Bayes(NB),and Extreme Gradient Boosting(XGBoost).The proposed framework has been evaluated by deploying the identified ML algorithm on a Jupyter notebook in Kubeflow to simulate Kubernetes for validation purposes.RF classifier has shown better outcomes(99.90%accuracy)than other classifiers in detecting anomalies/intrusions in the containerized environment.

Whole-process case management effects on mental state and selfcare ability in patients with liver cancer

BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.

Heat transfer enhanced inorganic phase change material compositing carbon nanotubes for battery thermal management and thermal runaway propagation mitigation

Developing technologies that can be applied simultaneously in battery thermal management(BTM)and thermal runaway(TR)mitigation is significant to improving the safety of lithium-ion battery systems.Inorganic phase change material(PCM)with nonflammability has the potential to achieve this dual function.This study proposed an encapsulated inorganic phase change material(EPCM)with a heat transfer enhancement for battery systems,where Na_(2)HPO_(4)·12H_(2)O was used as the core PCM encapsulated by silica and the additive of carbon nanotube(CNT)was applied to enhance the thermal conductivity.The microstructure and thermal properties of the EPCM/CNT were analyzed by a series of characterization tests.Two different incorporating methods of CNT were compared and the proper CNT adding amount was also studied.After preparation,the battery thermal management performance and TR propagation mitigation effects of EPCM/CNT were further investigated on the battery modules.The experimental results of thermal management tests showed that EPCM/CNT not only slowed down the temperature rising of the module but also improved the temperature uniformity during normal operation.The peak battery temperature decreased from 76℃to 61.2℃at 2 C discharge rate and the temperature difference was controlled below 3℃.Moreover,the results of TR propagation tests demonstrated that nonflammable EPCM/CNT with good heat absorption could work as a TR barrier,which exhibited effective mitigation on TR and TR propagation.The trigger time of three cells was successfully delayed by 129,474 and 551 s,respectively and the propagation intervals were greatly extended as well.

Is medical management useful in Moyamoya disease?

Moyamoya disease(MMD),characterized by progressive internal carotid artery stenosis and collateral vessel formation,prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes.A multifa-ceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy,while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arte-rial stenosis and fragile collateral vessels.Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants,despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemo-rrhagic complications.Transcranial doppler has proven useful in thromboembolic detection,despite persisting challenges concerning the efficacy and safety of an-tithrombotic treatments.Furthermore,antihypertensive interventions aim to ma-nage blood pressure meticulously,especially during intracerebral hemorrhage,with recommendations and protocols varying based on the patient’s hypertension status.Additionally,lipid-lowering therapeutic strategies,particularly employing statins,are appraised for their possible beneficial role in MMD management,even as comprehensive data from disease-specific clinical trials remains elusive.Com-prehensive guidelines and protocols to navigate the multifaceted therapeutic ave-nues for MMD,while maintaining a delicate balance between efficacy and safety,warrant further meticulous research and development.This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.