Definite Value Research Articles

The effect of different definitions of hepatic injury on incidence and mortality rates in the ICU patient population with secondary hepatic injury

ObjectiveThe aim was to investigate how different hepatic injury (HI) definitions used in the same study population change incidence and mortality rates and which would best diagnose secondary HI. DesignSingle-centre retrospective observational cohort study. SettingTertiary hospital ICU, ANKARA, Turkey. PatientsFour hundred seventy-eight adult patients were included in the study. InterventionsNone. Main variables of interestThree definitions of HI were compared. Taking the SOFA hepatic criteria (SOFA: Total bilirubin (TBL) > 1.2 mg/dl) as the gold standard, sensitivity, specificity, positive and negative predictive values, and accuracy of the modified 2017 definition by the American College of Gastroenterology (ACG) and the 2019 European Association for the Study of the Liver (EASL) were calculated. ResultsIncidence rates ranged from 10% to 45% according to the definition (p < 0.005), while mortality rates ranged from 38% to 57%. When the SOFA1.2 (TBL > 1.2 definition was taken as the gold standard, the diagnostic value of the ACG definition was high, and HI was found to be an independent risk factor that increased mortality four times. ConclusionsAccording to this study’s results, the incidence and mortality rates of secondary HI vary greatly depending on the definition used. A definition that includes minimal increases in ALT, AST, and TBL predicts mortality with reasonable incidence rates.

Validation of the Valve Academic Research Consortium High Bleeding Risk Definition in Patients Undergoing TAVR.

Background: The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk (HBR) in patients undergoing transcatheter aortic valve replacement (TAVR). The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale TAVR population. Methods: Multicenter study including 10,449 patients undergoing TAVR. Based on consensus, twenty-one clinical and laboratory criteria were identified and classified as major or minor. Patients were stratified as at low, moderate, high, and very high bleeding risk according to VARC-HBR definition. The primary endpoint was the rate of BARC type 3 or 5 bleeding at 1 year, defined as the composite of peri-procedural (within 30 days) or late (after 30 days) bleeding. Results: Patients with at least one VARC-HBR criterion (n=9,267, 88.7%) had a higher risk of BARC 3 or 5 bleeding, proportional to the severity of risk assessment (10.8%, 16.1%, and 24.6% for moderate, high, and very high-risk groups, respectively). However, a comparable rate of bleeding events was observed in the low-risk and moderate-risk groups. The area under ROC curve was 0.58. Patients with VARC-HBR criteria also exhibited a gradual increase in 1-year all-cause mortality, with an up to 2-fold increased mortality risk for high and very high-risk groups (HR: 1.33, 95% CI: 1.04-1.70; and HR: 1.97, 95% CI: 1.53-2.53, respectively). Conclusions: The VARC-HBR consensus offered a pragmatic approach to guide bleeding risk stratification in TAVR. The results of the present study would support the predictive validity of the newly definition and promote its application in clinical practice to minimize bleeding risk and improve patient outcomes.

LV reverse remodeling after SAVR in patients with severe symptomatic aortic stenosis: impact on the clinical outcome

Abstract Introduction Surgical aortic valve replacement (SAVR) is the treatment of choice for young patients with severe aortic stenosis (AS) and low surgical risk. Left ventricular (LV) reverse remodeling (RR) after surgery is expected to occur. However, this is not always the case following afterload relief, and this may impact the prognosis. We aimed to assess the prognostic effect of distinct definitions of LV RR after SAVR in the long-term outcome of patients with severe AS. Methods Single-centre prospective study including patients referred for SAVR due to severe symptomatic AS, with no previous history of ischemic cardiomyopathy. Both pre- and post-operative transthoracic echocardiographic (TTE) and cardiac magnetic resonance (CMR) study (at the 3rd to 6th month after SAVR) were performed. LV RR was defined when in presence of at least one of the imaging criteria: &amp;gt;15% decrease in end-diastolic volume (EDV) by CMR; &amp;gt;15% decrease in LV indexed mass (LVM) by CMR; &amp;gt;10% decrease in geometric remodeling (LV mass/EDV ratio) by CMR; &amp;gt;10% increase in LV ejection fraction (LVEF) by CMR; &amp;gt;50% increase on global longitudinal strain (GLS) by TTE. We assess the prognostic value of RR definitions for the outcome after SAVR using Cox regression and Kaplan-Meier analysis. The primary endpoint was defined as all-cause mortality, heart failure (HF) hospitalization or worsening HF. Results We enrolled 140 patients – mean age 71±9 years-old, 49% male, predominantly high-gradient-normal flow AS (mean gradient 65±18mmHg, aortic valve area 0.7±0.2cm2, index stroke volume 47±11mL/m2) submitted to SAVR. At a mean follow-up (FUP) of 34±12 months, 23 (16%) patients met the primary endpoint: 4% (5 patients) died immediately after surgery; three patients died at the FUP (overall mortality rate of 6%). 12 patients (9%) were admitted for HF and 7 (5%) had at least one episode of worsening HF. 118 patients had complete pre and post-surgery imaging study (mean FUP: 36±10 months): 103 patients (87%) had at least one RR parameter (Table 1). Post-operative RR was not independently associated with the clinical outcome (Figure 1A). LVM was the sole independent predictor of the outcome at univariate analysis (Figure 1B–F). Conclusions LV RR after SAVR is highly prevalent in a cohort of patients with classical severe symptomatic AS. However, only LVM regression independently predicts the clinical outcome after surgery. This may stand the greater importance of structural reverse remodeling, rather than LV functional improvement, after pressure overload relief.

Trends in blood pressure: following subarachnoid haemorrhage and preceding cerebral vasospasm

Background Trends in Blood Pressure (BP) following Subarachnoid Haemorrhage (SAH) have been reported in literature since 1982. Recent studies suggest a correlation to the incidence of Cerebral Vasospasm. This renders BP a candidate for possible early detection of Vasospasm. However, conflicting results regarding the nature and numerical of this correlation exist. Objectives To determine trends in BP following SAH in terms of Systolic (SBP), Diastolic (DBP) and Mean Arterial Pressure (MAP) and collaborate current literature evidence of their association to Cerebral Vasospasm. Methods Two databases (EBSCO Medline and PubMed) systematically reviewed using specified search criteria. Thirteen studies were portrayed, of which ten were accessible. Thorough critical appraisal of each paper was then manually performed using the CASP Cohort study checklist. Results A consistent pattern of change is seen through time in majority of studies with differences in the definite values of the BP variables. Collation of results showed a gradual rise in SBP followed by a plateau of 154.08 (±10.79) mmHg on days 4-8 post-SAH. Variations exist with regards to the association with Cerebral Vasospasm: a third of the studies depicted a significant steeper rise in SBP in Vasospasm patients, another third conversely reported sudden drops in SBP, and one study concluded that MAP has no significant relation to Vasospasm. Conclusion A biphasic trend is expected following SAH with an initial gradual rise followed by a sustained hypertensive plateau. Considerable conflict exists in the nature of association between BP and Vasospasm. Further analysis of such beneficial predictive potential is recommended for advancement in Vasospasm and Neuro-Cardiogenic care.

The Efficiency Evaluation of DEA Model Incorporating Improved Possibility Theory

The data envelopment analysis (DEA) models have been widely recognized and applied in various fields. However, these models have limitations, such as their inability to globally rank DMUs, the efficiency values are definite numerical values, they are unable to reflect potential efficiency changes, and they fail to adequately reflect the degree of the decision maker’s preference. In order to address these shortcomings, this paper combines possibility theory with self-interest and non-self-interest principles to improve the DEA model to provide a more detailed reflection of the differences between DMUs. First, the self-interest and non-self-interest principles are employed to establish the DEA evaluation model, and the determined numerical efficiency is transformed into efficiency intervals. Second, an attitude function is added to the common possible-degree formula to reflect the decision maker’s preference, and a more reasonable method for solving the attitude function is presented. Finally, the improved possible-degree formula proposed in this paper is used to rank and compare the interval efficiencies. This improved method not only provides more comprehensive ranking information but also better captures the decision maker’s preferences. This model takes preference issues into account and has improved stability and accuracy compared with existing models. The application of the improved model in airlines shows that the model proposed in this paper effectively achieved a full ranking. From a developmental perspective, the efficiency levels of Chinese airlines were generally comparable. Joyair and One Two Three performed poorly, exhibiting significant gaps compared with other airlines.

Validating ICD-10 Diagnosis Codes for Guillain-Barré Syndrome in Taiwan's National Health Insurance Claims Database.

To validate the International Classification of Diseases, 10th Revision (ICD-10) codes for Guillain-Barré syndrome (GBS) in Taiwan's insurance claims database. We identified adult patients hospitalized at any Chang Gung Memorial Foundation branch hospital between January 1st, 2017, and December 31st, 2022, with ICD-10 code G61.0 in any of the five discharge diagnosis positions, indicating possible Guillain-Barré syndrome. We then validated the possible GBS diagnosis using data from electronic medical records of the identified patients, based on the diagnostic criteria established by the National Institute of Neurological Disorders and Stroke. We determined the positive predictive values (PPV) of various operational definitions, including the position (primary or other) where the code was recorded in the discharge diagnosis, nerve conduction study (NCS) claims, and / or specific GBS treatments. The final validation cohort of 484 patients with ICD-10 code for GBS in the discharge diagnosis was found to include 368 true GBS patients. Identifying inpatients using only the ICD-10 code for GBS in any of the five positions for discharge diagnosis yielded a PPV of 76.0%. With more restrictive definitions (primary diagnosis only, or requiring additional claims for NCS and/or treatments), the PPV tended to increase, but with fewer true GBS patients identified. Using ICD-10 GBS code in the primary diagnosis plus NCS and treatment claims yielded the highest PPV (98.3%); however, 140 (38.0%) of the true GBS patients were missed using this definition. In contrast, using the ICD-10 GBS code in any position, plus claims for NCS, achieved a relatively good PPV (85.8%) with minimal loss of true GBS patients (13, ie, 3.5%). In Taiwan's NHI claims data, identifying true GBS patients using only the ICD-10 code yielded a PPV of 76.0%; however, adding claims for diagnostic procedure and GBS treatment increased the PPV to 98.3%.

Dark Age Consistency in the 21cm Global Signal.

We propose a new observable for the 21cm global signal during the dark ages, "the dark age consistency ratio," which could serve as a critical test of models beyond the standard Λ cold dark matter (ΛCDM) model, particularly in future missions using a telescope on the moon or satellite orbiting around the moon. The new observable is motivated from the fact that the shape of the functional form of the 21cm signal against the frequency is almost cosmological-parameter independent in the ΛCDM. The dark age consistency ratio takes a certain definite value in the ΛCDM case, which enables us to easily falsify models beyond the standard model motivated by some particle physics and gravity theories. The new observable just needs measurements of the brightness temperature at a few frequency bands during the dark ages, and thus it allows us to test cosmological scenarios even with limited information on the 21cm global signal at the early stage of future lunar missions.

Background independent tensor networks

Conventional holographic tensor networks can be described as toy holographic maps constructed from many small linear maps acting in a spatially local way, all connected together with “background entanglement”, i.e. links of a fixed state, often the maximally entangled state. However, these constructions fall short of modeling real holographic maps. One reason is that their “areas” are trivial, taking the same value for all states, unlike in gravity where the geometry is dynamical. Recently, new constructions have ameliorated this issue by adding degrees of freedom that “live on the links”. This makes areas non-trivial, equal to the background entanglement piece plus a new positive piece that depends on the state of the link degrees of freedom. Nevertheless, this still has the downside that there is background entanglement, and hence it only models relatively limited code subspaces in which every area has a definite minimum value. In this note, we simply point out that a version of these constructions goes one step further: they can be background independent, with no background entanglement in the holographic map. This is advantageous because it allows tensor networks to model holographic maps for larger code subspaces. In addition to pointing this out, we address some subtleties involved in making it work.

Prediction of regional water resources carrying capacity based on stochastic simulation: A case study of Beijing-Tianjin-Hebei Urban Agglomeration

Study regionBeijing-Tianjin-Hebei urban agglomeration in China Study focusThe prediction of water resources carrying capacity (WRCC) can provide an effective reference for the rational allocation and efficient utilization of water resources. Traditional prediction methods obtained a definite WRCC value but fail to reflect the uncertainty of WRCC changes and limit reference for the optimal allocation of water resources. To ensure the accuracy, availability and comprehensiveness of prediction, this paper adopts the improved principal component analysis (PCA) to screen indicators, and predicts the WRCC through the coupled model of Monte Carlo and Grey Wolf Optimization-Support Vector Machine(GWO-SVM), addressing single result issues and computational complexity. At the same time, various regulation schemes for sensitive indicators are designed to provide an effective guidance for the optimal allocation and sustainable use of water resources. New hydrological insights for the regionIn 2025, the probability of WRCC in Tianjin, Handan, Xingtai, Hengshui, Cangzhou, Langfang to maintain grade III is more than 80 %, and that in Beijing, Baoding, Tangshan, Qinhuangdao, Zhangjiakou, Chengde to reach grade IV is more than 50 %. The sensitivity analysis shows that the sensitive indicators mainly focus on water supply and consumption, water use efficiency and pollutant gas emissions. The WRCC can be further improved under different schemes. The results can provide effective guidance for the optimal allocation of water resources and maintain sustainable economic and social development in Beijing-Tianjin-Hebei urban agglomeration.

Construction and Explanation Analysis of a Hypotension Risk Prediction Model in Hemodialysis Based on Machine Learning

Objective. To establish a risk prediction model for intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients and to analyze the explainability of the risk prediction model. Methods. A total of 2,228,650 hemodialysis records of 1075 MHD patients were selected as the research objects. Thirteen important clinical features including demographic features and clinical features were screened, the blood pressure measured before hemodialysis was collected, then an IDH risk prediction model during hemodialysis was established based on a machine learning algorithm. The contribution of each feature to the risk prediction of IDH was measured based on the Gini evaluation index. The TreeSHAP method was used to provide global and individual explanations for the IDH risk prediction model. Results. Hemodialysis duration, pre-dialysis mean arterial pressure, and pre-dialysis systolic blood pressure were the most important predictive variables for the occurrence of IDH during hemodialysis in MHD patients. The best IDH risk prediction model based on machine learning had an accuracy of 0.92 (95% CI 0.90–0.94) and an AUC of 0.95 (95% CI 0.94–0.96), indicating that machine learning has a good effect on the prediction of IDH during hemodialysis treatment. Our research innovatively achieved IDH risk prediction during the entire hemodialysis period based on blood pressure before the start of hemodialysis and other clinical features, thus enabling the medical team to quickly adjust hemodialysis prescriptions or initiate treatment for timely management and prevention of IDH. Global and individual explanations of the IDH risk prediction model can help hemodialysis medical staff understand the overall prediction mechanism of the model, discover prediction outliers, and identify potential biases or errors in the model. Conclusions. The IDH risk prediction model has definite clinical value in actual hemodialysis treatment.

Observations and Simulations of the Winds at a Bridge in Hong Kong during Two Tropical Cyclone Events in 2023

The impact of tropical cyclones on the operation of bridges and railways are mostly dependent on the forecast wind speed trend (upward, downward or staying steady) at present in Hong Kong. There are requests to forecast the exceedance of wind speed thresholds for such operations with a lead time of many hours ahead. This study considers the technical feasibility of forecasting the wind speed along a recently built bridge in Hong Kong with a coupled mesoscale numerical weather prediction (NWP)–computational fluid dynamics (CFD) model. This bridge features numerous anemometers where the coupled model can be verified. It is found that these two tropical cyclone cases are very challenging, especially in representing the wind structure of the cyclone because of its relatively small circulation. As such, the timing of the maximum wind could be 2 to 4 h earlier than the actual observation. The maximum wind speed from CFD modeling could be higher than that from the NWP model alone by 5 to 10 m/s, which shows that CFD modeling could add value in the forecasting of wind speed exceedance, although the maximum simulated value is still lower than the actual observation by as much as 10 m/s. As a result, while the general wind speed trend may be forecast, the exceedance of definite values of wind speed limits is still practically rather challenging, given the present two cases of tropical cyclones.

Evaluation and benchmarking of research-based microgrid systems using FWZIC-VIKOR approach for sustainable energy management

Microgrid (MG) is one of the technologies considered in the direction of providing green and sustainable energy resources for local communities. Ensuring the best performance of these MG technologies requires extensive research to provide the most efficient system. Research-based microgrids (RB-MGs) play a vital role in the development of green energy platforms, as microgrid applications vary according to different scenarios and locations. Selecting the best research-based microgrid ensures providing local communities and stakeholders with well-tested and examined MG systems. Assessing research-based microgrid systems (RB-MG) for sustainable green applications poses a challenging multi-attribute decision-making (MADM) problem. These complexities encompass the consideration of several evaluation criteria, the relative importance of these criteria, variations in data, and the inherent trade-offs and conflicts between these factors. Crisp and definite values to evaluate the research-based microgrids could not be found despite a comprehensive investigation. In this regard, appraisals and opinions of experts and professionals in providing sustainable energy with vast knowledge and experience in assessment, selection, installation, and operation were addressed as data. A novel decision-making model was developed to evaluate and select the most proper RB-MG system by processing these data. This study proposes an integrated MADM modelling approach using Fuzzy Weighted with Zero Inconsistency (FWZIC) method in conjunction with the Vlse-kriterijumska Optimizcija I Kaompromisno Resenje (VIKOR) method. The underlying process starts with constructing a decision matrix (evaluation criteria intersectioned with RB-MGs). Then, evaluation criteria are weighted using FWZIC, and the RB-MGs are ranked for each category using VIKOR. The results derived from FWZIC weights provide valuable insights. Key criteria such as 'installed power (KW)' and 'storage capacity (C3)' show notable values of 0.159 and 0.151, respectively, underscoring their importance in identifying optimal RB-MGs. These weights and alternatives were used to rank the highest RB-MG, which is LIER-CIRCE of the average PV power group, and Ormazabal from the 'Highest PV Power' group. Ormazabal obtained the lowest Qi (0.426). For the average PV power group, alternative number 7 (Atenea Centre) ranked as the best alternative with the lowest Qi among other RB-MGs in the same group (0.158107). Comparative assessments with various MCDM methods reveal strong correlations with TOPSIS and MABAC, but negative correlations with MAIRA. Additionally, there is a statistical difference in grouping by PV installed power (KW) or MPC.

Comparison of Various Ranking Methods with Pareto Distribution Methods in Imprecise Data

The Pareto distribution has seen wide application in many different fields recently. Nowadays, the data we collect may be imprecise and contain uncertainties. This means that the values we gather cannot necessarily be considered a single, definitive value. In this paper, it is explored how various estimation methods like the method of moments, maximum likelihood estimation, and least squares estimation are used to determine the parameters of a Pareto distribution when the data is fuzzy or uncertain in nature. When making decisions, ranking methods are often heavily relied upon. For this reason, the application of several different ranking techniques to triangular fuzzy numbers (TFNs) is considered. The ranking methods for TFNs are found to tend to produce estimated parameters that are quite similar or even identical. The estimating parameters of a Pareto distribution can be solved for when dealing with fuzziness by the use of ranking methods such as alpha-cut, Yeager’s method, sub-interval method, Pascal method, magnitude method, and centroid method on the TFNs. By comparing the results of these various ranking techniques, an analysis is conducted to whether the estimated parameters of the Pareto distribution are consistent across the different ranking methods for TFNs get the uniqueness of the solution or differ. The decision making done by among the various ranking techniques, which method preferable for future comparison with extended of new ranking techniques. The conclusion is that the simulation results match up well with actual application data, serving as a good example for explaining this overall strategy.

Diuretic resistance in acute heart failure: proposal for a new urinary sodium-based definition

BackgroundDiuretic resistance is a relevant clinical issue in acute heart failure (AHF), but a standardized, quantitative definition is still missing. The aim of this analysis was to highlight discrepancies between previously proposed definitions of diuretic response and to propose a new urinary sodium (NaU)-based definition of diuretic efficiency (DE) to identify diuretic resistant (DR) patients. MethodsThree historical definitions of diuretic response and a new NaU-based DE definition, evaluating total NaU after the first diuretic bolus per 40 mg furosemide administered, were applied in a retrospective analysis to an AHF population treated with intravenous (i.v.) loop diuretics. Baseline characteristics, in-hospital clinical data and outcomes at discharge and mid-term follow-up were collected and compared among DR and non-DR patients for each definition. ResultsAmong 53 patients, 39 (73.6%), 51 (96.2%) and 3 (5.7%) were DR according to weight-derived, diuresis-derived, and spot NaU definition, respectively. The median value of the new NaU-based definition was 31 mmol/40 mg and patients were stratified accordingly. DR patients showed lower cumulative diuresis (5200 mL, 3300–6700 vs 9825 mL, 6200–12200, p = 0.007) and weight loss (4 kg, 1–5 vs 6 kg, 3–8.5, p = 0.023), higher BNP levels (808 pg/mL, 443–1037 vs 351 pg/mL, 209–859, p = 0.062) at the conclusion of protocol-guided i.v diuretic therapy, which was less frequently stopped due to decongestion in DR as compared to non-DR patients (57.7% vs 85.2%, p = 0.026). Six-months mortality or HF hospitalizations were more frequent in DR patients (OR 18.6, 95% CI 2.1–161.2, p = 0.008). ConclusionsThe NaU-based DE definition might solve discrepancies of other previously proposed definitions.

Perfusion Imaging‐Based Triage for Acute Ischemic Stroke: Trends in Use and Impact on Clinical Outcomes

Background Perfusion imaging (PI) serves as a valuable tool for triaging patients with acute ischemic stroke for endovascular treatment (EVT). This study aims to investigate trends in PI use and its impacts on EVT rates and clinical outcomes, particularly focusing on variations across different time windows. Methods Data from a prospective, nationwide, acute stroke registry in South Korea were analyzed retrospectively. PI was regarded as treatment‐decision imaging when conducted either (1) prior to EVT, or (2) within 3 hours from hospital arrival in patients not receiving EVT. The study spanned 3 epochs: 2011–2014, 2015–2017, and 2018–2021. Based on the time from onset to arrival, patients were categorized into 2 time windows: early (0–6 hours) and late (6–24 hours). We evaluated EVT rates and clinical outcomes in patients with anterior large vessel occlusion. Results From 2011 to 2021 among 49 449 patients with acute ischemic stroke presenting within 24 hours of onset, PI use rates declined from 36.9% to 30.1%. In the early window, rates dropped from 48.4% to 32.4%, whereas in the late window, they increased from 23.5% to 27.8%. Factors such as older age, atrial fibrillation, anterior large vessel occlusion, and severe stroke were associated with higher rates in the late window. Conversely, younger age and male sex were associated with higher rates in the early window. For patients with anterior large vessel occlusion, PI use increased the likelihood of receiving EVT in the late window and minimized the risk of symptomatic intracranial hemorrhage in the early window. However, 3‐month functional outcomes and mortality were. unaffected. Conclusion The study revealed distinct trends in PI use across early and late time windows, indicating varying roles of PI in these time frames. However, the definitive value and necessity of PI in guiding EVT decision‐making remain unclear, underscoring the need for further research

The additional value of ultrasound markers in the diagnosis of polycystic ovary syndrome

ObjectiveTo study the value of current definitions for follicle number per ovary and ovarian volume in the diagnosis of polycystic ovary syndrome (PCOS). DesignCross-sectional study. SubjectsWomen diagnosed with PCOS after standardized screening were eligible for inclusion in the PCOS group. Women without PCOS who underwent the same screening, had regular menstrual cycles, normal hormonal values, and no other endocrine pathology were eligible for inclusion. Exposure: -Main Outcome measuresFollicle number per ovary and ovarian volume in women with PCOS, stratified by age. Linear regression models to investigate the influence of BMI on follicle number per ovary and ovarian volume. Differences of follicle number per ovary and ovarian volume between the PCOS phenotypes and the additional value of ovarian volume compared to follicle number per ovary. ResultsA total of 2492 women (16 – 50 years) with PCOS and 152 women without PCOS were included. Most women with PCOS up to age 35 exhibit a follicle number per ovary ≥ 20 (87.8 – 100%) (using an ultrasound transducer ≥ 8 MHz) or ≥ 12 (95.1 – 98.6%) (using a transducer < 8 MHz), followed by a decline in follicle number per ovary above the age of 35. Median ovarian volume was below the 10 mL cut-off in every age group, for both ultrasound transducers. Follicle number per ovary and ovarian volume was higher in women with PCOS compared to women without PCOS in every age category. In our cohort, 13/2297 women with PCOS (0.6%) would not have received the diagnosis if ovarian volume was not considered as a marker for polycystic ovarian morphology. For both ultrasound transducers, women with phenotype A (ovulatory dysfunction + hyperandrogenism + polycystic ovarian morphology) exhibited the highest follicle number per ovary and ovarian volume, followed by phenotype D (ovulatory dysfunction + polycystic ovarian morphology), then phenotype C (hyperandrogenism + polycystic ovarian morphology), and then phenotype B (ovulatory dysfunction + hyperandrogenism) (all p-values < 0.001 after adjusting for age). No clinically significant correlation between BMI and follicle number per ovary or ovarian volume was observed. ConclusionCriteria to define follicle number per ovary should be established per age category, as follicle number per ovary decreases with age. Ovarian volume shows a less clear decline with age and has a lower discriminative power, and therefore could be excluded from the diagnostic criteria. follicle number per ovary does not need to be stratified by BMI.

Analytic soliton solutions to the shallow water dispersive long gravity wave equations: the first integral approach in nonlinear physics

In this article, we investigate the (2+1)-dimensional dispersive long water wave equation and the (1+1)-dimensional Phi-four equation, which describe the behavior of long gravity waves with small amplitudes, long wave propagation in oceans and seas, coastal structures and harbor design, effects of wave motion on sediment transport, quantum field theory, phase transitions of matter, ferromagnetic systems, liquid-gas transitions, and the structure of optical solitons. We use the first integral technique and obtain new and generic solutions for the models under consideration. By setting definite values for the associated parameters, various types of richly structured solitons are generated. The solitons include kink, flat kink, bell-shaped, anti-bell-shaped, and singular kink formations. These solutions allow for a profound understanding of the behavior and properties of the phenomena, offering new insights and potential applications in the associated field. The first integral technique is simpler, directly integrates the models, and the solutions offer clear insights into the underlying phenomena without requiring intermediate steps, making it widely applicable to various other models, including nonlinear equations and those that are challenging to solve using other standard techniques.

The Contralateral Ankle Joint Is a Reliable Reference for Testing Syndesmotic Stability Using Bilateral External Torque CT.

Subtle chronic or latent instabilities are difficult to delineate with currently available diagnostic modalities and do not allow assessment of ligamentous functionality. The noninvasive bilateral external torque computed tomography (CT) was able to reliably detect syndesmotic lesions in a cadaveric study. The aim of the study was to test the external torque device in young, healthy subjects at 3 different torque levels and to demonstrate comparability with the contralateral side. Ten healthy subjects without history of injury or surgery to the ankle joint were enrolled in this cross-sectional study. Four CT scans were performed. During the scans, the lower legs and feet were placed in an external torque device with predefined external rotation torques of 0, 2.5, 5, and 7.5 Nm. Five different radiographic measures of syndesmotic stability were measured: anterior distance (AD), tibiofibular clear space (TCS), posterior distance (PD), external rotation (ER), and β angle. With increasing external torque, slight increases in AD, ER, and β angle were observed, whereas TCS and PD decreased slightly. Large absolute differences were found between the healthy subjects for all measured parameters, regardless of the external torque applied. Differences from the contralateral side using the same external torque were minimal for all parameters, but smallest for AD with a maximum difference of 0.5 mm. Using the healthy contralateral ankle joint is appropriate for assessing syndesmotic stability based on minimal intraindividual side differences using the external torque device. Side differences >0.5 mm in AD and >0.9 mm in PD may be considered abnormal and may indicate significant instability of the syndesmosis. However, future studies are needed to define definitive cutoff values for relevant side differences in acute and chronic syndesmotic instability to guide clinicians in their treatment decisions.

The impact of aneurysm volume on midterm Post-EVAR outcomes

Aim: We examined the impact of preoperative three-dimensional aortic volume on outcomes following Endovascular Aortic Repair (EVAR). Material and Methods: A total of 146 patients who underwent elective EVAR at our hospital between January 2018 and January 2023, and who had preoperative and postoperative multislice Computed Tomographic Angiography (CTA), were included in the study. The effects of aneurysm sac volumetric measurements on post-EVAR endoleak, reintervention, and late mortality were evaluated. Since there is no definite cut-off value for aneurysm volume and EVAR results in the literature, we compared patients with aneurysm volumes above and below 231.7 cm³ obtained by roc analysis. Results: During the follow-up period, the rate of secondary intervention was higher if the preoperative aneurysm volume was greater than 231.7 cm³ (p=0.001) or if the preoperative thrombus volume was greater than 206.1 cm³ (p=0.002). There was no notable difference in terms of endoleak (p=0.5) and during follow-up mortality rate (p=0.8) between patients with sac volumes above and below 231.7 cm³. After EVAR, when morphological changes were examined, it was noted that there was a dilatation of the neck (preoperative 23±4 mm and postoperative 26±4 mm) (p&lt;0.001) and a decrease in neck (infrarenal) angulation (preoperative 39 degrees and postoperative 31.5 degrees) (p&lt;0.001). Conclusion: This study demonstrates that aneurysms with high volume are prone to secondary intervention. However, it is not correlated with early or midterm mortality and outcomes. Volumetric analysis of the aneurysms preoperatively may be an indicator of surveillance protocols and treatment choices. Lifetime follow-up and volumetric analysis of aneurysms seem crucial for effective and reliable surveillance.

Defining Active Travel: A Response to Cook et al, 2022

Cook et al. (2022) have defined active travel as that in which “physical exertion of the traveller directly contributes to their motion”. This response argues that there is more value and justice in an inclusive definition that incorporates non-normative conceptualisations of physical activity.