This study aims to evaluate the safety and effectiveness of TIPS-PVR in patients with cirrhosis with acute PVT. A retrospective analysis of cirrhotic patients with acute PVT who underwent TIPS-PVR at a single academic institution. Patients were categorized by PVT etiology and thrombus extent according to AASLD criteria. Outcomes assessed included technical success, one-year patency of the TIPS and porto-mesenteric venous system, need for TIPS reintervention, symptom recurrence, and overall survival. Overall survival was defined as the time from TIPS-PVR to death or last follow-up. Fifty cirrhotic patients underwent TIPS-PVR for acute PVT. Technical success was 100%. Superior mesenteric vein (SMV) involvement was seen in 30/50 (60%), and splenic vein in 11/50 (22%). At one year, 32 patients had follow-up. Primary patency was 75% (24/32), primary-assisted patency 94% (30/32) for TIPS and 97% (31/32) for the portal vein. Patency rates improved at one year: Main portal vein from 18 to 97% (p < 0.001), SMV from 50 to 91% (p < 0.001), splenic vein from 78 to 100% (p = 0.0108). 9 patients underwent liver transplantation after TIPS-PVR. There were no grade 4 or grade 5 CIRSE adverse events. There were five Grade 6 events after the procedure. Overall survival was 78% at 12months, with 95% CI 64-87%. TIPS-PVR appears to be a safe and effective procedure for cirrhotic patients with acute PVT, offering a viable option for restoring portal venous flow.

Fluoroscopically guided jejunal tube placement via percutaneous endoscopic gastrostomy (PEG-J) provides minimally invasive post-pyloric access in children. Limited data exist regarding routine application and procedural risks. To evaluate the safety and technical success of PEG-J in pediatric patients, performed without general anesthesia or sedation. All pediatric cases of fluoroscopically guided PEG-J procedures performed between 2011 and 2025 were included. Fluoroscopic images were reviewed to determine the final position of the tube tip. Technical success, complications, anatomical variants, and tube patency were assessed. Fluoroscopy time and dose area product (DAP) were documented. A total of 126 PEG-J procedures in 60 children (36 males) were analyzed. The technical success rate was 85% (107/126) with final tube tip placement in the jejunum in 88 cases (82%) and in the duodenum in 19 cases (18%). Nineteen procedures (15%) were unsuccessful, including six with documented anatomical causes (steep vertical duodenal entry, n=2; malrotation, hiatus hernia, hooked stomach in superior mesenteric artery syndrome, steep take-off of the jejunum with kinking of the tube at the ligament of Treitz, n=1 each) and 13 without documented reasons. The median fluoroscopy time was 5min 24s (range, 2s-37min), at a frame rate of 0.5 frames per second. The median DAP was 6.1cGy·cm2 (range, 0.08-343cGy·cm2). Fluoroscopically guided PEG-J placement is a safe and effective procedure in pediatric patients, with high technical success and low radiation exposure.

Endometrial Polyps.

This systematic review and meta-analysis aimed to evaluate the most effective minimally invasive intra-articular procedure for reducing pain and improving maximum mouth opening (MMO) in individuals diagnosed with painful articular TMD, specifically TMJ osteoarthritis and/or internal derangement. Only randomized clinical trials (RCTs) assessing the efficacy of minimally invasive procedures, such as arthrocentesis and intra-articular injection (IAI), were included. The meta-analysis included seven studies with a 6-month follow-up, while 23 studies with different follow-up periods were evaluated qualitatively. The meta-analysis showed that IAI with tenoxicam was the most effective procedure for pain reduction, with the highest [7.44 mean difference (MD); 6.28-8.60 confidence interval (CI)], followed by opioids (5.93; 5.03-6.83), the combination of hyaluronic acid (HA) with platelet-rich plasma (PRP) (5.10; 4.52-5.68), and PRP alone (4.99; 3.13-6.85). For improvement in MMO, tenoxicam had the highest MD (+11.50 mm; 15.47-7.53), followed by PRP (+10.46 mm; 14.89-6.02) and the HA-PRP combination (+10.10 mm; 11.89-8.31). Tenoxicam showed promising results for pain reduction and improvement in MMO, although the evidence remains limited, followed by opioids and the combination of HA and PRP with arthrocentesis. Further high-quality studies are needed to confirm their clinical applicability.

To assess the oncological outcomes of targeted microwave ablation (TMA) using organ-based tracking (OBT) Fusion® via KOELIS Trinity® (KOELIS, Meylan, France) in men with intermediate-risk prostate cancer (PCa): the VIOLETTE trial (ClinicalTrials.gov identifier: NCT04582656) PATIENTS AND METHOD: In this prospective phase II, multicentre European study, men with a prostate-specific antigen (PSA) level <20 ng/mL, a single magnetic resonance imaging (MRI)-visible lesion ≤15 mm, International Society of Urological Pathology (ISUP) Grade Group 2 on MRI-targeted biopsy, and clinical T stage ≤2, were enrolled. The microwave applicator was placed using OBT Fusion guidance, either transperineally or transrectally. The primary endpoint was the absence of clinically significant PCa (csPCa), defined as ISUP Grade Group ≥2, within the treated area at 12 months. Secondary endpoints included safety, functional outcomes using validated measures, and the need for subsequent radical treatment. A total of 76 patients were treated across six centres with 66 (87%) completing the 12-month follow-up. At 6 months, six patients had csPCa after positive MRI control, including four within the treated area. At 12 months, csPCa was detected in 15 additional patients, including nine in-field recurrences, yielding an 81% in-field csPCa-free rate. Five serious adverse events in three patients were reported. Sexual (-2.5 points; P < 0.001) and ejaculatory (-1 points; P < 0.001) scores decreased significantly, whereas urinary function remained stable. Radical treatment was required in four (5.2%) patients at 12 months. Targeted microwave ablation using OBT Fusion technology appears to be a safe and effective focal therapy procedure for localised intermediate-risk PCa. The VIOLETTE trial achieved its primary endpoint, with 81% patients free of in-field csPCa at 12 months.

The earthquake doublet on 6 February 2023 served as an important test in Türkiye. It helped assess the vulnerability of Türkiye’s building stock under different seismic loading conditions across a large region. The widespread destruction and casualties observed in heavily damaged cities following the 6 February 2023 earthquakes served as a warning. This urged a re-evaluation of the seismic performance assessment framework and risk mitigation strategies. Seismic isolation technology is considered the best method for earthquake-resilient design. Passive control systems are primarily preferred for use in critical facilities, such as healthcare complexes and data centers. Properly designed seismically isolated hospital buildings exhibited superior performance during the 6 February 2023 earthquakes compared to fixed-base counterparts. However, their use in residential buildings in Türkiye is still limited due to impediments such as stringent code requirements and peer review processes. This study evaluates the effectiveness of the ELF procedure in the Turkish Seismic Design Code-2018, incorporating two site-specific studies and earthquake record scaling in Antakya city center. Moreover, it examines the influence of considering directivity effects for using seismic isolation systems in regions with high seismicity. An effective and rapid evaluation procedure is employed for the inelastic response of seismically isolated residential buildings in accordance with the TSDC-2018 without needing any particular academic or commercial software. A suite of differential equations using the design parameters is arranged to represent the overall dynamics of seismically isolated buildings. Disregarding the directivity effects in site-specific studies for the selected construction site in Antakya city center can result in large earthquake demands and careful attention should be given to reconstruction studies for urban planning and more detailed studies should be carried out including other complex mechanisms experienced during the 6 February 2023 Türkiye earthquake doublet.

Multi-view clustering (MVC) is a fundamental unsupervised learning task for exploring latent structures from heterogeneous multi-view data. Existing MVC methods face critical challenges including the high computational cost of full-graph tensor models, neglect of high-order interactions between diversity and consistency information, and anchor misalignment across different views. In this paper, we propose an efficient anchor-guided MVC framework (EAG-DCT) via diversity–consistency learning and low-rank tensor recovery. The proposed method jointly learns consensus anchors, view-specific diversity graphs, and a global consistency graph in a unified model that integrates all graphs into a high-order tensor to capture rich cross-view correlations. By imposing a nonconvex low-rank constraint on the tensor, we effectively enhance the synergy between diversity and consistency learning. Our framework achieves high computational efficiency and scalability for large-scale data. Comprehensive experimental results on benchmark datasets validate that EAG-DCT outperforms state-of-the-art MVC methods in both clustering effectiveness and efficiency.

ABSTRACT The effectiveness of early intervention programs is often limited by funding shortages, staffing challenges, and inconsistencies across providers. One means of addressing these limitations is to train early childhood teachers as interventionists in their own classrooms. The purpose of the current study was to evaluate the impact of a pilot Tier 1 preschool behavioral skills training intervention on students’ classroom behavior. Fourteen preschool aged children enrolled in a six-week, school-based early intervention program received the pilot behavior program, which focused on increasing adaptive skills and reducing challenging behavior. Results suggest improvement across skill domains (d = 2.3), along with a 20-point increase in teacher-reported self-efficacy. Total consultation time across classrooms (M = 5.8 hours) suggests these procedures may be scalable to other settings. These findings suggest that teachers can be trained to implement efficient and effective behavior change procedures with relatively few external resources.

Due to the significant economic and ecological value of forest land resources, they have received extensive attention in recent years. The level of forest productivity is the primary factor considered when developing and utilizing forest land resources. However, the assessment indicators for the productivity level of forest land are complex and diverse. In practical applications, by using multi-index assessment methods, more reasonable assessment results can be obtained. As a widely used assessment model, the Measurement Alternatives and Ranking according to Compromise Solution (MARCOS) method is proposed to solve the problem of ranking alternatives in multi-index assessment. Since the proposal of this method, many research results have emerged regarding its theory and application. Aiming at the shortcomings of the MARCOS method in the ranking effect of other options and the unreasonable change trend of its ideal alternative utility degree, in this study, the utility formulas for both the positive and negative ideal alternatives are improved, and the calculation formula of comprehensive utility degree is reconstructed. The revised MARCOS enhances the applicability and effectiveness of the original MARCOS method. We also compare and analyze the revised method with several multi-index assessment methods. The comparison results show that the revised method exhibits excellent consistency with other methods and has better decision flexibility and resolution. By assessing forest productivity, the applicability and validity of the revised MARCOS method are illustrated.

Objective: To assess the diagnostic yield, safety, and outcomes of medical thoracoscopy in patients with suspected pleural tuberculosis. Study Design: Cross sectional study. Setting: Department of Pulmonology, Shaikh Zayed FPGMI, Lahore. Period: January 2015 and December 2024. Methods: This is a retrospective study. A total of 119 patients who underwent medical thoracoscopy for suspected pleural tuberculosis between January 2015 and December 2024 were included. Data were analyzed using descriptive statistics. Results: Tuberculosis was confirmed in the majority of cases, demonstrating a high diagnostic yield. Pleural adhesions were seen in over half of the patients; most were managed successfully during thoracoscopy, while a few required additional interventions. No major complications occurred. Minor events included post-procedural pain (35.3%), surgical emphysema (4.2%), air leak (4.2%), and wound site infection (0.8%). Three patients required surgical referral. Conclusion: Medical thoracoscopy is a safe, reliable, and effective procedure for diagnosing pleural tuberculosis, with minimal complications and added therapeutic benefit in managing pleural adhesions.

Recently, in weighted automata theory the weight structure of strong bimonoids has found much interest; they form a generalization of semirings and are closely related to near-semirings studied in algebra. Here, we define polynomials over a set X of indeterminates as well as an addition and a multiplication. We show that with these operations, they form a right-distributive strong bimonoid, that this polynomial strong bimonoid is free over X in the class of all right-distributive strong bimonoids and that it is both left- and right-cancellative. We show by purely algebraic reasoning that two arbitrary terms are equivalent modulo the laws of right-distributive strong bimonoids if and only if their representing polynomials are equivalent by the laws of only associativity and commutativity of addition and associativity of multiplication. We give effective procedures for constructing the representing polynomials. As a consequence, we obtain that the equivalence of arbitrary terms modulo the laws of right-distributive strong bimonoids can be decided in exponential time. Using term-rewriting methods, we show that each term can be reduced to a unique polynomial as normal form. We also derive corresponding results for the free idempotent right-distributive polynomial strong bimonoid over X. We construct an idempotent strong bimonoid which is weakly locally finite but not locally finite and show an application of it in weighted automata theory.

BACKGROUNDPancreatic pseudocyst (PPC) is a well-encapsulated peri-pancreatic fluid collection that occurs at least 4 weeks after acute pancreatitis. The prevalence of PPC is 8%-41% among patients with a history of pancreatitis. Management includes conventional surgery and percutaneous radiological or endoscopic approaches. Endoscopic ultrasound (EUS)-guided drainage of PPC appears to be a safe and less invasive treatment option. Its efficacy is well established in the adult population. However, data regarding its usage in the pediatric population are limited.AIMTo determine the safety and efficacy of EUS-guided PPC drainage in children over 10 years.METHODSA retrospective review was conducted of pediatric patients (aged < 18 years) who were referred for EUS-guided PPC drainage between 2015 and 2024. Twenty-eight patients were identified who had been referred to our department for EUS-guided PPC drainage, including 21 patients with symptoms who underwent the procedure. Effectiveness was assessed based on technical success and clinical resolution of symptoms.RESULTSThe mean age was 13.81 ± 3.25 years (range: 6-18 years) with 52.4% males. The locations of the PPCs were distributed along the pancreatic body (38.1%) and head/neck regions (38.1%). EUS-guided drainage was performed under general anesthesia. Complete aspiration without stent placement was performed in 11 patients (52.4%) with an average PPC size of 4.3 cm × 3.9 cm. Two double-pigtail plastic stents were required in 9 patients (47.6%) with a mean size of 8.4 cm × 8.0 cm. Lumen-apposing metal stents were required in 1 patient. Technical and clinical successes were achieved in all cases. One patient (4.8%) experienced recurrence that required repeat drainage. No major complications were observed.CONCLUSIONEUS-guided PPC drainage was a safe and effective procedure for our pediatric population and should be preferred over conventional techniques, performed by experienced endoscopists under general anesthesia by pediatric anesthetists.

The article is devoted to a comparative analysis of appellate mechanisms in ad hoc tribunals (the International Criminal Tribunal for the former Yugoslavia and the International Criminal Tribunal for Rwanda) and the International Criminal Court. It examines the evolution of appellate proceedings, grounds for appeal, scope of review (de novo in ad hoc tribunals versus limited review of errors in the ICC), procedural features, and their impact on the effectiveness of international criminal justice. Particular attention is paid to the role of appeal in ensuring fair trial, the presumption of innocence, and complementarity. The relevance of the topic is emphasised in the context of contemporary conflicts, particularly the ICC investigations into crimes associated with the aggression of the Russian Federation against Ukraine. The practice of key cases (Tadić, Akayesu, Lubanga, Bemba, Al-Senussi, Katanga, Ngudjolo Chui) is analysed, illustrating common features (independence of chambers, right to appeal) and differences in mechanisms. The experience of ad hoc tribunals significantly influenced the formation of the Rome Statute norms, contributing to the unification of jurisprudence and overcoming impunity. The comparative analysis indicates the evolutionary development of appellate proceedings: from reactive and broad mechanisms of temporary tribunals focused on specific conflicts to limited but more effective and universal procedures of a permanent court. The experience of ad hoc tribunals substantially shaped the Rome Statute norms, particularly regarding standards of fair trial, protection of the rights of the accused and victims, and unification of jurisprudence. For Ukraine, integration of ICC appellate principles into national legislation is recommended to ensure effective investigation of international crimes.

Covariate-constrained randomization is an effective treatment allocation procedure for controlling imbalance across multiple baseline covariates in randomized trials. Motivated by the GroupPMPlus cluster randomized trial, we introduce the asymptotic theory for a broad class of estimators, known as M-estimators, under covariate-constrained randomization. Here, M-estimators refer to estimators obtained by optimizing an objective function, such as a log-likelihood function, and include commonly used methods such as analysis of covariance and linear mixed models. We show that M-estimators remain consistent in this setting but can exhibit non-Gaussian asymptotic distributions depending on the specification. Using examples of common M-estimators, we delineate conditions under which covariate-constrained randomization can be safely ignored in statistical analysis. Our results extend to stratified covariate-constrained randomization and semiparametric efficient estimators based on data-adaptive machine learning methods. We illustrate these theoretical findings using the GroupPMPlus study to evaluate the causal effect of a psychological treatment on mental health outcomes following a disaster.

Long-term nephro-urological follow-up after hellstrom-chapman vascular hitch: A safe and effective procedure preserving renal perfusion.

Flatfoot is a common condition in children; surgical treatment should be reserved for severe and symptomatic cases. Calcaneal lengthening osteotomy (CLO) has been associated with good results; the original technique considers the use of allografts or autografts. This study aimed to evaluate advantages of a titanium trapezoidal wedge (TTW) in a pediatric population, compared with traditional grafts. At our knowledge, there are no studies in pediatric patients. This is a retrospective study of 11 patients (14 feet) with severe flatfoot treated with CLO and TTW and a control group of nine patients (13 feet) treated with CLO and traditional grafts. The mean age of TTW group was 13.4 years, and the mean follow-up was 15 months. The mean age in the control group was 13.7 years, and the mean follow-up was 36 months. Pre- and postoperative clinical and radiographic measures were evaluated, as well as operative time and radiation exposure. At follow-up, feet treated with TTW showed an improvement in all radiographic parameters measured on weight-bearing radiographs and also an improvement in the American Orthopedic Foot and Ankle Society Score, comparable to the control group. The use of TTW significantly reduced radiation exposure and operating time. No cases of graft fracture or migration were observed. All TTW appeared osteointegrated at the last follow-up. CLO using TTW is an effective procedure, allows correction to be maintained over time and reduces operative time and radiation exposure. Despite the promising results, our findings should be considered as a preliminary report; more data are needed to confirm our results.

Mastectomy in transgender patients: The experience of a Portuguese reference center.

Acute coronary syndrome (ACS) is a life-threatening condition requiring accurate diagnosis for better outcomes. However, variability in signs and symptoms among racial subgroups could cause disparities in diagnostic accuracy. In this study, we use machine learning models to diagnose ACS, focusing on mitigating disparities and ensuring fairness between Black and non-Black populations. We built on a state-of-the-art random forest classifier to compare three mitigation strategies. The first two approaches involved resampling or partitioning the data prior to training, while the third approach proposed an innovative framework called adversarial debiasing. To evaluate our model performance, we used the receiver operating characteristic (ROC) curve and an operating point at 80% specificity for clinical importance. After mitigation with adversarial debiasing, the difference in sensitivities between the two subgroups decreased from 9.8% to 1.3%. Specifically, this approach achieved areas under the ROC of 0.810 and 0.817, and sensitivities of 70.1% and 71.4%, respectively for Black and non-Black subgroups. The proposed adversarial debiasing model outperformed the other two methods in both diagnostic accuracy and effectiveness in minimizing disparities. We expect this framework to achieve fair diagnostic models across diverse demographic populations globally and be generalizable to other outcomes.

Apparent resistivity evaluation method of slurry diffusion-solidification and grouting effect of water-bearing fractured rock mass

Although advanced age is no longer a contraindication for renal transplantation, real-world data on elderly transplant recipients remain limited. This multicenter, prospective study enrolled de novo kidney transplant recipients aged 60 years or older receiving once-daily tacrolimus immunosuppression, following recovery of renal function and referral to the transplant clinic. The primary objective was to describe clinical characteristics and post-transplant outcomes over a 12-month follow-up. Secondary objectives included assessing changes in quality of life and the relationship between biopsy-proven acute rejection (BPAR) and tacrolimus levels. Of 280 evaluable patients, 239 completed the 12-month follow-up (mean recipient age: 69.8 years; mean donor age: 69.1 years) and 41 (14.6%) terminated due to graft loss (13, 31.7%), tacrolimus termination (12, 29.3%), death (10, 24.4%), loss to follow-up (3, 7.3%), other (2, 4.9%), and temporary tacrolimus interruption (1, 2.4%). BPAR occurred in 8.2% of patients who showed significantly higher tacrolimus levels vs those without BPAR over the follow-up (9.8ng/mL vs. 8.9ng/mL; p = 0.01). Opportunistic infections were reported in 78.3% patients with BPAR vs 58.8% without BPAR (p = 0.07). Quality of life improved across different domains of the Kidney Transplant Questionnaire and the ESRD-SCL. This study monitored clinical outcomes during the first year post-transplant in older de novo kidney transplant recipients receiving grafts from older donors and under a once-daily tacrolimus-based immunosuppressive regimen. The incidence of BPAR, graft loss, and mortality was low, and patients generally experienced an improvement in quality of life, indicating an effective and safe procedure in this population.