Normal Flow Research Articles

Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study.

To investigate midbrain growth, including corpus callusum (CC) and cerebellar vermis (CV) and cortical development in late fetal growth restricted (FGR) subclassified according to the umbilical vein blood flow (UVBF) values. This was a prospective study on singleton fetuses late FGR with abnormal placental cerebral ratio (PCR). FGR fetuses were further subdivided into normal (≥fifth centile) and abnormal (<fifth centile) UVBF blood flow corrected forAC (UVBF/AC), neurosonography was performed at 33-34weeks of gestation to assess CC and CV lengths and the depth of Sylvian fissure (SF), parieto-occipital (POF) and calcarine fissures (CF). Neurosonographic variables were normalized for fetal head circumference size. The study cohort included 60 late FGR, 31 with normal UVBF/AC and 29 with abnormal UVBF/AC values. The latter group showed significant differences in CC (median (interquartile range (IQR) normal 0.96 (0.73-1.16) vs. abnormal UVBF/AC 0.60 (0.47-0.87); p<0.0001)), CV (normal 1.04 (0.75-1.26) vs. abnormal UVBF (AC 0.76 (0.62-1.18)); p=0.0319), SF (normal 0.83 (0.74-0.93) vs. abnormal UVBF/AC 0.56 (0.46-0.68); p<0.0001), POF (normal 0.80 (0.71-0.90) vs. abnormal UVBF/AC l 0.49 (0.39-0.90); p≤0.0072) and CF(normal 0.83 (0.56-1.01) vs. abnormal UVBF/AC 0.72 (0.53-0.80); p<0.029). Late onset FGR fetuses with of reduced umbilical vein flow showed shorter CC and CV length and a delayed cortical development when compared to those with normal umbilical vein hemodynamics. These findings support the existence of a link between abnormal brain development and changes in umbilical vein circulation.

Remarks on the normal hyperbolic mean curvature flow

In this paper, we investigate the various aspects of normal hyperbolic mean curvature flow by LeFloch and Smoczyk. It is remarkable that the equation admits the null condition in three-dimensional case and only satisfies the first null condition when [Formula: see text]. Based on the interesting findings, we can obtain the results of global existence of smooth solutions, as well as the stability of hyperplanes under this flow when [Formula: see text], which relates to the famous Bernstein theorem. Some explicit solutions for this flow have been also derived. It should be emphasized that the null structures of this hyperbolic mean curvature flow have not been found before.

Management of Pain in People Living With Chronic Limb Threatening Ischemia: Highlights From a Rapid Umbrella Review.

Peripheral artery disease is a complex health condition. It is associated with atherosclerotic occlusive lesions in the arteries limiting normal blood flow, mostly involving the lower extremities, leading to chronic limb-threatening ischemia (CLTI). Chronic unrelenting ischemic leg pain can be debilitating and distressing, contributing to poor health-related quality of life. Comprehensive management of pain associated with CLTI requires multimodal approaches that draw on a range of strategies and specialist treatments delivered by an interdisciplinary team across various health care settings. We recognized a significant gap in evidence-based strategies that are accessible, appropriate, acceptable, effective, and safe for the elderly with CLTI-associated pain. We therefore conducted an umbrella review or overview of multiple existing reviews that employ a rigorous and transparent method to comprehensively identify and synthesize relevant literature including systematic, scoping, and narrative reviews. The purpose of this umbrella review was to aggregate and compare various management options to inform best practices and quality indicators for the management of ischemic pain in older patients with peripheral artery disease.

Abstract TMP53: MR-ASL Imaging Can Predict the Collaterals in Moyamoya Disease

Introduction: Digital subtraction angiography (DSA) is the gold standard investigation for the diagnosis and prognostication of moyamoya disease (MMD). Magnetic resonance arterial spin labelling (MR-ASL) is a newer non-invasive technique that can predict the perfusion reliably. Our study aims at prediction of collaterals with MR-ASL in addition to parenchymal perfusion deficit. Methodology: It is an observational single centre cohort study where consecutive MMD patients with both DSA and MR-ASL done within 3 months of each other were included in the study. Images were reviewed by 2 radiologists independently. MMD severity was graded using Suzuki staging and collaterals were graded using DSA and MR-ASL in 7 different regions [4 areas in basal ganglia level - basal ganglia, M1, A1 and P1], 3 areas at superficial cortical level above basal ganglia [M2, A2, P2]. DSA collateral grading used was: grade 0 - no collaterals visible (absence of any capillary blush) with perfusion deficit, grade 1 - mild to moderate collaterals with some perfusion deficit, grade 2 - extensive collaterals with no perfusion deficit, grade 3 - normal antegrade flow. Collateral grading used on MR-ASL was: grade 0 - no or minimal ASL signal; grade 1 - moderate ASL signal with arterial transit artefact (ATA), grade 2 - high ASL signal with ATA, grade 3 - normal perfusion without ATA. Results: Of the 46 MMD patients (males - 22), 92 hemispheres were included. 4 hemispheres were excluded as the patient underwent revascularisation in the corresponding hemisphere. Among the remaining 88 hemispheres, 7 were normal on angiography. At various Suzuki grades, the degree of collaterals graded on ASL changed according to Suzuki staging (p&lt;0.001). Whether collateral grading using ASL can predict the collaterals graded using DSA was tested using Cohen Kappa’s method, and it was found that MR-ASL can predict collaterals graded by DSA with very good agreement in all the regions studied (p&lt;0.001). Conclusion: MR-ASL is a simple, safe, effective and reproducible alternative for DSA in determining the collaterals and perfusion status in MMD patients without the untoward effects like contrast exposure.

Generative machine learning for detector response modeling with a conditional normalizing flow

In this paper, we explore the potential of generative machine learning models as an alternative to the computationally expensive Monte Carlo (MC) simulations commonly used by the Large Hadron Collider (LHC) experiments. Our objective is to develop a generative model capable of efficiently simulating detector responses for specific particle observables, focusing on the correlations between detector responses of different particles in the same event and accommodating asymmetric detector responses. We present a conditional normalizing flow model (𝒞𝒩ℱ) based on a chain of Masked Autoregressive Flows, which effectively incorporates conditional variables and models high-dimensional density distributions. We assess the performance of the 𝒞𝒩ℱ model using a simulated sample of Higgs boson decaying to diphoton events at the LHC. We create reconstruction-level observables using a smearing technique. We show that conditional normalizing flows can accurately model complex detector responses and their correlation. This method can potentially reduce the computational burden associated with generating large numbers of simulated events while ensuring that the generated events meet the requirements for data analyses. We make our code available at https://github.com/allixu/normalizing_flow_for_detector_response.

Using learned priors to regularize the Helmholtz equation least-squares method

The Helmholtz equation least-squares (HELS) method is a valuable tool for estimating equivalent sound sources of a radiating object. It solves an inverse problem by mapping measured pressures to a set of basis functions satisfying the Helmholtz equation in spherical coordinates. However, this problem is often ill-posed, necessitating additional regularization methods, in which often variations of Ridge or Lasso are used. These conventional methods do not explicitly consider the distribution underlying the source radiations (besides sparsity) and are often used in the context of obtaining only a point estimate, even in the presence of ambiguity in the data. In this work, we propose the use of empirical priors through a normalizing flow model to enhance the inversion results obtained with the HELS method. We first validate our approach using numerical data and subsequently demonstrate its superior performance in interpolating a measured violin directivity compared to Lasso and Ridge methods, even when optimal regularization parameters are selected.

INEVITABLE MYOMECTOMY OF EXTRUDING INTRAMURAL FIBROID DURING CAESAREAN SECTION- A CASE REPORT

Myomectomy during caesarean sections have been avoided routinely in the past in the fear of massive hemorrhagewhich may lead to obstetric hysterectomy. However in the recent times with adequate facilities and expertise, caesarean myomectomies are being performed with good outcomes. Case Presentation: A35-year-oldprimi gravida was diagnosed to have intramural fibroid - anterior 4.6*4.3cm and posterior 1.8cm*2.8cm at 8 weeks of gestation.By 13 weeks, during her NT scan there was increase in the size of anterior wall fibroid 7.0*6.6cm, the rest of NT scan and first trimester screening was normal. She developed early onset intrauterine growth restriction in her anomaly scan. She was conservatively managed as the doppler flow was normal. Her scan at 36 weeks showed estimated fetal weight at 2nd centile with normal doppler flow in breech presentation and an anterior intramural fibroid of size 9.5*8.2cm.Hence an elective caesarean section was planned at 37 weeks.Baby was delivered by breech extraction. Manual removal of placenta was done. As the uterus started contracting, the intramural fibroid started extruding, became submucosal and bulging into uterine edges. Hence planned for myomectomy. Injection vasopressin was injected into the surface of myoma,enucleation of the myoma done and myoma bed closed in 2 layers followed by the closure of uterine edges. Intra operative blood loss was around 800ml. No primary or secondary PPH noted. Patient was discharged on 5th post operative day without any complaints. Conclusions: Routine myomectomy at the time of cesarean section is not a standard procedure worldwide. However, it may be considered in carefully selected patients in centers with good facilities to tackle complications by the experienced obstetricians.

Spiritual Well-Being to the Quality of Life of Heart Failure Patients

Heart failure is caused by the heart being unable to maintain normal blood flow. Some patients with heart failure expressed that they needed nurses' help with their physical, psychological, and spiritual problems. Spiritual Well-Being and its components play an important role in a person's declining quality of life and have been linked to various other health factors. This research aims to determine the relationship between spiritual well-being and the quality of life of heart failure patients. The sample for this research was 100 respondents taken using the accidental sampling technique. Data analysis uses the chi-square correlation test if the test conditions are met. If the test requirements are not met, use the alternative Fisher exact test. The instruments used in this research were the Spiritual Needs Questionnaire (SpNQ) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The results of this study illustrate that there is no relationship between quality of life scores and all aspects of the spiritual needs of heart failure patients (p&gt; 0.05). The results of the analysis carried out showed that NYHA functional status (p= 0.044) and ejection fraction (r= -0.205, p= 0.041) influenced the spiritual needs of heart failure patients. The results of this study indicate that the patient's spiritual needs are not related to the general quality of life score, but have a significant relationship with the physiological dimensions of quality of life, ejection fraction, and NYHA functional status.

Fast light-field 3D microscopy with out-of-distribution detection and adaptation through conditional normalizing flows.

Real-time 3D fluorescence microscopy is crucial for the spatiotemporal analysis of live organisms, such as neural activity monitoring. The eXtended field-of-view light field microscope (XLFM), also known as Fourier light field microscope, is a straightforward, single snapshot solution to achieve this. The XLFM acquires spatial-angular information in a single camera exposure. In a subsequent step, a 3D volume can be algorithmically reconstructed, making it exceptionally well-suited for real-time 3D acquisition and potential analysis. Unfortunately, traditional reconstruction methods (like deconvolution) require lengthy processing times (0.0220 Hz), hampering the speed advantages of the XLFM. Neural network architectures can overcome the speed constraints but do not automatically provide a way to certify the realism of their reconstructions, which is essential in the biomedical realm. To address these shortcomings, this work proposes a novel architecture to perform fast 3D reconstructions of live immobilized zebrafish neural activity based on a conditional normalizing flow. It reconstructs volumes at 8 Hz spanning 512x512x96 voxels, and it can be trained in under two hours due to the small dataset requirements (50 image-volume pairs). Furthermore, normalizing flows provides a way to compute the exact likelihood of a sample. This allows us to certify whether the predicted output is in- or ood, and retrain the system when a novel sample is detected. We evaluate the proposed method on a cross-validation approach involving multiple in-distribution samples (genetically identical zebrafish) and various out-of-distribution ones.

ELUQuant: event-level uncertainty quantification in deep inelastic scattering

We introduce a physics-informed Bayesian neural network with flow-approximated posteriors using multiplicative normalizing flows for detailed uncertainty quantification (UQ) at the physics event-level. Our method is capable of identifying both heteroskedastic aleatoric and epistemic uncertainties, providing granular physical insights. Applied to deep inelastic scattering (DIS) events, our model effectively extracts the kinematic variables x, Q 2, and y, matching the performance of recent deep learning regression techniques but with the critical enhancement of event-level UQ. This detailed description of the underlying uncertainty proves invaluable for decision-making, especially in tasks like event filtering. It also allows for the reduction of true inaccuracies without directly accessing the ground truth. A thorough DIS simulation using the H1 detector at HERA indicates possible applications for the future electron–ion collider. Additionally, this paves the way for related tasks such as data quality monitoring and anomaly detection. Remarkably, our approach effectively processes large samples at high rates.

Sex-specific microvascular and hemodynamic responses to passive limb heating in young adults.

We examined sex-specific microvascular reactivity and hemodynamic responses under conditions of augmented resting blood flow induced by passive heating compared to normal blood flow. Thirty-eight adults (19 females) completed a vascular occlusion test (VOT) on two occasions preceded by rest with or without passive heating in a randomized, counterbalanced order. Skeletal muscle tissue oxygenation (StO2, %) was assessed with near-infrared spectroscopy (NIRS), and the rate of desaturation and resaturation as well as maximal StO2 (StO2max) and prolonged hypersaturation (area under the curve, StO2AUC) were quantified. Before the VOT, brachial artery blood flow (BABF), vascular conductance, and relative BABF (BABF normalized to forearm lean mass) were determined. Sex × condition ANOVAs were used. A p-value ≤.05 was considered statistically significant. Twenty minutes of heating increased BABF compared to the control (102.9 ± 28.3 vs. 36.0 ± 20.9 mL min-1; p < .01). Males demonstrated greater BABF than females (91.9 ± 34.0 vs. 47.0 ± 19.1 mL min-1; p < .01). There was no sex difference in normalized BABF. There were no significant interactions for NIRS-VOT outcomes, but heat did increase the rate of desaturation (-0.140 ± 0.02 vs. -0.119 ± 0.03% s-1; p < .01), whereas regardless of condition, males exhibited greater rates of resaturation and StO2max than females. These results suggest that blood flow is not the primary factor causing sex differences in NIRS-VOT outcomes.

Reaction coordinate flows for model reduction of molecular kinetics.

In this work, we introduce a flow based machine learning approach called reaction coordinate (RC) flow for the discovery of low-dimensional kinetic models of molecular systems. The RC flow utilizes a normalizing flow to design the coordinate transformation and a Brownian dynamics model to approximate the kinetics of RC, where all model parameters can be estimated in a data-driven manner. In contrast to existing model reduction methods for molecular kinetics, RC flow offers a trainable and tractable model of reduced kinetics in continuous time and space due to the invertibility of the normalizing flow. Furthermore, the Brownian dynamics-based reduced kinetic model investigated in this work yields a readily discernible representation of metastable states within the phase space of the molecular system. Numerical experiments demonstrate how effectively the proposed method discovers interpretable and accurate low-dimensional representations of given full-state kinetics from simulations.

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention.

Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.

Asymmetric Dimethylarginine Is Associated with the Phenomenon of Coronary Slow Flow in Patients with Nonvalvular Atrial Fibrillation

Introduction: Coronary slow flow phenomena (CSFP) are associated with endothelial and blood component abnormalities in coronary arteries. Asymmetric dimethylarginine (ADMA) can damage the endothelium of the heart or blood vessels in patients with non-valvular atrial fibrillation (NVAF), causing changes in levels of biological indicators. Our aim was to analyze the relationship between ADMA and CSFP in NVAF patients. Methods: We consecutively enrolled 134 patients diagnosed with NVAF and underwent coronary angiography, 50 control patients without a history of atrial fibrillation and with normal coronary angiographic flow were included at the same time. Based on the corrected TIMI frame count (CTFC), the NVAF patients were categorized into two groups, CTFC ≤27 frames and CTFC >27 frames. Plasma ADMA, P-selectin (p-sel), von Willebrand factor (vWF), D-dimer (D-Di), plasminogen activator inhibitor 1 (PAI-1), and nitric oxide (NO) were detected by ELISA in the different groups. Results: We found that plasma ADMA levels were significantly higher among NVAF patients in the CTFC >27 grade group compared with the control or CTFC ≤27 group. In addition, the levels of blood cells and endothelium-related biomarkers (NO, P-selectin, vWF, D-Di, and PAI-1) were significantly altered and correlated with ADMA levels. Multifactorial analysis showed that plasma ADMA (odd ratio [OR; 95% CI]: 1.65 [1.21–2.43], p < 0.001) and left atrial internal diameter (OR [95% CI]: 1.04 [1.02, 1.1], p < 0.001) could be used as independent risk factors for the development of CSFP in patients with NVAF. The ROC curves of ADMA can predict the development of CSFP in NVAF patients. The minimum diagnostic concentration for the development of CSFP in patients was 2.31 µmol/L. Conclusion: Our study demonstrated that CSFP in NVAF patients was associated with high levels of ADMA and left atrial internal diameter. Therefore, aggressive preoperative detection and evaluation of ADMA and left atrial internal diameter can help deal with the intraoperative presence of CSFP.

Generalized acoustic impedance metasurface

Impedance theory has become a favorite method for metasurface design as it allows perfect control of wave properties. However, its functionality is strongly limited by the condition of strict continuity of normal power flow. In this paper, it is shown that acoustic impedance theory can be generalized under the integral equivalence principle without imposing the continuity of power flow. Equivalent non-local power flow transmission is instead realized through local design of metasurface unit cells that are characterized by a passive, asymmetric impedance matrix. Based on this strategy, a beam splitter loosely respecting local power flow is designed and demonstrated experimentally. It is concluded that arbitrary wave fields can be connected through arbitrarily shaped boundaries, i.e. transformed into one another. Generalized impedance metasurface theory is expected to extend the possible design of metasurfaces and the manipulation of acoustic waves.

CSF and venous blood flow from childhood to adulthood studied by real-time phase-contrast MRI

PurposeIn vivo measurements of CSF and venous flow using real-time phase-contrast (RT-PC) MRI facilitate new insights into the dynamics and physiology of both fluid systems. In clinical practice, however, use of RT-PC MRI is still limited. Because many forms of hydrocephalus manifest in infancy and childhood, it is a prerequisite to investigate normal flow parameters during this period to assess pathologies of CSF circulation. This study aims to establish reference values of CSF and venous flow in healthy subjects using RT-PC MRI and to determine their age dependency.MethodsRT-PC MRI was performed in 44 healthy volunteers (20 females, age 5–40 years). CSF flow was quantified at the aqueduct (Aqd), cervical (C3) and lumbar (L3) spinal levels. Venous flow measurements comprised epidural veins, internal jugular veins and inferior vena cava. Parameters analyzed were peak velocity, net flow, pulsatility, and area of region of interest (ROI). Statistical tests: linear regression, student's t-test and analysis of variance (ANOVA).ResultsIn adults volunteers, no significant changes in flow parameters were observed. In contrast, pediatric subjects exhibited a significant age-dependent decrease of CSF net flow and pulsatility in Aqd, C3 and L3. Several venous flow parameters decreased significantly over age at C3 and changed more variably at L3.ConclusionFlow parameters varies depending on anatomical location and age. We established changes of brain and spinal fluid dynamics over an age range from 5–40 years. The application of RT-PC MRI in clinical care may improve our understanding of CSF flow pathology in individual patients.

Bi-channel hybrid GAN attention based anomaly detection system for multi-domain SDN environment

Software-Defined Networking (SDN) is a strategy that leads the network via software by separating its control plane from the underlying forwarding plane. In support of a global digital network, multi-domain SDN architecture emerges as a viable solution. However, the complex and ever-evolving nature of network threats in a multi-domain environment presents a significant security challenge for controllers in detecting abnormalities. Moreover, multi-domain anomaly detection poses a daunting problem due to the need to process vast amounts of data from diverse domains. Deep learning models have gained popularity for extracting high-level feature representations from massive datasets. In this work, a novel deep neural network architecture, supervised learning based LD-BiHGA (Low Dimensional Bi-channel Hybrid GAN Attention) system is designed to learn class-specific features for accurate anomaly detection. Two asymmetric GANs are employed for learning the normal and abnormal network flows separately. Then, to extract more relevant features, a bi-channel attention mechanism is added. This is the first study to introduce an innovative hybrid architecture that merges bi-channel hybrid GANs with attention models for the purpose of anomaly detection in a multi-domain SDN environment that effectively handles real-time unbalanced data. The suggested architecture demonstrates its effectiveness on three benchmark datasets, achieving an average accuracy improvement of 7.225% on balanced datasets and 3.335% on imbalanced datasets compared to previous intrusion detection system (IDS) architectures in the literature.

Crop Coefficient of Sunflowers under Drip Irrigation with Plastic Film in Different Hydrological Years in the Hetao Irrigation District

An accurate assessment of crop water requirements during the crop growth period can help organize irrigation schedules and investigate the hydrological environments in irrigation districts, especially in shallow groundwater districts. In irrigation scheduling, crop coefficients, representing three development stages, play a critical role in modeling evapotranspiration. Therefore, in this study, the crop coefficient (Kc) of sunflowers under drip irrigation in different hydrological years in the Hetao irrigation district with shallow groundwater is determined. Based on the analysis of rainfall frequency, the experimental situations of 2012, 2013, and 2014 are adopted as high, normal, and low flow years. Using the water balance method, groundwater recharge and crop evapotranspiration in different hydrological years were investigated. The results showed that the groundwater recharge in a high-flow year was larger than that in normal and low-flow years with values of 67.47, 66.75, and 42.61 mm, respectively. Crop evapotranspiration is directly related to the irrigation amount at the same growth stage. The Kc of sunflowers in a high-flow year is higher by 0.1 and 0.15 than that in normal and low-flow years. The Kc of sunflowers under drip irrigation is lower than that under surface irrigation by 8.9% in the initial and late stages of sunflower growth, but higher than that by 10.6% in the mid-stage, which is due to differences in small water potential differences and less evapotranspiration in the initial and late stages under drip irrigation. The study is of great significance for formulating a reasonable schedule of drip irrigation with shallow groundwater and improving the field environment.

PENILE TORSION OF A TWO-YEAR-OLD BOY: A CASE REPORT

Objective: This case report presented Penile Torsion in pediatrics. Case(s) Presentation: A two-year-old boy with a chief complaint of rotated penile to the right side since birth. There were 45º in clockwise torsion, slight chordee, and uncircumcised. Patient underwent penile reconstruction surgery, including penile degloving, urethral mobilization, and plication. After seven days follow-up, parents were satisfied with straight penile erection and no torsion at all. After 3 months follow-up, parents reported satisfaction with the surgical outcome such as cosmetic appearance, straight erection, and normal stream urine. Discussion: Surgical techniques ranging from simple penile degloving with foreskin repositioning to more complex surgical procedure involving corporeal tissue. Surgery by using degloving of penile skin and realignment could be suitable for penile torsion &lt;90°. For the cases of &gt;90°, other techniques should be considered such as corporopexy procedure, rotation flap of dorsal dartos, or diagonal suturing of corporeal folds away from and parallel to the neurovascular bundle. Conclusion: Penile reconstruction surgery using penile degloving, urethral mobilization, and plication for penile torsion showed satisfaction result including cosmetic appearance, penile erection, and normal urine flow.&#x0D; Keywords: Chordee, penile reconstruction, penile torsion.

The Effectiveness of Traffic Flow Scenarios during Eid Al-Fitr at The Sidoarjo Tollgates Based on Microsimulation Modeling

On the eve of Eid al-Fitr 2023, there was an increase in the number of vehicles heading eastbound of Java Island through the Transjawa Toll Road from the normal traffic flow. The drastic increase in vehicle volume resulted in congestion at the Sidoarjo Tollgate. An effort to unravel the existing traffic congestion was to implement diversion and contraflow scenarios. This study was conducted to prove the most effective scenario to overcome transportation problems during the homecoming flow through microscopic simulations using PTV VISSIM software. In the diversion scenario, 35% of vehicles heading south will be diverted to exit through Sidoarjo 1 Tollgate. This scenario caused an increase in queue length by 34.66% and a delay of 28 seconds at Sidoarjo 1 Tollgate. On the other hand, with the same scenario, there is a decrease in queue length of 16.84% and a decrease in delay time of 58 seconds at Sidoarjo 2 Tollgate. Regarding average speed, there is a decrease of 18.24% on the road section after Sidoarjo 2 Tollgate due to merging. Under the contraflow scenario, there is no significant change in queue length and delay time at both gates, but there is an increase in the average speed of 62.22% at Sidoarjo 2 Tollgate. The simulation showed that the diversion scenario only moves the density of vehicles. In contrast, the contraflow scenario was an effective alternative to break down the density in the 2023 homecoming flow, as evidenced by the increased average speed.