Select Group Research Articles

Short-Stay Left Colectomy for Colon Cancer: Is It Safe?

Advances in surgical practices have decreased hospital length of stay (LOS) after surgery. This study aimed to determine the safety of short-stay (≤24-hour) left colectomy for colon cancer patients in the US. Adult colon cancer patients who underwent elective left colectomies were identified using the American College of Surgeons NSQIP database (2012 to 2021). Patients were categorized into 4 LOS groups: LOS 1 day or less (≤24-hour short stay), 2 to 4, 5 to 6, and 7 or more. Primary outcomes were 30-day postoperative overall and serious morbidity. Secondary outcomes were 30-day mortality and readmission. Multivariable logistic regression was performed to explore the association between LOS and overall and serious morbidity. A total of 15,745 patients who underwent left colectomies for colon cancer were identified with 294 (1.87%) patients undergoing short stay. Short-stay patients were generally younger and healthier with lower 30-day overall morbidity rates (LOS ≤1 day: 3.74%, 2 to 4: 7.38%, 5 to 6: 16.12%, and ≥7: 37.64%, p < 0.001). Compared with patients with LOS 2 to 4 days, no differences in mortality and readmission rates were observed. On adjusted analysis, there was no statistical difference in the odds of overall (LOS 2 to 4 days: odds ratio 1.90, 95% CI 1.01 to 3.60, p = 0.049) and serious morbidity (LOS 2 to 4 days: odds ratio 0.86, 95% CI 1.42 to 1.76, p = 0.672) between the short-stay and LOS 2 to 4 days groups. Although currently performed at low rates in the US, short-stay left colectomy is safe for a select group of patients. Attention to patient selection, refinement of clinical pathways, and close follow-up may enable short-stay colectomies to become a more feasible reality.

Application of computed tomographic angiography and echocardiography in predicting left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.

We aimed to explore the application of computed tomographic angiography (CTA) and echocardiography in predicting left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation. The clinical data of 164 atrial fibrillation patients receiving cardiac CTA and real-time three-dimensional transoesophageal echocardiography (RT-3D-TEE) were retrospectively analysed. The patients were divided into group A (anticoagulant treatment group, n = 112) and group B (selective anticoagulant treatment group, n = 52) according to the CHA2DS2-VASc score, which scored for the presence or absence of congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischaemic attack, vascular disease, age 65-74 years and gender (female). The CHA2DS2-VASc score was used to predict risk of thromboembolism from atrial fibrillation. The correlations of CHA2DS2-VASc score with CTA-based LAA classification and RT-3D-TEE measurement parameters were explored using Spearman's analysis. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of CTA and RT-3D-TEE for LAA thrombus. There were significant differences in age, disease course, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke/transient ischaemic attack/thromboembolism, vascular disease, B-type natriuretic peptide and serum uric acid levels, CHA2DS2-VASc score, LAA classification, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length (p < 0.05). CHA2DS2- VASc score was positively correlated with cauliflower LAA, LAD, maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length, and negatively correlated with LVEF (p < 0.001). ROC curve analysis indicated that CTA, RT-3D-TEE and CHA2DS2-VASc score had similar predictive values for risk of LAA thrombosis in atrial fibrillation patients, with the areas under the curve being 0.778, 0.814 and 0.792, respectively. Both CTA and RT-3D-TEE had high predictive values for LAA thrombosis in atrial fibrillation patients.

Abstract 16169: Use of Ramen in Heart Failure: Correction of Severe Hyponatremia With Salt Intake

Background Hyponatremia (Na&lt;136mmol) is the most common electrolyte imbalance in patients with heart failure (HF) and is associated with increased mortality, morbidity and rehospitalizations. The mechanisms of hyponatremia in heart failure are multifold and include an increased sympathetic tone and renin-angiotensin-aldosterone-system, salt and water retention in the proximal and distal tubules, high antidiuretic hormone coupled low glomerular filtration rate and diuretic use. We present a case highlighting the complexity of sodium balance in acute decompensated heart failure. Case Presentation A 65-year-old female with a medical history of heart failure with preserved ejection fraction (EF 60-65%), pulmonary hypertension, atrial fibrillation, and CKD presented to the Emergency Department with volume overload. We began diuresis with bumetanide on hospital day 1 (HD#), however given inadequate urine output chlorthalidone was added on HD #5 and metolazone on HD #7. On admission, her sodium was 134 and down trended to a low of 121 on HD#13. She had worsening BUN/Cr from 62/2.14 at admission to a peak 135/2.66. She developed oral intake intolerance, asterixis and encephalopathy. The management changed to halting diuretics, fluid restriction, and hypertonic saline without improvement. Urine electrolytes were used to tailor treatment, leading to cessation of hypertonic saline stopped and introducing Ramen (875 mg of Na) and salt tablets (394 mg of Na). While maintaining euvolemia, there was resolution of symptoms and improvement in Na=134, BUN 49, Cr 1.16. Discussion Treatment options for hyponatremia in HF, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The use of high oral salt intake with close monitoring of jugular vein pressure, weight, symptoms, and urine electrolytes can help a select group of patients with hyponatremia and advance heart failure despite traditional knowledge.

Abstract 15455: Unraveling the Mechanism of Ischemia in Pediatric Patients With R-AAOCA: Fixed and Dynamic Obstruction

Introduction: Although rare, anomalous aortic origin of the right coronary artery (R-AAOCA) is associated with exercise-related sudden cardiac death and dynamic obstruction to coronary flow in the intramural segment has been proposed as the ischemia mechanism. We aim to describe fixed and dynamic obstruction mechanism of ischemia in select group of R-AAOCA patients undergoing invasive transcatheter stress FFR and iFR. Hypothesis: Ischemia in R-AAOCA involves a 2-tier mechanism involving both fixed and dynamic obstruction. Methods: Single institution retrospective study of R-AAOCA patients undergoing cardiac catheterization due to ischemic symptoms and negative perfusion defects on dobutamine stress CMRI. Coronary angiography was performed in all patients. Instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) were performed at baseline and under pharmacologic stress with adenosine (aFFR)/dobutamine (diFR) when the coronary ostium was engaged in a stable manner. Significant fixed obstruction was considered if aFFR&lt;0.80 and dynamic if diFR &lt;0.85. Results: A total of 14/446 (3%) R-AAOCA patients were included. In 10 patients, a Verrata pressure guide wire (Volcano, San Diego, CA) was able to be advanced to perform iFR and FFR. Fixed RCA obstruction was demonstrated in 4/10 patients (40%) and 2 of these (2/10, 20%) also had dynamic RCA obstruction (Table). All 4 patients were referred to surgery: 3 completed, 1 pending. In 4/14 (28%) patients, iFR and FFR were not performed due to inability to engage the RCA ostium, all of which found to be hypoplastic (1-1.5 mm) and slit-like at surgery. There were no procedural complications. Conclusions: In a small cohort of R-AAOCA patients, mechanisms for myocardial ischemia during stress suggest dynamic and fixed components. Our preliminary results provide important insight for risk stratification. Long-term follow-up will be important to validate the performance of iFR/FFR in R-AAOCA

Content-based image retrieval for medical diagnosis using fuzzy clustering and deep learning

Brain tumors are one of the most threatening causes of death worldwide. Neuroradiologists widely use Magnetic Resonance Imaging as a golden standard non-invasive imaging method for diagnosing Glioma grades. Brain tumor diagnosis based on radiology images is tedious and highly subjective to intra and inter-observer variability; it adversely affects therapeutic planning. Better medical treatment can be provided relating to similar past cases if relevant images are retrieved from an extensive medical image database. Content-Based Image Retrieval systems are potent image tools for dealing with such massive datasets. In a CBIR system, accurate classification and retrieval of similar pathological images can be effectively automated by utilising Convolutional Neural Network-based feature extraction methods. This paper presents a Content-Based Medical Image Retrieval pipeline on a medical domain using the CNN model for feature extraction and the clustering method used to index the feature map database. The proposed system applies a Multi-level Gain-based feature selection to reduce the dimensionality of the feature vectors obtained from the pre-trained CNN models. The experiment follows five-fold cross-validation on BraTS 2018 and 2020 datasets. The proposed system achieves state-of-the-art MRI brain image retrieval performance with a mean Average Precision and Precision@10 of 98.15% and 97.62%, respectively. The results prove the proposed method’s effectiveness and validate its clinical application.

Preoperative Embolization in Surgical Resection of Cervical Paragangliomas: Usefulness and Current Evidence.

Cervical paragangliomas (CPG) are slow-growing tumours, most of which are highly vascular, making surgical resection challenging. Preoperative embolisation of afferent arteries has been recommended to facilitate operative dissection, reduce perioperative blood loss, and shorten the duration of the operation. However, there is conflicting evidence on the benefits of preoperative embolisation on surgical outcomes, operative time, and bleeding. The objective of this study was to compare the perioperative parameters and outcomes like duration of surgery, blood transfusion, duration of stay in the ICU, cranial nerve injuries, and postoperative stroke between patients who underwent excision of CPGs with and without preoperative embolisation. This is a retrospective study conducted at the Division of Vascular Surgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. The study included a review of the medical records of 32 patients who underwent excision of CPGs.Patients who underwent surgical resection without preoperative embolisation (SR) were compared with those who underwent surgical resection with embolisation (SREMB). Statistical analysis was done in R statistical software (R Foundation for Statistical Computing, Vienna, Austria). Categorical variables were reported in absolute numbers and percentages continuous variables were compared with an unpaired Mann-Whitney U test. The chi-square test was used to compare the categorical data. Out of 32 patients included in this study, 13 (40.6%) patients were included in the SREMB group. Between the two groups, there were no significant differences in operative time (120 vs. 150 minutes; p = 0.59), blood transfusion requirement (0.69 vs. 0.37 units; p = 0.39) and ICU stays (1 vs. 1; p = 0.56).Postoperative cranial nerve injury was significantly more in the SREMB group (6 vs 1; p = 0.01) but stroke (0 vs 2; p = 0.50) was not statistically significant between the two groups. In this study, we found that there was insufficient evidence to support routine preoperative embolisation in CPG.Hence, preoperative embolisation should only be used in a very select group of patients.

Repositioning of Ureteropelvic Junction in Robot-assisted Laparoscopic Pyeloplasty

ObjectiveTo describe the technique of ureteropelvic junction (UPJ) repositioning in robot-assisted dismembered pyeloplasty as a modified approach during which the UPJ is brought to a new location to facilitate the anastomosis. Materials and MethodsRetrospective review of pediatric and adult cases of robot-assisted laparoscopic pyeloplasty performed between the years 2016-2022. In a select group of patients, repositioning of the UPJ was performed. Demographic data, surgical and post-surgical outcomes was compared to a group that underwent classical AH dismembered pyeloplasty. ResultsOverall, 70 patients underwent robot-assisted laparoscopic dismembered pyeloplasty and were included in the study, with 15 in the repositioning group and 55 in the AH group. The median age of patients included was 26 months (IQR 7-203). Median operative time was 140 minutes (IQR 129-192) and 170 minutes (IQR 135-207) for the repositioning and AH group, respectively. The indications for UPJ repositioning were high UPJ insertion (n=8), crossing vessel (n=5) and renal malformations (n=2). Clinical significance was shown in SFU classification and split renal function postoperatively respectively (p<0.001;p<0.01). Postoperatively, both groups showed improvement in APD and diuretic T1/2 (p=0.48). There was one case of surgical failure requiring revisional surgery in the repositioning group (6.6%) and three in the AH group (5.5%) (p>0.05). Overall, there were three cases of Clavien-Dindo Grade 3 complications, all in the AH group (Two cases of urine leak from anastomosis, one case of port side hernia). ConclusionRepositioning of the UPJ is optional in cases when the obstructed UPJ is in a suboptimal anatomical position.

Preoperative Metal Allergy Testing for Pectus Excavatum Repair Does Not Effectively Identify Patients Who Develop Metal bar Allergy

BackgroundMetal allergy following placement of a metal pectus bar for minimally invasive repair of pectus excavatum (MIRPE) is a rare complication with potentially significant morbidity. There is no consensus regarding preoperative metal allergy testing (MAT). This study aims to assess incidence of metal allergy and titanium bar use in tested and untested patients and trends in MAT with different approaches to MAT. MethodsA retrospective chart review was performed on patients who underwent MIRPE from July 2009 to June 2022 at a single institution. During this time, MAT was performed routinely (RT; routine testing) and selectively (ST; selective testing). ResultsThe cohort included 741 patients for analysis. Metal bar allergy was documented in 1.3 % of all patients; the incidence was 1.3 % in patients with MAT and 1.4 % without MAT. The incidence of bar allergy was 1.1 % in the RT group and 1.6 % in the ST group. In the RT group, bar allergy occurred in 1.4 % (3/216) of patients with a negative MAT. In the ST group, bar allergy occurred in 1.2 % (2/164) of patients with a negative MAT and in 1.9 % (3/162) of untested patients with a stainless-steel bar. Titanium bar use was not significantly different between the RT and ST groups (18.3 % vs 16.3 %, p > 0.05). ConclusionThe incidence of metal bar allergy after MIRPE was less than 2 %, and titanium bar use was not significantly different in routine and selective testing groups. MAT was not associated with a reduction in bar allergy, and its use remains unsupported. Level of EvidenceIII.

A polemic on the use of reversed-phase liquid chromatography to determine descriptors for the solvation parameter model

Revised descriptors for 74 varied compounds recommended for the characterization of reversed-phase silica columns using the solvation parameter model are assigned by the Solver method from experimental retention factors for calibrated gas-liquid and reversed-phase liquid chromatographic (RPLC) and biphasic liquid-liquid partition systems. These descriptors are taken as the best estimate of the true descriptor values and used to evaluate several RPLC systems as a single-technique approach for descriptor assignments. Various combinations of isocratic single column and multiple mobile phase compositions, multiple columns with a single mobile phase composition, and multiple columns and multiple mobile phase compositions are evaluated. A multiple column (Discovery HS C18 and HS F5, Fluophase-RP, and XBridge Shield RP18, Phenyl, and C18) with acetonitrile- and methanol-water mobile phases provided the best results with an absolute average deviation (AAD) of 0.043 for the electron lone pair interaction descriptor E, 0.047 for the dipole-type interaction descriptor S, 0.020 for the hydrogen-bond acid descriptor A, and 0.010 for the hydrogen-bond base descriptor B° for 46 varied compounds. These values compare favorably with the larger all columns and mobile phase composition RPLC dataset with the best estimate of the true descriptors, or all data set, with AAD = 0.026 for E, 0.044 for S, 0.027 for A, and 0.011 for B° for 74 varied compounds. The preferred RPLC systems for descriptor assignments contain columns identified as belonging to different selectivity groups that maximize the relative magnitude of the dipole-type contribution, s system constant, hydrogen-bond basicity, a system constant, and electron lone pair interactions, e system constant. RPLC systems are well suited to assigning the B° descriptor and, with proper system selection, the A and S descriptors. The E descriptor for compounds unavailable by calculation is more problematic and a few extreme values with an AAD > ± 0.1 were observed and can affect the reliability of the S descriptor assignments for these compounds. The likelihood of poor descriptor assignments using the Solver method can be identified by evaluating descriptor wells.

Antenna Selections Strategies for Massive MIMO Systems With Limited-Resolution ADCs/DACs

In millimeter wave (mmWave) communication systems with massive multiple-input multiple-output (MIMO) architecture, selecting the antennas contributing most from the candidate array to transmit/receive signals is one of the effective solutions to reduce hardware cost and power consumption while maintaining high spectral efficiency. In this paper, for the communication systems where the base station (BS) equipped with massive MIMO antenna array communicates with multiple single-antenna users, the impact of limited-resolution analog-to-digital converters (ADCs) and digital-to-analog converters (DACs) on system capacity is investigated, and two antenna selection (AS) algorithms, namely quantization-aware greedy with square maximum-volume (QAG-SMV) and group-selection (GS) schemes, are proposed to enhance system capacity for the uplink and downlink transmission, respectively. Specifically, after the quantization noise caused by limited-resolution ADCs/DACs is converted to independent additive noise, the problem of maximizing system capacity is formulated. Then, two novel AS schemes are proposed to improve system capacity. Simulation results show that the proposed AS algorithms can obtain higher average system capacity, and the computational complexity is reduced as well.

Lumbar lordosis restoration by minimally invasive short-segment fusion with anterior column realignment for adult spinal deformity: minimum 2-year follow-up.

The efficacy of anterior column realignment (ACR) remains relatively unclear, possibly because some safety concerns have limited its adoption and extensive evaluation. The authors aimed to study whether a minimally invasive surgery (MIS) triad consisting of ACR, lateral lumbar interbody fusion, and percutaneous pedicle screw fixation in a select group of adult spinal deformity (ASD) patients helps shorten fusion length without compromising clinical and radiographic outcomes over a minimum 2-year follow-up period. A series of 61 ASD patients (mean age 72.8 years) with pelvic incidence (PI) - lumbar lordosis (LL) (PI-LL) mismatch > 10° underwent the short-segment MIS triad (mean fusion length 3.0 levels) as a single-stage operation with a mean operative time and estimated blood loss of 157 minutes and 127 mL, respectively. Exclusion criteria were 1) thoracic scoliosis as the main deformity, 2) thoracolumbar junction kyphosis > 25°, 3) ankylosed facet joints, and 4) previous spinal fusion surgery. Seven patients, who needed fusion to be extended to S1, underwent mini-open transforaminal lumbar interbody fusion at L5-S1. The segmental disc angle at the ACR level more than quintupled, averaging from 2.9° preoperatively to 18.9° at the latest follow-up (p < 0.0001). LL, in turn, nearly doubled from 17.0° to 32.8° (p < 0.0001) and PI-LL decreased by nearly half from 28.8° to 13.2° (p < 0.0001). At the same time, other spinopelvic deformity parameters as well as Oswestry Disability Index (ODI) scores significantly improved. Patients were divided into two groups at the latest postoperative evaluation: 36 patients whose PI-LL improved to < 10° and 25 patients who maintained a PI-LL mismatch > 10°. Binary logistic regression revealed preoperative PI-LL mismatch as the only factor that significantly influenced this dichotomous separation postoperatively. Receiver operating characteristic curve analysis identified the critical preoperative mismatch of 26.4° with 68% sensitivity and 84% specificity. Despite this different radiographic consequence, the two groups had an equally successful clinical outcome with no significant difference in ODI scores. As long as the ASD characteristics are consistent with the authors' exclusion criteria, the short-segment MIS triad served as an excellent surgical option in the patients with preoperative PI-LL mismatch < 26.4°, but the technique also worked well even in those with a mismatch > 26.4°, although ideal spinopelvic alignment targets were not necessarily achieved in these patients.

Aquatic and Terrestrial Invertebrate Welfare.

Invertebrates are a diverse group of animals that make up the majority of the animal kingdom and encompass a wide array of species with varying adaptations and characteristics. Invertebrates are found in nearly all of the world's habitats, including aquatic, marine, and terrestrial environments. There are many misconceptions about invertebrate sentience, welfare requirements, the need for environmental enrichment, and overall care and husbandry for this amazing group of animals. This review addresses these topics and more for a select group of invertebrates with biomedical, economical, display, and human companionship importance.

Susceptibility to antimicrobial preparations of Klebsiella pneumoniae strains isolated from patients in a multidisciplinary hospital

Introduction. The extraordinary genetic potential of microorganisms has benefited from human overuse antibiotics to develop multiple resistance mechanisms. The large size and heterogeneity of the Russian population, the presence of territories with significant differences in demographic, cultural, and socio-economic indicators, the features of the management and availability of medical care are significant factors influencing the spread of resistance genes to antibacterial therapy of some strains of microorganisms.&#x0D; Materials and methods. Susceptibility to twenty one antimicrobial agents of one hundred twenty eight Klebsiella pneumoniae isolates, isolated from various loci of patients in a multidisciplinary hospital, including 16% of strains from the lower respiratory tract, 44% from wounds and wound discharge, and 40% from urine, was assessed.&#x0D; Results. Among isolates from urine, 20% of isolates were found to have the multidrug resistance (MDR) phenotype, 42% had the extreme resistance phenotype (XDR). Among the isolates of Kl. pneumoniae from purulent wounds, 18% had the MDR phenotype, and 43% had the XDR phenotype. Among the isolates of Kl. Рneumoniae from the lower respiratory tract, 37% had the MDR phenotype, 40% had the XDR phenotype. There are no pan-resistant strains in all groups. &#x0D; The presence of genes for metallo-beta-lactamase (VIM, IMP, NDM groups) and serine carbapenemase (bovine and OXA-48) in molecular genetic study by real-time PCR of isolated Kl. pneumoniae was found in 73.4% of cases. &#x0D; The results of determining the sensitivity of the isolates revealed a low activity of amoxicillin / clavulanic acid, III and IV generation cephalosporins (ceftazidime, cefotaxime, cefepime). 86.7% of isolates are resistant to drugs of the aminoglycoside group (amikacin), and 100% to gentamicin. Of the group of carbapenems, meropenem showed the highest activity – 26.6%, about 7% were sensitive to ertapenem. From the group of fluoroquinolones, sensitivity ranged from 20 to 30%. The highest activity of all drugs was shown by ticarcillin/clavulanate – 33.3%.&#x0D; Limitations. The criteria for inclusion in the group of examination and selection of biomaterial were the presence of previous massive antibacterial therapy in the anamnesis, the presence of catheters, drains, etc.&#x0D; Conclusions. There was established a high proportion of strains Kl. pneumoniae with the phenotype of multiple antibiotic resistance.

Impact of cystic fibrosis multidisciplinary virtual clinics on patient experience, time commitments and costs.

The experience of outpatient care may differ for select patient groups. This prospective study evaluates the adult patient experience of multidisciplinary outpatient cystic fibrosis (CF) care with videoconferencing through telehealth compared with face-to-face care the year prior. People with CF without a lung transplant were recruited. Patient-reported outcomes were obtained at commencement and 12 months into the study, reflecting both their face-to-face and telehealth through videoconferencing experience, respectively. Three patient cohorts were analysed: (i) participants with a regional residence, (ii) participants with a nonregional including metropolitan residence and (iii) participants with colonised multiresistant microbiota. Seventy-four patients were enrolled in the study (mean age, 37 ± 11 years;50% male;mean forced expiratory volume in the first second of expiration, 60% [standard deviation, 23]) between February 2020 and May 2021. No differences between models were observed in the participants' rating of the health care team, general and mental health rating, and their confidence in handling treatment plans at home. No between-group differences in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) were observed. Travel duration and the cost of attending a clinic was significantly reduced, particularly for the regional group (4 h, AU$108 per clinic;P < 0.05). A total of 93% respondents preferred to continue with a hybrid approach. In this pilot study, participants' experience of care and quality of life were no different with face-to-face and virtual care between the groups. Time and cost-savings, particularly for patients living in regional areas, were observed. Most participants preferred to continue with a hybrid model for outpatient care.

Selective and Efficient Platinum Group Metal Adsorption from Wastewater by Localized Triethylamine-Based Poly(Ionic Liquid)

Selective and Efficient Platinum Group Metal Adsorption from Wastewater by Localized Triethylamine-Based Poly(Ionic Liquid)

Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient.

Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allograft. By comparison, the role of single lung transplantation for pulmonary hypertension (PAH) is less clear. The remaining diseased lung will limit clinical improvements and permit downstream sequelae; including residual cough, recurrent infection, and continued pulmonary hypertension. But not every patient can undergo DLT. Advanced age, frailty, co-morbid conditions, and limited availability of organs will all affect surgical candidacy and can offset the benefits of double lung procedures. Studies that compare SLT and DLT do not commonly explore the utility of single lung procedures even though multiple theoretical advantages exist; including reduced waiting times, less waitlist mortality, fewer surgical complications, and lower operative mortality. Worse, multiple forms of publication and selection bias may favor DLT in registry-based studies. In this review, we present the prevailing literature on single and double lung transplants in patients with secondary pulmonary hypertension and clarify the potential utility of these procedures. Materials and Methods: A PubMed search for English-language articles exploring single and double lung transplants in the setting of secondary pulmonary hypertension was conducted from 1990 to 2023. Key words included "single lung transplant", "double lung transplant", "pulmonary hypertension", "rejection", "complications", "extracorporeal membranous oxygenation", "death", and all appropriate Boolean operators. We prioritized research from retrospective studies that evaluated clinical outcomes from single centers. Conclusions: The question is not whether DLT is better at resolving lung disease; instead, we must ask if SLT is an acceptable form of therapy in a select group of high-risk patients. Further research should focus on how best to identify recipients that may benefit from each type of procedure, and the clinical utility of perioperative VA ECMO.

Special Education Prospective Teachers' Views on Supporting the Academic Self-Concept of Gifted Students in Selective Groups

Özel yetenekli öğrencilerin eğitimlerinde sıklıkla kullanılan yöntemlerden biri gruplama stratejisidir. Gruplama stratejisi içerisinde yer alan homojen gruplarda özel yetenekli bireyler yetenek düzeylerine göre bir arada eğitim alırlar. Böylece yetenek düzeyi üst seviyede seçkin bir grup içerisinde yer almış olurlar. Seçkin grupların özel yetenekli öğrencilere olumlu ve olumsuz etkileri olabilir. Grupların etki yarattığı boyutlardan biri de öğrencilerin akademik benlik algısıdır. Bu çalışmada özel eğitim bölümünde lisans öğrencisi olan öğretmen adaylarının, seçkin gruplardaki özel yetenekli öğrencilerin akademik benlik algılarını desteklemeye ilişkin görüşlerinin belirlenmesi amaçlanmıştır. Bu amaç kapsamında katılımcılardan seçkin grupların etkileriyle ilgili görüşleri ve akademik benlik algısını desteklemeye dair önerileri alınmıştır. Çalışma nitel araştırma yöntemiyle gerçekleştirilen betimsel bir çalışmadır. 32 katılımcıdan açık uçlu sorularla toplanan veriler içerik analiziyle çözümlenmiştir. Çalışmanın sonuçları seçkin grupların özel yetenekli öğrencilerin düzeylerine uygun eğitim alma ve yalnız hissetmeme gibi olumlu getirileriyle birlikte çok akademik odaklı olma ve rekabetçi ortamda zorlanma gibi dezavantajları olabileceğini göstermiştir. Katılımcılar seçkin grupların etkilerini paylaşırken, akademik benlik algısının hem olumlu hem de olumsuz etkilenebileceğini ifade etmişlerdir. Özel yetenekli öğrencilerin akademik benlik algısını olumlu yönde desteklemek için öğrencilere, ailelere, öğretmenlere, yöneticilere ve diğer uzmanlara yönelik önerilerde bulunmuşlardır. En dikkat çeken öneriler ise özel yetenekli öğrencilerin ve seçkin grupların özelliklerinin iyi bilinmesi üzerine yapılmıştır. Ayrıca katılımcılar özel yetenekli öğrencilere sadece akademik değil, sosyal duygusal bağlamda da destekler sunulmasını tüm paydaşlara önermişlerdir.

Texture driven adaptive multi-level block selection based reversible data hiding in encrypted image

Texture driven adaptive multi-level block selection based reversible data hiding in encrypted image

Manajemen Pembelajaran Ilmu Tajwid Melalui Nadhom Di Pesantren

This research demonstrates how adult female students at the Pondok Pesantren Riyadul Awamil Islamic, Serang Regency, understand Ilm Tajwid utilizing nadhom in the book Tuhfatul Atfal Wal Ghilman Fi Tajwid al-Quran (Tuhfatul). This kitab kuning is used at Islamic boarding schools throughout Indonesia, even Southeast Asia as a manual for reading the Quran. In order to gather information for this qualitative case study, interviews with Kyai, ustazah, and a select group of students were conducted along with observations of how the learning was being put into practice. this education was inextricably linked to the standard pesantren curriculum for mastering the kitab kuning. Its power comes in the ease with which students can learn the contents of the Tuhfatul book because the nadhoms are regular and rhythmic lines that students can easily pronounce, sing, and remember. Spreading its use to the community may be offered, along with suggestions for adjusting the learning process to the learner.

A negotiation model of individual matching and zonal-based travel behavior in carpooling

AbstractCarpooling is a sustainable and ecologically acceptable transportation mode. Individuals commonly engage in coordination and negotiation processes to find matching partners and typically modify their schedules to enable cooperation. Mutual cooperation between carpooling individuals plays an important role in executing trips. Through cooperation, participants can achieve challenging agreements effectively in a repetitive manner. This paper presents a negotiation mechanism that can match individuals for carpooling using organization and agent-based concepts. It describes a matching model and a carpooling social network. It studies several aspects of multi-zonal individual behavior to identify groups of carpooling candidates. The carpooling social network is simulated on an ongoing basis for each of the following carpooling activities: interaction, negotiation, and trip execution. The interaction process enables communication between individuals within carpooling social groups in order to activate the negotiation process. During the negotiation process, participants typically modify their schedules to support cooperation by considering their personal preferences and constraints. Negotiation leads to matching of individuals based on trip start times, driver selection, detour duration, and carpool group pickup and dropoff sequences. Trip start times are established on travel, social, financial, and schedule-related factors. The carpoolers’ pickup and dropoff sequences that are feasible for an optimal carpool group are projected using specific scoring methods. Carpooling community candidates are recognized via outcomes projected using the FEATHERS activity–based model. The framework is implemented through the Janus multi-agent system.