Size Criteria Research Articles

TECHNICAL CHARACTERISTICS OF THE VERY SHORT STORY: A STUDY IN SELECTED MODELS

At every intellectual developmental stage, literary genres appear that find suitable soil for growth, in which they cultivate their path and entrust them with their characteristics and characteristics, in order to seep into the cosmic space quietly and smoothly. They undermine it, limit it, and diminish its status and importance. Like everything new, he must fight his war to impose his literary self, which the writer generated from the womb of reality. Perhaps the nature of this contemporary materialistic time that we live in, and the rapid change taking place in it, affected many aspects of our lives; He made technology invade every home in the world, and turned cities and villages on earth into a small spot where nothing is hidden, thanks to progress and development in means of communication and transportation. What afflicted our material life affected our literary and cultural life, so we witnessed the emergence of new literary genres in their techniques, so we saw the novel, the play, then the article, the thought, the biography, the short story, and finally the very short story. And if it is logical to establish a relationship between the novel and the short story, then it is also logical to establish a relationship between the short story and the very short story. However, the distinction between these races is not valid only by looking at the size criterion only; The circumstances of the emergence of each race differ greatly from other races as well

ПИЛОТНАЯ ВЕРСИЯ ШКАЛЫ СЛОЖНОСТИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПРИ НЕЙРОГЕННЫХ ОПУХОЛЯХ АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ У ДЕТЕЙ

The purpose of this research was to develop a scale for risk, difficulty and complexity assessment of laparoscopic surgical interventions for neurogenic tumors of abdominal localization in children taking into account IDRF, tumor size and other criteria that affect the surgical outcome. Materials and methods used: 124 patients (68 (55%) boys/56 (45%) girls) aged 0 to 18 y/o (median age of 20.5 [5-50.5] months old) who have undergone laparoscopic surgery for neurogenic tumors of abdominal localization in Jan. 2018-Apr. 2022 were included in a single-center retrospective cohort study. An analysis was made of the relationship between the 24 criteria for the complexity of the surgical intervention and the parametric evaluation of its results (duration of surgical intervention; intraoperative blood loss; intraoperative blood transfusion; intraoperative complications and access conversion). As for the quantitative variables, the Spearman's rank correlation coefficient was used, and the eta coefficient for qualitative variables. Cluster analysis was used to distribute points by the difficulty levels. The ROC curve analysis with sensitivity and specificity for high level of complexity was used to check the scale of complexity. Results: median duration of surgical intervention was 105 [75; 150] min, volume of intraoperative blood loss - 5 [5; 20] ml. Blood transfusion was required in 15 (12%) cases, median blood transfusion was 0 [0; 0] ml. Intraoperative complications developed in 4 (3%) cases. Conversions were performed in 4 (3%) patients. 10 complexity criteria were selected: IDRF F1, F2, F3, F4, F5, location of the tumor center, extension beyond the midline, previous open surgery, contact of the tumor with the inferior vena cava, and the tumor volume (ml)/height (m) ratio of > or </= 28. A pilot difficulty scale with three levels of difficulty has been developed. Sensitivity for a high level of complexity (6 or over pts) was 60% (95% CI 23.1-88.2%), specificity was 98.3% (95% CI 94.1-99.5%). Conclusion: different IDRFs contribute differently to the complexity and risk of laparoscopic surgery. The ratio of tumor size to growth is more significant criterion of complexity than the absolute size of the neoplasm. Other criteria of complexity also play an important role, such as previous open surgeries and tumor localization, in particular. The Authors do not recommend this scale for clinical use because the results obtained in this research would form the basis for further prospective study aiming to the development of a more accurate scale of the complexity of laparoscopic operations in neurogenic tumors of the abdominal localization.

Eligibility of patients with esophageal and gastroesophageal cancer for biology-guided radiotherapy in a retrospective cohort.

e16100 Background: Biology-guided radiotherapy (BgRT) is a novel radiotherapy modality that uses real-time positron emission tomography (PET) to guide radiotherapy beamlets. The FDA recently cleared BgRT for clinical use for tumors in lung and bone using 18F FDG radiotracer. We sought to identify esophageal cancer (EC) and gastroesophageal junction cancer (GEJC) patients who may be BgRT candidates based on diagnostic FDG PET/CT imaging. Methods: Through IRB-approved extraction of patient medical record data from an institutional repository of prospectively maintained data, we verified a database of EC and GEJC patients diagnosed at a US tertiary care center between 01/01/2006 and 12/31/2013. When insufficient diagnostic clinical information was present, patients were excluded. Patient and tumor qualities were quantified and subjected to parameters of tumor diameter (≥2cm, <5cm) and maximum standardized uptake value (≥6) to observe potential characteristics of a patient population eligible for this novel BgRT mechanism. Results: Thirty patients met tumor size and FDG uptake criteria for BgRT therapy out of an overall patient cohort of 90 patients. A significantly greater proportion of patients within the BgRT-eligible cohort presented with esophageal tumors (83.3%) compared to non-eligible patients (58.3%, P=0.0177). Otherwise, there was no significant variation of patient sex, race, tumor histology, tumor stage, comorbidity score, and pre-treatment weight loss between patients eligible and not eligible for BgRT therapy. Conclusions: After applying current boundaries of tumor size and radiotracer uptake for effective BgRT intervention, we observed broad applicability of the novel treatment modality across EC/ GEJC patients of varying characteristics and tumor qualities. The high eligibility of patients with tumors located within the esophagus supports further investigation of BgRT in their management. [Table: see text]

ПИЛОТНАЯ ВЕРСИЯ ШКАЛЫ СЛОЖНОСТИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПРИ НЕЙРОГЕННЫХ ОПУХОЛЯХ АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ У ДЕТЕЙ

The purpose of this research was to develop a scale for risk, difficulty and complexity assessment of laparoscopic surgical interventions for neurogenic tumors of abdominal localization in children taking into account IDRF, tumor size and other criteria that affect the surgical outcome. Materials and methods used: 124 patients (68 (55%) boys/56 (45%) girls) aged 0 to 18 y/o (median age of 20.5 [5-50.5] months old) who have undergone laparoscopic surgery for neurogenic tumors of abdominal localization in Jan. 2018-Apr. 2022 were included in a single-center retrospective cohort study. An analysis was made of the relationship between the 24 criteria for the complexity of the surgical intervention and the parametric evaluation of its results (duration of surgical intervention; intraoperative blood loss; intraoperative blood transfusion; intraoperative complications and access conversion). As for the quantitative variables, the Spearman's rank correlation coefficient was used, and the eta coefficient for qualitative variables. Cluster analysis was used to distribute points by the difficulty levels. The ROC curve analysis with sensitivity and specificity for high level of complexity was used to check the scale of complexity. Results: median duration of surgical intervention was 105 [75; 150] min, volume of intraoperative blood loss - 5 [5; 20] ml. Blood transfusion was required in 15 (12%) cases, median blood transfusion was 0 [0; 0] ml. Intraoperative complications developed in 4 (3%) cases. Conversions were performed in 4 (3%) patients. 10 complexity criteria were selected: IDRF F1, F2, F3, F4, F5, location of the tumor center, extension beyond the midline, previous open surgery, contact of the tumor with the inferior vena cava, and the tumor volume (ml)/height (m) ratio of > or </= 28. A pilot difficulty scale with three levels of difficulty has been developed. Sensitivity for a high level of complexity (6 or over pts) was 60% (95% CI 23.1-88.2%), specificity was 98.3% (95% CI 94.1-99.5%). Conclusion: different IDRFs contribute differently to the complexity and risk of laparoscopic surgery. The ratio of tumor size to growth is more significant criterion of complexity than the absolute size of the neoplasm. Other criteria of complexity also play an important role, such as previous open surgeries and tumor localization, in particular. The Authors do not recommend this scale for clinical use because the results obtained in this research would form the basis for further prospective study aiming to the development of a more accurate scale of the complexity of laparoscopic operations in neurogenic tumors of the abdominal localization.

Analysis of tumor progression among patients with glioma after COVID-19 infection.

2041 Background: As of January 2023, there have been 6.7 million worldwide deaths attributed to SARS-CoV-2 COVID-19, which has impacted outcomes and medical care for all patients. Relatively little is known about the direct effects mediated by the virus on CNS tumor biology, despite the fact that viral neurotropism is well described, various coronavirus receptors have been observed in glioblastoma (GBM) tissues, and differential monocytic infiltration has been proposed to dysregulate the immune microenvironment. We detected a trend of rapid progression following COVID-19 infection among several patients with primary brain tumor patients and sought to systematically evaluate the pace of progression among infected patients in our institution. Methods: A single-institutional database of COVID-19 patients and an electronic medical record (EMR) search tool were used to identify a total cohort of 67 patients with glioma for retrospective analysis. This included 38 GBMs, 18 IDH-mutant gliomas, 5 ependymomas, 2 pilocytic astrocytomas, 1 diffuse midline glioma, 1 diffuse hemispheric glioma, and 1 ganglioglioma patients, each of whom had a documented COVID-19 infection between June 2020-December 2022. Hyperprogression was defined as tumor increase ≥40% compared to previous scan using RECIST size criteria. Results: Thirty-nine (58%) patients experienced tumor progression following COVID-19 infection at a median of 34 days (range=1-734 days) after testing positive for COVID-19. Twenty-two (56%) had received COVID-19 vaccine before their infection and 5 (13%) had asymptomatic infections. Twenty-two patients had measurably increased tumor area by a median of 63% (range=10-2,900%), 18 of which constituted hyperprogression;16 patients developed multifocal disease, 8 developed new nodular enhancement, 3 developed leptomeningeal disease (LMD), and 2 experienced increased infiltrative disease alone. Ten patients’ presentation with new glioma was preceded by COVID-19 infection by a median of 31 days. GBM patients represented the majority of progression events, among whom 59% progressed within 60 days of documented infection (median 25 days). This subgroup of GBM with rapid progression within 60 days had a mOS from infection of 5.2 months; 89% had TERT promotor mutations and 42% had MGMT promoter methylation. Conclusions: Glioma patients appear to have disease progression at an accelerated pace in the first two months after COVID-19 infection. This suggests that glioma patients should continue observing strict precautions to prevent infection and should be clinically monitored vigilantly after infection, with consideration for short interval imaging during treatment. These preliminary data warrant further investigation exploring changes of immune cell infiltration in the tumor microenvironment and the possible correlation between tumor progression and COVID-19.

Precocious Rupture of Abdominal Aortic Aneurysms Below Size Criteria for Repair: Risk Factors and Outcomes

Practice guidelines recommend elective repair for abdominal aortic aneurysms (AAA) ≥5.5cm in men and ≥5cm in women to prevent rupture; however, some rupture at smaller diameters. We identify risk factors for rupture (rAAA) below this threshold and compare outcomes following rAAA repair above/below size criteria. The Vascular Quality Initiative (2013-2019) was queried for patients undergoing repair for rAAA and stratified based on diameter into Small and Large cohorts [Small: <5.5cm (men), <5.0cm (women)]. Univariate analysis was performed, and Kaplan-Meier analysis compared overall survival, aneurysm-related mortality, and reintervention at 12-months. 5,162 rAAA were identified. Small rAAA patients [n = 588] were more likely to have hypertension (81.3% vs. 77.0%, p<0.02), diabetes (18.2% vs. 14.9%, p<0.04), and ESRD (2.9% vs. 0.9%, p<0.01), and be on optimal medical therapy (32.1% vs. 26.8%, p<0.01). Women were more likely to rupture at smaller diameters compared to men (p<0.01). Small rAAA patients were more likely to undergo EVAR (70.2% vs. 56.0%, p<0.01), and had lower in-hospital mortality (17.7% vs. 27.7%, p<0.01), and fewer perioperative complications across all categories. At 12-months, small rAAA patients had better overall survival, freedom from aneurysm-related mortality, and freedom from reintervention, largely driven by EVAR approach. More than 11% of patients presenting with ruptured AAA were below the recommended size threshold for repair, and they tended to be younger, non-white, and have hypertension, diabetes and/or renal failure. Patients with small rAAA experienced lower in-hospital morbidity and mortality and improved 1-year survival, and EVAR was associated with better outcomes than open repair. However, women more frequently rupture at smaller diameters compared to men. Given contemporary elective outcomes for women, a randomized controlled trial for EVAR vs. surveillance at a sex-specific size threshold is needed.

The importance of discriminative power rather than significance when evaluating potential clinical biomarkers in epilepsy research.

The quest for epilepsy biomarkers is on the rise. Variables with statistically significant group-level differences are often misinterpreted as biomarkers with sufficient discriminative power. This study aimed to demonstrate the relationship between significant group-level differences and a variable's power to discriminate between individuals. We simulated normal-distributed datasets from hypothetical populations with varying sample sizes (25-800), effect sizes (Cohen's d: .25-2.50), and variability (standard deviation: 10-35) to assess the impact of these parameters on significance and discriminative power. The simulation data were illustrated by assessing the discriminative power of a potential real-case biomarker-the EEG beta band power-to diagnose generalized epilepsy, using data from 66 children with generalized epilepsy and 385 controls. Additionally, we evaluated recently reported epilepsy biomarkers by comparing their effect sizes to our simulation-derived effect size criterion. Group size affects significance but not discriminative power. Discriminative power is much more related to variability and effect size. Our real data example supported these simulation results by demonstrating that group-level significance does not translate, one to one, into discriminative power. Although we found a significant difference in the beta band power between children with and without epilepsy, the discriminative power was poor due to a small effect size. A Cohen's d of at least 1.25 is required to reach good discriminative power in univariable prediction modeling. Slightly over 60% of the biomarkers in our literature search met this criterion. Rather than statistical significance of group-level differences, effect size should be used as an indicator of a variable's biomarker potential. The minimal required effects size for individual biomarkers-a Cohen's d of 1.25-is large. This calls for multivariable approaches, in which combining multiple variables with smaller effect sizes could increase the overall effect size and discriminative power.

A-140 MANAGEMENT OF NON-METASTATIC DUODENAL NEUROENDOCRINE TUMOURS

Abstract Background The management of duodenal neuroendocrine tumours (NET) between 1 and 2 cm is not codified. Currently, depending on the centre, endoscopic (ER) or surgical (SR) resection is offered. The main objective of our study was to describe the management of non-metastatic duodenal NETs in France. Methods A study was conducted on 153 patients with non-metastatic duodenal NET diagnosed between 2000 and 2019 in 14 French centres by the GTE group (Endocrine Tumors Group). Results 58 (37.9%) patients treated with ER and 95 (62.1%) patients treated with SR were found. Surgery allowed significantly more complete resection than endoscopy (p &amp;lt; 0.001). ER margins were significantly less well-defined than SR margins (p &amp;lt; 0.001). Among the 51 patients with positive lymph node dissection, tumour size was ≤ 1 cm in 25 cases, between 1 and 2 cm in 14 cases and ≥ 2 cm in 12 patients. No difference in survival was demonstrated regardless of type of treatment. Surgical complications were more numerous than endoscopic complications (p = 0.001). Regardless of the type of incomplete resection, there was no significant difference between the two groups according to the criteria of location, size, grade, or adenopathy. In the subgroup analysis of duodenal NETs between 11 and 19 mm, the tumour stages were equivalent in pre-procedure between the two groups. In contrast, there was a difference in post-procedure after anatomopathological analysis (p = 0.001). Conclusion Based on the study results, the type of endoscopic or surgical resection of duodenal NETs has no impact on the long-term results. Lymph node invasion is independent of tumour size.

Proposing Clinicopathological Staging and Mitotic Count as Prognostic Factors for Canine Soft Tissue Sarcomas.

Soft tissue sarcomas (STSs) are a heterogeneous group of malignant mesenchymal tumors with similar histological features and biological behaviors. They are characterized by a low to moderate local recurrence rate and low metastasis, affecting approximately 20% of patients. Although this tumor set is vital in veterinary medicine, no previous unified staging system or mitotic count has been associated with patient prognosis. Therefore, this study proposed a new clinicopathological staging method and evaluated a cut-off value for mitosis related to the survival of dogs affected by STS. This study included 105 dogs affected by STS, treated only with surgery, and a complete follow-up evaluation. The new clinicopathological staging system evaluated tumor size (T), nodal involvement (N), distant metastasis (M), and histological grading criteria (G) to categorize the tumor stage into four groups (stages I, II, III, and IV). The proposed tumor staging system was able to differentiate patients' prognoses, with dogs with stage IV disease experiencing the lowest survival time and dogs with stage I disease having the highest survival time (p < 0.001). Moreover, we assessed the median mitosis (based on mitotic count) and its association with overall survival. Our study's median mitosis was 5, and patients with ≤5 mitoses had a higher survival time (p = 0.006). Overall, the proposed staging system and mitotic count seemed promising in the prediction of patient prognosis.

The use of various sizes of burs by orthopedists of Volgograd state dental clinics

The correct execution of teeth preparation for metal-ceramic crowns requires a certain range of dental bores, different in shape and cutting properties. However, according to a 2014 study, orthopedic dentists tend to use a reduced set of burs in their daily practice. The research material is the results of a survey of 59 orthopedic dentists of urban dental clinics, obtained by the questionnaire method. Data on the frequency of use of hogs of various shapes and grain size were obtained. There is an expansion of the range of tools used according to the criteria of grain size and shape. Despite this, there is a tendency to use a reduced set of dental burs and the prevalence of coarse-grained burs in its composition.

68Ga-Pentixafor PET/MRI for Treatment Response Assessment in Mantle Cell Lymphoma: Comparison Between Changes in Lesion CXCR4 Expression on PET and Lesion Size and Diffusivity on MRI.

The aim of this study was to compare CXCR4 imaging with 68Ga-pentixafor PET to MRI for treatment response assessment in patients with mantle cell lymphoma (MCL). Twenty-two posttreatment 68Ga-pentixafor PET/MRI scans of 16 patients (7 women and 9 men; mean age, 69.9 ± 7.9) with a total of 67 target lesions on baseline PET/MRI were analyzed. Rates of complete remission per lesion and per scan, according to MRI (based on lesion size) and 68Ga-pentixafor PET (based on SUV decrease to lower than liver and blood pool uptake), were compared using McNemar tests. The t tests and Pearson correlation coefficients (r) were used to compare rates of change in lesion diameter products (DPs) on MRI, and standardized uptake values (SUVmax, SUVmean) on PET, relative to baseline. At interim PET/MRI, 18/32 (56.3%) target lesions met CR criteria on 68Ga-pentixafor PET, and 16/32 (50.0%) lesions met size-based MRI criteria for CR (P = 0.63). At end-of-treatment PET/MRI, 40/57 (70.2%) target lesions met 68Ga-pentixafor PET criteria for CR, and 27/57 (47.4%) lesions met size-based MRI criteria for CR (P = 0.021). Complete remission after treatment was observed more frequently on 68Ga-pentixafor PET (11/22 scans, 54.5%) than on MRI (6/22 scans, 27.3%) (P = 0.031). Rates of change did not differ significantly between lesion DP (-69.20% ± 34.62%) and SUVmax (-64.59% ± 50.78%, P = 0.22), or DP and SUVmean (-60.15 ± 64.58, P = 0.064). Correlations were strong between DP and SUVmax (r = 0.71, P < 0.001) and DP and SUVmean (r = 0.73, P < 0.001). In MCL patients, 68Ga-pentixafor PET may be superior for assessment of complete remission status than anatomic MRI using lesion size criteria, especially at the end of treatment.

Aortic Size at the Time of Type A and Type B Dissections

BackgroundAortic diameter at time of dissection remains an indispensable risk-determining characteristic for prophylactic repair of thoracic aortic aneurysms. Histograms of aortic size at the time of dissection have the potential to shed more light on this relationship. MethodsSize of the thoracic aorta at the time of dissection was determined from imaging of 407 naturally occurring, acute, flap-type ascending or descending aortic dissections treated at 1 institution (1990-2022). Histograms were constructed to depict aortic size at the time of dissection. Data were analyzed by logistic regression. ResultsThere were 170 (69.11%) of 246 type A dissections (median, 5.07 cm; interquartile range, 4.60-5.67 cm) and 130 (80.75%) of 161 type B dissections (median, 4.2 cm; interquartile range, 3.60-4.87 cm) that occurred at diameters <5.5 cm. By unadjusted regression, factors associated with significantly increased odds of type A dissection at diameters <5.5 cm were female sex (odds ratio [OR], 2.06; P = .023), hypertension (OR, 1.82; P = .036), and smoking (OR, 1.92; P = .029). Patients with bicuspid aortic valve had significantly decreased odds of type A dissection at diameters <5.5 cm (OR, 0.3; P = .047). The recent "left shift" to 5.0 cm in the criterion for ascending aortic intervention could prevent an additional 29.3% of type A dissections. ConclusionsAortic diameter at the time of type A dissection is consistent with the new guidelines that recommend surgical intervention at 5.0 cm. Type B dissection occurs at small sizes and cannot be prevented with a size criterion.

Analytically optimal parameters of supplemental brace-damper system in single-degree-of-freedom structure based on stability maximization criterion

In this study, optimal parameters (i.e., optimal additional stiffness ratio α and damping ratio λ) for supplemental brace-damper system in a single-degree-of-freedom (SDOF) structure are analytically derived. Different from the design formulations for supplemental brace-damper system proposed by Londoño, which are essentially fitting formulae through extensive parametric study, analytically optimal parameters for supplemental brace-damper system are derived by combining the research work by Londoño and the stability maximization criterion (SMC). Similar to Optimum Brace Stiffness (OBS) criterion and Optimum Damper Size (ODS) criterion proposed by Londoño, SMC-based OBS criterion and SMC-based ODS criterion are respectively proposed to assure a desired structural performance represented by the targeted overall damping ratio of the considered system. Through numerical study, it is demonstrated that the seismic response of the proposed SMC-based OBS criterion and SMC-based ODS criterion excellently agree with those of the existing OBS criterion and ODS criterion, respectively.

Outcomes of Surgical Repair of Aberrant Subclavian Arteries in Adults

BackgroundSymptoms, imaging characteristics, and early and midterm surgical outcomes for aberrant subclavian arteries (ASCA) are not well defined in the adult population. MethodsA single-institution retrospective review was conducted of adults undergoing surgical repair of ASCA and descending aorta origin/Kommerell diverticulum (KD) from January 1, 2002, to December 31, 2021. Symptom improvement and differences in imaging characteristics between anatomic groups and the number of symptoms were assessed. ResultsMean age was 46 ± 17 years. There were 23 of 37 left aortic arches with right ASCA (62%) and 14 of 37 right aortic arches with left ASCA (38%). Of these, 31 of 37 (84%) were symptomatic, and 19 of 37 (51%) had KD size/growth meeting criteria for surgical repair. KD aortic origin diameter was larger in more symptomatic patients: 20.60 mm (interquartile range [IQR], 16.42-30.68 mm) in patients with ≥3 symptoms vs 22.05 mm (IQR, 17.52-24.21 mm) for 2 symptoms vs 13.72 mm (IQR, 12.70-15.95 mm) for 1 symptom (P = .018). Aortic replacement was required in 22 of 37 (59%). There were no early deaths. Complications occurred in 11 of 37 (30%): vocal cord dysfunction (4 of 37 [11%]), chylothorax (3 of 37 [8%]), Horner syndrome (2 of 37 [5%]), spinal deficit (2 of 37 [5%]), stroke (1 of 37 [3%]), and temporary dialysis requirement (1 of 37 [3%]). Over a median follow-up of 2.3 years (IQR, 0.8-3.9 years), there was 1 endovascular reintervention and no reoperations. Dysphagia and shortness of breath resolved in 92% and 89%, respectively, whereas gastroesophageal reflux persisted in 47%. ConclusionsThe KD aortic origin diameter correlates with the number of symptoms, and surgical repair of ASCA and descending aorta origin/KD effectively relieves symptoms, with low rates of reintervention. Given the operative complexity, surgical repair should be performed in patients meeting size criteria or with significant dysphagia or shortness of breath symptoms.

Nonsize Criteria for Surgical Intervention on the Ascending Thoracic Aorta.

For decades, aortic surgery has relied on size criteria for intervention on the ascending aorta. While diameter has served well, diameter alone falls short of an ideal criterion. Herein, we examine the potential application of other, nondiameter criteria in aortic decision-making. These findings are summarized in this review. We have conducted multiple investigations of specific alternate nonsize criteria by leveraging our extensive database, which includes complete, verified anatomic, clinical, and mortality data on 2,501 patients with thoracic aortic aneurysm (TAA) and dissections (198 Type A, 201 Type B, and 2102 TAAs). We examined 14 potential intervention criteria. Each substudy had its own specific methodology, reported individually in the literature. The overall findings of these studies are presented here, with a special emphasis on how the findings can be incorporated into enhanced aortic decision-making-above and beyond sheer diameter. The following nondiameter criteria have been found useful in decision-making regarding surgical intervention. (1) Pain: In the absence of other specific cause, substernal chest pain mandates surgery. Well-developed afferent neural pathways carry warning signals to the brain. (2) Aortic length/tortuosity: Length is emerging as a mildly better predictor of impending events than diameter. (3) Genes: Specific genetic aberrations provide a powerful predictor of aortic behavior; malignant genetic variants obligate earlier surgery. (4) Family history: Aortic events closely follow those in relatives with a threefold increase in likelihood of aortic dissection for other family members once an index family dissection has occurred. (5) Bicuspid aortic valve: Previously thought to increase aortic risk (as a "Marfan light" situation), current data show that bicuspid valve is not a predictor of higher risk. (6) Diabetes actually protects against aortic events, via mural thickening and fibrosis. (7) Biomarkers: A specialized "RNA signature test" identifies aneurysm-bearing patients in the general population and promises to predict impending dissection. (8) Aortic stress: Blood pressure (BP) elevation from anxiety/exertion precipitates dissection, especially with high-intensity weightlifting. (9) Root dilatation imposes higher dissection risk than supracoronary ascending aneurysm. (10) Inflammation on positron emission tomography (PET) imaging implies high rupture risk and merits surgical intervention. (11) A KIF6 p.Trp719Arg variant elevates aortic dissection risk nearly two-fold. (12) Female sex confers some increased risk, which can be largely accommodated by using body-size-based nomograms (especially height nomograms). (13) Fluoroquinolones predispose to catastrophic dissection events and should be avoided rigorously in aneurysm patients. (14) Advancing age makes the aorta more vulnerable, increasing likelihood of dissection. In conclusion, nondiameter criteria can beneficially be brought to bear on the decision to observe or operate on specific TAA.

Giant Osteochondroma of Tibia in a Case of Hereditary Multiple Exostoses: A Case Report

Osteochondromas, aka exostoses, are benign neoplasms of the cartilage. Genetic mutations of the EXT1 and EXT2 genes leads to a syndrome causing multiple osteochondromas, namely the hereditary multiple exostoses. Among the complications related to multiple osteochondromas, malignant degeneration into chondrosarcoma has the worst prognosis. Sudden enlargement of size of an osteochondroma or sudden onset of pain at the site of previous osteochondroma in a skeletally mature patient is concerning for malignant transformation. However, the size criterion does not apply for skeletally immature individuals, as observed in the case report here. The imaging of an uncommonly large osteochondroma of the extremity in a skeletally immature patient with hereditary multiple exostoses has been described here. Normal thickness of the cartilage cap (&lt;3cm) proved the benignity of the lesion on imaging, thereby nullifying the size criterion in the skeletally immature. Keywords: Hereditary multiple exostoses, Osteochondroma, Cartilage cap, Heparan sulphate, Bayonet deformity, Chondrosarcoma.

Current Legal Problems of Supporting the Development of Start-Ups in the Conditions of the Russian-Ukrainian War

Problem setting. The criminal attack of the Russian Federation on Ukraine without a declaration of war on February 24, 2022 fundamentally changed the entire system of legal relations of our state. Such armed aggression was also reflected in the entrepreneurial activity of startups as newly created subjects of entrepreneurial activity. Currently, the legal system of our country is in constant evolution in order to develop methods of supporting such subjects of entrepreneurial activity. Attention is also drawn to a number of law-enforcement aspects of startups that are not regulated at the level of regulatory and legal acts, which have a direct impact on the prospects of their development in Ukraine. Аnalysis of recent researches and publications. The issue of startup activity became the subject of scientific research by such scientists as S. V. Hlibko, O. V. Rozgon, I. V. Podrez-Ryapolova, A. S. Petkevich, A. V. Sherstobitov, I. V. Yashchyshina, and others. Within the framework of this scientific article, the specifics of the activity and support of startups in the conditions of martial law at the current stage of the Russian-Ukrainian war will be investigated. Тarget of the research is to examine the problems of startups that are in the Expansion and Exit stages of development at the current stage of the Russian-Ukrainian war. These are the final stages of the development of startups, which occurs after the stages of Pre-seed, Seed, Startup, Early Growth. After successfully passing the specified stages, the subject of entrepreneurial activity turns from a startup to an innovative enterprise, as it ceases to meet the criterion of small size and innovation. That is why the effective passage of these stages of development makes it possible to strengthen the economy of our state with another large enterprise, which at the same time has a positive effect on the market of innovative products and makes contributions to the budget of Ukraine through the payment of taxes and fees Аrticle’s main body. A startup is a high-risk type of entrepreneurship, as a result of which the challenges faced by representatives of Ukrainian business during the full-scale war mostly had a greater impact on startups. The analysis of the monitoring data allows us to state that the most observed influence is the regional location of business entities, while the negative influence of such factors as tax and regulatory pressure, the corruption component, lack of qualified employees, etc., was significantly reduced. Relocation is considered to affect the fault of the party to the obligation and is the basis for reducing the amount. Conclusions and prospects for the development. The analysis of statistical studies makes it possible to claim that a number of risks, which were key for startups in previous years, have reduced their impact. Instead, in 2022-2023, the biggest risks for startups are circumstances related to the conduct of hostilities. So, in particular, the regional location of the startup’s production plays a key role. At the same time, the risk of an unfavorable geographical location of a startup can be partially reduced due to state support for startups in certain sectors of the economy. Considerable support for startups was provided through the relocation program, which, in addition to its main goal of keeping enterprises in the front-line territory, is considered to affect the fault of the party to the obligation and is the basis for reducing the amount of fines, as well as delaying the execution of the court decision.

Influence of Menstrual Cycle on Internal and External Load in Professional Women Basketball Players

The menstrual cycle can be seen as a potential determinant of performance. This study aims to analyze the influence of the menstrual cycle in women on sports performance, more specifically on the internal and external load of professional women basketball players. The sample consisted of 16 women players and 14 training sessions were recorded. A descriptive analysis of the mean and standard deviation of the variables according to the different phases of the menstrual cycle was performed, as well as an ANCOVA, partial Eta2 effect size criteria, and Bonferroni's Post Hoc test to identify differences among phases. The results establish that ovulation is the phase in which higher values of external load are recorded and, therefore, the late follicular phase is the time of the cycle where a greater intensity in explosive distance, accelerations and decelerations are recorded. Considering women's hormonal cycles, understanding their function and the individual characteristics of each athlete is essential since it allows for the development of specific training, the prevention of injuries and therefore positively affects the performance of women players. To this end, individual training profiles should be created in specific contexts, not following general rules. In addition, psychological factors and the specific position of the athletes should be monitored.

SPECT at the speed of PET: a feasibility study of CZT-based whole-body SPECT/CT in the post 177Lu-DOTATATE and 177Lu-PSMA617 setting.

To evaluate the feasibility of using the StarGuide (General Electric Healthcare, Haifa, Israel), a new generation multi-detector cadmium-zinc-telluride (CZT)-based SPECT/CT, for whole-body imaging in the setting of post-therapy imaging of 177Lu-labeled radiopharmaceuticals. Thirty-one patients (34-89 years old; mean ± SD, 65.5 ± 12.1) who were treated with either 177Lu-DOTATATE (n=17) or 177Lu-PSMA617 (n=14) as part of standard of care were scanned post-therapy with the StarGuide; some were also scanned with the standard GE Discovery 670 Pro SPECT/CT. All patients had either 64Cu-DOTATATE or 18F-DCFPyL PET/CT prior to first cycle of therapy for eligibility check. The detection/targeting rate (lesion uptake greater than blood pool uptake) of large lesions meeting RECIST 1.1 size criteria on post-therapy StarGuide SPECT/CT was evaluated and compared to the standard design GE Discovery 670 Pro SPECT/CT (when available) and pre-therapy PET by two nuclear medicine physicians with consensus read. This retrospective analysis identified a total of 50 post-therapy scans performed with the new imaging protocol from November 2021 to August 2022. The StarGuide system acquired vertex to mid-thighs post-therapy SPECT/CT scans with 4 bed positions, 3 min/bed and a total scan time of 12 min. In comparison, the standard GE Discovery 670 Pro SPECT/CT system typically acquires images in 2 bed positions covering the chest, abdomen, and pelvis with a total scan time of 32 min. The pre-therapy 64Cu-DOTATATE PET takes 20 min with 4 bed positions on GE Discovery MI PET/CT, and 18F-DCFPyL PET takes 8-10 min with 4-5 bed positions on GE Discovery MI PET/CT. This preliminary evaluation showed that the post-therapy scans acquired with faster scanning time using StarGuide system had comparable detection/targeting rate compared to the Discovery 670 Pro SPECT/CT system and detected large lesions defined by RECIST criteria on the pre-therapy PET scans. Fast acquisition of whole-body post-therapy SPECT/CT is feasible with the new StarGuide system. Short scanning time improves the patients' clinical experience and compliance which may lead to increased adoption of post-therapy SPECT. This opens the possibility to offer imaged-based treatment response assessment and personalized dosimetry to patients referred for targeted radionuclide therapies.

Educational Leadership Management Practices: A Perspective to Educational Transformation

The paper investigates the educational leadership management practices as a perspective to educational transformation. The descriptive correlation research design is utilized in the study to quantify and measure the profile of the respondents, contribution of effective style educational leadership management and practices, and educational transformation perspective of the educational management practices of the respondents. Likewise, purposive quota sampling employs in the study to define the criteria for the sample size. The study comprised fifty (50) respondents only. Results show that the contribution of effective style educational leadership management and practices of the respondents involves democratic leaders where they yield with a high morale environment to generate and motivate creative solutions of effective leadership style in school organization, show that instructional leadership involves on planning practice, coordination, evaluation, and teaching improvement learning, show that authoritative leaders ensure that the systems are in order, and quick in the decision process and control the organization, show that coaching leadership involves behavior, attitude, work performance, evaluation, process of the work, and the policies in the school organization, and show that transformational leaderships is an essential element in the organization to be imposed for good, better, and best because all employees in the school organization are determinant for the process. Hence, educational transformation perspective of the educational management practices of the respondents explores career, advocacy, and policy in pursuing equity in education, contributes to the school system in the organization, reveals significant effect on positive and negative effects of the transformational leadership process, maintains school culture and identity for the diverse and challenging condition strength of school organization and setting, and supports the innovation of learning in the school organization and supports advanced flexible learning technology.