In this article, we present the case of a 38-year-old female who suffered from serious respiratory distress. After an extensive pulmonary artery imaging diagnostic work-up (CTPA, MRA and PET), we ...were unable to differentiate between chronic thromboembolic pulmonary hypertension (CTEPH) vs. pulmonary artery sarcoma (PAS) due to extensive filling defects and extraluminal findings. Although surgery was postponed for nine months due to the COVID-19 pandemic, CTEPH diagnosis, due to a high-thrombus burden, was finally confirmed after pulmonary endarterectomy (PEA). Conclusively, imaging findings of rare cases of CTEPH might mimic PAS and the surgical removal of the lesion are both needed for a final diagnosis. What is Already Known about This Topic? Pulmonary artery sarcoma (PAS) is a rare but aggressive malignancy, which originates from the intimal layer of the pulmonary artery (PA); Chronic thromboembolic pulmonary hypertension (CTEPH) is based on chronic, organized flow-limiting thrombi inside PA circulation and subsequent pulmonary hypertension. What Does This Study Contribute? Since radiological findings of CTEPH cases might rarely mimic PAS, pulmonary artery endarterectomy and subsequent histopathologic study are needed for a final diagnosis.
•Hyper-heuristics have been recently introduced to treat project scheduling problems.•PSO-HH is the first PSO hyper-heuristic applied to project scheduling problems.•PSO-HH is the first ...hyper-heuristic treating the library PSPLIB.•PSO-HH proved to be promising for treating project scheduling problems.•PSO-HH is a flexible procedure that easily can be applied to different problems.
In this paper, we propose a particle swarm optimization (PSO) based hyper-heuristic algorithm for solving the resource constrained project scheduling problem (RCPSP). To the best of our knowledge, this is the first attempt to develop a PSO hyper-heuristic and apply to the classic RCPSP. The hyper-heuristic works as an upper-level algorithm that controls several low-level heuristics which operate to the solution space. The solution representation is based on random keys. Active schedules are constructed by the serial scheduling generation scheme using the priorities of the activities which are modified by the low-level heuristics of the algorithm. Also, the double justification operator, i.e. a forward–backward improvement procedure, is applied to all solutions. The proposed approach was tested on a set of standard problem instances of the well-known library PSPLIB and compared with other approaches from the literature. The promising computational results validate the effectiveness of the proposed approach.
Introduction
: Informed consent is essential to the patient-physician relationship. The paternalistic old-time approach used by physicians to achieve the optimal management is changing today; ...detailed medical information must be disclosed to the patients regarding their health problem.
Aim
: The aim of this study was to highlight the value of informed consent in the context of medical practice as well as to emphasize its importance through the prism of human rights.
Materials and methods:
A patient survey was conducted in two public and one private hospitals in Greece. Eighty-three inpatients from the Surgical Departments of Democritus University Hospital of Alexandroupolis (DUHA), Laikon University Hospital of Athens (LUHA) and a private hospital were included in the study. A questionnaire regarding patients' attitude towards informed consent was distributed to patients prior to surgery.
Results
: The majority of the patients (63.86% in DUHA, 59.38% in LUHA, and 78.95% in the private hospital) opted for full disclosure regarding the course and development of their condition.
Conclusion
: Patients want to be informed about their treatment options and possible complications so that they can make decisions about their treatment after a comprehensive and understandable discussion.
This study aims to investigate any associations of the proinflammatory cytokine IL-1 in treated patients with inflammatory bowel disease (IBD) and the enteropathic seronegative spondylarthritis ...(eSpA).
Thirty-four patients with Crohn's disease (CD), 26 with ulcerative colitis (UC) and 14 patients with SpA participated in the study. Valid clinical indexes, CRP values and the endoscopic and histologic examination were used for the determination of disease activity. IL-1α, IL-1β, IL-1 receptor antagonist (IL-1Ra) were measured by ELISA. Nonparametric tests were used for continuous and categorical data.
Enteropathic SpA diagnosed in 29.4 % CD and 30.8 % UC patients. Active disease had 58.8 % CD (aCD), 76.9 % UC and 50 % SpA patients. Active and inactive CD (iCD) significantly differ on IL-1α levels (11.2 vs. 3.9 pg/ml; p = 0.034). Active and inactive UC significantly differ on IL-1β (3.7 vs. 2.3 pg/ml; p = 0.054) and IL-1Ra levels (15.9 vs. 12.7 pg/ml; p = 0.023). Active and inactive SpA (iSpA) significantly differ on IL-1Ra (16.9 vs. 14.8 pg/ml; p = 0.033) and marginally on IL-1α levels (20 vs. 3.9 pg/ml; p = 0.06). Patients with aCD/ieSpA exhibited significant differences on IL-1α (p = 0.022) compared to those with iCD/ieSpA.
IL-1α is associated with CD activity, while IL-1β and IL-1Ra are associated with UC activity in treated patients with IBD. Prominent cytokine in SpAs seems to be IL-1α.
Background. Several investigators have suggested the possibility that the expression of both EGFR and HER2 could be utilized for molecularly targeted therapy in urinary bladder cancer. We tried to ...evaluate the expression of HER2 and EGFR and activation of the AKT/PTEN/mTOR pathway in urothelial carcinomas and if there is any association between them and cellular adhesion molecules (CAMs). Materials and Methods. Forty-one paraffin-embedded urothelial cancer tissue blocks were collected. Immunostains for HER2, EGFR, MIB1, phospho-AKT, PTEN, phospho-mTOR, e-cadherin, p-cadherin, and b-catenin were performed on tissue microarrays sections. The immunohistochemical results were correlated with clinicopathological parameters. Results. The overexpression of HER2 was found in 19.6% of the cases and it was associated with high grade tumors with a high mitotic index and phosphorylation of AKT and mTOR. Muscle-invasive tumors presented both cytoplasmic and nuclear losses of PTEN expression. There was no association between HER/AKT/mTOR pathway activation and CAM expression. Although cadherins were often coexpressed, only p-cadherin immunoreactivity was associated with tumor grade and high proliferative index. Conclusions. HER2 overexpression is found in a respective proportion of urothelial carcinomas. P-cadherin expression is associated with high grade UCs but it is not affected by HER2 overexpression or by activation of HER/AKT/mTOR pathway.
When decentralized strategies are considered for managing wastewater, natural systems for wastewater treatment (NSWT) (constructed wetlands) seem to be strongly preferred in comparison with the ...conventional activated sludge wastewater treatment systems. However, because of their high land requirements, land-use suitability analysis should be conducted to specify adequate areas for their accommodation. Multicriteria spatial decision support systems have emerged as the technology that takes into account both decision criteria and constraints in complex land-use planning problems. This study presents a multiattribute decision analysis approach called the spatial fuzzy Analytic Hierarchy Process (SFAHP) to support raster-based land-use suitability studies for the implementation of NSWT. The SFAHP enables decision makers to circumvent vagueness when they perform evaluations using linguistic variables. Its application in a region of Northeastern Greece using a two-level criteria hierarchical model demonstrates its potential use for suitability analyses.
Celotno besedilo
Dostopno za:
DOBA, FGGLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
We perform Monte Carlo simulations of a supersymmetric matrix model, which is obtained by dimensional reduction of 4D SU(N) super Yang-Mills theory. The model can be considered as a four-dimensional ...counterpart of the IIB matrix model. We extract the space-time structure represented by the eigenvalues of bosonic matrices. In particular we compare the large-N behavior of the space-time extent with the result obtained from a low energy effective theory. We measure various Wilson loop correlators which represent string amplitudes, and we observe a nontrivial universal scaling in N. We also observe that the Eguchi-Kawai equivalence to ordinary gauge theory does hold at least within a finite range of scale. Comparison with the results for the bosonic case clarifies the role of supersymmetry in the large-N dynamics. It does affect the multi-point correlators qualitatively, but the Eguchi-Kawai equivalence is observed even in the bosonic case. (Author)
The present work concerns with the investigation of the interior transmission problem, which is naturally associated to the inverse elastic scattering problem of determining the support of an ...isotropic homogeneous penetrable body from a knowledge of the time harmonic incident plane waves and the far-field patterns of the corresponding scattered wave-fields. Our approach combines a boundary integral formulation of the problem and a compact perturbation argument to establish the discreteness of the set of transmission eigenvalues and the well-posedness of the interior transmission problem under the most general assumptions on the elastic parameters of the underlying media.
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