Search Results (3,314)

Background: The gold standard treatment of acute cholecystitis is early laparoscopic cholecystectomy (LC), as indicated in the Tokyo Guidelines (TG). However, the definition of “early” is still unclear. In 2013, TG suggested surgical intervention within 72 h from the onset of the symptoms; however, according to the 2018 revision, LC must be performed as soon as possible, regardless of symptom onset. Therefore, the optimal timing for surgery is still debated. In order to avoid any complications, surgeons need to know all the surgical strategies for safety in case of a difficult cholecystectomy. Methods and Materials: Starting from January 2023 at Cittiglio Hospital (Italy), the following strategies were implemented: LC within 72 h from the onset of symptoms, systematic intraoperative use of indocyanine green fluorescence cholangiography, systematic identification of the Critical View of Safety (CVS), and subtotal cholecystectomy when the CVS was impossible to identify. We retrospectively analyzed a cohort of patients who underwent LC in our surgical department, subdividing them into two groups: Group 1 (G1) included patients operated on in 2022, and Group 2 (G2) included patients operated on in 2023. End points were length of stay and in-hospital postoperative complications, with particular interest in biliary duct injury. Results: Overall, 210 LC have been performed (97 in G1 and 113 in G2). After the introduction of the new safety strategy, the median length of stay (3 days in G1 vs 2 in G2), BDI rate (2 in G1 vs 0 in G2), and conversion rate to open procedure (5 in G1 vs 1 in G2) were decreased. Conclusions: Our data are promising, highlighting that LC with the standardization of new safety strategies, especially in case of acute cholecystitis, immediately improves surgical outcomes in terms of length of stay and complications. Full article

Accounts are an integral part of most modern information systems and provide their owners with the ability to authenticate within the system. This paper presents an analysis of existing methods for detecting simple account passwords in automated systems. Their advantages and disadvantages are listed. A method was developed to detect simple exploitable passwords that administrators can use to supplement other existing methods to increase the overall security of automated systems against threats from accounts potentially compromised by attackers. The method was based on the analysis of commands executed in automated or manual modes with the indication of credentials in plain text. Minimum password strength requirements are provided based on the security level. A special case was considered in which all passwords analyzed in this way were found explicitly in the system logs. We developed a unified definition of the classification of passwords into simple and strong, and also developed machine learning technology for their classification. The method offers a flexible adaptation to a specific system, taking into account the level of significance of the information being processed and the password policy adopted, expressed in the possibility of retraining the machine learning model. The experimental method using machine learning algorithms, namely the ensemble of decision trees, for classifying passwords into strong and potentially compromised by attackers based on flexible password strength criteria, showed high results. The performance of the method is also compared against other machine learning algorithms, specifically XGBoost, Random Forest, and Naive Bayes. The presented approach also solves the problem of detecting events related to the use and storage of credentials in plain text. We used the dataset of approximately 770,000 passwords, allowing the machine learning model to accurately classify 98% of the passwords by their significance levels. Full article

Endometriosis and adenomyosis are chronic gynecological conditions that significantly impact women’s quality of life, leading to symptoms such as pelvic pain, dysmenorrhea, and infertility. Despite ongoing research, a definitive cure for these conditions remains elusive, and treatment often focuses on managing symptoms. Minimally invasive surgery is considered the gold standard for surgical management, but novel surgical techniques are continuously being developed to enhance outcomes. These innovations aim to reduce disease recurrence, improve fertility rates, and provide better long-term symptom relief. In addition, techniques like robot-assisted laparoscopy (RAS) have revolutionized the treatment of complex cases, such as deep infiltrating endometriosis (DIE), offering improved precision and effectiveness. This review explores the latest advancements in surgical approaches, their clinical efficacy, and future directions, emphasizing the need for individualized multidisciplinary care to optimize patient outcomes. Full article

Analyzing the fluctuations of particulate matter (PM) concentrations and their scaling correlation structures are useful for air quality management. Multifractal characterization of PM2.5 and PM10 of three cities in India wase considered using the detrended fluctuation procedure from 2018 to 2021. The cross-correlation of PM concentration in a multifractal viewpoint using the multifractal cross-correlation analysis (MFCCA) framework is proposed in this study. It was observed that PM2.5 was more multifractal and complex than PM10 at all the locations. The PM–gaseous pollutant (GP) and PM–meteorological variable (MV) correlations across the scales were found to be weak to moderate in different cities. There was no definite pattern in the correlation of PM with different meteorological and gaseous pollutants variables. The nature of correlation in the pairwise associations was found to be of diverse and mixed nature across the time scales and locations. All the time series exhibited multifractality when analyzed pairwise using multifractal cross-correlation analysis. However, there was a reduction in multifractality in individual cases during PM–GP and PM–MV paired analyses. The insights gained into the scaling behavior and cross-correlation structure from this study are valuable for developing prediction models for PMs by integrating them with machine learning techniques. Full article

Background: Cranial vault lesions are common in children, with dermoid and epidermoid cysts being the most frequent. Management is debated due to their slow growth, but early resection can prevent complications and provide a definitive histological diagnosis, which is sometimes linked to systemic diseases. Methods: A retrospective study of children treated surgically for cranial vault tumors from January 2011 to April 2023 was conducted. The data collected included age, gender, symptoms, comorbidities, lesion location, radiological features, surgical techniques, histopathology, and recurrence rates. Results: Eighty-eight children (mean age: 3.5 years, mean tumor size: 1.21 cm) underwent surgery. The most common locations were the frontal and occipital bones. The main diagnoses were dermoid cysts, myofibroma, and Langerhans cell histiocytosis. Gross total resection was achieved in 64 cases with simple skin incisions. In 13 cases, small cranioplasties with bone cement were used. Craniotomy and cranioplasty with autologous bone grafting were performed for 11 patients with lesions larger than 2 cm and full skull thickness erosion. Conclusions: Early resection is recommended for complete removal with minimally invasive surgery and to ensure histological diagnosis. For lesions larger than 2 cm with full skull erosion, cranioplasty with autologous bone is the preferred technique. Full article

Numerical modeling of hydraulic fracturing is complicated when a fracture reaches a stress barrier. For high barriers, it may require changing the computational scheme. In view of the strong influence of stress barriers on the final footprint and opening of a hydraulic fracture, for decades, their modeling has been the subject of special investigations. Actually, classical models of propagation within a pay layer with impenetrable boundaries referred to the case of extremely high-stress contrast in neighbor layers. Further improvements tended to account for the fracture growth in these layers by including stress contrasts as input parameters of a model. This tendency resulted in the suggestion and successive enhancements of pseudo-three-dimensional models. All of them have used stress intensity factors (SIFs) to characterize the combined resistance caused by stress contrasts, material strength, and fluid viscosity. Specifically, the SIFs served to formulate the conditions that control the front penetration into a neighbor layer. This key concept presents the background of our research. Despite examples of modeling propagation through barriers, there is no general theory clarifying when and why conventional schemes may become inefficient and how to overcome computational difficulties. This paper presents the theory and practical recommendations following it. We start with the definition of the barrier intensity, which exposes that the barrier strength may change from zero for contrast-free propagation to infinity for channelized propagation. The analysis reveals two types of computational difficulties caused by spatial discretization as follows: (i) general, arising for fine grids and aggravated by a barrier, and (ii) specific, caused entirely by a strong barrier. The asymptotic approach, which avoids spatial discretization, is suggested. It is illustrated by solving benchmark problems for barriers of arbitrary intensity. The analysis distinguishes three typical stages of the fracture penetration into a barrier and provides theoretical values of the Nolte–Smith slope parameter and arrest time as functions of the barrier intensity. Special analysis establishes the accuracy and bounds of the asymptotic approach. It appears that the approach provides physically significant and accurate results for fracture penetration into high, intermediate, and even weak stress barriers. On this basis, simple practical recommendations are given for modeling hydraulic fractures in rocks with stress barriers. The recommendations may be promptly implemented in any program using spatial discretization to model fracture propagation. Full article

The increasing availability of direct-to-consumer personalized nutrition products has raised questions about their scope of personalization and added value compared to general dietary guidelines. This study evaluated eleven personalized nutrition products across six distinct methodologies, including DNA analysis, blood marker analysis, microbiome testing, blood glucose monitoring, questionnaire-based personalization, and consultation with a dietitian, comparatively evaluating their consistency and added value compared to general dietary guidelines. A 24-year-old obese male with no pre-existing illnesses was chosen as the case participant to represent a typical individual seeking personalized nutrition advice for weight loss. Significant variability and inconsistency were observed across and within the different methodologies, particularly in recommendations for energy intake and macronutrient distribution. Most advice was generic and aligned closely with existing dietary guidelines, with a notable lack of behavioral change strategies. This study underscores the challenges in personalized nutrition, highlighting the problem that current practices often fall short of delivering truly tailored recommendations. There is a critical need for clearer definitions, evidence-based guidelines, and more comprehensive approaches to fully realize the potential of personalized nutrition in improving individual health. Full article

From time to time, some well-known terms are extended with adjectives to create new topics, which is exactly what happened in the case of regenerative agritourism. This article aims to try to explain the term “regenerative” as the next step in thinking about sustainable development and in relation to the definition of agritourism. The research methods used include the literature analysis, the bibliographic program VoSwiver (version 1.6.20), the descriptive method, and logical–comparative analysis. The authors conducted a systematic literature review to highlight the role of agritourism in supporting sustainable rural development and describe the concept of regenerative agritourism. The results of this analysis suggest that regenerative agritourism is “agritourism by another name” and is neither more sustainable nor more environmentally friendly. The characteristics attributed to the new term used to describe this form of tourism can already be found in agritourism perceived in its classical sense and in what is practiced as a tourist activity on many farms. The results of our literature research have shown that regenerative agritourism is nothing other than agritourism that takes place on traditional farms. Full article

This article describes the leadership and organizational elements that have made the Seven Mountains Mandate (7MM), one of the main doctrines of the Apostolic Restoration Movement (ARM), a very adaptable, simple to explain, and feasible to implement message and portable practice, which can be started at the local level and expand progressively to acquire regional and national dimensions. A new classification of apostolic networks is proposed in this article and a partial map of some of the networks that participated in the expansion of the 7MM is presented. Additionally, using definitions from network leadership theory, it is shown how different types of leaders, who function as horizontal connectors in apostolic networks, such as conveners, catalysts, mobilizers, facilitators, weavers, provocateurs, illuminators, hosts, and curators, contribute to the diffusion of the 7MM by promoting its global Widening, Deepening, and Lengthening (WDL). The article first describes the evolution of the church from denominations to networks and how the ARM adopted the network organizational structure that serves as a channel for the diffusion of the 7MM. Cases from the USA, Guatemala, Zambia, and Venezuela are used as examples to demonstrate how the 7MM’s expansion, or Widening (W); its contextualization and adaption, or Deepening (D); and its sustainability, reproduction, and evolution, or Lengthening (L), occur globally based on the network nature of the ARM and the network leadership enacted in the process. Full article

Background/Objectives: One of the most important diagnostic tools in bone tumors is X-rays. Preliminary and, in the case of some benign lesions, definitive diagnoses are formed using this basic tool. Part of the decision making in this stage is based on statistical probability using the patient’s age, as well as the incidence and predilection sites of different entities. The information used today is based on older and fragmented data. To verify the underlying principles, we retrospectively evaluated all bone tumors in children and adolescents treated by our tertiary center in the last 20 years. Methods: For this retrospective study, patients under the age of 18 years suffering from histopathologically verified bone tumors were evaluated. Data were retrieved from our local musculoskeletal tumor database. Results: We were able to include 420 children treated for bone tumors in our tertiary center. The cohort consisted of 335 benign and 85 malignant lesions. The most common lesions were 137 osteochondromas; the malignant tumors consisted mainly of osteosarcomas (53) and Ewing’s sarcomas (28). The primary predilection sites were the metaphyses of long bones. Conclusions: We were able to confirm and supplement the fragmentary data of these rare diseases using our own cohort. Full article

A certain proportion of patients undergoing cardiac surgery may experience bleeding complications that worsen outcomes. Numerous studies have investigated bleeding in cardiac surgery and some evaluate the role of hemostatic point-of-care tests in cardiac surgery patients. The prevalence of excessive bleeding varies in the literature, and such variability stems from the lack of a standardized definition of excessive bleeding. Herein, we report numerous definitions of excessive bleeding and methodological considerations for studies evaluating bleeding using hemostatic point-of-care tests in cardiac surgery patients. We evaluated the role of hemostatic point-of-care devices in contemporary research on bleeding complications and hemostatic management in cardiac surgery. The type of studies (prospective vs. retrospective, interventional vs. observational), patient selection (less complex vs. complex cases), as well as data analysis with comprehensive statistical considerations have also been provided. This article provides a comprehensive insight into the research field of bleeding complications in cardiac surgery and may help readers to better understand methodological flaws and how they influence current evidence. Full article

In a highly dynamic and complex environment where risks and uncertainties are inevitable, the ability of a system to quickly recover from disturbances and maintain optimal performance is crucial for ensuring operational continuity and efficiency. In this context, resilience has become an increasingly important topic in the field of engineering and the management of productive systems. However, there is no single quantitative indicator of resilience that allows for the measurement of this characteristic in a productive system. This study proposes the use of permutation entropy of ordinal patterns in time series as an indicator of resilience in industrial equipment and systems. Based on the definition of resilience, the developed method enables precise and efficient assessment of a system’s ability to withstand and recover from disturbances. The methodology includes the identification of ordinal patterns and their analysis through the calculation of a permutation entropy indicator to characterize the dynamics of industrial systems. Case studies are presented and the results are compared with other resilience models existing in the literature, aiming to demonstrate the effectiveness of the proposed approach. The results are promising and highlight a highly applicable and simple indicator for resilience in industrial systems. Full article

Background: Vitamin D plays an important role in maintaining bone health with numerous benefits for extraskeletal health as well. Objectives: We aimed to assess the prevalence of vitamin D deficiency in children (0–18 years old) in a tertiary hospital in Romania between August 2019 and January 2024 and to investigate the role of adequate supplementation in this vulnerable population. Methods: The serum 25(OH)D levels were measured using a chemiluminescence binding assay. Results: A total of 744 participants were included in this study: 396 female (53.23%) and 348 male (46.77%). The serum levels of 25(OH)D ranged between 2.2 and 125.4 ng/mL, with a mean value of 27.4 ng/mL and a median value of 23.5 ng/mL. According to the cutoff values for the definition of vitamin D status (severe deficiency: <10 ng/mL, deficiency: <20 ng/mL, insufficiency: 20–29 ng/mL, and sufficiency: ≥30 ng/mL), the sample consisted of 77 (10.34%) cases of severe deficiency, 221 (29.7%) cases of deficiency, 194 (26.07%) cases of insufficiency, and 245 (32.93%) cases of sufficiency. There were seven cases of hypervitaminosis D with values above 100 ng/mL. The mean values (and corresponding 95% confidence intervals, CIs) were as follows: 27.85 ng/mL [25.95–29.76] in the males, 22.45 ng/mL [25.12–28.82] in the females, 24.82 ng/mL [21.86–27.77] in the spring, 28.62 ng/mL [26.42–30.81] in the summer, 32.30 ng/mL [29.16–35.44] in the autumn, and 24.01 ng/mL [21.57–26.44] in the winter. We observed a notable decline in the serum 25(OH)D levels with age, with 82.08% of the children in the age group above 6 years old having serum 25(OH)D levels below 30 ng/mL. In obese subjects, a higher prevalence of hypovitaminosis D was observed compared to non-obese subjects, with a mean value of 19.54 [17.50–21.57] ng/mL in obese children versus 28.89 [27.39–30.40] ng/mL in normal weight children. Conclusions: In our sample, the mean serum concentration of 25(OH)D was 27.4 ng/mL. Notably, 66.11% of the cases demonstrated varying degrees of hypovitaminosis D, with a significantly higher prevalence of 86.16% observed in the obese group. Healthcare providers should prioritize routine screening for vitamin D levels in pediatric patients with obesity to facilitate timely intervention and personalized supplementation strategies tailored to individual needs Full article

Let $\mathfrak{F}\left({\nu }_j\right)=\{Q_{m_j}^{{\nu }_j},m_j\in (m_{-}^{{\nu }_j},m_{+}^{{\nu }_j})\}$, $j=1,2$, be two Cauchy–Stieltjes Kernel (CSK) families induced by non-degenerate compactly supported probability measures ${\nu }_1$ and ${\nu }_2$. Introduce the set of measures $\mathcal{F}=\mathfrak{F}\left({\nu }_1\right)⊞\mathfrak{F}\left({\nu }_2\right)=\{Q_{m_1}^{{\nu }_1}⊞Q_{m_2}^{{\nu }_2},m_1\in (m_{-}^{{\nu }_1},m_{+}^{{\nu }_1})and{m}_2\in (m_{-}^{{\nu }_2},m_{+}^{{\nu }_2})\}.$ We show that if $\mathcal{F}$ remains a CSK family, (i.e., $\mathcal{F}=\mathfrak{F}\left(\mu \right)$ where $\mu$ is a non-degenerate compactly supported measure), then the measures $\mu$, ${\nu }_1$ and ${\nu }_2$ are of the Marchenko–Pastur type measure up to affinity. A similar conclusion is obtained if we substitute (in the definition of $\mathcal{F}$) the additive free convolution ⊞ by the additive Boolean convolution ⊎. The cases where the additive free convolution ⊞ is replaced (in the definition of $\mathcal{F}$) by the multiplicative free convolution ⊠ or the multiplicative Boolean convolution ⨃ are also studied. Full article

Background/Objectives: Achieving disease control is the main goal in asthmatic patients in order to prevent future risks and exacerbations. There are several clinical guidelines that set different definitions of asthma control, and these differences may affect management and treatment in many patients. Our aim was to describe asthma control patterns according to the Global Initiative for Asthma (GINA) 2023 in patients considered to have uncontrolled asthma as per previous GINA 2010 guidelines. Methods: A total of 1299 patients from the COAS study were analyzed. The COAS study was a cross-sectional multicenter study conducted in routine clinical practice that included patients with uncontrolled asthma according to GINA 2010. These patients were then re-classified using the now updated GINA 2023 asthma control criteria. Results: After applying GINA 2023 control criteria, previously uncontrolled patients were now classified as having controlled asthma in 24.3% of cases and partially controlled asthma in 16.3% of cases. Only 59.4% maintained their previous diagnosis of uncontrolled asthma. ACT in the uncontrolled patients remained similar after re-classification, as did the percentage of active smokers, respiratory allergy, rhinitis, and lung function. Conclusions: Changes in clinical guideline criteria affect the definition of asthma control. When excluding pulmonary function abnormalities in GINA 2023 asthma control criteria, the percentage of controlled patients greatly increased. Full article