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Background: Bologna criteria poor ovarian responders have a very low prognosis. Although, it has been proposed that LH supplementation could be beneficial in women with previous hypo-response to FSH. There are no studies comparing the cumulative live birth rates (LBRs) between corifollitropin alfa (CFA) and highly purified human menopausal gonadotrophin (hp-hMG).Objective: To compare cumulative LBRs in Bologna poor ovarian responders undergoing ovarian stimulation with CFA followed by hp-hMG vs. hp-hMG alone in a GnRH antagonist protocol.Design: This is a retrospective cohort study. We included in total 917 poor responders fulfilling the Bologna criteria for poor ovarian response (POR) at a university-affiliated tertiary center from January 2011 until March 2017. Patients were administered either fixed daily doses of 300–450 IU of hp-hMG (group A) or a single dose of 150 μg of CFA followed by daily injections of ≥300 IU of hp-hMG from Day 8 of stimulation until the day of ovulation trigger (group B), in a fixed GnRH antagonist protocol.Results: LBRs after fresh embryo transfer (ET) were similar in group A 71/510 (14%) and B 42/407 (10%). Cumulative LBR per cycle was significantly higher in group A (16.9%) compared to group B (11.8%); (P = 0.03). However, logistic regression analysis showed no association between the type of gonadotropin administered and cumulative LBR. Only age was significantly associated with cumulative LBR (OR = 0.93, P = 0.007).Conclusion: Cumulative LBRs are similar in Bologna poor responders stimulated with CFA followed by hp-hMG compared to hp-hMG monotreatment in an antagonist protocol.

Research Question: What is the effect of gonadotropin-releasing hormone (GnRH)-agonist treatment on serum anti-Müllerian hormone (AMH)?Design: This prospective cohort study conducted in a tertiary university hospital comprised patients (n = 52) who self-administered daily triptorelin (0.1 mg/0.1 mL) subcutaneously for 14 days from menstrual cycle day 21 ± 3, between July 2015 and March 2016. Enrolled women were 18–43 years old, considered normal ovarian responders, with a planned GnRH agonist controlled ovarian stimulation protocol. The primary endpoint was to evaluate the effect of GnRH agonist on serum AMH levels after 7 and 14 days of treatment.Results: Under GnRH agonist treatment, serum AMH was significantly decreased vs. baseline on day 7 (mean change from baseline: −0.265 ng/mL; 95% confidence interval [CI], −0.395 to −0.135 ng/mL; p < 0.001). On day 14, serum AMH was significantly increased (mean change from baseline: 0.289 ng/mL; 95% CI, 0.140–0.439 ng/mL; p < 0.001). Although the median change in AMH from baseline was only −14.9% on day 7 and +17.4% on day 14, from day 7 to 14 AMH significantly increased by 0.55 ng/mL (43.8%; p < 0.001), which is of paramount clinical importance. A linear, mixed-effect model demonstrated that GnRH agonist treatment for 7 and 14 days had a highly significant effect on serum AMH concentration after adjustment for confounding factors (age, body mass index, baseline antral follicle count, and visit). AMH assay precision was excellent (four aliquots/sample); coefficient of variation was 1.2–1.4%.Conclusions: GnRH agonist treatment had a clinically significant effect on serum AMH, dependent on treatment duration. The clear V-shaped response of AMH level to daily GnRH agonist treatment has important clinical implications for assessing ovarian reserve and predicting ovarian response, thus AMH measurements under GnRH agonist downregulation should be interpreted with great caution.

The Koch curve was first described by the Swedish mathematician Helge von Koch in 1904 as an example of a continuous but nowhere differentiable curve. Such functions are now characterised as fractal since their graphs are in general fractal sets. Furthermore, it can be obtained as the graph of an appropriately chosen iterated function system. On the other hand, a fractal interpolation function can be seen as a special case of an iterated function system thus maintaining all of its characteristics. Fractal interpolation functions are continuous functions that can be used to model continuous signals. An in-depth discussion on the theory of affine fractal interpolation functions generating the Koch Curve by using fractal analysis as well as its recent development including some of the research made by the authors is provided. We ensure that the graph of fractal interpolation functions on the Koch Curve are attractors of an iterated function system constructed by non-constant harmonic functions.

Fusarium head blight (FHB) is a devastating fungal disease of small-grain cereals that causes significant yield losses and mycotoxin contamination, diminishing food and feed safety worldwide. In contrast to wheat, little is known about the agricultural practices that influence FHB and Fusarium mycotoxins in barley. Thus, a nationwide survey was conducted across Switzerland for harvest samples in 2016 and 2017, accompanied with a questionnaire to obtain information about the agricultural practices in each barley field. In total, 253 grain and 237 straw samples were analyzed. In both years, F. graminearum was the predominant Fusarium species in grains followed by F. avenaceum and F. poae. Growing maize before barley was associated with increased amount of F. graminearum DNA in grains and straw as well as with elevated concentrations of deoxynivalenol in grains of barley. On the other hand, growing pasture before barley resulted in increased incidence of F. poae and concentration of numerous mycotoxins in grains (e.g., enniatins) and straw (e.g., beauvericin). Reduced tillage practices were linked to increased incidence of F. graminearum and deoxynivalenol content in grains and straw. In contrast, conventional tillage was linked to higher incidence of F. poae. Moreover, use of spring barley was associated with decreased amount of F. graminearum DNA in grains and straw, but increased incidence of F. poae and F. avenaceum. Use of the spring variety Eunova was linked to increased concentrations of several Fusarium mycotoxins in grains (e.g., enniatins and nivalenol). Furthermore, the application of strobilurin-based fungicides was associated with higher deoxynivalenol and beauvericin contents in grains. The application of plant growth regulators was associated with increased concentration of some Fusarium mycotoxins in grains (e.g., culmorin), while absence of growth regulators application was linked to elevated concentration of some other mycotoxins (e.g., nivalenol). We conclude that individual agricultural practices can suppress some FHB causing species and reduce the associated mycotoxins, but can promote others. Hence, integrated control measures combining numerous prevention and intervention strategies should be applied for the sustainable management of mycotoxins in barley.

The methodological foundations of mainstream economics have been cited as one of the main reasons for its failure to account for the economic crisis of 2008. In spite of this, the status of economic methodology has not been elevated. This is due to the persistent aversion towards methodological discourse by most mainstream economists. The anti-methodology stance has a long presence as exemplified in Frank Hahn’s (1992) work. After focusing on the debate originating after the publication of Hahn’s arguments, the paper offers a categorization of the main explanations for mainstream methodological aversion. Subsequently, it suggests an explanation based on the role of the physics scientific ideal, arguing that the endeavor to achieve the high scientific status of physics by following the methods of physics, contributed to the negative mainstream attitude towards economic methodology. The relevant writings of the extremely influential mainstream economists Irving Fisher and Milton Friedman, reinforce the assertion that the alleged hard science status of economics renders methodological discussions and especially methodological criticism, rather pointless. The paper also calls for a more systematic discussion of this issue, especially in the wake of the line of argument that links the recent failings of mainstream economics to its methodological basis

Background: Cyclic aminals are core features of natural products, drug molecules and important synthetic intermediates. Despite their relevance, systematic investigations into their stability towards hydrolysis depending on the pH value are lacking.Results: A set of cyclic aminals was synthesized and their stability quantified by kinetic measurements. Steric and electronic effects were investigated by choosing appropriate groups. Both molecular mechanics (MM) and density functional theory (DFT) based studies were applied to support and explain the results obtained. Rapid decomposition is observed in acidic aqueous media for all cyclic aminals which occurs as a reversible reaction. Electronic effects do not seem relevant with regard to stability, but the magnitude of the conformational energy of the ring system and pKa values of the N-3 nitrogen atom.Conclusion: Cyclic aminals are stable compounds when not exposed to acidic media and their stability is mainly dependent on the conformational energy of the ring system. Therefore, for the preparation and work-up of these valuable synthetic intermediates and natural products, appropriate conditions have to be chosen and for application as drug molecules their sensitivity towards hydrolysis has to be taken into account.

Computer games play an increasingly important role in cultural heritage preservation. They keep tradition alive in the digital domain, reflect public perception about historical events, and make history, and even legends, vivid, through means such as advanced storytelling and alternative timelines. In this context, understanding the respective underlying player base is a major success factor as different game elements elicit various emotional responses across players. To this end, player profiles are often built from a combination of low- and high-level attributes. The former pertain to ordinary activity, such as collecting points or badges, whereas the latter to the outcome of strategic decisions, such as participation in in-game events such as tournaments and auctions. When available, annotations about in-game items or player activity supplement these profiles. In this article, we describe how such annotations may be integrated into different player profile clustering schemes derived from a template Simon–Ando iterative process. As a concrete example, the proposed methodology was applied to a custom benchmark dataset comprising the player base of a cultural game. The findings are interpreted in the light of Bartle taxonomy, one of the most prominent player categorization. Moreover, the clustering quality is based on intra-cluster distance and cluster compactness. Based on these results, recommendations in an affective context for maximizing engagement are proposed for the particular game player base composition.

In this article, firstly, an overview of affine fractal interpolation functions using a suitable iterated function system is presented and, secondly, the construction of Bernstein affine fractal interpolation functions in two and three dimensions is introduced. Moreover, the convergence of the proposed Bernstein affine fractal interpolation functions towards the data generating function does not require any condition on the scaling factors. Consequently, the proposed Bernstein affine fractal interpolation functions possess irregularity at any stage of convergence towards the data generating function.

Cognitive maps are high level representations of the key topological attributes of real or abstract spatial environments progressively built by a sequence of noisy observations. Currently such maps play a crucial role in cognitive sciences as it is believed this is how clusters of dedicated neurons at hippocampus construct internal representations. The latter include physical space and, perhaps more interestingly, abstract fields comprising of interconnected notions such as natural languages. In deep learning cognitive graphs are effective tools for simultaneous dimensionality reduction and visualization with applications among others to edge prediction, ontology alignment, and transfer learning. Fuzzy cognitive graphs have been proposed for representing maps with incomplete knowledge or errors caused by noisy or insufficient observations. The primary contribution of this article is the construction of cognitive map for the sixteen Myers-Briggs personality types with a tensor distance metric. The latter combines two categories of natural language attributes extracted from the namesake Kaggle dataset. To the best of our knowledge linguistic attributes are separated in categories. Moreover, a fuzzy variant of this map is also proposed where a certain personality may be assigned to up to two types with equal probability. The two maps were evaluated based on their topological properties, on their clustering quality, and on how well they fared against the dataset ground truth. The results indicate a superior performance of both maps with the fuzzy variant being better. Based on the findings recommendations are given for engineers and practitioners.

The term disentangled refers to polymers with fewer entanglements in the amorphous regions, a metastable condition that can significantly affect the material’s properties and processing behavior. The lower entanglement density in ultra-high molecular weight polyethylene (dis-UHMWPE) facilitates the solid-state processability into uniaxially-oriented specimens reaching very high draw ratios and crystallinities. In this study, Au/dis-UHMWPE nanocomposites were formulated and processed at variable draw ratios. Polarized light microscopy suggests gold nanoparticles are oriented in arrays following the drawing of polymer chains. The structural features, upon orientation, are studied by means of Raman spectroscopy, wide- and small-angle X-ray scattering, and near-infrared spectrophotometry. Crystallinity is found to increase by 15%, as calculated by wide-angle X-ray scattering. The change in optical absorbance in the visible spectrum indicates that, with orientation, the average size of gold aggregates increases, supported quantitatively by small-angle X-ray scattering. Since the gold nanoparticles are expected to be found within amorphous chain segments, the aforementioned findings are attributed to the increase of crystallinity and thus the decrease of available (amorphous) space.

Some years ago, several authors tried to construct fractal surfaces which pass through a given set of data points. They used bivariable functions on rectangular grids, but the resulting surfaces failed to be continuous. A method based on their work for generating fractal interpolation surfaces is presented. Necessary conditions for the attractor of an iterated function system to be the graph of a continuous bivariable function which interpolates a given set of data are also presented here. Moreover, a comparative study for four of the most important constructions and attempts on rectangular grids is considered which points out some of their limitations and restrictions.

At the dawn of the 10V or big data data era, there are a considerable number of sources such as smart phones, IoT devices, social media, smart city sensors, as well as the health care system, all of which constitute but a small portion of the data lakes feeding the entire big data ecosystem. This 10V data growth poses two primary challenges, namely storing and processing. Concerning the latter, new frameworks have been developed including distributed platforms such as the Hadoop ecosystem. Classification is a major machine learning task typically executed on distributed platforms and as a consequence many algorithmic techniques have been developed tailored for these platforms. This article extensively relies in two ways on classifiers implemented in MLlib, the main machine learning library for the Hadoop ecosystem. First, a vast number of classifiers is applied to two datasets, namely Higgs and PAMAP. Second, a two-step classification is ab ovo performed to the same datasets. Specifically, the singular value decomposition of the data matrix determines first a set of transformed attributes which in turn drive the classifiers of MLlib. The twofold purpose of the proposed architecture is to reduce complexity while maintaining a similar if not better level of the metrics of accuracy, recall, and F 1 . The intuition behind this approach stems from the engineering principle of breaking down complex problems to simpler and more manageable tasks. The experiments based on the same Spark cluster indicate that the proposed architecture outperforms the individual classifiers with respect to both complexity and the abovementioned metrics.

Several infertile patients, who may even represent around 40% of the infertile cohort, may respond “suboptimally” (4–9 oocytes retrieved) following IVF, despite being predicted as normal responders. The aim of our longitudinal study was to evaluate the ovarian response of suboptimal responders in terms of the number of oocytes retrieved, following their second IVF cycle, evaluating exclusively patients who had the same stimulation protocol and used the same or higher initial dose of the same type of gonadotropin compared to their previous failed IVF attempt. Overall, our analysis included 160 patients treated with a fixed antagonist protocol in their second cycle with the same [53 (33.1%)] or higher [107 (66.9%)] starting dose of rFSH. The number of oocytes retrieved was significantly higher in the second IVF cycle [6 (5–8) vs. 9 (6–12), p < 0.001]. According to our results, a dose increment of rFSH remained the only significant predictor of the number of oocytes retrieved in the subsequent IVF cycle (coefficient 0.02, p-value = 0.007) after conducting GEE multivariate regression, while adjusting for relevant confounders. A regression coefficient of 0.02 for the starting dose implies that an increase of 50 IU of the initial rFSH dose would lead to 1 more oocyte.

ObjectivesTo determine the influence of hearing loss on perception of vowel slices.MethodsFourteen listeners aged 20-27 participated; ten (6 males) had hearing within normal limits and four (3 males) had moderate-severe sensorineural hearing loss (SNHL). Stimuli were six naturally-produced words consisting of the vowels /i a u æ ɛ ʌ/ in a /b V b/ context. Each word was presented as a whole and in eight slices: the initial transition, one half and one fourth of initial transition, full central vowel, one-half central vowel, ending transition, one half and one fourth of ending transition. Each of the 54 stimuli was presented 10 times at 70 dB SPL (sound press level); listeners were asked to identify the word. Stimuli were shaped using signal processing software for the listeners with SNHL to mimic gain provided by an appropriately-fitting hearing aid.ResultsListeners with SNHL had a steeper rate of decreasing vowel identification with decreasing slice duration as compared to listeners with normal hearing, and the listeners with SNHL showed different patterns of vowel identification across vowels when compared to listeners with normal hearing.ConclusionAbnormal temporal integration is likely affecting vowel identification for listeners with SNHL, which in turn affects vowel internal representation at different levels of the auditory system.

Fournier′s gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation) requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier′s gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified. Subsequently, the patient underwent scheduled cecostomy closure (right hemicolectomy), while the scrotum trauma healed with tertiary intention. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier′s gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development.

Aim: In the current study, a contribution to the knowledge on the prevalence and level of contamination of Listeria monocytogenes in ready-to-eat (RTE) seafood marketed in Thessaloniki (Northern Greece) was provided; the serovar identity of the L. monocytogenes isolates was also determined. Materials and Methods: A total of 132 RTE seafood samples consisting of 74 smoked fish products, 18 salted fish products, 16 dried fish products, 9 raw marinated fish products, 10 cooked marinated cephalopods and 5 surimi crab stick products were analyzed. L. monocytogenes were isolated and enumerated based on ISO 11290-1/A1 and ISO 11290-2/A1 protocols, respectively, and identified using a multiplex polymerase chain reaction (PCR) system utilizing genus and species specific primers. For the identification of serotypes a second multiplex PCR assay was used which clusters L. monocytogenes strains into four major serogroups. Results: Of the samples examined, 11 (8.3%) proved positive for Listeria spp. with 8 (6.1%) yielding L. monocytogenes. Only in one sample of smoked mackerel the level of L. monocytogenes exceeded the legal safety limit of 100 cfu/g set out in Commission Regulation (EC) No. 1441/2007. Serotyping showed higher percentages of isolates belonging to PCR serogroup 3:1/2b, 3b, 7 (46.7%) and serogroup 1:1/2a, 3a (40%) followed by serogroup 4:4b, 4d, 4e (13.3%). Conclusion: This study demonstrated that L. monocytogenes can be isolated from processed RTE seafood products at retail in Thessaloniki (Northern Greece) in low concentrations. However, the presence of this human pathogen in RTE seafood should not be overlooked, but it should be considered as having significance public health implications, particularly among the persons who are at greater risk. Therefore, RTE seafood should be produced under appropriate hygienic and technological conditions since the product does not undergo any treatment before consumption.

Inflammatory pseudotumor of the spleen with expression of follicular dendritic cell markers is an extremely rare lesion with only a few cases reported previously. The present study reports on an inflammatory pseudotumor of the spleen 10 × 8 × 7 cm in size that was incidentally found in a 61-year-old man and increased gradually in size during a period of 3 months. Abdominal ultrasonography revealed a well-circumscribed splenic mass, and abdominal computed tomography confirmed the presence of a well-circumscribed isodense lesion in the splenic hilum with inhomogenous enhancement in the early-phase images and no enhancement on delayed-phase contrast-enhanced images. Magnetic resonance imaging of the abdomen showed a well-defined isodense tumor on T1-weighted images with mildly increased signal intensity on T2-weighted images, and this is only the second study that provides MRI findings of this entity. The patient underwent an uncomplicated open splenectomy for definitive histologic diagnosis. Under microscopic examination, the lesion was an admixture of lymphocytes, plasma cells and spindle cells. In situ hybridization analysis for Epstein-Barr virus (EBV) revealed that most of the spindle cells were positive for EBV, and immunochemistry showed the expression of the follicular dendritic cell markers CD21, CD35 and CD23 within the tumor. The diagnosis of inflammatory pseudotumor-like follicular dendritic cell tumor was established.

Intestinal neuronal dysplasia (IND) is a well-defined entity which raises controversy among authors, described as a congenital malformation of gastrointestinal innervation and caused by dysplastic embryonal development of the enteric nervous system. It is potentially associated with mild and chronic gastrointestinal motility disturbances. IND is rarely reported in adults and especially elderly patients. The present study reports on the case of a 71-year-old man suffering from longstanding idiopathic constipation and who was misdiagnosed for more than 60 years, despite several hospital admissions and a sigmoidectomy in the meantime. On the last admission, the patient presented with megacolon, abdominal pain and X-ray finding of bowel obstruction. Due to massive large bowel dilatation, an exploratory laparotomy failed to reveal any obvious mechanical cause, and a subtotal colectomy and Hartmann's procedure was performed. Bowel continuity was performed 3 months later. Analysis of full-thickness biopsies revealed enlarged myenteric and submucosal neurons as well as an increased number of giant cells and increased acetylcholinesterase activity in the mucosa. The diagnosis of IND was established. The main diagnostic criteria, the underlining pathophysiology and the recommended therapeutic approach of this rare entity are extensively reviewed.

Presacral ganglioneuroma is an extremely rare tumor of neural crest origin. To the best of our knowledge, less than 20 cases have been reported previously. The present study reports on a presacral ganglioneuroma, 10.5 × 8 × 4 cm in size, that was found incidentally in a 35-year-old man with prior history of diverticulitis. He was admitted to our hospital due to lower left abdominal pain. Abdominal computed tomography and magnetic resonance imaging confirmed the extension of the lesion from the S2 level to the coccyx. The mass had low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images with no intraspinal or rectal extension. T2-weighted images demonstrated a compartmentalized solid tumor with cystic components. Complete tumor resection with free surgical margins was achieved using an abdominal approach. The patient remains asymptomatic 2 years after surgery. We emphasize on clinical features, radiologic appearance and surgical treatment of this rare entity. The clinical and pathologic features of previously reported studies are also briefly reviewed.

In computer science and information theory, data compression, source coding, or bit-rate reduction is the process of encoding digital information using fewer bits than the original representation. Specifically, digital-image compression is important due to the high storage and transmission requirements. Various compression methods have been proposed using different techniques to achieve high compression ratios. Fractal image encoding is a technique based on the representation of an image by contractive transformations. Fractal-based image compression methods belong to different categories according to the different theories they are based on. In this article, first we try to clarify the terminology used and then to comprehensively unveil the mathematical principle behind fractal image compression as well as to briefly overview a variety of schemes that have been investigated.