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Patient-prosthesis mismatch (PPM) is the situation in which the area of an artificial valve is smaller than that of a healthy native valve it replaces. By this definition, all artificial valves demonstrate PPM, but large observational studies and several meta-analyses suggest that it is present in 30-50% of patients after surgical aortic valve replacement (SAVR). PPM has an impact on outcomes only when the indexed aortic valve area (AVAi) is ≤0.85cm2/m2 (moderate PPM) or 0.65cm2/m2 (severe PPM), particularly in patients with reduced LVEF. In transcatheter aortic valve replacement, the prevalence of PPM may be as low as 0.1%, and its impact on hard outcomes is not clear. We present a review of the relevant literature together with a framework for the differential diagnosis of increased pressure gradient and reduced area in prosthetic aortic valves and different strategies to reduce the risk of PPM with SAVR.

The title compound, bis[μ-2,2′-(4H-1,2,4-triazole-3,5-diyl)diacetato]bis[diaquacopper(II)] dihydrate, [Cu2(C6H5N3O4)2(H2O)4]·2H2O, is a dinuclear octahedral CuII triazole-based complex. The central copper atoms are hexa-coordinated by two nitrogen atoms in the equatorial positions, two equatorial oxygen atoms of two carboxylate substituents in position 3 and 5 of the 1,2,4-triazole ring, and two axial oxygen atoms of two water molecules. Two additional solvent water molecules are linked to the title molecule by O—H...N and O...H—O hydrogen bonds. The crystal structure is built up from the parallel packing of discrete supramolecular chains running along the a-axis direction. Hirshfeld surface analysis suggests that the most important contributions to the surface contacts are from H...O/O...H (53.5%), H...H (28.1%), O...O (6.3%) and H...C/C...H (6.2%) interactions. The crystal studied was twinned by a twofold rotation around [100].

This study aims to present the main guidelines published by the Bucharest Stock Exchange regarding the general principles of corporate governance, as well as an analysis of the level of compliance with them by listed companies. Thus, the authors have developed a three-level corporate governance index by means of which the level of compliance with the guidelines published by the BVB can be measured. Following the analysis, the authors conclude that the score obtained by the analysed companies is positive, based on their level of compliance with most of the guidelines presented by the BVB. Moreover, companies in the Premium category have a higher level of compliance with the guidelines of the Code of Corporate Governance than other companies listed on the regulated market. From the perspective of future research, the authors aim to investigate whether corporate governance can influence a company’s financial performance.

Background/Objectives: Retinopathy of Prematurity (ROP) remains a leading cause of vision impairment in premature infants, especially those with Respiratory Distress Syndrome (RDS) necessitating respiratory support. This study aimed to identify correlations between plasma levels of Insulin-like Growth Factor 1 (IGF1) and Tumor Necrosis Factor-alpha (TNF-alpha), and the risk of developing ROP. Additionally, it explored the association of ROP severity grades with plasma levels of glucose, lactate dehydrogenase (LDH), creatin phosphokinase (CPK), and other biomarkers, aiming to uncover predictive markers for ROP risk and severity in this population. Methods: This prospective study included premature neonates admitted with RDS requiring respiratory support, conducted over 18 months at the Neonatal Intensive Care Unit of the Louis Turcanu Emergency Clinical Hospital for Children, Timisoara. Plasma levels of IGF1 and TNF-alpha were measured on days 1 and 14 post-birth, alongside the initial assessment of glucose, LDH, and CPK levels. Results: Significant correlations were observed between lower gestational age and elevated LDH levels on day 7–10 (rho = −0.341, p = 0.0123) and between TNF-alpha levels at 2 weeks and ROP severity (rho = 0.512, p = 0.0004). Elevated IGF1 levels were protective against ROP, with Beta coefficients of 0.37 (p = 0.0032) for the first collection and 0.32 (p = 0.0028) for the second, suggesting their potential as biomarkers for ROP risk assessment. Higher levels of TNF-alpha at 2 weeks were associated with an increased risk of ROP (Beta = −0.45, p = 0.0014), whereas higher IGF1 levels offered protective effects against ROP, with Beta coefficients of 0.37 (p = 0.0032) for the first collection and 0.32 (p = 0.0028) for the second. Elevated LDH levels on day 7–10 post-birth were linked to an increased risk of ROP (Beta = 0.29, p = 0.0214). Conclusions: These findings highlight the potential of IGF1 and TNF-alpha as predictive biomarkers for ROP, offering avenues for early intervention and improved management strategies in this high-risk group.

Due to the increasing impacts of climate change on flood management, it is vital to implement effective flood mitigation measures. Economic factors significantly influence the feasibility and speed of these implementations. Evaluations must go beyond just the implementation costs. This paper introduces tools and methods for incorporating environmental economics into flood risk management at various scales, from urban areas to entire river basins. Comprehensive analysis should include social, environmental, direct, and indirect factors. Despite the variability in flood mitigation costs across different economies, the methods discussed are highly adaptable. Data limitations for appraisal tools like Multicriteria Analysis (MCA) and Cost-Benefit Analysis (CBA) can be addressed through expert judgment, qualitative assessment, or using GDP-proportional data for cost estimation. This approach utilizes databases from experienced countries, making the methods adaptable to different contexts.

In the title complex, [U(C10H7N3O3)O2(CH3OH)]n, the UVI cation has a typical pentagonal–bipyramidal environment with the equatorial plane defined by one N and two O atoms of one doubly deprotonated 2-[5-(2-hydroxyphenyl)-1H-1,2,4-triazol-3-yl]acetic acid ligand, a carboxylate O atom of the symmetry-related ligand and the O atom of the methanol molecule [U—N/Oeq 2.256 (4)–2.504 (5) Å]. The axial positions are occupied by two oxide O atoms. The equatorial atoms are almost coplanar, with the largest deviation from the mean plane being 0.121 Å for one of the O atoms. The benzene and triazole rings of the tetradentate chelating–bridging ligand are twisted by approximately 21.6 (2)° with respect to each other. The carboxylate group of the ligand bridges two uranyl cations, forming a neutral zigzag chain reinforced by a strong O—H...O hydrogen bond. In the crystal, adjacent chains are linked into two-dimensional sheets parallel to the ac plane by C/N—H...N/O hydrogen bonding and π–π interactions. Further weak C—H...O contacts consolidate the three-dimensional supramolecular architecture. In the solid state, the compound shows a broad medium intensity LMCT transition centred around 463 nm, which is responsible for its red colour.

Financial knowledge is necessary not only for consumers of banking products and services when purchasing products but also for the unbanked population when they have to decide how much to borrow or save to keep their monthly budget in a comfort zone and to meet medium and long-term financial goals

A direct measurement of the ground-state-to-ground-state electron-capture decay Q value of 95Tc has been performed utilizing the double Penning trap mass spectrometer JYFLTRAP. The Q value was determined to be 1695.92(13) keV by taking advantage of the high resolving power of the phase-imaging ion-cyclotron-resonance technique to resolve the low-lying isomeric state of 95Tc (excitation energy of 38.910(40) keV) from the ground state. The mass excess of 95Tc was measured to be −86015.95(18) keV/c2, exhibiting a precision of about 28 times higher and in agreement with the value from the newest Atomic Mass Evaluation (AME2020). Combined with the nuclear energy-level data for the decay-daughter 95Mo, two potential ultra-low Q-value transitions are identified for future long-term neutrino-mass determination experiments. The atomic self-consistent many-electron Dirac–Hartree–Fock–Slater method and the nuclear shell model have been used to predict the partial half-lives and energy-release distributions for the two transitions. The dominant correction terms related to those processes are considered, including the exchange and overlap corrections, and the shake-up and shake-off effects. The normalized distribution of the released energy in the electron-capture decay of 95Tc to excited states of 95Mo is compared to that of 163Ho currently being used for electron-neutrino-mass determination.

The concept of sustainable entrepreneurship is becoming an increasingly pivotal area of focus in the global effort to address a range of pressing challenges, including climate change, resource scarcity, and social inequality. Entrepreneurs who integrate economic, environmental, and social goals into their business models can serve as pivotal agents in achieving both profitability and societal well-being. Nevertheless, despite the growing interest in sustainable business models, entrepreneurs encounter considerable obstacles that impede the scalability and success of their ventures. This study focuses on the identification and analysis of the principal obstacles across five key dimensions: economic, regulatory, social, technological, and environmental. The aim of this research is to examine the difficulties encountered by those engaged in sustainable entrepreneurship and to suggest strategies for surmounting these challenges. Methodologically, the study employs a multi-dimensional approach, with each challenge examined through qualitative analysis. The economic challenges, including the high initial costs and difficulties in accessing funding, are identified as some of the most significant barriers. The presence of regulatory challenges, such as inconsistent environmental policies and the absence of governmental incentives, serves to further complicate the business landscape. Furthermore, social challenges, such as consumer reluctance to pay higher prices for sustainable products and resistance to adopting new, eco-friendly habits, also play a crucial role in hindering the success of sustainable ventures. Furthermore, the absence of access to sophisticated green technologies and the requisite expertise to deploy them constitutes a substantial technological impediment for entrepreneurs. The results of the study indicate the existence of several potential avenues for addressing these challenges. For example, the increasing consumer demand for environmentally friendly products and services, in conjunction with technological advancements, presents a substantial opportunity for sustainable entrepreneurship. The practical value of the research lies in its strategic recommendations, which encourage collaboration between policymakers, businesses, and investors. Such collaborative endeavours can facilitate the creation of an enabling environment for sustainable entrepreneurship, thereby reducing economic and regulatory burdens while simultaneously promoting technological advancements. In conclusion, the study emphasises the necessity of a coordinated approach in order to overcome the barriers faced by sustainable entrepreneurs. By capitalising on emerging opportunities and cultivating a supportive ecosystem, entrepreneurs can simultaneously achieve financial success and a positive impact on society and the environment.

Lesions of the cerebellopontine angle (CPA) are frequent and represent 6%–10% of all intracranial tumors. Acoustic neuromas, which are also called vestibular schwannomas, along with meningiomas are the two most frequent lesions and account for approximately 85%–90% of all CPA tumors. These benign lesions involving the middle ear comprise a diverse spectrum of local manifestations within the temporal bone. Despite their usually benign histopathological characteristics, these lesions may be locally destructive. Prompt diagnosis and treatment are therefore necessary to prevent progression of audiologic, vestibular, and facial nerve dysfunction, which may also be present. Because of the surgically formidable anatomical location of these tumors, curative resection often proves challenging. Treatment options include surgical resection, stereotactic radiosurgery (SRS), hypofractionated stereotactic radiotherapy (SRT), alone or in combination. Stereotactic radiosurgery is a minimally invasive option for management of skull base tumors. Brain stereotactic radiosurgery involves the use of precisely directed closed skull single fraction (one surgical session) radiation to create a desired radiobiologic response within the target with minimal effects to surrounding structures or tissues. Stereotactic radiosurgery is associated with a high rate of local tumor control and a low risk of neurologic complications for patients with skull base tumors. Stereotactic radiosurgery can be used as an up-front treatment or as an adjuvant therapy for patients with recurrent or residual tumor after surgical resection. The superior safety efficacy of stereotactic radiosurgery over microsurgery in small- to middle-sized vestibular schwannomas is demonstrated in worldwide comparative studies. Normal motor facial nerve function and serviceable hearing are more likely to be preserved with radiosurgery as compared with microsurgery. In very large schwannomas, a combined approach with a deliberate subtotal removal with functional monitoring of the facial nerve followed by radiosurgery of the remnant dramatically reduces the risk of facial palsy as compared with radical removal. Hypofractionation of radiosurgery (stereotactic radiotherapy or multisession radiosurgery) has failed until now to demonstrate any advantage over single-dose, high-precision radiosurgery. Literature has documented the cost savings benefit of stereotactic radiosurgery versus invasive surgical procedures and the lower risk potential of bleeding, anaesthesia problems, infections, and side effects which may result in transient or permanent disabilities from open surgery. At the same time, literature has demonstrated that the risk of radiation-associated intracranial malignancy after stereotactic radiosurgery was found to be similar to the risk of developing a malignant CNS tumour in the general population of the USA and some European countries as estimated by the CBTRUS and IARC data, respectively.

Clinical research to refine and minimize surgical interventions has continued to be one of the most important features of the neurosurgical development during the last half of the XX century. Prof. Lars Leksell, the inventor of the Gamma-Knife radiosurgery (GKRS), was a leader in stereotactic surgery. In addition, he coined the concept of radiosurgery more than 60 years ago. Leksell and his coworkers have defined the indications for radiosurgery and introduced stereotactic techniques into radiosurgery. Today, GKRS is one of the three generally accepted treatment modalities in the treatment of cerebral AVMs together with microsurgery and endovascular techniques. The authors present their experience in treating 461 patients harbouring cerebral AVMs with a Leksell Gamma-Knife unit between 2005 and 2023. The follow-up schedule was a MR examination performed 6 and 12 months after the treatment in order to define if a radiation induced oedema had developed or not, as this represents the beginning and the end of the timer period in which the complications usually occur. If a radiation induced oedema was visible and the patient asymptomatic, the oedema was not treated. After that, a MRI and a MRA examination after two years to define the timing of the angiogram are of need. If the 2-year MR suggests complete AVM occlusion, we always perform an angiogram to verify the occlusion, as we know that a small remnant cannot be definitely excluded by using MR examinations. If the 2-year MR examination reveals a persistent AVM nidus, we postpone the angiogram to 3 years after the treatment. Naturally, as for all patients, a neuroradiological examination can be prompted by clinical symptoms. The outcome of our patients following a GKRS in relation to their age can be summarized as follows: - AVMs in children: cure rate 86% at 24 months, cure rate 100% at 36 months; - AVMs in young adults: cure rate 81% at 24 months, cure rate 86% at 36 months; - AVMs in adults: cure rate 41% at 24 months, cure rate 82% at 36 months. Predilect areas for oedema were the Parietal lobe and the basal ganglia, and 5 of the 6 patients which developed it had AVMs in excess of 11 cm3. The probability for AVM obliteration is dependent of the dose to the AVM periphery, the volume of the nidus and its localization, best results being recorded in children.

Purpose Skull base meningiomas represent a very challenging pathology due to relatively difficult surgical access. In contrast, stereotactic radiosurgery (SRS) proved to be an effective and more secure treatment technique based on the greater accuracy in delivering precise focused radiation into the target, sparing at the same time healthy surrounding tissues. Methods and Results Our study, based on almost 20 years of experience in delivering SRS treatments using various models of Leksell Gamma-Knife units, reports a high tumor control rate for complex-shaped skull base meningiomas close to critical structures. We retrospectively evaluated the risk factors and complications after high-dose irradiation in patients undergoing single-fraction radiosurgery combined with clinical imaging criteria established using MRI scans (in T1 weighted imaging with gadolinium and the edema in T2 weighted sequences). The mean volume of the tumors was 18.6 cubic centimetres (only tumors with a volume in excess of 15 cubic centimetres were included in the study). The median administered marginal dose was 12.5 Gy. Mean imaging follow-up was 112 months. Tumor control rate was not influenced by sex, age, tumor site, neurological status of the patient or irradiated volume, even though larger meningiomas are associated with poor long-term local control in most published series. The long-term follow-up data indicates tumor control in 88,5% of patients after 10 years, with low incidence of complications. Conclusions Current practice shows a slight potential increase in the incidence of meningiomas, the superiority of the individual techniques needing to be confirmed in prospective and methodologically rigorous studies with at least 20 years of follow-up.

Purpose In the multimodal treatment of pituitary adenomas Radiosurgery is mainly used as a secondary treatment after the medical treatment and neurosurgery. Yet the Gamma Knife Treatment isn’t possible without some risks and complications. Material and Methods In this retrospective study 841 treatments were included. The patients were treated in the Radiotherapy Laboratory of the “Bagdasar-Arseni” Emergency Clinical Hospital, between 2004 and 2024, initially using a Gamma Knife 4C device, then a Gamma Knife Perfection and now an Esprit model. Most of the cases underwent surgery beforehand. The purpose of the treatment was tumor growth control and, in functioning adenomas, hormone hypersecretion control with the preservation of normal pituitary functions and the normal functioning of surrounding structures. Due to the treatment guidelines, we used during the treatments, very few complications occurred. There were 7 cases of hypopituitarism, 3 cases of oculomotor palsies, 6 cases of pituitary apoplexy. There were no recorded cases of significant optic neuropathy or carotid stenosis. Results and Conclusions The Gamma Knife treatment determined, in almost all cases, the stopping of tumor growth and in most cases a reduction in tumor volume. Complications (optic neuropathy, hypopituitarism, damage to the nerves inside the cavernous sinus) were very scarce. Gamma Knife Radiosurgery, if basic rules are followed, is an efficient and safe method in the treatment of pituitary adenomas.

Purpose In the treatment of nasopharyngeal carcinomas, a multimodal approach is always needed. The present study attempts to show the necessity and role of Gamma Knife Stereotactic Radiosurgery in the treatment of this kind of tumors. Material and Methods In this retrospective study, 34 patients were included. All had been previously treated with fractionate radiotherapy, but had local or intracranial recurrence at the time of the Gamma Knife treatment. The patients were treated in the Radiotherapy Laboratory of the Emergency Clinical Hospital “Bagdasar-Arseni”, between 2004 and 2024, initially using a Gamma Knife 4C device, then a Perfection and lately an Esprit model. The purpose of the treatments was total tumor destruction, but also, in a significant number of cases the treatment of debilitating symptoms: epistaxis, secondary trigeminal neuralgia, and oculomotor nerve palsies. Results and Conclusions The Gamma Knife treatment determined a significant prolongation of the life span and an improvement in the quality of life, without the occurrence of a significant number of complications. This treatment remains a palliative method, applicable only in selected cases, yet we consider that the number of Gamma Knife treated patients is very small, compared with the general incidence of this disease.

Sports anxiety is an important obstacle for athletes’ performance, negatively affecting their life satisfaction levels. Positive thinking skills can contribute to overcoming such negative conditions. This study explored the relationships between sport anxiety, positive thinking skills, and life satisfaction in male athletes. A total of 338 male athletes participated voluntarily, using convenience sampling. The study employed a relational survey model, and data were collected through the Sports Anxiety Scale-2, Positive Thinking Skills Scale, and Life Satisfaction Scale. Analyses, including Pearson’s correlation, were performed using the JAMOVI program, with mediation analysis verified through bootstrapping. Results indicated a negative correlation between sport anxiety and life satisfaction, and a positive correlation between positive thinking skills and life satisfaction. Moreover, positive thinking skills were found to moderate the relationship between sport anxiety and life satisfaction. These insights underscore the value of developing positive thinking skills to help athletes reduce anxiety and enhance their life satisfaction. Therefore, incorporating strategies to foster these skills in training programs could be crucial for improving athletes’ overall wellbeing.

Background There is strong interest in the evaluation of longer‐term outcome metrics for congenital heart diseases (CHDs); however, registries focus on postoperative metrics. Methods and Results Informed by user online discussion forums and scoping of national data, we selected sentinel CHDs and long‐term outcome metrics suitable for routine monitoring. We then developed sentinel CHD phenotypes and algorithms for identifying treatment pathway procedures using clinical codes. Finally, we calculated the metrics within a retrospective national cohort analysis. The 9 selected sentinel CHDs had a higher‐than‐average prevalence, typically involved surgery in infancy, and were associated with an increased risk of late mortality. The selected metrics of survival and reinterventions at 1, 5, and 10 years were both important and feasible. The cohort included 29 319 (41.3% of all operated CHD births) English and Welsh children born with sentinel CHDs in 2000 to 2022. Example metrics at age 10 years included: survival—hypoplastic left heart syndrome: 57.6% (95% CI, 54.9%–60.4%), functionally univentricular heart: 86.7% (95% CI, 84.6%–88.9%), transposition of the great arteries: 93.1% (95% CI, 92.2%–93.9%), pulmonary atresia: 81.0% (95% CI, 79.1%–82.9%), atrioventricular septal defect: 88.5% (95% CI, 87.5%–89.5%), tetralogy of Fallot: 95.1% (95% CI, 94.4%–95.8%), aortic stenosis: 94.4% (95% CI, 93.3%–95.6%), coarctation: 96.7% (95% CI, 96.2%–97.3%), and ventricular septal defect: 96.9% 95% CI, (96.4%–97.3%); and (2) cumulative incidence of reintervention—hypoplastic left heart syndrome : 54.5% (95% CI, 51.5%–57.3%), functionally univentricular heart: 57.3% (95% CI, 53.9%–60.5%), transposition of the great arteries: 20.9% (95% CI, 19.5%–22.3%), pulmonary atresia: 66.8% (95% CI, 64.2%–69.1%), atrioventricular septal defect: 21.6% (20.3%–23.0%), tetralogy of Fallot: 26.6% (95% CI, 25.2%–28.0%), aortic stenosis: 31.2% (95% CI, 28.8%–33.6%), coarctation: 19.8% (95% CI, 18.6%–21.1%), and ventricular septal defect: 6.1% (95% CI, 5.5%–6.8%). Conclusions It is feasible to report important long‐term outcomes of survival and reintervention for sentinel CHDs using routinely collected procedure records, adding value to national audit.