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Context.-The Nottingham Grading System (NGS) developed by Elston and Ellis is used to grade invasive breast cancer (IBC). Glandular (acinar)/tubule formation is a component of NGS. Objective.-To investigate the ability of pathologists to identify individual structures that should be classified as glandular (acinar)/tubule formation. Design.-A total of 58 hematoxylin-eosin photographic images of IBC with 1 structure circled were classified as tubules (41 cases) or nontubules (17 cases) by Professor Ellis. Images were sent as a PowerPoint (Microsoft) file to breast pathologists, who were provided with the World Health Organization definition of a tubule and asked to determine if a circled structure represented a tubule. Results.-Among 35 pathologists, the [kappa] statistic for assessing agreement in evaluating the 58 images was 0.324 (95% CI, 0.314-0.335). The median concordance rate between a participating pathologist and Professor Ellis was 94.1% for evaluating 17 nontubule cases and 53.7% for 41 tubule cases. A total of 41% of the tubule cases were classified correctly by less than 50% of pathologists. Structures classified as tubules by Professor Ellis but often not recognized as tubules by pathologists included glands with complex architecture, mucinous carcinoma, and the "inverted tubule" pattern of micropapillary carcinoma. A total of 80% of participants reported that they did not have clarity on what represented a tubule. Conclusions.-We identified structures that should be included as tubules but that were not readily identified by pathologists. Greater concordance for identification of tubules might be obtained by providing more detailed images and descriptions of the types of structures included as tubules. (Arch Pathol Lab Med. 2024;148:1119-1125; doi: 10.5858/arpa.2023-0163-OA), Histologic grading of invasive breast carcinoma (IBC) represents a morphologic assessment of the degree of tumor differentiation and is routinely reported in the pathologic assessment of IBC. Histologic grade is [...]

This is a broad survey that investigates the use of machine learning (ML) methods for detecting distributed denial of service (DDoS) attacks. Traditional intrusion detection systems face difficulties in application-layer DDoS attacks because they target legal web traffic forms using standard transmission control protocol connections. This paper reviews different ML methods used in recent studies to tackle these issues. These studies use various data sets, such as UNSW-np-15, CICDDoS2019, and the novel dataset LATAM-DDoS-Internet of Things., which prove the efficacy of the proposed models in terms of accuracy and performance metrics. The second group of studies shows more advanced designs, such as protocol-based deep intrusion detection and autoencoder-multi-layer perceptron. These use deep learning to find features and group attacks. All of these approaches present favorable outcomes when it comes to distinguishing normal, DoS, and DDoS traffic with a high level of accuracy. Furthermore, the review discusses works that emphasize the early detection of noise-robust models and distributed frameworks. Different techniques, such as snake optimizer with ensemble learning, metastability theory, and spark-based anomaly detection, highlight the trend of predicting DDoS attacks, whereas hyperband-tuned deep neural networks and evolutionary support vector machine models show higher accuracy in cloud systems as well as software-defined networking environments. Hence, this review gives a general observation of how DDoS attacks develop on their way and proves that ML techniques help to strengthen network security.

Abstract Introduction The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. Aimof this study The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. Patients & methods The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). Results Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 – 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 – 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). Conclusion Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.

This paper explores how the integration and performance of Wireless Body Area Networks (WBANs) contribute to sustainable healthcare practices. WBANs play a crucial role in reducing the environmental footprint of healthcare systems by providing continuous monitoring that can prevent unnecessary hospitalizations and reduce the consumption of disposable medical supplies. Additionally, the design of WBANs using environmentally friendly materials, low-power devices, and recyclable components is discussed to optimize the sustainability of healthcare practices. To enhance infrastructure, services, and quality of life, new technologies have been integrated to improve WBANs. Patients' essential health data may be continuously and instantly collected thanks to these networks, and healthcare providers can receive the data right away for quick analysis and action. WBANs have healthcare benefits, but there are also major drawbacks. Technologies that can combine low power consumption, minimal delay, and high enough data rates are needed for WBANs in order to support a variety of medical applications. The effectiveness of the LoRaWAN and IEEE 802.15.6 technologies in WBAN is assessed in this paper. With the use of seven crucial metrics which are throughput, arrival rate, delay, energy consumption, residual energy, network lifetime, and packet delivery ratio (PDR), this paper seeks to study which technology is appropriate with WBANs using NS3 as a simulation program. With network parameters, 1000 seconds, and 50 nodes, the paper evaluated the performance of each technology. The results show that IEEE 802.15.6 is superior in terms of throughput, PDR, and arrival rate whereas LoRaWAN is superior in terms of energy consumption, residual energy, network lifetime, and delay.

Objective To assess pathological characteristics, clinical features and outcomes of patients diagnosed with peripheral zone (PZ) and transition zone (TZ) prostate cancer after prostatectomy.Methods and analysis We systematically reviewed PubMed, EMBASE and MEDLINE. Primary endpoints were biochemical relapse-free survival (bRFS) and distant metastases rate; secondary endpoints included clinical and pathological features.Results Ten retrospective cohort studies were identified, six reported HRs for bRFS between PZ and TZ tumours. Patients with TZ tumours had significantly better bRFS (pooled HR 0.57 (0.47, 0.68)) than those with PZ tumours. Two studies reported a lower proportion of distant metastasis in patients diagnosed with TZ tumours compared with PZ tumours (1.5% vs 4.9% (median follow-up 7.0 years) and 0% vs 5% (median follow-up 7.8 years)). PZ tumours presented higher Gleason group and T staging more frequently, while TZ tumours were associated with higher prostate specific antigen levels at diagnosis.Conclusion PZ tumours were associated with poorer prognostic clinical features and outcomes. Despite adjusting for poor prognostic clinical features, PZ tumours consistently showed worse clinical outcomes than TZ tumours. Our systematic review underscores the need for further research comparing PZ and TZ prostate cancer to understand the underlying differences and refine clinical practice.

Background and purpose: Bleeding during rhinoplasty is a complication that causes the surgeon to lose vision and will cause other complications. So far, various methods have been proposed to reduce bleeding during nose surgery. The present study aims to compare the effect of oral clonidine and tranexamic acid on intraoperative bleeding in patients undergoing rhinoplasty. Materials and methods: In this randomized, double-blind clinical trial, 120 patients who were candidates for elective rhinoplasty surgery were included. In the first group, three µg/kg of clonidine was administered orally 90 minutes before surgery. In the second group, 250 µg/kg bw tranexamic acid capsules were administered orally two hours before surgery. There was no intervention in the control group. Bleeding levels, hemodynamic parameters, and surgeons' visual satisfaction were evaluated. Results: The mean age of patients (28.67±5.35) years and 96 (80.0%) were women. Regarding the effect of drug and surgeon’s visual satisfaction, there is a significant difference between the clonidine and tranexamic acid groups (P=0.055); the mean bleeding volume in the clonidine group was 112.0±0.47 and in the tranexamic acid group was 132.0±0.36. In addition, the clonidine group (P=0.008) and tranexamic acid (P

Cystic echinococcosis mainly affects the liver and lungs, in which the larvae from the microvascular wall in the liver pass to the lungs and then to the blood circulation and settle in any tissue or organ.

Background Caffeine citrate (CC)-induced excessive energy expenditure, diuresis, natriuresis, and other CC-associated potential side effects (CC-APSEs) result in lower daily weight gain (WG) in premature neonates. This study aimed to assess higher CC-doses’ effect on the mean daily-WG (MD-WG) and CC-APSE development, considering 5 mg/kg/day as the standard regimen. Method This retrospective cohort study included neonates of ≤36 weeks gestational age and received CC-therapy. The same participants were followed for data analysis in two postnatal phases: 15–28 and 29–42 days of life (DOL). Based on daily CC-dose, formed group-I=(5 mg/kg/day), group-II=(>5–7 mg/kg/day), and group-III=(>7 mg/kg/day). Data was analyzed separately for group-II and group-III using group-I as the standard. Results The study included 284 neonates. During phase-I, the MD-WG was significantly higher in group-I than group-II (19.9 ± .88 g/kg/d vs 17.5 ± .49, P = .031) and group-III (19.9 ± .88 g/kg/d vs 16.7 ± .71, P < .001). During 29–42 DOL, the MD-WG of group-I was only significantly higher than group-III (21.5 ± .42 g/kg/d vs 18.1 ± .39 g/kg/d, P = .003) and comparable with group-II. During 15–28 DOL, CC-APSEs were significantly higher in group-II and group-III but during 29–42 DOL was significant only in group-III. Conclusion Exposure to higher caffeine doses in this study cohort is associated with lower postnatal WG in preterm neonates than standard daily doses may be due to its catabolic effects and CC-APSEs.

Digital video coding aims to reduce the bitrate and keep the integrity of visual presentation. High-Efficiency Video Coding (HEVC) can effectively compress video content to be suitable for delivery over various networks and platforms. Finding the optimal coding configuration is challenging as the compression performance highly depends on the complexity of the encoded video sequence. This paper evaluates the effects of motion content on coding performance and suggests an adaptive encoding scheme based on the motion content of encoded video. To evaluate the effects of motion content on the compression performance of HEVC, we tested three coding configurations with different Group of Pictures (GOP) structures and intra refresh mechanisms. Namely, open GOP IPPP, open GOP Periodic-I, and closed GOP periodic-IDR coding structures were tested using several test sequences with a range of resolutions and motion activity. All sequences were first tested to check their motion activity. The rate–distortion curves were produced for all the test sequences and coding configurations. Our results show that the performance of IPPP coding configuration is significantly better (up to 4 dB) than periodic-I and periodic-IDR configurations for sequences with low motion activity. For test sequences with intermediate motion activity, IPPP configuration can still achieve a reasonable quality improvement over periodic-I and periodic-IDR configurations. However, for test sequences with high motion activity, IPPP configuration has a very small performance advantage over periodic-I and periodic-IDR configurations. Our results indicate the importance of selecting the appropriate coding structure according to the motion activity of the video being encoded.

ئەڤ ڤەکولینە روناهیەکێ دئیخیتە سەر سیستەمێ پەروەردەیا ناچاری یا کورێن ساخلەم د دەولەتا باژێر یا سپارتا کەڤندا، کو ب پەروەردەیا ئاگوج(Agoge) دهێتە نیاسین، تێدا ب دەستبسەرداگرتنا هەمی لایەنێن ژیانا کورێن ساخلەم یێن سپارتایی بخۆڤە گرتبوو، هەر ژ دەستپێکا تەمەنێ زاروکاتیێ، و بتایبەتی ژ تەمەنێ حەفت سالی تاتەمەنێ سیهـ سالیێ د گروپێن پەروەردەیا ئاگوج دا بەردەوامبوون، راستەخۆ لژێر چاڤدێریەکا توند یا دەولەتێ دابوون، پەروەردەیا ئاگوج کلتورەکێ جیاواز ژ دەولەتا باژێرێن دیتر یێن یونانی ب سپارتا بەخشی. ژبۆ هندێ بەردەوامیا دەولەتا باژێرێ خۆ مسوگەربکەت، سپارتا دیارکر کو پێدڤی ب نەوەیێن خۆدان تایبەتمەندیێن سەربازی هەبوو، لەورا ژبۆ ڤێ مەبەستێ سیستەمێ پەروەردەیا کورێن ساخلەم کریە ئارمانجا سەرەکی، هەروەسا بەحسکرنا ئەوان رێک و شێوازێن زور توند و درندانە ب سەرنجدان لسەر مەشق و راهێنانێن سەربازی، ژوانا ناڤەروکا ماددەیێن فێرکاری و وەرزشا جەستەیی و لێدان وسزادان و یاریێن کێبرکیێ و زورانبازی و برساتیێ و ژیانا سەربازگەهێ بوو، کو تێدا پەروەردەیا سپارتایی بەرنامەکێ راهێنانی بخۆڤەگرتبوو، و سیستەمەکێ گشتگیری کومەلایەتی دابین کربوو، ئەوژی بمەرەما بەرهەڤکرنا رەگەزێ نێر ژبۆ هندێ ببیتە سەربازەکێ پیشەکار، کو هەمی دەمان ئامادەبیت بۆ جێبەجێکرنا فەرمانێن دەولەتێ، و بسەختی خۆراگربن و دشەریدا سەرکەفتنێ بدەستڤە بینن، واتە ئارمانجا وێ یاسەرەکی بنیاتنانا کارەکتەرەکێ کومەلایەتی، بئاراستەیەکێ سەربازی یێ تایبەت بوو.

Archaeological research in the Kuala Muda district until 2022 has recorded three archaeological complexes that are still in-situ and can be visited by tourists. The archaeological evidence at Sungai Batu, Bukit Batu Pahat and Pengkalan Bujang Archaeological Complex which proves the existence of the Kedah Tua kingdom as the main trading location in the world. In order to obtain primary data, field research such as surveys, mapping and archaeological excavations are carried out to obtain in-situ data. The results of the study revealed that the Sungai Batu Archaeological Complex has been used as an iron smelting industrial area since 788 BC while the Bukit Batu Pahat and Pengkalan Bujang Archaeological Complexes have been used as a port and a HinduBuddhist complex since the 7th Century AD to the 13th Century AD. Based on the uniqueness of the archaeological data in the complex, as many as five tourism packages have been created to preserve this archaeological heritage tourism with the Sungai Batu Archaeological Complex (SBAC) has been made as a one stop center for the management of the tourism package.