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Complex genomic structural variants (CGSVs) are abnormalities that present with three or more breakpoints, making their discovery a challenge. The majority of existing algorithms for structural variant detection are only designed to find simple structural variants (SSVs) such as deletions and inversions; they fail to find more complex events such as deletion–inversions or deletion–duplications, for example. In this study, we present an algorithm named CleanBreak that employs a clique partitioning graph-based strategy to identify collections of SSV clusters and then subsequently identifies overlapping SSV clusters to examine the search space of possible CGSVs, choosing the one that is most concordant with local read depth. We evaluated CleanBreak's performance on whole genome simulated data and a real data set from the 1000 Genomes Project. We also compared CleanBreak with another algorithm for CGSV discovery. The results demonstrate CleanBreak's utility as an effective method to discover CGSVs.

This work is devoted to the further development of the methodology for optimizing the microclimate parameters of orthodox churches by means of geometric modeling. The relevance of the chosen research topic is due, in particular, to the current tense situation with the COVID-19 pandemic. The proper sanitary and hygienic condition of public buildings is quite important for the preservation of people's health in modern conditions. This applies to various institutions of medicine, education, trade, nutrition, sports, culture, etc. Orthodox churches are no exception in this regard.It is well known that the parameters of the microclimate of the building depend on its geometric characteristics such as the area and volume of rooms, wall thickness, dimensions of window and door openings, etc. This is on the one hand. On the other hand, there is the dependence on the materials used for the construction, the selected heating, ventilation, air conditioning systems, etc. The external environment (air temperature, humidity, the presence of harmful substances, etc.) and the internal features of the building, for example, the number of people present in it, the duration and frequency of their stay, the activities carried out, etc. are also very significant. All this fully applies to orthodox churches.Due to the presence of certain material, financial and other restrictions that always exist during the construction of architectural structures and their further operation, it is essential to take into account the above aspects during the construction of new orthodox churches. The last mentioned processes are quite widespread in Ukraine now, what is due to the spiritual revival of the nation after decades of forced atheism.Thus, many factors, in particular, architectural space-planning solutions, selected building structures, heating, ventilation, air conditioning systems, etc., affect the microclimate of buildings. One of the ways of successful solution of the analyzed technical problem is the application of a complex variant design of the microclimate parameters of the rooms with the use of computer graphics. This approach is based on the fact that in the environment of the BIM (Building Information Modeling) technologies the central place is occupied by geometric model of the creating object, which combines the rest of its mathematical and other descriptions into one whole. Coverage of the outlined direction of scientific research on the example of orthodox churches is the main purpose of this publication.

To evaluate the current state of minimally-invasive living donor hepatectomy by briefly summarizing its history, examining up-to-date technical considerations, reviewing important recently published reports, and discussing the path forward to continued progress. The last several years have seen a surge in reports of purely laparoscopic major donor hepatectomy. These accounts span several continents and include updates from centers with significant experience. Other studies come as case reports or small case series from centers just developing their minimally invasive expertise. There are now centers that perform purely laparoscopic donor hepatectomies with no donor selection criteria with equivalent outcomes compared with conventional hepatectomy. However, even these centers continue to urge caution in donors with complex variant anatomy. Rapid growth in minimally invasive donor hepatectomy has developed within the past decade. There is no single technique adopted by all centers, and regional and center-specific preferences continue to exist. Equivalent outcomes can be achieved with appropriate donor selection that matches center expertise. Despite continued progress, pure laparoscopic living donor hepatectomy should remain available only in highly specialized centers. Aggressive efforts should be made to transfer knowledge, skills, and expertise to centers transitioning to more minimally invasive approaches.

Relevance. The current view of the problem of specialized care for children with congenital cleft upper lip and palate in the literature is described as a system-forming complex of medical and surgical aids. The issue of the further development of individual methods and algorithms for the rehabilitation of children of complex types of cleft, showing a pronounced asymmetry of the affected tissues, remains an urgent issue. The creation of «special» algorithms for therapeutic tactics and the choice of the method of surgical benefits of asymmetric forms of cleft upper lip and palate involves the interaction of each specialist, taking into account the variety of clinical characteristics of complex defects.Purpose. On specific clinical material describe the features of the algorithm for eliminating the asymmetric cleft of the upper lip and palate, taking into account the author’s methods of cheilorino-palatoplasty.Materials and methods. For the period 2015-2019. a group of patients (62 patients) with congenital asymmetric cleft of the upper lip and / or palate, including those with deficiency of their own tissues, was studied in the Multiprofile Clinical Medical Center «Bonum». The study used clinical, anthropometric, statistical methods, analysis of photographs of patients.Results. An algorithm has been developed to eliminate a complex variant of damage to tissues and structures of the maxillofacial region, taking into account the proprietary technologies for surgical care.Conclusions. The proposed methodological algorithm for the treatment tactics of complex clinical and anatomical variants of the cleft of the upper lip and / or palate allows us to assess the severity of damage of the maxillofacial region, establish indications for the use of additional therapeutic methods for orthodontic-surgical preparation for cheilorino-palatoplasty and adequately choose the method of surgical intervention.The use of original methods for surgical removal of asymmetric clefts of the upper lip and / or palate, including “wide” crevices with a deficit of their own tissues, increases the effectiveness of surgical and rehabilitation tactics in the general complex of specialized care for patients with complex tissue lesions of the maxillofacial region.The awareness of maxillofacial surgery doctors and rehabilitation dentistry specialists about modern methods of surgical care, about an improved methodological algorithm for eliminating asymmetric cleft upper lip and / or palate, including with deficiency of own tissues, can serve as a «road map» for the development of a specialized interdisciplinary health recovery complex this category of patients.

Background/aim Chronic myelogenous leukemia (CML) is characterized by the presence of the Philadelphia chromosome, resulting from the reciprocal translocation involving chromosomes 9 and 22. About 5-10% of newly diagnosed patients in chronic-phase (CP) CML show complex additional chromosomal aberrations (ACA), that may involve one or more chromosomes in addition to 9 and 22. Data concerning the prognostic significance of ACA in CP-CML subjects at diagnosis are controversial. Furthermore, there is no evidence showing that selection of imatinib (IM) or second-generation tyrosine kinase inhibitors (2G-TKI) would be of benefit for these patients. Case report We report the three-way complex variant translocation t(2;9;22) in a CP-CML patient. Conventional cytogenetic analysis was employed to identify the ACA. Multiplex reverse transcription-PCR was used to identify the BCR-ABL1 transcript and its levels were measured using quantitative real-time-PCR. This rare ACA t(2;9;22) in our young patient displayed primary resistance to IM, but was responsive to second-line treatment with nilotinib. Conclusion CP-CML patients exhibiting this rare aberration at diagnosis may benefit from a 2G-TKI therapy compared to IM.

Isolated, closed, conjoint bicondylar Hoffa fracture in a child is extremely rare with only three cases reported in literature till date. We report a complex variant of this very rare injury. An 11-year-old male child reported 2-week post-trauma with history of fall from a tree and injury to his right knee. Radiographs revealed a coronal plane fracture of the distal femur. The patient was operated using the swashbuckler approach, which revealed a sagittal split of the lateral femoral condyle along with a conjoint bicondylar Hoffa fracture. Fixation was done using multiple lag screws and fracture went on to uneventful union. Patient was followed up for 3 years and except for limb shortening of around 1.5 cm secondary to premature physeal closure as a consequence of the injury, he had excellent outcome with full range of motion at the knee, without any deformity.

A coordinate change of conjugation twin boundaries in Ni-Mn-Sn single crystals is studied with scanning electron microscopy. During mechanical training, the so-called orthogonal shear process initiates variant reorientation leading to the replacement of the main with conjugation type I twin boundaries. The experimental data demonstrate that highly organized redistribution of adjacent variants, in the neighboring areas, is then critical for the removal of conjugation boundaries by coordinated secondary twinning. In addition, a more complex variant reorientation mechanism is uncovered and it is found to allow for transitioning between non-conjugate twin systems. The proposed mechanism appears consistent with the orientation relationship between austenite and martensite, which is controlled by a shear deformation and martensite crystallography leading to an equal distribution of martensitic variants. This contribution complements the existing theory of martensite crystallography providing direct evidence for the general nature of the orthogonal shear process as a first step in variant reorganization during mechanical training of martensite.

A 3-year-old child with a complex variant of double outlet right ventricle achieved a successful biventricular repair after detailed delineation of the intracardiac anatomy on multimodality imaging. A virtual three-dimensional (3D) model based on computed tomography was used successfully in the absence of an actual 3D-printed model. This case report seeks to highlight and hence increase the utilization of the virtual 3D model in resource-limited settings.

This paper presents a new Quantum Inspired Harmony Search algorithm with Variable Population Size QIHSVPS for a complex variant of vehicle routing problem (VRP), called HVRPMBTW (Vehicle Routing Problem with Heterogeneous fleet, Mixed Backhauls and Time Windows). This variant is characterized by a limited number of vehicles with various capacities and costs. The vehicles serve two types of customers: linehauls customers and backhauls customers. Each customer must be visited in a specific interval of time. The authors propose to use quantum principles to accelerate evolution process and variable population size to decrease the number of solution's evaluation, when the improvement is insignificant. This new approach was tested on benchmarks and produces satisfactory results compared to other approaches.

Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment. Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion. Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.

The commonly described congenital atlanto-axial dislocation and Basilar-Invagination is antero-posterior or rotational or vertical plane. However, congenital dislocation in lateral plane has received scant attention. The purpose of this manuscript is to describe this unusual entity and discuss its management. The clinic-radiological feature of seven patients with congenital lateral angular AAD (CLAAAD) were studied and managed. The unilateral C1 facet had subluxed lateral to C2–3 complex. The C1 and C2 facets were drilled comprehensively and repositioned with distraction, placement of metallic spacers and facet manipulation after insertion of screws. The post operative outcome was studied. The presentation is usually with neck tilt (progressive in 3) and/or progressive spastic quadriparesis. The mean C1–2 tilt was 25.2°. C1 was bifid in six patients. C1 lateral mass was assimilated with occipital condyle on dislocated side in and the other side was normal (6 patients). The dislocated C1–2 joint was abnormally oblique as compared to contralateral side. The relationship of occiput and C1 was normal. Correction of dislocation and lateral tilt was achieved in all patients with subsequent correction of neck tilt and deficits. One patient required reoperation. The acute angulation of joint on one side and near normal on other side leads to differential vertical movement, further accentuated by splaying of bifid C1. The entity is seen in young patients and often present with neck tilt and spastic quadriparesis. Management requires reshaping the joints and facet manipulation. If the reshaping is inappropriate, the joint is likely to redislocate before fusion occurs.

In this article, we employ the complex method to obtain all meromorphic solutions of complex variant Boussinesq equations (1), then find out related traveling wave exact solutions of System (vB). The idea introduced in this paper can be applied to other nonlinear evolution equations. Our results show that all rational and simply periodic solutions w r , 1 ( k x - λ t ) , w r , 2 ( k x - λ t ) , w s , 1 ( k x - λ t ) and w s , 2 ( k x - λ t ) of System (vB) are solitary wave solutions, and there exist some rational solutions wr,2(z) and simply periodic solutions ws,2(z) which are not only new but also not degenerated successively by the elliptic function solutions. We believe that this method should play an important role for finding exact solutions in the mathematical physics. We also give some computer simulations to illustrate our main results.

Aim: Chronic myeloid leukemia (CML) is characterized by the Philadelphia (Ph) chromosome created by the reciprocal translocation t(9 ; 22) (q34 ; q11), resulting in the hybrid gene breakpoint cluster region - Abelson (BCR-ABL1). Around 5–10% of CML cases develop complex variant Ph translocations involving one or more chromosomal regions besides 9 and 22. We report in this study a case of acute lymphoblastic leukemia (ALL) developed from CML displaying a novel four- way translocation. Case report: Complete blood analysis of 46-year- old male patient showed an increase in white blood cells, lower levels of red blood cells and platelets. Bone-marrow sample was subjected to conventional cytogenetic (Giemsa- banding) and fluorescence in situ hybridization methods and four - way translocation was identified. Considering hepatosplenomegaly and breakpoint cluster region that was characterized as major (M- bcr) on quantitative real-time polymerase chain reaction (RQ-PCR), ALL was diagnosed as a transformation from CML. Conclusion: This study reports new four-way translocation ins(22 ; 1)(q11.2 ; q31q32)t(1 ; 9 ; 12 ; 22) (q32 ; q34 ; q13 ; q11.2) in an ALL patient developed from the CML and was cross- checked in Mitelman Database of Chromosome Aberrations and Gene Fusions in Cancer.

Decision trees are one of the most popular classifiers used in a wide range of real-world problems. Thus, it is very important to achieve higher prediction accuracy for decision trees. Most of the well-known decision tree induction algorithms used in practice are based on greedy approaches and hence do not consider conditional dependencies among the attributes. As a result, they may generate suboptimal solutions. In literature, often genetic programming-based (a complex variant of genetic algorithm) decision tree induction algorithms have been proposed to eliminate some of the problems of greedy approaches. However, none of the algorithms proposed so far can effectively address conditional dependencies among the attributes. In this paper, we propose a new, easy-to-implement genetic algorithm-based decision tree induction technique which is more likely to ascertain conditional dependencies among the attributes. An elaborate experimentation is conducted on thirty well known data sets from the UCI Machine Learning Repository in order to validate the effectiveness of the proposed technique.

The strong matching preclusion number of a graph is the minimum number of vertices and edges whose deletion results in a graph that has neither perfect matchings nor almost perfect matchings. This is an extension of the matching preclusion problem that was introduced by Park and Ihm. The burnt pancake graph is a more complex variant of the pancake graph. In this paper, we examine the properties of burnt pancake graphs by finding its strong matching preclusion number and categorising all optimal solutions.

Next-generation sequencing (NGS) is widely used and cost-effective. Depending on the specific methods, NGS can have limitations detecting certain technically challenging variant types even though they are both prevalent in patients and medically important. These types are underrepresented in validation studies, hindering the uniform assessment of test methodologies by laboratory directors and clinicians. Specimens containing such variants can be difficult to obtain; thus, we evaluated a novel solution to this problem in which a diverse set of technically challenging variants was synthesized and introduced into a known genomic background. This specimen was sequenced by 7 laboratories using 10 different NGS workflows. The specimen was compatible with all 10 workflows and presented biochemical and bioinformatic challenges similar to those of patient specimens. Only 10 of 22 challenging variants were correctly identified by all 10 workflows, and only 3 workflows detected all 22. Many, but not all, of the sensitivity limitations were bioinformatic in nature. We conclude that Synthetic controls can provide an efficient and informative mechanism to augment studies with technically challenging variants that are difficult to obtain otherwise. Data from such specimens can facilitate inter-laboratory methodologic comparisons and can help establish standards that improve communication between clinicians and laboratories.

This paper presents a new enhanced biogeography-based optimization algorithm (EBBO) for a complex variant of vehicle routing problem (VRP) called HVRPMBTW (vehicle routing problem with heterogeneous fleet, mixed backhauls, and time windows). This variant is characterized by a limited number of vehicles with various capacities and costs. The vehicles serves two types of customers: linehaul customers and backhaul customers. Each customer must be visited in a specific interval of time. We propose to improve and to adapt the biogeography-based optimization (BBO) approach to the problem by integrating simulated annealing algorithm to enhance solution quality, at each iteration. This new approach was tested on benchmarks and produces very satisfactory results compared to other approaches, PSO and ACO [1].

Dysembryoplastic neuroepithelial tumors (DNTs) mostly display typical clinical, neuroimaging and histopathological features, but sometimes they reveal heterogeneous or non-specific morphology, which results in diagnostic dilemmas. We present a case of a young adult with longstanding, intractable epilepsy associated with a multinodular cystic lesion in the temporal lobe. The lesion consisted of morphologically different components. In particular, a few cortical nodules displayed a specific glioneuronal element with floating neurons typically found in DNT. Two large, well-circumscribed nodules were entirely composed of biphasic, piloid, astroglial patterns that corresponded strictly to a pilocytic astrocytoma. The well-defined areas, which contained numerous distinct neurocytic-like rosettes, were identical with rosette-forming glioneuronal tumors (RGNTs). This type of neurocytic rosette was widespread within the surrounding piloid background. Some solid nodules exhibited increased cellularity, oligodendroglioma-like elements and a focal ribbon cell arrangement. The lesion was associated with advanced reactive gliosis and foci of dysplastic changes in the adjacent cortex. The clinico-radiological and main histopathological features were consistent with a diagnosis of a complex variant of DNT composed of pilocytic and rosette-forming glioneuronal components. Although both piloid tissue and rosette-like formations have been occasionally mentioned in DNT lesions, the present case of DNT was unique in its well-circumscribed, separate pilocytic and RGNT nodules. We concluded that it represented an unusual, mixed pilocytic/RGNT variant of DNT.

Follicular lymphoma (FL) is a neoplasm of mature B cells that has a nodular cell growth pattern. Eighty percent of patients with FL have t(14;18)(q32;q21.3), the standard type of 18q21.3/BCL2 trans...

Diffusion-weighted imaging (DWI) is among the most commonly performed type of MR study in the clinic. A more complex variant of DWI is Diffusion Tensor Imaging (DTI), which helps the physician to interrogate tissue with anisotropic (direction-specific) diffusion behavior that may be useful in rendering a diagnosis for a patient. In this chapter we will discuss images for common DTI acquisitions along with their strengths and weaknesses. We will show distorted and artifacted images to demonstrate typical pitfalls in standard DTI, and we will provide suggestions to resolve the artifacts, which are presented in order to accustom the reader to viewing and evaluating diffusion tensor images. To help with this, we will present a checklist to aid troubleshooting and it is intended to be a starting point for the puzzled operator. To aid you in navigating and understanding each section’s main points, you will find a short summary called “To review” which outlines the major take-home messages from that section. In summary, this chapter is intended to help with standard DTI acquisitions, improve and optimize image quality of such exams, and is presented in a way to help ensure the acquisition is robust and reproducible. In the case that artifacts occur, we will show how to best change the scan parameters to avoid and minimize their recurrence.

What is the relationship between logic and argumentation theory? The answer to this question depends, of course, to a large extent on the way in which logic and argumentation theory are conceived and defined. Opting for different concepts of logic and argumentation theory could result in the view that there is no relationship at all, that logic and argumentation theory are the same, that logic is part of argumentation theory, that argumentation theory is part of logic, or that some more complex variant of either of these possibilities prevails. Acknowledging that other choices can be made, I start my attempt to answer the question about the relationship between logic and argumentation theory with a general indication of my understanding of logic and argumentation theory.

THE IDEA of enlarging or replacing the urinary bladder with isolated segments of bowel is not new in urologic surgery. However, Scheele’s description (1923) of his “ring plastik” to enlarge the bladder was more or less forgotten until Couvelaire in 1950 initiated the present era of interest in bladder enlargement and partial substitution by isolated loops of ileum. Various types of ileocystoplasty have been tried and enthusiastically reported by European authors, viz., Cibert, Tasker, Pyrah, Annis, May and associates, Schwartz, Glaser, and Jacobs. Couvelaire’s review of the literature, from the time of Mikulicz in 1898, is the best summary of the literature to that time. In 1957, Quenu presented the most recent complete review. In the American literature, however, there are to date fewer articles concerning this useful operation. Shoemaker and co-workers described experimental and clinical studies in which they used isolated ileac loops, denuded of mucosa and turned inside out, to form seromuscular grafts for bladder and ureteral replacement. This procedure is said to obviate difficulty with mucus formation and electrolyte exchange. Shoemaker’s article with Marucci19 contains a review of the background literature to be found in American journals. Campbell recently described an equivocal success with Shoemaker’s technique, but the procedure has not yet found wide acceptance. Ferris has succinctly reported his success with a patch type of ileocystoplasty (similar to that described by Tasker) in 2 patients treated at the Mayo Clinic. Our own interest in this problem began in 1953 when animal experiments were initiated to study partial substitution of the bladder with isolated segments of both ileum and sigmoid colon in the dog.22 To date we have employed ileocystoplasty in 17 patients utilizing a more complex variant of the “patch” technique described by Tasker. The surgical procedures have been technically satisfactory. There has been 1 death from coronary thrombosis. There have been no serious complications related to the surgery. Late results of the procedure are to be described elsewhere. In the present article the technique is described in detail as we have used it.

We quantify the relation between trading activity - measured by the number of transactions N(Deltat)-and the price change G(Deltat) for a given stock, over a time interval [t, t+Deltat]. To this end, we analyze a database documenting every transaction for 1000 U.S. stocks for the two-year period 1994-1995. We find that price movements are equivalent to a complex variant of classic diffusion, where the diffusion constant fluctuates drastically in time. We relate the analog for stock price fluctuations of the diffusion constant-known in economics as the volatility-to two microscopic quantities: (i) the number of transactions N(Deltat) in Deltat, which is the analog of the number of collisions and (ii) the variance W(2)(Deltat) of the price changes for all transactions in Deltat, which is the analog of the local mean square displacement between collisions. Our results are consistent with the interpretation that the power-law tails of P(G(Deltat)) are due to P(W(Deltat)), and the long-range correlations in |G(Deltat)| are due to N(Deltat).

Les variants cytogénétiques simples et complexes constituent 5 à 10% de tous les cas de leucémie myéloïde chronique. Le mécanisme de leur formation a été proposé par certains auteurs. Les aspects clinique, thérapeutique et pronostique ne sont pas différents des formes classiques à l’aire des anti-tyrosines kinases. Nous rapportons deux cas traités par Imatinib dont l’évolution cytogénétique a été particulière. Les deux patients ont été inclus dans le programme GIPAP après signature d’un consentement éclairé. Chaque patient a bénéficié d’un examen clinique, d’un hémogramme, d’un myélogramme, d’un caryotype et ou d’une hybridation intra-génique avec fluorescence avant inclusion dans le programme. Chaque patient après inclusion a été traité avec l’Imatinib à la dose quotidienne de 400mg. La surveillance clinique, hématologique et cytogénétique et moléculaire a été faite selon les recommandations de LeukemiaNet.Key words: Leucémie myéloïde chronique, complexe variant, évolution cytogénétique

Scimitar syndrome, a rare congenital cardiopulmonary condition, presents in both pediatric and adult populations as an anomalous pulmonary venous return of most of the right lung to the inferior vena cava. Recently, asymptomatic adult cases have been diagnosed with advances in imaging studies. We report the case of an asymptomatic 43-year-old male, with a complex variant scimitar syndrome diagnosed by computed tomographic angiography.

Japanese chess called shogi is the most complex variant of chess-like games. Several services are provided to play shogi on the Internet, but they do not provide enough functions for kansousen, which is a reviewing discussion session after games. SAKURA, a network shogi environment developed by us, provides supports for kansousen.

In this paper some interesting aspects of practical implementation of AES crypto algorithm, performed by using elements of digital electronics, are described. Also, one example for practical realization of the most complex variant of this algorithm, AES 256, is analyzed in detail through the context of selected realization platform, and achieved results are given.

Cytogenetic variants of the Philadelphia (Ph) chromosome can be observed in 5-8% of patients diagnosed with Chronic Myelogenous Leukemia (CML), and usually involve at least one chromosome other than 9 and 22. Despite the genetically heterogeneous nature of these alterations, available data indicate that CML patients displaying complex variant translocations (CVTs) do not exhibit a less favorable outcome as compared to individuals presenting conventional Ph-positive CML.We report our experience with 10 CML patients carrying CVTs among 153 newly diagnosed cases followed at our Institution.Unlike previously published reports, in our series only two CML patients exhibiting CVTs achieved an optimal response to tyrosine kinase inhibitors (TKI) treatment. The remaining eight patients obtained either a suboptimal response or failed drug therapy. Our data suggest that the presence of CVTs at diagnosis might confer an unfavorable clinical outcome, as these genetic alterations might be markers of genomic instability and indicate a higher likelihood of disease progression.

We report an unusual case of a variant of Lisfranc injury, plantar dislocation of the medial cuneiform with plantar fracture-dislocation of the intermediate cuneiform and dorsal fracture-dislocation of the lateral cuneiform, which has never been reported, to our knowledge. The entire pathologic abnormality was treated by open reduction and fixation with Kirschner wires, which were removed 8 weeks postoperatively because of pin-tract infection. Complex regional pain syndrome, which was a problem early in the recovery process, is now in remission, and at the 25-month follow-up examination, the patient was almost symptom free. (J Am Podiatr Med Assoc 99(4): 359–363, 2009)

The Philadelphia (Ph1) chromosome arising from the reciprocal t(9;22) translocation is found in more than 90% of chronic myeloid leukemia (CML) patients and results in the formation of the chimeric fusion geneBCR-ABL. However, a small proportion of patients with CML have simple or complex variants of this translocation, involving various breakpoints in addition to 9q34 and 22q11. We report five CML cases carrying variant Ph translocations involving both chromosomes 9 and 22 as well as chromosomes 3, 5, 7, 8, or 10. G-banding showed a reciprocal three-way translocation involving 3q21, 5q31, 7q32, 8q24, and 10q22 bands.BCR-ABLfusion signal on der(22) was found in all of the cases by FISH.

Even in its most basic form, the Vehicle Routing Problem and its variants are notoriously hard to solve. More often artificially intelligent algorithms are employed to provide near-optimal solutions. To be classified as “intelligent”, however, a solution strategy should be able to first analyze the environment in which the problem occurs, then solve it, and afterwards reflect on the solution process so as to improve future decision-making. Although reference is made to the entire context of the intelligence research project, this paper reports on the Tabu Search algorithm designed that catered for a problem with multiple soft time windows, a heterogeneous fleet, double scheduling, and time dependent travel time. An adaptive memory procedure was employed, initially populated with good initial feasible solutions, and the algorithm was tested on 60 problems based on established benchmark sets. The complex variant of the Vehicle Routing Problem required between 670 and 4762 seconds on a standard laptop computer, which is considered to be reasonable in the proposed application, and was consistent between different runs with an absolute mean deviation of 3.6%. The contribution is significant as it provides an algorithm that efficiently addresses a complex and practical application of the Vehicle Routing Problem. The algorithm can easily be extended to make use of multiple processors so as to reduce computational time.

We consider two variants of a quantum-statistical generalization of the Cramer-Rao inequality that establishes an invariant lower bound on the mean square error of a generalized quantum measurement. The proposed complex variant of this inequality leads to a precise formulation of a generalized uncertainty principle for arbitrary states, in contrast to Helstrom's symmetric variant in which these relations are obtained only for pure states. A notion of canonical states is introduced and the lower mean square error bound is found for estimating of the parameters of canonical states, in particular, the canonical parameters of a Lie group. It is shown that these bounds are globally attainable only for canonical states for which there exist efficient measurements or quasimeasurements., Comment: 17 pages. Translated from Russian and typeset in LaTeX from Teoreticheskaya i Matematichescheskaya Fizika, Vol. 26, No.3 pp. 316--329, March, 1976

We analyze different levels of meta-evolution using a graph based GP system. The system allows one to represent individuals of the search space and genetic variation operators in a coherent way as graph programs differing only in the operator set. Seven variants of meta-evolution are tested on three real world classification problems. The most complex variant consists of three meta-levels where graph programs on meta-level 1 recombine individuals of the search space (base level), graph programs on meta-level 2 recombine programs on meta-level 1, and programs on meta-level 3 recombine programs on meta-level 2 and themselves. The empirical results shows that the use of meta levels is advantageous.

Genetic testing can be considered a complex variant of diagnostic testing. If the results are not actionable, the findings may lead to anxiety or even life-disrupting actions with little offsetting benefit. Even if the results are actionable, the anxiety or actions resulting from disclosure may outweigh any benefit. Because the benefits of genetic testing are often modest, and the tests themselves are often imprecise in identifying risk, consideration must be given to potential harm in revealing the test results. A test that discloses an elevated risk of Alzheimer's disease — a fearsome condition involving memory loss, personality change, and physical . . .

Odontomas are the most frequent hamartomatous lesions involving the oral cavity. The complex variant is an agglomerate of all dental tissues characterized by abnormal morphodifferentiation despite normal histodifferentiation. These are usually asymptomatic and are frequently associated with eruption disturbances. We report an unusual case of erupting complex odontoma associated with an impacted maxillary second molar.

The implicitly updated Arnoldi method introduced by Sorensen with an internal QR-iteration is a very useful eigenvalue solver for nonsymmetric eigenvalue problems. To make this method rigorous in finding internal eigenvalues, a complex shift-and-invert strategy is used. Therefore a complex variant of the method has been constructed and the method has been compared with a Lanczos method, as implemented by Cullum at al., for a practical problem in magnetohydrodynamics. (c) 1995 Academic Press, Inc.

Chromosome studies in C. apella were carried out with G-, C-, and NOR banding in 20 specimens from Rio de Janeiro, Bahia, and Para (Brazil). The standard karyotype of the species was similar to that previously reported in animals from Colombia and Bolivia. There was no indication that specimens of different geographic origin, frequently described as C. apella subspecies, might be cromosomally different. Differences in the size of the constitutive heterochromatic regions were frequently found in many chromosome pairs in animals of different geographic origin. These variant chromosome types have probably been maintained as chromosome polymorphisms. Other variant types have probably originated by chromosome rearrangement, mainly paracentric inversions of both euchromatic and heterochromatic regions, as well as by partial deletions of heterochromatic blocks. These complex variant types have probably originated by de novo rearrangements although the possibility that they are maintained as chromosome polymorphisms could not be reled out. A small deletion affecting a NO-region was also detected with silver staining.

A case of chronic myelogenous leukemia is described with a variant Philadelphia (Ph 1 ) chromosome involving chromosomes No. 11, 14, and 22. The description of all G-banded cells is 46, XX, t(11;14;22)(q13;q32;q11). The pathogenetic implications are discussed.

This small text, written by an orthopedic surgeon and a pathologist who have apparent extensive clinical experience, sets forth the interesting thesis that the complex clinical situation frequently seen following severe trauma (called by the author "the illness of trauma") is due to fat embolism primarily. While they concede that pump failure and pure hypovolemic shock does exist, they believe that "traumatic shock" is a more complex variant in which increased capillary permeability secondary to hypoxia results in fluid loss and sludging. The supposedly physiologic explanations for the changes that occur, the clinical signs and symptomatology, and therapy based on this thinking is difficult to follow in many instances. For example, the authors state that as capillary permeability increases and fluid is lost from the vascular compartment, hydrostatic pressure increases relative to osmotic pressure, and blood elements and protein are forced through the capillary walls! The authors attempt to develop