An Adaptive Parameter-Free Optimal Number of Market Segments Estimation Algorithm Based on a New Internal Validity Index

An appropriate optimal number of market segments(ONS)estimation is essential for an enterprise to achieve successful market segmentation,but at present,there is a serious lack of attention to this issue in market segmentation.In our study,an independent adaptive ONS estimation method BWCON-NSDK-means++is proposed by integrating a newinternal validity index(IVI)Between-Within-Connectivity(BWCON)and a newstable clustering algorithmNatural-SDK-means++(NSDK-means++)in a novel way.First,to complete the evaluation dimensions of the existing IVIs,we designed a connectivity formula based on the neighbor relationship and proposed the BWCON by integrating the connectivity with other two commonly considered measures of compactness and separation.Then,considering the stability,number of parameters and clustering performance,we proposed the NSDK-means++to participate in the integrationwhere the natural neighbor was used to optimize the initial cluster centers(ICCs)determination strategy in the SDK-means++.At last,to ensure the objectivity of the estimatedONS,we designed a BWCON-based ONS estimation framework that does not require the user to set any parameters in advance and integrated the NSDK-means++into this framework forming a practical ONS estimation tool BWCON-NSDK-means++.The final experimental results showthat the proposed BWCONand NSDK-means++are significantlymore suitable than their respective existing models to participate in the integration for determining theONS,and the proposed BWCON-NSDK-means++is demonstrably superior to the BWCON-KMA,BWCONMBK,BWCON-KM++,BWCON-RKM++,BWCON-SDKM++,BWCON-Single linkage,BWCON-Complete linkage,BWCON-Average linkage and BWCON-Ward linkage in terms of the ONS estimation.Moreover,as an independentmarket segmentation tool,the BWCON-NSDK-means++also outperforms the existing models with respect to the inter-market differentiation and sub-market size.

Clinical features and prognostic factors in 49 patients with follicular lymphoma at a single center:A retrospective analysis

BACKGROUND Follicular lymphoma(FL)is a type of B-cell lymphoma that originates at the germinal center and has a low malignancy rate.FL has become the most common inert lymphoma in Europe and America but has a relatively low incidence in Asia.AIM To explore the clinical features,curative effects,and prognostic factors of FL.METHODS Completed medical records of 49 patients with FL who were admitted to the Ningbo First Hospital from June 2010 to June 2021 were examined.These patients were definitively diagnosed by pathological biopsy or immunohistochemical staining.The diagnostic criteria were based on the 2008 World Health Organization classification of lymphomas.Ann Arbor staging was performed according to the imaging and bone marrow examination results.Risk stratification of all patients was performed based on the International Prognostic Index(IPI),age-adjusted IPI,Follicular Lymphoma International Prognosis Index(FLIPI),and FLIPI2 to compare the efficacy of different treatment regimens and analyze the related prognostic factors.RESULTS The age of onset in patients ranged from 24 to 76 years,with a median age of 51 years.Most patients developed the disease at 40–59 years of age,and the male:female ratio was 1.6:1.No significant difference was noted in the curative effect between the non-chemotherapy,combined chemotherapy,and other chemotherapy regimens(P>0.05).Hemoglobin(Hb)level<120 g/L,Ki-67 value>50%,bone marrow involvement,and clinical stagesⅢ–IV were associated with a poor prognosis of FL(P<0.05).However,the influence of other indicators was not statistically significant.Risk grouping was performed using the FLIPI,and the results showed that 24.5%,40.8%,and 34.7%of patients were in the low-,moderate-,and high-risk groups,respectively.According to the survival analysis results,the survival rate of patients was lower in the high-risk group than in the other low-risk and moderate-risk groups(P<0.05).CONCLUSION FL mainly occurs in middle-aged and elderly men,primarily affecting lymph nodes and bone marrow.Hb level,Ki-67 value,bone marrow involvement,and clinical staging were used to evaluate prognosis.

Benefit of rituximab maintenance is associated with Follicular Lymphoma International Prognostic Index in patients with follicular lymphoma

Rituximab maintenance(RM)prolongs the progression-free survival(PFS)of responding patients with follicular lymphoma(FL),but the maintenance efficacy in different Follicular Lymphoma International Prognostic Index(FLIPI)risk group is still confusing.We performed a retrospective analysis of the effect of RM treatments in patients with FL responding to induction therapy based on their FLIPI risk assessment carried out prior to treatment.We identified 93 patients between 2013 and 2019 who received RM every 3 months for≥4 doses(RM group),and 60 patients who did not accept RM or received rituximab less than 4 doses(control group).After a median follow-up of 39 months,neither median overall survival(OS)nor PFS was reached for the entire population.The PFS was significantly prolonged in the RM group compared to the control group(median PFS NA vs 83.1 months,P=.00027).When the population was divided into the 3 FLIPI risk groups,the PFS differed significantly(4-year PFS rates,97.5%vs 88.8%vs 72.3%,P=.01)according to group.There was no significant difference in PFS for FLIPI low-risk patients with RM compared to the control group(4-year PFS rates,100%vs 93.8%,P=.23).However,the PFS of the RM group was significantly prolonged for FLIPI intermediate-risk(4-year PFS rates,100%vs 70.3%,P=.00077)and high-risk patients(4-year PFS rates,86.7%vs 57.1%,P=.023).These data suggest that standard RM significantly prolongs the PFS of patients assigned to intermediate-and high-risk FLIPI groups but not to low-risk FLIPI group,and pending larger-scale studies to validate.

Validity of premature ejaculation diagnostic tool and its association with International Index of Erectile Function-15 in Chinese men with evidence-based-defined premature ejaculation

The premature ejaculation diagnostic tool （PEDT） is a brief diagnostic measure to assess premature ejaculation （PE）. However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE （LPE）/acquired PE （APE） according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores （14.28 ± 3.05） and lower IIEF-15 （41.26 ± 8.20） than men without PE （PEDT： 5.32 ± 3.42, IIEF-15：52.66 ± 6.86, P 〈 0.001 for both）. It was suggested that a score of 〉9 indicated PE in both LPE and APE by sensitivity and specificity analyses （sensitivity： 0.875, 0.913; specificity： 0.865, 0.865, respectively）. In addition, IIEF-15 were higher in men with LPE （42.64 ± 8.11） than APE （39.43 ± 7.84, P 〈 0.001）. After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE （adjust r = -0.225, P 〈 0.001） and APE （adjust r = -0.378, P 〈 0.001）. In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.

Use of generated artificial road profiles in road roughness evaluation

In the evaluation of road roughness and its effects on vehicles response in terms of ride quality, loads induced on pavement, drivers＇ comfort, etc., it is very common to generate road profles based on the equation provided by ISO 8608 standard, according to which it is possible to group road surface profiles into eight different classes. However, real profiles are significantly different from the artificial ones because of the non-stationary fea- ture of the first ones and the not full capability of the ISO 8608 equation to correctly describe the frequency content of real road profiles. In this paper, the international roughness index, the frequency-weighted vertical acceleration awz according to ISO 2631, and the dynamic load index are applied both on artificial and real profiles, highlighting the different results obtained. The analysis carried out in this work has highlighted some limitation of the ISO 8608 approach in the description of performance and conditions of real pavement profiles. Furthermore, the different sensitivity of the various indices to the fitted power spectral density parameters is shown, which should be taken into account when performing analysis using artificial profiles.

Fertility Cancer and Hereditary Risks in Soil Sample of Nasarawa, Nasarawa State, Nigeria

A survey of Fertility Cancer and Hereditary Risks in Soil Sample of Nasarawa was carried out.This study assessed the level of Fertility Cancer and Hereditary Risks from the naturally occurring radionuclides;^(232)Th,^(226)Ra and ^(40)K.12 soil samples collected from the respective part of the Nasarawa were analyzed using the gamma-ray spectrometry NaI(Tl)detector system.The mean concentration for ^(40)K was 645.29±07.32 Bq/kg,for ^(226)Ra was 28.43±4.8422 Bq/Kg and for ^(232)Th was 66.84±2.0201 Bq/Kg.The average effective dose due to the ingestion was 0.36±0.1μSv/y which was approximately 1000 times lower than the world average effective dose.Radium equivalent activity Ra_(eq)(Bq/kg),alpha index and total cancer risk were found to be 161.44±8.08 Bq/kg,0.142±0.02 and(0.21±0.05)×10^(-5) respectively.UNSCEAR/USEPA stipulated that;radium equivalent activity,alpha index,effective dose and total cancer risk should not exceed the limit of 370 Bq/kg,unity,300μSv/y and 1×10^(-4) respectively.Hence the values obtained in this work were within the acceptable limits.This implies that the ingestion or inhalation of soil is not associated with any radiological risk of concern.

Medical management of erectile dysfunction in aging males： is it too late to treat？

Erectile dysfunction （ED） is a common disorder among aging males. However, most aging males refuse to seek medical help and believe that ED is an irreversible event in the aging process. The purpose of this study was to describe the current medical management of ED in aging males and to examine whether it is too late to treat this disorder in these elderly men. From 2007 to 2008, 4507 patients diagnosed with ED were gathered from 46 centers in China; 4241 completed the study, 3837 of whom were treated with sildenafil. The 3837 patients were divided into five groups based on age （group A： 20-30 years; group B： 31-40 years; group C： 41-50 years; group D： 51-60 years; and group E： 〉60 years）. After comparing pre- and posttreatment International Index of Erectile Function-Erectile Function domain （IIEF-EF） questionnaires, Erection Hardness Scale （EHS）, and IIEF Q13 （＂How satisfied have you been with your overall sex life？＂）, we discovered that the aging males had worse erectile function, erection hardness, and sexual satisfaction than the younger males （P〈 0.001）. After treatment, the improvement rates in the IIEF-EF, EHS, and IIEF Q13 scores were 107.0%, 83.1%, and 116.5%, respectively. The magnitude of these changes demonstrated significant differences among groups （P 〈 0.001）. Accordingly, aging males are likely to benefit more from medical treatment. We propose that aging males should be informed that age is not a limiting factor for medical ED management, and it is never too late to treat.

Sexual dysfunctions and their treatment in liver diseases

Sexual dysfunction(SD)is a prevalent but very commonly ignored aspect in the treatment of liver diseases and cirrhosis.The etiology of SD is multifactorial and therefore treatment strategies are complex,especially in females.Phosphodiesterase inhibitors are useful and effective in erectile dysfunction in males but in females,no single drug is available for SD,therefore multimodal treatment is required depending upon the cause.The foremost and fundamental requirement in both genders is to be stress-free and have adequate control of liver diseases.Improved quality of life is helpful in improving SD and vice versa is also true.Therefore,patients suffering from liver diseases should come forward and ask for treatment for SD,and physicians should actively enquire about SD while history taking and evaluating these patients.SD results in deterioration of quality of life,and both are modifiable and treatable aspects of liver diseases,which are never addressed actively,due to social taboos and fears of SD treatment in the presence of liver diseases.The diagnosis of SD does not require costly investigations,as the diagnosis can be established based on validated questionnaires available for both genders,therefore detailed targeted history taking using questionnaires is essential.Data are emerging in this area but is still at an early stage.More studies should be dedicated to SD in liver diseases.

An Empirical Study on Internal Control and Corporate Performance in Transportation Industry

In order to study whether the intemal control of enterprises is effective, this paper studies the relationship between the quality of internal control and the performance of the company in 2012-2015, in which 61 listed companies in China＇s Shanghai traffic transportation industry are studied. The results show that the quality of internal control has a significant positive correlation with the financial performance of enterprises. In particular, the internal control is significantly correlated with the company＇s growth ability, and the internal control is positively correlated with the profitability of the company. This research provides empirical data and decision-making basis for the state to deepen the construction of internal control system and strengthen internal control management of enterprises.

How Did the Globally Top Competitive Countries Perform？

Countries do also compete among themselves to develop their economies like business organizations compete. This paper assesses the performance of the top globally competitive countries in terms of the degree of globalization, international trade, investment in research and technology, tariffs, foreign direct investment, and ethical practices in carrying-out international business. Analysis of these factors indicates that all the top globally competitive countries could not exhibit corresponding performance in the globalization levels, exports, investment in research and development, attracting and providing foreign direct investment, and doing business ethically. Therefore, it is suggested that these countries should implement the practices that would reflect their position as one of the top globally competitive countries.

Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction

Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be established.This was an observational study of 113 patients with ED,evaluated between January 2019 and December 2021 in Andrology Unit at the Department of Urology and Renal Transplantation,University of Foggia(Foggia,Italy).Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction(IIEF-5)questionnaire was administered to assess the severity of ED.This was repeated 1 month after treatment.Patients with a peak systolic velocity(PSV)<30 cm s−1 were considered eligible for Li-ESWT.Our protocol consisted of 8 weekly sessions with 1500 strokes distributed in 5 different locations along the penis.After treatment,a significant mean(±standard deviation[s.d.])PSV increase of 5.0(±3.4)cm s−1 was recorded and 52/113(46.0%)patients reached a PSV>30 cm s−1 at posttherapeutic penile dynamic Doppler.A clinically significant IIEF-5 score improvement was observed in 7 patients,21 patients,and 2 patients with mild-to-moderate,moderate,and severe pretreatment ED,respectively.No different outcomes were assessed based on smoking habits,previous pelvic surgery,or use of oral phosphodiesterase-5 inhibitor(PDE5i).On the other side,only 1(6.7%)in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after Li-ESWT.Shockwave treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED patients.This advantage seemed particularly evident for moderate ED and was not affected by smoking habits,previous pelvic surgery,and use of PDE5i.Conversely,diabetic patients did not benefit from the treatment.

Influence of erectile dysfunction course on its progress and efficacy of treatment with phosphodiesterase type 5 inhibitors

Background Erectile dysfunction （ED） is a common impairment among older men, and the prevalence rates increase sharply after age of 60 years. Most studies have focused on the prevalence rate or dangerouse factors. The aim of this study was to investigate the basic epidemiologic data about ED patients with different ED courses. The purpose of this researth was to understand the therapeutic effect of phosphodiesterase type 5 inhibitor （PDE5-1） and see how and why the ED course impact the progress of ED and the therapeutic effect of PDE5-1 treatment. Methods From June 2008 to June 2009, 4252 questionnaires （Quality of Erection Questionnaire, QEQ） were gathered from 46 centers by urology or andrology doctors all around China. Patients with ED （age 〉 20 years） filled in first half of the questionnaires when they came for the first time, and then completed the second half 4 weeks after PDE5-1 therapy. Results ED courses of most patients were less than 5 years （〈5 years, 74.0%; 5-10 years 20.8%; 〉10 years, 5.2%）. As ED course increasing, the incidence of the risk factors of ED, such as smoking, drinking, hypertension, diabetes, heart disease and hyperlipidemia also increase （P 〈0.01）. PDES-I was effective in improving the quality of sexual activities （P 〈0.01）. Administration of PDE5-1 improves satisfaction, enjoyment and frequency of sexual activities. The longer the ED course, the worse the therapeutic effect （〈5 years, 96.1%; 5-10 years, 94.9%; 〉10 years, 89.0%） （P 〈0.01）. Conclusions The ED course greatly affected the therapeutic effect of PDE5-1, the patients with ED should consult doctor at early stage of the disease. Admistration of PDE5-1 effectively improves the penile erection and the quality of sexual life of the patients hence should be considered as first-line medicine in the treatment of ED.

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction:correlation with the severity of cavernous artery disease

We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction(ED)combined with cavernous artery disease(CAD).ED was evaluated by the International Index of Erectile Function,subdividing patients into mild and moderate/severe forms.CAD was assessed using penile color Doppler ultrasonography.Patients(n=111)with a positive outcome after treatment,based upon the minimal clinically important difference of the International Index of ED,were followed up for 3 months and 6 months.We found a significant mean increase in the index of erectile function,with an overall improvement in hemodynamic parameters of the cavernous artery.In particular,93.9%of the patients with mild ED without CAD responded to treatment and 72.7%resumed normal erectile function.Only 31.2%of the patients with moderate/severe ED and CAD responded to treatment,and none resumed normal erectile function.All patients with mild ED and no CAD maintained the effects of therapy after 3 months,while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months.Thus,patients with mild ED and no CAD have better and longer lasting responses to such treatment,with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.

Comparison of the efficacy and safety of once-daily dosing and on-demand use of udenafil for type 2 diabetic patients with erectile dysfunction

We compared the efficacy and safety between once-daily dosing and on-demand use of udenafil for type 2 diabetic patients with erectile dysfunction （ED）. A multi-center, randomized, open-label, parallel-group, 12-week study was conducted. 161 patients who improved with on-demand 200 mg of udenafil according to Sexual Encounter Profile （SEP） diary Question 2 and 3 （Q2 and Q3） were randomized into 200 mg on-demand （n = 80） or 50 mg once-daily （n = 81） dosing groups for 8 weeks. The dosing period was followed by a 4-week treatment-free period. The primary efficacy endpoint was the change of the International Index of Erectile Function （IIEF） erectile function domain （EFD） score. The secondary efficacy endpoints included changes to the SEP diary Q2, Q3, IIEF Q3, Q4, other domains of IIEF, Global Assessment Question, and shift to the normal rate （EFD 〉 26）. Vascular endothelial markers were also assessed. The IIEF-EFD score of both groups improved after 8 weeks of treatment （P 〈 0.0001）. There was no statistically significant difference between two groups. Improvement was not maintained after the treatment-free follow-up period. Similar results were observed in the secondary efficacy endpoints. There was also no significant difference in vascular endothelial markers. Daily udenafil was well-tolerated, and there was no significant difference in the adverse drug reactions and adverse events between the two groups. Flushing and headache were the most frequent adverse events. Both regimens improved ED in diabetic patients and were well-tolerated. Further studies are needed to assess the effect of daily udenafil treatment in diabetic patients.

Prevalence of and risk factors for erectile dysfunction in young nondiabetic obese men:results from a regional study

Erectile dysfunction(ED),a condition closely related to cardiovascular morbidity and mortality,is frequently associated with obesity.In this study,we aimed to determine the prevalence of ED and evaluate the associated risk factors in a cohort of 254 young(18–49 years)nondiabetic obese(body mass index[BMI]≥30 kg m−2)men from primary care.Erectile function(International Index of Erectile Function[IIEF-5]questionnaire),quality of life(Aging Males'Symptoms[AMS scale]),and body composition analysis(Tanita MC-180MA)were determined.Total testosterone was determined using high-performance liquid chromatography–mass spectrometry.Multivariate logistic regression analysis was used to study the factors associated with ED.ED prevalence was 42.1%.Subjects with ED presented higher BMI,waist circumference,number of components of the metabolic syndrome,AMS score,insulin resistance,and a more unfavorable body composition than those without ED.Multivariate logistic regression analysis showed that a pathological AMS score(odds ratio[OR]:4.238,P<0.001),degree of obesity(BMI≥40 kg m−2,OR:2.602,P=0.005,compared with BMI 30–34.9 kg m−2),high-density lipoprotein(HDL)-cholesterol levels(OR:0.956,P=0.004),and age(OR:1.047,P=0.016)were factors independently associated with ED.In conclusion,we demonstrate that,in a primary care-based cohort of nondiabetic young obese men,ED affected>40%of subjects.A pathological AMS score,the degree of obesity,and age were positively associated with ED,while elevated HDL-cholesterol levels were inversely associated with the odds of presenting ED.Further prospective studies are needed to evaluate the long-term consequences of ED in this population.

Prediction of pavement roughness using a hybrid gene expression programming-neural network technique

Effective prediction of pavement performance is essential for transportation agencies to appropriately strategize maintenance, rehabilitation, and reconstruction of roads. One of the primary performance indicators is the international roughness index （IRI） which rep- resents the pavement roughness. Correlating the pavement roughness to other perfor- mance measures has been under continuous development in the past decade. However, the drawback of existing correlations is that most of them are not practical yet reliable for prediction of roughness. In this study a novel approach was developed to predict the IRI, utilizing two data sets extracted from long term pavement performance （LTPP） database. The proposed methodology included the application of a hybrid technique which combines the gene expression programming （GEP） and artificial neural network （ANN）. The developed algorithm showed reasonable performance for prediction of IRI using traffic parameters and structural properties of pavement. Furthermore, estimation of present IRI from his- torical data was evaluated through another set of LTPP data. The second prediction model also depicted a reasonable performance power. Further extension of the proposed models including different pavement types, traffic and environmental conditions would be desir- ab]e in future studies.

Is Li-ESWT effective in diabetic patients with severe erectile dysfunction?

Noninvasive low-intensity extracorporeal shockwave treatment(Li-ESWT)has been widely used to treat erection disorders.There is no clear information regarding either the selection of patients for the treatment or the treatment protocol.In this study,we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction(International Index of Erectile Function-5[IIEF-5]scores of 5 to 7).Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study.The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores.The IIEF-5 score(mean±standard deviation[s.d.])increased from 5.29±1.67 to 5.56±1.85,with a difference of 0.27±0.18(P>0.05).The Erection Hardness Scale scores(mean±s.d.),on the other hand,increased from 1.46±0.50 to 1.48±0.50,with a difference of 0.02±0(P>0.05).In conclusion,the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction(IIEF-5 scores of 5 to 7).