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Lakshmi, Muthu, Ganesh Kumar, Bala Subramanian, and Priti Rishi. "MULTI VARIATE NEURO-STATISTICAL SPARSE TRANSFORM FOR GRAY SCALE IMAGES." Latin American Applied Research - An international journal 52, no. 2 (March 25, 2022): 167–72. http://dx.doi.org/10.52292/j.laar.2022.583.
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Abstract-- The main objective of this paper is to examine the performance of Neuro- Statistical sparse transformation function for implementation in a still image vector coding based compression system. This paper discusses the important features of low bit-rate image coding which is based on recent developments in the theory of multivariate nonlinear piecewise polynomial approximation in still images. It combines Binary Space Partition (BSP) scheme with Geometric Wavelet (GW) tree approximation so as to efficiently capture curve singularities and provide a sparse representation of the image. The quality of the reconstructed image is measured objectively using Peak Signal to Noise Ratio. Experimental results show that the proposed image compression system yields higher compression with minimal loss.
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MITSUI, Toshiyuki, Syuji OKUYAMA, and Yoshikazu FUJIMURA. "Determination of the blend composition ratio of gasoline to kerosene by multi-variate analysis." Bunseki kagaku 40, no. 8 (1991): 389–94. http://dx.doi.org/10.2116/bunsekikagaku.40.8_389.
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Gholizadeh, Pouya, and Behzad Esmaeili. "Developing a Multi-variate Logistic Regression Model to Analyze Accident Scenarios: Case of Electrical Contractors." International Journal of Environmental Research and Public Health 17, no. 13 (July 6, 2020): 4852. http://dx.doi.org/10.3390/ijerph17134852.
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The ability to identify factors that influence serious injuries and fatalities would help construction firms triage hazardous situations and direct their resources towards more effective interventions. Therefore, this study used odds ratio analysis and logistic regression modeling on historical accident data to investigate the contributing factors impacting occupational accidents among small electrical contracting enterprises. After conducting a thorough content analysis to ensure the reliability of reports, the authors adopted a purposeful variable selection approach to determine the most significant factors that can explain the fatality rates in different scenarios. Thereafter, this study performed an odds ratio analysis among significant factors to determine which factors increase the likelihood of fatality. For example, it was found that having a fatal accident is 4.4 times more likely when the source is a “vehicle” than when it is a “tool, instrument, or equipment”. After validating the consistency of the model, 105 accident scenarios were developed and assessed using the model. The findings revealed which severe accident scenarios happen commonly to people in this trade, with nine scenarios having fatality rates of 50% or more. The highest fatality rates occurred in “fencing, installing lights, signs, etc.” tasks in “alteration and rehabilitation” projects where the source of injury was “parts and materials”. The proposed analysis/modeling approach can be applied among all specialty contracting companies to identify and prioritize more hazardous situations within specific trades. The proposed model-development process also contributes to the body of knowledge around accident analysis by providing a framework for analyzing accident reports through a multivariate logistic regression model.
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Hemalatha, M., S. Geetha, R. Saraswathi, M. Raveendran, and G. Hemalatha. "Diversity and Multi-variate Analysis of Basmati and Non-Basmati Rice Genotypes over Two Seasons using Organo-leptic Traits." International Journal of Plant & Soil Science 35, no. 18 (July 25, 2023): 923–41. http://dx.doi.org/10.9734/ijpss/2023/v35i183359.
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Investigation on multi-variate analysis was done with Mahalanobis’ D2 statistic, Principal Component Analysis (PCA), genetic variability studies and Pearson’s correlation coefficient analysis among fifty-one rice genotypes over two consecutive seasons i.e., Kharif 2021 and Rabi 2021. It led to the clustering of the genotypes into ten clusters with maximum intra cluster distance found in cluster III and inter cluster distance between clusters III and X. PCA led to six principal components that had eigen values greater than one, explaining cumulative of 76.77% of the total variation. Based on the per se performance, D2 analysis and PCA, it was found that the genotypes, Improved white ponni, CO 52, VGD 1, BPT 5204, RNR 15048, Pusa Basmati 1121 and Pusa Basmati 1 were highly divergent due to the large genetic distance from the genotypes viz., TRY 3, TPS 5, Palawan, Azucena and Khao do ngoi for both grain yield and organoleptic traits indicating the possibilities for the potential use of these parents in future breeding programme aimed at improvement of grain yield and desirable organoleptic traits . Linear elongation ratio was positively correlated with amylose content, kernel length, L/B ratio and kernel length after elongation but negatively correlated with kernel breadth, kernel breadth after cooking, water uptake ratio and volume expansion ratio and hence indirect selection for longer grains and intermediate to high amylose content would improve LER inspite of the seasonal influence. These traits attribute to the selection of genotypes with desirable cooking quality that fetches premium price in the market in particular to that of non-basmati genotypes.
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Yee, Jeong, Woorim Kim, Byung Chul Chang, Jee Eun Chung, Kyung Eun Lee, and Hye Sun Gwak. "Association between VEGFA gene polymorphisms and bleeding complications in patients maintaining therapeutic international normalized ratio." Pharmacogenomics 20, no. 9 (June 2019): 659–67. http://dx.doi.org/10.2217/pgs-2019-0005.
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Aim: This study was designed to identify the possible effects of VEGFA polymorphisms on the occurrence of bleeding complications in patients with mechanical heart valves who have achieved therapeutic international normalized ratio (INR). Materials & methods: 13 SNPs of VEGFA were analyzed. Uni- and multi-variate analyses were conducted to identify associations between polymorphisms and bleeding complications. Results & conclusion: Patients with the CC genotype of rs35410204 had an approximately tenfold higher bleeding complication than those with the T allele. For rs866236, patients who had wild-type homozygotes showed an approximately 2.9-fold higher bleeding complication than C allele carriers. This study demonstrated that bleeding complications during warfarin therapy are associated with VEGFA polymorphisms in patients with mechanical heart valves.
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İdil Soylu, Ayşegül, Sümeyra Arıkan Cortcu, Fatih Uzunkaya, Yunus Oktay Atalay, Tumay Bekçi, Levent Güngör, and Ümit Belet. "The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease." Vascular 25, no. 3 (October 20, 2016): 299–306. http://dx.doi.org/10.1177/1708538116673770.
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Objectives Platelet-to-lymphocyte ratio is a novel biomarker, recently shown to be correlated with atherosclerotic inflammation. This study investigated the role of platelet-to-lymphocyte ratio in patients with carotid artery stenosis and stroke. Methods Patients, who underwent carotid angiography with Multiple Detector Computed Tomography Angiography at our hospital, were retrospectively screened. Patients enrolled were divided into three groups based on the platelet-to-lymphocyte ratio. Patients with a platelet-to-lymphocyte ratio value between 55.0 and 106.71 were assigned to Group I, patients with a platelet-to-lymphocyte ratio value between 106.79 and 160.61 were assigned to Group II and patients with a platelet-to-lymphocyte ratio value between 162.96 and 619.61 were assigned to Group III. The carotid arterial stenosis calculated was classified as per the criteria of North American Symptomatic Carotid Endarterectomy Trial. Results One hundred fifty patients were included in our trial (mean age 61.9 ± 13.1 with 104 males). The rate of carotid arterial stenosis was detected to be higher in patients with a high platelet-to-lymphocyte ratio value (p = 0.010). Additionally, the platelet-to-lymphocyte ratio was positively correlated with the carotid arterial stenosis percentage (r = 0.250, p = 0.002). In the multi-variate regression analysis, platelet-to-lymphocyte ratio was detected to be an independent variable with respect to stroke (odd’s ratio = 1.012, confidence interval = 1.001–1.024, p = 0.031). Conclusions Increased platelet-to-lymphocyte ratio could be a simple and practical marker of the clinical course in patients with carotid arterial stenosis.
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Ziman, Nathan, Laura P. Sands, Christopher Tang, Jiafeng Zhu, and Jacqueline M. Leung. "Does postoperative delirium following elective noncardiac surgery predict long-term mortality?" Age and Ageing 49, no. 6 (March 31, 2020): 1020–27. http://dx.doi.org/10.1093/ageing/afaa047.
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Abstract Objective to determine whether incident postoperative delirium in elective older surgical patient was associated with increased risk for mortality, controlling for covariates of 5-year mortality. Design secondary analysis of prospective cohort studies. Setting academic Medical Center. Subjects patients ≥65 years of age undergoing elective non-cardiac surgery. Outcomes postoperative assessments of delirium measured using the Confusion Assessment Method (CAM), mortality within 5 years of the index surgery was determined from National Death Index records. Results postoperative delirium occurred in 332/1,315 patients (25%). Five years after surgery, 175 patients (13.3%) were deceased. Older age was associated with an increased odds of mortality [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.20–2.70] for those aged 70–79 years compared to those aged <70 years, and OR 3.29, 95% CI 2.14–5.06 for those aged >80 years. Other variables associated with 5-year mortality on bi-variate analyses were white race, self-rated functional status, lower preoperative cognitive status, higher risk score as measured by the American Society of Anesthesiologists (ASA) classification, higher surgical risk score, history of congestive heart failure, myocardial infarction, renal disease, cancer, peripheral vascular disease and postoperative delirium. However, postoperative delirium was not associated with 5-year mortality on multi-variate logistic regression (OR 1.18, 95% CI 0.85–1.65). Conclusions our results showed that delirium was not associated with 5-year mortality in elective surgical patients after consideration of co-variates of mortality. Our results suggest the importance of accounting for known preoperative risks for mortality when investigating the relationship between delirium and long-term mortality.
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Atakla, Hugues Ghislain, Fatoumata Lounceny Barry, Mahugnon Maurel Ulrich Dénis Noudohounsi, Benjamin Bekoe Ofosu, Ummi Sulaimi Sulemana, and Dismand Stephan Houinato. "Prognostic Indicators in Patients with Intracerebral Hematoma in an urban clinical setting of a resource limited Country." Nepal Journal of Neuroscience 18, no. 4 (November 30, 2021): 33–38. http://dx.doi.org/10.3126/njn.v18i4.36701.
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Context and Objective: Hemorrhagic Cerebrovascular Accidents represent 10 to 15% of all strokes and are often related to the spontaneous rupture of small vessels weakened by chronic arterial hypertension or amyloid angiopathy. The aim of this work was to study the prognostic determinants of intracerebral haematomas at the neurology department of Conakry University Hospital.
Patients and Method: This was a retrospective analytical study conducted on all patients who were hospitalized with intracerebral hematoma over the 24-month period. Only the records of patients in whom intracerebral hematoma was confirmed by brain imaging were included in this study. Logistic regression (uni-variate and multi-variate) identified prognostic determinants of intracerebral hematoma at p < 0.05. The data were entered using Epi Info software version 7.1.4.0 then analysed using STATA / SE software version 11.2.
Results: This study found 21% of cases of intracerebral hematomas during the study period, with a male predominance of 60% and a sex ratio of 1.50. The study was conducted in the presence of a male patient. Hypertension was the cause found in 89.52% of patients; followed by arteriovenous malformations in 6.67% of patients, 2.86% of cases of amyloid angiopathy and 0.95% of unknown cause. Nevertheless, we still recorded 20% of deaths during hospitalization.
Conclusion: Previous quality of life and co-morbidities also modify the prognosis and should be taken into account in the prediction of disability and future quality of life of patients with intracerebral haematoma.
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Milesi, Marco, Justin Tan, and Phillip Urquijo. "Lepton identification in Belle II using observables from the electromagnetic calorimeter and precision trackers." EPJ Web of Conferences 245 (2020): 06023. http://dx.doi.org/10.1051/epjconf/202024506023.
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We present a major overhaul to lepton identification for the Belle II experiment, based on a novel multi-variate classification algorithm. Boosted decision trees are trained combining measurements from the electromagnetic calorimeter (ECL) and the tracking system. The chosen observables are sensitive to the different physics that governs interactions of hadrons, electrons and muons with the calorimeter crystals. Dedicated classifiers are used in various detector regions and lepton momentum ranges. The tree output is eventually combined with classifiers that rely upon independent measurements from other sub-detectors. Using simulation, the performance of the new algorithm is compared against the method used for analysis of the 2018 Belle II data, namely a likelihood discriminator based on the ratio of energy measured in the ECL over the momentum measured by the trackers. In the low momentum region, we largely improve the lepton-pion separation power, decreasing misidentification probability by a factor of 10 for electrons, and 2 for muons at fixed identification efficiency.
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Allenet, Clément, Clément Klein, Benjamin Rouget, Gaëlle Margue, Grégoire Capon, Eric Alezra, Peggy Blanc, et al. "Can Pre-Operative Neutrophil-to-Lymphocyte Ratio (NLR) Help Predict Non-Metastatic Renal Carcinoma Recurrence after Nephrectomy? (UroCCR-61 Study)." Cancers 14, no. 22 (November 19, 2022): 5692. http://dx.doi.org/10.3390/cancers14225692.
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Recent studies suggested that the neutrophil-to-lymphocyte ratio (NLR) could play a key role in tumor initiation, progression and response to treatments. The main objective was to assess the prognostic value of the pre-operative NLR on recurrence-free survival (RFS) in patients with non-hereditary localized renal cell carcinoma. From the UroCCR database (NCT03293563), factors influencing the disease recurrence of consecutive patients who underwent nephrectomy for cT1-T4 N0M0 were analyzed using multi-variate cox regression and log-rank methods. We included 786 patients, among which 135 (17.2%) experienced a recurrence at a median time of 23.7 [8.5–48.6] months. RFS for patients with a pre-operative NLR of <2.7 was 94% and 88% at 3 and 5 years, respectively, versus 76% and 63% for patients with a NLR of ≥2.7 (p < 0.001, log-rank test). To predict the risk of post-operative recurrence, the NLR was combined with the UCLA integrated staging system (UISS), and we defined four groups of the UroCCR-61 predictive model. The RFS rates at 3 and 5 years were 100% and 97% in the very-low-risk group, 93% and 86% in the low-risk group, 78% and 68% in the intermediate-risk group and 63% and 46% in the high-risk group (p < 0.0001). The pre-operative NLR seems to be an inexpensive and easily accessible prognostic bio-marker for non-metastatic RCCs.
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Fox, Matthew, Russell Farmer, Charles R. Scoggins, Kelly M. McMasters, and Robert C. G. Martin. "Lymph Node Ratio is a Significant Predictor of Disease-Specific Mortality in Patients Undergoing Esophagectomy for Cancer." American Surgeon 78, no. 5 (May 2012): 528–34. http://dx.doi.org/10.1177/000313481207800532.
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The seventh edition of the American Joint Committee on Cancer esophageal cancer staging system classifies nodal status by the number of malignant nodes (LNMs) found. This may be confounded by variations in lymphadenectomy and specimen review. The ratio of lymph nodes containing metastases to the total nodes excised (LNR) has been suggested as an alternative. We seek to validate the use of LNR for staging and determine the effect of the total lymph node yield (LNY) on its accuracy. A review of our prospective esophageal database identified 94 patients who underwent esophagectomy for cancer at out institution from 1992 until 2010. Univariate and multi-variate analyses were performed. The mean age of our patients was 59.4 years. Transthoracic esophagectomy was performed in all but three instances. The majority of tumors were adenocarcinoma, 76 per cent. Overall survival at 2 and 5 years was 52 and 29 per cent, respectively. LNY correlated with LNM ( r = 0.302, P = 0.001) but not LNR ( r = 0.012, P = 0.912). Using Kaplan-Meier analysis, LNR had no effect on disease-specific (DS) survival ( P = 0.803). However, a Cox proportional hazards regression model showed LNR to be a significant predictor of DS mortality (hazard ratio, 9.47; P = 0.049). The lack of correlation between LNR and LNY suggests that LNR may be a more robust staging method when LNY is low. Furthermore, LNR was found to be a significant predictor of DS mortality when controlling for other factors influencing survival. However, neither a staging system based on LNR nor its efficacy compared with the current system could be determined from these data.
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Simões, Mariana Roberta Lopes, Adelaide De Mattia Rocha, and Carla Souza. "Factors associated with absenteeism-illness in rural workers in a timber company." Revista Latino-Americana de Enfermagem 20, no. 4 (August 2012): 718–26. http://dx.doi.org/10.1590/s0104-11692012000400012.
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The monitoring of absenteeism-illness has revealed its high prevalence, and a strong relationship with work. This study aimed to analyze the factors associated with absenteeism-illness among the rural workers in a timber company in Minas Gerais, Brazil. It is an analytical cross-sectional study, carried out among 883 workers. The medical certificates issued in the company over one year were surveyed. For the analysis, use was made of descriptive statistics and bi- and multivariable analyses. The strength of association was measured by the odds ratio (OR) with help from logistic regression (p<0.05). A prevalence of 54% of medical certificates was found in the population. Bivariate analysis revealed an association between job (forestry assistant (OR=13.1), carpenter (OR=15) and chainsaw operator (OR=39.6)), length of service in the company, departments and length of schooling with absenteeism-illness. In the multi-variate analysis, the association between length of schooling and being a carpenter disappeared, while the other associations remained. It is concluded that there is important evidence about the occupational and demographic factors and absenteeism-illness among forestry workers.
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Shen, Chaoyong, Zhongke Feng, and Daoqin Zhou. "Analysing the effect of paddy rice variety on fluorescence characteristics for nitrogen application monitoring." Royal Society Open Science 5, no. 6 (June 2018): 180485. http://dx.doi.org/10.1098/rsos.180485.
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Paddy rice is one of the most important cereal crops worldwide, so it is very important to accurately monitor its growth status and photosynthetic efficiency. The nitrogen (N) level is a key factor closely related to crop growth. In this study, laser-induced fluorescence (LIF) technology combined with multi-variate analysis was applied to investigate the effect of paddy rice variety on N fertilizer level monitoring. Principal components analysis was conducted to extract the variables of the main fluorescence characteristics to identify N levels. Experimental results demonstrated that no nitrogen fertilizer can be completely identified for each paddy rice variety. In addition, other N levels can also be well classified based on the fluorescence characteristics. The relationship between the fluorescence ratio (F735/F685 : F735, and F685 denote the fluorescence intensity at 735 nm, and 685 nm, respectively) and leaf N content of different paddy rice varieties is also discussed. Experimental results revealed that LIF technology is an effective method of monitoring the N fertilizer and leaf biochemical components of paddy rice.
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Soslow, Jonathan H., Matthew Hall, W. Bryan Burnette, Kan Hor, Joanne Chisolm, Christopher Spurney, Justin Godown, Meng Xu, James C. Slaughter, and Larry W. Markham. "Creation of a novel algorithm to identify patients with Becker and Duchenne muscular dystrophy within an administrative database and application of the algorithm to assess cardiovascular morbidity." Cardiology in the Young 29, no. 3 (January 26, 2019): 290–96. http://dx.doi.org/10.1017/s1047951118002226.
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AbstractBackgroundOutcome analyses in large administrative databases are ideal for rare diseases such as Becker and Duchenne muscular dystrophy. Unfortunately, Becker and Duchenne do not yet have specific International Classification of Disease-9/-10 codes. We hypothesised that an algorithm could accurately identify these patients within administrative data and improve assessment of cardiovascular morbidity.MethodsHospital discharges (n=13,189) for patients with muscular dystrophy classified by International Classification of Disease-9 code: 359.1 were identified from the Pediatric Health Information System database. An identification algorithm was created and then validated at three institutions. Multi-variable generalised linear mixed-effects models were used to estimate the associations of length of stay, hospitalisation cost, and 14-day readmission with age, encounter severity, and respiratory disease accounting for clustering within the hospital.ResultsThe identification algorithm improved identification of patients with Becker and Duchenne from 55% (code 359.1 alone) to 77%. On bi-variate analysis, left ventricular dysfunction and arrhythmia were associated with increased cost of hospitalisation, length of stay, and mortality (p<0.001). After adjustment, Becker and Duchenne patients with left ventricular dysfunction and arrhythmia had increased length of stay with rate ratio 1.4 and 1.2 (p<0.001 and p=0.004) and increased cost of hospitalization with rate ratio 1.4 and 1.4 (both p<0.001).ConclusionsOur algorithm accurately identifies patients with Becker and Duchenne and can be used for future analysis of administrative data. Our analysis demonstrates the significant effects of cardiovascular disease on length of stay and hospitalisation cost in patients with Becker and Duchenne. Better recognition of the contribution of cardiovascular disease during hospitalisation with earlier more intensive evaluation and therapy may help improve outcomes in this patient population.
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Yoshikawa, Takaki, Toru Aoyama, Hiroshi Kuwabara, Yo Mikayama, Takashi Ogata, Haruhiko Cho, and Akira Tsuburaya. "Body weight loss after surgery as an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 125. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.125.
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125 Background: S-1 adjuvant chemotherapy improves survival of stage II/III gastric cancer, however, the compliance is not high. The aim of the present study is to clarify risk factors for continuation of S-1 after gastrectomy. Methods: Patients were retrospectively selected according to the following criteria; (1) patients underwent curative D2 gastrectomy for gastric cancer during 2002 and 2010, (2) pathological stage II/III, (3) creatinine clearance more than 60 ml/min, and (4) S-1 was initiated at a dose of 80mg/m2 within 6 weeks after surgery. Clinical factors when starting S-1 chemotherapy were examined by uni- and multi-variate analyses. Results: Seventy-five patients were eligible. Median age was 62 years (range: 36-80). Performance status was 0 in 65 patients and 1 in 10. Serum albumin level was >4.0 g/dl in 34 patients and <4.0 g/dl in 39. Operative procedure was total gastrectomy (TG) in 46 patients and distal one in 29. Median percentile of body weight loss to preoperative state (%BW loss) was 9.3 (range 0-21.1). Stage was II in 22 patients and III in 53. When %BW loss was classified to two groups; LOW (<15%, n=64) and HIGH (>15%, n=11), S-1 continuation rates were 82.8% in the LOW and 54.6% in the HIGH at 3 months and 73.2% in the LOW and 45.5% in the HIGH at 6 months, which were statistically significant (p=0.025). Among age, performance status, type of gastrectomy, %BW loss, serum albumin, and stage, only %BW loss was a significant independent risk factor for S-1continuation with hazard ratio of 2.437 by multi-variate Cox proportional hazard analyses (p=0.039). Conclusions: To improve drug compliance which leads to survival, it is a key to maintain BW before starting adjuvant chemotherapy. Peri-operative nutritional therapy should be developed and be focused on chronic inflammatory phase after surgery and on starvation after gastrectomy. A randomized phase III trial is on-going to show efficacy of peri-operative nutritional support including eicosapentaenoic acid (EPA).
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Sato, Tsutomu, Toru Aoyama, Tsutomu Hayashi, Haruhiko Cho, Taiichi Kawabe, Hirohito Fujikawa, Takashi Ogata, et al. "Impact of preoperative sarcopenia on morbidity in gastric cancer surgery." Journal of Clinical Oncology 32, no. 3_suppl (January 20, 2014): 40. http://dx.doi.org/10.1200/jco.2014.32.3_suppl.40.
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40 Background: Skeletal muscle depletion, known as sarcopenia, is characterized by decrease in muscle mass and function. Recent reports demonstrated that sarcopenia was a significant risk factor for complications in colorectal cancer surgery. This study aimed to evaluate impact of preoperative sarcopenia on morbidity in gastric cancer surgery. Methods: Between May 2011 and June 2013, 293 consecutive primary gastric cancer patients who underwent curative surgery were retrospectively examined. All patients received the same perioperative care of enhanced recovery after surgery program. Preoperative skeletal muscle mass was evaluated by bioelectrical impedance analysis and was expressed as skeletal muscle index or SMI (muscle mass/height2) by adjusting absolute muscle mass with height. Preoperative muscle function was measured by hand grip strength (HGS). Each cutoff value was determined as the gender-specific lowest 20% of the distribution of each measurement. Grade 2 or higher morbidity, evaluated by Clavien-Dindo classification, was picked-up from the patient record. Risk factor for morbidity was examined by uni- and multi-variate analyses. Results: Median age (range) was 68 years (37-85 years). Male to female ratio was 192:101. Operative procedure was 122 total, 169 distal, and 2 proximal gastrectomy. Lymphadenectomy was 162 D1+ and 131 D2 including 53 splenectomy. Pathological stage was I in 149, II in 39, III in 91, and IV in 14 patients. Morbidity included 7 pancreatic leakage, 12 anastomotic leakage, 4 intra-abdominal abscess, and others. In total, morbidity was observed in 39 patients (13.3%); 21 in grade 2, 16 in grade 3a, 1 in grade 3b, and 1 in grade 4. No mortality was observed. Univariate analysis showed that male, total gastrectomy, splenectomy, and low HGS were significant risk factor for morbidity. Low SMI was not a risk factor. By multi-variate analysis, low HGS(HR 2.457, p=0.029), male(HR 2.610, p=0.038)and total gastrectomy(HR 2.747, p=0.027)remained significant. Conclusions: Low hand grip strength was one of significant risk factor for morbidity in gastric cancer surgery. Hand grip strength as a surgical risk has a value to be examined in the future prospective studies.
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Gök, Gulay, Mehmet Karadağ, Tufan Çinar, Zekeriya Nurkalem, and Dursun Duman. "In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism." Journal of Cardiovascular and Thoracic Research 12, no. 4 (November 28, 2020): 321–27. http://dx.doi.org/10.34172/jcvtr.2020.51.
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Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV)dysfunction and myocardial injury. Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediate high risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in hospital and 30 days follow-up data of patients from medical records. Results: During the in-hospital stay (9.5±4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multi variate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI,0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality. Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality.
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Gupta, Indra N., and Keith L. McLaughlin. "Attenuation of ground motion in the Eastern United States." Bulletin of the Seismological Society of America 77, no. 2 (April 1, 1987): 366–83. http://dx.doi.org/10.1785/bssa0770020366.
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Abstract Frequency-dependent attenuation of ground motion in the Eastern United States is investigated for both vertical and horizontal components of motion. This is accomplished by digitizing and analyzing three-component, short-period Long Range Seismic Measurements data from over 200 earthquake-station pairs with epicentral distances less than about 1000 km. Pseudo-relative velocity as well as velocity response spectra, for 5 per cent damping, are obtained for the frequency range of 0.5 to 7 Hz. A multi-variate least-squares inversion is used to derive the station and source terms as well as the mean Q. Analysis of data for the entire Eastern United States indicates Q values for the vertical and horizontal components to be indistinguishable, substantial increase in Q with frequency (a factor of about 2 from 1 to 7 Hz), large (as much as a factor of 20 in amplitude) site terms for both the vertical and horizontal components, and the mean ratio of the peak horizontal to peak vertical component to be a stable characteristic of the site. Large regional variations in Q are also indicated by subsets of data such as for the Central United States and the Appalachian Mountains region.
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Barton, Sinead, Salaheddin Alakkari, Kevin O’Dwyer, Tomas Ward, and Bryan Hennelly. "Convolution Network with Custom Loss Function for the Denoising of Low SNR Raman Spectra." Sensors 21, no. 14 (July 6, 2021): 4623. http://dx.doi.org/10.3390/s21144623.
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Raman spectroscopy is a powerful diagnostic tool in biomedical science, whereby different disease groups can be classified based on subtle differences in the cell or tissue spectra. A key component in the classification of Raman spectra is the application of multi-variate statistical models. However, Raman scattering is a weak process, resulting in a trade-off between acquisition times and signal-to-noise ratios, which has limited its more widespread adoption as a clinical tool. Typically denoising is applied to the Raman spectrum from a biological sample to improve the signal-to-noise ratio before application of statistical modeling. A popular method for performing this is Savitsky–Golay filtering. Such an algorithm is difficult to tailor so that it can strike a balance between denoising and excessive smoothing of spectral peaks, the characteristics of which are critically important for classification purposes. In this paper, we demonstrate how Convolutional Neural Networks may be enhanced with a non-standard loss function in order to improve the overall signal-to-noise ratio of spectra while limiting corruption of the spectral peaks. Simulated Raman spectra and experimental data are used to train and evaluate the performance of the algorithm in terms of the signal to noise ratio and peak fidelity. The proposed method is demonstrated to effectively smooth noise while preserving spectral features in low intensity spectra which is advantageous when compared with Savitzky–Golay filtering. For low intensity spectra the proposed algorithm was shown to improve the signal to noise ratios by up to 100% in terms of both local and overall signal to noise ratios, indicating that this method would be most suitable for low light or high throughput applications.
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Hoang, Thuyvan, Wei Qiao, Jorge E. Cortes, Keyur Patel, Farhad Ravandi, Tapan M. Kadia, Mark Brandt, Raja Luthra, Hagop M. Kantarjian, and Gautam Borthakur. "Quantitative Assessment of Translocation Transcript Ratio Predicts for Relapse Free Survival Among Patients with Core Binding Factor Acute Myeloid Leukemia." Blood 124, no. 21 (December 6, 2014): 2354. http://dx.doi.org/10.1182/blood.v124.21.2354.2354.
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Abstract Presence of unique translocation events allows us to monitor minimal residual disease by quantitative polymerase chain reaction (qPCR) in patients with core binding factor acute myeloid leukemia (CBF-AML) that includes Inversion(16), t(16;16) and t (8;21) cytogenetic abnormalities. Fludarabine based regimens; Fludarabine, cytarabine, G-CSF and gemtuzumab ozogamicin (FLAG-GO) and FLAG, idarubicin (FLAG-Ida) have been two consecutive regimens used as front-line therapy for all new patients with CBF-AML presenting to MD Anderson Cancer Center since 2007. MRD has been monitored by baseline and periodic qPCR studies from bone marrow samples during induction/consolidation and follow up. Based on recent literature we investigated whether time to achievement of lowest qPCR value or the lowest qPCR value are important to predict for relapse free survival (RFS) in a multi-variate analysis. Between 2007 and early 2014, 89 patients (pts) have achieved remission with frontline induction regimens; FLAG-GO=41 (46%) and FLAG-Ida=48 pts (54%); 44 patients with Inv (16) and 45 pts with t(8;21). Median presenting WBC count is 12.5x 106/L (range 1.9-97.2) and median qPCR ratio with ABL1 as control at presentation is >100. Median lowest qPCR following induction/consolidation is 0 (range 0-15.9) and is the same for inv (16) and t(8;21) (p=0.14). The median lowest qPCR value by regimen is 0 for FLAG-GO and the same for FLAG-Ida is 0.01 (p=0.003). RFS with a median follow up of more than 3 years is 80% and is not different among regimens (p=0.5). Because of infrequency of events, the analysis was mostly done using both cytogenetic groups and both regimens together. Median time to lowest qPCR was 7 months for both cytogenetic subgroups as well as for both FLAG-GO and FLAG-Ida regimens (range 1-28 months). In a univariate analysis that included age, log WBC and platelet counts, cytogenetics, regimen, time to lowest qPCR value and the log lowest qPCR value as variables; log lowest qPCR is the only variable significantly predicting for RFS (p<0.01) while time to lowest qPCR is not (p=0.7). Conclusion: RFS remains high among patients treated with FLAG-GO or FLAG-Ida and lowest qPCR value rather than the time to achieve lowest qPCR. Disclosures No relevant conflicts of interest to declare.
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Westfall, Kristen M., Rebecca Brown, and Anthony G. Charles. "Appendiceal Malignancy: The Hidden Risks of Nonoperative Management for Acute Appendicitis." American Surgeon 85, no. 2 (February 2019): 223–25. http://dx.doi.org/10.1177/000313481908500233.
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One potential harm of nonoperative management for acute appendicitis is missed appendiceal cancer, a rare and often aggressive malignancy due to the frequency of late stage of diagnosis. Previous studies have reported an increasing incidence of appendiceal neoplasms in the population. This is a retrospective case–control study of 1007 adult patients, who presented to the University of North Carolina-Memorial Hospital (UNC-MH) between 2011 and 2015 with clinical signs and symptoms of appendicitis. We evaluated the incidence of primary appendiceal cancer in this population and determined factors that predict appendiceal cancer diagnosis using multi-variate logistic regression analysis. The overall incidence of appendiceal neoplasm for adult patients presenting to UNC-MH with appendicitis from 2011 to 2015 was 2.3 per cent (23/1007). The incidence in patients without appendiceal perforation on pathology was 1.9 per cent (16/832). Age (odds ratio (OR) 1.03), number of days of abdominal pain (OR 1.16), self-reported fever (OR 2.08), appendiceal width (OR 1.95), and appendiceal wall thickness (OR 1.30) were predictors of appendiceal neoplasm diagnosis in patients that present with acute appendicitis. We recommend that an operative approach to acute appendicitis should remain the standard of care because operative management may not only be diagnostic but potentially therapeutic.
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Lison, Linda, Irawan Yusuf, Bambang Sutrisna, Peter Kabo, Teguh Santoso, and Ferry Sandra. "Which Biology Marker Can be a Predictor for Higher Syntax Score?" Indonesian Biomedical Journal 6, no. 2 (August 1, 2014): 107. http://dx.doi.org/10.18585/inabj.v6i2.37.
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BACKGROUND: Syntax score is a lesion-based angiographic scoring system, originally devised to grade the anatomic complexity of coronary artery disease (CAD) and thereby facilitate consensus in the study of a diagnostic angiogram between surgeons and interventional cardiologists. Suitable biology marker to predict the severity of CAD and to have a treatment decision for revascularization by percutaneous coronary intervention (PCI) or bypass surgery, is still unknown. Which biology marker can be a predictor for higher Syntax score remains unknown as well.METHODS: Severity of 105 patients who underwent coronary angiography, were evaluated with Syntax score. Laboratory tests were conducted for routine blood test, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), high-sensitivity C-reactive protein (hs-CRP), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, kidney function, creatinine and hemoglobin A1c (HbA1c).RESULTS: Ureum had significant correlation with Syntax score, p=0.016 and 95% confidence interval (CI)=0.05-0.55. Result of logistic regression analysis showed that HDL and haematocrit had significant correlation with Syntax score, with cut off point 34 (p=0.02, p=0.0033, respectively). Based on multi-variate analysis, Syntax score 34 = 16 (HDL ≤40 + Ureum ≥23) + 10 (Neutrophil/Lymphocyte ≥3.789) +10 (HbA1c ≥7 ) + 13 ( monocyte ≥9%).CONCLUSION: HDL cholesterol, ureum, neutrophil-lymphocyte ratio, HbA1c and monocyte altogether can predict the higher Syntax score.KEYWORDS: syntax, neutrophil, lymphocyte, HDL, cholesterol, ureum, HbA1c, monocyte
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Wijaya, I. P. K., A. Joshi, M. N. Alam, S. Jayasinghe, and N. Laila. "Climate Change Induced Landslide Susceptibility Assessment - for Aiding Climate Resilient Planning for Road Infrastructure: A Case Study in Rangamati District, Chittagong Hill Tracts, Bangladesh." IOP Conference Series: Earth and Environmental Science 1091, no. 1 (November 1, 2022): 012010. http://dx.doi.org/10.1088/1755-1315/1091/1/012010.
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Climate change induced extreme hydro-meteorological conditions have increased the prevalence of landslides in the hilly and geologically fragile region of Chittagong Hill Tract districts (including Rangamati) in Bangladesh. These landslides have attributed to significant damages to transportation infrastructures such as roads and bridge. In this study, we investigated the susceptibility of landslides due to extreme rainfall events under different climate change scenarios in Rangamati district. We developed high-resolution 1km x 1km downscaled extreme rainfall projections under RCP 4.5 and RCP 8.5 scenarios for baseline period 1976-2005 and for future time horizons 2030s, 2050s, and 2080s. Based on these extreme rainfall scenarios, the combination of the Frequency Ratio (FR) and Analytical Hierarchy Process (AHP) techniques were applied to map and analyse the landslide susceptibility maps. Nine multi-variate factors contributing to the landslides were considered including terrain slope, aspect, elevation, lithology, soil, distance from the lineaments, distance from the stream, land use and mean annual rainfall in four different time periods for scenario RCPs. Further, an Area Under the Curve (AUC) approach was used to evaluate the quality of the model A total of seven landslide susceptibility maps were developed and classified into five susceptible classes. The models were validated using the Receiver Operating Characteristic curve (ROC) approach, which showed a satisfactory result of 80-86 percent accuracy.
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Bichha, R. P., K. K. Jha, V. S. Salhotra, A. P. Weerakoon, K. B. Karki, and Navneet Bichha. "An Epidemiological Study to Find out Risk Factors of Multi Drugs Resistance Tuberculosis in Nepal." SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 14, no. 2 (March 13, 2018): 31–38. http://dx.doi.org/10.3126/saarctb.v14i2.19335.
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Introduction: Drug resistant tuberculosis is a threat to tuberculosis control worldwide. Previous anti- tuberculosis treatment is a widely reported risk factor for multi drug resistant tuberculosis (MDR-TB), whereas other risk factors are less well described. In Nepal National Tuberculosis Control Programme initiated DOTSPLUS Pilot project from September 2005 using standardized treatment regimen.Objective: To explore the risk factors for MDR-TB in Nepal.Methodology: Institution based matched case control study with a case: control ratio of 1:2 was carried out in three regions of Nepal. Fifty five cases and 110 controls were selected. Current MDR-TB patients on treatment from DOTS–Plus clinic were enrolled as cases. Controls were age, sex matched cured TB patients and who had completed treatment either from the same centre or any DOTS Centre adjacent to that DOTS Plus Centre. Data was collected by a trained research assistant using interviewer administered structured questionnaire. Matched analysis was done using SPSS 16 version. Confounding effects were controlled by using matching, matched analysis and regression analysis.Results: In matched analysis following were the significant risk factors for MDR-TB in Nepal.(1) HIV Sero positivity (OR 15.9, CI 1.9- 133.0) (2) Travel cost more than 50 NRs per day (OR 6.5, CI 2.4- 9.8) (3) Contact history of TB (OR 3.8, CI 2.2- 6.6) (4) Living in a nuclear family (OR 6.0, CI 2.6- 13.9)(5) Non adherence to DOTS (OR 18.6, CI 2.27- 151.0) (6) Distance to treatment centre more than 5 Km ( OR 3.9, CI 1.5- 10.) (7) Previous history of TB ( OR 12.0, CI 5.4 -26.5)(8) Living in a rural area (OR 4, CI 2.1- 8.5) (9) Unmarried (Crude OR 3.3,CI 1.6- 6.8) (10) Un-employment (OR 3.4,CI 1.6-7.6)(11) Living in a rented house (OR 3.5, CI 1.77- 3.67) (12) Single bed room (OR 2.8, CI 1.13- 6.9). Using muti-variate analysis except living in a rented house and single bed room other variables were positive significant predictors for MDR –TB in Nepal.Conclusions: Many risk factors were related to the DOTS. Strengthening of DOTS programme to tackle the identified risk factors can reduce the MDR –TB burden in Nepal.SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS, Vol. 14, No. 2, 2017, Page: 31-38
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Hussain, Tahir, Rafeah Khan, Muhammad Saqib Qamar Ishaqi, Syed M. Shahnawaz Hyder, Manoj Kumar, and Sheema Ihtisham. "Usefulness of Carotid Ultrasonography in the Diagnosis of Coronary Artery Disease Patients." Pakistan Journal of Medical and Health Sciences 16, no. 10 (October 30, 2022): 846–50. http://dx.doi.org/10.53350/pjmhs221610846.
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Objective: The research aimed to examine whether the carotid condition is linked to coronary artery disease in sufferers sent to exercise echocardiography and when it raises the exercise echocardiography capability to forecast coronary artery disease. Place and Duration: During the last five years, continuous subjects over eighteen years with diagnosed coronary artery disease underwent exercise echocardiography and carotid ultrasound at Indus Hospital Karachi. Study Design: Cross-sectional Methodology: We studied 312 participants without past heart disease who experienced exercise echocardiography, coronary angiography, and carotid ultrasonography over five years. Specific variables had been described as proportions, and evaluation among groups was according to Fisher’s exact and chi-square tests. Constant variables had been described as mean or median whenever their distribution deceased from average, and variations had been evaluated through the un-paired t-test. Continuous and binary quantitative variables have been likened to utilizing binary logistic regression. IBM SPSS, Version 20 was utilized. Results: 178 (57.1 percent) participants had substantial coronary artery disease. Components linked to CAD in multi-variate evaluation were FPG (OR 2.04, p=0.062), pre-test possibility of CAD greater than 65 percent (odds ratio 7.42, p less than0.004), positive exercise echocardiography (odds ratio 42.04, p less than 0.004) and carotid plaque presence (odds ratio 5.8, p= 0.052). There wasn't a statistical factor in the area below the curve after the inclusion of carotid plaque to exercise echocardiography results (3.08 vs. 3.24, p=1.05) nor the level of sensitivity, uniqueness, predictive efficiency, or values. Conclusion: Carotid plaque is linked to CAD in sufferers going through exercise echocardiography (EE), although its inclusion to EE doesn't improve coronary artery disease (CAD) prediction, most likely because of inadequate mathematical power. Carotid plaque reclassified 1 / 3 of sufferers to high risk class in spite of negative exercise echocardiography (EE) or absence of coronary artery disease; these subjects take advantage of aggressive primary prevention treatments. Keywords: Carotid Ultrasonography, Coronary Artery Disease, echocardiography
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Chung, Joon, Matthew Goodman, Tianyi Huang, Tamar Sofer, Suzanne Bertisch, Shaun Purcell, Cecilia Castro_Diehl, Jarvis Chen, and Susan Redline. "0724 Objectively Regular Sleep of Optimal Duration and Mortality: The Multi-Ethnic Study of Atherosclerosis." SLEEP 46, Supplement_1 (May 1, 2023): A318—A319. http://dx.doi.org/10.1093/sleep/zsad077.0724.
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Abstract Introduction Irregularly timed sleep, inconsistent duration, and non-optimal sleep duration have been implicated in the etiology of cardiovascular disease and premature mortality. These dimensions of sleep map behaviorally to regular bed and wake times. Our aim was to estimate the association of regular sleep of optimal sleep duration with all-cause mortality in a diverse US sample. Methods We used data from the Multi-Ethnic Study of Atherosclerosis Sleep Study (2010-2013) at Exam 5. Sleep was measured by 7-day wrist actigraphy, concurrent with at-home polysomnography and validated sleep questionnaires. We used K-means clustering on wrist-actigraphy regularity and duration data to assign individuals to categories of ‘regular-optimal’ or ‘irregular-insufficient’ sleep, labels describing sleep tendencies in each group. Using proportional hazard models with multi-variate adjustment for socio-demographics (age, female sex, race/ethnicity, marital status, and day vs non-day work schedules), lifestyle (moderate-vigorous physical activity, smoke status), health status (depressive symptoms, body mass index, total medications, prevalent cardiovascular disease), and measures of major sleep disorders (the Apnea-Hypopnea Index, insomnia severity, restless legs), we estimated all-cause mortality associations with sleep patterns. Sensitivity analyses additionally adjusted or, via propensity scores, matched on income, education, prevalent chronic lung disease, prevalent cancer, hypertension, diabetes, and diet. Results Among 1,726 participants who were followed for a median of 7.0 years (Q1-Q3, 6.4-7.4 years,) there were 171 deaths. The ‘regular-optimal’ group had 42% lower mortality risk compared to the ‘irregular-insufficient’ sleep group (Hazard Ratio [95% Confidence Interval]: 0.58 [0.43, 0.80]), in the fully adjusted model and was robust to sensitivity analyses. Conclusion Individuals characterized by a sleep pattern of ‘regular and optimal’ duration sleep had significantly lower mortality compared to those with an ‘irregular and less sufficient’ sleep pattern. The regular and optimal duration phenotype maps behaviorally to regular bed and wake times, suggesting potential health benefits of adherence to recommended sleep practices. Support (if any) JC was supported by the American Academy of Sleep Medicine’s Foundation Grant: 269-FP-22 This work was also supported by the following National Institute of Health (NIH) grants: 5T32HL007901-19, 5K01HL138211-05, K01HL143034, R01HL098433. SR was partly funded by the NIH National Heart, Lung, and Blood Institute (NHLBI) R35HL135818.
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Cao, Yanshuo, Xiaotian Zhang, Jian Li, Jifang Gong, Ming Lu, Zhihao Lu, Xicheng Wang, et al. "Clinical characters and prognostic factors of young female patients (pts) with metastatic gastric adenocarcinoma (GC)." Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 133. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.133.
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133 Background: GC is one of the most common cancers worldwide, and has an even higher incidence rate in China. The incidence rate of GC is rising in young pts (≤ 40 years). Previous studies suggested that the percentage of female pts was higher in young pts than that in older pts. The clinical characters and potential prognostic factors have not been well described for young female pts with metastatic GC. Methods: A retrospective chart review was conducted for all GC pts treated at our institution from 1995 to 2012. Pt demographics, clinical characters, treatment related information and survival data were collected. Kaplan-Meier test was used for the survival analysis. Cox regression was conducted for uni- and multi-variate analysis. Results: In total, 1,862 pts with histologically confirmed GC were identified. Among these pts, 11.3% were young pts when first diagnosed. The male to female ratio was 2.76:1 for the whole group and 1:1.02 for young pts. Ninety-eight female pts were ≤ 40 years when diagnosed of metastatic GC. For this group, median age was 35 years (range: 19-40 years). Seventy-one (72.4%) had > 1 metastatic sites, and 85 (86.7%) received palliative chemotherapy. The median overall survival (OS) was 14.9 months (95% confidence interval [CI] 11.8-18.0 months). Seventy-six (77.6%) pts had intact primary tumor when diagnosed of metastatic disease. Compared to 22 pts who relapsed after radical surgery, OS was similar for pts presented with de novo metastatic disease (Hazard Ratio (HR) 1.03, 95% CI: 0.55 to 1.92, P= 0.9). Of these 76 pts, 36 underwent palliative gastric resection, which was associated with improved OS (15.3 vs. 9.0 months; HR 0.37, 95% CI: 0.19 to 0.74, P = 0.003). Forty-six (46.9%) pts had ovarian metastasis, and 20 had oophorectomy. Palliative oophorectomy was associated with significantly improved OS (36.6 vs. 12.4 months, HR 0.34, 95% CI: 0.14 to 0.80, P = 0.013). Conclusions: There was an increased ratio of females in young GC pts. In young female pts with metastatic GC, palliative resection of gastric primary and ovarian metastasis were associated with significantly improved OS, and should be considered in appropriate pts.
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Jazieh, Abdul Rahman, Huseyin Cem Onal, Daniel Shao-Weng Tan, Ross A. Soo, Kumar Prabhash, Amit Kumar, Reto Huggenberger, and Byoung Chul Cho. "Real-world global data on targeting epidermal growth factor receptor mutations in stage III non-small-cell lung cancer: the results of the KINDLE study." Therapeutic Advances in Medical Oncology 14 (January 2022): 175883592211227. http://dx.doi.org/10.1177/17588359221122720.
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Background: Tyrosine kinase inhibitors (TKIs) are the standard of care for resectable and metastatic non-small-cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations (EGFRm). We describe the real-world practice of EGFRm testing, prevalence, treatment and outcomes in EGFRm stage III NSCLC from a multi-country, observational study. Methods: The KINDLE study retrospectively captured diagnostic information, treatments and survival outcomes in patients with stage III NSCLC from January 2013 to December 2017. Baseline characteristics and treatments were described and real-world outcomes from initial therapy were analysed using Kaplan–Meier methods. Results: A total of 3151 patients were enrolled across three regions: Asia ( n = 1874), Middle East and North Africa (MENA) ( n = 1046) and Latin America (LA) ( n = 231). Of these, 1114 patients (35%) were tested for EGFRm (46% in Asia, 17% in MENA and 32% in LA) and EGFRm was detected in 32% of tested patients (34.3% in Asia, 20.0% in MENA and 28.4% in LA). In a multi-variate analysis, overall EGFRm patients treated with EGFR-TKI monotherapy as initial treatment, without any irradiation, had twice the risk of dying (hazard ratio: 1.983, 95% confidence interval: 1.079–3.643; p = 0.027) versus any other treatment. Finally, unresectable patients with EGFRm NSCLC who received concurrent chemoradiotherapy (cCRT) as initial therapy had longer overall survival (OS) compared with their counterparts who only received TKI monotherapy without any irradiation (48 months versus 24 months; p < 0.001). Conclusion: The KINDLE study showed that a minority of stage III NSCLC patients were tested for EGFRm. Patients with EGFRm with unresectable NSCLC had similar outcomes from cCRT as initial therapy compared with EGFR wild type with a trend in OS favouring the EGFRm group. Outcomes with EGFR-TKI monotherapy as initial therapy, without any irradiation, were worse. The ongoing LAURA study (NCT03521154) will help define the role of EGFR-TKIs in EGFRm stage III NSCLC treated with cCRT. Trial Registration: NCT03725475.
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Schuitemaker, Joost H. N., Rik H. J. Beernink, Arie Franx, Thomas I. F. H. Cremers, and Maria P. H. Koster. "First trimester secreted Frizzled-Related Protein 4 and other adipokine serum concentrations in women developing gestational diabetes mellitus." PLOS ONE 15, no. 11 (November 18, 2020): e0242423. http://dx.doi.org/10.1371/journal.pone.0242423.
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Background The aim of this study was to evaluate whether soluble frizzled-related protein 4 (sFRP4) concentration in the first trimester of pregnancy is individually, or in combination with Leptin, Chemerin and/or Adiponectin, associated with the development of gestational diabetes (GDM). Methods In a nested case-control study, 50 women with GDM who spontaneously conceived and delivered a live-born infant were matched with a total of 100 uncomplicated singleton control pregnancies based on body mass index (± 2 kg/m2), gestational age at sampling (exact day) and maternal age (± 2 years). In serum samples, obtained between 70–90 days gestational age, sFRP4, Chemerin, Leptin and Adiponectin concentrations were determined by ELISA. Statistical comparisons were performed using univariate and multi-variate logistic regression analysis after logarithmic transformation of the concentrations. Discrimination of the models was assessed by the area under the curve (AUC). Results First trimester sFRP4 concentrations were significantly increased in GDM cases (2.04 vs 1.93 ng/ml; p<0.05), just as Chemerin (3.19 vs 3.15 ng/ml; p<0.05) and Leptin (1.44 vs 1.32 ng/ml; p<0.01). Adiponectin concentrations were significantly decreased (2.83 vs 2.94 ng/ml; p<0.01) in GDM cases. Further analysis only showed a weak, though significant, correlation of sFRP4 with Chemerin (R2 = 0.124; p<0.001) and Leptin (R2 = 0.145; p<0.001), and Chemerin with Leptin (R2 = 0.282; p<0.001) in the control group. In a multivariate logistic regression model of these four markers, only Adiponectin showed to be significantly associated with GDM (odds ratio 0.12, 95%CI 0.02–0.68). The AUC of this model was 0.699 (95%CI 0.605–0.793). Conclusion In the first trimester of pregnancy, a multi-marker model with sFRP4, Leptin, Chemerin and Adiponectin is associated with the development of GDM. Therefore, this panel seems to be an interesting candidate to further evaluate for prediction of GDM in a prospective study.
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Sieweke, Jan Thorben, Arash Haghikia, Christian Riehle, Carolin Klages, Muharrem Akin, Tobias König, Carolin Zwadlo, et al. "Prediction of heart failure and death in an adult population of Fontan patients." Cardiology in the Young 29, no. 5 (April 30, 2019): 602–9. http://dx.doi.org/10.1017/s1047951119000258.
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AbstractBackground:Late Fontan survivors are at high risk to experience heart failure and death. Therefore, the current study sought to investigate the role of non-invasive diagnostics as prognostic markers for failure of the systemic ventricle following Fontan procedure.Methods:This monocentric, longitudinal observational study included 60 patients with a median age of 24.5 (19–29) years, who were subjected to cardiac magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing, and blood analysis. The primary endpoint of this study was decompensated heart failure with symptoms at rest, peripheral and/or pulmonary edema, and/or death.Results:During a follow-up of 24 months, 5 patients died and 5 patients suffered from decompensated heart failure. Clinical (NYHA class, initial surgery), functional (VO2peak, ejection fraction, cardiac index), circulating biomarkers (N-terminal pro brain natriuretic peptide), and imaging parameters (end diastolic volume index, end systolic volume index, mass-index, contractility, afterload) were significantly related to the primary endpoint. Multi-variate regression analysis identified afterload as assessed by cardiac magnetic resonance imaging as an independent predictor of the primary endpoint (hazard ratio 1.98, 95% confidence interval 1.19–3.29, p = 0.009).Conclusion:We identified distinct parameters of cardiopulmonary exercise testing, cardiac magnetic resonance imaging, and blood testing as markers for future decompensated heart failure and death in patients with Fontan circulation. Importantly, our data also identify increased afterload as an independent predictor for increased morbidity and mortality. This parameter is easy to assess by non-invasive cardiac magnetic resonance imaging. Its modulation may represent a potential therapeutic approach target in these high-risk patients.
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Amano, Shinya, Toru Aoyama, Mariko Kamiya, Junya Morita, Yukio Maesawa, Sho Sawazaki, Masakatsu Numata, et al. "Incidence and risk factor analysis of the postoperative delirium after gastrointestinal surgery: An exploratory analysis of a prospective, randomized phase II trial." Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 30. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.30.
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30 Background: The postoperative complications, delirium are a particularly common morbidity after gastrointestinal surgery. Postoperative delirium makes patient management much more difficult, increases costs, and causes severe discomfort to the patient. The aim of this study was to evaluate the incidence of the postoperative delirium and a predictor for postoperative delirium using phase II clinical trial data. Methods: We analyzed the cases that were enrolled to randomized clinical trials of the efficacy and safety of TJ-54 (Yokukansan; a traditional Japanese medicine [Kampo]) for the prevention and/or treatment of postoperative delirium in a randomized phase II trial of patients receiving surgery for gastrointestinal and lung malignancies (UMIN000005423). The American Psychiatric Association’s the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was used to assess. A uni- and multivariate logistic regression analyses was performed to identify risk factors for morbidity. Results: Between October 2009 and July 2011, a total of 186 patients were registered to the Yokukansan trial. Among them, 167 patients received surgery for gastrointestinal malignancy and were eligible for the present study. The incidence of postoperative delirium was 9.0% (15 patients) and postoperative delirium was the most common postoperative complication in the study. Risk factors for postoperative delirium were analyzed by uni- and multi-variate analyses using clinical factors determined before the enrollment of the study. Among these, high patients’ age ( > 80 years) and low MMSE score ( < 27) were identified as significant independent risk factor for postoperative delirium (Odds ratio: 3.90, 95% CI; 1.25-12.16, p = 0.013 and Odds ratio: 0.24, 95% CI; 0.08-0.73, p = 0.013). Conclusions: The major of the findings were that high patients’ age (≥ 80 years) and low MMSE score ( < 27) were significant independent risk factors for predicting postoperative delirium. Careful attention for postoperative delirium is required in patients with high patients’ age and MMSE score when surgeons perform surgery for gastrointestinal malignancies. Clinical trial information: 000005423.
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Hodgkinson, J. D., G. Worley, J. Warusavitarne, G. B. Hanna, C. J. Vaizey, and O. D. Faiz. "Evaluation of the Ventral Hernia Working Group classification for long-term outcome using English Hospital Episode Statistics: a population study." Hernia 25, no. 4 (March 13, 2021): 977–84. http://dx.doi.org/10.1007/s10029-021-02379-8.
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Abstract Purpose The Ventral Hernia Working Group (VHWG) classification of ventral/incisional hernia (IH) was developed by expert consensus in 2010. Subsequently, Kanters et al. have demonstrated the validity of a modified version of the system for predicting short-term outcomes. This study aims to evaluate the modified system for predicting hernia recurrence. Methods Patients undergoing IH surgery (defined by OPCS codes) in the England Hospital Episode Statistics (HES) database, from 1997 to 2012, were identified. Baseline demographics at index hernia operation and episodes of further hernia surgery (FHS) were recorded. Risk factors for FHS were identified using cox regression and evaluated against the modified-VHWG grade using receiver-operating characteristics (ROC). Results The final analysis included 214,082 index IH operations. Of these, 52.6% were female and mean age was 56.59 (SD15.9). An admission for FHS was found in 8.3% cases (17,714 patients). Multi-variate cox regression revealed contaminated hernia (p < 0.0001), pre-existing IBD (p < 0.0001) and hernia comorbidity (p = 0.05) to be significantly related to long-term FHS. Classifying patients using these factors, according to the modified-VHWG classification, revealed that compared to Grade 1, the hazard ratio (HR) of FHS increased in Grade 2 (HR 1.19; p < 0.0001) and further increased in Grade 3 (HR 1.79; p < 0.0001). ROC analysis revealed the area under the curve to be 0.73 (95% CI 0.73–0.74). Conclusion This analysis demonstrates the broad validity of the modified-VHWG classification in discriminating risk for FHS. Inclusion of pre-existing IBD as a factor defining Grade 2 patients would be recommended. This analysis is limited by the absence of certain factors within the HES database, such as BMI.
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Poudyal, Yogesh, Chandra Bhal Jha, and Niraj Parajuli. "Gender Differences in Clinical and Epidemiological Profile of Adult Patients with Vitiligo." Journal of Universal College of Medical Sciences 9, no. 01 (June 22, 2021): 24–27. http://dx.doi.org/10.3126/jucms.v9i01.37958.
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INTRODUCTION
Vitiligo is an acquired disorder of skin characterized by white macules. Though there are many studies describing clinical and epidemiological features of vitiligo; there are few studies which have attempted to see the differences between male and female. Understanding the gender differences in clinico-epidemiological features will help to find the direction for further research in understanding pathogenesis. The objective was to find the gender wise differences in clinico-epidemiological pattern of vitiligo.
MATERIAL AND METHODS
This was cross sectional study done at Dermatology and Venereology out-patient clinic of Universal College of Medical Sciences Teaching hospital, Bhairhawa, Nepal from January 1, 2015 to December 31, 2016. Consecutive sampling technique was used and the cases of 18 years and above were taken. Chi-square test, multi-variate logistic regression, two sample t-tests were used to analyze the data.
RESULTS
The total number of case was 190. Female to male ratio was 1.38:1. Vitiligo vulgaris was seen more in female and mucosal vitiligo more in male and the difference was statistically significant. However, there was no statistically significant difference among gender in family history, duration of disease, mucosal and hair involvement, history of recurrence and various age groups.
CONCLUSION
Vitiligo vulgaris is seen more in female and mucosal vitiligo is seen more in male. This study has strengthened the evidence regarding the difference noted in clinic-epidemiological aspect of vitiligo. There should be more studies, so that more patterns in gender differences could be understood, and this will help in understanding the pathogenesis of vitiligo.
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Jiang, Zhizhao, Jianan Ren, Huajian Ren, Zhiwu Hong, Gefei Wang, Guosheng Gu, and Xiuwen Wu. "Early Active Irrigation-Suction Drainage among Enterocutaneous Fistulas Patients with Chronic Critical Illness: A Retrospective Cohort Study." American Surgeon 86, no. 4 (April 2020): 346–53. http://dx.doi.org/10.1177/000313482008600431.
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Enterocutaneous fistulas (ECFs) requiring admission to ICU is a serious surgical complication. A growing number of patients survive ECFs but remain chronically critically ill. The aim of our study was to investigate the risk factors of hospital death in patients with chronic critical illness attributed to ECFs. A retrospective single-center study was conducted in 163 ECF patients between 2013 and 2017. Patient-specific baseline characteristics, outcomes, and process of care variables were collected. Risk factors for hospital mortality were determined using univariate and multi-variate analyses. Patients were divided into the following two groups according to the hospital discharge outcome: group survivors (n = 106) and group nonsurvivors (n = 57). Patients who received active irrigation-suction drainage (AISD) within 24 hours after the diagnosis of ECFs had a significantly lower hospital mortality rate than those who received AISD after more than 24 hours (17.9% vs 46.9%, P < 0.001). Multivariate logistic regression analysis demonstrated that delayed AISD (adjusted odds ratio [AOR], 10.24; 95% confidence interval [CI], 3.03234.59; P < 0.001) and no rehabilitation therapy (AOR, 4.77; 95% CI, 1.43215.98; P = 0.011) were independently associated with a greater risk of hospital mortality. The hospital mortality rate in patients with more than or equal to four risk factors was 92.6 per cent (n = 57), compared with a mortality rate of 9.4 per cent (n = 106) in patients who did not have these risk factors ( P < 0.001). The risk of hospital death is exceptionally high among patients with chronic critical illness attributed to ECFs. Efforts aimed at early AISD and rehabilitation therapy are likely to be associated with improved clinical outcomes.
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Borthakur, Gautam, Amer Beitinjaneh, E. Lin, Jorge E. Cortes, Rajyalakshmi Luthra, Farhad Ravandi, Sherry A. Pierce, et al. "Impact of FLT3-ITD Allelic Ratio In Treatment of Acute Myelogenous Leukemia Including Allogeneic Stem Cell Transplant." Blood 116, no. 21 (November 19, 2010): 1722. http://dx.doi.org/10.1182/blood.v116.21.1722.1722.
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Abstract Abstract 1722 Background: Internal tandem duplication (ITD) mutations in the fms-like tyrosine kinase 3 (FLT3) are associated with poor outcome (shorter relapse free and overall survival) among patients with acute myelogenous leukemia (AML). We and others have reported that a higher allelic burden is associated with worse outcome while patients with lower allelic burden may not have uniformly poor outcome. Though stem cell transplant (SCT) early in disease course is increasingly pursued in patients with FLT3-ITD mutation, its role in the context of mutant FLT3-ITD allelic burden has not been reported. We undertook such an analysis among patients with newly diagnosed AML treated at MD Anderson Cancer Center. Patients and Methods: Patients from 2003 to 2009 were included in the analysis. As the impact of FLT3-ITD allelic burden among patients with unfavorable or favorable cytogenetic group is unclear, we restricted our analysis to patients with intermediate risk cytogenetics (Diploid, -Y/X). Patients with tyrosine kinase domain (TKD) mutations in FLT3 were also excluded as their outcome is different from those with ITD mutation. To minimize possible bias favoring SCT, this analysis was limited to patients who achieved complete remission with or without platelet recovery (CR/CRp) after induction chemotherapy. Quantification of FLT3-ITD allelic ratio was performed by summing the area under the curve for all ITD peaks divided by the total peak areas for mutant and unmutated peaks. Statistical analysis: Age, WBC, Platelet count, bone marrow blast percentage, creatinine, bilirubin, SCT and FLT3-ITD allelic ratio (<0.2=low vs ≥0.2=high) were included into a uni and multivariate Cox proportional hazards model and stepwise model selection method was used with both entering and staying probability of 0.2. The cut-off for FLT3-ITD allelic ratio of 0.2 was derived from our earlier analysis (Santos and Borthakur: Cancer 2010 in press). Kaplan-Meier product-limit survival probability estimates of overall survival (OS) and event-free survival (EFS) were calculated and log-rank tests were performed to compare the time to events between FLT3-ITD allelic ratio (low vs high) or SCT (yes vs no) groups. Results: 1043 patients with newly diagnosed AML were treated between years 2003–2009, 530 were with intermediate cytogenetics and 97 (18.3%) of these carried FLT-ITD mutation. Sixty-six (68%) patients achieved CR/CRp after induction therapy (largely high-dose cytarabine based). Among these 66 patients median age was 57.5 years (range,17-81 years), median WBC count was 13.5x 106/L (range, 1–161.5). Median OS in the entire group was 54 weeks (95% CI, 36–82 weeks). OS and EFS were better among patients with low FLT3-ITD burden (p=.006 and .003 respectively) and patients who underwent SCT (p=.01 and .005 respectively). In univariate analysis, FLT3-ITD allelic ratio and SCT were the only factors impacting OS and EFS (p= .008, .01 for OS and .005, .007 for EFS respectively). After stepwise model selection,only WBC count remained significant for OS (p= .02) while FLT-ITD allelic ratio trended towards significance (p=.07) to the exclusion of SCT. For EFS both WBC count (p=.03) and FLT-ITD allelic ratio (p=.04) remained significant in the stepwise model selection. Conclusion: Among patients with FLT-ITD mutated intermediate-risk AML who achieve CR/CRp after induction chemotherapy, OS and EFS are better among patients with low mutation burden and among patients who undergo SCT. On multi-variate analysis, FLT3-ITD mutation ratio and WBC counts appear to impact OS and EFS more than SCT. Disclosures: No relevant conflicts of interest to declare.
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Lambadiari, Vaia, George Pavlidis, Foteini Kousathana, Eirini Maratou, Dimitrios Georgiou, Ioanna Andreadou, Aikaterini Kountouri, et al. "Effects of Different Antidiabetic Medications on Endothelial Glycocalyx, Myocardial Function, and Vascular Function in Type 2 Diabetic Patients: One Year Follow–Up Study." Journal of Clinical Medicine 8, no. 7 (July 5, 2019): 983. http://dx.doi.org/10.3390/jcm8070983.
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Background: Poor glycaemic control affects myocardial function. We investigated changes in endothelial function and left ventricular (LV) myocardial deformation in poorly controlled type 2 diabetics before and after glycaemic control intensification. Methods: In 100 poorly-controlled diabetic patients (age: 51 ± 12 years), we measured at baseline and at 12 months after intensified glycaemic control: (a) Pulse wave velocity (PWV, Complior); (b) flow-mediated dilatation (FMD, %) of the brachial artery; (c) perfused boundary region (PBR) of the sublingual arterial micro-vessels (side-view dark-field imaging, Glycocheck); (d) LV global longitudinal strain (GLS), peak twisting (pTw), peak twisting velocity (pTwVel), and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography, where the ratio of PWV/GLS was used as a marker of ventricular-arterial interaction; and (e) Malondialdehyde (MDA) and protein carbonyls (PCs) plasma levels. Results: Intensified 12-month antidiabetic treatment reduced HbA1c (8.9 ± 1.8% (74 ± 24 mmol/mol) versus 7.1 ± 1.2% (54 ± 14 mmol/mol), p = 0.001), PWV (12 ± 3 versus 10.8 ± 2 m/s), PBR (2.12 ± 0.3 versus 1.98 ± 0.2 μm), MDA, and PCs; meanwhile, the treatment improved GLS (−15.2 versus −16.9%), PWV/GLS, and FMD% (p < 0.05). By multi-variate analysis, incretin-based agents were associated with improved PWV (p = 0.029), GLS (p = 0.037), PBR (p = 0.047), and FMD% (p = 0.034), in addition to a reduction of HbA1c. The patients with a final HbA1c ≤ 7% (≤ 53 mmol/mol) had greater reduction in PWV, PBR, and markers of oxidative stress, with a parallel increase in FMD and GLS, compared to those who had HbA1c > 7% (> 53 mmol/mol). Conclusions: Intensified glycaemic control, in addition to incretin-based treatment, improves arterial stiffness, endothelial glycocalyx, and myocardial deformation in type 2 diabetes after one year of treatment.
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Aghemo, Alessio, Maria Grazia Rumi, Sara Monico, Gian Maria Prati, Roberta D'Ambrosio, Maria Francesca Donato, and Massimo Colombo. "The pattern of pegylated interferon-α2b and ribavirin treatment failure in cirrhotic patients depends on hepatitis C virus genotype." Antiviral Therapy 14, no. 4 (May 2009): 577–84. http://dx.doi.org/10.1177/135965350901400415.
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Background Failure of anti-hepatitis C therapy encompasses both primary non-response and post-treatment relapse. Treatment failure to pegylated interferon (PEG-IFN)-α2b and ribavirin (RBV) largely depends upon virus genotype, but the interaction between genotype, cirrhosis and pattern of treatment failure is unclear. We aimed to assess whether cirrhosis modifies the pattern of PEG-IFN-α2b and RBV treatment failure. Methods A total of 471 treatment-naive patients with histologically proven chronic hepatitis C virus (HCV) infection (106 with cirrhosis; 185 with HCV genotype 1 [HCV-1], 157 with HCV genotype 2 [HCV-2], 92 with HCV genotype 3 [HCV-3] and 37 with HCV genotype 4 [HCV-4]) were consecutively treated with PEG-IFN-α2b 1.5 μg weekly and weight-based RBV. Results The sustained virological response (SVR) rates were 31% in HCV-1 and HCV-4, 80% in HCV-2 and 72% in HCV-3, and were lower in cirrhotic than in non-cirrhotic HCV-1 and HCV-4 (17% versus 36%; P=0.01), and HCV-3 (33% versus 79%; P=0.001), but not HCV-2 (69% versus 83%; P=0.1) patients. Treatment failure was the consequence of lower end-of-treatment response rates (37% versus 53%; P=0.06) plus higher post-treatment relapse rates (55% versus 31%; P=0.07) in cirrhotic HCV-1 and HCV-4 patients and higher rates of post-treatment relapse in HCV-2 (29% versus 10%; P=0.01) and HCV-3 cirrhotic patients (61% versus 12%; P<0.001). By multi-variate analysis, HCV-1 and HCV-4 (odds ratio [OR] 7.44, 95% confidence interval [CI] 4.87–11.36), and cirrhosis (OR 3.00, 95% CI 1.80–5.00) were independent predictors of treatment failure. Conclusions Cirrhosis is an important moderator of SVR, accounting for different patterns of treatment failure in patients infected with different genotypes.
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Madeira, I., B. Terris, M. Voss, A. Denys, A. Sauvanet, J.-F. Flejou, V. Vilgrain, J. Belghiti, P. Bernades, and P. Ruszniewski. "Prognostic factors in patients with endocrine tumours of the duodenopancreatic area." Gut 43, no. 3 (September 1, 1998): 422–27. http://dx.doi.org/10.1136/gut.43.3.422.
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Background—The development of endocrine tumours of the duodenopancreatic area (ETDP) is thought to be slow, but their natural history is not well known. The aim of this study was to determine the factors that influence survival of patients with ETDP.Patients/Methods—Eighty two patients with ETDP (44 non-functioning tumours, 23 gastrinomas, seven calcitonin-secreting tumours, four glucagonomas, three insulinomas, one somatostatinoma) followed from October 1991 to June 1997 were included in the study. The following factors were investigated: primary tumour size, hormonal clinical syndrome, liver metastases, lymph node metastases, extranodular/extrahepatic metastases, progression of liver metastases, local invasion, complete resection of the primary tumour, and degree of tumoral differentiation. The prognostic significance of these factors was investigated by uni- and multi-variate analysis.Results—Twenty eight patients (34%) died within a median of 17 months (range 1–110) from diagnosis. Liver metastases (p = 0.001), lymph node metastases (p = 0.001), progression of liver metastases (p<0.00001), lack of complete resection of the primary tumour (p = 0.001), extranodular/extrahepatic metastases (p = 0.001), local invasion (p = 0.001), primary tumour size ⩾3 cm (p = 0.001), non-functioning tumours (p = 0.02), and poor tumoral differentiation (p = 0.006) were associated with an unfavourable outcome by univariate analysis. Multivariate analysis identified only liver metastases (risk ratio (RR) = 8.3; p<0.0001), poor tumoral cell differentiation (RR = 8.1; p = 0.0001), and lack of complete resection of the primary tumour (RR = 4.8; p = 0.0007) as independent risk factors. Five year survival rates were 40 and 100% in patients with and without liver metastases, 85 and 42% in patients with and without complete resection of primary tumour, and 17 and 71% in patients with poor and good tumour cell differentiation respectively.Conclusion—Liver metastases are a major prognostic factor in patients with ETDP. Progression of liver metastases is also an important factor which must be taken into account when deciding on the therapeutic approach. The only other independent prognostic factors are tumoral cell differentiation and complete resection of the primary tumour.
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Van Den Eynde, Marc, Carine El Sissy, Amos Kirilovsky, Florence Marliot, Nacilla Haicheur, Cristina Anca Dragean, Etienne Danse, et al. "Association of T-cell infiltration assessed in pretherapeutic biopsies (PTB) of patients with locally advanced rectal adenocarcinoma (LARC) with tumor response and relapse after chemoradiotherapy (CRT) and rectal surgery." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 3599. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.3599.
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3599 Background: Pre-operative CRT followed by total mesorectal excision (TME) is nowadays the standard of care for patient with LARC (cT3-T4N0 or cTxN+). Currently, pathologic complete response occurs in +/- 15% after CRT. Colorectal cancer T-cell infiltration is a strong prognostic factor for survival after primary tumor resection. Our aim was to determine whether T-cell infiltration in PTB could be predictive of tumor response and relapse after CRT + TME. Methods: Between 1999 and 2012, patients with LARC who underwent CRT + TME and with available clinical follow-up and PTB (with sufficient tumor cells density) were identified at the Cliniques universitaires St-Luc. The density of CD3 (T cells) and CD8 (cytotoxic) was quantified on immunostained PTB slides and analyzed with a dedicated image analysis software on whole-slide imaging. Comparisons were made using the Wilcoxon-Mann-Whitney test. Cumulative disease-free survival (DFS) was performed using the Kaplan-Meier estimator and compared by log-rank tests. Cox regression we used for uni- and multi-variate analysis. P value of less than 0.05 was considered statistically significant. Results: 154 patients (sex ratio M/F 1.8; mean age 65 years-old; upper (20%), mid (29%) and low rectum (51%), synchronous metastases (11%)) were analyzed. High CD3 and CD8 PTB densities were significantly associated with a higher pathological response (Dworak 3-4) and lower ypTNM stage after CRT +TME (p < 0,05). Higher CD3 and CD8 PTB densities were associated with higher patient DFS (CD3: HR = 2,30 (CI95%:1,15-4,59) p = 0,02; CD8: HR = 1,95 (CI95%: 1,01-3,75) p = 0,04). These results were confirmed in uni and multivariate analysis. CD3 and CD8 PTB densities added to pathological response (ypTNM/Dworak) but also clinical response (ycTNM) after CRT + TME increases significantly the accuracy prediction of tumor relapse. Conclusions: Pretherapeutic T-cell infiltration of LARC is predictive of tumor response and relapse after CRT +TME. This biomarker could be helpful for patient treatment decision. It must be validated in larger patient cohorts.
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Satahoo, Shevonne, Juvonda Hodge, and Victor C. Joe. "566 Burn Disparities: Do Race, Gender and Insurance Status Affect Mortality?" Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S119—S120. http://dx.doi.org/10.1093/jbcr/irac012.194.
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Abstract Introduction The National Inpatient Sample (NIS) provides ideas of trends across the country. A recent study in trauma patients found that there were no differences in race or insurance status in regard to mortality. As such, we sought to examine these effects in burn patients and hypothesized that these trends would be similar. Methods The NIS was queried for all patients age ≥18 years with ICD-9 codes for total body surface area (TBSA) burn ≥ 20% and non-elective admissions. Years included were 2013 to the third quarter of 2015. Age, race, insurance status, TBSA, median household income for patient's zip code quartile and mortality were recorded. Cases with missing data for race, insurance status and mortality were excluded. Statistical analysis was done with student’s t-test and Chi-Square testing, as appropriate. Mortality was then used to run a binary logistic regression using these variables. A p-valve ≤0.05 was considered significant. Results There were 5685 weighted cases. Females encompassed 28.3%. The mortality rate was 21.1%. The patients that died were older (58.6 ± 19.1 years versus 44.7 ± 17.1 years for survivors, p< 0.001). On multi-variate analysis of mortality using these variables, older age (p< 0.001), female gender (odds ratio (OR) 1.26 [1.05-1.50], p=0.011), lower median household income zip code quartile (highest quartile compared to lowest OR 0.69 [0.51-0.80], p< 0.001) and insurance status (compared to government insurance, private insurance OR 0.59 [0.47-0.72]; self pay OR 1.51 [1.18-1.93], p< 0.001) were associated with mortality. Increasing TBSA was also associated with mortality. Race was not a significant contributor (p=0.432). Conclusions While there was a trend towards a higher rate of mortality in the black population, race was not associated with mortality in a statistically significant manner. Socioeconomic factors were associated with higher mortality. The dynamics between race and other social determinants of health, and the potential impact of structural racism and bias should be the focus of future research rather than on race itself, especially considering that access and resources vary by state.
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Sato, Tsutomu, Toru Aoyama, Yukio Maezawa, Kazuki Kano, Kenki Segami, Tetsushi Nakajima, Kosuke Ikeda, et al. "Impact of preoperative sarcopenia on recurrecnce in gastric cancer surgery." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 120. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.120.
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120 Background: Our previous study clarified that morbidity was a negative prognostic factor and sarcopenia defined by of the handgrip strength was a risk factor for the morbidity in gastric cancer surgery. Sarcopenia was reportedly a negative prognostic factor in colorectal cancer, hepatocellular carcinoma and malignant melanoma. This study aimed to evaluate impact of preoperative sarcopenia on recurrence-free survival (RFS) in gastric cancer surgery. Methods: Between May 2011 and June 2013, 256 consecutive primary gastric cancer patients who underwent curative surgery were retrospectively examined. Patients who received neoadjuvant chemotherapy or were diagnosed with pathological stage IV were excluded. Preoperative skeletal muscle mass was evaluated by bioelectrical impedance analysis and was expressed as skeletal muscle index or SMI (muscle mass/height2) by adjusting absolute muscle mass with height. Preoperative muscle function was measured by hand grip strength (HGS). Each cutoff value was determined as the gender-specific lowest 20% of the distribution of each measurement. Univariate and multivariate analyses were preformed to identify risk factors for RFS using a Cox proportional hazards model. Results: Median age (range) was 66 years (37-85 years). Male to female ratio was 168:88. Median follow-up period was 33.4 months. Pathological stage was I in 160, II in 48 and III in 48 patients. Univariate analysis showed that age, adjuvant chemotherapy, pT, pN, histological type, tumor size, total gastrectomy, low SMI and low HGS were significant risk factors for RFS. Multi-variate Cox’s proportional hazard analyses demonstrated that pT (HR 2.76, p = 0.0001), pN (HR 1.375, p = 0.037), histological type (HR 3.46, p = 0.014), low SMI (HR2.17, p = 0.036) were the significant risk factors for RFS. The three-year RFS was 89.1% in the patients with high SMI and 73.2% in those with low SMI (p = 0.007). Conclusions: Low SMI was an independent risk factor for RFS in Stage I-III gastric cancer. Low HGS, a risk factor for morbidity shown in our previous study, was not a risk independent factor for RFS. Preoperative sarcopenia as the short- and long-term outcomes has a value to be tested in the future prospective studies in gastric cancer surgery.
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Kuhlman, Patrick, Scott Isom, Timothy S. Pardee, Cynthia Burns, Bernard Tawfik, Zanetta S. Lamar, Bayard L. Powell, and Heidi D. Klepin. "Association between glycemic control, age, and outcomes among intensively treated patients with acute myeloid leukemia (AML)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10043. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10043.
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10043 Background: Hyperglycemia and increased glycemic variability are associated with infection and increased mortality. We evaluated the relationship between glycemic control during AML induction and outcomes by age. Methods: We retrospectively evaluated outcomes in 262 consecutive patients (pts) with newly diagnosed AML hospitalized for intensive induction at Wake Forest Baptist Hospital (2002-2009). Data on mean blood glucose (BG) (mg/dL) during hospitalization and standard deviation (SD) of BG (measure of glycemic variability, GV), complete remission ± incomplete count recovery (CR+CRi), and overall survival (OS) were collected. Modified Charlson Comorbidity Index (CCI), diabetes, age, gender, race, cytogenetics, hemoglobin, WBC, LDH, body mass index, and insurance were used in uni- and multi-variate models. We used logistic regression to evaluate CR+CRi, and Cox proportional hazard models for OS, stratified by age ( < 60 vs ≥60 yrs). Results: 124 pts were < 60 (median age 47, median OS 23.1 months), 138 were ≥60 yrs (median age 70, median OS 7.9 months). Older pts had higher baseline comorbidity (CCI > 1 60.1% vs 25.8%) and a higher prevalence of diabetes (20.3% vs 7.3%). The mean ±SD number of BG values obtained per patient during hospitalization was 61±71. The mean ±SD of each individuals mean BG during hospitalization was 111.6±16.4 in younger versus 121.7±25.9 older pts. The mean SD of BG values [GV] was 26.8±18.6 in younger versus 33±22.8 in older pts. In multivariable analysis higher mean BG was associated with lower odds of CR+CRi in younger (odds ratio (OR) 0.67, 95% CI 0.48-0.93) and older pts (OR 0.78, 95% CI 0.65-0.93) per 10 mg/dL BG increase. Higher mean BG was associated with shorter OS in older adults (HR 1.12, 95% CI 1.04-1.21). Higher GV was associated with lower odds of CR+CRi in younger (OR 0.73, 95% CI 0.56-0.96) and older (OR 0.71, 95% CI 0.57-0.88), as well as shorter OS in older pts (HR 1.17, 95% CI 1.08-1.26) for each 10 mg/dL SD increase in GV. Conclusions: Hyperglycemia and GV during intensive induction are associated with lower CR+CRi rates (all ages) and shorter OS among older adults.Glycemic control during induction may be a modifiable factor to improve AML outcomes.
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Deepa, A., D. Yashwant Singh, S. V. Mukesh Varma, and Pranshu Khakhar. "Analysis on Multi Linkage Brake System with Variable Pedal Ratio." Materials Today: Proceedings 5, no. 5 (2018): 13606–11. http://dx.doi.org/10.1016/j.matpr.2018.02.357.
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Saraf, Santosh L., Seema Sidhwani, Mohammed Farooqui, Giovanni Infusino, Lani Krauz, Michael Gowhari, Stephen Vara, et al. "Significance of, and Difficulty in Diagnosing, Erythropoietin Deficiency in Sickle Cell Anemia." Blood 112, no. 11 (November 16, 2008): 2479. http://dx.doi.org/10.1182/blood.v112.11.2479.2479.
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Abstract The clinical diagnosis of erythropoietin deficiency is usually prompted by new onset anemia on a background of elevated serum creatinine, and is then confirmed by measurement of serum erythropoietin. In patients with sickle cell anemia (SCA), who are already anemic, and in whom base-line creatinine and erythropoietin levels tend to run low, it is easy to miss this diagnosis. We demonstrate the clinical significance of erythropoietin deficiency in SCA and suggest alternative criteria for considering this diagnosis. Compensatory reticulocytosis maintains hemoglobin levels compatible with life in the chronic hemolytic anemia of SCA. Relative reticulocytopenia (RR) has been defined by the Multi-Center Study of Hydroxyurea Follow-Up Study (MSH-FU) as reticulocytes <250×109/L despite hemoglobin <9g/dl and is associated with decreased survival. However, to effectively address RR as a possible cause of early death, its underlying cause(s) must be defined. In a population of 433 SCA adult patients followed in our outpatient clinic between 1997 and 2008, 47 patients had consecutive out-patient laboratory values that met the MSH-FU definition of RR. In these patients, the mortality rate for those with RR was 55% compared to 7% in the patients without RR. Median survival from the initial clinic visit was 383 weeks for patients with RR but was not reached for patients without RR. Despite their increased risk for mortality, patients with RR did not have more frequent vaso-occlusive crises or emergency room (ER) visits (ie., ER visit frequency was a poor indicator of this population at risk). SCA causes multi-organ damage, therefore, RR could result from decreased bone marrow function, from renal damage causing a decrease in erythropoietin levels, or from both processes. In univariate analyses, RR was significantly associated with thrombocytopenia, leucopenia, elevated serum creatinine and proteinuria (p<0.001 Chi-Square). This suggested that both global bone marrow function and renal damage causing erythropoietin deficiency could be contributing to RR. This was confirmed in multi-variate analyses, in which both platelet counts and proteinuria were significantly associated with RR (p<0.0001, logistic regression). Erythropoietin levels, and the erythropoietin/reticulocyte ratio, were especially low in RR patients with hemoglobin levels <8g/dl, suggesting that erythropoietin deficiency was the major cause of RR in patients with the greatest declines in hemoglobin. Importantly, the erythropoietin/reticulocyte ratios that implicated erythropoietin deficiency in the etiology of RR were mostly noted in patients who did not meet standard clinical definitions of chronic renal failure: < 30% of the patients with RR had serum creatinine levels >1.1 or calculated creatinine clearance <60ml/min. However, 87% of the patients with RR had proteinuria as evidence of renal damage. Therefore, early renal damage, sufficient to cause proteinuria, but insufficient to cause azotemia, was associated with clinically significant erythropoietin deficiency in SCA. In conclusion, RR in adult SCA is not associated with more frequent vaso-occlusive crises but nonetheless has a major association with mortality. An important and potentially correctable cause of RR is erythropoietin deficiency, which can be diagnosed in patients with early renal damage manifest by proteinuria but without azotemia. This sub-set of SCA patients requires more study, including evaluation for the causes of death, and the possible benefits of erythropoietin replacement therapy, using end-point criteria such as survival or progression of chronic organ damage (for eg., left-ventricular dysfunction) rather than vaso-occlusive crisis frequency.
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Rofiqoh, Siti Nur Indah, Ririn Tri Ratnasari, Anik Rufaidah, and Fatin Fadhilah Hasib. "Risk-Based Bank Rating: Studi Multi Kasus pada Perbankan Syariah." Jihbiz : Jurnal Ekonomi, Keuangan dan Perbankan Syariah 6, no. 1 (January 31, 2022): 15–26. http://dx.doi.org/10.33379/jihbiz.v6i1.1039.
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Artikel ini bertujuan untuk menjelaskan analisis internal dan eksternal risiko pembiayaan bermasalah perbankan syariah. Analisis internal berkenaan dengan Capital Adequacy Ratio (CAR), Financing to Deposit Ratio (FDR), Return on Assets (ROA) Operating Expenses Ratio (OER), Financing to Value (FTV), Profit and Loss Sharing (PLS). Analisis eksternal berkenaan dengan 17 sektor Gross Domestic Product (GDP) menurut lapangan usaha. Laporan keuangan Statistik Perbankan Syariah (SPS) dan Statistik Ekonomi Keuangan Indonesia (SEKI) merupakan data sekunder yang mendukung penetapan skala prioritas pada analisis SWOT elemen IFAS dan EFAS setelah uji analisis regresi berganda. Berbeda dengan hasil uji statistik, temuan penelitian berdasarkan analisis SWOT menyimpulkan bahwa variabel internal lebih berdampak pada risiko pembiayaan bermasalah dibandingkan variabel eksternal. Adapun variabel internal yang dominan mempengaruhi adalah kenaikan Rasio Beban Biaya Operasional. Kelemahan penulisan artikel ini adalah implikasi SPS dan SEKI sebagai data kuantitatif yang dikualitatifkan, kepatuhan syariah dari regulator manajemen perbankan syariah serta kepatuhan syariah dari penyedia data SPS dan SEKI.
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GADRE, M. P., and R. N. RATTIHALLI. "LIKELIHOOD RATIO BASED MULTI-ATTRIBUTE CONTROL CHART." International Journal of Reliability, Quality and Safety Engineering 12, no. 02 (April 2005): 149–66. http://dx.doi.org/10.1142/s0218539305001744.
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In a production process, when quality of the product depends on more than one characteristic, 'Multivariate Quality Control' (MQC) techniques are efficiently used. Many MQC techniques have been developed to control the multivariate variable processes, but no much work has been reported to control the multivariate attribute processes. In this article, to detect a change in the vector of fraction non-conforming, we develop 'Likelihood Ratio based Multi-Attribute Control Chart' (LR-MACC) using the exact joint distribution and the LR-test under multinomial setup. It is verified that, in some situations, LR-MACC is superior to the MNP chart proposed by Lu et al.7 When MACC gives a signal, the attributes responsible are not readily identifiable. Therefore, a procedure to detect the responsible attributes is also developed.
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Garas, Samy, and Suzanna ElMassah. "Corporate governance and corporate social responsibility disclosures." critical perspectives on international business 14, no. 1 (March 5, 2018): 2–26. http://dx.doi.org/10.1108/cpoib-10-2016-0042.
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Purpose The purpose of this study is to explore the impact of corporate governance (CG) on the corporate social responsibility (CSR) disclosures. This is done in the context of firms operating in the Gulf Cooperation Council (GCC) countries and is largely based on the legitimacy theory, although other theories such as principal–agent theory and stakeholder theory are disucssed. Design/methodology/approach This study used the annual reports of 147 firms in the GCC countries, drawing on a legitimacy theory framework to determine the impact of CG characteristics, such as management ownership, ownership concentration, independence of board members, duality of CEO and chairman positions and the existence of an audit committee, on firms’ CSR disclosures to various stakeholders. Accordingly, the authors developed five hypotheses to examine the above variables and used a data set from Hawkamah – the Institute of Corporate Governance. This study covers a period of six years (2007-2012). The data set had been regressed in a multi-variate regression analysis. Findings The authors reported that greater managerial ownership and concentration of ownership have positive impact on CSR disclosures. The findings of this study also show that internal CG mechanisms, such as the independence of board members, the separation of powers, between the CEO and chairman positions and the existence of an independent audit committee, also have a positive influence on CSR disclosures. In addition, the leverage ratio, return on assets, company’s size and age emerge as important determinants of CSR disclosures; nevertheless, the company’s size and age are statistically not significant. These significant findings corroborate the recent concern with CG in developing countries that brings greater attention to CSR disclousures, as both internal and external CG mechanisms are effective in influencing the CSR practices. Practical implications This study fills the gap in literature by providing empirical evidence on the impact of CG on CSR disclosures in a significant region in the emerging economies. Furthermore, it alerts regulators, policy-makers, practitioners and firms’ executives in the GCC region and other developing countries to pay more attention to CG reforms and enforcement as well as to increase institutional pressures regarding CSR adaptation. Originality/value The study on how CG and CSR disclosures are connected has been limited. This study addresses this research gap and focuses on a region that has often been overlooked by accounting research.
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KANG, Jungchul, Masaharu KOMORI, Fumi TAKEOKA, and Yuji ONODERA. "Multi-Speed Ratio Variable System to Transmit Power and Motion Continuously." TRANSACTIONS OF THE JAPAN SOCIETY OF MECHANICAL ENGINEERS Series C 77, no. 782 (2011): 3871–80. http://dx.doi.org/10.1299/kikaic.77.3871.
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Murugapoopathi, S., and D. Vasudevan. "Energy and exergy analysis on variable compression ratio multi-fuel engine." Journal of Thermal Analysis and Calorimetry 136, no. 1 (October 3, 2018): 255–66. http://dx.doi.org/10.1007/s10973-018-7761-2.
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Temesgen, Hailemariam, Valerie LeMay, and Stephen J. Mitchell. "Tree crown ratio models for multi-species and multi-layered stands of southeastern British Columbia." Forestry Chronicle 81, no. 1 (February 1, 2005): 133–41. http://dx.doi.org/10.5558/tfc81133-1.
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The ratio of live crown length to tree height (crown ratio; CR) is often used as an important predictor variable for tree level growth equations, particularly for multi-species and multi-layered stands. Also, CR indicates tree vigour and can be an important habitat variable. Measurement of CR for each tree can be time-consuming and difficult to obtain in very dense stands and for very tall trees where the base of live crown is obscured. Models to predict CR from size, competition and site variables were developed for several coniferous and one hardwood tree species growing in multispecies and multi-layered forest stands (complex stands) of southeastern British Columbia. Simple correlations indicated the expected relationships of CR decreasing with increasing height, and with increasing competition. A logistic model form was used to constrain predicted CR values to the interval [0,1]. Also, predictors were divided into tree size, stand competition, and site measures, and the contribution of each set of contributors was examined. For all models, height was an important predictor. The stand competition measure, basal area of larger trees, contributed significantly to predicting CR given that crown competition factor was also included as a measure of competition. Logical trends in CR versus size and competition variable groups were reflected by the models; site variable slightly improved predictions for some species. Much of the variability in CR was not accounted for, indicating that other variables are important for explaining CR changes in these complex stands. Key words: crown ratio, multi-species stands, multi-layered stands, basal area of larger trees