Chance Of Survival Research Articles

Metal-Free Custom-Made Zirconia Implants-A Prospective 5-Year Follow-Up Single-Arm Clinical Trial.

Dental implants made of zirconia (ZrO2) are a potential alternative for titanium implants in dentistry because of their good biocompatibility, mechanical properties and excellent aesthetic results. However, solid long-term scientific data to prove clinical success of ZrO2 implants are scarce. The aim of this study was to describe and to examine the clinical performance of custom-made two-piece ZrO2 implants, to identify possible influencing factors: a) manipulation of the implant after placement and b) the occlusal scheme on the survival rate, and to evaluate the performance of the implant-supported crown. This follow-up study collected and examined the 5-year data to answer the main question: What are the survival and the success rates of custom-made ZrO2 implants in the maxillary premolar region after 5 years? Of the 31 included patients in this prospective 5-year follow-up single-arm clinical trial, 30 received a custom-made ZrO2 implant to replace a missing single maxillary premolar, which was subsequently restored with a lithium disilicate crown. Parameters regarding clinical performance, marginal bone-level (MBL) changes, and patient-related outcome measures (PROMs) were assessed preoperatively, at the baseline, as well as 1 and 5 years after crown placement. Chances of survival and success of the implant were calculated and displayed using Kaplan-Meier statistics. Kaplan-Meier survival analysis was also performed with stratification based on the variables "manipulation of the implant prior to impression taking" and "occlusal scheme" and compared using log-rank tests. Bone-level moderation in time was compared using a paired samples t-test. Patient's expectations and satisfaction after 5 years were compared as a measure of fulfilled expectations, using a Wilcoxon signed-rank test. Performance of the implant-supported crowns was evaluated using validated criteria. Survival and success probabilities after 5 years were, respectively, 75.8% (95% CI [60.0%; 91.0%]) and 71.0% (95% CI [54.0%; 88.0%]) for the custom-made ZV3 implants. No significant differences in survival rate were found after stratification on "manipulation of the implant" and on "occlusal scheme." Mean bone-level alteration between baseline and the first follow-up was +0.06 mm (95% CI [-0.23 mm; 0.12 mm]; SD = 0.42 mm) and between baseline and the second follow-up was +0.04 mm (95% CI [-0.35 mm; 0.26 mm]; SD = 0.54 mm). Patients' satisfaction for patients with implants still in function after 5 years was 91.7% (IQR = [90.5%-97.3%]), indicating satisfaction with the treatment. Pooled satisfaction in patients with successful implants after 5 years was significantly higher than patients' expressed expectations before treatment. None of the crowns failed, and no interventions were required. Survival rate of these particular ZV3 implants in our study was lower than expected and clinically not acceptable. Hence, ZV3 implant placement as applied in this study cannot be recommended for clinical practice. Further research on the different appearances of mechanical failure in ZrO2 implants would be highly recommended before a larger prospective randomized clinical trial is conducted to evaluate treatment with custom-made ZrO2 dental implants.

Incremental and Radical Innovations that Contribute to the Survival of Small Businesses in Environments of Crisis

This paper examines the influence of incremental and radical innovations on the survival capacity of micro and small companies (MSE) in contexts of economic crisis.State of the art on innovation points to a lack of a specific methodology to segregate incremental and radical innovation in MSEs. Identifying such a method allows for action to promote innovation in such more assertive companies, contributing to the survival of companies in the most adverse moments, such as crises.In this sense, a methodology was developed to identify the type and degree of innovation based on the level of innovation in the sector of activity and was applied to a sample of 60 companies in the textile retail sector. The dependent variable was business survival, measured by the continuity or cessation of activity in 2020. The estimate of the probability of survival was carried out using a binary logistic regression model.The dimensions of incremental innovation, which are the most common in the business environment, did not significantly affect survival. The dimensions of radical innovation, which imply deeper and more disruptive changes in the business model, had a positive impact. significant impact on survival in all cases. The most complex actions in the Solutions dimension increased the chances of survival by 42%; improving Processes by 39%; and innovation in the Square by 38%. These findings suggest that small businesses that adopt radical innovations have greater adaptability and resilience to adverse situations.

Energy and protein nutrition adequacy in general wards among intensive care unit survivors: A systematic review and meta-analysis.

Adequate energy and protein provision is mandatory to optimize survival chances in critical illness, prevent loss of muscle mass, and reduce length of stay. Data are available concerning feeding adequacy in intensive care unit (ICU) participants, but little is known about the adequacy in post-ICU participants. This systematic review aimed to evaluate feeding adequacy in post-ICU participants and addressed causes of feeding interruption leading to suboptimal adequacy. For this systematic review, a bibliographic search was performed in PubMed, Scopus, and Web of Science. Randomized controlled studies, non-randomized controlled studies, and observational studies conducted between January 1990 and November 2023 fulfilling the inclusion criteria were withheld. Eight studies were included. Outcomes reported were energy and protein adequacy, barriers, and feeding routes. Energy and protein requirements were determined in various ways, including indirect calorimetry and standardized and weight-based formulas. Energy adequacy ranged from 52% to 102% and protein adequacy between 63% and 86%. Participants were mainly fed with enteral nutrition (EN) or a combination of oral nutrition and EN. The main barrier reported for inadequate nutrition intake was feeding tube removal. Next to different ways in calculating targets and reporting results, a wide range in energy and protein adequacy was observed, but with constant protein underfeeding. Participants fed with EN or a combination of EN and oral nutrition had the best adequacy; inappropriate tube removal is a common barrier leading to inadequate therapy. Standardized reporting and larger studies are needed to guide nutrition care for post-ICU participants.

Adaptation to different temperatures results in wing size divergence of the invading species Drosophila nasuta (Diptera: Drosophilidae) in Brazil.

Invasive species threaten biodiversity on a global scale. The success of invasions depends on the species' adaptation to the different environmental conditions of new territories. Studies show that invasive insects present evolutionary changes in wing morphology in areas they are introduced to in response to abiotic conditions. In the last decade, the Asian Drosophila nasuta fly invaded and spread widely throughout Brazil. This insect has preferences for conserved environments and is related to the likely reduction in the abundance of native drosophilids in the Atlantic Forest. Ecological niche modelling analyses showed that rainfall and temperature are the main factors which delimit the geographic distribution of this species. Herein, we verified the existence of significant differences in the wing sizes of D. nasuta in Brazil and evaluated the influence of abiotic factors (rainfall and temperature) on the observed patterns. We conducted 11 measurements on the right-side wings of 240 D. nasuta males collected in the Amazon Forest, Caatinga, Cerrado and Atlantic Forest. Statistical analyses revealed the existence of two groups: one with larger wings, which brought together samples from locations with the lowest temperatures; and one with smaller wings, which corresponded to places with a hotter climate. One explanation for this result is the fact that large wings favour greater heat capture by flies in colder climates, increasing their survival chances in these environments. These rapid evolutionary changes in D. nasuta in this first decade of invasion in Brazil reveal the enormous adaptive potential of this species in this megadiverse country.

External morphology and growth patterns of larvae and juveniles of Bryconops gracilis (Characiformes, Iguanodectidae) from Amazon basin

During early development, fishes undergo significant changes that influence external morphology and the functioning of internal organs and systems. This often results in gradual variation of the morphological traits of individuals across developmental stages. The investigation of larval and juvenile fish development and growth patterns has pertinent implications for the systematic and ecological elucidation of species. Bryconops gracilis is a medium-sized fish, omnivorous that inhabits lotic and lentic environments with acidic and transparent waters in the Amazon basin. In this study, the early development of B. gracilis is described, until recently a practically unknown species. In terms of development, we used morphological, meristic, and morphometric data to characterize the larvae and juveniles. The individuals were collected in the Curuá-Una River, Amazon basin, Brazil. Fifty-four specimens were examined. Samples include individuals with 3.39 to 21.79mm SL. Yolk-sac larvae have two attachment organs on the dorsal surface of head and body. The larvae of B. gracilis are considered altricial, with a fusiform body, and the intestine reaches the median region of the body. Initially, the mouth is subterminal and becomes isognathic from the postflexion stage on. During the postflexion stage, the most relevant morphological changes occur (e.g., presence of all fins, mouth position similar to adults, increased body pigmentation), making individuals more specialized to explore new habitats and diets and maximize their chances of survival. Furthermore, vertebrae and myomeres are compared and assist with differentiating some Bryconops species at early life stages that occur in sympatry in the Amazon basin. Our results contribute to knowledge about the external morphology of neotropical freshwater fishes, enabling the identification of larvae and juveniles through traditional taxonomy and broadening the perspective on the ontogenetic study of the adipose fin in Characoidei.

NOVEL DRUG COMBINATIONS AND DONOR LYMPHOCYTE INFUSIONS ALLOW PROLONGED DISEASE CONTROL IN MULTIPLE MYELOMA PATIENTS RELAPSING AFTER ALLOGENEIC TRANSPLANT: New treatments for Multiple Myeloma patients relapsing after Allo transplant

BackgroundEven if allogeneic stem cell transplantation (allo-SCT) is curative for a minority of patients with multiple myeloma (MM), the patients who have relapsed after allo-SCT can experience long-term survival, suggesting a synergy between anti-myeloma drugs administered after allo-SCT and donor T cells. ObjectivesWe retrospectively evaluated the outcome of MM patients reported to the “Gruppo Italiano Trapianto Midollo Osseo e Terapia Cellulare” (GITMO) network, who underwent allo-SCTs between 2009 and 2018 in order to identify predictors for long-term outcome in the whole population (242 patients) and for prolonged overall survival (OS) after relapse in the subgroup of relapsed patients (118 patients). ResultsAt a median follow-up of 40.9 months after allo-SCT median OS and progression free survival (PFS) of the whole population were respectively 39.4 and 19.0 months from allo-SCT. The cumulative incidence (CI) of non-relapse mortality (NRM) was 10.3 % at one year and 27.6% at five years. Grade 2-4 acute GVHD CI was 19.8% and 5-year CI of moderate or severe chronic GVHD was 31.8%. In the multivariate model older age at transplant (p=0.020), treatment with more than 2 lines of therapy before allo-SCT (p=0.003) and transplant from unrelated or haploidentical donor (p=0.025) were significant factors associated with reduced OS. Relapse after allo-SCT occurred in 118 (59%) patients at a median of 14.3 months (IQR 7.2-26.9). Twenty (17%) received only steroids, radiotherapy or supportive care, 41 (35%) received 1 line, 23 (19%) 2 lines and 34 patients (29%) 3 or 4 lines of salvage treatment. Nine patients were exclusively treated with chemotherapy, 9 received at least one salvage treatment including immunomodulating agents (Imids), 43 patients were treated with at least one rescue therapy including proteasome inhibitors (PIs) and 37 patients received at least one salvage treatment including monoclonal antibodies (33 daratumumab, 1 elotuzumab, 1 isatuximab, 2 belantamab). Median OS of relapsed patients was 38.5 months from allo-SCT and 20.2 months from relapse. In multivariate analysis, OS after relapse was significantly prolonged in patients with a longer time to relapse after allo-SCT (time to relapse 6-24 months p=0.016; time to relapse ≥ 24 months p< 0.001) and in those who had received at least 3 salvage treatment lines (p<0.036) and donor lymphocyte infusions (DLI) (p=0.020). ConclusionsIn our study, patients transplanted in early phases of disease and with HLA identical sibling donors had the best chance of long-term survival. Late relapse after allo-SCT, multiple courses of salvage treatment and the association with DLI could allow long disease control in patients who experienced relapse after allo-SCT.

Hypoxic Stress Induces Complement-Mediated Lysis of Mesenchymal Stem Cells by Downregulating Factor H and CD59.

Factor H and membrane inhibitor of reactive lysis (CD59) are key regulators of complement activation. Mesenchymal stem cells (MSCs) secrete Factor H and express CD59 to protect themselves from complement-mediated damage. Severe hypoxia found to decrease the survival chances of MSCs after transplantation; however, little is known about the impact of severe hypoxia on modulating the complement system activity and its effect on MSCs survival. Our study seeks to explore the effect of severe hypoxia on modulating the complement cascade in MSCs. Human adipose tissue-derived MSCs (hAD-MSCs) were cultured under severe hypoxia using 400μM Cobalt Chloride (CoCl2) for 48h. The protein expressions of survival marker; Phosphoinositide 3-kinases (PI3K), and pro-apoptotic marker; Caspase-3 were assessed using western blotting. The level of complement system related factors; Factor H, CD59, C3b, iC3b, C5b, C9, and the complement membrane attack complex (MAC) were analyzed using Elisa assays, western blotting, and immunocytochemistry. Our results showed for the first time that severe hypoxia can significantly impair Factor H secretion and CD59 expression in MSCs. This has been associated with upregulation of MAC complex and increased level of cell lysis and apoptosis marked by downregulation of PI3K and upregulation of Annexin v and Caspase-3. The loss of Factor H and CD59 in hypoxic MSCs can initiate their lysis and apoptosis mediated by activating MAC complex. Preserving the level of Factor H and CD59 in MSCs has significant clinical implication to increase their retention rate in hypoxic conditions and prolong their survival.

Risk for appropriate ICD intervention and complications in patients implanted after an out-hospital cardiac arrest compared to patients implanted for primary and other secondary prevention indication

Abstract Background Few data are available about patients implanted with an implantable cardioverter defibrillators (ICDs) after an out-of-hospital cardiac arrest (OHCA). In particular, it is unclear if these patients have a higher risk of appropriate device therapy than patients implanted for primary and other secondary prevention. Purpose To assess if appropriate device interventions (ATP/shocks) are higher in patients implanted after OHCA compared to patients implanted for primary and secondary prevention other than OHCA. To verify also if mortality, implantation-related complications (pneumothorax, hemothorax, hematoma, cardiac tamponade), device-related complications (lead displacement and fracture, infections) and inappropriate shocks/ATP are higher in OHCA patients compared to other patients. Methods This is a retrospective multicenter international study. All the patients implanted with an ICD between January 2015 and December 2016 in the participating centers were included. Follow-up was considered concluded in case of death or at the last follow-up available until December 2023. Patients were divided according to ICD implantation indication (secondary prevention after OHCA, other secondary prevention, primary prevention). Results 1386 patients (79% males; median age 67, IQR 59-74) from 15 centers were included with a median follow-up of 83 months: 111 patients in OHCA group, 134 in other secondary prevention group and 1141 in primary prevention group. Considering the first appropriate intervention, a significant difference among the three groups was observed (Fig.1A) and, at post-hoc comparison, the OHCA group was at higher risk than primary prevention (HR 1.51, 95%CI 1.06-2.17, p=0.02), but was at similar risk than other secondary prevention (HR 0.79, 95%CI 0.51-1.23, p=0.3). This was confirmed also after correction for age, gender, history of atrial fibrillation, aetiology and multi-comorbidity (Fig.2A). However, considering the number of appropriate interventions during follow-up, the risk of OHCA group was lower than other secondary prevention (IRR 0.28, 95%CI 0.11-0.68, p&amp;lt;0.01) and similar to primary prevention (IRR 0.97, 95%CI 0.47-1.96, p=0.93), also after correction for the other predictors (Fig.2B). The three groups showed no differences in survival (Fig.1B), implantation-related complication, device-related complications (Fig.1C) and inappropriate shocks/ATP. Conclusion Patients implanted with an ICD after an OHCA have a risk similar to those implanted for other secondary prevention, when considering the first appropriate intervention, but a risk similar to those implanted for primary prevention when considering the number of appropriate interventions during follow-up. Our study confirms that OHCA patients represents a peculiar population with the same chance of survival and rate of complications compared to primary and other secondary prevention patients suggesting the need of more studies to improve their long-term treatment.Figure 1 (Panel A, B and C)Figure 2 (Panel A and B)

Breast cancer imaging-clinical experience with two-dimensional-shear wave elastography: A retrospective study.

Breast cancer morbidity has been increasing worldwide, but treatments are improving. The therapeutic response depends on the stage at which the disease is diagnosed. Therefore, early diagnosis has never been more essential for successful treatment and a reduction in mortality rates. Radiology plays a pivotal role in cancer detection, and advances in ultrasound (US) palpation have shown promising results for breast cancer imaging. The addition of two-dimensional-shear wave elastography (2D-SWE) US in the routine breast imaging exam can increase early cancer detection and promote better surveillance. To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities. The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions. All patients underwent mammography, bright mode (B-mode) US, and 2D-SWE followed by US-guided biopsy in two consecutive sessions. Combining B-mode and shear wave US imaging with X-ray mammography revealed 100% of the suspicious lesions, resulting in greater sensitivity, specificity, and negative predictive value. The result improves compared to either B-mode or 2D-SWE alone (P = 0.02). Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection. Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Lung cancer screening: Real screening site data, Vojvodina, Serbia

Abstract Background Lung cancer (LC) is the top cause of cancer-related deaths globally and in Serbia, often diagnosed in advanced stage of disease with when 5-year survival is 10% to 20%. LC screening with low-dose CT (LDCT) can decrease LC mortality and overall mortality. The first pilot LC screening program in Serbia started in the Institute for Pulmonary Diseases of Vojvodina in September 2020. The main objective of this study was to analyze LC patient characteristics according to their screening status. Methods This retrospective study utilized LC hospital registry data from September 2020 to December 2023, including gender, age at diagnosis, settlement area, smoking habits, cancer histological type, TNM classification, disease stage (1-4), and data on participation in LC screening. Group differences were assessed using chi-square and Student’s t-tests, with analyses conducted in SPSS v24.0. Results During observed period from a total of 4649 LC cases 2948 (63.4%) were males, and 73 (1.6%) were included in LC screening. Average age of all LC patients was 66 years, without differences between groups (p = 0.778). Significant differences between groups by gender were find (p = 0.042). Non-screened LC patients were significantly common males compared to females (63.6% vs 36.4%), while among screened difference by gender were lower (52.1% vs 47.9%, respectively). Screened compared to non-screened LC patients have significantly lower percentage of SCLC (9.6% vs 19.1%), and higher percentage of NSCLC (90.4% vs 80.9%), (p = 0.040). According to LC stage, screened compared to non-screened patients were significantly common diagnosed in stage I of disease (45.8% vs 7.8%), and significantly less common in higher LC stages; stage IIIB (11.1% vs 22.5%), and in stage IV (22.2% vs 45.7%), (p &amp;lt; 0.001). Conclusions LC screening with LDCT is proven secondary preventive measure with significant influence on decreasing LC mortality by increasing number of LC patients in early stages of disease. Key messages • Lung cancer screening with low-dose CT significantly increases early-stage diagnoses, improving survival chances. • Population strategies to prevent smoking and screening programs for high-risk groups are needed to reduce lung cancer incidence and mortality rates in Serbia.

Tax Evasion and Company Survival: A Brazilian Case Study

Enterprises face significant growth and survival challenges in highly competitive markets. Many companies fail to meet their tax obligations, which deprives society of essential resources and often results in tax penalties. This article examines whether companies that receive tax fines for evasion have a longer or shorter life expectancy compared to those that consistently comply with tax regulations. To analyze survival rates, the Kaplan–Meier estimator and Cox regression model were applied, considering factors such company size, sector, location, and tax evasion fines. The study included data from 11,297 firms established in 2017, in Rio Grande do Sul, Brazil. The findings indicate that companies fined for tax evasion had a higher survival rate (69%) compared to those without fines (38%) by 2023. This suggests that fines might serve as a corrective measure, helping companies realign and improve their chances of survival. Additionally, the study shows that medium-sized enterprises face significant challenges, possibly due to exceeding the limits of a simplified tax regime. This study highlights the importance of continued research across different regions and countries to validate these findings and enhance tax administration strategies.

Time to Treatment and Outcomes of Hemorrhagic Stroke, Comparing Patients Entering Surgery before and after 120 Minutes Upon Arrival at the Emergency Department Pattani Hospital

Background: The duration between a patient’s hospital arrival and the point at which they enter surgery for hemorrhagic stroke affects survival, length of stay, health care costs, and outcome (Glasgow Outcome Scale). Therefore, a study to explore the effects of time on these outcomes is warranted. Objective: To compare treatment outcomes of patients with hemorrhagic stroke having entered surgery before and after 120 minutes upon arrival at the emergency department. Materials and Methods: A therapeutic and interventional study with a retrospective observational cohort design at Pattani Hospital in patients with hemorrhagic stroke who received treatment between October 2018 and April 2023. A retrospective review of medical records, which collected clinical characteristics and the time to treatment. Glasgow Outcome Scale was evaluated at 72 hours, two weeks, one month, and date of hospital discharge. Length of stay, health care costs, and survival status at date of hospital discharge were analyzed. Comparative analysis was performed by Fisher’s exact probability test and t-test, and prognostic analysis was performed by risk ratio. Results: Of all the patients in the present study, 49 and 182 received treatment before and after 120 minutes, respectively, upon arrival at the emergency department. Clinical characteristics of gender, age, underlying conditions, regular medications, and level of consciousness were not significantly different between the two groups. Patients who entered surgery within 120 minutes of arrival had more occurrences of basal ganglia hemorrhage compared with those who received surgery thereafter. Furthermore, patients who received surgery within 120 minutes had a 11.4% increased chance of survival. The number needed to treat (NNT) hemorrhagic stroke patients with a time to treatment of under 120 minutes is 9. However, there was an associated increase in complications, health care cost, and length of stay. The Glasgow Outcome Scale improvement was greater only in the two-week follow-up period. These results were similar when subarachnoid hemorrhage and anticoagulating medication used were excluded. Conclusion: Patients with hemorrhagic stroke who receive early surgical treatment have lower mortality rates. Adequate provision of personnel and facilities for delivering prompt care should be made available. Measures should be taken to reduce the complications of patients who receive surgical treatment after 120 minutes upon arrival at the emergency department.

Aromatase, testosterone, TMPRSS2: determinants of COVID-19 severity

BackgroundMale sex has been identified as a risk factor for worse COVID-19 outcomes. This sex difference has been mostly attributed to the complex role of sex hormones. Cell surface entry of SARS-CoV-2 is mediated by the transmembrane protease serine 2 (TMPRSS2) which is under transcriptional regulation by androgens. P450 aromatase enzyme converts androgens to estrogens. This study measured concentrations of aromatase enzyme, testosterone, estradiol, and TMPRSS-2 in plasma of hospitalized COVID-19 patients to elucidate the dynamics of sex-linked disparity in COVID-19 and correlate them with disease severity and mortality.MethodsIn this prospective cohort study, a total of 265 patients (41% women), age 18 years and older, who had a positive COVID-19 PCR test and were hospitalized for COVID-19 at Memorial Hermann Hospital in Houston, (between May 2020 and May 2021) were enrolled in the study if met inclusion criteria. Plasma concentrations of Testosterone, aromatase, TMPRSS-2, and estradiol were measured by ELISA. COVID-19 patients were dichotomized based on disease severity into moderate-severe (n = 146) or critical (n = 119). Mann Whitney U and logistic regression were used to correlate the analytes with disease severity and mortality.ResultsTMPRSS2 (2.5 ± 0.31 vs. 1.73 ± 0.21 ng/mL, p < 0.01) and testosterone (1.2 ± 0.1 vs. 0.44 ± 0.12 ng/mL, p < 0.01) were significantly higher in men as compared to women with COVID-19 after adjusting for age in a multivariate model. There was no sex difference seen in the level of estradiol and aromatase in COVID-19 patients. TMPRSS2 and aromatase were higher, while testosterone was lower in patients with increased COVID-19 severity. They were independently associated with COVID-19 severity, after adjusting for several baseline risk factors in a multivariate logistic regression model. In terms of mortality, TMPRRS2 and aromatase levels were significantly higher in non-survivors.ConclusionsOur study demonstrates that testosterone, aromatase, and TMPRSS2 are markers of COVID-19 severity. Estradiol levels do not change with disease severity in COVID-19. In terms of mortality prediction, higher aromatase and TMPRSS-2 levels can be used to predict mortality from COVID-19 in hospitalized patients.Plain English SummaryCOVID-19 has caused over a million deaths in the U.S., with men often getting sicker than women. Testosterone, a male hormone, helps control a protein called TMPRSS-2, which allows the COVID-19 virus to spread more easily in the body. A protein called aromatase converts the male hormone testosterone into the female hormone estrogen. It is thought that female hormone estrogen helps protect women from getting seriously ill from COVID-19. To understand the role of these hormones in COVID-19 and sex differences, we measured levels of testosterone, estrogen, aromatase (which turns testosterone into estrogen), and TMPRSS-2 in hospitalized COVID-19 patients. We also checked how this level might reflect the severity of the disease. We found that critically ill COVID-19 patients (the ones in ICU) had higher levels of TMPRSS-2 and aromatase, and lower testosterone levels. When we used these hormone levels to predict death in hospitalized COVID-19 patients, higher levels of TMPRSS-2 and aromatase were linked to a lower chance of survival.

They Deserve to Live: Impact of the Berlin Heart EXCOR on Small Children's Heart Transplant Waitlist in Low-Resource Settings.

Background: In newly emerging economy countries, the shortage of pediatric donor hearts and poor healthcare infrastructure poses a significant challenge. Although mechanical circulatory support (MCS) has been proven effective in enhancing heart transplant waiting list outcomes, economic barriers hinder its widespread adoption. Methods: A single-center retrospective study reviewed children under 10 kg on the heart transplant (HTx) list from 2012 to 2023. Elective or priority status was assigned based on their clinical condition at the time of transplant. In cases of clinical decompensation, centrifugal pump and extracorporeal membrane oxygenation, transitioned to the Berlin Heart EXCOR (BHE) pediatric ventricular assist device (VAD) was employed. Pre- and post-HTx outcomes were analyzed with descriptive statistics, Cox regression, and competing survival risks. Results: Out of 81 infants on the HTx list, 61.7% (50/81) were in critical condition. The median wait time was 224 days, and 34% (28/81) died while waiting. Out of 37 transplanted patients, 6 (16%) had graft dysfunction, and 10 (27%) had acute renal injury. Survival to discharge was 84% (31/37). Patients who received the BHE exhibited higher chances of receiving a transplant (hazard ratio: 2.3; 95% confidence interval: 1.2-4.6; P = .01). Priority status or MCS use did not significantly impact mortality post-transplant. Conclusion: Advanced MCS technologies can potentially reduce the mortality risk on the pediatric HTx waitlist. The findings highlight the significant waiting time for HTx and the critical role of the BHE in improving outcomes in children, particularly those under 10 kg. The results advocate for the adoption of ventricular assist devices as a viable interim solution to bridge critically ill children to HTx, ultimately enhancing their chances of survival despite limited donor heart availability.

Spatial attention-based CSR-Unet framework for subdural and epidural hemorrhage segmentation and classification using CT images

BackgroundAutomatic diagnosis and brain hemorrhage segmentation in Computed Tomography (CT) may be helpful in assisting the neurosurgeon in developing treatment plans that improve the patient’s chances of survival. Because medical segmentation of images is important and performing operations manually is challenging, many automated algorithms have been developed for this purpose, primarily focusing on certain image modalities. Whenever a blood vessel bursts, a dangerous medical condition known as intracranial hemorrhage (ICH) occurs. For best results, quick action is required. That being said, identifying subdural (SDH) and epidural haemorrhages (EDH) is a difficult task in this field and calls for a new, more precise detection method.MethodsThis work uses a head CT scan to detect cerebral bleeding and distinguish between two types of dural hemorrhages using deep learning techniques. This paper proposes a rich segmentation approach to segment both SDH and EDH by enhancing segmentation efficiency with a better feature extraction procedure. This method incorporates Spatial attention- based CSR (convolution-SE-residual) Unet, for rich segmentation and precise feature extraction.ResultsAccording to the study’s findings, the CSR based Spatial network performs better than the other models, exhibiting impressive metrics for all assessed parameters with a mean dice coefficient of 0.970 and mean IoU of 0.718, while EDH and SDH dice scores are 0.983 and 0.969 respectively.ConclusionsThe CSR Spatial network experiment results show that it can perform well regarding dice coefficient. Furthermore, Spatial Unet based on CSR may effectively model the complicated in segmentations and rich feature extraction and improve the representation learning compared to alternative deep learning techniques, of illness and medical treatment, to enhance the meticulousness in predicting the fatality.

Machine learning algorithm approach to complete blood count can be used as early predictor of COVID-19 outcome.

Although the SARS-CoV-2 infection has established risk groups, identifying biomarkers for disease outcomes is still crucial to stratify patient risk and enhance clinical management. Optimal efficacy of COVID-19 antiviral medications relies on early administration within the initial five days of symptoms, assisting high-risk patients in avoiding hospitalization and improving survival chances. The complete blood count can be an efficient and affordable option to find biomarkers that predict the COVID-19 prognosis due to infection-induced alterations in various blood parameters. This study aimed to associate hematological parameters with different COVID-19 clinical forms and utilize them as disease outcome predictors. We performed a complete blood count in blood samples from 297 individuals with COVID-19 from Belo Horizonte, Brazil. Statistical analysis, as well as ROC Curves and machine learning Decision Tree algorithms were used to identify correlations, and their accuracy, between blood parameters and disease severity. In the initial four days of infection, traditional hematological COVID-19 alterations, such as lymphopenia, were not yet apparent. However, the monocyte percentage and granulocyte-to-lymphocyte ratio proved to be reliable predictors for hospitalization, even in cases where patients exhibited mild symptoms that later progressed to hospitalization. Thus, our findings demonstrate that COVID-19 patients with monocyte percentages lower than 7.7% and a granulocyte-to-lymphocyte ratio higher than 8.75 are assigned to the hospitalized group with a precision of 86%. This suggests that these variables can serve as important biomarkers in predicting disease outcomes and could be used to differentiate patients at hospital admission for managing therapeutic interventions, including early antiviral administration. Moreover, they are simple parameters that can be useful in minimally equipped health care units.

A data mining approach to identify key radioresponsive genes in mouse model of radiation induced intestinal injury

Radiation-mediated GI injury (RIGI) in humans either due to accidental or intentional exposures, can only be managed with supporting care with no approved countermeasures available till now. Early detection and monitoring of RIGI is important for effective medical management and improve survival chances in exposed individual. The present study aims to identify new signatures of RIGI using data mining approach followed by validation of selected hub genes in mouse model. Using microarray datasets from Gene Expression Omnibus database, differentially expressed genes were identified. Pathway analysis suggested lipid metabolism as one of the predominant pathways altered in irradiated GI tissue. A protein-protein interaction network revealed top 08 hub genes related to lipid metabolism, namely Fabp1, Fabp2, Fabp6, Npc1l1, Ppar-α, Abcg8, Hnf-4α, and Insig1. qRT-PCR analysis revealed significant up-regulation of Fabp6 and Hnf-4α and down-regulation of Fabp1, Fabp2 and Insig1 transcripts in irradiated intestine. Radiation dose and time kinetics study revealed that the selected 05 genes were altered differentially in the irradiated intestine. Extensive alteration in lipid profiles and modification was observed in irradiated intestine. Finding suggests that lipid metabolism is one of the key targets of radiation and its mediators may act as biomarkers in detection and progression of RIGI.

Molecular mechanisms of resistance and new therapeutic approaches in the treatment of colorectal cancer - a review of the literature

CRC occupies one of the leading positions among gastrointestinal malignancies and is a significant problem in Europe since it is the third most frequently diagnosed cancer. Recent developments in diagnostic techniques have led to higher chances of early diagnosis and survival; nevertheless, CRC is highly likely to relapse in the survivorably younger individuals. The importance of the current chemotherapy treatment and potential key therapeutic targets are identified in this review so that the molecular alterations causing drug resistance in CRC can be studied.Current literature formed the basis of this review by reviewing the molecular processes that underlie CRC, with emphasis on the mutational alterations in genes such as SENP1, KRAS, APC, TP53, and BRAF that play critical roles in CRC and resistance to treatment. Chemotherapy for CRC, targeting therapies, and immuno therapies have been discussed particularly with reference to their effectiveness for treatment and overcoming resistance.Genomic alterations in some important genes are involved in the onset of CRC and also determined the response to therapies. The KRAS mutations are associated with the resistance to EGFR inhibitors; however, BRAF mutations require BRAF/MEK inhibitors. Lack of MMR system SSR as a trigger for MSI-H status suggests a better response to immunotherapies. In addition, new molecules including SENP1, which involved the DNA repair pathway, and combination using CDK4/6 inhibitors are currently under development to overcome resistance and enhance the patients’ benefits.Colorectal cancer is still a problem, primarily because of its genetic character and high rates of recurrence. Even though chemotherapy and targeted therapies offer helpful results, the problem of resistance stands in the way. Subsequent studies should aim at symptomatic treatment outcomes and combine different drugs in order to enhance long-term treatment outcomes.

Potential Identification of Root System Architecture Using GPR for Tree Translocation as a Sustainable Forestry Task: A Case Study of the Wild Service Tree

Sustainable economic development serves society but requires taking over space, often at the expense of areas occupied by single trees or even parts of forest areas. Techniques for transplanting adult trees used in various conflict situations at the interface of economy and nature work as a tool for sustainable management of urbanized and industrial areas, as well as, in certain circumstances, forest or naturally valuable areas. This study aimed to evaluate the effectiveness of ground-penetrating radar (GPR) in determining the horizontal and vertical extent of tree root systems before transplantation. Employing this non-invasive method to map root system architecture aids in the appropriate equipment selection and helps define the dimensions and depth of trenches to minimize root damage during excavation. This study specifically focused on the root systems of wild service trees (Sorbus torminalis (L.) Crantz) found in a limestone mine area, where some specimens were planned to be transplanted, as the species is protected under law in Poland. The root systems were scanned with a ground-penetrating radar equipped with a 750 MHz antenna. Then, the root balls were dug out, and the root parameters and other dendrometric parameters were measured. The GPR survey and manual root analyses provided rich comparative graphic material. The number of the main roots detected by the GPR was comparable to those inventoried after extracting the stump. The research was carried out in problematic soil, causing non-standard deformations of the root systems. Especially in such conditions, identifying unusually arranged roots using the GPR method is valuable because it helps in a detailed planning of the transplanting process, minimizing root breakage during the activities carried out, which increases the survival chances of the transplanted tree in a new location.

XU-NetFullSharp: The Novel Deep Learning Architecture for Chest X-ray Bone Shadow Suppression

Background and objectivesChest X-ray image (CXR) is vital for screening, preventing, and monitoring various lung diseases. In particular, the early detection of lung cancer can significantly improve patients’ chances of survival and quality of life. Unfortunately, approximately 82–95 % of missed pulmonary nodules are estimated to be obscured by rib shadows, making them difficult to recognize. This study addresses this problem by considering the rib shadows in CXRs as noise that can be reduced using deep learning. The result of the proposed model is a CXR with improved clarity for easier and more accurate analysis by radiologists or computer algorithms. MethodsAn automated deep learning-based model for bone shadow suppression from frontal CXRs, called xU-NetFullSharp, was proposed. This network is inspired by the most modern U-NetSharp architecture and was modified using different approaches to preserve as many details as possible and accurately suppress bone shadows. For comparison, recent state-of-the-art models were implemented and trained. JSRT, VinDr-CXR, and Gusarev DES datasets were utilized for the experiments, where the JSRT dataset was extensively augmented. ResultsThe performance of the proposed xU-NetFullSharp was analyzed using statistical measures and compared with that of other architectures. The proposed model significantly outperformed the others, reaching the best values of the most used metrics (0.9846 SSIM; 0.9870 MS-SSIM). It also achieves a correlation of 96.31 % and an intersection of 10.0285 between the predicted and ground truth histograms, together with the smallest value of the Bhattacharyya distance. The obtained results were validated by experts from the University Hospital Olomouc with positive feedback, thus achieving the best objective and subjective results. The proposed method has the potential to be implemented in hospital environments. ConclusionA comprehensive comparison of the proposed architecture with state-of-the-art methods proves its efficiency in suppressing noise in CXRs and its ability to distinguish the signals of important tissues from noise components. This methodology can potentially improve the performance of the existing CXR processing methods. The source code is released in a GitHub repository that can be accessed from the following link: https://github.com/xKev1n/xU-NetFullSharp.