Critical Events Research Articles

Remembering the Recession: Marketplace and Status Quo Journalism

Ten years after the 2008 Great Recession, US media recalled the experiences and lessons learned from its aftermath. Among these was Marketplace's Divided Decade project, which spanned calendar year 2018 and included 66 discrete stories covering the impact on individuals and different sectors. The project cut across both Marketplace Morning and its evening broadcast Marketplace, both syndicated by American Public Media (APM). Marketplace appeals to a public radio audience of elite, educated listeners who are located away from financial power centers but still wield influence. This audience is larger than any other U.S. broadcast business program. Using theories of affect, this paper will demonstrate how Marketplace's recollection of a critical event continued to shape attitudes about the economy. By using critical discourse analysis (CDA), I unearth how power is reified through financial news reporting practices. Marketplace's focus on individual narratives decoupled the crisis from its structural context, while its reliance on economic policy leaders emphasized their affective memories and justified official responses. Divided Decade upheld the status quo by separating the impact of the crisis from the lives that were affected, while foreclosing alternative approaches to the problems the 2008 crisis laid bare.

Why Talking Is Not Cheap: Adverse Events and Informal Communication.

Healthcare management faces significant challenges related to upward communication. Sharing information in healthcare is crucial to the improvement of person-centered, safe, and effective patient care. An adverse event (AE) is an unintended or unexpected incident that causes harm to a patient and may lead to temporary or permanent disability. Learning from adverse events in healthcare is crucial to the improvement of patient safety and quality of care. Informal communication channels represent an untapped resource with regard to gathering data about the development of AEs. In this viewpoint paper, we start by identifying how informal communication played a key factor in some high-profile adverse events. Then, we present three Critical Challenge points that examine the role of informal communication in adverse events by (1) understanding how the prevailing trends in healthcare will make informal communication more important, (2) explaining how informal communication is part of the group-level sensemaking process, and (3) highlighting the potential role of informal communication in "breaking the silence" around critical and adverse events. Gossip, as one of the most important sources of informal communication, was examined in depth. Delineating the role of informal communication and adverse events within the healthcare context is pivotal to understanding and improving team and upward communication in healthcare organizations. For clinical leaders, the challenge is to cultivate a climate of communication safety, whereby informal communication channels can be used to collect soft intelligence that are paths to improving the quality of care and patient safety.

AUTOMATED TEXT ANALYSIS OF HISTORICAL DOCUMENTS USING MACHINE LEARNING TECHNIQUES

This paper presents an innovative approach to the automated analysis of historical documents through the application of advanced machine learning techniques. The problem background in automated text analysis of historical documents using machine learning techniques is efficiently processing large volumes of diverse historical texts to extract valuable insights and patterns, enhancing historical research and understanding. Leveraging the power of natural language processing, this study proposes a comprehensive framework that encompasses data preprocessing, feature extraction, and model training, enabling the efficient extraction of valuable insights from vast collections of historical texts. By utilizing cutting-edge algorithms, including deep learning and sentiment analysis, the research demonstrates the potential of this approach in uncovering hidden patterns, sentiments, and semantic nuances within historical documents, thereby facilitating a deeper understanding of the past and shedding light on critical historical events and societal developments.

The Effect of Nucleo-Olivary Stimulation on Climbing Fiber EPSPs in Purkinje Cells

Climbing fibers, connecting the inferior olive and Purkinje cells, form the nervous system's strongest neural connection. These fibers activate after critical events like motor errors or anticipation of rewards, leading to bursts of excitatory postsynaptic potentials (EPSPs) in Purkinje cells. The number of EPSPs is a crucial variable when the brain is learning a new motor skill. Yet, we do not know what determines the number of EPSPs. Here, we measured the effect of nucleo-olivary stimulation on periorbital elicited climbing fiber responses through in-vivo intracellular Purkinje cell recordings in decerebrated ferrets. The results show that while nucleo-olivary stimulation decreased the probability of a response occurring at all, it did not reduce the number of EPSPs. The results suggest that nucleo-olivary stimulation does not influence the number of EPSPs in climbing fiber bursts.

Belt electrode tetanus muscle stimulation reduces denervation-induced atrophy of rat multiple skeletal muscle groups

Belt electrode-skeletal muscle electrical stimulation (B-SES) involves the use of belt-shaped electrodes to contract multiple muscle groups simultaneously. Twitch contractions have been demonstrated to protect against denervation-induced muscle atrophy in rats, possibly through mitochondrial biosynthesis. This study examined whether inducing tetanus contractions with B-SES suppresses muscle atrophy and identified the underlying molecular mechanisms. We evaluated the effects of acute (60 Hz, 5 min) and chronic (60 Hz, 5 min, every alternate day for one week) B-SES on the tibialis anterior (TA) and gastrocnemius (GAS) muscles in Sprague–Dawley rats using belt electrodes attached to both ankle joints. After acute stimulation, a significant decrease in the glycogen content was observed in the left and right TA and GAS, suggesting that B-SES causes simultaneous contractions in multiple muscle groups. B-SES enhanced p70S6K phosphorylation, an indicator of the mechanistic target of rapamycin complex 1 activity. During chronic stimulations, rats were divided into control (CONT), denervation-induced atrophy (DEN), and DEN + electrically stimulated with B-SES (DEN + ES) groups. After seven days of treatment, the wet weight (n = 8–11 for each group) and muscle fiber cross-sectional area (CSA, n = 6 for each group) of the TA and GAS muscles were reduced in the DEN and DEN + ES groups compared with that in the CON group. The DEN + ES group showed significantly higher muscle weight and CSA than those in the DEN group. Although RNA-seq and pathway analysis suggested that mitochondrial biogenesis is a critical event in this phenomenon, mitochondrial content showed no difference. In contrast, ribosomal RNA 28S and 18S (n = 6) levels in the DEN + ES group were higher than those in the DEN group, even though RNA-seq showed that the ribosome biogenesis pathway was reduced by electrical stimulation. The mRNA levels of the muscle proteolytic molecules atrogin-1 and MuRF1 were significantly higher in DEN than those in CONT. However, they were more suppressed in DEN + ES than those in DEN. In conclusion, tetanic electrical stimulation of both ankles using belt electrodes effectively reduced denervation-induced atrophy in multiple muscle groups. Furthermore, ribosomal biosynthesis plays a vital role in this phenomenon.

Twenty-year tango: Exploring the reciprocal influence of macro-financial instability and climate risks

This study presents a novel investigation of the reciprocal relationship between financial instability and climate risks, focusing on the influence of climate policy uncertainty within the US financial system from a macroeconomic perspective. By adopting the bootstrap rolling-window causality method, the analysis captures structural changes over an extended period between January 2000 and March 2021. Importantly, this method provides a robust data-driven approach, avoiding ad hoc assumptions about temporal breakpoints. The results support the climate fragility hypothesis, highlighting the amplifying effect of financial instability on climate risks. The study reveals that periods of economic and political turbulence exacerbate these effects by generating substantial financial turbulence, which, in turn, influences climate policy. The results also indicate that climate policy uncertainty contributes to worsening financial instability during critical events such as sudden changes in interest rates and major financial crises. The implications of this research extend to policymakers and investors, encouraging them to integrate climate factors into decision-making processes and adopt sustainable practices to promote financial stability and mitigate climate-related risks.

Unraveling cradle-to-grave disease trajectories from multilayer comorbidity networks

We aim to comprehensively identify typical life-spanning trajectories and critical events that impact patients’ hospital utilization and mortality. We use a unique dataset containing 44 million records of almost all inpatient stays from 2003 to 2014 in Austria to investigate disease trajectories. We develop a new, multilayer disease network approach to quantitatively analyze how cooccurrences of two or more diagnoses form and evolve over the life course of patients. Nodes represent diagnoses in age groups of ten years; each age group makes up a layer of the comorbidity multilayer network. Inter-layer links encode a significant correlation between diagnoses (p < 0.001, relative risk > 1.5), while intra-layers links encode correlations between diagnoses across different age groups. We use an unsupervised clustering algorithm for detecting typical disease trajectories as overlapping clusters in the multilayer comorbidity network. We identify critical events in a patient’s career as points where initially overlapping trajectories start to diverge towards different states. We identified 1260 distinct disease trajectories (618 for females, 642 for males) that on average contain 9 (IQR 2–6) different diagnoses that cover over up to 70 years (mean 23 years). We found 70 pairs of diverging trajectories that share some diagnoses at younger ages but develop into markedly different groups of diagnoses at older ages. The disease trajectory framework can help us to identify critical events as specific combinations of risk factors that put patients at high risk for different diagnoses decades later. Our findings enable a data-driven integration of personalized life-course perspectives into clinical decision-making.

Anterior knee laxity is greater in athletic females who attain menarche at a younger age.

Females with above-average anterior knee laxity values are at increased risk of anterior cruciate ligament (ACL) injury. The purpose of this study was to examine the effects of menarche age (MA) and menarche offset on anterior knee laxity in young, physically active women. Anterior knee laxity (KT-2000) and menstrual characteristics (per self-report) were recorded in 686 Slovenian sportswomen from team handball, volleyball and basketball club sports (average years sport participation: 7.3 ± 3.6 years). Females were stratified into four groups based on their self-reported age at menarche: 9-11, 12, 13 and 14+ years. Anterior knee laxity was compared across MA groups using a univariate analysis of variance (ANOVA) with Bonferroni correction, with and without controlling for factors that could potentially differ between groups and influence anterior knee laxity. Females were then stratified into four groups based on the number of years they were away from their age at onset of menarche. Groups were compared using a univariate ANOVA with Bonferroni correction, with and without controlling for factors that differed between groups and could influence anterior knee laxity. Anterior knee laxity was greater in females who attained menarche at 12 years of age (6.4 ± 1.5 mm) or younger (6.6 ± 1.6 mm) compared to 14 years of age or older (5.8 ± 1.2 mm) (p < 0.001; partial η2 = 0.032). Anterior knee laxity was 0.7-1.4 mm greater in females who were 5 or more years away from menarche compared to those who were within 2 years of menarche (5.8 ± 1.3 mm; p < 0.001). Anterior knee laxity is greater in females who attained menarche at a younger age and in females who are 5 or more years postmenarche. Age of menarche represents a critical pubertal event that is easy for women to recall and may provide important insights into factors that moderate anterior knee laxity, a risk factor for ACL injury in women. Level IV.

Telomerase-related advances in hepatocellular carcinoma: A bibliometric and visual analysis.

As a critical early event in hepatocellular carcinogenesis, telomerase activation might be a promising and critical biomarker for hepatocellular carcinoma (HCC) patients, and its function in the genesis and treatment of HCC has gained much attention over the past two decades. To perform a bibliometric analysis to systematically assess the current state of research on HCC-related telomerase. The Web of Science Core Collection and PubMed were systematically searched to retrieve publications pertaining to HCC/telomerase limited to "articles" and "reviews" published in English. A total of 873 relevant publications related to HCC and telomerase were identified. We employed the Bibliometrix package in R to extract and analyze the fundamental information of the publications, such as the trends in the publications, citation counts, most prolific or influential writers, and most popular journals; to screen for keywords occurring at high frequency; and to draw collaboration and cluster analysis charts on the basis of coauthorship and co-occurrences. VOSviewer was utilized to compile and visualize the bibliometric data. A surge of 51 publications on HCC/telomerase research occurred in 2016, the most productive year from 1996 to 2023, accompanied by the peak citation count recorded in 2016. Up to December 2023, 35226 citations were made to all publications, an average of 46.6 citations to each paper. The United States received the most citations (n = 13531), followed by China (n = 7427) and Japan (n = 5754). In terms of national cooperation, China presented the highest centrality, its strongest bonds being to the United States and Japan. Among the 20 academic institutions with the most publications, ten came from China and the rest of Asia, though the University of Paris Cité, Public Assistance-Hospitals of Paris, and the National Institute of Health and Medical Research (INSERM) were the most prolific. As for individual contributions, Hisatomi H, Kaneko S, and Ide T were the three most prolific authors. Kaneko S ranked first by H-index, G-index, and overall publication count, while Zucman-Rossi J ranked first in citation count. The five most popular journals were the World Journal of Gastroenterology, Hepatology, Journal of Hepatology, Oncotarget, and Oncogene, while Nature Genetics, Hepatology, and Nature Reviews Disease Primers had the most citations. We extracted 2293 keywords from the publications, 120 of which appeared more than ten times. The most frequent were HCC, telomerase and human telomerase reverse transcriptase (hTERT). Keywords such as mutational landscape, TERT promoter mutations, landscape, risk, and prognosis were among the most common issues in this field in the last three years and may be topics for research in the coming years. Our bibliometric analysis provides a comprehensive overview of HCC/telomerase research and insights into promising upcoming research.

Analyzing Questions About Alcohol in Pregnancy Using Web-Based Forum Topics: Qualitative Content Analysis.

Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol spectrum disorder. Although UK national guidance recommends abstaining from alcohol if pregnant or planning a pregnancy, evidence suggests that confusion remains on this topic among members of the public, and little is known about what questions people have about consumption of alcohol in pregnancy outside of health care settings. This study aims to assess what questions and topics are raised on alcohol in pregnancy on a web-based UK-based parenting forum and how these correspond to official public health guidelines with respect to 2 critical events: the implementation of the revised UK Chief Medical Officers' (CMO) low-risk drinking guidelines (2016) and the first COVID-19 pandemic lockdown (2020). All thread starts mentioning alcohol in the "Pregnancy" forum were collected from Mumsnet for the period 2002 to 2022 and analyzed using qualitative content analysis. Descriptive statistics were used to characterize the number and proportion of thread starts for each topic over the whole study period and for the periods corresponding to the change in CMO guidance and the COVID-19 pandemic. A total of 395 thread starts were analyzed, and key topics included "Asking for advice on whether it is safe to consume alcohol" or on "safe limits" and concerns about having consumed alcohol before being aware of a pregnancy. In addition, the Mumsnet thread starts included discussions and information seeking on "Research, guidelines, and official information about alcohol in pregnancy." Topics discussed on Mumsnet regarding alcohol in pregnancy remained broadly similar between 2002 and 2022, although thread starts disclosing prenatal alcohol use were more common before the introduction of the revised CMO guidance than in later periods. Web-based discussions within a UK parenting forum indicated that users were often unclear on guidance and risks associated with prenatal alcohol use and that they used this platform to seek information and reassurance from peers.

Ficolin-A/2 Aggravates Severe Lung Injury through Neutrophil Extracellular Traps Mediated by Gasdermin D–Induced Pyroptosis

Neutrophil extracellular traps (NETs) and pyroptosis are critical events in lung injury. We aimed to investigate whether Ficolin-A influences NET formation through pyroptosis to exacerbate lipopolysaccharides (LPS)-induced lung injury. The expression of Ficolin-A/2, NETs, and pyroptosis-related molecules was investigated in animal and cell models. Knockout and knockdown (recombinant protein) methods were employed to elucidate regulatory mechanisms. Pearson's correlation coefficient was utilized to analyze the correlation between Ficolins and pyroptosis- and NET-related markers in clinical samples. In this study, Ficolin-2 (similar to Ficolin-A) showed significant overexpression in patients with acute respiratory distress syndrome (ARDS). In vivo, knockout of Ficolin-A, but not Ficolin-B, attenuated lung inflammation and inhibited NET formation in LPS-induced mouse model. DNaseI further alleviated lung inflammation and NET formation in Ficolin-A knockout mice. In vitro, neutrophils derived from Fcna-/- mice exhibited less pyroptosis and necroptosis than those from the control group after LPS stimulation. Additionally, gasdermin D (GSDMD) knockdown or Nod-like receptor protein 3 (NLRP3) inhibitor reduced NET formation. Addition of recombinant Ficolin-2 protein to human peripheral blood neutrophils promoted NET formation and pyroptosis after LPS stimulation, whereas Ficolin-2 knockdown had opposite effects. ARDS patients exhibited increased levels of pyroptosis- and NET-related markers, which were positively correlated with Ficolin-2 levels. In conclusion, these results suggested that Ficolin-A/2 exacerbated NET formation and LPS-induced lung injury via the GSDMD-mediated pyroptosis.

RETINOBLASTOMA RELATED 1 switches mitosis to meiosis in rice

The transition from mitosis to meiosis is a critical event in the reproductive development of all sexually reproducing species. However, the mechanisms that regulate this process in plants remain largely unknown. Here, we find that the rice (Oryza sativa L.) protein RETINOBLASTOMA RELATED 1 (RBR1) is essential to the transition from mitosis to meiosis. Loss of RBR1 function results in hyper-proliferative sporogenous-cell-like cells (SCLs) in the anther locules during early stages of reproductive development. These hyper-proliferative SCLs are unable to initiate meiosis, eventually stagnating and degrading at late developmental stages to form pollen-free anthers. These results suggest that RBR1 acts as a gatekeeper of entry into meiosis. Furthermore, cytokinin content is significantly increased in rbr1 mutants, whereas the expression of type-B response factors, particularly LEPTO1, is significantly reduced. Given the known close association of cytokinins with cell proliferation, these findings imply that hyper-proliferative germ cells in the anther locules may be attributed to elevated cytokinin concentrations and disruptions in the cytokinin pathway. Using a genetic strategy, the association between germ cell hyper-proliferation and disturbed cytokinin signaling in rbr1 has been confirmed. In summary, we reveal a unique role of RBR1 in the initiation of meiosis; our results clearly demonstrate that the RBR1 regulatory module is connected to the cytokinin signaling pathway and switches mitosis to meiosis in rice.

The self-management experiences of individuals who perceive health as beyond their control: An interpretive phenomenological study of individuals with ischemic heart disease.

This qualitative study aimed to gain an understanding of what it means to live with ischemic heart disease for individuals who perceive health as beyond their control and how these individuals navigate their choices regarding adhering or not adhering to self-management behavior. Participants were recruited through purposive sampling, and semi-structured interviews were conducted. Content analysis was employed to identify themes and subthemes in the interview data. The theme, "attribution of ischemic heart disease," revealed that the participants attributed their condition to lifestyle, critical events, and the natural aging process. The theme, "experiences of self-management," highlighted the different behaviors among participants who perceived health to be beyond their control. The theme, "barriers and facilitators," identified factors such as a strong sense of responsibility toward family members, the work environment, and access to medical resources. Our study showed that despite perceiving their health to be beyond their control, some individuals may still adhere to self-management practices. Understanding factors such as "attribution" and "barriers and facilitators" can provide nurses with insights into the patients' decisions to adhere or not adhere to self-management behaviors.

Experimental characterisation of a launcher’s fairing separation shock and its influence on RF antennas’ supporting structures

Fairing separation is a critical event during a rocket’s launch as it generates mechanical shocks that can cause partial or total onboard equipment failure. This study details the experimental results of the fairing separation shock of the launcher RFA ONE and its influence on the supporting structures of RF antennas. Accelerometers were used at multiple points of neighbouring structures to characterise the separation devices’ shock during fairing separation tests. Moreover, the shock propagation on different material structures, such as aluminium, carbon fibre, and Viton® elastomer sealant, was investigated. The results showed that the presence of Viton® sealant increased shock transmissibility. Further investigation was conducted to study the influence of applied torque on the separation locks on the shock levels. The study revealed that higher torques lead to increased magnitudes of shock acceleration. Finally, the paper provides recommendations for reducing the shock levels. The experimental results and recommendations presented in this paper provide valuable insights for launcher designers and manufacturers to ensure the safety and reliability of shock-sensitive components during flight.

Lysine methyltransferase5C increases the proliferation and metastatic abilities of clear cell renal cell carcinoma via aerobic glycolysis.

Among all types of renal cancer, clear cell renal cell carcinoma (ccRCC) is the most common and lethal subtype and is associated with a high risk of metastasis and recurrence. Histone modifications regulate several biological processes that are fundamental to the development of cancer. Lysine methyltransferase5C (KMT5C; also known as SUV420H2) is an epigenetic modifier responsible for the trimethylation of H4K20, which drives critical cellular events, including genome integrity, cell growth and epithelial‑mesenchymal transition (EMT), in various types of cancer. However, the role of KMT5C in ccRCC remains unclear. As such, the expression and function of KMT5C in ccRCC were investigated in the present study. KMT5C expression was significantly increased in ccRCC tissues compared with normal tissues (P<0.0001), and it was closely associated with the overall survival rate of patients with ccRCC. By establishing ccRCC cell lines with KMT5C expression knockdown, the role of KMT5C in the maintenance of aerobic glycolysis in ccRCC cells via the regulation of several vital glycolytic genes was identified. Additionally, KMT5C promoted the proliferation and EMT of ccRCC cells by controlling crucial EMT transcriptional factors. Together, these data suggested that KMT5C may act as an oncoprotein, guide molecular diagnosis, and shed light on novel drug development and therapeutic strategies for patients with ccRCC.

Comprehensive risk assessment of a renewables‐based stand‐alone electric vehicle charging station with multiple energy storage technologies

AbstractThis study presents the application of a comprehensive risk assessment and risk management framework on a grid‐independent and renewable energy‐based electric vehicle charging station with multiple energy storage techniques including hydrogen and ammonia. The design comprises complex subsystems such as concentrated photovoltaic thermal, wind turbine, biomass standby generator, hydrogen storage, fuel cell, Ammonia storage and fuel cell, Lithium‐ion battery storage, Salt‐hydrate thermal storage, lithium‐bromide absorption cooling, and fast charging units. Systematic risk‐based approaches compromising multiple phases and qualitative and quantitative risk assessment techniques are applied to identify the causes and consequences of potentially critical events associated with the incorporated subsystems and components. The results show that out of 15 identified technical, economic, environmental, and health and safety risks, three health and safety risks were found unacceptable with risk values above 14. In contrast, three technical, three environmental, two health and safety, and one economic risks were found undesirable with risk values between 8 and 12. Appropriate preventive and protective measures are applied to lessen the high‐risk levels to acceptable safe limits below 6. Proper safety barriers and distances are considered while recommending the associated subsystems and components' optimal physical site distribution plan.

Development of a deep learning model for predicting critical events in a pediatric intensive care unit.

Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality. This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing. Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700-1.000). The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.

Interventions of Body Image Disorder among Adolescent: A Literature Review

Adolescence represents the transition from childhood to adulthood and is associated with physical and social changes. Adolescence is a critical period in the development of body image. Critical events or sequences of events such as temptation and rejection can cause body image misperceptions or disturbances. The aim of this literature review is to identify interventions that nurses can do to overcome the problem of body image disorders in adolescents. The method used in the search is the literature study method with a series that includes searching for journal articles using certain keywords from the PubMed and CINAHL databases in the 2018 - 2023 period. The search results obtained 445 articles discussing body image disturbance interventions in adolescents, but only five articles that can meet the inclusion criteria. The results of the study showed that five interventions can be used to treat body image disorders in adolescents, namely application-based interventions (BodiMojo), Healthy Body Image (HBI) interventions, puberty education based on health belief models, application-based Cognitive-behavioral Therapy (CBT), and universal wellness programs. The five interventions proved to be effective in overcoming body image disorders in adolescents.

Development of a deep learning model that predicts critical events of pediatric patients admitted to general wards

Early detection of deteriorating patients is important to prevent life-threatening events and improve clinical outcomes. Efforts have been made to detect or prevent major events such as cardiopulmonary resuscitation, but previously developed tools are often complicated and time-consuming, rendering them impractical. To overcome this problem, we designed this study to create a deep learning prediction model that predicts critical events with simplified variables. This retrospective observational study included patients under the age of 18 who were admitted to the general ward of a tertiary children’s hospital between 2020 and 2022. A critical event was defined as cardiopulmonary resuscitation, unplanned transfer to the intensive care unit, or mortality. The vital signs measured during hospitalization, their measurement intervals, sex, and age were used to train a critical event prediction model. Age-specific z-scores were used to normalize the variability of the normal range by age. The entire dataset was classified into a training dataset and a test dataset at an 8:2 ratio, and model learning and testing were performed on each dataset. The predictive performance of the developed model showed excellent results, with an area under the receiver operating characteristics curve of 0.986 and an area under the precision-recall curve of 0.896. We developed a deep learning model with outstanding predictive power using simplified variables to effectively predict critical events while reducing the workload of medical staff. Nevertheless, because this was a single-center trial, no external validation was carried out, prompting further investigation.

Hyper Mucinous Proliferations in the Mucosa of Patients with Inflammatory Bowel Disease: Histological Lesions with a Real Potential for Neoplastic Evolution?

Mucin disfunction is a critical event in the pathogenesis of inflammatory bowel disease (IBD). Although hyper mucinous conditions have a still debated implication in the clinical evolution of this disorder, hyper mucinous villous proliferations were found to have a preneoplastic biologic potential. We studied morphologic and immunophenotypic characteristics of these lesions in ileocolonic resections for IBD to add evidence about the evolutive potential of these lesions in samples with well oriented wall structures. Morphologic characteristics of bowel samples from 20 patients resected for IBD and with raised lesions at gross examination were studied and sections from cases with hyper mucinous lesions were stained with the following antibodies: Ki 67, p21, and p27, which were employed to evaluate the characteristics of the proliferative and differentiative activity of the epithelial structures; mismatch repair proteins and p53 have been studied as proteins implicated in carcinogenesis in IBD-affected mucosa; mucins subtypes in hyper mucinous structures were evaluated with MUC-2 and MUC-6. The results in 11 cases of saplings were that they harbored hyper mucinous proliferations. The occurrence of hyper mucinous structures was not related to dysplastic lesions, pseudo pyloric metaplasia, subtype of disease, or activity. In only one of our cases, mild cytologic atypia in the proliferative compartment was detected. Proliferation markers (Ki 67, p53) were expressed in the proliferative compartments of mucosal crypts and antiproliferative proteins p21 and p27 were expressed in differentiated epithelium. MMR proteins expression was limited to the proliferative compartment of the hyper mucinous projections. Mucin subtypes distribution was regular in the epithelium of hyper mucinous proliferations. The present monocentric retrospective study was conducted on surgical samplings with well oriented crypts. Collected data show that hyper mucinous features are frequent occurrences in raised lesions in IBD patients. In hyper mucinous proliferations of the selected cases, the status of the proliferative cycle, the expression of the proteins most frequently involved in carcinogenetic pathways of mucosa affected by IBD, and the mucins subtypes expression have no evident anomalies. Findings are not consistent with the increased risk of neoplastic evolution observed in other studies; rather, they suggest a hyperplastic nature. However, the capacity of hyper mucinous raised lesions for neoplastic evolution should be ruled out with more extensive prospective studies to identify functional defects that could explain the hypothesized neoplastic potential.