Cumulative Distribution Function Research Articles

Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center

BackgroundPeritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes.MethodsBetween 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed.ResultsThe overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, hemodialysis transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%.ConclusionsThe implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.

MDE and LLM Synergy for Network Experimentation: Case Analysis of Wireless System Performance in Beaulieu-Xie Fading and κ-µ Co-Channel Interference Environment with Diversity Combining

Channel modeling is a first step towards the successful projecting of any wireless communication system. Hence, in this paper, we analyze the performance at the output of a multi-branch selection combining (SC) diversity receiver in a wireless environment that has been distracted by fading and co-channel interference (CCI), whereby the fading is modelled by newer Beaulieu-Xie (BX) distribution, and the CCI is modelled by the κ-µ distribution. The BX distribution provides the ability to include in consideration any number of line-of-sight (LOS) useful signal components and non-LOS (NLOS) useful signal components. This distribution contains characteristics of some other fading models thanks to its flexible fading parameters, which also applies to the κ-µ distribution. We derived here the expressions for the probability density function (PDF) and cumulative distribution function (CDF) for the output signal-to-co-channel interference ratio (SIR). After that, other performances are obtained, namely: outage probability (Pout), channel capacity (CC), moment-generating function (MGF), average bit error probability (ABEP), level crossing rate (LCR), and average fade duration (AFD). Numerical results are presented in several graphs versus the SIR for different values of fading and CCI parameters, as well as the number of input branches in the SC receiver. Then, the impact of parameters on all performance is checked. From our numerical results, it is possible to directly obtain the performance for all derived and displayed quantities for cases of previously known distributions of fading and CCI by inserting the appropriate parameter values. In the second part of the paper, a workflow for automated network experimentation relying on the synergy of Large Language Models (LLMs) and model-driven engineering (MDE) is presented, while the previously derived expressions are used for evaluation. Due to the aforementioned, the biggest value of the obtained results is the applicability to the cases of a large number of other distributions for fading and CCI by replacing the corresponding parameters in the formulas for the respective performances.

Association of neutrophil-lymphocyte ratio with all-cause and cardiovascular mortality in US adults with diabetes and prediabetes: a prospective cohort study

BackgroundThe neutrophil-lymphocyte ratio (NLR) is a novel hematological parameter to assess systemic inflammation. Prior investigations have indicated that an increased NLR may serve as a potential marker for pathological states such as cancer and atherosclerosis. However, there exists a dearth of research investigating the correlation between NLR levels and mortality in individuals with diabetes and prediabetes. Consequently, this study aims to examine the connection between NLR and all-cause as well as cardiovascular mortality in the population of the United States (US) with hyperglycemia status.MethodsData were collected from a total of 20,270 eligible individuals enrolled for analysis, spanning ten cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The subjects were categorized into three groups based on tertiles of NLR levels. The association of NLR with both all-cause and cardiovascular mortality was evaluated using Kaplan-Meier curves and Cox proportional hazards regression models. Restricted cubic splines were used to visualize the nonlinear relationship between NLR levels and all-cause and cardiovascular mortality in subjects with diabetes after accounting for all relevant factors.ResultsOver a median follow-up period of 8.6 years, a total of 1909 subjects with diabetes died, with 671 deaths attributed to cardiovascular disease (CVD). And over a period of 8.46 years, 1974 subjects with prediabetes died, with 616 cases due to CVD. The multivariable-adjusted hazard ratios (HRs) comparing high to low tertile of NLR in diabetes subjects were found to be 1.37 (95% CI, 1.19–1.58) for all-cause mortality and 1.63 (95% CI, 1.29–2.05) for CVD mortality. And the correlation between high to low NLR tertile and heightened susceptibility to mortality from any cause (HR, 1.21; 95% CI, 1.03–1.43) and CVD mortality (HR, 1.49; 95% CI, 1.08–2.04) remained statistically significant (both p-values for trend < 0.05) in prediabetes subjects. The 10-year cumulative survival probability was determined to be 70.34%, 84.65% for all-cause events, and 86.21%, 94.54% for cardiovascular events in top NLR tertile of diabetes and prediabetes individuals, respectively. Furthermore, each incremental unit in the absolute value of NLR was associated with a 16%, 12% increase in all-cause mortality and a 25%, 24% increase in cardiovascular mortality among diabetes and prediabetes individuals, respectively.ConclusionsThe findings of this prospective cohort study conducted in the US indicate a positive association of elevated NLR levels with heightened risks of overall and cardiovascular mortality among adults with diabetes and prediabetes. However, potential confounding factors for NLR and the challenge of monitoring NLR’s fluctuations over time should be further focused.

Vascular syndrome predicts the development and course of epilepsy after perinatal stroke.

Epilepsy develops in one third of the patients after perinatal stroke. It is still unclear which vascular syndrome of ischemic stroke carries higher risk of epilepsy. The aim of the current study was to evaluate the risk of epilepsy according to the vascular syndrome of perinatal stroke. The study included 39 children with perinatal arterial ischemic stroke (13 with anterior or posterior trunk of the distal middle cerebral artery occlusion, 23 with proximal or distal M1 middle cerebral artery occlusion and three with lenticulostriate arteria infarction), and 44 children with presumed perinatal venous infarction. Magnetic resonance imaging obtained at the chronic stage was used to evaluate the vascular syndrome of stroke. The median follow-up time was 15.1 years (95% CI: 12.4-16.5 years), epilepsy developed in 19/83 (22.9%) patients. The cumulative probability to be without epilepsy at 15 years was 75.4% (95% CI: 65.8-86.4). The probability of having epilepsy was higher in the group of proximal or distal M1 artery occlusion compared to patients with periventricular venous infarction (HR 7.2, 95% CI: 2.5-26, p = .0007). Patients with periventricular venous infarction had significantly more often status epilepticus or spike-wave activation in sleep ≥85% of it compared to patients with anterior or posterior trunk of the distal middle cerebral artery occlusion (OR = 81; 95% CI: 1.3-5046, p = .029). The emphasis of this study is placed on classifying the vascular syndrome of perinatal stroke and on the targeted follow-up of patients for epilepsy until young adulthood. The risk for having epilepsy after perinatal stroke is the highest in children with proximal or distal M1 middle cerebral artery occlusion. Patients with periventricular venous infarction have a more severe course of epilepsy.

Time-dependent reliability analysis for structures under multilevel loads based on fatigue damage theory

This paper proposes an efficient method to evaluate the time-dependent fatigue reliability of structures under complex multilevel loads using a finite set of fatigue test data obtained under single-level loading conditions. The method preserves the simplicity of linear damage accumulation theory while considering the interactions among multiple load levels and the influence of load sequence on reliability. Leveraging the linear damage rule, a cumulative damage probability model was established under single-level constant amplitude loading. This model incorporates a fatigue life degradation function to characterize the cumulative damage effect of load cycles and corrects the fatigue reliability curve under single-level constant amplitude loading. By employing the principle of fatigue damage equivalence, the method determines the damage equivalence at the load switching point using the damage curve method, enabling the conversion of equivalent reliability under multilevel loads. The proposed method was validated by combining the test data obtained under three working conditions, including two-level loads loading, load blocks loading, and changing loads loading. The results demonstrate that the proposed method can accurately and efficiently evaluate the time-dependent fatigue reliability under different types of multilevel loads, using only a limited set of fatigue life data under single constant amplitude loads.

Inverse Transformation to Generate Neutrosophic Random Variables Following Weibull and Geometric Distributions

In practical applications, we encounter many systems that cannot be studied directly, and the reason for this is due to the nature of the system or to the high cost. Therefore, we resort to the simulation process, which depends on conducting the study on systems similar to real systems, and then projecting these results, if they are appropriate, onto the system. The real system. The simulation process depends on generating a series of random numbers that follow a uniform probability distribution in the field [0, 1], then converting these random numbers into random variables that follow the probability distribution in which the system to be simulated operates. One of the most important conversion methods is the conversion method. The opposite. This method is used for probability distributions in which we can obtain a function inverse of its cumulative distribution function. In two previous researches, we used this method to generate neutrosophic random variables that follow a uniform distribution in the field [a, b] and the exponential distribution. In this research, we present a valuable study to clarify how to use this method. The method for generating neutrosophic random variables follows the Weibull distribution and the geometric distribution, based on what was presented in the classic study and in the research on neutrosophic random number generation.

Online detection of the incidence via transfer learning

AbstractThe counting process has abundant applications in reality, and Poisson process monitoring actually has received extensive attention and research. However, conventional methods experience poor performance when shifts appears early and only small number of historical observations in Phase I can be used for estimation. To overcome it, we creatively propose a new online monitoring algorithm under the transfer learning framework, which utilizes the information from observations of additional data sources so that the target process can be described better. By making the utmost of the somewhat correlated data from other domains, which is measured by a bivariate Gamma distributed statistic presented by us, the explicit properties (e.g., posterior probability mass function, posterior expectation, and posterior variance) are also strictly proved. Furthermore, based on the above theoretical results, we design two computationally efficient control schemes in Phase II, that is a control chart based on the cumulative distribution function for large shifts and an exponentially weighted moving average control chart for small shifts. For a better understanding of the more practical applications and transferability matter, we provide some optimal values for parameter setting. Extensive numerical simulations and a case of skin cancer incidence in America verify the superiorities of our approach.

Effect of gastric acids on the mechanical properties of conventional and CAD/CAM resin composites - An in-vitro study

ObjectivesDental erosion in patients with gastroesophageal reflux disease (GERD) is a current and frequent condition that may compromise the mechanical properties and clinical durability of resin-based composites (RBCs). This study assessed the mechanical properties of conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) RBCs subsequent to simulated gastric acid aging. Materials and methodThree conventional and three CAD/CAM composites were assessed. They were divided into an experimental group (exposed to simulated gastric acid aging) and a control group (no aging). Both groups were analyzed for Vickers microhardness (VHN), wear and flexural strength over a period of six months. The failure rate probability for each RBC was calculated through the Weibull cumulative distribution function (m). Statistical analysis was conducted using repeated measures ANOVA, 3-way ANOVA, a non-parametric Kruskal-Wallis and U Mann-Whitney tests (α = 0.05). ResultsThe mechanical properties of all the RBCs dropped significantly after aging (p < 0.05). Lower VHN and flexural strength values, along with greater wear values were evident in the experimental groups, though the effects of the treatment varied between RBCs. The Weibull m of all the RBCs decreased over time. ConclusionConventional RBCs might show greater reduction in mechanical properties compared to CAD/CAM RBCs when exposed to gastric acid attack. Thus, CAD/CAM composites may represent a suitable choice for the treatment of patients presenting erosive issues.

Abstract PO3-23-07: Evaluation of the role of axillary ultrasound to estimate axillary nodal burden to guide de-escalation of upfront axillary surgery in node positive early breast cancer patients

Abstract Background: Axillary surgery is now routinely de-escalated in clinically node negative breast cancer patients with limited axillary nodal burden (up to 2 involved sentinel nodes) based on the results of ACOSOG-Z0011 and AMAROS trials. However, patients with proven axillary metastasis following on ultrasound (AUS) guided core needle biopsy (CNB), undergoing primary surgery are still subjected to an axillary lymph node dissection (ALND) irrespective of the magnitude of the axillary nodal burden. If we could predict axillary nodal burden with a low false negative rate (FNR) for the presence of extensive axillary nodal involvement, we can then hypothesize that axillary surgery could be safely de-escalated in this cohort of patients. We investigated whether pre-operative AUS suggesting limited axillary burden is sensitive enough to rule out gross axillary disease burden. Methods: A single institution retrospective study. We undertook an electronic chart review of all T1 to T3 patients undergoing upfront ALND with either mastectomy or breast conserving surgery between January 2019 and June 2023. Patients with palpable axillary nodes, locally advanced breast cancer or a completion ALND after positive sentinel lymph node biopsy (SLNB) were excluded from the study. Clinical and pathological characteristics associated with nodal burden of disease were evaluated. Limited axillary burden was defined as &amp;lt; 2 involved nodes with ≥3 taken as gross nodal burden for primary analyses. Sensitivity analyses were carried out with limited axillary burden defined as &amp;lt; 3 involved nodes (N1) and ≥4 (N2) taken as gross nodal burden. Subgroup analyses in T1 or T2 tumors were carried out as well. The probabilities of discordant events, defined as limited burden on AUS-CNB but gross burden on final histopathology evaluation (HPE), assuming 10% FNR, were estimated using inverse cumulative binomial distribution function. Results: Data on the exact number of suspicious nodes on AUS were missing for 2 patients, therefore, the final study cohort included 39 patients. The correlation between AUS nodal burden and that on HPE was moderate (Spearman’s rho = 0.48; p = 0.0018). The sensitivity and specificity of AUS in identifying gross nodal burden were 61% and 81% respectively. Observation of 9 discordant events in 22 patients with low burden on AUS ruled out an FNR of &amp;lt; 10% with 99.99% certainty. The sensitivity and specificity in T1/T2 subgroup were 60% and 75% respectively. The sensitivity analyses classifying N1 as limited and N2 as gross axillary burden showed the sensitivity and specificity of 35% and 82% respectively and an FNR of &amp;lt; 10% was ruled out with 99.996% certainty. Conclusion: Pre-operative AUS alone lacks the sensitivity and specificity to accurately predict the true axillary nodal burden to safely guide de-escalation of axillary surgery. AUS followed by targeted axillary dissection (TAD) in conjunction with a dual technique SLNB may provide the desired sensitivity and specificity to guide de-escalation of axillary surgery. A prospective evaluation of this approach is merited. Given the limited number of patients that could be enrolled in such prospective study from individual institutions, an international collaborative effort is needed to address this important research question. Citation Format: Nidhi Garg, Mangesh Thorat, Hisham Hamed, Ashutosh Kothari. Evaluation of the role of axillary ultrasound to estimate axillary nodal burden to guide de-escalation of upfront axillary surgery in node positive early breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-23-07.

ESTIMATING THE COSTS, HEALTH-RELATED QUALITY OF LIFE, AND REVISION RISK IN THE YEAR AFTER ELECTIVE PRIMARY AND REVISION HIP ARTHROPLASTY PROCEDURES BY IMPLANT BEARING MATERIALS: AN ANALYSIS OF LINKED DATA FROM THE NATIONAL JOINT REGISTRY (NJR), HOSPITAL EPISODE STATISTICS (HES), AND PATIENT-REPORTED OUTCOME MEASURES (PROMS) FOR ENGLISH PATIENTS

Implants in total hip replacement (THR) are associated with different clinical and cost-effectiveness profiles,. We estimate the costs and outcomes for NHS patients in the year after THR associated with implant bearing materials using linked routinely collected data.We linked NJR primary elective THR patients for osteoarthritis to HES and National PROMs. We estimated health care costs, health-related quality of life indices, and revision risks, in the year after primary and revision THRs overall. We used generalised linear models adjusting for patient and hospital characteristics and estimated 10-year cumulative probability of revision. We imputed utilities using chained equations for half the sample with missing PROMS.We linked 577,973 elective primary THRs and 11,812 subsequent revisions. One year after primary THR, patients with the cemented THRs using cobalt chrome or stainless steel head with HCLPE liner/cup cost the NHS, on average, £13,101 (95%CI £13,080,£13,122), had an average quality-of-life score of 0.788 (95%CI 0.787,0.788), and a 10-year revision probability of 1.9% (95%CI 1.6,2.3). Compared to the reference, patients receiving a cemented THR with delta ceramic head and HCLPE liner/cup, hybrid THR with delta ceramic head and HCLPE liner/cup, and hybrid THR with alumina head and HCLPE liner/cup had lower 1-year costs (-£572 \[95% CI -£775,-£385\], -£346 \[-£501,-£192\], -£371 \[-£574,-£168\] respectively), better quality of life (0.007 \[95% CI 0.003,0.011\], 0.013 \[0.010,0.016\], 0.009 \[0.005,0.013\] respectively), and lower 10-year revision probabilities (1.4% \[1.03,2.0\], 1.5 \[1.3,1.7\], 1.6%\[1.2,2.1\] respectively).Implant bearing materials are associated with varying mean costs and health outcomes after primary THR. Ours is the first study to derive costs and health outcomes from large, linked databases using multiple imputation methods to deal with bias. Our findings are useful for commissioning and procurement decisions and to inform a subsequent cost-effectiveness model with more granular detail on THR implant types.

Faster Person Re-Identification: One-Shot-Filter and Coarse-to-Fine Search.

Fast person re-identification (ReID) aims to search person images quickly and accurately. The main idea of recent fast ReID methods is the hashing algorithm, which learns compact binary codes and performs fast Hamming distance and counting sort. However, a very long code is needed for high accuracy (e.g., 2048), which compromises search speed. In this work, we introduce a new solution for fast ReID by formulating a novel Coarse-to-Fine (CtF) hashing code search strategy, which complementarily uses short and long codes, achieving both faster speed and better accuracy. It uses shorter codes to coarsely rank broad matching similarities and longer codes to refine only a few top candidates for more accurate instance ReID. Specifically, we design an All-in-One (AiO) module together with a Distance Threshold Optimization (DTO) algorithm. In AiO, we simultaneously learn and enhance multiple codes of different lengths in a single model. It learns multiple codes in a pyramid structure, and encourage shorter codes to mimic longer codes by self-distillation. DTO solves a complex threshold search problem by a simple optimization process, and the balance between accuracy and speed is easily controlled by a single parameter. It formulates the optimization target as a Fβ score that can be optimised by Gaussian cumulative distribution functions. Besides, we find even short code (e.g., 32) still takes a long time under large-scale gallery due to the O(n) time complexity. To solve the problem, we propose a gallery-size-free latent-attributes-based One-Shot-Filter (OSF) strategy, that is always O(1) time complexity, to quickly filter major easy negative gallery images, Specifically, we design a Latent-Attribute-Learning (LAL) module supervised a Single-Direction-Metric (SDM) Loss. LAL is derived from principal component analysis (PCA) that keeps largest variance using shortest feature vector, meanwhile enabling batch and end-to-end learning. Every logit of a feature vector represents a meaningful attribute. SDM is carefully designed for fine-grained attribute supervision, outperforming common metrics such as Euclidean and Cosine metrics. Experimental results on 2 datasets show that CtF+OSF is not only 2% more accurate but also 5× faster than contemporary hashing ReID methods. Compared with non-hashing ReID methods, CtF is 50× faster with comparable accuracy. OSF further speeds CtF by 2× again and upto 10× in total with almost no accuracy drop.

The [formula omitted]-[formula omitted] composite distribution with pointing errors: Theory and applications to RIS

The α-F composite fading distribution with pointing errors is investigated in this paper. New expressions for the probability density function and cumulative distribution function of the envelope/instantaneous signal-to-noise ratio (SNR), higher-order moments, and moment generating function of the instantaneous SNR are derived. Based on the aforementioned statistics, expressions for the outage probability, symbol error probability, and ergodic channel capacity are obtained. An asymptotic analysis is also provided. Furthermore, an application of the α-F model with pointing errors in a wireless emerging system, namely reconfigurable intelligent surfaces (RIS), is shown. Several curves, corroborated by Monte-Carlo simulations, are presented for different values that characterize the channel and pointing error parameters.

Experimental-based groundwater salinization from the carbonate aquifer of eastern Saudi Arabia: Insight into machine learning coupled with meta-heuristic algorithms

Groundwater (GW) salinization of coastal aquifers has become a serious problem for attaining sustainable water resource management in Saudi Arabia and other parts of the world. Therefore, it is crucial to assess the extent of this salinization to protect and manage our water resources effectively. This research proposed real fieldwork GW samples at several locations supported with experimental based on chromatography (IC) and inductively coupled plasma mass spectrometry (ICP-MS) to analyze several GW physical, chemical, and hydro-geochemical elements. In this study, we model GW salinization with machine learning algorithms such as support vector regression, gaussian process regression, artificial neural networks, and least squares ensemble boosting regression tree. The performance of the standalone models was optimized with metaheuristic optimization-based algorithms such as fuzzy hybridized genetic algorithm (ANFIS-GA) and particle swarm optimization (ANFIS-PSO). The outcomes based on three variable input combinations were validated using several performance indicators and graphical methods. The quantitative analysis indicated that GPR-Combo1(MAE=0.006 mg/L), Ensm- Combo2 (MAE=0.025 mg/L), and GPR- Combo3 (MAE=0.078 mg/L) proved merit among the standalone combinations. Where combo 1, 2, and 3 stand for model combinations derived from feature selection. The cumulative probability function (CPF) demonstrated that heuristic optimization ANFIS-GA (MAE=0.0025 mg/L, MAPE=0.19183) and ANFIS-PSO (MAE=0.0018 mg/L, MAPE=0.0723) outperformed the standalone error accuracy and served reliable approach. Both the standalone models and heuristic algorithms used for GW salinization modeling have demonstrated promising results in accurately predicting salinity. This approach could aid in effectively managing the GW resources for sustainable development.

ARCSINE RAYLIEGH PARETO DISTRIBUTION: PROPERTIES AND APPLICATION TO CARBON FIBERS DATA SETS

In this paper, we introduce a new modified distribution called arcsine Rayliegh Pareto (ASRP) Distribution. We derived its mathematical and statistical properties, including survival function, hazard function, entropy, moment, moment generating function, and order statistics. We also used maximum likelihood estimation for estimating the parameters of the distribution. The plots of the cdf, pdf, hazard rate function, and survival function were illustrated with right skewed probability density function, cumulative distribution function with monotone increasing function, which converge at one. The value of some goodness of fit measure (i.e. AIC, AICc, and BIC) were computed, as well as the KS, A, and W statistic. Finally, we suggested that the new modified model outperform better than the other standard distribution using Carbon fibers data sets.

On the Bivariate Extension of the Extended Standard U-quadratic Distribution

This paper derives the bivariate version of the extended standard U-quadratic (eSU)  distribution using the method of compounding or pseudo family of distributions. The joint probability and cumulative distribution functions of the derived distribution are obtained and it is observed that the said distribution can generate bivariate shape with the following properties: $(i)$ $X$ and $Y$ have bathtub shapes; $(ii)$ $X$ has constant and $Y$ has bathtub shapes; and $(iii)$ $X$ has inverted bathtub and $Y$ has bathtub shapes. Moreover, some properties of the derived distribution such as the marginal distribution, conditional distributions, conditional moments, product and ratio moments are derived. Further, the maximum likelihood estimation is performed to estimate the parameters of the derived distribution. Also, a simulation study is carried out to evaluate the behavior of the estimates of the parameters. Moreover, we derive a new bivariate Kumaraswamy distribution and use it to simulate bivariate data with $X$ and $Y$ having bathtub shapes. Furthermore, A new bivariate version of the Cubic Transmuted Uniform (CTU) distribution is also derived. Finally, the proposed Bivariate eSU distribution is applied to simulated data and compared with the said Bivarite Cubic Transmuted Uniform distribution. The result shows that the proposed Bivariate eSU distribution provides a better fit for the said simulated dataset as compared with the Bivariate CTU distribution.

The association between vascular access satisfaction and all-cause mortality in maintenance hemodialysis patients.

The mortality is significantly higher in patients undergoing maintenance hemodialysis (MHD) than in the general population. It is well-known that vascular access (VA) is critical for MHD patients. But the association between VA satisfaction and all-cause mortality in MHD patients is still not clear. The aim of this study was to explore the relationship between VA satisfaction and all-cause mortality in MHD patients with a 30-month follow-up. Two hundred twenty-nine MHD patients in two dialysis centers were enrolled in this observational prospective study. VA satisfaction was assessed using the Short Form Vascular Access Questionnaire (VAQ). Health-related quality of life (HRQoL) score was calculated with Short Form 36 (SF-36) questionnaire. Multiple logistic regression analysis was used to evaluate the influencing factors of all-cause mortality. During the 30-month follow-up period, 35 patients dropped out of the study. Among them, 31 patients died, and 4 patients stopped MHD treatment after renal transplantation. Multivariable analyses showed that the age, VAQ total score, social functioning score and dialysis-related complication score of the VAQ, the total score and MCS of the SF-36 were factors influencing all-cause mortality in MHD patients. The Kaplan-Meier curve further showed that the cumulative survival probability was significantly higher in the MHD patients with VAQ scores <7 at baseline than in patients with VAQ scores ⩾7 (p = 0.031). The present study showed that VA satisfaction was significantly associated with all-cause mortality in MHD patients. These findings suggest that a holistic approach is required for VA choice.

Treatment sequencing and impact of number of treatment lines on survival in follicular lymphoma: A national population‐based study

AbstractFollicular lymphoma (FL) is a clinically heterogeneous disease. The need for treatment, treatment sequencing, number of treatment lines, and its association with survival have not been described in a population‐based setting. We identified all patients diagnosed with FL in the Swedish Lymphoma register from 2007 to 2014, followed until 2020, with detailed data on progression/relapse, transformation, and 2nd and further lines of therapy. During a median follow‐up of 6.8 years, 1226 patients (69%) received 1st systemic treatment, 358 patients (20%) were managed with watch‐and‐wait (WaW) only, and 188 (10%) patients were treated with radiotherapy and did not require additional therapy during the study period. Among patients starting systemic treatment, 496 (40%), 224 (18%), and 88 (7%) received 2nd‐, 3rd‐, or 4th‐line therapy, respectively. The 10‐year cause‐specific cumulative incidence of transformation was 13%. Among patients managed with 1st line R‐single, R‐CHOP, or BR, 54%, 33%, and 29% required 2nd line, respectively. The cumulative probability of starting subsequent treatment within 2 years was 26% after 1st line and 35% after 2nd line treatment. Two‐year OS following 1st, 2nd, 3rd, and 4th line systemic treatment was 84%, 70%, 52%, and 36%, respectively, and remained similar when excluding transformations. We conclude that a substantial proportion of FL patients can be managed with WaW for a long period of time, while patients who require multiple treatment lines constitute a group with a large clinical unmet need. These results constitute valuable real‐world reference data for FL.

Detection of scapholunate interosseous ligament injury using dynamic computed tomography-derived arthrokinematics: A prospective clinical trial

Scapholunate interosseous ligament injuries are a major cause of wrist instability and can be difficult to diagnose radiographically. To improve early diagnosis of scapholunate ligament injuries, we compared injury detection between bilateral routine clinical radiographs, static CT, and dynamic four-dimensional CT (4DCT) during wrist flexion-extension and radioulnar deviation. Participants with unilateral scapholunate ligament injuries were recruited to a prospective clinical trial investigating the diagnostic utility of 4DCT imaging for ligamentous wrist injury. Twenty-one participants underwent arthroscopic surgery to confirm scapholunate ligament injury. Arthrokinematics, defined as distributions of interosseous proximities across radioscaphoid and scapholunate articular surfaces at different positions within the motion cycle, were used as CT-derived biomarkers. Preoperative radiographs, static CT, and extrema of 4DCT were compared between uninjured and injured wrists using Wilcoxon signed rank or Kolmogorov-Smirnov tests. Median interosseous proximities at the scapholunate interval were significantly greater in the injured versus the uninjured wrists at static-neutral and maximum flexion, extension, radial deviation, and ulnar deviation. Mean cumulative distribution functions at the radioscaphoid joint were not significantly different between wrists but were significantly shifted at the scapholunate interval towards increased interosseous proximities in injured versus uninjured wrists in all positions. Median and cumulative distribution scapholunate proximities from static-neutral and 4DCT-derived extrema reflect injury status.

Survival in systemic sclerosis associated pulmonary arterial hypertension in the current treatment era-results from a nationwide study.

Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis (SSc). This nationwide study aims to describe real world treatment characteristics and assess survival rates of patients with SSc-PAH. In this retrospective cohort study, patients with SSc-PAH were identified from Turkish Ministry of Health National Electronic Database (from January 2016 to September 2022), using ICD-10 codes. Data on demographics, treatment characteristics, and death was collected. Kaplan-Meier curves were used to calculate cumulative probabilities of survival at 1, 3, and 5years. Five hundred forty-seven patients (90.7% female) with SSc-PAH were identified. Median age at PAH diagnosis was 59.9 (50.0-67.4) years. During a median follow-up duration of 3.2 (1.5-4.8) years, 199 (36.4%) deaths occurred. Estimated survival rates at 1, 3, and 5years were 90.2%, 73.2%, and 56.6%, respectively. Survival was similar among patients with and without interstitial lung disease (p = 0.20). Patients who used immunosuppressives had better survival than those who did not (p < 0.001). No difference was observed in survival rates according to initial PAH-specific treatment regimen (monotherapy or combination) (p = 0.49). Compared to most of historical cohorts, higher survival rates for SSc-PAH were observed in this study. Early diagnosis of PAH may have contributed to these findings. The impact of immunosuppressive therapy on prognosis of SSc-PAH needs to be further investigated in prospective studies. Key Points • Early diagnosis is pivotal for better outcomes in SSc-PAH. • Implementation of PAH treatment guidelines in routine clinical practice is still poor and should be improved. • Effect of immunosuppressive therapies on disease course has to be defined in SSc-PAH.

Vine Copula-Based Multivariate Distribution of Rainfall Intensity, Wind Speed, and Wind Direction for Optimizing Qatari Meteorological Stations

This study employs copula functions to establish the dependency structure of the joint distribution among rainfall intensity, wind speed, and wind direction in Qatar. Based on a Vine Copula, the trivariate distribution between rainfall intensity, wind speed, and wind direction is found to exhibit a root-mean-square error (RMSE) of 0.0072 on the observed vs. modeled cumulative probabilities using ranked normalized observations. It is also found that the winter Shamal winds are most pronounced during rainfall. However, a secondary component of easterly winds known as the Kaus winds is also found to exert an important influence. This wind pattern is observable during rainfall at all the selected stations, albeit with minor variations. It is also found that rainfall stations where the rainfall is obstructed in any way from northwest to north and from east to southeast significantly influence the rainfall measurements. Specific rain gauges in Qatar are found to be situated in disrupted surroundings, such as meteorological stations close to passing traffic, where road spray could infiltrate the rain gauge funnel, impacting the accuracy of rainfall measurements. The study results necessitated the relocation of approximately half of these roadside gauges to mitigate wind-induced biases from road spray. An evaluation of operations is recommended for approximately 80 meteorological stations responsible for measuring rainfall in Qatar. The methodology devised in this study holds potential for application to other Middle Eastern countries and regions with similar climates.