Cumulative Survival Research Articles

#529 Educational level and mortality in patients receiving chronic hemodialysis in Lazio Region—Italy

Abstract Background and Aims In 2010, 2.6 million people received Kidney Replacement Treatment (KRT) worldwide. Hemodialysis (HD) is the most commonly used KRT. HD patients have a consistent risk of death. The impact of Educational Level (Edl) on the mortality in HD patients is unclear. This study aims to analyse the association between the Edls and mortality in incident chronic HD patients using the Lazio Regional Dialysis and Transplant Registry. Method A cohort of incident HD patients between 2008 and 2022 was selected. Patients under 18 years old and with a follow-up period shorter than 91 days were excluded. All patients were characterized by sociodemographic and clinical characteristics at the incident date and were followed from the incident date until the earliest of the following dates: death, transplantation, renal function recovery or end of the study (one or three years after initiation). One-year and three-year Crude Mortality Rates*100 Person Years (CMR*100PY) overall and by Edal (low: up to primary school, medium: secondary school, high: university degree and more) were calculated. Cumulative survival estimates at one year and three years since starting HD, were presented as Kaplan-Meier curves by EdL and compared using the log-rank test. Crude and adjusted Hazard Ratios (HR) and respective 95% Confidence Intervals (95% CI) of the association between EdL and one and three-year mortality were calculated using univariate and multivariate Cox regression models (reference category: low EdL). Sociodemographic and clinical characteristics were considered potential confounders or effect modifiers in the adjusted Cox regression models. Results The cohort counted 9,776; 33.5% had a low EdL, 30.7% had a medium, and 35.8% had a high EdL. The mean age decreased with increasing EdL (73 and 65 in low and high EdL, respectively) as the proportion of females (43.0% and 26.0% in low and high EdL, respectively). During the first year of HD, 1,683 deaths occurred, and 3,827 occurred within three years. One-year CMR*100PY were 24.1 (95% CI 22.4-26.0) in low EdL, 17.4 (95% CI: 15.9-19.0) in medium EdL and 15.0 (95% CI: 13.8-16.4) in high ED. The corresponding three-year CMR were 22.7 (95% CI 21.6-23.8), 17.4 (95% CI 16.4-18.4) and 15.1 (95% CI 14.2-16.0). One-year survivals estimates were 78.0% in low EdL, 83.8% in medium and 85.8% in high EdL (log-rank test: p-value < 0.001). The three-years survival estimates were 51.0% in low EdL, 59.3% in medium EdL and 63.7% in high EdL (log-rank test: p-value < 0.001). In one-year mortality the crude HRs were 0.72 (95% CI: 0.64–0.81) and 0.62 (95% CI: 0.55–0.70) of medium and high EdL vs. low EdL respectively; the corresponding adjusted HRs were 0.93 (95% CI: 0.83–1.06) and 0.92 (95% CI: 0.81–1.04) (Fig. 1). Similar results were obtained for three-year mortality: crude HRs were 0.77 (95% CI: 0.71–0.83) and 0.66 (95% CI: 0.62–0.72); adjusted HRs were 0.99 (95% CI: 0.92–1.08) and 0.97 (95% CI: 0.89–1.06), respectively (Fig. 2).). Conclusion Based on the present study, high educational level does not appear to be associated with lower mortality risk at either one-year or three-years. Hemodialysis patients are constantly monitored by National Health Service; this probably cancels the effect of low educational level on mortality. Although EdL is a strong indicator of socioeconomic position, it does not capture all dimensions of disadvantage. The mechanisms that underline the poor prognosis in Haemodialysis patients are complex and further investigations are needed.

#673 Predictive value of insulin resistance and GFR-adjusted uricemia on all-cause mortality: the URRAH study

Abstract Background and Aims Uric acid (UA) and insulin resistance (IR) are interlinked: UA contributes to adversely affects the insulin signaling pathway, while IR predicts the development of hyperuricemia. Both UA and IR are related to metabolic syndrome, which is nowadays one of the most prevalent risk factors for mortality. In the clinical scenario, the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio has been proved to have a high correlation with IR. Lipoprotein-based markers of IR are at least as strongly associated with subclinical atherosclerosis and with newly developing atherosclerotic manifestations than Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). The aim of the research was to explore the extent of interaction between IR and GFR-adjusted uricemia in determining mortality risk in a large population cohort study. Method data from 18,694 subjects were included from Uric acid Right foR heArt Healt (URRAH) database. Differences between TG/HDL-C ratio quintiles were evaluated by t-test or chi-square test. We evaluated the association between TG/HDL-C ratio and GFR-adjusted uricemia, and the development of outcomes during the follow-up study period. The primary endpoint was all-cause mortality. The Kaplan-Meier method was used to calculate the cumulative survival rate. Cox proportional hazard regression models were used to analyze the prognosis associated with IR. Results after a mean follow-up of 124 ± 64 months, there were 2,665 (14.2%) deaths for all causes. The incidence of fatal, non-fatal cardiovascular events, and all-cause mortality increased in parallel with the increase of TG/HDL-C quintiles. In both diabetic and non-diabetic patients, TG/HDL-C ratio showed a positive association with increasing of GFR-adjusted uricemia (UA/GFR ratio). TG/HDL-C ratio and GFR-adjusted uricemia significantly interact in determining all-cause mortality, even in non-diabetic patients (P < 0.0001). Subjects with higher TG/HDL-C ratio quintile had a statistically significantly higher rate of mortality than patients with lower quintiles (Fig. 1, log rank test P < 0.0001), independently by uricemia, GFR, the presence of diabetes and body mass index (BMI). Multivariate analysis showed that the TG/HDL-C ratio increase the mortality risk even after adjustment for potential confounding factors included age, diabetes, UA/GFR, BMI and statins treatment (Table 1). Conclusion For practical purposes, the easily obtainable TG/HDL-C ratio may suffice to determine the impact of insulin resistance as a risk factor. TG/HDL-C ratio interacts with GFR-adjusted uricemia in predicting mortality, even in non-diabetic patients. In conclusion, Both IR and GFR-adjusted UA levels seems to have an important predictive role on all-cause mortality, independently of age, gender, diabetes, hypertension and statins.

Type III Endoleak Incidence and Outcomes in Endovascular Aortic Repair: Comparison of Anatomical and Proximal Fixation Devices.

To evaluate the influence of endograft fixation type on the incidence, treatment, and outcomes of type III endoleaks (TIIIELs). Abdominal aortic aneurysms (AAAs) treated with bifurcated endografts between 1994 and 2020 were prospectively collected and reviewed. The endograft included were classified as "Anatomical Fixation" (AF) (Powerlink [Endologix] and AFX [Endologix]) or "Proximal Fixation" (PF). The primary outcome was the incidence of TIIIEL over time, stratified by fixation type. Secondary outcomes included between-group comparisons of baseline characteristics, intraoperative details during TIIIEL correction, and survival analysis after TIIIEL diagnosis. A total of 2065 endovascular aneurysm repairs were performed: 872 (42.2%) with AF and 1193 (57.8%) with PF devices. The estimated incidence of TIIIEL at 1, 5, and 10 years was 0.4%, 4.2%, and 7.3%, and 0.5%, 3.2%, and 4.6% for AF and PF, respectively (p=0.157), and fixation type was not associated with TIIIEL development in the competing risk regression model (p=0.101). The cumulative overall survival rate in patients diagnosed with TIIIEL did not differ significantly between the groups (p=0.077). The rate of recurrent TIIIELs was significantly lower in the AF group (7.1% vs 22.7%; p=0.044); however, no significant difference was found in secondary reintervention between the two groups (11.9% vs 27.3%, p=0.074). Patients with angulated and calcified aortic neck (SHR 3.4, 95% CI 1.2-9.6, p=0.022) and larger aneurysms (SHR 1.2; 95% CI 1.1-1.3; p<0.001) had a higher risk of TIIIEL. Likewise, the use of three or more endograft components increased the risk of TIIIEL by 3.1 times (SHR 3.1; 95% CI 1.7-5.4; p<0.001). The occurrence of TIIIELs was not affected by the type of endograft fixation. For larger abdominal aortic aneurysms (AAAs) and aneurysms with angulated and calcified aortic necks, there is a higher likelihood of developing TIIIELs during follow-up, regardless of the endograft type used. The type of fixation does not influence the incidence of TIII ELs. EVAR in larger AAAs and aneurysms with angulated and calcified aortic necks have a higher risk of developing TIII EL. Moreover, the risk of TIII EL is considerably increased by the use of three or more modular components.

Myopic Regression After FS-LASIK and SMILE.

To compare the degree of myopic regression after myopia correction with either femtosecond laser-assisted in situ keratomileusis (FS-LASIK) or small-incision lenticule extraction (SMILE) over 18 months. Patients undergoing FS-LASIK or SMILE surgery for myopia correction were retrospectively recruited. The propensity scores were used to match patients by age and preoperative manifest spherical equivalent (SEQ) from these 2 groups. Myopic regression was analyzed using the Cox proportional hazard model. A total of 416 eyes of 416 patients undergoing FS-LASIK and 416 eyes of 416 patients undergoing SMILE were matched. Using 1-month SEQ as baseline, the SEQ regression values after FS-LASIK were 0D, -0.17 ± 0.69D, -0.24 ± 0.65D, -0.31 ± 0.65D, -0.32 ± 0.63D, and -0.33 ± 0.62D and the SEQ regression values after SMILE were 0D, -0.07 ± 0.75D, -0.18 ± 0.77D, -0.23 ± 0.82 D, -0.21 ± 0.77D, and -0.24 ± 0.68D at 1, 3, 6, 9, 12, and 18 months, respectively. The Cox proportional hazard model showed that preoperative manifest SEQ ( P = 0.021) and designed optical zone ( P = 0.048) are significant predictors. The selected surgical procedure had no significant effect on predicting myopic regression ( P = 0.470). The cumulative survival rates of myopic regression were 54.74% and 42.10% in the FS-LASIK group and 58.66% and 43.83% in the SMILE group, at 12 and 18 months, respectively (log-rank test, P = 0.11). After matching based on age and preoperative manifest SEQ, we found that higher myopia and a smaller optical zone contribute significantly to the development of myopic regression after undergoing FS-LASIK or SMILE surgery at 18 months. The selected surgical procedure, however, does not affect the likelihood of myopic regression.

Clinical manifestations, diagnosis and long-term prognosis of adult autoimmune enteropathy: Experience from Peking Union Medical College Hospital.

Autoimmune enteropathy (AIE) is a rare disease whose diagnosis and long-term prognosis remain challenging, especially for adult AIE patients. To improve overall understanding of this disease's diagnosis and prognosis. We retrospectively analyzed the clinical, endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023, whose diagnosis was based on the 2007 diagnostic criteria. Diarrhea in AIE patients was characterized by secretory diarrhea. The common endoscopic manifestations were edema, villous blunting and mucosal hyperemia in the duodenum and ileum. Villous blunting (100%), deep crypt lymphocytic infiltration (67%), apoptotic bodies (50%), and mild intraepithelial lymphocytosis (69%) were observed in the duodenal biopsies. Moreover, there were other remarkable abnormalities, including reduced or absent goblet cells (duodenum 94%, ileum 62%), reduced or absent Paneth cells (duodenum 94%, ileum 69%) and neutrophil infiltration (duodenum 100%, ileum 69%). Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies. All patients received glucocorticoid therapy as the initial medication, of which 14/16 patients achieved a clinical response in 5 (IQR: 3-20) days. Immunosuppressants were administered to 9 patients with indications of steroid dependence (6/9), steroid refractory status (2/9), or intensified maintenance medication (1/9). During the median of 20.5 months of follow-up, 2 patients died from multiple organ failure, and 1 was diagnosed with non-Hodgkin's lymphoma. The cumulative relapse-free survival rates were 62.5%, 55.6% and 37.0% at 6 months, 12 months and 48 months, respectively. Certain histopathological findings, including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies, might be potential diagnostic criteria for adult AIE. The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications, which highlights the need for early diagnosis and novel medications.

Descemet membrane endothelial keratoplasty and penetrating keratoplasty in pseudophakic bullous keratopathy: comparison of visual outcomes, graft survival rates, and complications

Objective: To compare the outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) and Penetrating Keratoplasty (PK) in patients with pseudophakic bullous keratopathy (PBK). Methods: Records of 51 eyes of 51 PBK patients (32 male, 19 female) who underwent PK (Group1=38 eyes) and DMEK (Group 2=13 eyes) were reviewed retrospectively. The two groups were compared for Best-corrected visual acuity (BCVA), graft survival rates, and complications. Results: The mean age was 69.1 and 67.1 years in group 1 and group 2, respectively. First-year cumulative survival rates for group 1 and group 2 were 92.1% and 61.5%, respectively, and 89.1% and 51.3% in the second year (P=0.001 by log-rank test). At the last follow-up visit, 2.7% of Group 1 and 30.8% of Group 2 had a BCVA of 0.3 or better (P=0.004). Graft failure was observed in 12 eyes (31.6%) in group 1 and 8 eyes (61.5%) in group 2 (P=0.056). At the last examination, the rates of transparent grafts were 73.7% and 69.2% in group 1 and group 2, respectively (P=0.756). Postoperative glaucoma was observed in 4 eyes (30.8%) in the group 2 and 4 eyes (10.5%) in the group 1 (P=0.083). There was no significant difference between the two groups regarding other complications (P&gt;0.05). Conclusions: DMEK surgery offers a better visual outcome than PK for the treatment of PBK. Careful follow-up of patients is required in terms of glaucoma and graft failure after DMEK. Although the graft survival rate was lower in the DMEK group, a similar rate of graft transparency was achieved at the final examination with repeated DMEK surgery.

Long-term follow-up results of prostate capsule-sparing and nerve-sparing radical cystectomy with neobladder: a single-center retrospective analysis

ObjectiveThis study aims to investigate and analyze the feasibility, oncological outcomes, functional efficacy, and complications with the prostatic capsule sparing (PCS) as well as the nerve sparing (NS) in radical cystectomy for bladder cancer.Patients and methodsBetween January 2007 and December 2021, 67 total cystectomies with PCS and 54 with NS were performed at our institution. The inclusion criteria for PCS were as follows: proactive, fully informed patient consent; negative transurethral resection of the bladder neck; normal prostate-specific antigen (PSA) level &amp;lt; 4 ng/dL; and normal transrectal ultrasonography with biopsy of any suspicious nodes. Patients received complete oncological and functional follow-ups. The Kaplan-Meier method was utilized to characterize survival outcomes after surgery.ResultsThe median follow-up times for PCS and NS were 144 and 122 months, respectively. Cumulative survival estimated the 5- and 10-years cancer-specific survival were 93.0% and 88.7% for the PCS group and 79.7% and 79.6% for the NS group, respectively (p = 0.123). In terms of function, the daytime urinary control at 3, 6, and 12 months postoperatively was 80.60%, 97.01%, and 100% in the PCS group, and 53.70%, 85.19%, and 94.44% in the NS group, respectively (p = 0.002, 0.023, and 0.100); and nocturnal urinary control was 62.69%, 94.03%, and 98.51% in the PCS group, and 40.74%, 72.22%, and 87.04% in the NS group, respectively (p = 0.016, 0.001, and 0.022). The erectile function recovery revealed that 62.69% and 40.74% of patients returned to preoperative levels (International Index of Erectile Function (IIEF)-5 score ≥ 15) in the PCS and NS groups, respectively (p = 0.016). Considering complications within 30 days after surgery, 4.48% and 7.69% patients had Clavien ≥ III complications in the PCS and NS groups, respectively (p = 0.700).ConclusionThe PCS provides better restored urinary control and sexual function than the NS technique and does not affect oncological outcomes. However, PCS is prone to bladder-neck obstruction complications and requires closer long-term follow-up.

Survival outcomes of radium-223 therapy for metastatic castration-resistant prostate cancer following national health insurance reimbursement in Taiwan.

Radium-223 dichloride (Ra-223) prolongs overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases. However, there is considerable variation in outcomes among individuals. We aimed to evaluate the prognostic determinants associated with patient survival following National Health Insurance (NHI) reimbursement for Ra-223 therapy in Taiwan. Patients with mCRPC who underwent Ra-223 treatment at Taipei Veterans General Hospital were retrospectively enrolled. Each intravenous Ra-223 dose was administered at 55 kBq/kg at 4-week intervals. Clinical outcomes were obtained from medical records; potential prognostic factors for survival were assessed. Kaplan-Meier analysis was used to generate cumulative survival curves; between-group differences were evaluated using the Chi-squared test. Statistical significance was set at p < 0.05. Seventy-six patients underwent Ra-223 therapy; 62 patients received NHI reimbursement and the remainder self-paid. Fifty patients (65.8%) completed six cycles of treatment; 26 (34.2%) received 1 to 5 cycles. Mortality occurred in 47 patients. Factors significantly associated with survival included ≤five bone metastases ( p = 0.0018), baseline prostate-specific antigen (PSA) ≤36 ng/mL ( p = 0.0004), baseline alkaline phosphate (ALP) <115 U/L ( p = 0.0007), and baseline hemoglobin (Hb) >12 g/dL ( p = 0.0029). Patients who completed six cycles of treatment achieved significantly higher OS compared to those who did not ( p < 0.0001). There has been a 4.4-fold increase in the number of patients since reimbursement began; there was no significant difference in OS between patients who received NHI reimbursement and those who self-paid. Administration of Ra-223 demonstrates considerable potential to extend the survival of patients with mCRPC. Survival outcomes may be influenced by various prognostic factors. However, no significant difference in OS was observed subsequent to reimbursement of Ra-223 therapy for mCRPC through the NHI system in Taiwan.

Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events

ObjectiveTo compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke trial to reduce barriers to independent living for community-dwelling stroke survivors. DesignRandomized controlled trial. SettingInpatient rehabilitation (IR) to home and community transition. ParticipantsStroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183). InterventionsParticipants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education. Main Outcome MeasuresDeath, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR. ResultsTime-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361). ConclusionsA home-based occupational therapist–led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.

"No-Touch" Left Approach for Recipient Hepatectomy: A Promising Strategy to Minimize Hepatocellular Carcinoma Recurrence in Liver Transplantation.

Managing hepatocellular carcinoma (HCC) presents significant clinical challenges, often necessitating orthotopic liver transplantation (OLT). To mitigate the risk of iatrogenic metastasis during OLT and reduce posttransplantation recurrence (PTR), we introduced the "no-touch" left (NTL) approach for recipient hepatectomy in OLT. In this retrospective cohort study, our aim was to compare the safety and PTR rates in patients undergoing OLT via either the NTL technique or the conventional approach for recipient hepatectomy. We included 106 patients who met the Hangzhou criteria and exhibited a high tumor burden in the right lobe, with 50 patients assigned to the NTL group and 56 to the conventional group. The primary endpoint was the 1-y PTR rate, whereas secondary endpoints encompassed the safety of the NTL approach, PTR rates at 2 and 5 y, and overall survival. Baseline demographics and clinical characteristics showed no significant differences between the groups. The NTL approach exhibited major surgical outcomes similar to those of the conventional approach. The cumulative PTR rates at 1, 2, and 5 y were 14.0% in the NTL group, compared with 24.5%, 35.8%, and 35.8% in the conventional group (P = 0.013). Cumulative overall survival rates at 1, 2, and 5 y were 94.0%, 91.9%, and 89.7% in the NTL group and 88.7%, 75.5%, and 72.5% in the conventional group (P = 0.03). This innovative surgical technique enhances safety and significantly reduces the risk of PTR, leading to improved long-term survival. Further prospective studies with larger cohorts and longer follow-up periods are needed to validate our findings and establish the NTL approach as a standard practice in OLT.

Expression of LASS2 Can be Regulated by Dihydroartemisinin to Regulate Cisplatin Chemosensitivity in Bladder Cancer Cells.

The aim of this study was to investigate the potential of dihydroartemisinin to augment the efficacy of cisplatin chemotherapy through the modulation of LASS2 expression. TCMSP, CTR-DB, TCGA-BLC, and other databases were used to analyze the possibility of LASS2 as the target gene of dihydroartemisinin. Cell experiments revealed the synergistic effect of DDP and DHA. Animal experiments showed that DHA inhibited the growth of DDP-treated mice. In addition, WB, real-time PCR, and immunohistochemical analysis showed that DHA enhanced LASS2 (CERS2) expression in bladder cancer cells and DDP-treated mice. LASS2 is associated with cisplatin chemosensitivity.LASS2 expression levels are different between BLC tissues and normal tissues. COX analysis showed that patients with high LASS2 expression had a higher cumulative overall survival rate than those with low LASS2 expression. The Sankey plot showed that LASS2 expression is lower in BLC tissues with more advanced stage and distant metastasis. The docking score of DHA and LASS2 reached the maximum value of -5.5259, indicating that DHA had a strong binding affinity with LASS2 targets. CCK8 assay showed that the most effective concentration ratio of DHA to DDP was 2.5μg/ml + 10μg/ml. In vivo experiments showed that DHA inhibited tumor growth in cisplatin-treated mice. In addition, WB, RT-qPCR, and immunohistochemical analysis showed that DHA was able to enhance LASS2 expression in BLC cells and DDP-treated mice. The upregulation of LASS2 (CERS2) expression in bladder cancer cells by DHA has been found to enhance cisplatin chemosensitivity.

A systematic review of optimization methods for recovery planning in cyber–physical infrastructure networks: Current state and future trends

Cyber–Physical Systems are increasingly complex and frequently integrated into modern societies via critical infrastructure systems, products, and services. Consequently, there is a need for reliable functionality of these complex systems under various scenarios, from physical failures due to aging to cyber attacks. However, the development of effective strategies to restore disrupted cyber–physical infrastructure systems continues to be a major challenge. Even though there have been an increasing number of papers evaluating recovery planning in cyber–physical infrastructures networks, a comprehensive literature review focusing on mathematical modeling and optimization methods is still lacking. Thus, this study critically analyzes the literature on optimization techniques for recovery planning of cyber–physical infrastructure networks after a disruption, to synthesize key findings on the current methods in this domain. A total of 152 relevant research papers are reviewed following an extensive assessment of all major scientific databases. The main mathematical modeling practices and optimization methods are identified for both deterministic and stochastic formulations, categorizing them based on the solution approach (exact, heuristic, metaheuristic), objective function, and network size. Having identified the gaps, a set of future trends for both the methodology and application of optimization algorithms is presented. Overall, there is a need to shift toward scalable optimization solution algorithms, empowered by data-driven methods and machine learning algorithms, to provide reliable and computationally efficient decision-support systems for decision-makers and practitioners.

Reliability and Residual Life of Cold Standby Systems

In this study, we conduct a reliability characterisation study of cold standby systems. Utilising synthetic rectangular formulas and cold preparedness equivalent models for cold standby systems, we analyse the lifetimes of several typical configurations, including series, parallel, and k/n:m voting systems. This study proposes system equivalent models for various types of cold standby systems, all composed of components that follow the same exponential distribution. We use the equivalent model to determine the optimal timing for the use of cold spares and derive the reliability function and residual lifetime function for each type of system. To demonstrate the validity of our model, the Monte Carlo simulation is strategically designed based on the system failure rate function. The experimental results are then compared with those obtained from the numerical model, highlighting that the numerical method incurs a lower time cost.

Survival rate of teeth adjacent and nonadjacent to dental implants: A retrospective cohort study.

The aim of this retrospective study was to investigate the risk of tooth loss for teeth adjacent and nonadjacent to dental implants. A total of 787 patients with an average follow-up of 57.1 months were examined to define the tooth loss, cumulative survival rate, and odds ratio (OR) for teeth adjacent versus nonadjacent to implants. A multivariate logistic regression was employed to assess the association between dental history and various recorded etiologies of tooth loss among teeth adjacent to implants. The incidence of tooth loss for teeth adjacent to implants was 8.1% at the tooth level and 15.1% at the patient level, while 0.7% and 9.5% at the tooth and patientlevel for teeth nonadjacent to implants. The 10-year cumulative survival rate for teeth adjacent to implants was 89.2%, and the primary etiology of tooth loss was root fracture (45.2%). The risk of tooth loss among teeth adjacent versus nonadjacent to implants was significantly higher (OR 13.15). Among teeth adjacent to implants, root canal-treated teeth had a significantly higher risk of tooth loss due to root fracture (OR 7.72), a history of existing restoration significantly increased the risk of tooth loss due to caries (OR 3.05), and a history of periodontitis significantly increased the risk of tooth loss due to periodontitis (OR 38.24). The present study demonstrated that after patients received dental implant treatment, teeth adjacent to implants showed a 13.2-fold higher risk of tooth loss compared to teeth nonadjacent to implants, with the primary etiology being root fracture.

Robust Radar Inertial Odometry in Dynamic 3D Environments

Millimeter-Wave Radar is one promising sensor to achieve robust perception against challenging observing conditions. In this paper, we propose a Radar Inertial Odometry (RIO) pipeline utilizing a long-range 4D millimeter-wave radar for autonomous vehicle navigation. Initially, we develop a perception frontend based on radar point cloud filtering and registration to estimate the relative transformations between frames reliably. Then an optimization-based backbone is formulated, which fuses IMU data, relative poses, and point cloud velocities from radar Doppler measurements. The proposed method is extensively tested in challenging on-road environments and in-the-air environments. The results indicate that the proposed RIO can provide a reliable localization function for mobile platforms, such as automotive vehicles and Unmanned Aerial Vehicles (UAVs), in various operation conditions.

Analysis of multiple factors influencing the survival of patients with advanced gastric cancer.

The aim of this study was to investigate the main factors influencing the survival of patients with advanced gastric cancer. The clinicopathological data of 120 patients with advanced gastric cancer were analyzed retrospectively, and clinical and pathological data were collected. Tumor tissue staging and grading were re-evaluated, and 5-year overall survival was followed up. The classified data were described by percentages, and the continuous data were described by standard deviations or medians. Univariate analysis was performed using the χ2 test or rank-sum test, followed by Kaplan-Meier survival analysis to calculate the median survival time and 5-year cumulative survival. A multivariate Cox regression model was used to evaluate the independent risk factors affecting survival. The test level was α = 0.05. Patients were followed up for 0 to 60 months, the 5-year overall survival rate was 36.2%, and the median survival time was 53.0 ± 1.461 months. K-M and log-rank test results revealed that tumor location, degree of differentiation, depth of invasion, regional lymph node involvement, and postoperative tumor stage were correlated with a decreased 5-year survival rate (P < 0.05). A multivariate Cox risk regression model was used to analyze the degree of histological differentiation (HR = 1.441; 95% CI = 1.049-1.979; P = 0.024), regional lymph node (HR = 1.626; 95% CI = 1.160-2.279; P = 0.005), and pTNM stage (HR = 2.266; 95% CI = 1.335-3.847; P = 0.002), which are independent risk factors for poor survival. Tumor location (P = 0.191), invasion depth (P = 0.579) and tumor size (P = 0.324) were not found to be independent risk factors. The degree of tumor differentiation, regional lymph node metastasis and postoperative pathological stage were found to be independent risk factors for 5-year overall survival in patients with advanced gastric cancer. Standardized and reasonable lymph node dissection and accurate postoperative pathological staging were very important.

ОЦІНЮВАННЯ ВПЛИВУ ЗАСОБІВ ПІДКЛЮЧЕННЯ РЕЗЕРВУ НА ПОКАЗНИКИ НАДІЙНОСТІ СИСТЕМИ ПЕРЕДАВАННЯ ДАНИХ

Structural redundancy is included in modern data transmission systems to ensure the specified reliability indicators. Structural redundancy gives the system fault tolerance and significantly increases its reliability. To manage the redundant resource, it is necessary to have additional tools that will connect the redundant equipment to the main configuration of the data transmission system. The redundant equipment is a separate technical means and, from the point of view of reliability, it is connected in series with other modules of the data transmission system. Thus, the inclusion of redundant connection facilities in the data transmission system reduces its reliability. In addition, even with perfect reliability, redundant connections may fail or malfunction and, under certain conditions, cause the transmission system to fail. To determine the impact of reserve connection facilities on the reliability of the transmission system, the article applies an original technology for building models of discrete-continuous stochastic systems. ASNA software was used as a software tool for modeling the reliable behavior of the data transmission system. This software provides automated construction of the model in the form of a graph of states and transitions based on a structural automaton model. Based on the graph of states and transitions, an analytical model is automatically generated in the form of a system of linear differential Kolmogorov-Chapman equations. Using the developed model, the article quantitatively analyzes the impact of redundant connection means (switches) on the reliability indicators of the data transmission system. In the study, the proposed models, unlike the existing ones, take into account both reliability indicators (probability of failure) and functionality indicators (probability of switching, speed) of the reserve connection means. On the basis of the developed model, the limit values of reliability and functionality of the redundant connection means (switches) were determined, at which they will minimize the reliability of the fault-tolerant data transmission system. Based on the analysis of the obtained results, practical recommendations for the selection of reliability indicators of the backup connection means, their speed and probability of switching are formed.

A 3D spheroid model of quadruple cell co-culture with improved liver functions for hepatotoxicity prediction

Drug-induced liver injury (DILI) is one of the major concerns during drug development. Wide acceptance of the 3 R principles and the innovation of in-vitro techniques have introduced various novel model options, among which the three-dimensional (3D) cell spheroid cultures have shown a promising prospect in DILI prediction. The present study developed a 3D quadruple cell co-culture liver spheroid model for DILI prediction via self-assembly. Induction by phorbol 12-myristate 13-acetate at the concentration of 15.42 ng/mL for 48 hours with a following 24-hour rest period was used for THP-1 cell differentiation, resulting in credible macrophagic phenotypes. HepG2 cells, PUMC-HUVEC-T1 cells, THP-1-originated macrophages, and human hepatic stellate cells were selected as the components, which exhibited adaptability in the designated spheroid culture conditions. Following establishment, the characterization demonstrated the competence of the model in long-term stability reflected by the maintenance of morphology, viability, cellular integration, and cell-cell junctions for at least six days, as well as the reliable liver-specific functions including superior albumin and urea secretion, improved drug metabolic enzyme expression and CYP3A4 activity, and the expression of MRP2, BSEP, and P-GP accompanied by the bile acid efflux transport function. In the comparative testing using 22 DILI-positive and 5 DILI-negative compounds among the novel 3D co-culture model, 3D HepG2 spheroids, and 2D HepG2 monolayers, the 3D culture method significantly enhanced the model sensitivity to compound cytotoxicity compared to the 2D form. The novel co-culture liver spheroid model exhibited higher overall predictive power with margin of safety as the classifying tool. In addition, the non-parenchymal cell components could amplify the toxicity of isoniazid in the 3D model, suggesting their potential mediating role in immune-mediated toxicity. The proof-of-concept experiments demonstrated the capability of the model in replicating drug-induced lipid dysregulation, bile acid efflux inhibition, and α-SMA upregulation, which are the key features of liver steatosis and phospholipidosis, cholestasis, and fibrosis, respectively. Overall, the novel 3D quadruple cell co-culture spheroid model is a reliable and readily available option for DILI prediction.

Clinical features and mutational spectrum of Chinese patients with primary hyperoxaluria type 2.

Primary hyperoxaluria type 2 (PH2) is a rare hereditary disease that causes nephrolithiasis, nephrocalcinosis and kidney failure. This study aimed to investigate the clinical features and mutational spectrum of Chinese patients with PH2. A retrospective cohort study was performed on PH2 patients admitted to our center over seven years. We also systematically reviewed all the articles on Chinese PH2 patients published from January 2000 to May 2023 and conducted a meta-analysis. A total of 25 PH2 patients (10 from our center and 15 from published studies) were included in this study. The median age of onset in patients from our center was 8.50 (1.00, 24.00) years, and 50% were male. Among the full cohort of 25 Chinese patients, the median age of onset was 8.00 (0.40, 26.00) years, and 64% of them were male. Seven patients progressed to end-stage kidney disease, with a median age of 27.50 (12, 31) years. The cumulative renal survival rates were 100%, 91.67%, 45.83% and 30.56% at 10, 20, 30 and 40 years of age, respectively. A total of 18 different variants were identified, and c.864_865del was the dominant variant, accounting for 57.69% of the total alleles. Patients who were heterozygous for c.864_865del were more susceptible to nephrocalcinosis than those who were homozygous for c.864_865del and those harboring other mutations (83.33% versus 33.3% and 0%, respectively) (p = 0.025). The clinical features and mutational spectrum of Chinese PH2 patients were described. This study helps to expand awareness of the phenotypes and genotypes of Chinese PH2 patients and contributes to the improvement of diagnostic and treatment strategies for PH2 patients.

Power Hardware-in-the-Loop Smart Inverter Testing with Distributed Energy Resource Management Systems

The increasing integration of grid-connected photovoltaic (PV) inverters and inverter-based resource (IBR) systems into the power grid emphasizes the critical need for standardized procedures to ensure their reliability and effective grid support functions. This research is driven by the gap in standardized testing methodologies for smart inverters, which are pivotal for the stability and quality of power in distributed energy systems. We used a Power Hardware-in-the-Loop (PHIL) laboratory setup to conduct a comprehensive analysis of smart inverters within a simulated real-world grid environment. Our approach integrates a Distributed Energy Resource Management System (DERMS) with PHIL testing to evaluate the smart inverter’s performance across various operational modes. The detailed test protocols mimic real-world grid conditions, enabling the examination of the inverter’s dynamic response to grid disturbances, control strategies, and communication protocols. The primary aim of this study is to rigorously test and validate the primary functions of smart inverters, focusing on their impact on overall grid stability and power quality management. This includes advanced features like Volt–VAR, Volt–Watt, dynamic power factor control, and the seamless integration of smart inverters into DERMSs and Advanced Distribution Management Systems (ADMSs). Furthermore, we aim to bridge the current gap in standardized testing procedures, contributing to the establishment of robust standards and operating protocols for smart inverter integration into the grid.