Higher Values Research Articles

Analysis of the Dairy Milk Supply Chain at Sapi Juara Farm, Bogor Regency

Pamijahan District in Bogor Regency, West Java, is known as one of the main sources of milk supply for dairy cows in the region. Dairy cow's milk is a product that has high and stable demand and selling value. Supply Chain Management (SCM) at Sapi Juara Farm in Pamijahan District involves the distribution of dairy cow's milk which includes product flow, information and finance. This study aims to understand the SCM of dairy milk at Sapi Juara Farm, including product flow, information and finance, as well as efficiency as measured through marketing margin and farmer's share. This research uses quantitative descriptive methods with primary data obtained from interviews. The results of the analysis show that there is a flow of dairy milk products, a flow of information from farmers to various actors in the supply chain, and a flow of funds that includes costs and profits from nine distribution channels that influence the performance of the supply chain based on the payment system. From the analysis of the profit share value, it can be seen that the SCM for dairy cow milk in Pamijahan District is running efficiently. It is hoped that SCM in Pamijahan District can be more efficient to avoid losses at each stage or link in the chain and stabilize milk prices in the market, while improving the welfare of farmers, especially at Sapi Juara Farm.

Absence of late gadolinium enhancement and outcomes of cardiac resynchronization therapy in non-ischemic dilated cardiomyopathy

Abstract Background Among patients with non-ischemic dilated cardiomyopathy (DCM) with indication for cardiac resynchronization therapy (CRT), there are no clear recommendations about who should receive a CRT-defibrillator (CRT-D) and who should have CRT-pacemaker (CRT-P). Absence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has a high negative predictive value for ventricular arrhythmias (VA) and sudden death (SD) in DCM and is a predictor of reverse remodelling in several scenarios. Purpose To evaluate the association between absence of LGE and VA/SD or echocardiographic response to CRT in DCM patients treated with CRT. Methods Multicenter retrospective observational cohort study including consecutive DCM patients with de-novo CRT implant and with available CMR. The primary endpoints were: 1) a combined arrhythmic endpoint including appropriate defibrillator therapies, sustained VA and sudden death. 2) echocardiographic response to CRT, intended as an increase ≥10% in left ventricular ejection fraction (LVEF). Results We included 167 patients, 55% males, with median QRS duration of 160ms and median LVEF of 25%. LGE was present in 46% of cases (LGE+). A CRT-D was implanted in 73% of patients. Median follow-up was 63 months. Of note, among patients without LGE (LGE-) we did not record any event of the combined arrhythmic endpoint. The cumulative incidence of the arrhythmic endpoint was significantly higher in LGE+ than in LGE- patients (25% vs 0%, p<0.001) and LGE was an independent predictor of this endpoint (adjusted HR 42, p<0.001). The proportion of responders to CRT was significantly higher in LGE- than in LGE+ cases (81% vs 53%, p<0.001); absence of LGE was the strongest predictor of echocardiographic response to CRT at multivariate analysis (adjusted OR 4.1, p=0.001). Super-responders (i.e. those with LVEF≥50% at follow-up) were also more frequent among LGE- than LGE+ patients (46% vs 21%, p=0.001) and absence of LGE was an independent predictor of LVEF normalization (HR 2.6, p=0.03). Conclusions Among DCM patients who receive CRT, those without LGE have an extremely low (or null in this case) arrhythmic risk and, at the same time, they have a high probability of echocardiographic response to CRT. Thus, LGE- patients could be ideal candidates for CRT-P instead of CRT-D.

Monocyte Anisocytosis Changes in Patients after Major Burn Injuries.

The recovery of patients after severe burns is a long and complex process. Recently, genomic analysis of white blood cells from burn and trauma patients revealed excessive and prolonged innate immune activation in patients with complicated outcomes. However, translating this knowledge into practical biomarkers has not been possible yet. Although several biomarkers for monitoring burn patients have been proposed, their ability to accurately distinguish between inflammation stemming from initial tissue destruction, infections, and organ failure complications is limited. Here, we focused on monocytes, critical innate immune cells in the response to burn injured tissues. We measured the monocyte anisocytosis (quantified as monocyte distribution width, MDW, a recently emerged marker of sepsis) throughout the recovery of patients from the time of burn injury until the end of the hospital stay. We observed that MDW increases in patients during the first week after major burns. Among the patients with major burns who survive, MDW starts decreasing in the second week and normalizes by the end of the hospital stay. The duration of hospital stay appears to be proportional to how fast MDW decreases during the second week after the injury. We also found that MDW decreases significantly in most patients after excision and debridement surgeries but not after allo- and auto-graft surgeries. Moreover, high MDW values correlated with a higher rate of positive microbiology blood culture samples and respiratory infections. These findings underscore the importance of monitoring MDW as a potential biomarker for the risk of complications during burn patient recovery.

Investigation on the efficiency of lentinan for injection combining cisplatin on treating malignant pleural effusion based on systematic review and meta-analysis.

Malignant pleural effusion (MPE) is a frequently observed complication in advanced malignant tumors. Clinical studies have shown that lentinan for injection (LNT) is beneficial for improving patients' quality of life and prolonging their survival. The purpose of this meta-analysis is to evaluate the efficacy and safety of LNT combining cisplatin in the treatment of MPE. Randomized controlled trials (RCTs) of LNT combining cisplatin in the treatment of MPE were searched in 6 literature databases from the establishment time of each database by 2 researchers. According to the inclusion criteria, 2 researchers independently screened studies, assessed the risk of bias and conducted subgroup analyses for different outcome indicators according to the specific characteristics of the included literature. Analyzing the data by Revman software, and evaluating the stability of the results by Stata software. A total of 52 RCTs were included. The results showed that combined use of LNT and cisplatin could improve the treatment effect, and the difference between groups was statistically significant (RR = 1.40, 95%CI: 1.33 ~ 1.46, P < .001). And the combined use of LNT could increase the quality of life (RR = 1.45, 95%CI: 1.35 ~ 1.56, P < .001). The using of LNT could significantly decrease the incidence of gastrointestinal reactions (RR = 0.86, 95%CI: 0.78 ~ 0.94, P < .001). Sensitivity analysis results showed that there were no qualitative changes in the indicator, and suggested the possibility of publication bias. Available evidence suggested the combined use of LNT and cisplatin showed better efficacy in treating MPE without increasing ADR incidence than using cisplatin alone. LNT is an ideal treatment for MPE, which has high clinical application value.

A nomogram model for the occurrence of bladder spasm after TURP in patients with prostate enlargement based on serum prostacyclin and 5-hydroxytryptamine and clinical characteristics.

With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

Nanostructuring of an additively manufactured CoCrFeNi multi-principal element alloy using severe plastic deformation: Comparison of two materials processed by different laser scan speeds

Experiments were conducted to reveal the refinement of the microstructure and the evolution of the hardness of an additively manufactured (AM) CoCrFeNi multi-principal element alloy (MPEA) processed by severe plastic deformation (SPD) using high pressure torsion (HPT) technique. AM was carried out by laser powder bed fusion (L-PBF) technique at two different laser scan speeds. The as-built alloys for both laser scan speeds have a single-phase face-centered cubic (fcc) structure with <110> fiber texture parallel to the building direction. X-ray line profile analysis (XLPA) revealed that the dislocation density was considerably high even in the AM-processed state before HPT (3 × 1014 m−2) which increased by two orders of magnitude during HPT. The saturation of the lattice defects (dislocation density and twin fault probability) as well as the crystallite size occurred at a shear strain of about 10 during HPT. In both AM-processed alloys, <111> fiber texture developed parallel to the normal of the HPT-processed disks. For both laser scan speeds, the initial grain size in the AM-processed samples was refined from 70 to 90 μm to the nanocrystalline regime after 10 turns of HPT. Additionally, nanotwins formed with a probability of about 3 %. The initial hardness of the AM-processed MPEA samples for both laser scan speeds was 2700–2800 MPa, which is superior to that of CoCrFeNi produced by casting (about 1380 MPa). This can be explained by the high dislocation density in the AM-processed specimens. The formation of nanostructure with high lattice defect density during HPT resulted in a very high hardness value of about 5500 MPa in the AM-processed CoCrFeNi MPEA samples for both laser scan speeds.

Phytotherapeutic options for the treatment of epilepsy: pharmacology, targets, and mechanism of action

Epilepsy is one of the most common, severe, chronic, potentially life-shortening neurological disorders, characterized by a persisting predisposition to generate seizures. It affects more than 60 million individuals globally, which is one of the major burdens in seizure-related mortality, comorbidities, disabilities, and cost. Different treatment options have been used for the management of epilepsy. More than 30 drugs have been approved by the US FDA against epilepsy. However, one-quarter of epileptic individuals still show resistance to the current medications. About 90% of individuals in low and middle-income countries do not have access to the current medication. In these countries, plant extracts have been used to treat various diseases, including epilepsy. These medicinal plants have high therapeutic value and contain valuable phytochemicals with diverse biomedical applications. Epilepsy is a multifactorial disease, and therefore, multitarget approaches such as plant extracts or extracted phytochemicals are needed, which can target multiple pathways. Numerous plant extracts and phytochemicals have been shown to treat epilepsy in various animal models by targeting various receptors, enzymes, and metabolic pathways. These extracts and phytochemicals could be used for the treatment of epilepsy in humans in the future; however, further research is needed to study the exact mechanism of action, toxicity, and dosage to reduce their side effects. In this narrative review, we comprehensively summarized the extracts of various plant species and purified phytochemicals isolated from plants, their targets and mechanism of action, and dosage used in various animal models against epilepsy.

Clinical validation of a novel digital twin framework for ventricular functional substrate simulation in post-infarction patients

Abstract Background Catheter ablation is a cornerstone treatment for scar related post-infarction ventricular arrhythmias. Functional substrate driven ablation strategies guided by local activation time (LAT) mapping have been proven as efficient and effective approaches, especially when dealing with large scar areas. In-silico electrophysiological modeling is emerging as a potential tool for procedural planning and guidance. Purpose To clinically validate the feasibility, diagnostic performance, and accuracy of a novel late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) based digital twin framework for simulated LAT map generation in post-infarction patients and their integration with CARTO3 EAM suite. Methods Five ischemic subjects who underwent CMR-aided scar-related ventricular tachycardia ablation at our referral center were retrospectively enrolled. Their CMR derived 3D pixel-signal-intensity (PSI) maps generated with ADAS3D were processed with novel in-house software to obtain patient-specific ventricular geometry, tissue characterization, and to generate a model of Purkinje system and myocyte fiber orientation. According to local normalized pixel intensity (NPI) values, myocardial regions were marked as healthy, scar, or border-zone. Electrophysiological properties of border-zone (BZ) were modulated according to local NPI. Continuous and 8-steps isochronal endo-epicardial LAT maps were generated and imported in CARTO3 system, aligned with electroanatomical mapping (EAM), and compared at an ASE 17-segments level, in terms of sensitivity, specificity, predictive values, and accuracy to actual high-density LAT maps obtained with a multipolar catheter. Deceleration Zones (DZ) were defined as previously described (&amp;gt;3 isochrones within 1 cm radius). Results A total of 85 ASE segments (34 epicardial) were analyzed. 24 EAM segments (28%) held DZs, 40 (47%) segments harbored bipolar scar or BZ. Thirty-seven (44%) CMR segments held scar core/BZ. Thirty (35%) digital model segments harbored DZs. Generated LAT maps were successfully imported and aligned with CARTO3 EAM suite for validation. In terms of DZ localization prediction, our LAT model showed 83% sensitivity (95% CI 63%-95%), 90% specificity (95% CI 80%-96%), 77% positive predictive value (PPV) (95% CI 56%-91%), 93% negative predictive value (NPV) (95% CI 83%-98%), 88% accuracy (95% CI 79%-94%). Conclusion Our newly developed framework for LGE-CMR derived functional substrate simulation in post-infarction patients holds high sensitivity, specificity, predictive values, and accuracy for DZ localization. Further validation, with a larger sample size, is required for evaluating potential implications in clinical practice.

Evaluation of health risk experienced by urban taxi drivers to whole-body vibration and multiple shocks

This cross-sectional study was done aiming at determining the exposure of taxi drivers to vibration on 35 safe taxis (19 cars with engine volume of 1.325 L, 9 cars with engine volume of 1.645 L, and 7 cars with engine volume of 1.761 L). Measurements were based on ‘ISO 2631-1’ on seats’ pans, by Castel GA2005 vibrometer. The results through two different evaluative methods indicated moderate exposure levels, corresponding to suggestive Health Guidance Caution Zone (HGCZ) in ‘ISO 2631-1’. Evaluation of exposure to the WBV among taxi drivers, in the taxis with low and high mean acceleration values, using the VDV method is preferred over the R.M.S method. In lower accelerations, in all conditions, the mean of the reckoned values in the VDV method was less than the R.M.S method, and in higher accelerations, where there are more differences, and the CF values were higher (PAIK 1761 cars), again the assessed mean duration in the VDV method is less than R.M.S method. In higher accelerations and with fewer crest factors, this matter didn’t hold, and the allowed time in the R.M.S method became lower.

Comparative analysis for nutrients, flavor compounds, and lipidome revealed the edible value of pond-cultured male Pelodiscus sinensis with different ages

Pelodiscus sinensis is an aquatic product with a long growth cycle in pond culture and high nutritional value meat. The flavor compounds, nutrients, and lipidome were investigated to explore the edible value changes of turtle meat aged 3 to 6 years (Y3 to Y6). Typically, P. sinensis meat is rich in high-quality protein (EAAI ≥81.22, AAS ≥86.47). Y6 has the highest level of Se, protein, amino acids, and high unsaturated fatty acids, including EPA + DHA. Y5 has the most delicious amino acids, polyunsaturated fatty acids, and key odorant content. The stronger flavor of Y5 may be mainly related to C18:2n6t and C18:2n6c. Further, triacylglycerols (TAG) and phosphatidylcholine (PC) were significant changes in Y5. Additionally, PI (16:0/18:1) was identified as the potential biomarker. These results provided available information on P. sinensis marketing age and revealed the potential impact of nutrients on the formation of VOCs.

Improved dual-threshold quantum image segmentation algorithm and simulation

Abstract Quantum image segmentation algorithm is crucial for quantum image processing. In this paper, a dual-threshold quantum image segmentation algorithm is designed and simulated in IBM Quantum Experience (IBM Q) platform, which can segment a complex image into three parts using fewer quantum bits. In our algorithm, given a high threshold and a low threshold, grayscale values larger than the high threshold are set to the high threshold and grayscale values smaller than the low threshold are set to the low threshold, with no change for the part between the two thresholds. Then we use a low-cost quantum comparator and design a complete and scalable quantum image segmentation circuit. Analysis of the circuit cost shows that the quantum gates required for the circuit are only related to the grayscale range q and are independent of the image size. The feasibility of the algorithm and the correctness of the quantum circuit are verified by simulation in IBM Q platform, and finally the MSE, PSNR AND SSIM value of the image is analyzed to prove the effectiveness of the segmentation algorithm.

Stabilizing Zinc Hexacyanoferrate Cathode by Low Contents of Cs Cations for Aqueous Zn-Ion Batteries.

Exploring cathode materials with excellent electrochemical performance is crucial for developing rechargeable aqueous zinc ion batteries (RAZIBs). Zinc hexacyanoferrate (ZnHCF), a promising candidate of cathode materials for RAZIBs, suffers from severe electrochemical instability issues. This work reports using low contents of alkaline metal cations as electrolyte additives to improve the cycle performance of ZnHCF. The cations with large sizes, particularly Cs+, changes the intercalation chemistry of ZnHCF in RAZIBs. During cycling, Cs+ cations co-inserted into ZnHCF stabilize the host structure. Meanwhile, a stable phase of CsZn[Fe(CN)6] forms on the ZnHCF cathode, suppressing the loss of active materials through dissolution. ZnHCF gradually converts to an electrochemically inert Zn-rich phase during long-term cycling in aqueous electrolyte, leading to irreversible capacity loss. Introducing Cs+ in the electrolyte inhibits this conversion reaction, resulting in the extended lifespan. Owing to these advantages, the capacity retention rate of ZnHCF/Zn full batteries increases from the original 7.0% to a high value of 54.6% in the electrolyte containing 0.03 M of Cs2SO4 after 300 cycles at 0.25 A∙g-1. This research provides an in-depth understanding of the electrochemical behavior of ZnHCF in aqueous zinc electrolyte, beneficial for further optimizing ZnHCF and other metal hexacyanoferrates.

The spatiotemporal evolution and impact of green land use efficiency in resource-based cities in the yellow river basin under the background of sustainable development

Introduction: With the rapid advancement of industrialization and urbanization in the Yellow River Basin, the number of resource-based cities is constantly increasing, leading to an imbalance in land use structure and the gradual worsening of adverse effects such as damage to the ecological environment. Hence, improving the efficiency of green land use in resource-based cities has extremely crucial ecological and practical meaning for sustainable development.Methods: This study comprehensively considers interdisciplinary theories such as ecology and management, and combines the actual situation of resource-based cities in the Yellow River Basin to construct a new type of urban field green utilization efficiency assessment index system. To promote the coordinated development of different dimensions, the corresponding spatiotemporal evolution process and related influencing factors were also analyzed. Results and discussion: The research results indicate that the overall spatial evolution of the Yellow River Basin has active correlation. During the period from 2006 to 2022, the number of high value agglomeration cities in upstream resource-based cities increased by nearly 25%; Nearly 3% of resourcecities exhibit low-value heterogeneity, while the number of resource cities with low value agglomeration has decreased to 0. In addition, population density and scientific education expenditure level are key factors affecting the ratio of green land use in resource-based cities, while the impact of economic indicators is gradually decreasing. In summary, the assessment indicator system for urban land green utilization ratio proposed in the study is more comprehensive, and the spatial distribution results of influencing factors can provide a solid data foundation for decision-makers.

Experimental Study of Interference in Calcitonin Testing: A Case Report and Literature Review.

Calcitonin (CT) is a sensitive serum marker of medullary thyroid carcinoma usually detected via immunoassays; however, its levels are easily disturbed by several endogenous factors. The study aimed to discuss a case of suspected interference resulting in aberrant CT values and review previous reports of CT interference. A female patient visited our clinic with a physical ultrasound examination showing a slightly enlarged thyroid gland with small nodules. She had elevated CT levels, inconsistent with the clinical presentation and other findings. We evaluated the results by retesting using the same platform, platform validation, multiplex dilution, Polyethylene Glycol (PEG) precipitation, heterophilic blocking tubes, and RET gene analysis. Retesting CT using the same platform confirmed the high value obtained. However, serial dilution of the sample produced nonlinear results, suggesting some interference. While PEG precipitation did not significantly reduce the CT level, incubating the sample in HBTs normalized the CT value, indicating interference from heterophilic antibodies. Gene sequencing revealed no RET mutations. In cases where elevated CT levels are inconsistent with clinical presentations and other findings, the laboratory technicians should communicate with clinicians, analyze the reasons for the inconsistent results, and use different methods to verify the results. Accurate testing provides realistic and reliable data for doctors and patients and helps to avoid unnecessary procedures.

Can prediction of acute myocardial infarction using a deep learning-enabled electrocardiogram be used in real-world practice?

Abstract Background Diagnosing acute myocardial infarction (MI) in the emergency department poses challenges. The utilization of a 12-lead electrocardiogram (ECG) is pivotal for detecting ST-segment elevation myocardial infarction (STEMI), yet enhancing ECG interpretation through a systematic algorithm could significantly improve diagnostic accuracy. Nonetheless, delayed diagnosis or misdiagnosis of STEMI is not uncommon in daily practice. Purpose This study aims to develop a fully convolutional network (FCN) based on ECG data as a diagnostic support tool and to evaluate its effectiveness in STEMI detection. Methods A retrospective cohort study involved 3,298 patients with angiographically confirmed STEMI and 37,393 control ECGs, comprising normal readings, false positives, and ECGs mimicking STEMI. The FCN underwent internal training, external validation, and testing across various data splits (80:10:10, 70:15:15, and 60:20:20). Performance evaluation on validation data included assessing the area under the receiver operating characteristic curve (AUC). Subsequently, the trained model predicted unseen data, and sensitivity, specificity, false positives, and false negatives were calculated to evaluate model performance. Results The FCN exhibited exceptional performance in STEMI detection during both internal training and external validation across different data splits. The receiver operating characteristic curves yielded AUC values of 0.995 (80:10:10), 0.994 (70:15:15), and 0.995 (60:20:20). Consistently high values were observed in precision-recall curves, with AUC values of 0.974 (80:10:10), 0.962 (70:15:15), and 0.973 (60:20:20). When utilizing this FCN model in the clinical setting to reanalyze 20 cases of previously misdiagnosed electrocardiograms, it correctly diagnosed 17 cases. Conclusion Integrating the FCN into clinical practice can notably improve the timely and accurate diagnosis of acute MI, reducing instances of delayed or erroneous STEMI diagnoses and facilitating prompt reperfusion therapy.

Stable Isotope Hydrology of Karst Groundwaters in Romania

In this article we present the first investigation of the stable isotope composition of groundwater in Romania, East-Central Europe, with a focus on the karst areas. Our aim is twofold: (1) to provide a countrywide map with the distribution of stable oxygen and hydrogen isotope ratios in groundwater, and (2) to assess the recharge patterns of karst water. We collected more than 600 water samples from springs and wells across Romania for stable isotope analyses and monitored in detail the stable isotope composition of the waters as they pass through five cave systems. Our data show a spatial distribution of the stable isotope composition of the groundwater with low values in the mountainous area and high values in the surrounding lowlands and the central Transylvanian Depression. However, waters in karst areas induce departures from this distribution, resulting from the fast (hours to days) transfer of waters from high (ponor) to low (spring) altitudes. Water emerging from the karst springs has generally lower δ values than before sinking through the ponors, thus indicating a substantial contribution of winter recharge through diffuse infiltration and seepage. This contribution results in overall dilution of the water entering through ponors, likely resulting in changes in the chemical composition of the water and diluting potential pollutants. Our data call for careful separation between karst and non-karst spring/well waters, as indiscriminate common treatment might lead to erroneous interpretations.

#2509 Longitudinal haemoglobin levels and mortality in an elderly population with advanced chronic kidney disease: insights from the EQUAL Study

Abstract Background and Aims The relationship between haemoglobin (Hb) levels and clinical outcomes in chronic kidney disease (CKD) is more intricate than previously understood, as both low and high values can have detrimental effects. Although the association between Hb and patient outcomes is widely reported, few studies have focused on older patients with advanced CKD or have explored this relationship both before and after kidney replacement therapy (KRT) initiation. The primary objective of this study is to describe the relationship between Hb levels and mortality in older patients with advanced CKD in the continuum from pre-KRT phase to subsequent KRT initiation, and to evaluate any effect modification by KRT initiation. Method We used data from the European QUALity Study on treatment in advanced CKD (EQUAL) cohort which includes patients aged ≥65 years and eGFR ≤20 ml/min per 1.73 m2 from six European countries. The association between Hb and all-cause and cause-specific mortality (cardiovascular [CV] and non-cardiovascular [non-CV] mortality) was explored in three separate CKD populations: pre-KRT, KRT and transition-CKD (transition phase surrounding the start of KRT) population. Multivariable adjusted time-dependent Cox regression models and natural cubic splines were used to investigate the association between longitudinal Hb levels (as categorical and continuous variable) and mortality risk in the pre-KRT and KRT population. The area under the Hb trajectory (AUC Hb) before KRT initiation was calculated to evaluate the relationship between the cumulative exposure of Hb before KRT initiation and all-cause mortality after KRT initiation in the transition-CKD population. We evaluated effect modification by pre-specified variables on the relationship between Hb and mortality. Results Overall, 1716 CKD patients were included in the study. During a median follow up of 3.0 years (IQR 2.6), 614 patients died, resulting in a 5-year survival probability of 51% (95% CI 48, 55). Low Hb levels were consistently associated with increased mortality risk in all study populations (Figure). A U-shaped association between both the lowest and highest levels of Hb and mortality risk was observed (Figure). A similar association was observed for non-CV mortality, with lower Hb values associated with an increased mortality risk (Figure). Conversely, a trend towards higher risk of cardiovascular death was observed as Hb levels increase, especially in the whole population and pre-KRT population (Figure), albeit not statistically significant. Low cumulative exposure of Hb in the transition-CKD population was associated with increased mortality risk after transitioning to KRT (p = 0.047). In subgroup analysis diabetic patients were more susceptible to low Hb levels (p-value for interaction = 0.003) while patients on ESA therapy (p-value for interaction = 0.005) or initiating KRT (p-value for interaction = 0.024) showed increased mortality risk for high Hb levels. Conclusion The relationship between Hb levels and mortality in advanced CKD patients is complex. Low Hb levels consistently indicate an increased risk of mortality, while high Hb levels also appear to have a negative effect, increasing mortality risk, particularly in patients receiving ESA therapy and after KRT initiation. Our work emphasizes how different stages of advanced kidney disease (i.e., before and after initiating KRT), as well as comorbidities such as diabetes or medications such as ESA therapy can significantly influence the relationship between Hb and mortality.

Synthesis and high-frequency magnetoelectric characterization of the 0–3 particulate lead-free multiferroic composite KNN/CFO

The research for lead-free magnetoelectric (ME) multiferroic composite materials has increased considerably because they are environmentally friendly. For composites with 0–3 connectivity, synthesis with lead-free phase has proven challenging to obtain high values of ME coupling. This work reports the successful synthesis of the KNN/CFO composite (K0.5N0.5NbO3/CoFe2O4) by conventional synthesis process. XRD and SEI showed two well-defined, also presenting good electric polarization values. The ME coefficient was very high, reaching values close to 2850 mV cm−1·Oe at the electromechanical resonance frequency. The dipolar interaction between the electric charges and magnetic moments of the KNN and CFO phases was responsible for the high value and the behavior of dependence on the applied magnetic field.

A nomogram for predicting survival in patients with gastrointestinal stromal tumor: a study based on the surveillance, epidemiology, and end results database

PurposeThe objective of this investigation was to construct and validate a nomogram for prognosticating cancer-specific survival (CSS) in patients afflicted with gastrointestinal stromal tumor (GIST) at 3-, 5-, and 8-years post-diagnosis.MethodsData pertaining to patients diagnosed with GIST were acquired from the Surveillance, Epidemiology, and End Results (SEER) database. Through random selection, a training cohort (70%) and a validation cohort (30%) were established from the patient population. Employing a backward stepwise Cox regression model, independent prognostic factors were identified. Subsequently, these factors were incorporated into the nomogram to forecast CSS rates at 3-, 5-, and 8-years following diagnosis. The nomogram’s performance was assessed using indicators such as the consistency index (C-index), the area under the time-dependent receiver operating characteristic curve (AUC), the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), calibration curves, and decision-curve analysis (DCA).ResultsThis investigation encompassed a cohort of 3,062 GIST patients. By analyzing the Cox regression model within the training cohort, nine prognostic factors were identified: age, sex, race, marital status, AJCC (American Joint Committee on Cancer) stage, surgical status, chemotherapy status, radiation status, and income status. The nomogram was subsequently developed and subjected to both internal and external validation. The nomogram exhibited favorable discrimination abilities, as evidenced by notably high C-indices and AUC values. Calibration curves confirmed the nomogram’s reliability. Moreover, the nomogram outperformed the AJCC model, as demonstrated by enhanced NRI and IDI values. The DCA curves validated the clinical utility of the nomogram.ConclusionThe present study has successfully constructed and validated the initial nomogram for predicting prognosis in GIST patients. The nomogram’s performance and practicality suggest its potential utility in clinical settings. Nevertheless, further external validation is warranted.

Differentiating Low-Grade from High-Grade Intracranial Ependymomas: Comparison of Dynamic Contrast-Enhanced MRI and Diffusion-Weighted Imaging.

The aim of this study was to determine the diagnostic value of fractional plasma volume derived from dynamic contrast-enhanced perfusion MR imaging versus ADC, obtained from DWI in differentiating between grade 2 (low-grade) and grade 3 (high-grade) intracranial ependymomas. A hospital database was created for the period from January 2013 through June 2022, including patients with histologically-proved ependymoma diagnosis with available dynamic contrast-enhanced MR imaging. Both dynamic contrast-enhanced perfusion and DWI were performed on each patient using 1.5T and 3T scanners. Fractional plasma volume maps and ADC maps were calculated. ROIs were defined by a senior neuroradiologist manually by including the enhancing tumor on every section and conforming a VOI to obtain the maximum value of fractional plasma volume (Vpmax) and the minimum value of ADC (ADCmin). A Mann-Whitney U test at a significance level of corrected P = .01 was used to evaluate the differences. Additionally, receiver operating characteristic curve analysis was applied to assess the sensitivity and specificity of Vpmax and ADCmin values. A total of 20 patients with ependymomas (10 grade 2 tumors and 10 grade 3 tumors) were included. Vpmax values for grade 3 ependymomas were significantly higher (P < .002) than those for grade 2. ADCmin values were overall lower in high-grade lesions. However, no statistically significant differences were found (P = .12114). As a dynamic contrast-enhanced perfusion MR imaging metric, fractional plasma volume can be used as an indicator to differentiate grade 2 and grade 3 ependymomas. Dynamic contrast-enhanced perfusion MR imaging plays an important role with high diagnostic value in differentiating low- and high-grade ependymoma.