Incidence In Recent Decades Research Articles

Vitamin C in the Management of Thyroid Cancer: A Highway to New Treatment?

Thyroid cancer (TC) is the most common endocrine malignancy, with an increased global incidence in recent decades, despite a substantially unchanged survival. While TC has an excellent overall prognosis, some types of TC are associated with worse patient outcomes, depending on the genetic setting. Furthermore, oxidative stress is related to more aggressive features of TC. Vitamin C, an essential nutrient provided with food or as a dietary supplement, is a well-known antioxidant and a scavenger of reactive oxygen species; however, at high doses, it can induce pro-oxidant effects, acting through multiple biological mechanisms that play a crucial role in killing cancer cells. Although experimental data and, less consistently, clinical studies, suggest the possibility of antineoplastic effects of vitamin C at pharmacological doses, the antitumor efficacy of this nutrient in TC remains at least partly unexplored. Therefore, this review discusses the current state of knowledge on the role of vitamin C, alone or in combination with other conventional therapies, in the management of TC, the mechanisms underlying this association, and the perspectives that may emerge in TC treatment strategies, and, also, in light of the development of novel functional foods useful to this extent, by implementing novel sensory analysis strategies.

Role of Circulating Biomarkers in Diabetic Cardiomyopathy.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder that has alarmingly increased in incidence in recent decades. One of the most serious complications of T2DM is diabetic cardiomyopathy (DCM), an often underrecognized yet severe condition that is a leading cause of mortality among diabetic patients. In the early stages of DCM, patients typically show no symptoms and maintain normal systolic and diastolic left ventricle function, making early detection challenging. Currently available clinical markers are often not specific enough to detect the early stage of DCM. Conventional biomarkers of cardiac mechanical stress and injury, such as natriuretic peptides (NPs) and cardiac troponin I (cTnI), have shown limited predictive value for patients with T2DM. NPs have proven efficacy in detecting diastolic dysfunction in diabetic patients when used alongside 2D echocardiography, but their utility as biomarkers is limited to symptomatic individuals. While cTnI is a reliable indicator of general cardiac damage, it is not specific to cardiac injury caused by high glucose levels or T2DM. This underscores the need for research into biomarkers that can enable early diagnosis and management of DCM to reduce mortality rates. Promising novel biomarkers that showed good performance in detecting diastolic dysfunction or heart failure in diabetic patients include galectin-3, ST2, FGF-21, IGFBP-7, GDF-15, and TGF-β. This review summarizes the current understanding of DCM biomarkers, aiming to generate new ideas for the early recognition and treatment of DCM by exploring related pathophysiological mechanisms.

Treatment of malignant melanoma with coxsackievirus A21 (V937): An emerging oncolytic virotherapy.

Despite rising melanoma incidence in recent decades, there is a trend towards overall decreased mortality, reflecting multiple factors including improved treatment options for metastatic disease. While local treatments are the mainstay for early-stage melanoma, metastatic disease necessitates systemic treatment, with oncolytic virotherapy emerging as a promising option. For this review, articles were retrieved from PubMed from 1964 through 2024. We conducted title, abstract and full-text screening in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles describing the use of coxsackievirus A21 (V937), either as monotherapy or as part of combination therapy for malignant melanoma. Fifteen articles met inclusion criteria, offering preclinical and clinical data on V937's efficacy in reducing tumour burden. In addition to reporting manageable safety profiles, clinical trial data examining intratumoral V937 combination therapy with pembrolizumab and ipilimumab also endorsed favourable objective response rates compared to immune checkpoint inhibitor monotherapy (47% vs. 38% and 21% vs. 10%, respectively). In contrast, intravenous V937 monotherapy failed to yield additional benefit in a cohort of patients with Stage IIIC/IV melanoma (n = 3) despite achieving detectable levels in tumour tissue (1 × 109 TCID50). Although small subsets of patients experienced severe adverse effects and study design limitations imposed constraints on collected data, evidence for the efficacy of V937 remains encouraging. With few clinical trials evaluating V937 in melanoma, additional data is required before routine usage in standard treatment for metastatic lesions.

Urbanization impact on scorpion stings: An epidemiological study

Accidents caused by venomous animals, especially scorpions, are a major public health problem due to the increase in incidence in recent decades, since scorpion species have become well adapted to urbanized environments. Nonetheless, the impact of urbanization in scorpionism is not clear. The objective of this study is to correlate the variation in the incidence of scorpion accidents with the rate of urbanized area. This was a retrospective, epidemiological study of accidents by scorpions in 376 of the most populous Brazilian cities in 2019 and compared to ten years earlier, using Spearman's correlation coefficient. Data were obtained by accessing DATASUS/TABNET and IBGE Cidades platforms. A weak negative correlation between scorpion stings and urbanization was found in 2009 (rs = −0.145). The correlation between the variation in the incidence of scorpionism and the percentage of urbanized area was not significant. Although the highest incidence of scorpionism occurs in-more urbanized environments, there is a wide distribution of scorpion accidents, especially in tropical and subtropical regions due to climatic conditions, the level of urbanization of Brazilian municipalities was not the major factor in the increase of scorpion accidents.

Chronic liver disease is an important risk factor for worse outcomes in acute pancreatitis: a systematic review and meta-analysis

Chronic liver diseases (CLD) affect 1.5 billion patients worldwide, with dramatically increasing incidence in recent decades. It has been hypothesized that the chronic hyperinflammation associated with CLD may increase the risk of a more severe course of acute pancreatitis (AP). This study aims to investigate the underlying impact of CLD on the outcomes of AP. A systematic search was conducted in Embase, Medline, and Central databases until October 2022. Studies investigating patients with acute pancreatitis and CLD, were included in the meta-analysis. A total of 14,963 articles were screened, of which 36 were eligible to be included. CLD was a risk factor for increased mortality with an odds ratio (OR) of 2.53 (CI 1.30 to 4.93, p = 0.01). Furthermore, renal, cardiac, and respiratory failures were more common in the CLD group, with ORs of 1.92 (CI 1.3 to 2.83, p = 0.01), 2.11 (CI 0.93 to 4.77, p = 0.062) and 1.99 (CI 1.08 to 3.65, p = 0.033), respectively. Moreover, the likelihood of developing Systemic Inflammatory Response Syndrome (SIRS) was significantly higher, with an OR of 1.95 (CI 1.03 to 3.68, p = 0.042). CLD is an important risk factor for worse outcomes in AP pancreatitis, leading to higher mortality and increased rates of local and systemic complications.

Human Papilloma Virus (HPV) driven oropharyngeal cancer in current or previous heavy smokers: should we look for a different treatment paradigm?

Human papillomavirus Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OSCC) has increased in incidence in recent decades and represents a heterogeneous disease entity in the context of Head and Neck Squamous Cell Carcinoma (HNSCC), in terms of disease prognosis. Treatment of locoregionally advanced OSCC is mainly based on concurrent chemoradiotherapy. Given the younger age of patients, if compared with HPV-negative counterparts, and the high cure rates, the acute- and long-term toxicity in survivors represents a field of interest. However, patient selection for de-escalation trials remains a major challenge due to the lack of robust validated prognostic indicators within the HPV-associated OSCC. The impact of smoking status on HPV-associated OSCC prognosis has been demonstrated in the majority of studies. However, the magnitude of the association is unclear due to variability in smoking metrics and study outcomes. Smoking status has been identified as a potential confounding factor in HPV-positive de-escalation trials. Smokers with HPV-positive OSCC have a worse prognosis in most studies than non-smokers and may require different and more aggressive therapeutic strategies.

Emergent spotted fever group Rickettsiae infections among hard ticks in Islamic Republic of Iran.

Tick-borne rickettsioses have become a health concern worldwide following the increasing incidence in recent decades. However, there is limited information about these diseases in Islamic Republic of Iran. This cross-sectional study was conducted to estimate the Rickettsia infection among ixodid ticks collected from cattle, sheep and goats in Islamic Republic of Iran. The DNA of ixodid ticks collected from cattle, sheep and goats in 54 villages of Zanjan Province, Islamic Republic of Iran, were collected and analysed using a spectrophotometer. Rickettsial-positive samples were screened by targeting the htrA gene and fragments of gltA gene were analysed. The variables were analysed using descriptive statistics and the χ2 test was used to compare the variables. A total of 528 ticks were tested. Overall, Rickettsia infection rate was 6.44%. Nine of the 12 tick species were infected. Rickettsial positive rates in Hyalomma marginatum and Dermacentor marginatus were 21.33% and 12.77%, respectively. R. aeschlimannii, the predominant rickettsia, was detected only in Hy. marginatum. R. raoultii, R. sibirica and R. slovaca comprised about half of the positive ticks and were recovered from more than one tick species. Considering the discovery of infected ticks in the Islamic Republic of Iran, there is a need to establish a tick control programme in the country, paying attention to populations at high-risk.

Liver Fibrosis Is Associated with Poorer Overall Survival and Higher Recurrence Rate in Patients with Cholangiocarcinoma

Introduction: Cholangiocarcinoma is the second most common primary liver tumour worldwide with an increasing incidence in recent decades. While the effects of fibrosis on hepatocellular carcinoma have been widely demonstrated, the impact on cholangiocarcinoma remains unclear. The aim of this study was to evaluate the impact of liver fibrosis on overall survival (OS) and disease-free survival (DFS) in patients who have undergone liver resection for cholangiocarcinoma. Methods: Eighty patients with cholangiocarcinoma who underwent curatively intended liver surgery between January 2007 and December 2020 were included in this retrospective single-centre study. Clinical and histopathological features were analysed. The primary endpoint was cause-specific survival. Secondary endpoints were DFS and identification of prognostic factors. Results: The present study shows that the median OS is significantly reduced in patients with fibrosis (p < 0.001). The median OS in patients with fibrosis was three times shorter than in the group without fibrosis. In addition, a significantly shorter DFS was observed in patients with fibrosis (p < 0.002). Multivariate analysis showed that fibrosis is the strongest independent factor with a negative impact on OS and DFS. Conclusion: Liver fibrosis has a significant impact on OS and DFS in patients with cholangiocarcinoma. Patients with known liver fibrosis require thorough perioperative care and postoperative follow-up.

P1217 The gut microbiota as a determinant in the development of post-surgical recurrence in Crohn`s disease

Abstract Background Crohn's disease (CD), is a chronic condition with a growing incidence in recent decades. Despite the development of new biologic therapies it is estimated that up to 70% of CD patients will require surgical intervention during their lifetime. However, surgery is not considered curative even in cases where a resection of all macroscopic involvement is performed, and the management of post-surgical recurrence remains a therapeutic challenge. Bacterial dysbiosis has been postulated as a precipitating factor in CD and may play a significant role in the development of post-surgical recurrence (PSR) of this condition. We prospectively studied the characteristics of bacterial diversity in patients with CD following ileocecal resection to identify the predictive value of intestinal microbiota in the onset of PSR. Methods We collected fecal and healthy and affected intestinal mucosal samples from 12 patients with CD who underwent surgery during the course of their disease. PSR was defined using a Rutgeerts index ≥i2b. The microbiota was assessed using 16S rRNA sequencing, and a correlation analysis was conducted between the intestinal microbiota and clinical variables of the patients. The study was conducted in accordance with the Helsinki Declaration, and all patients were recruited from among those undergoing scheduled colonoscopy for clinical indications at the Gastroenterology Unit of the University Clinical Hospital San Cecilio in Granada, Spain. Results In patients with CD and severe recurrence, mucosa-associated microbiota was characterized by a significant reduction in alpha and beta diversity compared to subjects in clinical remission. An enrichment of bacteria belonging to the phyla Bacillota and Pseudomonadota was observed, along with a reduction in Bacteroidota in subjects with PSR. We observed a negative correlation between the presence of E. coli and Shigella in patients in clinical remission and those actively undergoing treatment with biological therapy. Conclusion The recolonization of microbiota after ileocecal resection differs between patients with and without recurrence, with Fusobacteria and butyrate-producing bacteria being the most prominent contributors to driving PSR. The reduction in the abundance of short-chain fatty acid-producing bacteria and stimulators of anti-inflammatory cytokines like IL-10 could create a proinflammatory environment conducive to the development of PSR. These findings may provide valuable insights into the disease prognosis, allowing for the identification of patients at higher risk of recurrence and laying the groundwork for more targeted therapeutic approaches after surgery

Primary ophthalmic natural killer/T-cell lymphoma: A population-based study

Ophthalmic lymphomas, a subgroup of extra-nodal lymphomas, have seen an increase in incidence in recent decades. Of these, the NK/T-cell lymphoma (NKTL) subtype is particularly aggressive. Though prevalent mostly in Asian patients, data on ophthalmic NKTL is still limited, especially in the western population. This study aimed to provide an additional analysis of primary ophthalmic NKTL using the Surveillance, Epidemiology, and End Results (SEER) database. A retrospective analysis was performed on the SEER database covering records from 2000 to 2020. Patients diagnosed with extranodal NKTL originating primarily from an ophthalmic structure were identified. Out of 4540 ophthalmic lymphomas registered in the SEER database between 2000 and 2020, 9 cases (0.2%) corresponded to ophthalmic NKTL, occurring in patients with a median age of 67 years. The majority of these patients underwent chemotherapy (88.8%) and radiotherapy (66.6%). The 6-month overall survival (OS) and cancer-specific survival (CSS) were both at 50.8%, dropping significantly at the 2-year follow-up. Primary orbital NKTL has a notably severe prognosis. An early diagnosis is important due to the aggressive nature of NKTL.

Hypoxia-induced PLOD2 promotes clear cell renal cell carcinoma progression via modulating EGFR-dependent AKT pathway activation

Clear cell renal cell carcinoma (ccRCC) is a type of kidney cancer that is both common and aggressive, with a rising incidence in recent decades. Hypoxia is a key factor that plays a vital role in the tumorigenesis and metastasis of malignancy. However, the precise mechanisms of hypoxia driving ccRCC progression were not totally uncovered. Our study found that hypoxia level was elevated in ccRCC and might be an independent risk factor of prognosis in ccRCC patients. We identified a key protein PLOD2 was induced under hypoxic conditions and strongly associated with poor prognosis in ccRCC patients. When PLOD2 was depleted, the proliferation and migration of ccRCC cells were reduced in vitro and in vivo, while overexpression of PLOD2 had the opposite effect. Mechanically, the study further revealed that PLOD2 was transcriptionally activated by HIF1A, which binds to a specific promoter region of the PLOD2 gene. PLOD2 was also shown to interact with EGFR, leading to the phosphorylation of the receptor. Furthermore, PLOD2 was responsible for binding to the extracellular domain of EGFR, which ultimately activated the AKT signaling pathway, thus promoting the malignant progression of ccRCC. Treatment with the PLOD2 inhibitor Minoxidil significantly suppressed ccRCC progression by inactivating the EGFR/AKT signaling axis. In summary, the findings of this study shed light on the molecular mechanisms behind PLOD2 expression in ccRCC and suggest that it may serve as a potential predictor and therapeutic target for the clinical prognosis and treatment of ccRCC.

Assessment of tumoral and peritumoral inflammatory reaction in cutaneous malignant melanomas.

Skin cancer is one of the most common types of cancer, with an increasing worldwide incidence in recent decades. The main risk factor for increasing the skin cancer incidence is ultraviolet (UV) radiation. Of the two major forms of skin cancer (melanomas and non-melanotic cancers), the cutaneous melanoma (CM) is the most aggressive form, causing about 80% of the deaths resulted from this type of tumor. Malignant melanoma develops through malignant transformation of melanocytes in the skin because of prolonged exposure to solar or artificial UV. The malignant transformation of the melanocytes in the skin is accompanied by the presence of a local inflammatory reaction that, in the initial stages of carcinogenesis, would oppose to tumor development. Chronic exposure to UV or other etiopathogenic factors induces chronic inflammation, which, by producing inflammatory molecules (cytokines, chemokines, prostaglandins), constitutes a tumoral microenvironment that favors carcinogenesis, tumor invasion, metastasis, and the presence of neoplastic "mutant cells" that avoid the protective action of the immune system. Using immunohistochemistry techniques, we assessed the intra- and peritumoral inflammatory infiltrate cells in CM. The chronic inflammatory infiltrate presented more intense in the peritumoral stroma compared to the intratumoral one, heterogenous, more intensely composed of lymphocytes, plasma cells, macrophages, and mast cells (MCs), the most numerous cells in the inflammatory infiltrate being T-lymphocytes, plasma cells and macrophages; B-lymphocytes and MCs were in a small number, especially intratumorally. Inflammatory cells had a direct contact with tumor cells, blood vessels, connective matrix, suggesting that the inflammatory microenvironment plays an important role in carcinogenesis, tumor invasion, local angiogenesis, and tumor metastasis.

NT5E DNA methylation in papillary thyroid cancer: Novel opportunities for precision oncology

The ectoenzyme CD73, encoded by the NT5E gene, has emerged as a potential prognostic and therapeutic marker for papillary thyroid carcinoma (PTC), which has increased in incidence in recent decades. Here, from The Cancer Genome Atlas Thyroid Cancer (TCGA-THCA) database, we extracted and combined clinical features, levels of NT5E mRNA, and DNA methylation of PTC samples and performed multivariate and random forest analyses to evaluate the prognostic relevance and the potential of discriminating between adjacent non-malignant and thyroid tumor samples. As a result, we revealed that lower levels of methylation at the cg23172664 site were independently associated with BRAF-like phenotype (p = 0.002), age over 55 years (p = 0.012), presence of capsule invasion (p = 0.007) and presence of positive lymph node metastasis (LNM) (p = 0.04). The methylation levels of cg27297263 and cg23172664 sites showed significant and inversely correlations with levels of NT5E mRNA expression (r = −0.528 and r = −0.660, respectively), and their combination was able to discriminate between adjacent non-malignant and tumor samples with a precision of 96%–97% and 84%–85%, respectively. These data suggest that combining cg23172664 and cg27297263 sites may bring new insights to reveal new subsets of patients with papillary thyroid carcinoma.

Identification of novel immune-related molecular subtypes and a prognosis model to predict thyroid cancer prognosis and drug resistance.

Background: Thyroid cancer is a common malignant tumor of the endocrine system that has shown increased incidence in recent decades. We explored the relationship between tumor-infiltrating immune cell classification and the prognosis of thyroid carcinoma. Methods: RNA-seq, SNV, copy number variance (CNV), and methylation data for thyroid cancer were downloaded from the TCGA dataset. ssGSEA was used to calculate pathway scores. Clustering was conducted using ConsensusClusterPlus. Immune infiltration was assessed using ESTIMATE and CIBERSORT. CNV and methylation were determined using GISTIC2 and the KNN algorithm. Immunotherapy was predicted based on TIDE analysis. Results: Three molecular subtypes (Immune-enrich(E), Stromal-enrich(E), and Immune-deprived(D)) were identified based on 15 pathways and the corresponding genes. Samples in Immune-E showed higher immune infiltration, while those in Immune-D showed increased tumor mutation burden (TMB) and mutations in tumor driver genes. Finally, Immune-E showed higher CDH1 methylation, higher progression-free survival (PFS), higher suitability for immunotherapy, and higher sensitivity to small-molecule chemotherapeutic drugs. Additionally, an immune score (IMScore) based on four genes was constructed, in which the low group showed better survival outcome, which was validated in 30 cancers. Compared to the TIDE score, the IMScore showed better predictive ability. Conclusion: This study constructed a prognostic evaluation model and molecular subtype system of immune-related genes to predict the thyroid cancer prognosis of patients. Moreover, the interaction network between immune genes may play a role by affecting the biological function of immune cells in the tumor microenvironment.

What is the future of treatment de-escalation for HPV-positive oropharyngeal cancer? A review of ongoing clinical trials.

Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has increased in incidence in recent decades. With higher cure rates in younger populations, long-term survivors may live with acute- and long-term toxicity, leading to increased interest in de-escalation treatment strategies for HPV-related OPSCC. Herein, we have examined the current landscape of clinical trials in this context. A review of active clinical trials related to de-escalation of HPV-associated OPSCC treatment was performed using the clinicaltrials.gov database from inception to January 2022. A search using the key words "oropharyngeal cancer" and "HPV" was completed. Three investigators independently reviewed each trial, with any discrepancies settled by a fourth. Data collected from each study included study phase, study design, primary, and secondary endpoints, and de-escalation treatment strategies. A final 24 articles were selected for full text review. Many trials (n=19, 79%) were non-randomized, and most studies employed a phase II design (n=14, 58%). Only 13% (n=3) were randomized trials, and 8% (n=2) included a phase III component. The most frequent primary endpoint was progression-free survival (PFS) (n=9, 37.5%). With regards to the identified de-escalation strategies, all the studies (n=24) had at least one component assessing changes in RT dose/fractionation and/or a reduction in RT volumes. A smaller percentage of trials assessed surgical interventions (n=9, 37.5%) and/or changes in systemic therapy (n=8, 33.3%). A small number of randomized trials are underway, and a transition to more randomized phase III trials in the future will be important to change clinical practice.

Dynamic Optical Coherence Tomography: A Non-Invasive Imaging Tool for the Distinction of Nevi and Melanomas

Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability to distinguish melanocytic lesions based on its focus on microvascularization. To determine if an addition to the gold standard of a clinical-dermoscopic examination improves the diagnosis of unclear lesions, further studies, including a larger sample of dysplastic nevi and artificial intelligence, should be conducted.

LncRNA HOTAIR impairs the prognosis of papillary thyroid cancer via regulating cellular malignancy and epigenetically suppressing DLX1.

Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a fast-growing incidence in recent decades. HOTAIR as a long non-coding RNA has been shown to be highly expressed in papillary thyroid cancer tissues with only a limited understanding of its functional roles and downstream regulatory mechanisms in papillary thyroid cancer cells. We applied three thyroid cancer cell lines (MDA-T32, MDA-T41 and K1) to investigate the phenotypic influence after gain or loss of HOTAIR. The Cancer Genome Atlas (TCGA) database were utilised to select candidate genes possibly regulated by HOTAIR with validation in the cellular system and immunohistochemical (IHC) staining of PTC tissues. We observed HOTAIR was highly expressed in MDA-T32 cells but presents significantly decreased levels in MDA-T41 and K1 cells. HOTAIR knockdown in MDA-T32 cells significantly suppressed proliferation, colony formation, migration with cell cycle retardation at G1 phase. On the contrary, HOTAIR overexpression in MDA-T41 cells dramatically enhanced proliferation, colony formation, migration with cell cycle driven toward S and G2/M phases. Similar phenotypic effects were also observed as overexpressing HOTAIR in K1 cells. To explore novel HOTAIR downstream mechanisms, we analyzed TCGA transcriptome in PTC tissues and found DLX1 negatively correlated to HOTAIR, and its lower expression associated with reduced progression free survival. We further validated DLX1 gene was epigenetically suppressed by HOTAIR via performing chromatin immunoprecipitation. Moreover, IHC staining shows a significantly stepwise decrease of DLX1 protein from normal thyroid tissues to stage III PTC tissues. Our study pointed out that HOTAIR is a key regulator of cellular malignancy and its epigenetic suppression on DLX1 serves as a novel biomarker to evaluate the PTC disease progression.

Automatic Malignant and Benign Skin Cancer Classification Using a Hybrid Deep Learning Approach.

Skin cancer is one of the major types of cancer with an increasing incidence in recent decades. The source of skin cancer arises in various dermatologic disorders. Skin cancer is classified into various types based on texture, color, morphological features, and structure. The conventional approach for skin cancer identification needs time and money for the predicted results. Currently, medical science is utilizing various tools based on digital technology for the classification of skin cancer. The machine learning-based classification approach is the robust and dominant approach for automatic methods of classifying skin cancer. The various existing and proposed methods of deep neural network, support vector machine (SVM), neural network (NN), random forest (RF), and K-nearest neighbor are used for malignant and benign skin cancer identification. In this study, a method was proposed based on the stacking of classifiers with three folds towards the classification of melanoma and benign skin cancers. The system was trained with 1000 skin images with the categories of melanoma and benign. The training and testing were performed using 70 and 30 percent of the overall data set, respectively. The primary feature extraction was conducted using the Resnet50, Xception, and VGG16 methods. The accuracy, F1 scores, AUC, and sensitivity metrics were used for the overall performance evaluation. In the proposed Stacked CV method, the system was trained in three levels by deep learning, SVM, RF, NN, KNN, and logistic regression methods. The proposed method for Xception techniques of feature extraction achieved 90.9% accuracy and was stronger compared to ResNet50 and VGG 16 methods. The improvement and optimization of the proposed method with a large training dataset could provide a reliable and robust skin cancer classification system.

Evolution and Trends of Meteorological Drought and Wet Events over the Republic of Djibouti from 1961 to 2021

Drought is a meteorological and hydrological phenomenon affecting the environment, agriculture, and socioeconomic conditions, especially in arid and semi-arid regions. A better understanding of drought characteristics over short and long timescales is therefore crucial for drought mitigation and long-term strategies. For the first time, this study evaluates the occurrence, duration, and intensity of drought over the Republic of Djibouti by using a long-term (1961–2021) rainfall time series at Djibouti Airport, completed by the CHIRPS precipitation product and local records from 35 weather stations. The drought is examined based on the Standardized Precipitation–Evapotranspiration Index (SPEI) and the Standardized Precipitation Index (SPI) at 3-, 6-, 9-, 12-, and 24-month timescales, so as to document short-, medium-, and long-duration events. The SPEI and SPI showed a significant drying tendency for the indices computed over 12 and 24 months at Djibouti Airport. The eastern coastal region of the Republic of Djibouti was the most affected by the increased drought incidence in recent decades, with more than 80% of the extremely and severely dry events occurring within the period 2007–2017. In contrast, the western regions recorded a positive trend in their SPIs during the period 1981–2021, due to the dominance of the June–September (JJAS) rains, which tend to increase. However, in the last few decades, the whole country experienced the droughts of 2006/2007 and 2010/2011, which were the longest and most intense on record. Large-scale climate variability in the Indo-Pacific region partially affects drought in Djibouti. The SPI and SPEI are significantly positively correlated with the Indian Ocean Dipole during October–December (OND), while for JJAS the SPI and SPEI are negatively correlated with Nino3.4. The wet event in 2019 (OND) causing devastating floods in Djibouti city was linked with a positive IOD anomaly. This study provides essential information on the characteristics of drought in the Republic of Djibouti for decision-makers to better plan appropriate strategies for early warning systems to adapt and mitigate recurrent droughts that put the country’s agro-pastoral populations in a precarious situation.

Current Challenges in the Treatment of the Omphalocele-Experience of a Tertiary Center from Romania.

Omphalocele is a congenital abdominal wall defect with a constant incidence in recent decades, sometimes representing a real burden for neonatal intensive care units due to prolonged hospitalization and the evolution to death. In our study, we aimed to detect the main risk factors of an unfavorable evolution in the case of omphalocele. Methods: Retrospective cohort study of all neonates with omphalocele treated in our tertiary pediatric hospital during the last three decades; from 158 patients, 139 patients were eligible for the study. We tried to determine the risk of death using logistic regression model. Results: If the neonate develops sepsis, then there is an increased risk (13.03 times) of evolution to death. Similarly, the risk of death is 10.82 times higher in the case of developing acute renal failure, 6.28 times higher in the case of associated abnormalities, 5.54 in the case of developing hemorrhagic disease, and 3.78 in the case of conservative treatment (applied for giant omphalocele or severe chromosomal abnormalities). Prematurity increases by 3.62 times the risk of death. All six independent variables contributed 61.0% to the risk of death. The area under the ROC curve is 0.91, meaning that the diagnostic accuracy of our logistic regression model is very good for predicting the contribution of the six independent variables to the risk of death. Conclusion: Although in the past 30 years we witnessed several improvements in the antenatal diagnosis and management of omphalocele, survival rate remained constant, 47.5% overall. Much effort is still needed to eliminate the risk factors for death in this condition.