Rank Statistics Research Articles

НАПРЯМИ ОНОВЛЕННЯ ЗБРОЙНИХ СИЛ УКРАЇНИ В УМОВАХ РОСІЙСЬКОЇ ВІЙСЬКОВОЇ АГРЕСІЇ

Ukraine, as a democratic and independent state, chose its own path of development, sought to enter the global system of security and development, and unreasonably experienced Russian armed aggression. As a result of the war, the economy in the east and south of Ukraine has been destroyed, business is being moved and/or reduced, people are killed and forced to migrate. The consequences of this are a significant reduction in budget revenues, along with a significant increase in economic spending, especially defense spending. This prompted the Ukrainian government to seek international military and political assistance. The unity of the Ukrainian people and the defense and security forces of Ukraine became an irresistible force supported by Western partner countries. The driving force behind the transformation of Ukraine into the strongest state in Europe is the renewal of its military potential. Based on the facts and current statistics, the possibilities of updating the Armed Forces of Ukraine in the face of Russia's armed aggression are analyzed. This made it possible to state that international military-political assistance to Ukraine has become the determining direction for the renewal of the Armed Forces of Ukraine and the formation of a powerful defense potential of our state, maintaining security and political stability in the world. The economic, military-scientific, social, moral-psychological (spiritual) directions of the renewal of the Armed Forces of Ukraine in the conditions of Russia's armed aggression are singled out. At the same time, it is proposed to consider international military-political assistance to our country as the determining direction for updating the Armed Forces of Ukraine in war conditions. Based on statistical information, an analysis and ranking of partner countries was carried out depending on the size of their military assistance to Ukraine. The trend of providing military assistance to Ukraine by partner countries has been identified and clearly illustrated. The analysis showed that partner countries with a high level of GDP and defense spending did not always provide appropriate military assistance to Ukraine in the context of deterring Russia's military aggression.

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Early-Stage Breast Cancer.

PurposeWe attempted to explore the prognostic value of baseline inflammatory and nutritional biomarkers at diagnosis in patients with early-stage breast cancer and develop a novel scoring system, the inflammatory-nutritional prognostic score (INPS).Patients and MethodsWe collected clinicopathological and baseline laboratory data of 1259 patients with early-stage breast cancer between December 2010 and November 2012 from Sun Yat-sen University Cancer Center. Eligible patients were randomly divided into training and validation cohorts (n = 883 and 376, respectively) in a 7:3 ratio. We selected the most valuable biomarkers to develop INPS by the least absolute shrinkage and selection operator (LASSO) Cox regression model. A prognostic nomogram incorporating INPS and other independent clinicopathological factors was developed based on the stepwise multivariate Cox regression method. Then, we used the concordance index (C-index), calibration plot, and time-dependent receiver operating characteristic (ROC) analysis to evaluate the prognostic performance and predictive accuracy of the predictive nomogram.ResultsFour inflammatory-nutritional biomarkers, including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), prognostic nutritional index (PNI), and albumin-alkaline phosphatase ratio (AAPR), were selected using the LASSO Cox analysis to construct INPS, which remained an independent prognostic indicator per the multivariate Cox regression analysis. Patients were stratified into low- and high-INPS groups based on the cutoff INPS determined by the maximally selected rank statistics. The prognostic model for overall survival consisting of INPS and other independent clinicopathological indicators showed excellent discrimination with C-indexes of 0.825 (95% confidence interval [CI]: 0.786–0.864) and 0.740 (95% CI: 0.657–0.822) in the training and validation cohorts, respectively. The time-dependent ROC curves showed a higher predictive accuracy of our prognostic nomogram than that of traditional tumor-node-metastasis staging.ConclusionBaseline INPS is an independent indicator of OS in patients with early-stage breast cancer. The INPS-based prognostic nomogram could be used as a practical tool for individualized prognostic predictions.

Analysis of Concentration Levels of Atmospheric Pollutants in Warri, Nigeria

A critical environmental problem facing the Niger Delta region is Air Pollution. This study therefore analyses concentration levels of atmospheric pollutants in the region. Statistical analysis of CH4 and O3 concentrations for the period of 2003 to 2012 and NO2 and CO2 concentrations for the period of 2011 to 2014 were carried out. The results showed that concentration levels of the pollutants were lower during the rainy season than during the dry year time. This is due to higher occurrences of atmospheric instability during the rainy season. On the other hand, ozone (O3) concentration reached its peak value during the peak period of the rainy season unlike the other pollutants. In all likelihood, some of the ozone-depleting substances such as aerosols and atmospheric hydrogen chloride become soluble in water and are being washed off by precipitation during rainy season, thereby leading to increased tropospheric ozone concentration during the rainy season. The study also revealed a steady increase in the concentration of CO2 within the period of investigation. This steady increase in CO2 can be traced to the alarming increase in anthropogenic activities which appreciably increases the amount of CO2 in the atmosphere. Methane (CH4) had higher standard deviation values than carbon dioxide (CO2), meaning that on a per molecule basis, a proportional rise in CH4 is much more effective as a greenhouse gas than a similar increase in CO2. However, CO2 has a greater effect than CH4 on climate change owing to its higher atmospheric concentration. The Mann-Kendall rank statistics of the atmospheric pollutants revealed that the standardization variables U(ti) and U'(ti) have a sequential fluctuating behavior around a zero level.

Variations in temperature in a tropical town: a case study

Trend analysis of temperature on a local scale provides vital clues to the changes in amplitude with time and possibly the reasons for the changes. The present paper attempts to examine the temporal and seasonal trends in temperature of a developing township, Pattambi, Kerala in India from 1950 to 2018. We used Mann-Kendall rank statistics to examine the historical temperature data. The results show a general increase in annual temperature, especially the mean annual maximum temperature of the region across the year with a statistically significant increasing trend. The same trend could be seen in the case of southwest monsoon temperature. Another notable observation from the study is the statistically significant decrement in the winter temperature of the region. The regional changes in the temperature will have much impact on the economy and society in the area since the local livelihood is heavily dependent on agriculture.

Response of mungbean to foliar application of nitrogen and micronutrients during reproductive stages

An experiment was conducted at the pot yard of Bangladesh Institute of Nuclear Agriculture, Mymensingh during the period from February to May 2017 to investigate the effect of foliar application of nitrogen and micronutrients on crop characters, yield attributes and yield of two mungbean genotypes. The experiment comprised four levels of nutrients foliar application like, i) T1 = Control; ii) T2 = Foliar application of urea at the rate of 1.5% four times from flowering start to pod development stage with an interval of 4 days; iii) T3 = T2 + 0.1% micronutrients (B, Mo, Zn, Mn, Ca, Fe, Cu) four times from flowering start to pod development stage with an interval of 4 days and iv); T4 = T3 + side dressing (soil application) of 1.5% N and 0.1% micronutrients solution four times from flowering start to pod development stage with an interval of 4 days. The genotypes were Binamoog-6 and Binamoog-7. Results revealed that morphological (plant height, branch and leaf number, leaf area plant-1), physiological (total dry mass plant-1, specific leaf weight, chlorophyll), yield attributes (number of pods plant-1, pod length, single pod weight, number of seeds pod-1 and 100-seed weight) and yield increased in foliar nutrients applied plants over control but the increment was greater in T2 and T3 than the T4 treatment. The highest plant height, branch and leaf number, leaf area, total dry mass, pod number, pod length, 100-seed weight and seed yield were recorded in T2 followed by T3 with same statistical rank (in most cases). The lowest morpho-physiological, yield attributes and yield were recorded in T1 (control) plants. Binamoog-7 was superior in most of plant parameters and yield compared to Binamoog-6.

ANALYSIS OF THE PREVALENCE OF ALCOHOL CONSUMPTION IN HYPERTENSION PATIENTS AT THE GLENO INPATIENT PUBLIC HEALTH CENTER ERMERA MUNICIPALITY, TIMOR-LESTE

Background; Arterial hypertension is a chronic disease where the blood pressure in the arteries is persistently above the normal value (systolic pressure > 140 mmHg or diastolic pressure is > 90 mmHg). The worldwide number of hypertension deaths reaches 9.4 million deaths. Hypertension data recorded at Gleno Inpatient Health Centre (IHC) in 2019 reaches 810 patients. Objective; This study aimed to analysis on alcohol consumption with prevalence of hypertension. Methods; This quantitative research used correlation approach, the samples were the patients who make an appointment and intern in Gleno IHC, the sampling technique was non-probability, the purposive sampling technique based of the inclusion criteria and the instrument was a questionnaire. Results; Sample size on study were 46 respondents. Based on the results of correlation statistical analysis Spearman Rank indicates the p-value was 0.001, which is lower than 0.05. This test showed a significant relationship between the consumption of alcohol with the occurrence of hypertension in Gleno IHC. Never the less, the result of the correlation test (r) was 0.473. Which means having the most high impact of alcohol consumption with an opportunity of 0.473 times. Which result in the most severe hypertension disease in Gleno IHC. Conclusion; This research indicated that the relationship is positive and significant between the alcohol consumption and the prevalence of hypertension in Gleno Inpatient Health Centre, municipality of Ermera. This result can be used as a good input to improve the health promotion program and better service for hypertension patients at this health centre.

Intraoperative lactic acid concentration during liver transplantation and cutoff values to predict early mortality: a retrospective analysis of 3,338 cases

BackgroundWe aimed to explore the distribution of intraoperative lactic acid (LA) level during liver transplantation (LT) and determine the optimal cutoff values to predict post-LT 30-day and 90-day mortality.MethodsIntraoperative LA data from 3,338 patients were collected between 2008 to 2019 and all-cause mortalities within 30 and 90 days were retrospectively reviewed. Of the three LA levels measured during preanhepatic, anhepatic, and neohepatic phase of LT, the peak LA level was selected to explore the distribution and predict early post-LT mortality. To determine the best cutoff values of LA, we used a classification and regression tree algorithm and maximally selected rank statistics with the smallest P value.ResultsThe median intraoperative LA level was 4.4 mmol/L (range: 0.5–34.7, interquartile range: 3.0–6.2 mmol/L). Of the 3,338 patients, 1,884 (56.4%) had LA levels > 4.0 mmol/L and 188 (5.6%) had LA levels > 10 mmol/L. Patients with LA levels > 16.7 mmol/L and 13.5–16.7 mmol/L showed significantly higher 30-day mortality rates of 58.3% and 21.2%, respectively. For the prediction of the 90-day mortality, 8.4 mmol/L of intraoperative LA was the best cutoff value.ConclusionsApproximately 6% of the LT recipients showed intraoperative hyperlactatemia of > 10 mmol/L during LT, and those with LA > 8.4 mmol/L were associated with significantly higher early post-LT mortality.

Pengaruh Aktivitas Olahraga Jalan Kaki terhadap Tingkat Stres pada Pekerja PHK Akibat Corona Virus Disease 2019

Stress is a self-response to various problems and problems that each individual cannot overcome and will cause mental disorders. One way to overcome stress symptoms is by doing walking sports activity therapy. The purpose of this study was to determine the effect of walking exercise therapy on the stress level of workers who experienced layoffs due to Covid-19 in Jembrana District in 2021. The design of this study used a pre-experimental design with a one-group pre-post test design approach. The sampling method is non probability sampling using purposive sampling method. The number of samples is 22 people. Hypothesis testing used statistical Wilcoxon Sign Rank Test with a p value = 0.000 (α = 0.05). The research instrument used the Depression Anxiety Stress Scale 42 (DASS 42). The results showed that there was a significant effect (p = 0.000) of walking sports activity therapy on the stress level of layoff workers in Jembrana District in 2021 and show that the walking sports activity therapy reduced the stress level of workers who had laid off. Thus, workers who have been laid off should increase their physical activity on foot to stimulate the production of endorphins.

Discrete fractional-order Caputo method to overcome trapping in local optima: Manta Ray Foraging Optimizer as a case study

Enhancing the exploration and exploitation phases of the metaheuristic (MH) optimization algorithms is the key to avoiding local optima. The Manta ray foraging optimizer is a recently proposed MH optimizer. The MRFO showed a good performance in the simple optimization problems. However, it is trapped into the local optimum in the more elaborated ones due to the original algorithm’s low capability in exploiting the optimal solutions and its convergence. From this principle, in this work, a novel variant of the Manta ray foraging optimizer has been proposed for global optimization problems, engineering design optimization problems, and multi-threshold segmentation. In the proposed approach, the fractional calculus (FC) using Caputo fractional differ-sum operator has been adopted to enhance the manta rays movement in the exploitation phase via utilizing history dependency of FC to boost exploiting the optimal solutions via sharing the past knowledge over the optimization process. Moreover, to avoid premature convergence, the somersault factor has been adaptively tuned. The fractional-order Caputo Manta-Ray Foraging Optimizer (FCMRFO) has been proposed. The proposed algorithm’s sensitivity for the FC coefficients has been tested with ten-dimensional CEC2017 benchmarks. The scalability test of the proposed algorithm has been performed with 30, 50 and 100-dimensional CEC2017. Moreover, CEC2020 benchmarks with dimensions 5 and 20 have been applied for providing an extensive investigation, and the FCMRFO has been compared with recent state-of-the-art algorithms. Through utilizing the non-parametric statistical analysis and ranking test, the FCMRFO confirms its superiority and ability to avoid the local optimum in several cases. For the second part of the study, three constrained engineering design problems have been investigated; then, numerous natural images are applied to appraise the FCMRFO for multilevel threshold image segmentation. By performing several metrics, the FCMRFO proves its quality and efficiency compared to recent well-regarded algorithms in engineering applications and image segmentation.

Method of Calculation of Integrated Performance Indicators of Defense Industry Organizations

The purpose of the study is to develop a parametric monitoring system for defense industry enterprises, optimizing on the principle of minimum sufficiency a set of key indicators of the activities of organizations and increasing the efficiency of management of research institutes, design bureaus, industrial and service enterprises of the military-industrial complex.Materials and methods. The methodological and theoretical basis of the presented scientific work is a system of mathematical methods for analyzing empirical data on the object of study, providing objective, accurate and systematic information on the researched processes. The reliability of scientific provisions, conclusions and practical recommendations is confirmed by the experience of applying the results of the study in the analysis of the activities of enterprises of Concern Almaz-Antey JSC, as well as comparing them with the results of research by domestic and foreign scientists in the field of organizing a management system for high-tech companies. Author relied on actual statistical information about the activities of organizations of the military-industrial complex, the results of research in the field of mathematical analysis, organization and planning of machine-building production, research of operations, rank statistics, probability theory, theory of adaptive management, economics and enterprise management.Results. A method has been developed for processing data on the activities of enterprises and reducing them to the optimal set of observed indicators without losing awareness of the monitoring object; possibilities of using non-parametric methods of statistics for analysis of complex systems, in particular, holdings of defense industry, have been researched.Conclusion. Each enterprise has its own specificity depending on the specifics of the production processes. There is now a significant number of different indicators that comprehensively, and often too extensively, characterize what is happening. This situation often makes it difficult to manage production facilities, since the actual picture of the state of the facilities is obscured by an excess of secondary information. In this regard, it seems reasonable to try to weed out unnecessary indicators and use only those that carry the necessary amount of information sufficient to reflect the specifics of the enterprise. The presented work theoretically and practically proved the advantages of using non-parametric statistics in enterprise monitoring, which allows reducing temporary losses in the development of management solutions and increasing their efficiency at the level of the parent companies of defense-industrial associations.

APAKAH PEMUDA DESA MENGETAHUI OBYEK WISATA DI DESANYA? Gambaran Pengetahuan Pemuda Tentang Potensi Wisata Desa Ciasmara Kecamatan Pamijahan Kabupaten Bogor

This study was conducted to identify the perception of rural youth on tourism potential in Ciasmara Village. In addition, this study also tries to describe individual characteristics, frequency of visits to tourist objects, analyse the relationship between individual characteristics and frequency of visits with youth perceptions. Indicators on individual characteristics include age, gender, and level of education. Indicators on the frequency of youth visits include the frequency of visits to waterfalls and the frequency of visits to hot springs. The research was carried out in Ciasmara Village, Pamijahan District, Bogor Regency from April 2019 to August 2020. This method uses two approaches, namely a Survey approach to see the distribution of perceptions. The sampling technique used was purposive sampling technique with descriptive-correlational quantitative methods, descriptive statistical data analysis techniques and non-parametric statistics (Rank Spearman Chi-Square). This research found that youth in Ciasmara village have a positive perception of tourism potential in Ciasmara village but from the results of in-depth interviews it was also found that there are several challenges that need to be considered if they want to develop Ciasmara Village as a tourist village

Bulk and Single-Cell Profiling of Breast Tumors Identifies TREM-1 as a Dominant Immune Suppressive Marker Associated With Poor Outcomes.

BackgroundTriggering receptor expressed on myeloid cells (TREM)-1 is a key mediator of innate immunity previously associated with the severity of inflammatory disorders, and more recently, the inferior survival of lung and liver cancer patients. Here, we investigated the prognostic impact and immunological correlates of TREM1 expression in breast tumors.MethodsBreast tumor microarray and RNAseq expression profiles (n=4,364 tumors) were analyzed for associations between gene expression, tumor immune subtypes, distant metastasis-free survival (DMFS) and clinical response to neoadjuvant chemotherapy (NAC). Single-cell (sc)RNAseq was performed using the 10X Genomics platform. Statistical associations were assessed by logistic regression, Cox regression, Kaplan-Meier analysis, Spearman correlation, Student’s t-test and Chi-square test.ResultsIn pre-treatment biopsies, TREM1 and known TREM-1 inducible cytokines (IL1B, IL8) were discovered by a statistical ranking procedure as top genes for which high expression was associated with reduced response to NAC, but only in the context of immunologically “hot” tumors otherwise associated with a high NAC response rate. In surgical specimens, TREM1 expression varied among tumor molecular subtypes, with highest expression in the more aggressive subtypes (Basal-like, HER2-E). High TREM1 significantly and reproducibly associated with inferior distant metastasis-free survival (DMFS), independent of conventional prognostic markers. Notably, the association between high TREM1 and inferior DMFS was most prominent in the subset of immunogenic tumors that exhibited the immunologically hot phenotype and otherwise associated with superior DMFS. Further observations from bulk and single-cell RNAseq analyses indicated that TREM1 expression was significantly enriched in polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) and M2-like macrophages, and correlated with downstream transcriptional targets of TREM-1 (IL8, IL-1B, IL6, MCP-1, SPP1, IL1RN, INHBA) which have been previously associated with pro-tumorigenic and immunosuppressive functions.ConclusionsTogether, these findings indicate that increased TREM1 expression is prognostic of inferior breast cancer outcomes and may contribute to myeloid-mediated breast cancer progression and immune suppression.

Associating cognitive reserve and brain‐wide gene expression regarding Alzheimer's disease

AbstractBackgroundCognitive reserve (CR) is susceptibility to brain damages, which impacts the development of Alzheimer’s disease (AD). Whereas CR is associated with certain subnetworks of brain connectivity, little research has been done on identifying genes that contribute to these subnetworks. In this study, we linked these subnetworks to regional variation in brain‐wide gene expression. We utilized Allen Human Brain Atlas (AHBA) in that it comprises gene expression data spanning the whole brain.MethodWe extracted a binary subnetwork regarding CR from AD patients. Then we drew out gene expression patterns in the subnetwork’s regions of interest (ROIs) and constructed a gene network through Weighted Gene Co‐expression Network Analysis (WGCNA). To research the distinctive trait of this sub‐region gene network (SGN), we also constructed a whole‐brain gene network (WGN). We detected modules (clusters of highly interconnected genes) of each network and identified their hub genes (genes with high intra‐modular connectivity). We sought non‐preserved, unique modules in SGN compared to WGN using the median rank statistic. Finally, the biological process ontology of the hub genes was investigated by functional enrichment analysis.ResultWe constructed gene networks based on gene expression data of 10544 genes. WGN consisted of 90 nodes of whole‐brain regions and SGN consisted of 49 nodes of the subnetwork ROIs. While 18 modules were detected in SGN, modules yellow, magenta, red and black were identified as unique modules. Module magenta included novel co‐expressed gene clusters, and the other modules combined genes that were classified as different modules in WGN. Apoptotic process, including apoptosis‐regulation and neuron death, was enriched distinctively in the 4 non‐preserved modules. Neuronal death due to apoptosis is a common pathological feature in the brains of AD patients.ConclusionWe identified brain‐wide gene co‐expression modules that have unique specific connectivity patterns related to the CR subnetwork. This non‐preservation highlights the relevance of CR and gene expression patterns. Moreover, the modules were enriched for AD risk genes, further demonstrating the functional context of CR in AD. This study will provide the groundwork for novel insights and extensive research to associate brain‐wide gene expression and connectome‐wide phenotype regarding AD.

Functional outcome in operated patients of multilevel lumbar canal stenosis and use of HRQoL role in depicting the anxiety and its correlation with the pain

BackgroundLumbar canal stenosis (LCS) is a degenerative spinal disease of elderly people, and it not only impairs the mechanical activity but also alters the economic and mental status of the patients indirectly.This is single-center observational prospective study conducted for 2 years and included 30 consecutive operated patients of multilevel LCS patients and excluded the patients with single-level LCS, with primary LCS or with grade II subluxation. We analyzed the various measurement indices used for the surgical outcome assessment as ED-5D 5L and OLBPDI (Oswestry low back pain disability index). Statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 21.0 statistical Analysis Software. The independent t test, post hoc analysis, Wilcoxon signed rank statistic test and RM-ANOVA test were also applied.ResultMost patients have improvement in pain and all the components of HRQoL (health-related quality of life) after surgery, which was further improved in mean follow-up of 1 year. Our study also suggested that the patients with higher anxiety/depression have higher pain intensity and low HRQoL, which was persistent in postoperative period (p < .001).ConclusionED-5D 5L and OLBPD are good indices to assess all the components of quality of life and give valuable information overall. Anxiety has shown important correlation with the pain component in both preoperative and postoperative phase.

The effect of prophylactic balloon occlusion in patients with placenta accreta spectrum: a Bayesian network meta-analysis.

Placenta accreta spectrum (PAS) can induce severe life-threatening obstetric hemorrhage. Herein, we conducted a Bayesian network meta-analysis of previous studies to evaluate the relative benefits of different prophylactic balloon occlusion (PBO) procedures. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to July 2021. Blood loss volume, blood transfusion volume, and hysterectomy rate were regarded as the primary endpoints. The data were pooled using a Bayesian network and traditional pairwise meta-analysis. Fifty-nine articles with a total sample size of 5150 patients were included. Compared with no PBO (non-PBO) intervention, PBO of the abdominal aorta (PBOAA, mean difference(MD) - 1.02, 95% credible interval (CrI) - 1.4 to - 0.67), common iliac artery (PBOCIA, MD - 0.84; 95%CrI - 1.36 to - 0.06) and internal iliac artery (PBOIIA, MD - 0.42; 95%CrI - 0.72 to - 0.13) significantly lowered blood loss volume, with PBOAA being more effective than PBOIIA (MD - 0.60; 95%CrI - 1.05 to - 0.17). PBOAA and PBOIIA also significantly decreased blood loss volume (MD - 2.33; 95%CrI - 3.74 to - 0.94, MD - 1.57; 95%CrI - 2.77 to - 0.47 respectively) and hysterectomy rate (OR 0.31; 95%CrI 0.16 to 0.54, OR 0.53; 95%CrI 0.29 to 0.92 respectively). PBOAA has the highest probability of being more effective in reducing the blood loss volume, blood transfusion volume, and hysterectomy rate. Performing PBOAA, PBOCIA, or PBOIIA in PAS patients is an effective way to minimize blood loss volume, while PBOAA and PBOIIA also reduce blood transfusion volume and hysterectomy rate. PBOAA is a notably more effective strategy to reduce blood loss volume than PBOIIA. • PBOAA, PBOCIA, and PBOIIA procedures can significantly reduce the blood loss volume compared to non-PBO intervention in PAS patients, of which PBOAA was more effective than the PBOIIA procedure. • PBOAA and PBOIIA could significantly reduce the blood transfusion volume and hysterectomy rate in contrast to the non-PBO intervention in patients with PAS. • According to our statistical treatment ranking, PBOAA was statistically superior in reducing blood transfusion volume, blood transfusion volume, and hysterectomy rate than other PBO procedures.

Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study.

Background and Objectives: In the intensive care unit (ICU), renal failure and respiratory failure are two of the most common organ failures in patients with systemic inflammatory response syndrome (SIRS). These clinical symptoms usually result from sepsis, trauma, hypermetabolism or shock. If this syndrome is caused by septic shock, the Surviving Sepsis Campaign Bundle suggests that vasopressin be given to maintain mean arterial pressure (MAP) > 65 mmHg if the patient is hypotensive after fluid resuscitation. Nevertheless, it is important to note that some studies found an effect of various mean arterial pressures on organ function; for example, a MAP of less than 75 mmHg was associated with the risk of acute kidney injury (AKI). However, no published study has evaluated the risk factors of mortality in the subgroup of acute kidney injury with respiratory failure, and little is known of the impact of general risk factors that may increase the mortality rate. Materials and Methods: The objective of this study was to determine the risk factors that might directly affect survival in critically ill patients with multiple organ failure in this subgroup. We retrospectively constructed a cohort study of patients who were admitted to the ICUs, including medical, surgical, and neurological, over 24 months (2015.1 to 2016.12) at Chiayi Chang Gung Memorial Hospital. We only considered patients who met the criteria of acute renal injury according to the Acute Kidney Injury Network (AKIN) and were undergoing mechanical ventilator support due to acute respiratory failure at admission. Results: Data showed that the overall ICU and hospital mortality rate was 63.5%. The most common cause of ICU admission in this cohort study was cardiovascular disease (31.7%) followed by respiratory disease (28.6%). Most patients (73%) suffered sepsis during their ICU admission and the mean length of hospital stay was 24.32 ± 25.73 days. In general, the factors independently associated with in-hospital mortality were lactate > 51.8 mg/dL, MAP ≤ 77.16 mmHg, and pH ≤ 7.22. The risk of in-patient mortality was analyzed using a multivariable Cox regression survival model. Adjusting for other covariates, MAP ≤ 77.16 mmHg was associated with higher probability of in-hospital death [OR = 3.06 (1.374–6.853), p = 0.006]. The other independent outcome predictor of mortality was pH ≤ 7.22 [OR = 2.40 (1.122–5.147), p = 0.024]. Kaplan-Meier survival curves were calculated and the log rank statistic was highly significant. Conclusions: Acute kidney injury combined with respiratory failure is associated with high mortality. High mean arterial pressure and normal blood pH might improve these outcomes. Therefore, the acid–base status and MAP should be considered when attempting to predict outcome. Moreover, the blood pressure targets for acute kidney injury in critical care should not be similar to those recommended for the general population and might prevent mortality.

Circulating Tumor Cells (CTCs) in Smoldering and Active Multiple Myeloma (MM): Mechanism of Egression, Clinical Significance and Therapeutic Endpoints

Circulating Tumor Cells (CTCs) in Smoldering and Active Multiple Myeloma (MM): Mechanism of Egression, Clinical Significance and Therapeutic Endpoints

A Novel Prognostic Model Based on the Serum Iron Level for Patients With Early-Stage Triple-Negative Breast Cancer.

The dysregulation of iron homeostasis has been explored in malignancies. However, studies focusing on the association between the serum iron level and prognosis of patients with early-stage triple-negative breast cancer (TNBC) are scarce. Accordingly, in current study, 272 patients with early-stage TNBC treated at Sun Yat-sen University Cancer Center (SYSUCC) between September 2005 and October 2016 were included as a training cohort, another 86 patients from a previous randomized trial, SYSUCC-001, were analyzed as a validation cohort (SYSUCC-001 cohort). We retrospectively collected their clinicopathological data and tested the serum iron level using blood samples at the diagnosis. In the training cohort, patients were divided into low-iron and high-iron groups according to the serum iron level cut-off of 17.84 μmol/L determined by maximally selected rank statistics. After a median follow-up of 87.10 months, patients with a low iron had a significantly longer median disease-free survival (DFS) of 89.13 [interquartile range (IQR): 66.88–117.38] months and median overall survival (OS) of 92.85 (IQR: 68.83–117.38) months than those in the high-iron group (median DFS: 75.25, IQR: 39.76–105.70 months, P = 0.015; median OS: 77.17, IQR: 59.38–110.28 months, P = 0.015). Univariate and multivariate Cox analysis demonstrated the serum iron level to be an independent predictor for DFS and OS. Then, a prognostic nomogram incorporating the serum iron level, T stage and N stage was developed for individualized prognosis predictions. It had good discriminative ability with a C-index of DFS (0.729; 95% CI 0.666–0.792) and OS (0.739; 95% CI 0.666–0.812), respectively. Furtherly, we validated the predictive model in the SYSUCC-001 cohort, which also showed excellent predictive performance with a C-index of DFS (0.735; 95% CI 0.614–0.855) and OS (0.722; 95% CI 0.577–0.867), respectively. All these suggested that the serum iron level might be a potential prognostic biomarker for patients with early-stage TNBC, the predictive model based on it might be served as a practical tool for individualized survival predictions.

Distribution-free Phase-I scheme for location, scale and skewness shifts with an application in monitoring customers' waiting time

Phase-I analysis of historical data from a statistical process is a strategic problem in Statistical Process Monitoring and control. Before the establishment of process stability, it is challenging to model historical data. Consequently, a distribution-free approach is a natural choice in Phase-I monitoring. Existing distribution-free Phase-I control charts are suitable for detecting instability in location and scale parameters only and are often insensitive in complex processes involving skewness or shape parameters. A new Phase-I control chart is proposed to identify more general shifts, including location, scale and skewness. The proposed Phase-I scheme is efficient in such a situation. The proposed Phase-I scheme uses subsamples, and the plotting statistic is based on the omnibus multi-sample linear rank statistic corresponding to the location, scale and skewness shifts. The new scheme can identify subsamples that are not in control, and it can also indicate one or more process parameters where a deviation has occurred. The encouraging performance of the proposed scheme is established with a large-scale numerical study based on Monte-Carlo in detecting shifts of various nature in a comprehensive class of situations. An illustration based on monitoring the waiting time data from a customer service centre is given. Some concluding remarks and some future research problems are also offered.

Long-Term Outcomes of a Prospective Clinical Trial of Proton Craniospinal Irradiation for Leptomeningeal Metastasis

Leptomeningeal metastasis (LM) is associated with limited survival and treatment options for patients with solid tumor malignancies. While photon involved-field radiotherapy (IFRT) is effective for local palliation, it lacks durability. Craniospinal irradiation (CSI), in contrast, treats the entire central nervous system (CNS) compartment, thus potentially improving disease control. We previously reported the safety and tolerability of proton CSI (pCSI) in a completed phase IB study, and we are now reporting the mature survival outcomes of these patients.We enrolled 24 patients with solid tumor LM to receive hypofractionated pCSI of 30 Gy (RBE) in 10 fractions in this phase I prospective trial between June 2018 and May 2019 (NCT03520504). The primary endpoint is dose-liming toxicity (DLT) within 1 month of treatment. Secondary endpoints, including time to CNS progression (CNS TTP), CNS progression-free survival (PFS), and overall survival (OS), were assessed using Kaplan-Meier analysis with median survival estimates and 95% confidence intervals (CI) reported. Correlations between cerebrospinal fluid (CSF) circulating tumor cells (CTCs) and survival outcomes were evaluated using Kaplan-Meier analysis. An optimal cutoff for CTCs was determined through maximally selected rank statistics using CNS PFS.Of the 24 patients enrolled, 3 did not complete treatment due to systemic disease progression and were excluded from this analysis. The majority of patients had metastatic lung (52%) and breast (33%) malignancies. The median age was 52 years (range 30-67 years) and the median Karnofsky performance status was 70 (range 60-90). The majority of patients had LM that progressed on other therapies prior to enrollment (57% vs. 43% of patients with newly diagnosed LM), and all patients with molecularly driven disease had CNS progression on small-molecule tyrosine kinase inhibitors prior to enrollment. Only 1 patient was censored at 24 months of follow-up, while 20 patients were followed until death with a median OS of 9 months (95% CI 6-22 months). The median CNS TTP was 8 months (95% CI 7-18 months), with 5 (24%) patients with durable CNS control for > 12 months after pCSI. The median CNS PFS was 7 months (95% CI 5-13 months). In the 18 patients with CSF CTCs evaluation at baseline, having a pre-pCSI CSF CTCs < 41/3mL was associated with improved CNS TTP (19 vs. 8 months, P < 0.01), CNS PFS (18 vs. 6 months, P < 0.01), and a trend toward improved OS (21 vs. 8 months, P = 0.06).We reported that pCSI is a safe treatment for patients with solid tumor LM. In this analysis, we demonstrated durable disease control and prolonged survival in some patients. Lower CSF CTCs at baseline, a potential biomarker of response, was associated with improved survival outcomes. An ongoing randomized phase II trial will determine the efficacy of pCSI compared to photon IFRT in patients with solid tumor LM.