Cumulative Survival Research Articles

Combining the vasoactive-inotropic score with lactate levels to predict mortality in post-cardiotomy patients supported with venoarterial extracorporeal membrane oxygenation.

Our goal was to determine the predictive role of the combined assessment of the vasoactive-inotropic score (VIS) and lactate levels for the prognosis of patients with postcardiotomy cardiogenic shock (PCS) requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). The data of adult patients with PCS requiring VA-ECMO between January 2015 and December 2018 at a tertiary hospital were analysed retrospectively. The incidence of in-hospital mortality and other clinical outcomes was analysed. The associations of the VIS and the lactate concentration and in-hospital mortality were assessed using logistic regression analysis. A total of 222 patients were included and divided into 4 groups according to the cut-off points of the VIS (24.3) and the lactate level (6.85 mmol/L). The in-hospital mortality rates were 37.7%, 50.7%, 54.8% and 76.5% for the 4 groups (P < 0.001), and the rates of successful weaning off VA-ECMO were 73.9%, 69%, 61.3% and 39.2%, respectively (P = 0.001). Groups 1 and 2 exhibited significant differences compared to group 4 in both in-hospital mortality and weaning rates (P < 0.05). There was a statistically significant difference in the incidence of multiple organ dysfunction between group 1 and group 4 (P < 0.05). Groups 1, 2 and 3 demonstrated significantly improved cumulative 30-day survival compared with group 4 (log-rank test, P < 0.05). Logistic regression analysis revealed that age, a VIS > 24.3 and lactate levels > 6.85 mmol/L were independently predictive of in-hospital mortality. Among patients with PCS requiring VA-ECMO, the initiation before reaching a VIS > 24.3 and lactate levels > 6.85 mmol/L was associated with improved in-hospital and 30-day outcomes, suggesting that the combined assessment of the VIS and lactate levels may be instructive for determining the initiation of VA-ECMO.

Multi-modal, Label-free, Optical Mapping of Cellular Metabolic Function and Oxidative Stress in 3D Engineered Brain Tissue Models.

Brain metabolism is essential for the function of organisms. While established imaging methods provide valuable insights into brain metabolic function, they lack the resolution to capture important metabolic interactions and heterogeneity at the cellular level. Label-free, two-photon excited fluorescence imaging addresses this issue by enabling dynamic metabolic assessments at the single-cell level without manipulations. In this study, we demonstrate the impact of spectral imaging on the development of rigorous intensity and lifetime label-free imaging protocols to assess dynamically over time metabolic function in 3D engineered brain tissue models comprising human induced neural stem cells, astrocytes, and microglia. Specifically, we rely on multi-wavelength spectral imaging to identify the excitation/emission profiles of key cellular fluorophores within human brain cells, including NAD(P)H, LipDH, FAD, and lipofuscin. These enable development of methods to mitigate lipofuscin's overlap with NAD(P)H and flavin autofluorescence to extract reliable optical metabolic function metrics from images acquired at two excitation wavelengths over two emission bands. We present fluorescence intensity and lifetime metrics reporting on redox state, mitochondrial fragmentation, and NAD(P)H binding status in neuronal monoculture and triculture systems, to highlight the functional impact of metabolic interactions between different cell types. Our findings reveal significant metabolic differences between neurons and glial cells, shedding light on metabolic pathway utilization, including the glutathione pathway, OXPHOS, glycolysis, and fatty acid oxidation. Collectively, our studies establish a label-free, non-destructive approach to assess the metabolic function and interactions among different brain cell types relying on endogenous fluorescence and illustrate the complementary nature of information that is gained by combining intensity and lifetime-based images. Such methods can improve understanding of physiological brain function and dysfunction that occurs at the onset of cancers, traumatic injuries and neurodegenerative diseases.

Stage-based recipient and donor outcome in twin-to-twin transfusion syndrome treated by fetoscopic laser surgery using Solomon technique.

To evaluate twin survival stratified by Quintero stage in patients with twin-to-twin transfusion syndrome (TTTS) after Solomon laser treatment. This was a single-center study at Johns Hopkins Center for Fetal Therapy, investigating a cohort of consecutive twin pregnancies treated with the Solomon laser technique for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were investigated in relation to neonatal survival of the recipient and donor twins at discharge. Determinants of twin survival were evaluated using univariate logistic regression and cumulative survival probability analyses. Of 402 pregnancies with TTTS that underwent Solomon laser treatment, 80 (19.9%) were diagnosed with Quintero Stage-I TTTS, 126 (31.3%) with Stage II, 169 (42.0%) with Stage III and 27 (6.7%) with Stage IV. Post-laser twin anemia polycythemia sequence or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser surgery. Preterm prelabor rupture of membranes occurred in 150 (37.3%) patients and median gestational age at delivery was 32 + 1 weeks. In 303 (75.4%) patients, both twins were alive at discharge; 67/80 (83.8%) were Stage I, 101/126 (80.2%) were Stage II, 113/169 (66.9%) were Stage III and 22/27 (81.5%) were Stage IV (P = 0.062). Donor twin survival was lower than that of recipients in cases with Stage-III TTTS (118/169 (69.8%) vs 145/169 (85.8%) (χ2 = 26.076, P < 0.0001)). Higher intertwin size discordance and absent or reversed umbilical artery (UA) end-diastolic velocity (EDV) were associated with donor demise (Nagelkerke R2, 0.38; P < 0.001). Overall, spontaneous post-laser donor demise occurred in 53 (39.6%) patients, accounting for the majority of all losses. Cumulative donor survival decreased from 92% to 65% when intertwin size discordance was >30% and to 48% when UA-EDV was absent or reversed (P < 0.001). The Solomon laser technique achieves TTTS resolution and double twin survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant intertwin size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in Stage-III TTTS, is the primary factor preventing double survival due to a higher rate of donor demise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Elevated Serum HMGB1 Levels and Their Association with Recurrence of Acute Ischaemic Stroke.

The study aimed to investigate the correlation between baseline serum levels of high mobility group box 1 (HMGB1) and the recurrence of acute ischemic stroke (AIS). A total of 544 AIS patients were enrolled and followed up monthly. Serum HMGB1 levels were measured using enzyme-linked immunosorbent assay (ELISA). The primary endpoint was the first recurrence of AIS. During a median follow-up period of 43 months, 62 of the 544 AIS patients experienced a recurrence. Both HMGB1 levels and national institute of health stroke scale (NIHSS) scores were significantly higher in the recurrence group compared to the no-recurrence group (p<0.05). According to the receiver operating characteristic curve analysis, the combination (0.855, 95% CI: 0.800-0.911) of HMGB1 (0.745, 95% CI: 0.663-0.826) and NIHSS (0.822, 95% CI: 0.758-0.886) had a higher value for predicting AIS recurrence than either of them (p<0.05). Kaplan-Meier analyses demonstrated that the cumulative survival without AIS recurrence was significantly lower in patients in the high HMGB1 level group than in the low HMGB1 level group (p<0.05). The multifactorial Cox analyses indicated that elevated baseline serum HMGB1 levels (HR: 7.489, 95% CI:4.383-12.795) were a highly effective predictor of recurrence in AIS. Elevated baseline serum HMGB1 levels were found to be a highly effective predictor of recurrence in AIS.

Pre-test Shrinkage Estimation for Reliability Function of Burr XII Distribution Using Progressive Type II Censored Sample under Precautionary Loss Function (PLF)

This article deal with the proposal of suggest and study of the properties of pre-test shrinkage estimators of Reliability Function for the Burr XII distribution using Progressive Type II censored sample. Since some difficulties to derive equations of risk function for proposed shrinkage estimators of reliability function under Precautionary Loss Function (PLF), we to study properties by using Monte-Carlo simulation. The numerical and Monte-Carlo simulations show that the performance of the proposed estimators is better than classical estimators in terms of relative risk.

On Reliability of Repairable Hot Double Redundant System with Arbitrarily Distributed Life- and Repair Times of Its Elements

The article introduces the concept of Marked Markov processes, which are used to study a repairable hot double redundant system with a single repair facility. It is assumed that components’ life- and repair times follow arbitrary distributions. The proposed approach allows for calculating the system’s reliability function, and its mean lifetime, as well as conducting the sensitivity analysis to the shape of input distributions. The new method was validated with numerical examples by comparing it with previously obtained analytical results and showed high accuracy.

Treatment strategies for patients over 80 years of age with oral squamous cell carcinoma

ObjectiveTo analyze the clinical characteristics of patients with oral squamous cell carcinoma aged ≥80 years, focusing on surgical treatments. Study DesignWe reviewed patients with oral squamous cell carcinoma aged ≥80 years who underwent surgery between 2005 and 2018. Basic information, comorbidities, multiple primary cancers, initial treatment, complications, and outcomes were evaluated. ResultsOf 197 patients aged ≥80 years, 119 patients underwent surgery (50 males, 69 females; mean age: 83.5 years). The gingiva was the most common primary tumor site (63 patients, 52.9%). The stage classification was stage I in 35 patients (29.4%), stage II in 44 (37%), stage III in 16 (13.4%), stage IVA in 22 (18.5%), and stage IVB in 2 (1.7%). Comorbidities were identified in 112 patients (94.1%). Surgery was the initial treatment in 111 patients (93.3%). Eight (6.7%) patients received postoperative adjuvant chemotherapy/radiotherapy; 20 patients (16.8%) underwent free tissue transplantation. Perioperative complications were observed in 36 patients (30.3%). The cumulative 5-year and 10-year overall survival rates were 82% and 68.3%, respectively; the disease-specific survival rates were 90%. ConclusionGood treatment outcomes were obtained with radical surgery. Surgery should be the first choice if quality of life is assured and there are no issues with surgical tolerance, regardless of age.

Long-Term Results of Meniscus Allograft Transplantation With Bone Fixation Show Improved Outcomes but Progression of Joint Space Narrowing, Osteoarthritis, and Cartilage Degeneration

PurposeTo investigate the clinical and objective outcomes of meniscal allograft transplantation (MAT) using bone fixation in patients after a minimum follow-up duration of 15 years, and to compare the demographic factors and allograft status between patients who experienced progression of osteoarthritis and those who did not. MethodsThe consecutive patients who underwent primary MAT between December 1996 and January 2008 were retrospectively reviewed. The inclusion criteria was primary MAT with a minimum follow-up duration of 15 years. Clinical outcomes were evaluated using the modified Lysholm score, along with an evaluation of clinical failure. In objective outcomes, the progression of joint space narrowing, osteoarthritis, and the status of the associated cartilages and allografts were evaluated with follow-up radiographs and MRI. ResultsAmong the 79 cases, 54 knees in 52 patients were included in the study and evaluated for clinical outcomes. The mean Lysholm score improved from 73.9 ± 17.5 preoperatively to 86.4 ± 15.6 over a mean follow-up period of 17.5 ± 3.8 years (P<0.001). Regarding the Minimal clinically important differences (MCID), 38 cases (70.4%) showed an improvement in the Lysholm score. The cumulative clinical survival rate was 87.0%. Objective evaluations evaluated in 32 cases with a minimum of 15 years of radiographic data revealed significant progression of joint space narrowing, osteoarthritis, and cartilage degeneration at the final follow-up, with 11 (34.4%) out of 32 cases exhibiting allograft tears involving ˃50% of the allograft. Patients with osteoarthritis progression exhibited more meniscal allograft tears and extrusion on the last follow-up MRI scan than those without progression. ConclusionNotable progression in joint space narrowing, osteoarthritis, and cartilage degeneration were observed in objective assessment. The progression of osteoarthritis might be associated with allograft tears and extrusion. In clinical evaluations, favorable long-term clinical outcomes were consistently demonstrated after MAT using the bone fixation technique. Level of EvidenceLevel Ⅳ, therapeutic case series.

Influence of intraoperative blood salvage and autotransfusion on tumor recurrence after deceased donor liver transplantation: a large nationwide cohort study.

The practice of intraoperative blood salvage and autotransfusion (IBSA) during deceased donor liver transplantation for hepatocellular carcinoma (HCC) can potentially reduce the need for allogeneic blood transfusion. However, implementing IBSA remains debatable due to concerns about its possible detrimental effects on oncologic recurrence. This study retrospectively enrolled nationwide recipients of deceased donor liver transplantation for HCC between 2015 and 2020. The focus was on comparing the cumulative recurrence rate and the recurrence-free survival rate. Propensity score matching was conducted repeatedly for further subgroup comparison. Recipients were categorized based on the Milan criteria, macrovascular invasion, and pretransplant α-Fetoprotein (AFP) level to identify subgroups at risk of HCC recurrence. A total of 6196 and 329 patients were enrolled in the non-IBSA and IBSA groups in this study. Multivariable competing risk regression analysis identified IBSA as independent risk factors for HCC recurrence ( P <0.05). Postmatching, the cumulative recurrence rate and recurrence-free survival rate revealed no significant difference in the IBSA group and non-IBSA group (22.4 vs. 16.5%, P =0.12; 60.3 vs. 60.9%, P =0.74). Recipients beyond Milan criteria had higher, albeit not significant, risk of HCC recurrence if receiving IBSA (33.4 vs. 22.5%, P =0.14). For recipients with macrovascular invasion, the risk of HCC recurrence has no significant difference between the two groups (32.2 vs. 21.3%, P =0.231). For recipients with an AFP level <20ng/ml, the risk of HCC recurrence was comparable in the IBSA group and the non-IBSA group (12.8 vs. 18.7%, P =0.99). Recipients with an AFP level ≥20ng/ml, the risk of HCC recurrence was significantly higher in the IBSA group. For those with an AFP level ≥400ng/ml, the impact of IBSA on the cumulative recurrence rate was even more pronounced (49.8 vs. 21.9%, P =0.011). IBSA does not appear to be associated with worse outcomes for recipients with HCC exceeding the Milan criteria or with macrovascular invasion. IBSA could be confidently applied for recipients with a pretransplant AFP level <20ng/ml. For recipients with AFP levels ≥20ng/ml, undertaking IBSA would increase the risk of HCC recurrence.

Efficacy of cumulative cisplatin dose on survival in patients with locally advanced cervical cancer treated with definitive chemoradiotherapy: multicenter study by Turkish Oncology Group

ObjectiveTo investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy.MethodsA retrospective analysis was conducted on 654 patients with stage IB3–IVA...

Efficiency-Centered Fault Diagnosis of In-Service Induction Motors for Digital Twin Applications: A Case Study on Broken Rotor Bars

The uninterrupted operation of induction motors is crucial for industries, ensuring reliability and continuous functionality. To achieve this, we propose an innovative approach that utilizes an efficiency model-based digital shadow system for in situ failure detection and diagnosis (FDD) in induction motors (IMs). The shadow model accurately estimates IM losses and efficiency across various operational conditions. Our proposed method utilizes efficiency as the primary indicator for fault detection, while losses serve as condition indicators for fault diagnosis based on real-time motor parameters and loss sources. We introduce a bond graph as a fault diagnosis network, linking loss sources, motor parameters, and faults. This interconnected approach is the key aspect of our proposed diagnostic method and aims to be used in fault diagnosis as a general method. A case study of a broken rotor bar is used to validate the proposed method using a dataset of five motors. Among these, one motor operates without failure, while the remaining four exhibit broken rotor faults categorized as 1, 2, 3, and 4. The proposed method achieves 99.99% precision in identifying one to four defective rotor bars in IMs. Comparative analysis demonstrates good performance compared to vibration-based FDD approaches. Moreover, our methodology is computationally efficient and aligned with Industry 4.0 requirements.

Immediate Insertion and Restoration of a Single Implant to Replace Two Adjacent Periodontally Compromised Lower Incisors: A Technique Report with up-to-8 Years Follow-up.

The study investigated the cumulative survival rate (CSR) and marginal bone loss (MBL) of single implants immediately placed and restored with two-unit cantilevered fixed dental prostheses after extraction of two adjacent mandibular incisors with a compromised periodontal condition. Patients in need of extraction and replacement of two adjacent mandibular incisors due to advanced periodontal loss of attachment were treated consecutively. Following a flapless procedure, a single implant was inserted at the time of extraction in one of the two fresh alveoli sockets and immediately restored with a screw retained two-unit provisional FDP. The area of extraction was grafted using xenograft particulate material. Peri-implant soft tissue and hard tissue condition at the last follow-up appointment, marginal bone loss at the last follow-up appointment at least 1 year after the delivery of the final prosthesis, and the final aesthetic result were evaluated. Twenty patients were recruited between January 2014 and December 2019 in a single private practice and each received single implants and immediate provisional restoration with a two-unit cantilevered fixed dental prosthesis. Patients were followed for 22 to 94 months (average follow-up &#61; 4 years) and none of the implants failed resulting in 100% CSR. Cumulative MBL -measured using the VixWin Platinum software -was 1.08 &#43;/- 0.35. A lower MBL was observed in the presence of platform switching (0.63 &#43;/- 0.11 mm) compared to the absence of platform switching (1.27 &#43;/- 0.20 mm). The preliminary results obtained from this study suggest that patients in need of replacing two adjacent periodontally compromised mandibular incisors can be treated with an immediately inserted and restored single implant.

Rapid Label-free and Amplification-free Detection of SARS-CoV-2 Using Solution-Gated Graphene Transistor-Based Nucleic Acid Biosensors in a Portable Biosensing Microsystem

Abstract The COVID-19 pandemic has highlighted the significance of swift and efficient large-scale screening to prevent epidemic outbreaks. Solution-gated graphene transistors (SGGTs) have emerged as a valuable asset in creating point-of-care (POC) sensing platforms for detecting SARS-CoV-2, owing to their notable stability and sensitivity in solution environments. However, the poor interface engineering of sensing electrodes is of great concern for reliable functionalization, leading to poor sensitivity. In this study, we present an interface engineering strategy for realizing the functionalization of SGGT sensing electrodes with high stability and sensitivity to construct a SARS-CoV-2 nucleic acid biosensor. The developed biosensor exhibits the capability to detect ORF1ab gene fragments at a concentration as low as 10−16 M without requiring additional nucleic acid amplification. Furthermore, the entire detection process can be accomplished using a portable biosensing microsystem within 30 minutes. This research holds promise for advancing the study of FET-based biosensors and facilitating their practical application in clinical settings.

Technical study of magnetorheological semi-active suspension control strategy for vehicles based on reinforcement learning

The suspension system is an important part of the car, the main function is to alleviate the road surface does not level brought about by the shake, to ensure that the vehicle driving smoothness and comfort, so as to improve the vehicle handling performance and safety, improve the vehicle to reduce the vibration performance more and more become a hot topic in the industry. Among them, semi-active suspension is a popular suspension system. This paper explains the significance and classification of the role of the suspension, and gives a relevant introduction to the magnetorheological fluid, on the basis of which it combines the domestic and international research results, looks forward to the development trend of the semi-active suspension of the vehicle, analyzes the advantages and shortcomings of four important semi-active suspension control strategies, and finally introduces the reinforcement learning and combines the reinforcement learning with the existing control strategies of the semi-active suspension, and designs a reliable reward function to enhance the suspension's damping performance by taking into account the multifaceted driving factors. The reward function to enhance the damping ability of the suspension by considering multiple driving factors, which can provide a reference for further research on the control of magnetorheological semi-active suspensions for vehicles.

Linguistic and cultural validation of symptom questionnaire for visual dysfunctions (SQVD) for psychometric analysis in the Chinese context.

The Spanish scale symptom questionnaire for visual dysfunctions (SQVD) was sinicized and tested for reliability and validity in the Chinese context, employing both classical measurement theory and item response theory. A meticulous translation was conducted using the modified Brislin translation model, with input from experts for cross-cultural debugging and in-depth review. Following a pre-survey study, the Chinese version of the SQVD was finalized. A convenience sampling method was used to select 270 patients from the target group and 252 valid questionnaires were successfully collected. The Rasch model was employed to assess response category functionality, fit statistics, unidimensionality, person and item reliability, separation, targeting, and differential item functioning. Classical test theory was applied to evaluate internal consistency and retest reliability, supplemented by correlation analysis. Job characteristic curves were also plotted to assess diagnostic accuracy. The Chinese SQVD conformed to a unidimensional structure with excellent reliability and validity. Person and item reliabilities were 0.85 and 0.99, respectively, indicating, high stability. Person and item separation indices were 2.37 and 11.54, respectively, signifying strong differentiation ability. Retest reliability was 0.917, further emphasizing the stability of the scale. The area under the receiver operating characteristic curve was 0.908 (95% CI: 0.854, 0.962), with a cutoff value of 7.5 and Youden index of 0.733, highlighting the scale's high diagnostic accuracy. The translated and culturally adapted Chinese SQVD demonstrated excellent psychometric properties. With streamlined items, short assessment time, and high efficiency, the scale is a stable and reliable clinical tool for detecting a variety of conditions related to refractive, regulatory, and binocular vision dysfunction.

A Modified Stress-Strength Reliability Function for Discrete Family of Distributions

A Modified Stress-Strength Reliability Function for Discrete Family of Distributions

Estimation of the Reliability Function of the Generalized Rayleigh Distribution under Progressive First-Failure Censoring Model

This study investigates the statistical inference of the parameters, reliability function, and hazard function of the generalized Rayleigh distribution under progressive first-failure censoring samples, considering factors such as long product lifetime and challenging experimental conditions. Firstly, the progressive first-failure model is introduced, and the maximum likelihood estimation for the parameters, reliability function, and hazard function under this model are discussed. For interval estimation, confidence intervals have been constructed for the parameters, reliability function, and hazard function using the bootstrap method. Next, in Bayesian estimation, considering informative priors and non-information priors, the Bayesian estimation of the parameters, reliability function, and hazard function under symmetric and asymmetric loss functions is obtained using the MCMC method. Finally, Monte Carlo simulation is conducted to compare mean square errors, evaluating the superiority of the maximum likelihood estimation and Bayesian estimation under different loss functions. The performance of the estimation methods used in the study is illustrated through illustrative examples. The results indicate that Bayesian estimation outperforms maximum likelihood estimation.

Reassessing Halm's clinical stability criteria in community-acquired pneumonia management.

Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in management of CAP in a contemporary real-world setting. This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017-2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan-Meier survival curves were used to analyse these outcomes, considering competing risks. The study population primarily comprised elderly individuals (median age: 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders, and 17.3% (276/1595) among the rest. Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this aging population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.

Stress hyperglycemia ratio and its influence on mortality in elderly patients with severe community-acquired pneumonia: a retrospective study

BackgroundCommunity-acquired pneumonia (CAP) is a significant health issue among the elderly, with severe cases (SCAP) having high mortality rates. This study assesses the predictive significance of the stress hyperglycemia ratio (SHR) in elderly SCAP patients and its impact on outcomes in both diabetic and non-diabetic patients.Methods and materialsThis retrospective study included 406 SCAP patients aged 65 or older from the Second People’s Hospital of Lianyungang (January 2020 to December 2023). Data collected included demographics, medical history, vital signs, and lab results. SHR was calculated from initial blood glucose and estimated average glucose (HbA1c). Statistical analyses, including Cox regression and Kaplan-Meier analysis, evaluated SHR’s impact on mortality. Mediation models explored the effects of neutrophil-lymphocyte ratio (NLR) and SHR.ResultsThe 28-day mortality rate was 21.67%. Deceased patients had higher age, Charlson Comorbidity Index, procalcitonin, NLR, glucose, and SHR levels compared to survivors (P < 0.05). Both SHR and NLR significantly increased mortality risk, particularly in non-diabetic patients. Combining NLR and SHR improved ROC AUC to 0.898, with 89.80% sensitivity and 81.10% specificity. Kaplan-Meier analysis showed higher cumulative survival for SHR < 1.14, regardless of diabetes status (P < 0.05). NLR mediated 13.02% of the SHR-survival relationship, while SHR mediated 14.06% of the NLR-survival relationship.ConclusionElevated SHR is a significant mortality risk factor in elderly SCAP patients, independent of diabetes status. Stringent glucose control and careful monitoring of SHR may improve outcomes in elderly patients with acute respiratory conditions.

Joint modelling of survival and backwards recurrence outcomes: an analysis of factors associated with fertility treatment in the U.S.

Abstract The motivation for this paper is to determine factors associated with time-to-fertility treatment (TTFT) among women currently attempting pregnancy in a cross-sectional sample. Challenges arise due to dependence between time-to-pregnancy (TTP) and TTFT. We propose appending a marginal accelerated failure time model to identify risk factors of TTFT with a model for TTP where fertility treatment is included as a time-varying treatment to account for their dependence. The latter requires extending backwards recurrence survival methods to incorporate time-varying covariates with time-varying coefficients. Since backwards recurrence survival methods are a function of mean survival, computational difficulties arise in formulating mean survival when fertility treatment is unobserved, i.e. when TTFT is censored. We address these challenges by developing computationally friendly forms for the double expectation of TTP and TTFT. The performance is validated via comprehensive simulation studies. We apply our approach to the National Survey of Family Growth and explore factors related to prolonged TTFT in the U.S.