Uniform Criteria Research Articles

Role of PETCT in multiple myeloma: A 3 year data analysis of tertiary care center.

e20030 Background: Bone involvement is one of the most common presentations of multiple myeloma, seen in about two-thirds of patients at the time of diagnosis. Therefore, imaging is an integral part of diagnosis for detection of lytic bone lesions and extra medullary disease. Evaluation of disease burden in both multiple myeloma and plasmacytoma as measured by PET/CT scan and response evaluation to induction therapy using PET based SUV changes is an important research topic. Methods: Single center prospective study done from 1st January,2020 to 30th June,2021 in Sarvodaya hospital and research center, Faridabad. All patients with multiple myeloma and solitary plasmacytoma coming to Sarvodaya hospital were eligible for the study. Total of 42 patients were enrolled into the study. PET-CT was done at baseline and post treatment as planned. Results: Out of 42 patients, 2 patients were diagnosed as solitary plasmacytoma and 40 patients were diagnosed as multiple myeloma. The median age of presentation was 64 years with male predominance (64.29%). PET-CT was done pre-treatment, On the basis of PET-CT findings it was seen that < 3 focal lesions were seen in 24(57.14%) patients and > 3 focal lesions were seen in 18(42.86%) of patients, based on SUV max, lesions with < 4.2 SUV max value were seen in 23(54.77%) patients and lesions with > 4.2 SUV max values were seen in 19(45.23%) patients. Presence of extra medullary disease was seen in 17(40.48%) of patients. 39(92.86%) patients were available for response analysis post treatment.3(7.14%) patients were expired during the study due to treatment complications and comorbidities. On the basis of PET-CT findings post treatment there was statistically significant response seen with p value of < 0.05 in the number of focal lesions, lesions with SUV max and burden of extra medullary disease. Evaluation of response when assessed radio logically by PET-CT scan, it was seen that Complete response was found in 22(56.40%) patients, VGPR was seen in 4(10.25%) patients, PR was found in 12(30.77%) patients and PD was seen in 1(2.58%) patient. But the results of co-relation of PET-CT findings with survival outcomes were not significant. Conclusions: PET-CT plays a significant role in diagnosis and response assessment. But there is still no uniform criteria for quantification and visualization of FDG avid lesions for patients with multiple myeloma.

An Update on Outcomes for COPD Pharmacological Trials: A COPD Investigators Report - Reassessment of the 2008 American Thoracic Society/European Respiratory Society Statement on Outcomes for COPD Pharmacological Trials.

Background: In 2008, a dedicated American Thoracic Society/European Respiratory Society task force published a paper on the possible use and limitations of clinical outcomes and biomarkers to evaluate the impact of pharmacological therapy in patients with chronic obstructive pulmonary disease. Since then, our scientific understanding of chronic obstructive pulmonary disease has increased considerably; there has been a progressive shift from a one-size-fits-all diagnostic and therapeutic approach to a personalized approach; and many new treatments currently in development will require new endpoints to evaluate their efficacy adequately. Objectives: The emergence of several new relevant outcome measures motivated the authors to review advances in the field and highlight the need to update the content of the original report. Methods: The authors separately created search strategies for the literature, primarily based on their opinions and assessments supported by carefully chosen references. No centralized examination of the literature or uniform criteria for including or excluding evidence were used. Measurements and Main Results: Endpoints, outcomes, and biomarkers have been revisited. The limitations of some of those reported in the American Thoracic Society/European Respiratory Society task force document have been highlighted. In addition, new tools that may be useful, especially in evaluating personalized therapy, have been described. Conclusions: Because the "label-free" treatable traits approach is becoming an important step toward precision medicine, future clinical trials should focus on highly prevalent treatable traits, and this will influence the choice of outcomes and markers to be considered. The use of the new tools, particularly combination endpoints, could help better identify the right patients to be treated with the new drugs.

An automated method to discover true events and classification of intracellular Ca2+ profiles for endothelium in situ injury assay.

Introduction: Endothelial cells (ECs), being located at the interface between flowing blood and vessel wall, maintain cardiovascular homeostasis by virtue of their ability to integrate chemical and physical cues through a spatio-temporally coordinated increase in their intracellular Ca2+ concentration ([Ca2+]i). Endothelial heterogeneity suggests the existence of spatially distributed functional clusters of ECs that display different patterns of intracellular Ca2+ response to extracellular inputs. Characterizing the overall Ca2+ activity of the endothelial monolayer in situ requires the meticulous analysis of hundreds of ECs. This complex analysis consists in detecting and quantifying the true Ca2+ events associated to extracellular stimulation and classifying their intracellular Ca2+ profiles (ICPs). The injury assay technique allows exploring the Ca2+-dependent molecular mechanisms involved in angiogenesis and endothelial regeneration. However, there are true Ca2+ events of nearly undetectable magnitude that are almost comparable with inherent instrumental noise. Moreover, undesirable artifacts added to the signal by mechanical injury stimulation complicate the analysis of intracellular Ca2+ activity. In general, the study of ICPs lacks uniform criteria and reliable approaches for assessing these highly heterogeneous spatial and temporal events. Methods: Herein, we present an approach to classify ICPs that consists in three stages: 1) identification of Ca2+ candidate events through thresholding of a feature termed left-prominence; 2) identification of non-true events, known as artifacts; and 3) ICP classification based upon event temporal location. Results: The performance assessment of true-events identification showed competitive sensitivity = [0.9995, 0.9831], specificity = [0.9946, 0.7818] and accuracy = [0.9978, 0.9579] improvements of 2x and 14x, respectively, compared with other methods. The ICP classifier enhanced by artifact detection showed 0.9252 average accuracy with the ground-truth sets provided for validation. Discussion: Results indicate that our approach ensures sturdiness to experimental protocol maneuvers, besides it is effective, simple, and configurable for different studies that use unidimensional time dependent signals as data. Furthermore, our approach would also be effective to analyze the ICPs generated by other cell types, other dyes, chemical stimulation or even signals recorded at higher frequency.

Eosinophilic granulomatosis with polyangiitis - Advances in pathogenesis, diagnosis, and treatment.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease characterized by eosinophil-rich granulomatous inflammation and necrotizing vasculitis, pre-dominantly affecting small-to-medium-sized vessels. It is categorized as a primary antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) but also shares features of hypereosinophilic syndrome (HES); therefore, both vessel inflammation and eosinophilic infiltration are suggested to cause organ damage. This dual nature of the disease causes variable clinical presentation. As a result, careful differentiation from mimicking conditions is needed, especially from HES, given the overlapping clinical, radiologic, and histologic features, and biomarker profile. EGPA also remains a diagnostic challenge, in part because of asthma, which may pre-dominate for years, and often requires chronic corticosteroids (CS), which can mask other disease features. The pathogenesis is still not fully understood, however, the interaction between eosinophils and lymphocytes B and T seems to play an important role. Furthermore, the role of ANCA is not clear, and only up to 40% of patients are ANCA-positive. Moreover, two ANCA-dependent clinically and genetically distinct subgroups have been identified. However, a gold standard test for establishing a diagnosis is not available. In practice, the disease is mainly diagnosed based on the clinical symptoms and results of non-invasive tests. The unmet needs include uniform diagnostic criteria and biomarkers to help distinguish EGPA from HESs. Despite its rarity, notable progress has been made in understanding the disease and in its management. A better understanding of the pathophysiology has provided new insights into the pathogenesis and therapeutic targets, which are reflected in novel biological agents. However, there remains an ongoing reliance on corticosteroid therapy. Therefore, there is a significant need for more effective and better-tolerated steroid-sparing treatment schemes.

Protocolo diagnóstico y terapéutico ante la enfermedad renal crónica en el anciano

Chronic kidney disease (CKD) is a highly prevalent pathology which increases proportionally with patient age; nevertheless, no uniform criteria have yet been proposed for the evaluation and management of elderly patients with this entity, in spite of their having different characteristics from those of the general population. These patients are frailer and have more comorbidities, so that the therapeutic attitude will change depending on the individual situation of each one. This protocol offers a toolkit to achieve a holistic approach to this specific population.

Competitive approach to assessing the national security of the Russian Federation

The object of the study is the procedure for assessing the state of national security of the Russian Federation, which is being considered for its improvement based on the implementation of a competitive approach when conducting assessments. The authors review the current procedure for assessing national security and justify the need for its improvement. A comparative analysis of domestic and international experience in the formation of criteria, the hierarchical structure of indicators and the prioritization of threats is carried out. The necessity of forming a hierarchical structure, universalization and integration of indicators as part of the implementation of a competitive approach in assessing the state of national security is substantiated. Particular attention is paid to studying the possibility of using uniform international criteria and a system of indicators in domestic practice. Based on the results of the study, the following conclusions are presented. The state of security is not an absolute value, but is characterized by relative indicators obtained from the results of a comparative assessment of the indicators of competing countries. Security monitoring and assessment should be carried out on a cross-country rating basis, comparing different countries, including countries whose activities are the source of the main challenges and threats. The novelty lies in the substantiation of the use of a competitive approach and rating methodology, allowing governing bodies to assess the state of security taking into account domestic development dynamics and a comparative analysis of the indicators of countries that can influence the state of security in Russia. Author also presented the associative series of national interests and national security indicators of the USA and Russia. In contrast to similar studies, an original approach to the formation of a set of indicators of the state of national security is proposed. Building a hierarchical structure of indicators provides an opportunity to focus on the most important international complex and integral indicators, and increase the efficiency and reliability of assessments. The main directions for improving assessment based on the implementation of structural-hierarchical and competitive approaches have been identified.

Pathogenetic variants of sepsis in oncologicy practice

Introduction Over the past 30 years, sepsis has been an urgent interdisciplinary problem of modern medicine due to the increase in morbidity and a consistently high mortality rate. Patients of oncological hospitals have a high predisposition to the development of sepsis, both in the postoperative period and in the departments of chemo and radiation therapy. In addition, sepsis may be a complication of the postoperative period in patients undergoing surgical treatment. Of interest is not only the clinical and laboratory diagnosis of sepsis in this category of patients, but also the features of its morphological picture, due to uniform diagnostic criteria. The greatest difficulties arise in the study of autopsies, after antitumor chemotherapy, which causes a secondary immunodeficiency condition characterized by the absence of a classical morphological picture of sepsis. The use of modern antibacterial drugs, as well as pathogenetic therapy of sepsis also leads to its pathomorphosis, which also complicates diagnosis.The aim of the study is to systematize the literature data and the results of our own research on the features of morphological manifestations of sepsis in oncological pathology, depending on cancer treatment.Material and methods The search and selection of literary sources was carried out in PubMed, GoogleScholar, electronic library systems elibrary.ru, the search depth is 30 years.Results and Discussion Sepsis in cancer patients after surgical interventions is characterized by hyperergic type of tissue reactions with hyperplasia of lymphoid and myeloid tissue and classic manifestations of septicopyemia of varying severity of purulent metastatic process: from macroscopically distinguishable abscesses to mini-foci of purulent inflammation. Against the background of antibiotic therapy, there is a pathomorphosis of sepsis with a predominance of microcirculation disorders and small focal ulcers. In patients after chemotherapy, accompanied by leukopenia and agranulocytosis, with sepsis, hypoplasia of myeloid and lymphoid tissue is noted, and in the internal organs, along with microcirculation disorders, foci of necrosis, severe dystrophic changes with the absence of neutrophil infiltration are found.Conclusion Sepsis in cancer patients from pathogenetic positions is heterogeneous, depending on the characteristics of the body and the nature of treatment, it should be divided into hyper- and anergic. The diagnosis of sepsis is clinico-morphological, which requires not only the use of clinical and laboratory diagnostic scales, but also the definition of criteria for morphological diagnosis.

The application of SUDEP in forensic diagnosis: a mini review.

In the epilepsy population, the risk of sudden death from epilepsy is rare but is ~24 times greater than the risk of sudden death from other causes. Sudden unexpected death in epilepsy (SUDEP) has been widely recognized in clinical studies. Despite its significance as a cause of death, SUDEP is rarely used in forensic practice. This review focuses on the forensic characteristics of SUDEP, analyzed the reasons for its underuse in forensic practice, and illustrated the prospect of establishing uniform diagnostic criteria for sudden unexpected death in epilepsy and molecular anatomy in aiding forensic diagnosis.

Accuracy of Conventional and Digital Workflows in Partially Edentulous Cases Restored with FPDs over Implants. A Systematic Review.

To compare conventional and digital workflows in terms of accuracy in partially edentulous cases restored with implant-supported restorations. An electronic search in the databases PubMed, Scopus, Web Of Science, and CENTRAL was conducted to identify relevant publications, comparing digital and conventional workflows in partially edentulous cases restored with implant-supported prostheses. 18 articles were included in the systematic review. Ten of the studies were in-vitro, and eight were clinical. Sample sizes varied considerably from 20 to 100. In three studies, three implants were investigated, whereas, in all other instances, accuracy was evaluated on two implants. Substantial heterogeneity in the methodology of the selected studies is evident, which prevents summarising the accuracy outcomes. Digital impressions showed similar results in terms of accuracy compared to the conventional approach. There is a lack of uniform criteria for the tolerable misfit, which hampers the ability to transfer in-vitro results to clinical situations. A need for a standardised approach in the evaluation of impression and workflow accuracy is warranted to enable the systematisation and analysis of results from different studies.

The application of radiomics in esophageal cancer: Predicting the response after neoadjuvant therapy.

Esophageal cancer (EC) is one of the fatal malignant neoplasms worldwide. Neoadjuvant therapy (NAT) combined with surgery has become the standard treatment for locally advanced EC. However, the treatment efficacy for patients with EC who received NAT varies from patient to patient. Currently, the evaluation of efficacy after NAT for EC lacks accurate and uniform criteria. Radiomics is a multi-parameter quantitative approach for developing medical imaging in the era of precision medicine and has provided a novel view of medical images. As a non-invasive image analysis method, radiomics is an inevitable trend in NAT efficacy prediction and prognosis classification of EC by analyzing the high-throughput imaging features of lesions extracted from medical images. In this literature review, we discuss the definition and workflow of radiomics, the advances in efficacy prediction after NAT, and the current application of radiomics for predicting efficacy after NAT.

Consensus for Flow Cytometry Clinical Report on Multiple Myeloma: A Multicenter Harmonization Process Merging Laboratory Experience and Clinical Needs

Flow cytometry is a highly sensitive and specific approach for discriminating between normal and clonal plasma cells in multiple myeloma. Uniform response criteria after treatment have been established by the International Myeloma Working Group and the EuroFlow Group; however, the way in which flow cytometry data are reported has suffered from no collaborative or multicentre efforts. This study, involving 8 expert laboratories and 12 clinical hematology units of the Lazio region in Italy, aims to produce a uniform and shared report among the various Centres. From the pre-analytical phase to sample processing, data acquisition, analysis, and evaluation of the potential limitations and pitfalls of the entire process, the study reaches a final conclusion shared by laboratories and clinicians according to the most updated principles and recommendations. The aim was to identify the necessary data to be included in the clinical report by using multiple-choice questionnaires at every single stage of the process. An agreement of more than 75% of the laboratories was considered mandatory for the data to be included in the report. By ensuring the operational autonomy of each laboratory, this study provides a clear report that limits subjective interpretations and highlights possible bias in the process, better supporting clinical decision-making.

Standards for evaluating the quality of undergraduate nursing e-learning programme in low- and middle-income countries: a modified Delphi study

BackgroundThe lack of standards for evaluating the quality of undergraduate nursing programmes hampers the evaluation of e-learning programmes in low- and middle-income countries. Fragmented approaches to evaluation coupled with a lack of uniform criteria have been a major deterrent to the growth of e-learning. Adopting standards from high-income countries has contextual challenges in low- and middle-income countries (LMICs). Holistic approaches coupled with uniform standards provide information to stakeholders hence the quality of the programmes is measurable. The e-learning situation in low-and middle-income countries provided an impetus to develop and validate these standards.DesignA modified Delphi technique.Review methodsFourteen experts with experience and expertise in e-learning and regulation of undergraduate nursing from fourteen countries from LMICs participated in three rounds of the modified Delphi process. A pre-described set of standards was shared electronically for independent and blinded ratings. An 80% threshold was set for consensus decisions. The standards were modified based on experts’ comments, and two subsequent rounds were used to refine the standards and criteria.ResultsAt the end of round one, the expert consensus was to keep 67, modify 39 and remove three criteria. At the end of the second round, the consensus was to modify 38 and remove one criteria. In the third round, experts agreed that the standards were feasible, usable, and practical in LMICs. A total of six broad standards with 104 criteria were developed.ConclusionThe Technological bloom permeating all spheres of society, including education is an essential component in the development of e-learning programmes. E-learning in nursing education requires critical evaluation to ensure quality in undergraduate nursing programmes. The intricacies of the Low and middle-income context were taken into consideration in developing the standards to offer sustainable evaluation of the quality of e-learning in LMICs, and local solutions to local problems.

Termination for breach: the prospects of the Unidroit Principles of International Commercial Contracts to interpret and supplement the Indian law of contract

Abstract Predicated on English law, termination for the breach of contract in India is regulated by the Indian Contract Act, 1872 and the Sale of Goods Act, 1930. However, these legislations do not adopt uniform criteria while stipulating the circumstances in which the parties may exercise their right to rescind the contract for breach. The complex nature of the rules on termination for breach has rendered the Indian law of contract unsuitable to govern domestic or transnational agreements. This article examines the plausible role of the International Institute for the Unification of Private Law’s (Unidroit) Principles of International Commercial Contracts (PICC) in developing the Indian law of contract. It argues in favour of a complete overhaul of the legal principles on which the parties’ right to rescind a contract for breach is based on the ground that these reflect a pro-termination instead of a favor contractus approach. Consequently, the author urges Indian lawmakers to consider employing the provisions of the PICC on the subject as a model to develop the law of the Republic to foster international trade and facilitate justice among litigants. Although an amendment to the Indian law of contract would be ideal, the judiciary should, in the meantime, refer to the PICC while adjudicating disputes arising from the breach of contracts to interpret and supplement the Indian law according to well-defined and internationally accepted standards.

Changes of abdominal organs in children with tuberculosis infection detected by ultrasound diagnostics

BACKGROUND: Ultrasound diagnostics of abdominal organs is an early method of detecting functional and structural changes in tuberculosis infection before the manifestation of clinical manifestations. Currently, there are no uniform criteria for interpreting the sonographic pathology of parenchymal organs in tuberculosis infection in children, which requires its analysis.
 AIM: The aim is to determine the frequency and nature of sonographic changes in abdominal organs in children with tuberculosis infection, as well as their dynamics against the background of chemotherapy.
 MATERIALS AND METHODS: 192 patients aged 6 months 14 years of tuberculosis department of City Childrens Infectious Hospital No. 3 for the period 20192021 were examined. 3 groups of patients were identified: group 1 92 children with active tuberculosis of the respiratory organs; group 2 52 children with residual post-tuberculosis changes; group 3 48 children with latent tuberculosis infection from tuberculosis risk groups. Comprehensive examination of patients included evaluation of the results of immunodiagnostics (Mantoux test with 2TE and test with recombinant tuberculosis allergen), multispiral computed tomography of the chest, laboratory tests. Ultrasound examination of the abdominal organs was prescribed to children in the diagnosis of tuberculosis infection and on the background of anti-tuberculosis therapy after 3 and 6 months.
 RESULTS: Sonographic changes of the liver (reactive and/or intrahepatic cholestasis and/or hepatomegaly) were observed in children with active tuberculosis in 40.2 5.1% of cases, in children of group 3 in 35.4 6.9% of cases and less often in children of group 2 in 17.3 5.3% of cases (p 0.05). Changes of the gallbladder (violations of bile outflow and/or shape changes) in children with active tuberculosis were visualized in 73.9 4.6% of cases, in children of group 3 (60.4 7.1%), less often in children of group 2 (55.8 6.7%, p 0.05 for group 1). Changes of the pancreas were reactive and were more often observed in children of group 1 (in 14.1 3.5%) than in children of group 2 (5.8 3.2%, p 0.05) and group 3 (4.2 2.9%). Changes of the spleen were more often detected in children with active tuberculosis (in 17.4 4.0%) than in children of group 2 (5.8 3.2%, p 0.05) and group 3 (2.1 2.1%, p 0.05). During chemotherapy, there was an increase in the number of sonographic changes of the liver and gallbladder by 23 months, which was due to the undesirable effects of anti-tuberculosis drugs.
 CONCLUSIONS: Ultrasound diagnostics of the abdominal organs allows the most timely diagnosis of changes in the abdominal organs in children with tuberculosis infection, which allows individualizing pathogenetic therapy, if necessary, tuberculosis chemotherapy regimen.

Non-Renal Factors Associated with Simultaneous Liver-Kidney Transplant in Patients with End-Stage Liver Disease and Stage 3-5 Chronic Kidney Disease Not Requiring Dialysis

We aimed to identify the non-renal risk factors for simultaneous liver-kidney transplantation (SLKT) vs. liver transplantation alone (LTA) in end-stage liver disease (ESLD) patients with estimated glomerular filtration rate (eGFR) <60 ml/min, not on dialysis. Using organ procurement and transplantation network data, we studied adult ESLD patients who received deceased-donor SLKT or LTA in July 2002-Mar 2016 with a 4-point modification of renal disease (MDRD) equation-estimated glomerular filtration rate (eGFR) stratified into chronic kidney disease stage 3 (CKD-3): 30-59 ml/min, CKD stage 4 (CKD-4): 15-29 ml/min, and CKD stage 5 (CKD-5): <15 ml/min) and not on maintenance dialysis (NOD). The outcome of the study was identification of non-renal risk factors predicting likelihood of SLKT vs. LTA. We reported the odds ratio (OR) and 95% confidence interval (CI) for SLKT vs. LTA associated with important clinical variables. Strong non-renal (non-creatinine-associated) risk factors for SLKT were WL-time >2 yrs. and 1-2 yrs. (OR = 3.80, CI = 2.94-4.91; OR = 3.20, CI = 2.58-3.97; respectively), African American or Hispanic recipient race/ethnicity (OR = 2.93, CI = 2.45-3.51; OR = 1.46, CI = 1.24-1.72; respectively), liver repeat transplant (OR = 1.66, CI = 1.39-1.99), and diabetes (OR = 1.53, CI = 1.36-1.72). Factors associated with lower likelihood of SLKT were donor age >60 years (OR = 0.25, CI = 0.19-0.32), female recipient sex (OR = 0.48, CI = 0.43-0.54), hepatocellular carcinoma (OR = 0.53, CI = 0.35-0.81), and transplant center procedure volume tercile ranks 3<sup>rd</sup> (OR = 0.74, CI = 0.62-0.89) and 2<sup>nd</sup> (OR = 0.78, CI = 0.64-0.95). Model for end-stage liver disease scores have varying associations with SLKT vs. LTA, depending on calculation time: at wait listing or transplant. CKD-5 and -4 at wait listing (WL) and transplant were the risk factors with highest point estimates for SLKT vs. LTA. In patients with ESLD and CKD stage 3-5, not on dialysis, strong non-renal risk factors favoring SLKT versus LTA include: prolonged waitlist time, African American or Hispanic race/ethnicity, previous liver transplant, and diabetes. Some novel associations found between risk factors and likelihood of SLKT need further study for confirmation. Lack of uniform criteria for SLK allocation during the period studied is a major limitation of the study.

10 Years of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): A Systematic Review and Meta-Analysis.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel intraperitoneal drug delivery method of low-dose chemotherapy as a pressurized aerosol in patients affected by peritoneal cancer of primary or secondary origin. We performed a systematic review and meta-analysis with the aim of assessing the feasibility, safety, and efficacy of PIPAC. A systematic literature search was performed using Medline and Web of Science databases from 1 January 2011, to inception, to 31 December 2021. Data were independently extracted by two authors. The Newcastle-Ottawa Scale was used to assess the quality and risk of bias of studies. Meta-analysis was performed for pathological response, radiological response, PCI variation along treatment, and for patients undergoing three or more PIPAC. Pooled analyses were performed using the Freeman-Tukey double arcsine transformation, and 95% CIs were calculated using Clopper-Pearson exact CIs in all instances. A total of 414 papers on PIPAC were identified, and 53 studies considering 4719 PIPAC procedure in 1990 patients were included for analysis. The non-access rate or inability to perform PIPAC pooled rate was 4% of the procedures performed. The overall proportion of patients who completed 3 or more cycles of PIPAC was 39%. Severe toxicities considering CTCAE 3-4 were 4% (0% to 38.5%). In total, 50 studies evaluated deaths within the first 30 postoperative days. In the included 1936 patients were registered 26 deaths (1.3%). The pooled analysis of all the studies reporting a pathological response was 68% (95% CI 0.61-0.73), with an acceptable heterogeneity (I2 28.41%, p = 0.09). In total, 10 papers reported data regarding the radiological response, with high heterogeneity and a weighted means of 15% (0% to 77.8%). PCI variation along PIPAC cycles were reported in 14 studies. PCI diminished, increased, or remained stable in eight, one and five studies, respectively, with high heterogeneity at pooled analysis. Regarding survival, there was high heterogeneity. The 12-month estimated survival from first PIPAC for colorectal cancer, gastric cancer, gynecological cancer and hepatobiliary/pancreatic cancer were, respectively, 53%, 25%, 59% and 37%. PIPAC may be a useful treatment option for selected patients with PM, with acceptable grade 3 and 4 toxicity and promising survival benefit. Meta-analysis showed high heterogeneity of data among up-to-date available studies. In a subset analysis per primary tumor origin, pathological tumor regression was documented in 68% of the studies with acceptable heterogeneity. Pathological regression seems, therefore, a reliable outcome for PIPAC activity and a potential surrogate endpoint of treatment response. We recommend uniform selection criteria for patients entering a PIPAC program and highlight the urgent need to standardize items for PIPAC reports and datasets.

Patients with esophageal adenocarcinoma had significantly better outcomes than patients with adenocarcinoma of the gastroesophageal junction.

Recent genomic studies by the Cancer Genome Atlas show much simpler genomic profiles in distal esophageal adenocarcinoma (EAC) than in adenocarcinoma of the gastroesophageal junction (AGEJ). However, the prognostic significance of categorizing patients in these two cancer groups remains unknown. We studied clinicopathologic and prognostic features of both cancers in 303 consecutive patients treated at the Veterans Affairs Boston Healthcare System over a 20-year period. Using uniform criteria and standardized routines, we studied and statistically compared the clinicopathologic and prognostic features between EAC and AGEJ. In this cohort, over 99% of patients were white men with mean age of 69.1 years and an average body mass index of 28.0. No significant difference was detected in age, gender, ethnicity, body mass index, and history of tobacco abuse between the two groups. Compared to AGEJ patients, a significantly higher proportion of EAC patients had gastroesophageal reflux disease, long-segment Barrett's esophagus, common adenocarcinoma type, smaller tumor size, better differentiation, more stages I/II but fewer stages III/IV diseases, scarcer lymphovascular invasion, fewer nodal and distant metastases, and better overall, disease-free, and relapse-free survival. The 5-year overall survival rate was significantly higher in EAC patients (41.3%) than in AGEJ patients (17.2%) (p<0.001). This improved survival among EAC patients remained significant after censoring all cases discovered during surveillance, suggesting different pathogenesis mechanisms between EAC and AGEJ. Our findings suggest that EAC patients showed significantly better outcomes than AGEJ patients. Our results require validation in other patient populations.

The Views of Greek Educators on Evaluation Techniques: The Case of Model Experimental Schools

The term "evaluation of the educational work" and, respectively, of the teachers was established in our country during the post-colonial period. The following questions particularly concerned both the educational community and the state in general: "How are or should the results of the evaluation be used?", "Can all aspects of the work produced at the school unit level and the effects of teachers on their students be objectively measured and evaluated?", "How can the subjective element be reduced in the procedure of teacher evaluation?", "Is it possible to apply uniform evaluation criteria to schools that operate in heterogeneous socio-economic, cultural, or geographical environments?", "What is the role of the teachers and the Management of each school and school counselor as well as other actors of the school community (students, parents, other staff)?" The answer to the above questions comes through the research carried out on 405 teachers in Greece and highlights various philosophical, political, and pedagogical dimensions concerning the purpose of Evaluation, the bodies, forms, techniques, and evaluation criteria.

Sarcopenic obesity in comorbid patients

Sarcopenia is a multifactorial syndrome with an insufficiently studied pathogenesis, manifested by a generalized loss of muscle mass and skeletal muscle strength. Despite the fact that sarcopenia is a risk factor for mortality and disability, especially in the elderly, this pathology is rarely diagnosed. The lack of the uniform criteria for the diagnosis and comorbidity of the elderly patients create difficulties in the differential diagnosis of this condition. Sarcopenia is most often combined with endocrine pathologies, such as obesity and diabetes mellitus. An accelerated decrease in the muscle mass leads to a decrease in insulin sensitivity, resulting in insulin resistance, which, in turn, leads to the excessive accumulation of adipose tissue sarcopenic obesity. The results of the studies indicate a higher risk of metabolic syndrome, type 2 diabetes mellitus and atherosclerosis among individuals with sarcopenic obesity, as opposed to those with simple obesity or sarcopenia. A vicious circle consisting of age-related changes in the skeletal muscles, obesity and impaired glucose regulation leads to a more severe course of diseases and a negative impact on a person's life expectancy. Due to the fact that there are presently no clear criteria for the diagnosis of sarcopenic obesity, there are no unambiguous data on its prevalence. A search for the modern methods of research, prevention and treatment of this condition is required.

Applicability of UAV-based optical imagery and classification algorithms for detecting pine wilt disease at different infection stages

ABSTRACT As a quarantine disease with a rapid spread tendency in the context of climate change, accurate detection and location of pine wilt disease (PWD) at different infection stages is critical for maintaining forest health and being highly productivity. In recent years, unmanned aerial vehicle (UAV)-based optical remote-sensing images have provided new instruments for timely and accurate PWD monitoring. Numerous corresponding analysis algorithms have been proposed for UAV-based image classification, but their applicability of detecting different PWD infection stages has not yet been evaluated under a uniform conditions and criteria. This research aims to systematically assess the performance of multi-source images for detecting different PWD infection stages, analyze effective classification algorithms, and further analyze the validity of thermal images for early detection of PWD. In this study, PWD infection was divided into four stages: healthy, chlorosis, red and gray, and UAV-based hyperspectral (HSI), multispectral (MSI), and MSI with a thermal band (MSI&TIR) datasets were used as the data sources. Spectral analysis, support vector machine (SVM), random forest (RF), two- and three-dimensional convolutional network (2D- and 3D-CNN) algorithms were applied to these datasets to compare their classification abilities. The results were as follows: (I) The classification accuracy of the healthy, red, and gray stages using the MSI dataset was close to that obtained when using the MSI&TIR dataset with the same algorithms, whereas the HSI dataset displayed no obvious advantages. (II) The RF and 3D-CNN algorithms were the most accurate for all datasets (RF: overall accuracy = 94.26%, 3D-CNN: overall accuracy = 93.31%), while the spectral analysis method is also valid for the MSI&TIR dataset. (III) Thermal band displayed significant potential in detection of the chlorosis stage, and the MSI&TIR dataset displayed the best performance for detection of all infection stages. Considering this, we suggest that the MSI&TIR dataset can essentially satisfy PWD identification requirements at various stages, and the RF algorithm provides the best choice, especially in actual forest investigations. In addition, the performance of thermal imaging in the early monitoring of PWD is worthy of further investigation. These findings are expected to provide insight into future research and actual surveys regarding the selection of both remote sensing datasets and data analysis algorithms for detection requirements of different PWD infection stages to detect the disease earlier and prevent losses.