.Bacground: Sepsis remains a major health challenge worldwide, characterized by a dysre-gulated host response to infection, leading to high mortality and morbidity in intensive care units (ICUs). The Fibrosis 4 (FIB-4) index, originally developed to assess liver fibrosis in hepatitis C patients, has recently been explored for its potential prognostic value in sepsis patients. Method: This study retrospectively analyzed 309 sepsis patients admitted to the Internal Me-dicine and Anaesthesia ICUs between December 12, 2021, and December 15, 2023, to inves-tigate the relationship between FIB-4 levels, Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) and clinical outcomes. Results: The study found that higher FIB-4 measurements were statistically significantly asso-ciated with increased 28-day mortality, with a cut-off value of 4.9 providing a sensitivity of 54.92% and specificity of 74.25%. Logistic regression analysis indicated that elevated Conclusion:FIB-4 levels were a significant predictor of early mortality, suggesting that the FIB-4 index could serve as a valuable prognostic tool in assessing the severity and prognosis of sepsis patients.

Cardiovascular diseases (CVDs) remain the leading cause of mortality. Traditional approaches to diagnosing and treating CVDs often involve interpretation, which can lead to errors. The emergence of Artificial Intelligence (AI) and Machine Learning aids the management of CVDs. AI examines amounts of data and identifies patterns offering solutions for disease detection, risk prediction, and patient care. The American Heart Association's 2023 Scientific Sessions (AHA23) showcased studies that highlight AIs potential to revolutionize cardiac healthcare. This article presents a review of these cutting-edge studies exploring how AI is applied in health, the outcomes of these applications, and their implications for clinical practice. The insights gained from this review will contribute to the discussion on AI's role in healthcare and its capacity to enhance outcomes.

Anthropogenic development can strongly influence natural river processes, leading to environmental changes that negatively affect important habitats and biodiversity, and consequently reduce economically important natural resources. This study investigated the effects of salinity intrusion on the habitat of the clam Corbicula japonica in the Seomjin River estuarine zone. We employed the Environmental Fluid Dynamics Code (EFDC) model, which incorporates topographic data and hydrological changes, to simulate salinity concentrations. Two salinity measurement facilities were installed in Seomjin River estuarine and operated to optimize the EFDC model. The results show that reduced flow rates due to intake have a negligible impact on the increased salinity. Maintaining optimal salinity (15–20 psu) during neap tides at the Seomjin River Bridge requires constant high flow rates, which poses significant challenges. Saltwater stratification is identified as the primary cause of pronounced salinity stratification, particularly during neap tides. Addressing this issue through river discharge and intake facility operation is challenging. Structural measures, including riverbed restoration and underwater barriers, are recommended to improve resistance to seawater intrusion. Future research should aim to develop scenarios to reduce salinity concentrations, quantify the reduction efficiency, and propose region-specific measures.

Chromosomal instability (CIN), defined by variations in the number or structure of chromosomes from cell to cell, is recognized as a distinctive characteristic of cancer, associated with the ability of tumors to adapt to challenging environments. CIN has been recognized as a source of genetic variation that leads to clonal heterogeneity (CH). Recent findings suggest a potential association between CIN and CH with the prognosis of BC patients, particularly in tumors expressing the epidermal growth factor receptor 2 (HER2+). In fact, information on the role of CIN in other BC subtypes, including luminal B BC, is limited. Additionally, it remains unknown whether CIN in luminal B BC tumors, above a specific threshold, could have a detrimental effect on the growth of human tumors, or if low or intermediate CIN levels could be linked to a more favorable BC patient prognosis when contrasted with elevated levels. Clarifying these relationships could have a substantial impact on risk stratification and the development of future therapeutic strategies aimed at targeting CIN in BC. This study aimed to assess CIN and CH in tumor tissue samples from ten patients with luminal B BC, and compared them with established clinicopathological parameters. The results of our study show that luminal B BC patients exhibit intermediate CIN and stable aneuploidy, both of which correlated with lymphovascular invasion. These findings suggest that evaluating CIN, CH and aneuploidy could improve risk stratification, the prediction of clinical outcomes and future therapeutic approaches in luminal B BC patients.

Introduction: The predictive value of the risk stratification scales in elderly patients with IPAH might differ from that in younger. It is unknown whether young and older IPAH patients have the same survival dependence on PAH-specific therapy numbers. The aim of the study was to evaluate the prognostic relevance of risk stratification scales and PAH medication numbers in elderly in comparison with young IPAH patients. Material and methods: 119 patients from a prospective single-center PAH registry were divided on to group I <60 years old (n=89) and group II ≥60 years old (n=30). ESC/ERS, REVEAL, and REVEAL 2.0 risk stratification scores were assessed at baseline, as well as H2FpEF- score and survival at follow-up. Results: During a mean follow-up period of 2.9 years (1.63; 6.0) 42 (35.3%) patients died; at 1, 2, 3, 5, 7, and 10 years survival was 95%, 88.6%, 78.5%, 61.7%, 48.5% and 33.7%, respectively. No survival difference was observed between the two groups despite the use of monotherapy in elderly patients. The best predictive value exhibited the REVEAL in group II (IPAH patients ≥60 years) - AUC 0.73 (0.56-0.91), p = 0.03; and in patients with LHD comorbidities in the entire cohort - AUC 0.73 (0.59-0.87), p<0.009. Factors independently associated with death in the entire cohort were CKD (p=0.01, HR 0.2), the right-to-left ventricle dimension ratio (p=0.0047, HR 5.97), and NT-proBNP >1400 pg/ml (p=0.008, HR 3.18). Conclusion: Risk stratification in elderly IPAH patients requires a fundamentally different approach than that of younger patients, taking into account the initial limitations in physical performance and comorbidities that interfere with current assessment scores. The REVEAL score reliably stratifies patients at any age and LHD comorbidities. The initial monotherapy seems to be reasonable in patients over 60 years. Selection tools for initial combination PAH therapy in older IPAH patients with comorbidities need to be validated in prospective observational studies.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease characterized by profound fatigue, post-exertional malaise (PEM), and neurocognitive dysfunction. Immune dysregulation and gastrointestinal symptoms are commonly observed in ME/CFS patients. Despite affecting approximately 0.89% of the general population, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to elucidate the relationship between immunological characteristics and intestinal barrier function in ME/CFS patients. ME/CFS patients were stratified into two groups based on their immune competence. After documentation of detailed medical records, serum and plasma samples were collected for assessment of inflammatory immune mediators and biomarkers for intestinal barrier integrity by ELISA. We found reduced complement protein C4a levels in immunodeficient ME/CFS patients suggesting a sub-group specific innate immune dysregulation. ME/CFS patients without immunodeficiencies exhibit a mucosal barrier leakage, as indicated by elevated levels of Lipopolysaccharide-binding protein (LBP). Stratifying ME/CFS patients based on immune competence enabled the distinction of two subgroups with different pathophysiological patterns. The study highlights the importance of emphasizing precise patient stratification in ME/CFS, particularly in the context of defining suitable treatment strategies. Given the substantial health and socioeconomic burden associated with ME/CFS, urgent attention and research efforts are needed to define causative treatment approaches.

To evaluate whether the extent of cardiac damage in severe aortic stenosis (AS) might be associated with the occurrence of conduction system disorders after TAVI. A total of 153 symptomatic patients with severe AS who had a TAVI were categorized before the procedure according to the extent of cardiac damage: stage 1 (13.5%): no or LV damage; stage 2 (58.8%): left atrial/mitral valve damage, atrial fibrillation (AF); stage 3 (27.7%): low-flow state, pulmonary vasculature/tricuspid valve/RV damage. After TAVI, 34% of patients exhibited LBBB and 10% high-degree atrioventricular block (HD-AVB). No patient in group 1 developed HD-AVD whereas new LBBB was frequent in groups 2 and 3. Twenty-one patients presented with resolutive paroxysmal AF with a higher rate for each group increment (group 1: n=0, 0%; group 2: n=11,15.7%; group 3: n=10, 30.3%) (p = 0.012). Patients in group 3 had the higher rate of permanent pacemaker implantation (PPMI) (group 1: n=1, 6.3%; group 2: n=7,10%; group 3: n=9, 27.3%) (p=0.012). No patient in group 1 died during the hospital stay. In conclusion, cardiac damage staging of AS might help identify patients at higher risk of conduction disorders and PPMI requirement after TAVI.

In natural, laboratory and industrial conditions, the density of a fluid or gas, depending on temperature, pressure, concentration of dissolved substances or suspended particles, changes under the influence of a large number of physical factors. We assume that undisturbed liquid is stratified. The analysis is based on a system of fundamental equations for the transfer of energy, momentum and matter in periodic flows of a viscous compressible fluid. The propagation of periodic flows in viscous uniformly stratified fluids is considered. Taking into account the compatibility condition, dispersion relations are constructed for two-dimensional internal, acoustic and surface linear disturbances with a positive definite frequency and complex wave number in a compressible viscous fluid exponentially stratified by density. The temperature conductivity and diffusion effects are neglected. The obtained regularly perturbed solutions to the equations describe weakly damped waves. Singular solutions characterize the thin ligaments that accompany each type of wave. In limiting cases, the constructed solutions transform into known expressions for a viscous homogeneous and ideal fluid or degenerate.

Localized turbulence is common in geophysical flows, where the roles of rotation and stratification are paramount. In this study, we investigate the evolution of a stratified turbulent cloud under rotation. Recognizing that a turbulent cloud is composed of vortices of varying scales and shapes, we start our investigation with a single eddy. Compared to an eddy under pure rotation, the stratified eddy shows the physical manifestation of a known potential vorticity mode, appearing as a static stable vortex. In addition, the expected shift from inertial waves to inertial-gravity waves is observed. In our numerical simulations of the turbulent cloud, carried out at a constant Rossby number over a range of Froude numbers, stratification causes columnar structures to deviate from vertical alignment. This deviation increases with increasing stratification, slowing the expansion rate of the cloud. The observed characteristics of these columnar structures are consistent with the predictions of linear theory, particularly in their tilt angles and vertical growth rates, suggesting a significant influence of inertial-gravity waves. Using Lagrangian particle tracking, we have identified regions where wave activity dominates over turbulence. In scenarios of milder stratification, these inertial-gravity waves are responsible for a significant energy transfer away from the turbulent cloud, a phenomenon that attenuates with increasing stratification.

This article describes rationales and limitations for making inferences based on data from randomized controlled trials (RCTs). We argue that obtaining a representative random sample from a patient population is impossible for a clinical trial because patients are accrued sequentially over time and thus comprise a convenience sample, subject only to protocol entry criteria. Consequently, the trial’s sample is unlikely to represent a definable patient population. We use causal diagrams to illustrate the difference between random allocation of interventions within a clinical trial sample and true simple or stratified random sampling, as done in surveys. We argue that group-specific statistics, such as a median survival time estimate for a treatment arm in an RCT, have limited meaning as estimates of larger patient population parameters. In contrast, random allocation between interventions facilitates comparative causal inferences about between-treatment effects, such as hazard ratios or differences between probabilities of response. Comparative inferences also require the assumption of transportability from a clinical trial’s convenience sample to a targeted patient population. We focus on the consequences and limitations of randomization procedures in order to clarify the distinctions between pairs of complementary concepts of fundamental importance to data science and RCT interpretation. These include internal and external validity, generalizability and transportability, uncertainty and variability, representativeness and inclusiveness, blocking and stratification, relevance and robustness, forward and reverse causal inference, intention to treat and per protocol analyses, and potential outcomes and counterfactuals.

Arrhythmic sudden cardiac death (SCD) has an annual prevalence of 1 per 1000 while 75% of the victims suffer from ischemic and 10% from non-ischemic or hypertrophic cardiomyopathy. Altogether, these three entities account for more than 80% of the total SCD victims. Guidelines for implantable cardiac defibrillators are still dominated by LVEF<30% from the MADIT II study. In terms of arrhythmic risk stratification, the PRESERVE-EF study restored in clinical practice the two-step arrhythmic risk stratification approach based on Electrocardiographic non-invasive risk factors (NIRFs) guiding to electrophysiological study. In our times with the multiple cardiac imaging methods and artificial intelligence applications availability, this two-step approach based on integrated arrhythmia mechanisms detection, emerges as an efficient SCD risk stratification paradigm for these three entities but also for the patients with congenital heart disease.

In a saline semi-isolated Lagoon on the Cape Zeleny (White Sea), the annual dynamics of the vertical hydrological structure, and the seasonal dynamics of phytoplankton were traced, including species composition, and vertical distribution, abundance, nutrition type,and biomass.293 species and supraspecific taxa of algae and cyanobacteria were found. Most of the identified species are marine, and 38 species are freshwater. Taxonomic composition changed in the Lagoon during the year. Dinoflagellates dominated in winter and early June; unidentified cocci and flagellates in July; diatoms, dinoflagellates and unidentified cells in August; dinoflagellates in September; and unidentified cocci and flagellates in October–November. The abundance of algae also changed in the Lagoon during the year. The integrated biomass in the water column varied from 0.01 g C/m2 in January to 0.78 g C/m2 in early September. According to the abiotic parameters, the water column of the Lagoon is subdivided into several zones with different conditions and corresponding phytoplankton communities. Similarity between the communities of different horizons was 32-46% in summer and 7% in winter. The chemocline layer was the most populous. Almost the entire year it contained a maximum of phytoplankton biomass, 1-2 orders of magnitude higher than that in the overlying horizons. Comparison phytoplankton in the lagoon and in the nearby sea area was carried out. Despite the connection between the Lagoon and the sea phytoplankton structure in the surface water layer in the Lagoon and in the sea differs significantly in composition, quantitative parameters, and seasonal dynamics. The similarity of the communities in the sea and the Lagoon never exceeded 50%. In terms of biomass, the Lagoon lags behind the sea until mid-summer, but, starting from August, it outnumbers it, and the phytoplankton development in the Lagoon lasts longer, until late autumn. The phytoplankton structure and dynamics in the Lagoon and the sea by 24.5% was related to the daylight, water salinity, oxygen content and pH, but did not depend on water T, underwater illuminance, and depth. Oxygen content and pH are defined by PhP activity. Salinity serves as a vector of the vertical sequence of ecological niches. The daylight length seems to be the crucial factor of the seasonal PhP dynamics in the semi-isolated coastal stratified lakes and lagoons.

Aim: To improve risk stratification in early-stage endometrial cancer (EC), we performed mo-lecular classification, and L1CAM immunohistochemistry (IHC) for additional risk assessment. Method: We analyzed archival tumor tissue from 247 early-stage EC patients. POLE mutations were detected using a Droplet digital polymerase chain reaction assay and Sanger sequencing, while the mismatch repair (MMR) status was determined by MMR protein IHC and MSI test. Additionally, we conducted IHC of p53 and L1CAM. Results: The 247 ECs were categorized into four subgroups: POLE-mutated (13.0%), MMR-deficient (27.9%), p53-abnormal (8.5%), and non-specific molecular profile (NSMP, 50.6%). We further subcategorized NSMP subgroup into NSMP-L1CAMneg (44.9%) and NSMP-L1CAMpos (5.7%), which we refer to as the molecu-lar-L1CAM classification. The molecular-L1CAM classification was an independent prognostic factor for recurrence-free survival (RFS) and overall survival (OS) (p <0.001, each). Similarly, the simplified L1CAM-p53 categorization, for practical use, remained an independent prognostic factor for RFS and OS (p <0.001, p =0.003, respectively). Conclusion: Integrating the molecu-lar-L1CAM classification or the simplified L1CAM/p53 categorization can enhance risk stratifi-cation in early-stage EC, providing valuable prognostic information to guide treatment deci-sions and improve patient outcomes.

The sensitivity of exercise ECG is marginally sufficient for detection of mild reduction of coronary blood flow in patients with early coronary atherosclerosis. Here we describe the application of new technique of ECG registration/analysis – ultrahigh resolution ECG (UHR ECG) – for early detection of myocardial ischemia (MIS). The utility of UHR ECG vs. conventional ECG (C ECG) was tested in anesthetized rats and pigs. Transmural MIS was induced in rats by the ligation of the left coronary artery (CA). In pigs, subendocardial ischemia of variable extent was produced by stepwise inflation of balloon within the right CA causing 25-100% reduction of its lumen. In rats, a reduction in power spectral density (PSD) in high-frequency (HF) channel of UHR ECG was registered at 60 s after ischemia (power 0.81±0.14 vs. 1.25±0.12 mW at baseline, p<0.01). This was not accompanied by any ST segment elevation on C ECG. In pigs, PSD in HF channel of UHR ECG was significantly decreased at 25% reduction of CA lumen, while ST segment on C ECG remained unchanged. In conclusion, UHR ECG enabled earlier detection of transmural MIS compared to C ECG. PSD in HF-channel of UHR ECG demonstrated greater sensitivity in the settings of subendocardial ischemia.

Primary Biliary Cholangitis (PBC) is a chronic, cholestatic liver disease with a heterogeneous presentation, symptomatology, disease progression, and response to therapy. The current risk stratification assessment, aimed at identifying patients with a higher risk of disease progression, encompasses an in-depth analysis of demographic data, clinical and laboratory findings, antibody profiles, and the evaluation of liver fibrosis using both invasive and non-invasive techniques. Treatment response scores after one year of therapy remain to date a major factor influencing the prognosis of PBC patients. While the initial therapeutic approach with ursodeoxycholic acid (UDCA) is universally applied, new second-line treatment options have recently emerged, with many others under investigation. Consequently, the prevailing one-size-fits-all approach is poised to be supplanted by tailored strategies, ensuring high-risk patients receive the most appropriate treatment regimen from diagnosis. This will require the development of a risk prediction model to assess, at the time of diagnosis, the course, outcome, and response to first and additional treatments of PBC patients. This manuscript provides a comprehensive overview of the current and emerging tools used for risk stratification in PBC and speculates on how these developments might shape the disease landscape in the near future.

(1) Background: This article presents a study that aims to provide a precise understanding of the temperature distribution within a Whole-Body Cryostimulation (WBC) chamber, whether it is empty or occupied by one or several individuals.; (2) Methods: The study employs a mixed numerical and experimental approach, utilizing simplified Computational Fluid Dynamics (CFD) simulations and an experimental analysis that employs thermocouples to determine the 3D thermal field in actual conditions.; (3) Results: The results reveal a non-negligible temperature difference between the setpoint and actual temperature in the middle of the cryochamber. Furthermore, it is shown that the presence of individuals inside the chamber results in both an average temperature rise and a more heterogeneous thermal behavior, which appear to be associated with the number of individuals present.; (4) Conclusions: The findings of this study emphasize the need for further research to establish temperature guidelines and standardize measurement methods for effective WBC treatment.

Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular sarcoma with variable aggressive clinical behavior. In this retrospective study we aimed to investigate prognostic factors based on clinicopathologic findings in a molecular/immunohistochemical confirmed nationwide multicenter cohort of 57 EHE. Patients had unifocal disease (n=29), multifocal disease (n=5), lymph node metastasis (n=8) and/or distant metastasis (n=15) at the time of diagnosis. The overall survival rate was 69.6% at 1 year and 50.5% at 5 years. Survival did not correlate with sex, age or histo-pathological parameters. No survival differences were observed between multifocal and metastatic disease suggesting that multifocality represents early metastases and treatment options are limited in comparison to unifocal disease. In unifocal tumors, survival could be predicted using the risk stratification model of Shibayama et al. dividing the cases into low (n=4), intermediate (n=15) and high (n=3) risk-groups. Larger tumor size (>3cm) and higher mitotic count (>1/10HPF) was asso-ciated with progressive unifocal disease course. Lymph node metastases at time of diagnosis oc-curred in 14.0% of the cases and was mainly associated with tumor localization in the head and neck area proposing lymph node dissection. In conclusion, our results demonstrate the aggressive behavior of EHE, emphasize the prognostic value of a previous described risk stratification model and may provide new insights regarding tumor focality, therapeutic strategies and prognosis.

(1) Background: Breast cancer is the second leading cause of cancer death among women. The accurate prediction of survival intervals will help physicians make informed decisions on treatment strategies or the use of palliative care for patients; (2) Methods: The gene expression is predictive and correlates to patient prognosis. To establish a reliable prediction tool, we collected the RNA-seq data of breast cancer patients, a total of 1187 RNA-seq data (median age 58 years), in FPKM format from the TCGA database. Among them, 144 RNA-seq data with date of death information was selected to establish the SaBrcada-AD dataset. We first normalized the SaBrcada-AD dataset to transcripts per million (TPM) to build survival prediction model SaBrcada. After normalization and dimension raising, the differential gene expression data were used for testing eight different deep learning architectures. Among them, GoogLeNet performed the best. Considering the effect of age on prognosis, we examined all ages between the lower and upper quartiles of patient age for a stratified random sampling test; (3) Results: Stratifying by age based on a cut-off of 61 years of age improved the accuracy of SaBrcada compared to previous findings, resulting in an accuracy of 0.798. We also built a free website tool to provide 5 kinds of predicted survival period information for clinician reference; (4) Conclusions: We established a breast cancer survival analysis prediction model, SaBrcada, and a website tool with the same name. Through this highly reliable survival analysis model and website tool, information on survival intervals will be provided for clinicians as part of precision medicine.

The current classification of acute myeloid leukemia (AML) relies largely on genomic alterations. AML with mutated Nucleophosmin1 (NPM1-mut) is the largest of the genetically defined groups, involving about 30% of adult AMLs and is currently recognized as a distinct entity in the actual AML classifications. NPM1-mut AML usually occurs in de novo AML and is associated predominantly with a normal karyotype and relatively favorable prognosis. However, NPM1-mut AMLs are genetically, transcriptionally, and phenotypically heterogeneous. Furthermore, NPM1-mut is a clinically heterogenous group. Recent studies have in part clarified the consistent heterogeneities of these AMLs and have strongly supported the need for an additional stratification aiming to improve the therapeutic response of the different subgroups of NPM1-mut AML patients.

The pandemic of obesity worldwide has been recognized as a very important challenge. Within its complexity the identification of higher risk patients becomes essential since it seems unsustainable trying to offer access to treatment to all people with obesity. Several new approaches have recently been presented as important tools for risk stratification. This research applied some of these tools in a cross-sectional study involving adults with obesity classes I, II, III and super obesity. The participants had their cardiometabolic risk profile assessed. The study included adults with obesity, aged 18 to 50 years (n=404) who were evaluated for anthropometric, body composition, hemodynamic, physical fitness and biochemical assessments. These variables were used to identify the prevalence of risk factors for cardiometabolic diseases according to the classes of obesity, by gender and age group. The results showed a high prevalence of risk factors, especially among the upper classes of obesity (BMI &gt; 35 kg/m2) using single parameters as the waist circumference with almost 90% above the cut-off point. But there were also smaller numbers as the Glycated Hemoglobin whose prevalence was around 30%. Indexes like the atherogenic index of plasma (AIP) had the highest prevalence, with 100% of the male participants identified with increased risk for cardiovascular diseases.

Berberis koreana Palibin is an endemic plant native to Korea. In this study, we aimed to study seed germination in this species using a water imbibition experiment, gibberellic acid (GA3) treat-ment (0, 10, 100, or 1000 mg·L−1), cold stratification (0, 2, 4, 8, or 12 weeks at 4 °C), a move-along experiment, and phenology studies. In the water imbibition experiment, the weight of the seeds increased by more than 120% in 24 h. Analysis of the internal and external morphological char-acteristics of the seed revealed that the embryo was already fully grown from the fruit and did not grow thereafter. The final germination percentages for cold stratification at 0, 2, 4, 8, and 12 weeks at 4 °C were 12, 32, 59, 59, and 71%, respectively. In the move-along experiment and phe-nology studies, a longer low-temperature treatment period resulted in a higher germination percentage. However, the GA3 treatment had little effect on seed germination. Our results indi-cate that B. koreana exhibits intermediate physiological seed dormancy.

The COVID-19 pandemic has presented an unprecedented challenge to the healthcare system. Identifying the genomics and clinical biomarkers for effective patient stratification and management is critical to controlling the spread of the disease. Omics datasets provide a wealth of information that can aid in understanding the underlying molecular mechanisms of COVID-19 and identifying potential biomarkers for patient stratification. Artificial intelligence (AI) and machine learning (ML) algorithms have been increasingly used to analyze large-scale omics and clinical datasets for patient stratification. In this manuscript, we demonstrate the recent advances and predictive accuracies in AI and ML-based patient stratification modeling linking omics and clinical biomarker datasets, focusing on COVID-19 patients. Our ML model not only demonstrates that clinical features are enough an indicator of COVID-19 severity and survival but also infers what clinical features are more impactful, which makes our approach a useful guide for clinicians for prioritization of best-fit therapeutics for a given cohort of patients. Moreover, with weighted gene network analysis, we are able to provide insights into gene networks that have a significant association with COVID-19 severity and clinical features. Finally, we have demonstrated the importance of clinical biomarkers in identifying high-risk patients and predicting disease progression.

Patients with pT1 high-grade (HG) bladder cancer (BC) and a very high risk of progression might benefit from immediate radical cystectomy (RC), but this option remains controversial. Validation of a standardized method to evaluate the extent of lamina propria (LP) invasion (with recognized prognostic value) in transurethral resections (TURBT) specimens is still needed. The Rete Oncologica Lombarda (ROL) system showed a high predictive value for progression after TURBT in recent retrospective studies. Our aim was to validate ROL system on a large mono-institutional prospective series of primary urothelial carcinomas. From 2016 to 2020, we adopted ROL for all patients with pT1 HG BC on TURBT. We employed a 1.0-mm threshold to stratify tumors in ROL1 and ROL2. A total of 222 pT1HGBC were analyzed. Median age was 74 years, with male predominance (73.8%). ROL was feasible in all cases: 91 cases were ROL1 (41%) and 131 ROL2 (59%). At a median follow up of 26.9 months (IQR 13.8-40.6), we registered 80 recurrences and 40 progressions. ROL was a significant predictor of tumor progression at both univariable (HR 3.53; CI 95% 1.56 – 7.99; p&lt;0.01) and multivariable (HR 2.90; CI 95% 1.25 – 6.75; p=0.01) Cox regression analyses. At Kaplan-Meier estimates, ROL showed correlation with both PFS (p=0.0012) and RFS (p=0.0167). Our results confirmed the strong predictive value of ROL for progression on a large prospective series. We encourage the application of ROL for reporting the extent of LP invasion, substaging T1 HG BC, and improving risk tables for urological decision making.

A key step in providing management/treatment options to men with suspected prostate cancer (PCa) is categorizing the risk for the presence of benign, low risk, intermediate risk, or high-risk disease. Our novel modality brings new evidence, based on the long-known hallmark characteristic of PCa – decreased Zinc (Zn), which is the most direct metabolic sign of malignancy and its aggressiveness. To date, this approach has not been adopted for clinical use for a number of reasons that are described in this article and which have been addressed by our approach: Zn has to be measured on fresh samples, prior to fixating in formalin, therefore samples have to be scanned during the biopsy session; as Zn depletion occurs in the glands, where the tumors develop, estimation of the glands’ levels in the scanned tissue along with their compactness, are essential for accurate diagnosis. Combined with the Zn depletion, this facilitates a reliable assessment of the disease aggressiveness. Data gathered in the clinical study described here indicate that in addition to improving the biopsy quality by real-time interactive guidance, a malignancy score can now be established for the entire prostate, allowing higher granularity personalized risk stratification and more decisive treatment decisions for all PCa patients.

Climate change may cause organisms to seek thermal refuge from rising temperatures, either by shifting their ranges or seeking microrefugia within their existing ranges. We evaluate the potential for thermal stratification to provide refuge for two fish species in the San Francisco Estuary (SFE): Chinook Salmon (Oncorhynchus tshawytscha) and Delta Smelt (Hypomesus transpacificus). We compiled water temperature data from multiple monitoring programs to evaluate spatial, daily, hourly, intra-annual, and inter-annual trends in stratification using generalized additive models. We used our data and models to predict the locations and periods of time that the bottom of the water column could function as thermal refuge for salmon and smelt. Periods in which the bottom was cooler than surface primarily occurred during the peak of summer and during the afternoons, with more prominent stratification during warmer years. Although the SFE is often exceedingly warm for fish species and well-mixed overall, we identified potential for thermal refugia in a long and deep terminal channel for Delta Smelt, and in the periods bordering summer for Chinook Salmon. Thermal stratification may increase as the climate warms, and pockets of cooler water at depth, though limited, may become more important for at-risk fishes in the future.

Rail impedance directly affects the transmission performance of track circuit . Considering the condition of earth stratification, for the difficult to calculate the rail impedance due to the semi-infinite integration interval and the oscillation of the integrand by using the Carson formula, The truncation method is proposed to divide the impedance formula is divided into definite integral and tail integral. The integral is approximated by the spline function, and the tail integral is calculated by using the exponential integral and Euler formula. Based on it, the rail impedance calculation formula of track circuit is obtained. The electromagnetic field model of track circuit with earth stratification is simulated by finite element method, and the correctness of the method is verified. Based on the formula, the influence of current frequency, soil depth and conductivity on rail impedance is studied. The relative error between the calculated results of rail impedance and the simulation results of finite element is within 5%. It can be seen that the formula has high accuracy and correctly reflects the law of rail impedance variation with current frequency, soil depth and resistivity. It provides a reliable reference for the theoretical calculation of rail impedance of track circuit.

In order to better understand the biogeochemical cycle of nitrogen in meromictic lakes, which can serve as a model for past aquatic environments, we measured dissolved concentrations of nitrate, nitrite, ammonium and organic nitrogen in deep (39 m maximal depth) subarctic Lake Svetloe (NW Russia). The lake is a rare type of freshwater meromictic water boy with high concentrations of methane, ferrous iron, manganese and low concentrations of sulfates and sulfides in the monimolimnion. In the oligotrophic mixolimnion, the concentration of mineral forms of nitrogen decreased in summer compared to winter, likely due to phytoplankton bloom. The decomposition of the bulk of organic matter occurs under microaerophilic/anaerobic conditions of the chemocline and accompanied by the accumulation of nitrogen in the form of N-NH4 in the monimonimlion. We revealed a strong relationship between methane and nitrogen cycles in the chemocline and monimolimnion horizons. The nitrate concentrations in Lake Svetloe varied in the range from 9 to 13 μM throughout the water column. This fact is rare for meromictic lakes, where nitrate concentrations up to 13 µM are found in the monimolimnion zone down to the bottom layers. We hypothesize, in accord with available data for other stratified lakes, that under conditions of high concentrations of manganese and ammonium at the boundary of redox conditions and below, anaerobic nitrification with the formation of nitrates occurs. Overall, most of organic matter in Lake Svetloe undergoes biodegradation essentially under microaerophilic/anaerobic conditions of the chemocline and the monimolimnion. Consequently, the manifestation of the biogeochemical nitrogen cycle is expressed in these horizons in the most vivid and complex relationship with other cycles of elements.

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

The past years saw the rise of genomic biobanks and mega-scale meta-analysis of genomic data that promise to reveal the genetic underpinnings of health and disease. However, the over-representation of Europeans in genomic studies not only limit the global understanding of disease risk and intervention efficacy, but also inhibit viable research into the genomic differences between carriers and patients. Whilst the community has agreed that more diverse samples are required, it is not enough to blindly increase diversity; the diversity must be quantified, compared, and annotated to lead to insight. Genetic annotations from separate biobanks need to be comparable, computable, operate without access to raw data due to privacy concerns. But they must be comparable, both for regular research and to allow international comparison in response to pandemics. Here, we evaluate the appropriateness of commonly used genomic tools used to depict population structure in a standardized and comparable manner. The end goal is to reduce the effects of confounding and learn from genuine variation in genetic effects on phenotypes across populations, which will improve the value of biobanks, locally and internationally, increase the accuracy of association analyses, and inform developmental efforts.

Chronic diseases are still known as incurable diseases, and we suspect that the medical research model is unfit for characterizing chronic diseases. In this study, we examined accuracy and reliability required for characterizing chronic diseases, reviewed implied presumptions in clinical trials and assumptions used in statistical analysis, examined sources of variances normally encountered in clinical trials, and conducted numeric simulations by using hypothetical data for several theoretical and hypothetical models. We found that the sources of variances attributable to personal differences in clinical trials can distort hypothesis test outcomes, that clinical trials introduce too many errors and too much inaccuracies that tend to hide weak and slow effects of treatments, and that the means of treatments used in statistical analysis have little or no relevance to specific patients. We further found that a large number of uncontrolled co-causal or interfering factors normally seen in human subjects can greatly enlarge the means and the variances of the experimental errors, and the use of high rejection criteria (e.g., low p values) further raises the chances of failing to find treatment effects. As a whole, we concluded that the research model using clinical trials is wrong on multiple grounds, under any of our realistic theoretical and hypothetical models, and that misuse of statistical analysis is most probably responsible for failure to identify treatment effects for chronic diseases and to detect harmful effects of toxic substances in the environment. We proposed alternative experimental models involving the use of single-person or mini optimization trials for studying low-risk weak treatments.

The research objectives was to determine the plants vegetation profile in forest revegetation and Mount Arjuna springs. The method used was descriptive method. While based on the techniques and tools used to research, the author uses the survey method to obtain facts that occur in the research area, namely in the area around the springs of Arjuna mount, Pasuruan, East Java, Indonesia. Data obtained in the field are then processed and analyzed using GIS, ArcView 3.3 and Google Earth programs. The results of the study explain the profile of plant vegetation, namely plant stratification, bird wealth, taxonomic wealth and plant density have a significant effect on forest revegetation and springs in Arjuna mount. The forest vegetation profile has a positive and significant effect on the preservation of springs. The better the profile of forest vegetation, the preservation of springs will be better, and vice versa.

Fresh water springs are unique natural resources in Florida, currently under threat from increasing groundwater pumping and pollution resulting from a variety of sources. This paper estimates current recreation benefits from visiting springs using the travel cost method and elicits residents’ willingness to contribute for springs restoration using the contingent valuation method. It further compares the performance of count data models correcting for endogenous stratification and truncation, and finds that the annual consumer surplus per person per trip is between $20 and $43. Furthermore, visitors are willing to contribute $12 to $14 per person per trip for springs restoration without reducing trip demand.

Major marine construction projects, resulting in the release of sediments, are subject to environmental assessment and other regulatory approval processes. An important tool used for this is the development of specialized numerical methods for these marine activities. An integrated set of numerical methods addresses four distinct topics: the near-field release and mixing of suspended sediments into the water column (i.e. the initial dilution zone); the transport of the suspended sediments under the influence of complex ocean currents in the far-field; the settling of the transported suspended sediments onto the seabed; and the potential for resuspension of the deposited sediments due to sporadic occurrences of unusually large near-bottom currents. A review of projects subjected to environmental assessment in the coastal waters of British Columbia from the year 2006 to 2017, is presented to illustrate the numerical models being used and their ongoing development. Improvements include higher resolution model grids to better represent the near-field, the depiction of particle size dependent vertical settling rates and the computation of resuspension of initially deposited sediments, especially in relation to temporary subsea piles of sediments arising from trenching for marine pipelines. The ongoing challenges for this numerical modeling application area are also identified.

Since very few empirical endeavors have looked into statue and funerary art that represents social identities, this study aims to fill this gap. The research article aims to portray social status from the funeral arts, traditions and rituals. This longitudinal case study used interviews and a series of observations. The finding reveals that each funerary art represents particular class of noble families. Every funerary art also depicts specific insightful meaning for their noble families. The process of ritual and funeral ceremony is performed according to each status of noble families. This paper also describes the implication of the funerary art in social and cultural interactions.

Climate change such as sea level rise, change in temperature, precipitation, and storminess are expected to impact significantly coastal lagoons. The nature and magnitude of these impacts are uncertain. The objective of the research is to determine the climate change impacts on mixing and circulation at Songkhla lagoon, Thailand. Songkhla lagoon is the largest lagoonal water resource in Thailand and Southeast Asia. The lagoon is a combined freshwater and estuarine complex of high productivity which represents an extraordinary combination of environmental resources believed to be unique in the region. This work is part of a Climate Change impact assessment framework. It is the validation phase (step 5) of the framework applying a case study. Delft 3D was used to simulate CC scenarios in the climate downscaling models, part of the previous framework steps. These results were compared to the current conditions to determine the main changes in mixing and circulation in the coastal lagoon. Three indicators were applied to quantify the impacts: flushing time, salinity intrusion and stratification. The results suggest an increase in water velocities at the inlet in future scenarios and a decrease of flushing time. Salinity and stratification showed more complex changes in futures scenarios.

Nutrition support is increasingly recognized as a clinically relevant aspect of the intensive care treatment of cardiac surgery patients. However, evidence from adequate large-scale studies evaluating its clinical significance for patients’ mid- to long-term outcome remains sparse. Considering nutrition support as a key component in the perioperative treatment of these critically ill patients, led us to review and discuss our understanding of the metabolic response to the inflammatory burst induced by cardiac surgery. In addition, we discuss how to identify patients who may benefit from nutrition therapy, when to start nutritional interventions, present evidence about the use of enteral and parenteral nutrition and the potential role of pharmaconutrition in cardiac surgery patients. Although the clinical setting of cardiac surgery provides advantages due to its scheduled insult and predictable inflammatory response, researchers and clinicians face lack of evidence and several limitations in the clinical routine, which are critically considered and discussed in this paper.

To estimate the recreational value provided by the Foy’s Lake annually using the most applicable model for on-site data is the main objective of this study. Adhere to the objective of this study; Individual Travel Cost Method (ITCM) has been applied and Zero Truncated Poisson Regression Model has been found plausible among other models to estimate consumer surplus. Based on the findings of the study, an estimate of the consumer surplus or recreational benefits per trip per visitor can be recommended as BDT 5,875 or US $ 73.44 and counting the consumer surplus per trip per visitor, the annual recreational value (total consumer surplus) provided by the lake is found to be BDT 321 million or US $ 40.2 million.

In this study, a basic study was performed to analyze the seasonal temperature status of a research room in the Global Environment Research Building where ceiling-embedded indoor units are installed to study the room temperature status of the building as well as to improve its thermal environment. In addition, a direction for improvement of the indoor thermal environment in the winter was proposed through a CFD (computational fluid dynamics) simulation and was proven by an additional experiment. Through the results of this study, it appeared that if the ceiling-embedded indoor unit was installed in the small indoor space without considering the thermal vulnerability of its perimeter boundary, the air temperature of the upper part was greatly different from that of the bottom part in the winter. Hence, in this study, as a means to improve it, convectors were installed to minimize the effect of the external thermal environment and angle-controllable air flowing fans were installed to mitigate the stratification distribution. With such result, it was intended to present the essential data for improvement of the thermal environment as well as conservation of heating energy in the winter for buildings by reviewing the use of the ceiling-embedded indoor unit in the future.