Individuals with familial adenomatous polyposis (FAP) have an almost 20% lifetime risk of duodenal adenocarcinoma, currently the leading cause of death in FAP. The Spigelman staging system provides ...guidance on the surveillance intervals and timing of prophylactic surgery. Still, its accuracy in predicting duodenal and papillary cancer development has not been systematically evaluated. We investigated the sensitivity and cancer risk of the Spigelman stages.
We performed a systematic review on PubMed, MEDLINE, EMBASE, and Cochrane and used a random-effects model to pool effect sizes.
After removing duplicate entries, we screened 1,170 records and included 27 studies for quantitative analysis. Once duodenal polyposis reaches Spigelman stage IV, the risk of duodenal and papillary cancers increased to 25% (95% confidence interval CI 12%-45%). However, the sensitivity of Spigelman stage IV for these cancers was low (51%, 95% CI 42%-60%), especially for papillary adenocarcinoma (39%, 95% CI 16%-68%). We investigated the reasons behind these low values and observed that duodenal cancer risk factors included polyps >10 mm, polyp count >20, and polyps with high-grade dysplasia. Risk factors associated with papillary cancer included a papilla with high-grade dysplasia or >10 mm. The evidence on other risk factors was inconclusive.
The current Spigelman staging system had a low sensitivity for duodenal and papillary adenocarcinomas. Two Spigelman variables (duodenal villous histology and polyp count) and the lack of papilla-specific variables likely contributed to the low sensitivity values for duodenal and papillary cancers, respectively. While clinicians may be familiar with its current form, there is an urgent need to update it.
Although CO2 field-flooding was first used during cardiac surgery more than 60 years ago, its efficacy is still disputed. The invisible nature of the gas and the difficulty in determining the "safe" ...quantity to protect the patient are two of the main obstacles to overcome for its validation. Moreover, CO2 concentration in the chest cavity is highly sensitive to procedural aspects, such suction and hand movements. Based on our review of the existing literature, we identified four major factors that influence the intra-cavity CO2 concentration during open-heart surgery: type of delivery device (diffuser), delivery CO2 flow rate, diffuser position around the wound cavity, and its orientation inside the cavity. In this initial study, only steady state conditions were considered to establish a basic understanding on the effect of the four above-mentioned factors. Transient factors, such as suction or hand movements, will be reported separately.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Whether clinical practice guidelines have a significant impact on practice is unclear. The effect of guideline recommendations on clinical practice often a lags behind the date of publication. We ...evaluated by means of a data-driven approach if and when the guidelines on red blood cell transfusions (RBCTs) issued by Swiss Smarter Medicine in 2016 had an impact on RBCTs practice within a hospital network, where awareness of guidelines was promoted mainly among internal medicine specialties. Data on RBCTs performed in a Swiss hospital network from January 2014 to April 2021 were analyzed by hospital site and specialty to assess whether guidelines led to a decrease in inappropriate RBCTs. RBCTs were defined as "inappropriate" if patients had a hemoglobin level ≥ 70 g/L without or ≥ 80 g/L with significant cardiovascular comorbidities. Changes in the rate of inappropriate transfusions were analyzed with an advanced statistical approach that included generalized additive models. Overall prior to March 2017 there were more inappropriate than appropriate RBCTs, but after October 2017 the opposite could be observed. A change-point in the time trend was estimated from transfusion data to occur in the time interval between March and October 2017. This change was mainly driven by practice changes in the medical wards, while no significant change was observed in the critical care, surgical and oncology wards. Change in practice varied by hospital site. In conclusion, our results show that a significant change in the RBCTs practice at the hospital level occurred approximately 18 months after national guidelines were issued.
The clinical staging model distinguishes different stages of mental illness. Early stages, are suggested to be more mild, diffuse and volatile in terms of expression of psychopathology than later ...stages. This study aimed to compare individual transdiagnostic symptom networks based on intensive longitudinal data between individuals in different early clinical stages for psychosis. It was hypothesized that with increasing clinical stage (i) density of symptom networks would increase and (ii) psychotic experiences would be more central in the symptom networks.
Data came from a 90-day diary study, resulting in 8640 observations within N = 96 individuals, divided over four subgroups representing different early clinical stages (n1 = 25, n2 = 27, n3 = 24, n4 = 20). Sparse Time Series Chain Graphical Models were used to create individual contemporaneous and temporal symptom networks based on 10 items concerning symptoms of depression, anxiety, psychosis, non-specific and vulnerability domains. Network density and symptom centrality (strength) were calculated individually and compared between and within the four subgroups.
Level of psychopathology increased with clinical stage. The symptom networks showed large between-individual variation, but neither network density not psychotic symptom strength differed between the subgroups in the contemporaneous (pdensity = 0.59, pstrength > 0.51) and temporal (pdensity = 0.75, pstrength > 0.35) networks.
No support was found for our hypothesis that higher clinical stage comes with higher symptom network density or a more central role for psychotic symptoms. Based on the high inter-individual variability, our results highlight the importance of individualized assessment of symptom networks.
Forecasting the volume of emergency events is important for resource utilization in emergency medical services (EMS). This became more evident during the COVID-19 outbreak when emergency event ...forecasts used by various EMS at that time tended to be inaccurate due to fluctuations in the number, type, and geographical distribution of these events. The motivation for this study was to develop a statistical model capable of predicting the volume of emergency events for Lombardy’s regional EMS called AREU at different time horizons. To accomplish this goal, we propose a negative binomial additive autoregressive model with smoothing splines, which can predict over-dispersed counts of emergency events one, two, five, and seven days ahead. In the model development stage, a large set of covariates was considered, and the final model was selected using a cross-validation procedure that takes into account the observations’ temporal dependence. Comparisons of the forecasting performance using the mean absolute percentage error showed that the proposed model outperformed the model used by AREU, as well as other widely used forecasting models. Consequently, AREU decided to adopt the new model for its forecasting purposes.
Although CO.sub.2 field-flooding was first used during cardiac surgery more than 60 years ago, its efficacy is still disputed. The invisible nature of the gas and the difficulty in determining the ..."safe" quantity to protect the patient are two of the main obstacles to overcome for its validation. Moreover, CO.sub.2 concentration in the chest cavity is highly sensitive to procedural aspects, such suction and hand movements. Based on our review of the existing literature, we identified four major factors that influence the intra-cavity CO.sub.2 concentration during open-heart surgery: type of delivery device (diffuser), delivery CO.sub.2 flow rate, diffuser position around the wound cavity, and its orientation inside the cavity. In this initial study, only steady state conditions were considered to establish a basic understanding on the effect of the four above-mentioned factors. Transient factors, such as suction or hand movements, will be reported separately.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Italy, particularly the Lombardy region, was among the first countries outside of Asia to report cases of COVID-19. The emergency medical service called Regional Emergency Agency (AREU) coordinates ...the intra- and inter-regional non-hospital emergency network and the European emergency number service in Lombardy. AREU must deal with daily and seasonal variations of call volume. The number and type of emergency calls changed dramatically during the COVID-19 pandemic. A model to predict incoming calls and how many of these turn into events, i.e., dispatch of transport and equipment until the rescue is completed, was developed to address the emergency period. We used the generalized additive model with a negative binomial family to predict the number of events one, two, five, and seven days ahead. The over-dispersion of the data was tackled by using the negative binomial family and the nonlinear relationship between the number of events and covariates (e.g., seasonal effects) by smoothing splines. The model coefficients show the effect of variables, e.g., the day of the week, on the number of events and how these effects change during the pre-COVID-19 period. The proposed model returns reasonable mean absolute errors for most of the 2020-2021 period.
The synthesis and characterization of the tetrathiomolybdatorhodium(I) monoanionic complexes L2Rh(μ-S)2MoS2− (L = CO (3), P(OPh)3 (4), P(O-o-Tol)3 (P(o-CH3C6H4)3; 5), P(OMe)3 (6), P(OEt)3 (7), ...P(O-i-Pr)3 (8); L2 = COD (1,5-cyclooctadiene; 2), cis-dppen (cis-Ph2PCHCHPPh2; 9), dppe (Ph2PCH2CH2PPh2; 10), dppb (Ph2P(CH2)4PPh2; 11)) is presented. The complex 2 (NEt4 + salt) was characterized by X-ray diffraction analysis. A detailed DFT study of the electronic structures of 2–4 and 6–8 has revealed the existence of extended electron delocalization over the four-membered Rh(μ-S)2Mo ring and hence the possibility of electronic communication between the metal centers. The electronic spectra were studied with TDDFT calculations, and the main absorption band in the visible region was assigned to ν(Rh→Mo) electron transfer transition, which is actually a HOMO–LUMO transition. The ν(Rh→Mo) transition was found to correlate linearly both with Tolman’s electronic parameter of the phosphite ligands and the calculated HOMO–LUMO gap of the complexes, rendering it a well-defined ligand electronic parameter, which describes the net donating ability of monodentate and bidentate ligands (CO, COD, phosphites, diphosphines). The study of the variation of Δδ(31P) and 1 J(Rh–P) of the phosphite complexes with respect to the QALE model electronic parameters χd, πp, and E ar has succeeded in the assessment of the σ and π effects on these NMR spectral parameters.
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