The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of ...intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.
Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality.
A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52
0.47, OR = 1.12, 95% CI: 1.06-1.18,
< 0.001), this association became non-significant in older patients (0.76
0.81,
= 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2%
77.7%,
< 0.001) and in patients undergoing revascularization (74.9%
77.3%,
< 0.001).
Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
Understanding the hospital impact of influenza requires enriching epidemiological surveillance registries with other sources of information. The aim of this study was to determine the validity of the ...Hospital Care Activity Record - Minimum Basic Data Set (RAE-CMBD) in the analysis of the outcomes of patients hospitalised with this infection.
Observational and retrospective study of adults admitted with influenza in a tertiary hospital during the 2017/2018 and 2018/2019 seasons. We calculated the concordance of the RAE-CMBD with the influenza epidemiological surveillance registry (gold standard), as well as the main parameters of internal and external validity. Logistic regression models were used for risk adjustment of in-hospital mortality and length of stay.
A total of 907 (97.74%) unique matches were achieved, with high inter-observer agreement (ƙ=0.828). The RAE-CMBD showed a 79.87% sensitivity, 99.72% specificity, 86.71% positive predictive value and 99.54% negative predictive value. The risk-adjusted mortality ratio of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio was higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001).
The RAE-CMBD is a valid source of information for the study of the impact of influenza on hospital care. The lower risk-adjusted mortality of patients admitted with influenza compared to other inpatients seems to point to the effectiveness of the main clinical and organisational measures adopted.
Accurate brain tissue segmentation in magnetic resonance imaging (MRI) has attracted the attention of medical doctors and researchers since variations in tissue volume and shape permit diagnosing and ...monitoring neurological diseases. Several proposals have been designed throughout the years comprising conventional machine learning strategies as well as convolutional neural networks (CNNs) approaches. In particular, in this paper, we analyze a sub-group of deep learning methods producing dense predictions. This branch, referred in the literature as fully CNN (FCNN), is of interest as these architectures can process an input volume in less time than CNNs. Our study focuses on understanding the architectural strengths and weaknesses of literature-like approaches. We implement eight FCNN architectures inspired by robust state-of-the-art methods on brain segmentation related tasks and use them within a standard pipeline. We evaluate them using the IBSR18, MICCAI2012, and iSeg2017 datasets as they contain infant and adult data and exhibit different voxel spacing, image quality, number of scans, and available imaging modalities. The discussion is driven in four directions: comparison between 2D and 3D approaches, the relevance of multiple imaging sequences, the effect of patch size, and the impact of patch overlap as a sampling strategy for training and testing models. Besides the aforementioned analysis, we show that the methods under evaluation can yield top performance on the three data collections. A public version is accessible to download from our research website to encourage other researchers to explore the evaluation framework.
Coronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not ...well established.
To assess indications and results of PCI in SCAD.
The minimum basic data set of the Spanish National Health System (years 2016-2019) was used to identify 804 episodes of acute myocardial infarction (AMI) and SCAD, with a crude in-hospital mortality rate of 3%. Of these, 368 (46.8%) patients were revascularized with PCI during admission whereas 436 (54.2%) were managed conservatively.
Revascularization and in-hospital mortality rates both declined over the study period (p for trend both < 0.05). SCAD patients treated with PCI were older, more frequently male, and had higher frequency of diabetes, ST-segment elevation AMI and cardiogenic shock, compared to patients managed conservatively. The crude in-hospital mortality rate was higher in patients treated with PCI (4.9% vs. 1.4%;
= 0.004). However, after adjusting by propensity score (223 pairs) the in-hospital mortality rate was similar in the two groups (Adj OR: 1.21; 95%CI: 0.30-1.57;
= 0.76). Readmissions at 30-days were higher in patients managed conservatively (7.1 vs. 1.6%,
< 0.001) and this difference was maintained after propensity score adjustment (Adj average treatment effect: 2% vs. 12.2%; OR: 0.15; 95%CI: 0.04-0.45;
< 0.001).
Revascularization is frequently used in unselected patients with AMI and SCAD but its use is declining. Patients with SCAD treated with PCI have a higher in-hospital mortality but this appears to be explained by their adverse baseline clinical characteristics.
This paper presents a new method in data mining to analyze the composition of the electric demand among the different consumption and the behavior of each type of load. The proposed method uses a ...heuristic optimization algorithm (Tabu Search) for minimizing the error between the real demand and the calculated approximation to this demand. This search is adaptative because the algorithm changes the relative weight of each load as well as the profile of each load. The obtained results show the good operation of the proposed methodology. Also, it is possible to observe that this approach to the knowledge of the demand is better than the classic approach in which “a picture” of the consumption can be obtained, while this methodology obtains the evolution of this consumption in time; that is to say, it shows “a movie” of the behavior of the loads.
Squamous cell carcinoma (SCC) or epidermoid cancer is a frequent and aggressive malignancy. However in apparent paradox it retains the squamous differentiation phenotype except for very dysplastic ...lesions. We have shown that cell cycle stress in normal epidermal keratinocytes triggers a squamous differentiation response involving irreversible mitosis block and polyploidisation. Here we show that cutaneous SCC cells conserve a partial squamous DNA damage-induced differentiation response that allows them to overcome the cell division block. The capacity to divide in spite of drug-induced mitotic stress and DNA damage made well-differentiated SCC cells more genomically instable and more malignant in vivo. Consistently, in a series of human biopsies, non-metastatic SCCs displayed a higher degree of chromosomal alterations and higher expression of the S phase regulator Cyclin E and the DNA damage signal γH2AX than the less aggressive, non-squamous, basal cell carcinomas. However, metastatic SCCs lost the γH2AX signal and Cyclin E, or accumulated cytoplasmic Cyclin E. Conversely, inhibition of endogenous Cyclin E in well-differentiated SCC cells interfered with the squamous phenotype. The results suggest a dual role of cell cycle stress-induced differentiation in squamous cancer: the resulting mitotic blocks would impose, when irreversible, a proliferative barrier, when reversible, a source of genomic instability, thus contributing to malignancy.
This article proposes a very specific approach to music, defined as a cultural, material or symbolic tool that intermeshes with certain people’s life experience. From that standpoint, music may be ...seen as one of the essential keys for interpreting a biography. The theoretical argument, described from a cultural and mediational perspective, is exemplified in the relationship established between musician and instrument. The singular value of each interpreter’s personal and non-transferable encounter with musical mediators is addressed, and the possible interweave between musicians’ technical and actual life horizons explored. The significance proposed refers to the specific ways in which music may translate world experience and model affect. The objective is to establish the relevance or possibility of expanding or nuancing the view of music as the outer representation of inner emotions through the conceit vitality affects, a term that stresses the dynamic and temporal dimensions of the emotive meaning of music.
Basaloid squamous cell carcinoma (BSCC) is an aggressive type of squamous cell carcinoma (SCC) predominant in the upper aerodigestive tract. To our knowledge, only one case of that tumor has been ...previously described in the parotid gland. Shadow (ghost) cell differentiation (SCD) is a specialized form of keratinization characteristic of pilomatricoma, and other skin tumors with follicular differentiation. SCD has also been described infrequently in some visceral carcinomas and rarely in the minor salivary glands. Recently, an SCC with prominent SCD has been reported in the parotid. We report for the first time the case of parotid BSCC with prominent SCD in an 87-year-old man. He was admitted due to the appearance in the last few months of a mass, painful on palpation, in the left parotid region. Imaging studies and tru-cut biopsies indicated the need for surgical removal. A left superficial parotidectomy, including the branch of the cervicofacial nerve, was performed. The BSCC showed predominance (62%) of SCD. Immunohistochemically, the basaloid cells were positive for
β
-catenin, pan-cytokeratin (pan-CK) AE1/AE3, CK19, high-molecular-weight CK (HMWCK), p63, p40, and cluster of differentiation 10 (CD10) in a diffuse pattern. No signs of recurrence or metastasis were observed four months after surgery. The main differential diagnoses include nuclear protein in testis (NUT) carcinoma, adamantinoma-like Ewing sarcoma, embryonal carcinoma, and basal cell adenocarcinoma of the solid type. SCD in BSCC of the parotid should be recognized to avoid misdiagnosis, especially in small samples. Although rare, BSCC with SCD should be added to the list of tumors that may originate in the parotid gland.
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