It is difficult to predict adverse patient outcomes associated with transvenous lead extraction (TLE) procedures.
The purpose of this study was to examine the safety and efficacy of chronic ...endovascular pacemaker and implantable cardioverter-defibrillator (ICD) lead extraction and risk factors associated with adverse patient outcomes.
Consecutive patients undergoing TLE at the Cleveland Clinic between August 1996 and August 2011 were included in the analysis. Univariate and multivariable logistic regression analyses were performed to evaluate for associations with outcomes. Continuous data are given as median (25th, 75th percentile). Categorical data are given as number (percentage).
In total, 5521 leads (4137 74.9% pacemaker, 1384 25.1% ICD) were extracted during 2999 TLE procedures (patient age 67.2 55.2, 76.2 years, 30.2% female). Lead implant duration was 4.7 (2.4, 8.3) years, and 2.0 (1.0, 2.0) leads were extracted per procedure. Powered sheaths were used in 74.9% of procedures. Overall, there was 95.1% complete procedural success, 98.9% clinical success, and 1.1% failure, with 3.6% minor complications and 1.8% major complications. All-cause mortality within 30 days of TLE was 2.2%. Multivariable predictors of major complications included cerebrovascular disease, ejection fraction ≤15%, lower platelet count, international normalized ratio ≥1.2, mechanical sheaths, and powered sheaths. Multivariable predictors of all-cause mortality within 30 days of TLE included body mass index <25 kg/m(2), end-stage renal disease, higher New York Heart Association functional class, lower hemoglobin, higher international normalized ratio, lead extraction for infection, and extraction of a dual-coil ICD lead.
TLE in this single-center experience was highly successful. Risk factors associated with adverse patient outcomes were identified.
Purpose Long-term prostate cancer specific mortality after radical prostatectomy is poorly defined in the era of widespread screening. An understanding of the treated natural history of screen ...detected cancers and the pathological risk factors for prostate cancer specific mortality are needed for treatment decision making. Materials and Methods Using Fine and Gray competing risk regression analysis we modeled clinical and pathological data, and followup information on 11,521 patients treated with radical prostatectomy at a total of 4 academic centers from 1987 to 2005 to predict prostate cancer specific mortality. The model was validated on 12,389 patients treated at a separate institution during the same period. Median followup in the modeling and validation cohorts was 56 and 96 months, respectively. Results The overall 15-year prostate cancer specific mortality rate was 7%. Primary and secondary Gleason grade 4–5 (each p <0.001), seminal vesicle invasion (p <0.001) and surgery year (p = 0.002) were significant predictors of prostate cancer specific mortality. A nomogram predicting 15-year prostate cancer specific mortality based on standard pathological parameters was accurate and discriminating with an externally validated concordance index of 0.92. When stratified by patient age at diagnosis, the 15-year prostate cancer specific mortality rate for pathological Gleason score 6 or less, 3 + 4, 4 + 3 and 8–10 was 0.2% to 1.2%, 4.2% to 6.5%, 6.6% to 11% and 26% to 37%, respectively. The 15-year prostate cancer specific mortality risk was 0.8% to 1.5%, 2.9% to 10%, 15% to 27% and 22% to 30% for organ confined cancer, extraprostatic extension, seminal vesicle invasion and lymph node metastasis, respectively. Only 3 of 9,557 patients with organ confined, pathological Gleason score 6 or less cancer died of prostate cancer. Conclusions Poorly differentiated cancer and seminal vesicle invasion are the prime determinants of prostate cancer specific mortality after radical prostatectomy. The prostate cancer specific mortality risk can be predicted with remarkable accuracy after the pathological features of prostate cancer are known.
In recent years, the substantial growth in satellite data transmission tasks and volume, coupled with the limited availability of ground station hardware resources, has exacerbated conflicts among ...missions and rendered traditional scheduling algorithms inadequate. To address this challenge, this paper introduces an improved tabu genetic hybrid algorithm (ITGA) integrated with heuristic rules for the first time. Firstly, a constraint satisfaction model for satellite data transmission tasks is established, considering multiple factors such as task execution windows, satellite–ground visibility, and ground station capabilities. Leveraging heuristic rules, an initial population of high-fitness chromosomes is selected for iterative refinement. Secondly, the proposed hybrid algorithm iteratively evolves this population towards optimal solutions. Finally, the scheduling plan with the highest fitness value is selected as the best strategy. Comparative simulation experimental results demonstrate that, across four distinct scenarios, our algorithm achieves improvements in the average task success rate ranging from 1.5% to 19.8% compared to alternative methods. Moreover, it reduces the average algorithm execution time by 0.5 s to 28.46 s and enhances algorithm stability by 0.8% to 27.7%. This research contributes a novel approach to the efficient scheduling of satellite data transmission tasks.
In 2012, Japanese national insurance started covering robot‐assisted surgery. We carried out a population‐based comparison between robot‐assisted and three other types of radical prostatectomy to ...evaluate the safety of robot‐assisted prostatectomy during its initial year. We ed data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot‐assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012–March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one‐to‐one propensity‐score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot‐assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot‐assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, −5.1%, −1.8% not significant, −10.8%) and shorter postoperative length of stay (–9.1%, +0.9% not significant, –18.5%, respectively). However, robot‐assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P < 0.05). Introduction of robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot‐assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost.
The trend of robot‐assisted and other types of radical prostatectomy in Japan 2012.
Purpose PCA3 is a urinary marker that has shown promise in predicting the presence of prostate cancer in men undergoing repeat prostate biopsy. We studied PCA3 before initial prostate biopsy. ...Materials and Methods Records from a single organization were retrospectively reviewed. The predictive value of PCA3 was explored using nonparametric receiver operating characteristic curve analysis (ROC) and multivariable logistic regression analysis. Results A total of 3,073 men underwent PCA3 analysis before initial prostate biopsy sampling of 12 to 14 areas. Mean PCA3 was 27.2 and 52.5 for patients without and with cancer, respectively. Prostate cancer was identified in 1,341 (43.6%) men. Overall 54.5% had Gleason 6 disease and 45.5% had Gleason 7 or greater (high grade prostate cancer). Mean PCA3 was 47.5 and 58.5 for the patients with Gleason 6 and 7 or greater disease, respectively. On multivariable logistic analysis PCA3 was statistically significantly associated with prostate cancer and high grade prostate cancer after adjusting for prostate specific antigen (p <0.001 for both), free prostate specific antigen (p = 0.04 and p = 0.01, respectively), age (p <0.001 for both), family history (p <0.001 and p = 0.59, respectively), abnormal digital rectal examination (p = 0.31 and p <0.001, respectively), prostate volume (p <0.001 for both) and body mass index (p <0.001 for both). Using ROC analysis PCA3 outperformed prostate specific antigen in the prediction of prostate cancer (AUC 0.697 vs 0.599, p <0.01) but not for high grade prostate cancer (AUC 0.682 vs 0.679, p = 0.702). Conclusions PCA3 proved a useful tool in identifying patients at risk for prostate cancer before initial prostate biopsy. To our knowledge this is the largest PCA3 study in the initial biopsy population. These results suggest that further exploration of the value of PCA3 is warranted.
In order to study the operation process and results of an actual intelligent production line, Plant Simulation was used to simulate the production line of a cross shaft. First of all, the basic ...layout is modeled, 3D model is used, and the actual machine model is imported or designed to make the effect more realistic. This study analyzed the production process, created orders according to customer requirements, used Simtalk language to complete the simulation logic of the model, and displayed the simulation data in the form of charts after the operation, so as to make the results more intuitive. Finally, the results are analyzed and optimized.
GATA transcription factors are ubiquitously present in eukaryotic organisms and play a crucial role in multiple biological processes, such as plant growth, stress response, and hormone signaling. ...However, the study of GATA factors in poplar is currently limited to a small number of proteins, despite their evident functional importance. In this investigation, we utilized the most recent genome annotation and stringent criteria to identify 38 GATA transcription factor genes in poplar. Subsequently, we conducted a comprehensive analysis of this gene family, encompassing phylogenetic classification, protein characterization, analysis of promoter cis-acting elements, and determination of chromosomal location. Our examination of gene duplication events indicated that both tandem and segmental duplications have contributed to the expansion of the GATA gene family in poplar, with segmental duplication potentially being a major driving force. By performing collinearity analysis of genes across six different species, we identified 74 pairs of co-linear genes, which provide valuable insights for predicting gene functions from a comparative genomics perspective. Furthermore, through the analysis of gene expression patterns, we identified five GATA genes that exhibited differential expression in leaf–stem–root tissues and eight genes that were responsive to salt stress. Of particular interest was GATA6, which displayed strong induction by salt stress and overlapped between the two gene sets. We discovered that GATA6 encodes a nuclear-localized protein with transcription activation activity, which is continuously induced by salt stress in leaf and root tissues. Moreover, we constructed a co-expression network centered around GATA6, suggesting the potential involvement of these genes in the growth, development, and response to abiotic stress processes in poplar through cell transport systems and protein modification mechanisms, such as vesicle-mediated transport, intracellular transport, ubiquitination, and deubiquitination. This research provides a foundation for further exploration of the functions and mechanisms of GATA transcription factors in poplar.
Industrial control protocol feature extraction is an important way to improve the accuracy and speed of industrial control protocol traffic classification. This paper firstly proposes a keyword ...feature extraction method for industrial control protocol, and then designs and implements an industrial control system (ICS) traffic classification based on this method. The proposed method utilizes the characteristics of the relatively fixed format of the industrial control protocol and the periodicity of the protocol traffic in ICS. The keyword features of the industrial control protocol can be accurately extracted after data preprocessing, data segmentation, redundant data filtering, and feature byte mining. A feature dataset is then formed. The designed ICS traffic classifier adopts decision tree and is trained with the feature dataset. Experiments are carried out on the open-source dataset. The results show that the proposed method achieves 99.99% classification accuracy, and the classification precision and classification recall rate reach 99.98% and 99.93%, respectively. The training time and predicting time of classifier are 0.34 s and 0.264 s, respectively, which meets the requirements of high precision and low latency of industrial control system.
Study Type – Prognosis (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Nomograms are available that combine clinical and biopsy findings to predict the ...probability of pathologically insignificant prostate cancer in patients with clinically low‐risk disease. Based on data from patients with Gleason score 6, clinical stage ≤ T2a and PSA <20 ng/ml, our group developed the first nomogram models for predicting insignificant prostate cancer that incorporated clinical data, detailed biopsy data and findings from MRI or MRI/MRSI (BJU Int. 2007;99(4):786–93). When tested retrospectively, these MR models performed significantly better than standard clinical models with and without detailed biopsy data.
We prospectively validated the previously published MR‐based nomogram models in a population of patients with Gleason score 6, clinical stage ≤ T2a and PSA <10 ng/ml. Based on data from this same population, we also developed two new models for predicting insignificant prostate cancer that combine MR findings and clinical data without detailed biopsy data. Upon initial testing, the new MR models performed significantly better than a clinical model lacking detailed biopsy data.
OBJECTIVES
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To validate previously published nomograms for predicting insignificant prostate cancer (PCa) that incorporate clinical data, percentage of biopsy cores positive (%BC+) and magnetic resonance imaging (MRI) or MRI/MR spectroscopic imaging (MRSI) results.
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We also designed new nomogram models incorporating magnetic resonance results and clinical data without detailed biopsy data. Nomograms for predicting insignificant PCa can help physicians counsel patients with clinically low‐risk disease who are choosing between active surveillance and definitive therapy.
PATIENTS AND METHODS
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In total, 181 low‐risk PCa patients (clinical stage T1c–T2a, prostate‐specific antigen level <10 ng/mL, biopsy Gleason score of 6) had MRI/MRSI before surgery.
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For MRI and MRI/MRSI, the probability of insignificant PCa was recorded prospectively and independently by two radiologists on a scale from 0 (definitely insignificant) to 3 (definitely significant PCa).
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Insignificant PCa was defined on surgical pathology.
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There were four models incorporating MRI or MRI/MRSI and clinical data with and without %BC+ that were compared with a base clinical model without %BC and a more comprehensive clinical model with %BC+. Prediction accuracy was assessed using areas under receiver–operator characteristic curves.
RESULTS
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At pathology, 27% of patients had insignificant PCa, and the Gleason score was upgraded in 56.4% of patients.
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For both readers, all magnetic resonance models performed significantly better than the base clinical model (P ≤ 0.05 for all) and similarly to the more comprehensive clinical model.
CONCLUSIONS
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Existing models incorporating magnetic resonance data, clinical data and %BC+ for predicting the probability of insignificant PCa were validated.
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All MR‐inclusive models performed significantly better than the base clinical model.
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