Reduction in chemotherapy relative dose intensity decreases overall survival of neoadjuvant chemoradiotherapy in patients with locally advanced esophageal carcinoma.

BACKGROUND: Many patients undergo dose reduction or early termination of chemotherapy to reduce chemoradiotherapy-related toxicity, which may increase their risk of survival. However, this strategy may result in underdosing patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This study aimed to analyze the relationship between the relative dose intensity (RDI) and survival outcomes in patients with LA-ESCC. METHODS: This retrospective study assessed patients with LA-ESCC (cT2N + M0, cT3-4NanyM0) receiving neoadjuvant chemoradiotherapy (NCRT) with curative-intent esophagectomy. The patients received 2 courses of paclitaxel plus carboplatin (TC) combination radiotherapy prior to undergoing surgery. During NCRT, RDI was computed, defined as the received dose as a percentage of the standard dose, and the incidence of dose delays was estimated (≥ 7 days in any course cycle). The best RDI cutoff value (0.7) was obtained using ROC curve. The Kaplan-Meier survival curves were compared using the log-rank test, the treatment effect was measured using hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: We included 132 patients in this study, divided into RDI < 0.7 and RDI ≥ 0.7 groups using cut-off value of 0.7. RDI grade was an independent prognostic factor for OS. Baseline demographic and clinical characteristics were well balanced between the groups. There was no evidence that patients with RDI < 0.7 experienced less toxicity or those with RDI ≥ 0.7 resulted in more toxicity. However, patients with RDI < 0.7 who were given reduced doses had a worse overall survival [HR 0.49, 95% CI 0.27-0.88, P = 0.015]. The risk of a lower RDI increased with a longer dose delay time (P < 0.001). CONCLUSION: The RDI below 0.7 for avoiding chemoradiotherapy toxicity administration led to a reduction in the dose intensity of treatment and decreased overall survival.

Prediction of jumbo drill penetration rate in underground mines using various machine learning approaches and traditional models.

Estimating penetration rates of Jumbo drills is crucial for optimizing underground mining drilling processes, aiming to reduce costs and time. This study investigates various regression and machine learning methods, including Multilayer Perceptron (MLP), Support Vector Regression (SVR), and Random Forests (RF), to predict the penetration rates (ROP) using multivariate inputs such as operation parameters and rock mass characteristics. The Rock Mass Drillability Index (RDi), incorporating both intact rock properties and structural parameters, was utilized to characterize the rock mass. The dataset was split into 80% for training and 20% for testing. Performance metrics including correlation coefficient (R2), variance accounted for (VAF), mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE) were calculated for each method to evaluate the accuracy of the predictions. SVR exhibited the best prediction performance for ROP, achieving the highest R2, lowest RMSE, MAE, and MAPE, as well as the largest VAF values of 0.94, 0.15, 0.11, 4.84, and 94.13 during training, and 0.91, 0.19, 0.13, 6.02, and 91.11 during testing, respectively. With this high accuracy, we conclude that the proposed machine learning algorithms are valuable and efficient predictors for estimating jumbo drill penetration rates in underground mining operations.

Combining a wireless radar sleep monitoring device with deep machine learning techniques to assess obstructive sleep apnea severity.

STUDY OBJECTIVES: The gold standard for diagnosing obstructive sleep apnea (OSA) is polysomnography (PSG). However, PSG is a time-consuming method with clinical limitations. This study aimed to create a wireless radar framework to screen the likelihood of 2 levels of OSA severity (ie, moderate-to-severe and severe OSA) in accordance with clinical practice standards. METHODS: We conducted a prospective, simultaneous study using a wireless radar system and PSG in a Northern Taiwan sleep center, involving 196 patients. The wireless radar sleep monitor, incorporating hybrid models such as deep neural decision trees, estimated the respiratory disturbance index relative to the total sleep time established by PSG (RDIPSG_TST), by analyzing continuous-wave signals indicative of breathing patterns. Analyses were performed to examine the correlation and agreement between the RDIPSG_TST and apnea-hypopnea index, results obtained through PSG. Cut-off thresholds for RDIPSG_TST were determined using Youden's index, and multiclass classification was performed, after which the results were compared. RESULTS: A strong correlation (ρ = 0.91) and agreement (average difference of 0.59 events/h) between apnea-hypopnea index and RDIPSG_TST were identified. In terms of the agreement between the 2 devices, the average difference between PSG-based apnea-hypopnea index and radar-based RDIPSG_TST was 0.59 events/h, and 187 out of 196 cases (95.41%) fell within the 95% confidence interval of differences. A moderate-to-severe OSA model achieved an accuracy of 90.3% (cut-off threshold for RDIPSG_TST: 19.2 events/h). A severe OSA model achieved an accuracy of 92.4% (cut-off threshold for RDIPSG_TST: 28.86 events/h). The mean accuracy of multiclass classification performance using these cut-off thresholds was 83.7%. CONCLUSIONS: The wireless-radar-based sleep monitoring device, with cut-off thresholds, can provide rapid OSA screening with acceptable accuracy and also alleviate the burden on PSG capacity. However, to independently apply this framework, the function of determining the radar-based total sleep time requires further optimizations and verification in future work. CITATION: Lin S-Y, Tsai C-Y, Majumdar A, et al. Combining a wireless radar sleep monitoring device with deep machine learning techniques to assess obstructive sleep apnea severity. J Clin Sleep Med. 2024;20(8):1267-1277.

Nanoparticles doped with methyl jasmonate: foliar application to Monastrell vines under two watering regimes. An alternative to improve grape volatile composition?

BACKGROUND: Elicitors induce defense mechanisms, triggering the synthesis of secondary metabolites. Irrigation has implications for a more sustainable viticulture and for grape composition. The aim was to investigate the influence on grape aroma composition during 2019 and 2020 of the foliar application of amorphous calcium phosphate (ACP) nanoparticles and ACP doped with methyl jasmonate (ACP-MeJ), as an elicitor, with rainfed or regulated deficit irrigation (RDI) grapevines. RESULTS: In both growing seasons, nearly all terpenoids, C13 norisoprenoids, benzenoid compounds and alcohols increased with ACP-MeJ under the RDI regimen. In 2019, under the rainfed regime, ACP treatment increased limonene, p-cymene, α-terpineol, 1,1,6-trimethyl-1,2-dihydronaphthalene (TDN), 2-ethyl-1-hexanol, (E,E)-2,4-heptadienal, and MeJ concentration in comparison with control grapes. In 2020, the rainfed regime treated with ACP-MeJ only increased the nonanoic acid content. Grape volatile compounds were most influenced by season and watering status whereas the foliar application mainly affected the terpenoids. CONCLUSION: A RDI regime combined with the elicitor ACP-MeJ application could improve the synthesis of certain important volatile compounds, such as p-cymene, linalool, α-terpineol, geranyl acetone, ß-ionone, 2-phenylethanol, benzyl alcohol, and nonanoic acid in Monastrell grapes. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Retrospective analysis of the impact of dose delay and reduction on outcomes of colorectal cancer patients treated with FOLFIRI­based treatment.

Objectives: To determine the relationship between chemotherapy dose delay/reduction with progression-free survival (PFS) and overall survival (OS) in colorectal cancer patients treated with FOLFIRI based first-line chemotherapy in real-world retrospectively study. Methods: We identified 144 eligible patients with advanced CRC who received FOLFIRI as first-line based treatment. The study protocol was submitted to the institutional review board and was exempted. Dose delay was defined as an average delay of more than 3 days (>3 days vs. ≤3 days) from the intended date. Dose reduction (actual dose/standard dose * 100%) ≤85% was considered as chemotherapy reduction in the chemotherapy dose relative to the standard (mg/m2) regimen for all cycles. Relative dose intensity (RDI) ≤80% was described as chemotherapy reduction. OS and PFS were measured using Kaplan-Meier and Cox proportional hazard models. Results: There were 114 patients with chemotherapy dose delay (dose delay >3 days). PFS of patients without dose delay had better survival than patients with dose delay (p = 0.002). There were 28.47% patients treated with dose reduction of 5-Fu. PFS and OS were better in patients without 5-Fu dose reduction than in patients with 5-Fu dose reduction with p values of 0.024 and <0.001, respectively. Patients with high 5-FU RDI had better PFS than patients with low 5-FU RDI (p < 0.001). While, there was no statistical difference in OS between the two groups. Then we stratified the analysis by age. In <65 years cohort, both PFS and OS were better in patients with high 5-Fu RDI than in those with low 5-Fu RDI (p < 0.001, p = 0.005, respectively). But, in ≥65 years cohort, OS were better in patients with low 5-Fu RDI than in those with high 5-Fu RDI (p = 0.025). Moreover, both dose reduction and RDI of irinotecan had no statistically significant difference in both PFS and OS. Conclusion: In the advanced colorectal cancer patients who received FOLFIRI based treatment as first-line regimen, chemotherapy dose delay and reduction dose of 5-Fu were associated with worse survival, especially among patients younger than 65 years.

Can large-scale RDI funding stimulate post-crisis recovery growth? Evidence for Finland during COVID-19.

The COVID-19 pandemic and subsequent public health restrictions led to a significant slump in economic activities around the globe. This slump has been met by various policy actions to cushion the detrimental socio-economic consequences of the COVID-19 crisis and eventually bring the economy back on track. We provide an ex-ante evaluation of the effectiveness of a massive expansion of RDI funding in Finland to stimulate post-crisis recovery growth through an increase in RDI activities of Finnish firms. We make use of the fact that novel RDI grants for firms in disruptive circumstances granted in 2020 were allocated through established RDI policy channels. This allows us to estimate the structural link between RDI funding and economic growth for Finnish NUTS-3 regions based on pre-COVID-19 data. Estimates are then used to predict regional recovery growth out of sample and to quantify the growth contribution of RDI funding. Depending on the chosen scenario, our out-of-sample predictions point to a mean recovery growth rate of GDP between ~2-4 % in 2021 after a decline of up to -2.5 % in 2020. RDI funding constitutes a significant pillar of the recovery process with mean contributions in terms of GDP growth of between 0.4 and 1 %-points.

Efficacy of using red dichromatic imaging throughout endoscopic submucosal dissection procedure.

BACKGROUND: Management of bleeding during endoscopic submucosal dissection (ESD) is critical. Red Dichromatic Imaging (RDI), a novel image-enhanced endoscopy technology, has been reported to improve the visibility of deep vessels and bleeding source compared to white light imaging (WLI). We hypothesized that using RDI during the entire cutting process (full time RDI ESD: FTR-ESD), higher R0 resection rate, shorter procedure time and fewer complications could be achieved. Therefore, the aims of the present study were to investigate the efficacy and safety of FTR-ESD. METHODS: This retrospective observational study included a total of 82 consecutive patients who underwent ESD by a single expert endoscopist for 40 esophageal, 17 gastric and 25 colorectal cancers at our institution from January 2018 to March 2021. The clinicopathological data were collected from patients' medical records and the treatment outcomes were analyzed according to the treatment phase (early; 57 WLI-ESD and late; 25 FTR-ESD). RESULTS: The median of the greatest diameter of resected specimen was 40.0 mm. The median procedure time was relatively shorter in the FTR-ESD group (35 min) than in the WLI-ESD group (40 min), but the difference was not statistically significant (p = 0.34). The median dissection speed in the FTR-ESD group (27.23 mm2/min) was significantly faster than that in the WLI-ESD group (20.94 mm2/min) (p = 0.025). The dissection speed was not different among different organs. A multivariate analysis revealed that tumor size (more than 30 mm) and FTR-ESD were significant independent factors contributing to faster dissection speed (p < 0.05). There were no significant differences in the rates of en bloc resection, HM0, VM0 or occurrence of adverse events between WLI-ESD and FTR-ESD. CONCLUSIONS: FTR-ESD significantly increases the dissection speed compared to WLI-ESD. FTR-ESD can be performed safely and therapeutic outcomes in FTR-ESD are comparable with WLI-ESD. A further multicenter prospective study is warranted to confirm our results.

Variceal ligation in decompensated cirrhosis before esophageal endoscopic submucosal dissection.

Video 1This video details our case as well as our method for successfully eradicating varices immediately prior to esophageal endoscopic submucosal dissection to minimize risks of variceal hemorrhage.

Lessons for science and technology policy? Probing the Linkedin network of an RDI organisation.

In this paper, we seek to examine the network of the Greek National Documentation Centre (EKT) as formed by its LinkedIn followers. By applying specific data collection and processing techniques, we explore the network of all the individuals that follow EKT's LinkedIn page. Significant manual and automatic approaches have been implemented with regard to data extraction, data curation and data homogenization. The aim is to identify the network's advancement over time, the institutions involved and the countries. The timeframe of the study spans from when the relevant LinkedIn page was constructed in 2015 to 2020. Findings indicate that there is a steady increase in the number of new followers, peaking in 2020. On an international scale, the evolution of the network of followers is imprinted and distributed in worldwide maps. In total, 68 countries have followed EKT over the examined time period. Also, in terms of followers' institutional sector the Business Sector (BES) stands out (46.5%). Higher Education (HES) and Government Sector (GOV) are associated with 26.4 and 22.2% of the followers, respectively. Lastly, this paper provides a first institutional and country-level mapping of who constitutes the organisation's interlocutors in the national and global RDI ecosystem.

Utility of red dichromatic imaging for identifying the bleeding point in endoscopic hemostasis of colonic diverticular bleeding.

Video 1Endoscopic hemostasis of colonic diverticular bleeding using red dichromatic imaging to identify the bleeding point.

Endoscopic submucosal dissection and tunneling procedures using novel image-enhanced technique.

Background and Aims: Recent innovations in image-enhanced endoscopy allow early detection and management of GI lesions. In this study, we aim to analyze the utility of texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI) during endoscopic submucosal dissection (ESD) and submucosal tunneling procedures. Methods: Patients who underwent ESD, submucosal tunneling endoscopic resection, and peroral endoscopic myotomy (POEM) using the novel imaging technique including TXI and RDI were included in the study. Results: Twenty-five patients (13 male; age 43 ± 15.69 years) underwent POEM for achalasia (n = 20), submucosal tunneling endoscopic resection for esophageal subepithelial lesions (n = 3), and ESD for gastric neuroendocrine tumors (n = 2). All of the procedures were successfully performed. Mean procedure duration was 55.52 ± 21.61 minutes. TXI mode was used in all the cases, whereas RDI mode was used on 15 occasions. While using RDI mode, hemostasis was achieved in 1 attempt on 12 (80%) occasions. The site of mucosal incision was revised in 3 cases during POEM based on TXI and RDI modes. Conclusions: Submucosal tunneling and endoscopic dissection procedures can be conveniently performed using a new image-enhanced technique. RDI is useful in localizing the site of bleeding during endoscopic dissection.

Efficacy of relative dose intensity of nab-paclitaxel for the short-term outcomes, survival, and quality of life in patients with advanced pancreatic cancer: a retrospective study.

Background: To optimize treatment, choosing the appropriate relative dose intensity (RDI) of nab-paclitaxel is an important way to improve patient tolerance, therapeutic efficacy, and survival. However, few studies have focused on the efficacy of the RDI of nab-paclitaxel in patients with advanced pancreatic cancer, and whether the RDI of nab-paclitaxel could be employed as an index for treatment remains unknown. To explore the relationship between RDI of nab-paclitaxel and chemotherapy efficacy, survival, quality of life (QoL), and adverse effects in patients with advanced pancreatic cancer. Methods: In this retrospective study, a total of 32 patients with advanced pancreatic cancer, ECOG score of 0 to 2 were included from January 2017 to March 2020. The patients were treated with nab-paclitaxel combined with gemcitabine as a first-line treatment and divided into high and low RDI groups. Chemotherapy efficacy, survival, QoL, and adverse effects between two groups were compared. Results: The disease control rate (DCR) was 20.0% in the low RDI group, compared with 81.8% in the high RDI group (P=0.002). A good correlation between nab-paclitaxel RDI and short-term efficacy was observed in all 32 patients (r=0.728, P<0.01). Furthermore, the high RDI group had significantly better median overall survival (mOS: 12 vs. 8 months, P=0.034) and median progression-free survival (mPFS: 5.5 vs. 3 months, P=0.052) compared to that of low RDI patients. Univariate regression analysis showed that longer overall survival was associated with lower ECOG score [hazard ratio (HR): 10.88; 95% confidence interval (CI): 2.54-46.5, P=0.001], tumors located in the body or tail of pancreases (HR: 3.82; 95% CI: 1.4-10.3, P=0.0081), and higher RDI (HR: 0.21; 95% CI: 0.071-0.6, P=0.004). The high RDI group had a significantly better physical function and emotional function improvement compared to the low RDI group (P<0.05). Moreover, high RDI did not increasing the severity and frequency of the adverse events. Conclusions: It is recommended to maintain a sufficient RDI of nab-paclitaxel to ensure that the balance between lerability, therapeutic efficacy, and survival benefits is satisfied in patients with advanced pancreatic cancer.

Impact of Hyoid Position, Mandible Body Length and Anthropometric Measurements on Sleep Indices in Patients with Snoring in North Indian Population.

Introduction: In Indian population, the estimated prevalence of OSA is 7.5% to 13.5%. Craniofacial anatomical variations and obesity are the major risk factors for OSA. Among the craniofacial anatomy, the neck circumference and abnormal craniofacial morphology play an important role in the pathogenesis of OSA. Obesity is the major risk factor for which waist and hip circumference and BMI are considered. Aim: The aim of this paper was to evaluate the impact of hyoid position, mandible body length (MBL) and anthropometric measurements on sleep indices in patients with snoring in North Indian population. Methods: In this cross-sectional study, we analyzed the position of the hyoid, mandible body length and anthropometric measurements, of 104 patients attending ENT OPD with the complaint of snoring and excessive daytime sleepiness. All subjects underwent a full overnight polysomnography. The position of the hyoid, MBL and the anthropometric measurements were compared with the sleep architecture of the subjects, and a p value < 0.05 was considered significant. Results: A strong positive correlation is seen between the position of the hyoid, MBL and anthropometric measurements on the sleep indices in this study. Pearson 2-tailed correlation was evaluated, and upon analysis, it was found that at significance level of 0.01, obesity (BMI) is strongly correlated with overall AHI with correlation coefficient of 0.926, whereas AHI in supine position was having coefficient of 0.837 and AHI on right side and left side was almost same 0.597 and 0.575, respectively. Similarly WC is strongly correlated with AHI and RDI, having coefficient of 0.930 with both. NC and HC also showed strong positive correlation with overall AHI and RDI having correlation coefficient of 0.893, 0.926 with AHI and 0.893, 0.926 with RDI, respectively. The MBL also showed a strong positive correlation with AHI and RDI with correlation coefficient of 0.994 in both. The position of the hyoid also showed a strong positive correlation with AHI and RDI. Conclusion: Results indicated that significant positive correlation was found between position of the hyoid, MBL and anthropometric measurements on the sleep indices in patients with snoring in North Indian population.

Parents' resolution of their child's diagnosis: A scoping review.

This scoping review focused on parents' resolution of their reactions to receiving a diagnosis for their child, based on Marvin and Pianta's model and Reaction to Diagnosis Interview (RDI). We aimed to map the populations examined, the prevalence of parents' narrated resolution, and what is known about its outcomes and determinants. A structured search identified 47 peer-reviewed papers published between 1992-2021. All employed the RDI and most had a cross-sectional design. Studies focused on a wide range of children's health and mental health diagnoses. Days to years after receiving the diagnosis, RDI narratives of 18.43% to 72.49% of the parents (44% on average) indicated lack of resolution. Studies reported associations between unresolved narratives and children's insecure attachment, higher parenting stress, and poorer parental health. However, findings on the associations of narrated resolution with parents' representations of their child, sensitivity, and psychological symptoms were equivocal, and findings on factors that may shape narrated resolution were limited. To advance the understanding of parents' narrated resolution and its effects, we recommend researchers employ prospective and longitudinal designs, evaluate narrated resolution as a continuous phenomenon, focus on outcomes derived from attachment theory, and systematically sample families from heterogenous cultures.

[LONG TERM ADMINISTRATION OF RELATIVE DOSE INTENSITY-ADJUSTED CABAZITAXEL FOR METASTATIC CASTRATION-RESISTANT PROSTATE CANCER: A CASE REPORT].

We report the case of a 74-year-old man with metastatic castration-resistant prostatic cancer (CRPC), who underwent treatment with cabazitaxel. Initially, he underwent docetaxel treatment for 2 years and exhibited severe neuropathy in his hands caused by its toxicity. As a result, we replaced docetaxel with cabazitaxel. On receiving 100% of the dose of cabazitaxel in the first course, febrile neutropenia (FN) was observed on the seventh day. However, he soon recovered from the FN and we began relative dose intensity (RDI) treatment with an adequate dose-volume and interval of treatments. He was successfully administered 51 cabazitaxel treatment courses without severe adverse effects. Cabazitaxel is a highly effective drug used as second-line chemotherapy following docetaxel, and it causes fewer adverse effects compared with docetaxel. Cabazitaxel may be a suitable alternative for outpatient treatment. Given that the patient in this case had a long overall survival of more than 3.5 years and received over 50 courses of cabazitaxel, it is crucial for RDI to be taken very seriously.

Esophageal endoscopic submucosal dissection on postendoscopic variceal ligation scars with injection under red dichromatic imaging.

Video 1Esophageal endoscopic submucosal dissection on post-endoscopic variceal ligation scars with injection under red dichromatic imaging.

In vivo restricted diffusion imaging (RDI) is sensitive to differences in axonal density in typical children and adults.

The ability to dissociate axonal density in vivo from other microstructural properties is important for the diagnosis and treatment of neurologic disease, and new methods to do so are being developed. We investigated one such method-restricted diffusion imaging (RDI)-to see whether it can more accurately replicate histological axonal density patterns in the corpus callosum (CC) of adults and children compared to diffusion tensor imaging (DTI), neurite orientation dispersion and density imaging (NODDI), and generalized q-sampling imaging (GQI) methods. To do so, we compared known axonal density patterns defined by histology to diffusion-weighted imaging (DWI) scans of 840 healthy 20- to 40-year-old adults, and to DWI scans of 129 typically developing 7-month-old to 18-year-old children and adolescents. Contrast analyses were used to compare pattern similarities between the in vivo metric and previously published histological density models. We found that RDI was effective at mapping axonal density of small (Cohen's d = 2.60) and large fiber sizes (Cohen's d = 2.84) in adults. The same pattern was observed in the developing sample (Cohen's d = 3.09 and 3.78, respectively). Other metrics, notably NODDI's intracellular volume fraction in adults and GQI generalized fractional anisotropy in children, were also sensitive metrics. In conclusion, the study showed that the novel RDI metric is sensitive to density of small and large axons in adults and children, with both single- and multi-shell acquisition DWI data. Its effectiveness and availability to be used on standard as well as advanced DWI acquisitions makes it a promising method in clinical settings.

Multimethod to prioritize projects evaluated in different formats.

The prioritization of Research, Development & Innovation Projects is an essential step in the innovation management process. As a rule, it is carried out applying methods that allow one to process experts' preferences concerning each project according to established criteria. However, there are different preference formats which experts can utilize: Ordering of Alternatives, Utility Values, Multiplicative Preference Relations, Fuzzy Estimates, Fuzzy Preference Relations, etc. Wherein, each prioritization method usually handles only one of these formats. Thus, the following question arises: how do we prioritize projects taken from portfolios evaluated in different formats? The proposed methodology presents a way to overcome this gap by achieving three main objectives. First, develop techniques that make it possible to crossover between preference formats and prioritization methods. Second, merge two portfolios of projects built applying different prioritization methods. Third, prioritize projects evaluated using different formats. The results of this study are universal and can be applied to replace any method of prioritization. In the specific case, the Mapping method is replaced by the Analytic Hierarchy Process and, then, by the Interactive Multicriteria Decision Making method (so called TODIM method). Techniques are also proposed to ensure compatibility between different preference formats and prioritization methods.•Prioritization of projects evaluated in different formats using the Mapping, AHP, and TODIM methods.•Providing fully consistent evaluation matrices.•Application of techniques to make different preference formats and prioritization methods compatible.

Red dichromatic imaging in peroral endoscopic myotomy: a novel image-enhancing technique.

Video 1Red dichromatic imaging in peroral endoscopic myotomy.