Clinical Factors, Management, and Outcomes of Patients Under 18 Years Old With Central Nervous System Tumors: Single-center Experience in Peru.

Few reports on clinical factors, treatment, and survival in children and adolescents with Central nervous system tumors in low-income and middle-income countries in Latin America exist. We retrospectively reviewed such data in all cases of patients younger than 18 years with brain tumors diagnosed in a single tertiary care center in Peru from 2007 through 2017. Variables were analyzed for association with overall survival and event-free survival by using the Kaplan-Meier method and the Cox hazards ratio regression. Seventy-five patients' data were analyzed (40 boys, 35 girls; mean age=7.7 y). The main clinical symptoms were headache, vomiting, difficulty walking, and visual disturbances. The most frequent clinical signs were hydrocephalus, cerebellar signs, visual abnormalities, and focal motor signs. The median time to diagnosis was 12 weeks. Tumor resection was performed in 68 patients, and 37 patients received postoperative radiotherapy. The most frequent histologic subtypes were low-grade gliomas and medulloblastomas. Overall survival rates at 1 and 5 years of disease were 78% (CI 95%, 0.67 to 0.86) and 74% (CI 95%, 0.62 to 0.82), respectively, and the 5-year event-free survival rate was 62% (CI 95%, 0.47 to 0.73). Although diagnosis occurred late in our cohort, the survival rate was higher than that in other Latin American countries.

A PID-Type Fuzzy Logic Controller-Based Approach for Motion Control Applications.

Motion control is widely used in industrial applications since machinery, robots, conveyor bands use smooth movements in order to reach a desired position decreasing the steady error and energy consumption. In this paper, a new Proportional-Integral-Derivative (PID) -type fuzzy logic controller (FLC) tuning strategy that is based on direct fuzzy relations is proposed in order to compute the PID constants. The motion control algorithm is composed by PID-type FLC and S-curve velocity profile, which is developed in C/C++ programming language; therefore, a license is not required to reproduce the code among embedded systems. The self-tuning controller is carried out online, it depends on error and change in error to adapt according to the system variations. The experimental results were obtained in a linear platform integrated by a direct current (DC) motor connected to an encoder to measure the position. The shaft of the motor is connected to an endless screw; a cart is placed on the screw to control its position. The rise time, overshoot, and settling time values measured in the experimentation are 0.124 s, 8.985% and 0.248 s, respectively. These results presented in part 6 demonstrate the performance of the controller, since the rise time and settling time are improved according to the state of the art. Besides, these parameters are compared with different control architectures reported in the literature. This comparison is made after applying a step input signal to the DC motor.

Blockchain Mechanism and Symmetric Encryption in A Wireless Sensor Network.

The Internet of Things (IoT) paradigm allows the connection and exchange of information between millions of smart devices. This paradigm grows and develops exponentially as do the risks and attacks on IoT infrastructures. Security, privacy, reliability, and autonomy are the most important requirements in IoT Systems. If these issues are not guaranteed, the IoT system could be susceptible to malicious users and malicious use. In centralized IoT systems, attacks and risks are greater, especially when data is transmitted between devices and shared with other organizations. To avoid these types of situations, this work presents a decentralized system that guarantees the autonomy and security of an IoT system. The proposed methodology helps to protect data integrity and availability based on the security advantages provided by blockchain and the use of cryptographic tools. The accuracy of the proposed methodology was measured on a temperature and humidity sensing IoT-based Wireless Sensor Network (WSN). The obtained results prove that the proposal fulfils the main requirements of an IoT system. It is autonomous, secure to share and send information between devices and users, has privacy, it is reliable, and the information is available in the infrastructure. Furthermore, this research demonstrates that the proposal is less susceptible to the most frequent attacks against IoT systems, such as linking attack, man in the middle, and Distributed Denial of Service (DDoS) attack.

Optical Methods Based on Ultraviolet, Visible, and Near-Infrared Spectra to Estimate Fat and Protein in Raw Milk: A Review.

The present manuscript focuses on reviewing the optical techniques proposed to monitor milk quality in dairy farms to increase productivity and reduce costs. As is well known, the quality is linked to the fat and protein concentration; in addition, this issue is crucial to maintaining a healthy herd and preventing illnesses such as mastitis and ketosis. Usually, the quality of the milk is carried out with invasive methods employing chemical reagents that increase the time analysis. As a solution, several spectroscopy optical methods have been proposed, here, the benefits such as non-invasive measurement, online implementation, rapid estimation, and cost-effective execution. The most attractive optical methods to estimate fat and protein in cow's milk are compared and discussed considering their performance. The analysis is divided considering the wavelength operation (ultraviolet, visible, and infrared). Moreover, the weaknesses and strengths of the methods are fully analyzed. Finally, we provide the trends and a recent technique based on spectroscopy in the visible wavelength.

A New Methodology Based on EMD and Nonlinear Measurements for Sudden Cardiac Death Detection.

Heart diseases are among the most common death causes in the population. Particularly, sudden cardiac death (SCD) is the cause of 10% of the deaths around the world. For this reason, it is necessary to develop new methodologies that can predict this event in the earliest possible stage. This work presents a novel methodology to predict when a person can develop an SCD episode before it occurs. It is based on the adroit combination of the empirical mode decomposition, nonlinear measurements, such as the Higuchi fractal and permutation entropy, and a neural network. The obtained results show that the proposed methodology is capable of detecting an SCD episode 25 min before it appears with a 94% accuracy. The main benefits of the proposal are: (1) an improved detection time of 25% compared with previously published works, (2) moderate computational complexity since only two features are used, and (3) it uses the raw ECG without any preprocessing stage, unlike recent previous works.

Revisiting Gaussian Process Regression Modeling for Localization in Wireless Sensor Networks.

Signal strength-based positioning in wireless sensor networks is a key technology for seamless, ubiquitous localization, especially in areas where Global Navigation Satellite System (GNSS) signals propagate poorly. To enable wireless local area network (WLAN) location fingerprinting in larger areas while maintaining accuracy, methods to reduce the effort of radio map creation must be consolidated and automatized. Gaussian process regression has been applied to overcome this issue, also with auspicious results, but the fit of the model was never thoroughly assessed. Instead, most studies trained a readily available model, relying on the zero mean and squared exponential covariance function, without further scrutinization. This paper studies the Gaussian process regression model selection for WLAN fingerprinting in indoor and outdoor environments. We train several models for indoor/outdoor- and combined areas; we evaluate them quantitatively and compare them by means of adequate model measures, hence assessing the fit of these models directly. To illuminate the quality of the model fit, the residuals of the proposed model are investigated, as well. Comparative experiments on the positioning performance verify and conclude the model selection. In this way, we show that the standard model is not the most appropriate, discuss alternatives and present our best candidate.

Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia.

BACKGROUND: Treatment with dasatinib, a highly potent BCR-ABL kinase inhibitor, has resulted in high rates of complete cytogenetic response and progression-free survival among patients with chronic myeloid leukemia (CML) in the chronic phase, after failure of imatinib treatment. We assessed the efficacy and safety of dasatinib, as compared with imatinib, for the first-line treatment of chronic-phase CML. METHODS: In a multinational study, 519 patients with newly diagnosed chronic-phase CML were randomly assigned to receive dasatinib at a dose of 100 mg once daily (259 patients) or imatinib at a dose of 400 mg once daily (260 patients). The primary end point was complete cytogenetic response by 12 months, confirmed on two consecutive assessments at least 28 days apart. Secondary end points, including major molecular response, were tested at a significance level of 0.0001 to adjust for multiple comparisons. RESULTS: After a minimum follow-up of 12 months, the rate of confirmed complete cytogenetic response was higher with dasatinib than with imatinib (77% vs. 66%, P=0.007), as was the rate of complete cytogenetic response observed on at least one assessment (83% vs. 72%, P=0.001). The rate of major molecular response was higher with dasatinib than with imatinib (46% vs. 28%, P<0.0001), and responses were achieved in a shorter time with dasatinib (P<0.0001). Progression to the accelerated or blastic phase of CML occurred in 5 patients who were receiving dasatinib (1.9%) and in 9 patients who were receiving imatinib (3.5%). The safety profiles of the two treatments were similar. CONCLUSIONS: Dasatinib, administered once daily, as compared with imatinib, administered once daily, induced significantly higher and faster rates of complete cytogenetic response and major molecular response. Since achieving complete cytogenetic response within 12 months has been associated with better long-term, progression-free survival, dasatinib may improve the long-term outcomes among patients with newly diagnosed chronic-phase CML. (ClinicalTrials.gov number, NCT00481247.)

Investigation of TiO2 Deposit on SiO2 Films: Synthesis, Characterization, and Efficiency for the Photocatalytic Discoloration of Methylene Blue in Aqueous Solution.

TiO2-SiO2 thin films were created on Corning glass substrates using a simple method. Nine layers of SiO2 were deposited; later, several layers of TiO2 were deposited, and their influence was studied. Raman spectroscopy, high resolution transmission electron spectroscopy (HRTEM), an X-ray diffractometer (XRD), ultraviolet-visible spectroscopy (UV-Vis), a scanning electron microscope (SEM), and atomic force microscopy (AFM) were used to describe the sample's shape, size, composition, and optical characteristics. Photocatalysis was realized through an experiment involving the deterioration of methylene blue (MB) solution exposed to UV-Vis radiation. With the increase of TiO2 layers, the photocatalytic activity (PA) of the thin films showed an increasing trend, and the maximum degradation efficiency of MB by TiO2-SiO2 was 98%, which was significantly higher than that obtained by SiO2 thin films. It was found that an anatase structure was formed at a calcination temperature of 550 °C; phases of brookite or rutile were not observed. Each nanoparticle's size was 13-18 nm. Due to photo-excitation occurring in both the SiO2 and the TiO2, deep UV light (λ = 232 nm) had to be used as a light source to increase photocatalytic activity.

Diagnostic Strategies for Breast Cancer Detection: From Image Generation to Classification Strategies Using Artificial Intelligence Algorithms.

Breast cancer is one the main death causes for women worldwide, as 16% of the diagnosed malignant lesions worldwide are its consequence. In this sense, it is of paramount importance to diagnose these lesions in the earliest stage possible, in order to have the highest chances of survival. While there are several works that present selected topics in this area, none of them present a complete panorama, that is, from the image generation to its interpretation. This work presents a comprehensive state-of-the-art review of the image generation and processing techniques to detect Breast Cancer, where potential candidates for the image generation and processing are presented and discussed. Novel methodologies should consider the adroit integration of artificial intelligence-concepts and the categorical data to generate modern alternatives that can have the accuracy, precision and reliability expected to mitigate the misclassifications.

Performance Evaluation of Different Object Detection Models for the Segmentation of Optical Cups and Discs.

Glaucoma is an eye disease that gradually deteriorates vision. Much research focuses on extracting information from the optic disc and optic cup, the structure used for measuring the cup-to-disc ratio. These structures are commonly segmented with deeplearning techniques, primarily using Encoder-Decoder models, which are hard to train and time-consuming. Object detection models using convolutional neural networks can extract features from fundus retinal images with good precision. However, the superiority of one model over another for a specific task is still being determined. The main goal of our approach is to compare object detection model performance to automate segment cups and discs on fundus images. This study brings the novelty of seeing the behavior of different object detection models in the detection and segmentation of the disc and the optical cup (Mask R-CNN, MS R-CNN, CARAFE, Cascade Mask R-CNN, GCNet, SOLO, Point_Rend), evaluated on Retinal Fundus Images for Glaucoma Analysis (REFUGE), and G1020 datasets. Reported metrics were Average Precision (AP), F1-score, IoU, and AUCPR. Several models achieved the highest AP with a perfect 1.000 when the threshold for IoU was set up at 0.50 on REFUGE, and the lowest was Cascade Mask R-CNN with an AP of 0.997. On the G1020 dataset, the best model was Point_Rend with an AP of 0.956, and the worst was SOLO with 0.906. It was concluded that the methods reviewed achieved excellent performance with high precision and recall values, showing efficiency and effectiveness. The problem of how many images are needed was addressed with an initial value of 100, with excellent results. Data augmentation, multi-scale handling, and anchor box size brought improvements. The capability to translate knowledge from one database to another shows promising results too.

Long-range wireless mesh network for weather monitoring in unfriendly geographic conditions.

In this paper a long-range wireless mesh network system is presented. It consists of three main parts: Remote Terminal Units (RTUs), Base Terminal Units (BTUs) and a Central Server (CS). The RTUs share a wireless network transmitting in the industrial, scientific and medical applications ISM band, which reaches up to 64 Km in a single point-to-point communication. A BTU controls the traffic within the network and has as its main task interconnecting it to a Ku-band satellite link using an embedded microcontroller-based gateway. Collected data is stored in a CS and presented to the final user in a numerical and a graphical form in a web portal.

Logit models, the area under receiver characteristic curves, sensitivity, and specificity for Co-enrollment density in college networks dataset.

This article describes the data related to co-enrollment density (CD), a new network clustering index, that can predict persistence and graduation. The data hold the raw results and charts obtained with the algorithm for CD introduced in ``Co-Enrollment Density Predicts Engineering Students' Persistence and Graduation: College Networks and Logistic Regression Analysis.'' There are data for eight institutions that show CD as a predictor for graduation at four years, graduation at six years, and ever graduated. The files were processed using R to estimate CD at one, two, three, and four years. Logistic regression models, receiver operating characteristic curves, specificity, sensitivity, and cut-off points were estimated for each model. The R code to reproduce the metanalysis for the summary data is included. The displays for the logistic regression models, receiver operating characteristic curves, density curves for classes, models, and parameters are included.

Applications of solar and wind renewable energy in agriculture: A review.

The growing demand for food and the unstable price of fossil fuels has led to the search for environmentally friendly sources of energy. Energy is one of the largest overhead costs in the production of greenhouse crops for favorable climate control. The use of wind-solar renewable energy system for the control of greenhouse environments reduces fuel consumption and so enhances the sustainability of greenhouse production. This review describes the impact of solar-wind renewable energy systems in agricultural greenhouses.

Draft Genome Sequence of Epilithonimonas sp. FP211-J200, Isolated from an Outbreak Episode on a Rainbow Trout (Oncorhynchus mykiss) Farm.

Here, we report the draft genome sequence of Epilithonimonas sp. FP211-J200, isolated from rainbow trout head kidney cells. The size of the genome is 4,110,772 bp, with a G+C content of 37.1%. The Epilithonimonas sp. FP211-J200 genome has genes related to tetracycline and ß-lactam resistance. This is the first reported Epilithonimonas species genome isolated from a fish host.

Neuralgia del glosofaríngeo izquierdo: una patología poco frecuente. Un reporte de caso

La neuralgia del glosofaríngeo es una patología rara donde hay dolor agudo y punzante en la fosa amigdalina, ángulo de la mandíbula y base de la lengua. Su principal causa es la compresión neurovascular la cual se puede diagnosticar con una resonancia cerebral. Su manejo es médico, principalmente; con fármacos, especialmente, carbamazepina y oxcarbazepina; y si no hay respuesta, va a cirugía mediante descompresión microvascular e interposición de material blando (politetrafluoroetileno), con o sin transección del IX par craneal. Se presenta el caso de una mujer de 64 años, hipertensa controlada, con dolor característico, que con 5 fármacos antineuropáticos y 1 derivado de opioides no cedía el dolor. La resonancia cerebral con secuencia FIESTA muestra una compresión neurovascular del IX PC con la PICA izquierda. Se le realiza descompresión microvascular del IX PC, con resolución de la sintomatología y sin recurrencia, saliendo de alta pronto. Se concluye que el manejo quirúrgico de esta patología en casos refractarios al tratamiento médico es una opción con buenas tasas de éxito y baja morbilidad.

Glossopharyngeal neuralgia is a rare pathology, with a sharp and stabbing pain in the tonsillar fossa, angle of the jaw and base of the tongue. Its main etiology is neurovascular compression, which can be diagnosed with a brain MRI. Its management is mainly medical with drug, especially carbamazepine and oxcarbazepine, and if there is no response, surgery is performed through microvascular decompression and interposition of soft material (polytetrafluoroethylene) with or without transection of IX cranial nerve. We present the case of a 64-year-old woman, with controlled hypertension, with classic pain, who did not relieve pain with 5 antineuropathic drugs and 1 opioid derivative. Brain MRI with FIESTA sequence shows a neurovascular compression of the glossopharyngeal nerve with the left PICA. Microvascular decompression of the glossopharyngeal nerve was performed, with resolution of the symptoms and without recurrence, and she was discharged soon. We concluded that the surgical management of this pathology in refractory cases to medical treatment is an option with good success rates and low morbidity.

Segmentation of OCT and OCT-A Images using Convolutional Neural Networks / Segmentación de imágenes de OCT y OCT-A por medio de Redes Neuronales Convolucionales

ABSTRACT Segmentation is vital in Optical Coherence Tomography Angiography (OCT-A) images. The separation and distinction of the different parts that build the macula simplify the subsequent detection of observable patterns/illnesses in the retina. In this work, we carried out multi-class image segmentation where the best characteristics are highlighted in the appropriate plexuses by comparing different neural network architectures, including U-Net, ResU-Net, and FCN. We focus on two critical zones: retinal vasculature (RV) and foveal avascular zone (FAZ). The precision obtained from the RV and FAZ segmentation over 316 OCT-A images from the OCT-A 500 database at 93.21% and 92.59%, where the FAZ was segmented with an accuracy of 99.83% for binary classification.

RESUMEN La segmentación juega un papel vital en las imágenes de angiografía por tomografía de coherencia óptica (OCT-A), ya que la separación y distinción de las diferentes partes que forman la mácula simplifican la detección posterior de patrones/enfermedades observables en la retina. En este trabajo, llevamos a cabo una segmentación de imágenes multiclase donde se destacan las mejores características en los plexos apropiados al comparar diferentes arquitecturas de redes neuronales, incluidas U-Net, ResU-Net y FCN. Nos centramos en dos zonas críticas: la segmentación de la vasculatura retiniana (RV) y la zona avascular foveal (FAZ). La precisión para RV y FAZ en 316 imágenes OCT-A de la base de datos OCT-A 500 se obtuvo en 93.21 % y 92.59 %. Cuando se segmentó la FAZ en una clasificación binaria, con un 99.83% de precisión.

Discapacidad mental y bioética: de la postergación a las oportunidades

Propósito/Contexto. La discapacidad mental altera el curso natural de la existencia humana porque impacta la construcción de la propia identidad y la interacción con el contexto en el que se habita. Pese a su relevancia, la discapacidad mental no ha estado en el centro del debate bioético. En el presente artículo se exponen algunas de las razones de esa postergación en este debate, revisando desde los modelos comprensivos anteriormente imperantes hasta los nuevos que incorporan principios éticos entre sus ejes. Metodología/Enfoque. Se revisaron los distintos modelos desde donde se comprende la discapacidad mental, comenzando por los de enfoque médico y social hasta los recientes modelos biopsicosociales y de la diversidad. Se identifica que los primeros modelos tenían el concepto de capacidad como eje teórico y que los actuales se proponen develar y erradicar la lógica de la exclusión aún no superada. Resultados/Hallazgos. La bioética tendría el doble rol de servir como modelo comprensivo y de instrumento que posibilite el debate ético en sociedades pluralistas, al propiciar abordajes ético-ontológicos útiles para el desarrollo de políticas sociosanitarias que permitan alcanzar la plena dignidad de las personas. Discusión/Conclusiones/Contribuciones. Se concluye que, si bien la bioética no ha sido indiferente al debate sobre discapacidad mental, esta tampoco ha estado en el centro de su interés ni ha logrado constituir un aporte para superar la postergación. A los profesionales expertos les cabe guiar a otros escenarios de impacto social, más allá de la investigación y de lo académico, de manera que los entornos educativos, culturales y comunitarios se conecten mejor alrededor de esa problemática.

Purpose/Context. Mental disability alters the natural course of human existence because it impacts the construction of one's identity and the interaction with the context in which one lives. Despite its relevance, mental disability has not been at the center of the bioethical debate. This article presents reasons for this postponement in the bioethical debate, ranging from the previously prevailing comprehensive models to new models that incorporate ethical principles into their pivotal elements. Methodology/Approach. We reviewed multiple models from which mental disability is understood, from the medical and social approach to the recent biopsycho-social and diversity models. We identified that the first models had the concept of ability as a theoretical line and current ones intend to unveil and eradicate the logic of exclusion not yet overcome. Results/Findings. Bioethics would have the dual role of serving as a comprehensive model and an instrument that enables ethical debate in pluralistic societies by promoting practical ethical-ontological approaches to develop socio-health policies and achieve the full dignity of individuals. Discussion/Conclusions/Contributions. While bioethics has not been indifferent to the debate on mental disability, it has not been its interest, nor has it been able to contribute to overcoming postponement. It is up to experts to guide other social impact settings beyond research and academia for educational, cultural, and community environments to better connect to this problem.

Objetivo/contexto. A deficiência mental altera o curso natural da existência humana porque impacta a construção da própria identidade e a interação com o contexto no qual habita-se. Apesar da sua relevância, a deficiência mental não tem estado no centro do debate bioético. No presente artigo expõem-se algumas das razões desse adiamento no debate bioético, revisando desde os modelos compreensivos anteriormente imperantes até os modelos novos que incorporam princípios éticos entre seus eixos. Metodologia/Abordagem. Foram revisados os diferentes modelos desde onde se compreende a incapacidade mental, começando pelos de enfoque médico e social até os recentes modelos biopsicossociais e da diversidade. Identifica-se que os primeiros modelos tinham o conceito de capacidade como eixo teórico e que os atuais propõem-se revelar e erradicar a lógica da exclusão ainda não superada. Resultados/Descobertas. A bioética teria o duplo papel de servir como modelo compreensivo e de instrumento que possibilite o debate ético em sociedades pluralistas, ao propiciar abordagens ético-ontológicos úteis para o desenvolvimento de políticas sociosanitárias que permitam alcançar a plena dignidade das pessoas. Discussão/Conclusões/Contribuições. Conclui-se que, embora a bioética não tenha sido indiferente ao debate sobre a deficiência mental, esta também não tem estado no centro de seu interesse nem tem conseguido constituir um contributo para superar o adiamento. Aos profissionais especializados devem ser orientados para outros cenários de impacto social, para além da investigação e do académico, de modo a que os ambientes educativos, culturais e comunitários se relacionem melhor em torno desta problemática.

A functional ferric uptake regulator (Fur) protein in the fish pathogen Piscirickettsia salmonis.

Piscirickettsia salmonis, a Gram-negative fastidious facultative intracellular pathogen, is the causative agent of the salmonid rickettsial septicemia (SRS). The P. salmonis iron acquisition mechanisms and its molecular regulation are unknown. Iron is an essential element for bacterial pathogenesis. Typically, genes that encode for the iron acquisition machinery are regulated by the ferric uptake regulator (Fur) protein. P. salmonis fur sequence database reveals a diversity of fur genes without functional verification. Due to the fastidious nature of this bacterium, we evaluated the functionality of P. salmonis fur in the Salmonella Δfur heterologous system. Although P. salmonis fur gene strongly differed from the common Fur sequences, it restored the regulatory mechanisms of iron acquisition in Salmonella. We concluded that P. salmonis LF-89 has a conserved functional Fur protein, which reinforces the importance of iron during fish infection. [Int Microbiol 2016; 49-55].

Diagnosis and Treatment of Chronic Myeloid Leukemia in the Imatinib Mesylate Era: Report of the Experience at "La Raza" Medical Center in Mexico.

BACKGROUND: With the advent of tyrosine kinase inhibitors (TKIs), the prognosis of chronic myeloid leukemia (CML) has undergone significant changes in all age groups and at different clinical stages over the past 15 years. Consequently, although disease incidence has remained stable, cumulative prevalence is increasing. PATIENTS AND METHODS: We reviewed our experience with imatinib mesylate (IM) as a first- and second-line treatment for different CML stages to examine demographic and clinical characteristics of patients, cytogenetic and molecular response rates, as well as overall survival (OS), progression-free survival, and event-free survival of patients at the Specialties Hospital of the National Medical Center "La Raza," which belongs to the Mexican Social Security Institute and serves a population with medium to low socioeconomic status. RESULTS: We analyzed data of 302 CML patients who received IM as a first- (n = 234) or second-line treatment (n = 68). Overall, 198 of 302 patients (66%) reached a complete cytogenetic response and at least 115 of 302 (38%) achieved a major molecular response. Among 302 IM-treated patients, 55 (18%) achieved a molecular response 4.5 (MR4.5) or major; at the time of writing this report, 283 (93.7%) were alive and 19 (6.29%) had died. At 60 months, OS was 94%. CONCLUSION: IM offers long-term OS expectations not previously observed with any other therapy, in addition to a good quality of life. However, more than a third of the patients require further treatment with a second-generation TKI; consequently, expectations for treatment-free remission and long-term OS are reduced. Timely change to second-generation TKIs could improve such expectations.