Association between the duration of palliative care service and survival in terminal cancer patients.

PURPOSE: Preliminary studies of early palliative care showed improved quality of life, less medical cost, and better survival time. But, most terminal cancer patients tend to be referred to palliative care late. For the proper care of terminal cancer patients, it is necessary to refer to hospice and palliative care timely. The aim of this study is to analyze the effect of the duration of palliative care services on the survival in terminal cancer patients. METHODS: We reviewed 609 patients who had died from terminal cancer between January 2010 and December 2012. We analyzed correlations of age, first Palliative Performance Scale (PPS) level, duration of palliative care service, and survival time. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. RESULTS: Duration of palliative care services was significantly correlated with survival time. In univariate Cox regression analysis, age, and each group of duration of palliative care service showed significant associations with survival. Final multivariate Cox regression model retained four parameters as independent prognostic factors for survival (age HR = 0.99 (p = 0.002), 1∼10 days HR = 2.64 (p < 0.001), 11∼30 days HR = 2.43 (p < 0.001), 31∼90 days HR = 1.87 (p < 0.001)). CONCLUSIONS: Shorter duration of palliative care services showed poor prognostic factor. Timely referral system from the end of chemotherapy is warranted.

Patient-specific reference model estimation for orthognathic surgical planning.

PURPOSE: Accurate estimation of reference bony shape models is fundamental for orthognathic surgical planning. Existing methods to derive this model are of two types: one determines the reference model by estimating the deformation field to correct the patient's deformed jaw, often introducing distortions in the predicted reference model; The other derives the reference model using a linear combination of their landmarks/vertices but overlooks the intricate nonlinear relationship between the subjects, compromising the model's precision and quality. METHODS: We have created a self-supervised learning framework to estimate the reference model. The core of this framework is a deep query network, which estimates the similarity scores between the patient's midface and those of the normal subjects in a high-dimensional space. Subsequently, it aggregates high-dimensional features of these subjects and projects these features back to 3D structures, ultimately achieving a patient-specific reference model. RESULTS: Our approach was trained using a dataset of 51 normal subjects and tested on 30 patient subjects to estimate their reference models. Performance assessment against the actual post-operative bone revealed a mean Chamfer distance error of 2.25 mm and an average surface distance error of 2.30 mm across the patient subjects. CONCLUSION: Our proposed method emphasizes the correlation between the patients and the normal subjects in a high-dimensional space, facilitating the generation of the patient-specific reference model. Both qualitative and quantitative results demonstrate its superiority over current state-of-the-art methods in reference model estimation.

Correspondence attention for facial appearance simulation.

In orthognathic surgical planning for patients with jaw deformities, it is crucial to accurately simulate the changes in facial appearance that follow the bony movement. Compared with the traditional biomechanics-based methods like the finite-element method (FEM), which are both labor-intensive and computationally inefficient, deep learning-based methods offer an efficient and robust modeling alternative. However, current methods do not account for the physical relationship between facial soft tissue and bony structure, causing them to fall short in accuracy compared to FEM. In this work, we propose an Attentive Correspondence assisted Movement Transformation network (ACMT-Net) to predict facial changes by correlating facial soft tissue changes with bony movement through a point-to-point attentive correspondence matrix. To ensure efficient training, we also introduce a contrastive loss for self-supervised pre-training of the ACMT-Net with a k-Nearest Neighbors (k-NN) based clustering. Experimental results on patients with jaw deformities show that our proposed solution can achieve significantly improved computational efficiency over the state-of-the-art FEM-based method with comparable facial change prediction accuracy.

Predicting Optimal Patient-Specific Postoperative Facial Landmarks for Patients with Craniomaxillofacial Deformities.

Orthognathic surgery traditionally focuses on correcting skeletal abnormalities and malocclusion, with the expectation that an optimal facial appearance will naturally follow. However, this skeletal-driven approach can lead to undesirable facial aesthetics and residual asymmetry. To address these issues, a soft-tissue-driven planning method has been proposed. This innovative method bases bone movement estimates on the targeted ideal facial appearance, thus increasing the surgical plan's accuracy and effectiveness. This study explores the initial phase of implementing a soft-tissue-driven approach, simulating the patient's optimal facial look by repositioning deformed facial landmarks to an ideal state. The algorithm incorporates symmetrization and weighted optimization strategies, aligning projected optimal landmarks with standard cephalometric values for both facial symmetry and form, which are integral to facial aesthetics in orthognathic surgery. It also includes regularization to preserve the patient's original facial characteristics. Validated using retrospective analysis of data from both preoperative patients and normal subjects, this approach effectively achieves not only facial symmetry, particularly in the lower face, but also a more natural and normalized facial form. This novel approach, aligning with soft-tissue-driven planning principles, shows promise in surpassing traditional methods, potentially leading to enhanced facial outcomes and patient satisfaction in orthognathic surgery.

Formation and degradation of strongly reducing cyanoarene-based radical anions towards efficient radical anion-mediated photoredox catalysis.

Cyanoarene-based photocatalysts (PCs) have attracted significant interest owing to their superior catalytic performance for radical anion mediated photoredox catalysis. However, the factors affecting the formation and degradation of cyanoarene-based PC radical anion (PC•‒) are still insufficiently understood. Herein, we therefore investigate the formation and degradation of cyanoarene-based PC•‒ under widely-used photoredox-mediated reaction conditions. By screening various cyanoarene-based PCs, we elucidate strategies to efficiently generate PC•‒ with adequate excited-state reduction potentials (Ered*) via supra-efficient generation of long-lived triplet excited states (T1). To thoroughly investigate the behavior of PC•‒ in actual photoredox-mediated reactions, a reductive dehalogenation is carried out as a model reaction and identified the dominant photodegradation pathways of the PC•‒. Dehalogenation and photodegradation of PC•‒ are coexistent depending on the rate of electron transfer (ET) to the substrate and the photodegradation strongly depends on the electronic and steric properties of the PCs. Based on the understanding of both the formation and photodegradation of PC•‒, we demonstrate that the efficient generation of highly reducing PC•‒ allows for the highly efficient photoredox catalyzed dehalogenation of aryl/alkyl halides at a PC loading as low as 0.001 mol% with a high oxygen tolerance. The present work provides new insights into the reactions of cyanoarene-based PC•‒ in photoredox-mediated reactions.

Screening obstructive sleep apnea patients via deep learning of knowledge distillation in the lateral cephalogram.

The lateral cephalogram in orthodontics is a valuable screening tool on undetected obstructive sleep apnea (OSA), which can lead to consequences of severe systematic disease. We hypothesized that a deep learning-based classifier might be able to differentiate OSA as anatomical features in lateral cephalogram. Moreover, since the imaging devices used by each hospital could be different, there is a need to overcome modality difference of radiography. Therefore, we proposed a deep learning model with knowledge distillation to classify patients into OSA and non-OSA groups using the lateral cephalogram and to overcome modality differences simultaneously. Lateral cephalograms of 500 OSA patients and 498 non-OSA patients from two different devices were included. ResNet-50 and ResNet-50 with a feature-based knowledge distillation models were trained and their performances of classification were compared. Through the knowledge distillation, area under receiver operating characteristic curve analysis and gradient-weighted class activation mapping of knowledge distillation model exhibits high performance without being deceived by features caused by modality differences. By checking the probability values predicting OSA, an improvement in overcoming the modality differences was observed, which could be applied in the actual clinical situation.

Three-dimensional topology-based T-index as an indicator of surgical difficulty of partial nephrectomy in patients with small renal mass.

PURPOSE: To accurately describe the three-dimensional topology of renal tumors, our study suggests a new nephrometry scoring system, the T-index, that combines information about intraparenchymal extension and peripherality of the renal tumor. MATERIALS AND METHODS: This study included 113 patients who underwent partial nephrectomy for small clear cell renal cell carcinoma between 2007 and 2014. Manual segmentation of the renal parenchyma, sinus, and tumor was performed using preoperative computed tomography images. The T-index was calculated by adding the reciprocals of the distances from all points on the tumor-parenchyma interface to the renal sinus. Correlations with perioperative factors and the impact of the T-index on postoperative complications were evaluated and compared with existing nephrometry scoring systems (PADUA, RENAL, contact surface area [CSA], and C-index). RESULTS: The mean value of the T-index among the 113 patients was 116.1±100.5 (1/mm). The T-index showed the strongest correlation with perioperative factors compared with other nephrometry scoring systems. The T-index was able to predict the risk for postoperative complications, either overall (p=0.015) or major complications (p=0.030). A predictive model based on the T-index of the overall postoperative complications presented the best performance (area under the curve, 0.692; 95% CI, 0.599-0.776) compared with other nephrometry scoring systems. CONCLUSIONS: The T-index can be considered as a single value comprising key structural indicators for surgical complexity. Our findings suggest that the T-index can provide a quantitative and objective scoring system associated with surgical difficulty and postoperative complications of partial nephrectomy.

Enhanced lysosomal activity is involved in Bax inhibitor-1-induced regulation of the endoplasmic reticulum (ER) stress response and cell death against ER stress: involvement of vacuolar H+-ATPase (V-ATPase).

Bax inhibitor-1 (BI-1) is an evolutionarily conserved protein that protects cells against endoplasmic reticulum (ER) stress while also affecting the ER stress response. In this study, we examined BI-1-induced regulation of the ER stress response as well as the control of the protein over cell death under ER stress. In BI-1-overexpressing cells (BI-1 cells), proteasome activity was similar to that of control cells; however, the lysosomal fraction of BI-1 cells showed sensitivity to degradation of BSA. In addition, areas and polygonal lengths of lysosomes were greater in BI-1 cells than in control cells, as assessed by fluorescence and electron microscopy. In BI-1 cells, lysosomal pH was lower than in control cells and lysosomal vacuolar H(+)-ATPase(V-ATPase), a proton pump, was activated, suggesting high H(+) uptake into lysosomes. Even when exposed to ER stress, BI-1 cells maintained high levels of lysosomal activities, including V-ATPase activity. Bafilomycin, a V-ATPase inhibitor, leads to the reversal of BI-1-induced regulation of ER stress response and cell death due to ER stress. In BI-1 knock-out mouse embryo fibroblasts, lysosomal activity and number per cell were relatively lower than in BI-1 wild-type cells. This study suggests that highly maintained lysosomal activity may be one of the mechanisms by which BI-1 exerts its regulatory effects on the ER stress response and cell death.

Effects of Acid-Reducing Agents on the Pharmacokinetics of Lazertinib in Patients with EGFR Mutation-Positive Advanced Non-Small-Cell Lung Cancer.

INTRODUCTION: Lazertinib is an irreversible, mutant-selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). Co-administration of TKIs with acid-reducing agents (ARAs) can lead to potential drug-drug interactions, which decreases solubility and absorption of TKIs and is ultimately associated with reduced efficacy of TKIs. This retrospective analysis evaluated the effect of ARAs on the pharmacokinetics of lazertinib using data obtained from patients with advanced EGFR mutation-positive non-small-cell lung cancer. METHODS: In a total of 234 patients with lazertinib pharmacokinetics observed at steady state, dose-normalized (DN) area under the concentration-time curve (AUCss), maximum concentration (Cmax,ss), and/or trough concentration on day 15 (CD15) were compared between a group receiving ARA concomitantly for at least 4 days (ARA group) and another group not receiving ARA (non-ARA group) in a dose-proportional range. Additionally, a comparison of pharmacokinetic parameters at a therapeutic dose of 240 mg once daily was evaluated. RESULTS: Geometric mean ratios (GMRs) with 90% confidence intervals (CIs) of ARA group to non-ARA group for DNAUCss, DNCmax,ss, and DNCD15 at 40 mg to 320 mg once daily showing the dose proportionality were 0.8743 (0.7285-1.0493), 0.9035 (0.7482-1.0910), and 0.9126 (0.7364-1.1311), respectively. GMRs with 90% CIs for AUCss, Cmax,ss, and CD15 at 240 mg were 0.9136 (0.6637-1.2576), 0.9012 (0.6703-1.2116), and 0.8850 (0.6463-1.2118), respectively. CONCLUSION: All pharmacokinetic parameters were not significantly different between the two groups (p values > 0.05), indicating that co-administered ARAs did not significantly affect the steady state pharmacokinetics of lazertinib. Therefore, no dose adjustment of lazertinib is required in patients receiving concomitant ARAs. GOV IDENTIFIERS: NCT03046992, NCT04075396.

An efficient transmission power control scheme for temperature variation in wireless sensor networks.

Wireless sensor networks collect data from several nodes dispersed at remote sites. Sensor nodes can be installed in harsh environments such as deserts, cities, and indoors, where the link quality changes considerably over time. Particularly, changes in transmission power may be caused by temperature, humidity, and other factors. In order to compensate for link quality changes, existing schemes detect the link quality changes between nodes and control transmission power through a series of feedback processes, but these approaches can cause heavy overhead with the additional control packets needed. In this paper, the change of the link quality according to temperature is examined through empirical experimentation. A new power control scheme combining both temperature-aware link quality compensation and a closed-loop feedback process to adapt to link quality changes is proposed. We prove that the proposed scheme effectively adapts the transmission power to the changing link quality with less control overhead and energy consumption.

Retinal Changes before and after Silicone Oil Removal in Eyes with Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography.

This study aimed to evaluate and compare the retinal and choroidal thickness and vessel density (VD) changes between silicone oil (SO) tamponade and after SO removal using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). Thirty patients who underwent pars plana vitrectomy for retinal detachment (RD) with SO tamponade were included. SS-OCT and OCTA were conducted before RD surgery, during SO tamponade, and after SO removal. A 3-dimensional volumetric wide scan protocol was used for the analysis. The segmented retina, choroidal thickness map, and peripapillary thickness were then measured. For the OCTA analysis, 4.5 × 4.5 mm scans were used. Superficial and deep capillary plexus VDs in unaffected fellow eyes and eyes after SO removal were compared. During the SO tamponade period, the thickness of the parafoveal total retina, ganglion cell-inner plexiform layer, and peripapillary retinal nerve fiber layer (ppRNFL) were significantly thinner than those of unaffected fellow eyes (p < 0.05). The parafoveal layer thickness thinning recovered up to three to six months after SO removal. Moreover, six months after SO removal, the parafoveal thickness was not significantly different compared to that of unaffected fellow eyes (p > 0.05). However, the ppRNFL thickness was significantly decreased during SO tamponade and remained unrecovered six months after SO removal. There was no significant difference in the VD on the OCTA. Thus, SO tamponade and removal for RD resulted in a change in the retinal and peripapillary thickness. This may be due to the mechanical pressure effect of SO.

Associations between Household Latrines and the Prevalence of Diarrhea in Idiofa, Democratic Republic of the Congo: A Cross-Sectional Study.

Despite the importance of sanitation, few studies have assessed the effects of latrines on the health outcomes of children under 5 years of age. We assessed the relations between latrine coverage and the prevalence of diarrhea in children under 4 years of age. In this cross-sectional study, we analyzed the baseline data obtained as part of a longitudinal survey targeting 720 households in Idiofa, Bandundu, Democratic Republic of the Congo. We categorized latrines according to the presence of each major component and investigated whether diarrhea prevalence of children under 4 years of age is associated with latrine availability and improvement. Latrines have health benefits regardless of whether they are improved. Also worth noting is that comparatively well-equipped and more appropriately managed latrines could prevent child diarrhea more effectively than less equipped or inappropriately managed latrines. Households who have a latrine with a superstructure, roof, and no flies (a partly improved latrine) were found to be 52% less likely to report cases of diarrhea than households with unimproved latrines (adjusted odds ratio [OR] = 0.48, confidence interval [CI] = 0.31-0.76), which are all the other latrines not included in the partly improved latrine category. We have observed the profound protective effect of latrines with a superstructure. This study demonstrates that latrines are associated with significant improvements in health even when they do not fully meet the conditions of improved latrines. This study adds value to the limited evidence on the effect of latrines on health parameters by demonstrating that latrines have correlations with health benefits regardless of whether they are improved, as well as by elucidating the most essential components of improved latrines.

Distribution of periodontal pathogens in Korean aggressive periodontitis.

BACKGROUND: Microbial associations in aggressive periodontitis versus different ethnic origins are substantially unknown. We undertook this study to determine the prevalence of seven putative periodontopathogens in Korean patients and to evaluate microbial differences in localized and generalized aggressive periodontitis patients. METHODS: Thirty-nine aggressive periodontitis patients between 20 and 35 years old (24 males and 15 females; mean age 29.6 years) were selected according to clinical criteria. The patients were subclassified into 17 localized and 22 generalized aggressive periodontitis patients. In each of the 39 individuals, subgingival plaque samples were collected from four diseased teeth (> or = 6 mm probing depth, 156 sites) and one healthy site (< or = 3 mm probing depth, 39 sites). Polymerase chain reaction (PCR) of the 16S ribosomal RNA gene fragments (about 530 bp) of plaque bacteria and their subsequent detection by dot-blot hybridization using specific oligonucleotide probes were performed to determine the presence of seven periodontopathogens. RESULTS: The prevalences were 75% for Actinobacillus actinomycetemcomitans, 94.2% for Tannerella forsythensis (formerly Bacteroides forsythus), 99.4% for Fusobacterium sp., 85.9% for Micromonas micros (formerly Peptostreptococcus micros), 96.8% for Porphyromonas gingivalis, 78.8% for Prevotella intermedia, and 96.8% for Treponema sp. The prevalences of these bacteria were significantly higher in diseased sites than in healthy sites. Logistic regression analysis showed that P. intermedia was more significantly associated with generalized aggressive periodontitis than the localized form, with an odds ratio of 3.28 (95% confidence interval 1.26-8.56, P = 0.015). CONCLUSIONS: Our results demonstrate that the seven periodontal pathogens analyzed are strongly associated with Korean aggressive periodontitis. In particular, P. intermedia are more significantly associated with generalized aggressive periodontitis, a more severe and progressive form, than with localized aggressive periodontitis.