Early Identification and Management of Patients with Rash on Apalutamide.

Apalutamide is a selective androgen receptor signalling inhibitor that is used in the treatment of prostate cancer. Skin rash is one of the most common adverse events with apalutamide. Although the majority of rash events are grade 1 and 2, the appearance of skin rash during treatment can lead to dose reduction, a pause in treatment or even treatment discontinuation, especially if patients present late when the rash has become severe. This in turn can result in a significant delay or even a permanent discontinuation in the patient's treatment of prostate cancer. As apalutamide is a generally well tolerated and an effective treatment for many men with advanced prostate cancer, it is extremely important to make attempts to prevent skin problems or to manage them at the earliest stage possible. We therefore have developed practical guidance for the management of apalutamide-related rash, including an infographic with recommendations for rash management by grade. Central to this approach is patient education and awareness. Encouraging patients to proactively care for their skin from the start of treatment and informing them of the risk of rash with apalutamide therapy are essential. If the patient observes any skin changes, they should be advised to report it straight away to their cancer care team. Adopting this simple, proactive approach of patient education and increased vigilance from the care team is expected to lead to early identification of rash and subsequent intervention to allow for quicker resolution and enable patients to continue their cancer treatment with a drug that can delay disease progression and increase survival in patients with prostate cancer.

Temporal variation in the structure, abundance, and composition of Laminaria hyperborea forests and their associated understorey assemblages over an intense storm season.

Kelp species function as important foundation organisms in coastal marine ecosystems where they provide biogenic habitat and ameliorate environmental conditions, often facilitating the development of diverse understorey assemblages. The structure of kelp forests is influenced by a variety of environmental factors, changes in which can result in profound shifts in ecological structure and functioning. Intense storm-induced wave action in particular, can severely impact kelp forest ecosystems. Given that storms are anticipated to increase in frequency and intensity in response to anthropogenic climate change, it is critical to understand their potential impacts on kelp forest ecosystems. During the 2021/22 northeast Atlantic storm season, the United Kingdom (UK) was subject to several intense storms, of which the first and most severe was Storm Arwen. Due to the unusual northerly wind direction, the greatest impacts of Storm Arwen were felt along the northeast coast of the UK where wind gusts exceeded 90 km/h, and inshore significant wave heights of 7.2 m and wave periods of 9.3 s were recorded. Here, we investigated temporal and spatial variation in the structure of L. hyperborea forests and associated understorey assemblages along the northeast coast of the UK over the 2021/22 storm season. We found significant changes in the cover, density, length, biomass, and age structure of L. hyperborea populations and the composition of understorey assemblages following the storm season, particularly at our most north facing site. We suggest continuous monitoring of these systems to further our understanding of temporal variation and potential recovery trajectories, alongside enhanced management to promote resilience to future perturbations.

Surrogate modelling of heartbeat events for improved J-peak detection in BCG using deep learning.

Sleep, or the lack thereof, has far-reaching consequences on many aspects of human physiology, cognitive performance, and emotional wellbeing. To ensure undisturbed sleep monitoring, unobtrusive measurements such as ballistocardiogram (BCG) are essential for sustained, real-world data acquisition. Current analysis of BCG data during sleep remains challenging, mainly due to low signal-to-noise ratio, physical movements, as well as high inter- and intra-individual variability. To overcome these challenges, this work proposes a novel approach to improve J-peak extraction from BCG measurements using a supervised deep learning setup. The proposed method consists of the modeling of the discrete reference heartbeat events with a symmetric and continuous kernel-function, referred to as surrogate signal. Deep learning models approximate this surrogate signal from which the target heartbeats are detected. The proposed method with various surrogate signals is compared and evaluated with state-of-the-art methods from both signal processing and machine learning approaches. The BCG dataset was collected over 17 nights using inertial measurement units (IMUs) embedded in a mattress, together with an ECG for reference heartbeats, for a total of 134 h. Moreover, we apply for the first time an evaluation metric specialized for the comparison of event-based time series to assess the quality of heartbeat detection. The results show that the proposed approach demonstrates superior accuracy in heartbeat estimation compared to existing approaches, with an MAE (mean absolute error) of 1.1 s in 64-s windows and 1.38 s in 8-s windows. Furthermore, it is shown that our novel approach outperforms current methods in detecting the location of heartbeats across various evaluation metrics. To the best of our knowledge, this is the first approach to encode temporal events using kernels and the first systematic comparison of various event encodings for event detection using a regression-based sequence-to-sequence model.

The HSCT procedure (II): Conditioning, hematopoietic stem cell infusion, supportive care, and monitoring.

Autologous hematopoietic stem cell transplantation (aHSCT) is a complex process, designed to replace the blood and lymphoid systems of a patient with hematopoietic stem cells (HSCs) that have been previously collected and cryopreserved, derived from the same patient. The rationale of aHSCT in neurologic diseases is to eliminate self-reacting cell clones and induce self-tolerance through a profound renewal of the immune system. The steps analyzed in this chapter are conditioning, HSCs infusion, supportive care, and monitoring. Before transplantation, ablation of the hemato-lymphopoietic system is achieved with chemotherapy; this stage is known as the conditioning regimen. The EBMT guidelines support the use of "intermediate intensity" regimens, either cyclophosphamide 200mg/kg or BEAM (bis-chloroethyl-nitrosourea, etoposide, cytarabine, and melphalan), in combination with serotherapy that consists of rabbit antithymocyte globulin (ATG) in most protocols. The infusion of HSC is performed through a central intravenous line, after being thawed at 37°C using either a water bath or a heat bath; in this phase, the prevention and management of infusion-related adverse events are crucial. The supportive care consists mainly of infection prophylaxis and treatment, administration of blood product transfusions, and nutritional and electrolyte support. The monitoring phase is focused on hematologic recovery and monitoring for early and late complications of aHSCT.

Event-related potentials of familiar monosyllabic words with unexpected lexical tones: A picture-word study of Mandarin-speaking preschoolers with and without a history of late talking.

This study examined how Mandarin-speaking preschoolers with and without a history of late talking (LT) process familiar monosyllabic words with unexpected lexical tones, focusing on both phonological and semantic violations. This study initially enrolled 64 Mandarin-speaking toddlers: 31 with a history of LT (mean age: 27.67 months) and 33 without a history of LT (non-LT) (mean age: 27.85 months). Event-related potentials were recorded at the age of 4 years during a picture-word mismatch task (LT mean age: 51.36 months; non-LT mean age: 51.20 months); in this task, the participants were presented with auditory words either matching (Tone 3) or mismatching with images in terms of their lexical tones; the mismatches encompassed acoustically dissimilar (Tone 1) and similar (Tone 2) mismatches. A significant difference in the phonological mapping negativity (PMN) responses to Tones 1 and 3 was observed only in the non-LT group. However, differences in the N400 responses to Tones 1 and 3 remained consistent across both groups. In addition, greater differences in the PMN responses between Tones 1 and 3 were associated with higher language proficiency during the preschool period. The PMN response serves as an indicator of neural correlates in lexical tone processing, reflecting challenges encountered by preschoolers with a history of LT when processing the lexical tones of familiar words. Furthermore, the PMN response was correlated with concurrent language abilities. These findings indicate the importance of early tonal perception development for Mandarin speakers with a history of LT. RESEARCH HIGHLIGHTS: Preschoolers with a history of late talking (LT), similar to preschoolers without such a history, can establish word expectations and detect the lexical tone violation in real time. However, those with a history of LT require additional time to process acoustic cues and differentiate between word semantics based on lexical tone information. The phonological mapping negativity response serves as an indicator of neural correlates in lexical tone processing, reflecting challenges encountered by preschoolers with a history of LT when processing the lexical tones of familiar words. The present findings indicate the importance of early intervention for Mandarin speakers with a history of LT, with an emphasis on lexical tone processing from toddlerhood.

Sjogren's syndrome due to immune checkpoint inhibitors (ICIs): Insights from a single-institution series and systematic review of the literature.

INTRODUCTION: Careful adverse event assessment and management are important when prescribing immune checkpoint inhibitors (ICIs) to cancer patients. Iatrogenic Sjogren's syndrome is a relatively rare immune-related adverse event (irAEs) that affects the moisture-producing glands. METHODS: We describe a series of four patients who developed Sjogren's syndrome while being treated with ICIs at a community cancer center in Southern California, USA (1/1/2017-12/31/2023). Patient, drug and disease-related data were collected by retrospective chart review. A systematic search of the PubMed database was performed to identify similar cases in the literature (1/1/2016-12/31//2023). RESULTS: Of 224 cancer patients at our center treated with ICIs, four (1.8%) developed iatrogenic Sjogren's syndrome. All of our patients were male; three received PD-1 inhibitors (nivolumab, pembrolizumab) and one received the PD-L1 inhibitor atezolizumab. The median time to development of Sjogren's syndrome was 24 weeks (range, 8-36 weeks); dry mouth symptoms were more prominent than dry eye symptoms. None of the patients had elevated SS-A, SS-B or antinuclear antibodies. One patient developed multiple tooth cavities and had several extractions, due to severe xerostomia. Management of all patients was primarily symptomatic. Two cases were irreversible; one was reversible and the 4th case is undermined as he is still on ICI therapy. Our systematic review of the literature identified 80 cases in five articles. Incidence of xerostomia was twice of that of xerophthalmia. The male/female ratio was 1.5:1. SS-A, SS-B, or antinuclear antibodies were found in only 9% of patients. Steroids were reported to have had only a limited role in management. CONCLUSIONS: The incidence of Sjogren's syndrome due to ICIs in our center was 1.8%. Details of clinical course and management in these patients are presented. Caring for patients with ICI-related Sjogren's syndrome is facilitated by a multidisciplinary effort including oncologists, otolaryngologists, dentists, ophthalmologists and rheumatologists. Expanding the knowledge base pertaining to iatrogenic Sjogren's syndrome in patients on ICIs will be helpful in promoting early detection and treatment, and improving outcomes.

When we fail to live up to our own standards: the relationship between self-discrepancy and moral injury.

BACKGROUND: Moral injury is a potentially debilitating outcome of exposure to events involving transgressions against an individual's moral code. It is often observed in the context of PTSD; however, treatments that do not differentiate the two are often ineffective for moral injury, suggesting different mechanisms contribute to the conditions. The most widely accepted model of moral injury proposes an important role for self-discrepancy processes in generating and maintaining event-related distress, but this has yet to be examined. METHODS: This study recruited 172 adults online who had been exposed to a potentially morally injurious event in the previous 5 years. Participants completed measures of event-related distress, PTSD, depression, and anxiety, as well as a self-discrepancy task involving subjective representations of their ideal, ought, and feared selves. RESULTS: Multiple regression analyses found a small but significant relationship between self-discrepancy and event-related distress, with higher levels of ought self-discrepancy independently predicting higher event-related distress scores. CONCLUSIONS: This study provides the first empirical evidence of the relationship between self-discrepancy and moral injury. We identified the ought self as a domain of self-discrepancy salient to moral injury, further differentiating moral injury from PTSD.

A multimedia dataset for object-centric business process mining in IT asset management.

This manuscript introduces a multimedia business process dataset provided by a German research institute. The dataset was systematically collected in a laboratory environment that reflects the workspace of IT staff managing IT Asset Management (ITAM) processes. It encompasses data from 121 process instances across six basic processes, captured using 37 video recordings from two camera perspectives, motion tracking, environmental sensors, an ITAM system trace, and event log data from user interactions. The data is made available in its raw state and processed form. The object-centric event log format (OCEL) provides discrete business process events from system activities. Event data from reality is supplied as raw video files and logs from environmental sensors. The video files were also manually labelled with identifiable business process activities and their associated entities. This multimedia dataset has been designed as a resource for developing, training, and evaluating process mining techniques based on unstructured data. Consequently, the dataset design emphasizes the traceability of activities and entities across the multimedia data sources.

Statistical approaches for component-wise censored composite endpoints.

Composite endpoints defined as the time to the earliest of two or more events are often used as primary endpoints in clinical trials. Component-wise censoring arises when different components of the composite endpoint are censored differently. We focus on a composite of death and a non-fatal event where death time is right censored and the non-fatal event time is interval censored because the event can only be detected during study visits. Such data are most often analysed using methods for right censored data, treating the time the non-fatal event was first detected as the time it occurred. This can lead to bias, particularly when the time between assessments is long. We describe several approaches for estimating the event-free survival curve and the effect of treatment on event-free survival via the hazard ratio that are specifically designed to handle component-wise censoring. We apply the methods to a randomized study of breastfeeding versus formula feeding for infants of mothers infected with human immunodeficiency virus.

Acute toxicity of hypofractionated radiotherapy for Japanese breast cancer patients after surgery: a single center prospective observational study (HyPORT-BC).

BACKGROUND: This single center prospective observational study was conducted to evaluate the acute toxicity of hypo-fractionated radiotherapy for Japanese breast cancer patients after surgery. METHODS: This study recruited patients who were scheduled for moderately hypo-fractionated radiotherapy including supraclavicular lymph node area (Cohort M) or ultra-hypo-fractionated radiotherapy for the conserved breast (Cohort U) as postoperative treatment for breast cancer. Radiotherapy plans were generated using automated planning system. Irradiation of 42.5 Gy/16 fractions (Cohort M) or 26 Gy/5 fractions (Cohort U) was delivered, and boost irradiation of 10 Gy/5 fractions was added as needed. The primary endpoint was the proportion of grade ≥ 2 acute adverse events within 90 days. The toxicities were evaluated using CTCAE ver 5.0. RESULTS: Between January 2023 and December 2023, 123 patients (81 in Cohort M and 42 in Cohort U) were enrolled. All the included patients were Japanese and completed their planned radiotherapy and were also able to be evaluated for acute adverse events. Grade 1/2/3-5 acute adverse events were observed in 67/12/0 for Cohort M and 31/4/0 for Cohort U. The proportion of grade ≥ 2 acute adverse events within 90 days was 15% (95% confidence interval 8-24%) for Cohort M and 10% (95% confidence interval 3-23%) for Cohort U. CONCLUSIONS: The proportion of acute toxicity of hypo-fractionated radiotherapy for Japanese breast cancer patients after surgery was shown to be acceptable in this study.

Atrial fibrillation and prediabetes: A liaison that merits attention!

Atrial fibrillation (AF) and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key role. The resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event (MACCE) events. However, the same has not convincingly been verified in real-world settings. In the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE, prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding variables. However, certain questions like the role of metformin, quantifying the risk for MACCE amongst prediabetes compared to diabetes, the positive impact of reversion to normoglycemia remain unanswered. We provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.

Unraveling the Enigma of Gossypiboma: A Series of 14 Cases Highlighting the Prevalence, Root Causes, and Outcomes in Resource-Limited Settings.

BACKGROUND: Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. MATERIALS AND METHODS: A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. RESULT: Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. CONCLUSION: A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations. Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.

Adverse events related to platelet-rich plasma therapy and future issues to be resolved.

Platelet-rich plasma (PRP) is the portion of plasma with a platelet concentration above baseline that is recovered through centrifugation of autologous blood. PRP therapy is currently used for wound healing and pain relief in diverse medical fields. Although there have been recent reports of adverse events (AEs) possibly related to PRP treatment, the safety profile of PRP treatment remains unclear. Therefore, this review discusses the risks inherent in PRP therapy and the current issues by surveying reports on AEs associated with PRP treatment within different fields. PubMed was searched for research articles referring to AEs associated with PRP therapy from inception to January 2024. Literature survey revealed that PRP therapy may involve several AEs, including postoperative infections, blindness, inflammation, allergic reactions, and nodule development. The most commonly reported AE was postoperative infections. Since PRP therapy generally proceeds in the process of blood collection, manufacturing, and administration to patients, it is conjectured that PRP may have been contaminated with microorganisms at some point in this series of processes, leading to bacterial infection. Additionally, because PRP cannot be sterilized like pharmaceuticals, it is important to prevent microbial contamination during each PRP treatment process. However, the specific process that involves the risk of microbial contamination remains unclear. To take measures to prevent microbial contamination of PRP, it may be necessary to elucidate the risk factors for microbial contamination during PRP treatment. It may be important to elucidate the effectiveness and risks of PRP therapy as well as to establish a follow-up system after PRP treatment. Currently, most reports of AEs related to PRP therapy are case reports; therefore, the accumulation of high-quality evidence and detailed verification are necessary to determine the causal relationship between PRP therapy and each AE.

Highly Curative Treatment of High-Risk Acute Promyelocytic Leukemia: Induction and Consolidation with ATRA+ATO+anthracyclines and Maintenance with ATRA+RIF.

Background: The aim of the study was to evaluate the efficacy and safety of induction and consolidation with all-trans retinoic acid (ATRA) +arsenic trioxide (ATO) +anthracyclines and maintenance with ATRA +Realgar-Indigo naturalis formula (RIF) for high-risk APL. Methods: Twenty-one patients with high-risk APL treated with ATRA+ATO+ anthracyclines for induction and consolidation and ATRA+RIF for maintenance from 2012 to 2021 were analyzed. Endpoints include morphological complete remission (CR) and complete molecular remission (CMR), early death (ED) and relapse, survival and adverse events (AEs). Results: After induction treatment, all 21 patients (100%) achieved morphological CR and 14 people (66.7%) achieved CMR. Five of the 21 patients did not undergo immunological minimal residual disease (MRD) examination after induction; however, 14 of the remaining 16 patients were MRD negative (87.5%). The median time to achieve CR and CMR was 26 days (range: 16-44) and 40 days (range: 22-75), respectively. The cumulative probability of achieving CR and CMR in 45 days was 100% and 76.2% (95% CI: 56.9-91.3%), respectively. All patients achieved CMR and MRD negativity after the three courses of consolidation treatment. The median follow-up was 66 months (25-142), with no central nervous system relapse and bone marrow morphological or molecular relapse until now, and all patients survived with 100% overall survival and 100% event-free survival. Grade 4 adverse events (AEs) were observed in 3 patients (14.3%) during the induction period including arrhythmia (n = 1), pulmonary infection (n = 1) and respiratory failure (n = 1); and the most frequent grade 3 AEs were pulmonary infection, accounting for 62.0% and 28.6%, respectively, during induction and consolidation treatment, followed by neutropenia, accounting for 42.9% and 38.1%, respectively. Conclusion: For newly diagnosed high-risk APL patients, induction and consolidation with ATRA+ATO+anthracyclines and maintenance with ATRA+RIF is a highly curative treatment approach.

Neural evidence of core foundations and conceptual change in preschool numeracy.

Symbolic numeracy first emerges as children learn the meanings of number words and how to use them to precisely count sets of objects. This development starts before children enter school and forms a foundation for lifelong mathematics achievement. Despite its importance, exactly how children acquire this basic knowledge is unclear. Here we test competing theories of early number learning by measuring event-related brain potentials during a novel number word-quantity comparison task in 3-4-year-old preschool children (N = 128). We find several qualitative differences in neural processing of number by conceptual stage of development. Specifically, we find differences in early attention-related parietal electrophysiology (N1), suggesting that less conceptually advanced children process arrays as individual objects and more advanced children distribute attention over the entire set. Subsequently, we find that only more conceptually advanced children show later-going frontal (N2) sensitivity to the numerical-distance relationship between the number word and visual quantity. The nature of this response suggested that exact rather than approximate numerical meanings were being associated with number words over frontal sites. No evidence of numerical distance effects was observed over posterior scalp sites. Together these results suggest that children may engage parallel individuation of objects to learn the meanings of the first few number words, but, ultimately, create new exact cardinal value representations for number words that cannot be defined in terms of core, nonverbal number systems. More broadly, these results document an interaction between attentional and general cognitive mechanisms in cognitive development. RESEARCH HIGHLIGHTS: Conceptual development in numeracy is associated with a shift in attention from objects to sets. Children acquire meanings of the first few number words through associations with parallel attentional individuation of objects. Understanding of cardinality is associated with attentional processing of sets rather than individuals. Brain signatures suggest children attribute exact rather than approximate numerical meanings to the first few number words. Number-quantity relationship processing for the first few number words is evident in frontal but not parietal scalp electrophysiology of young children.

Effects of mixed land use on urban stormwater quality under different rainfall event types.

The joint effect of mixed land uses and rainfall event types was studied using a two-year field monitoring program in four urban catchments in Calgary, Alberta, Canada. Event mean concentration (EMC) and event pollutant load (EPL) were employed to evaluate the total suspended sediment (TSS), nitrogen and phosphorus. The correlation analysis showed that most nitrogen and phosphorus components (except for NO2-/NO3- and TDP) predominantly exist in particulate form in the study areas. The correlation for EPL was notably stronger than EMC, which can be attributed to varying rainfall characteristics. The differences in EMCs and EPLs of TSS, nitrogen and phosphorus across catchments indicated that the complexity and spatial distribution of mixed land use can influence the generation and transportation of pollutants in urban runoff. The impacts of rainfall characteristics on stormwater quality are integrated rather than driven by a single rainfall characteristic. Brief but intense events tended to elevate TSS, nitrogen and phosphorus concentrations, especially in complex land-use catchments. Events with long antecedent dry days and short duration also resulted in increased pollutant concentrations, while events with long duration and low intensity could result in higher EPLs. The effect of mixed land use on water quality can vary depending on rainfall event types. Seasonal variations were found in EMC and EPL of TSS, nitrogen and phosphorus, with higher values in the spring and summer than the fall. Seasonal variations are mainly influenced by rainfall conditions, temperature and anthropogenic activities (e.g. lawn fertilization and de-icing with sands). MLR considering rainfall characteristics is an effective method for predicting stormwater quality within a single catchment. Considering complexity and spatial distribution of mixed land use can improve the accuracy of the harmonized MLR model. This research provided insights into understanding the complexities introduced by mixed land use and rainfall event types in urban stormwater quality.

Signal mining and gender differences analysis of adverse events in NMIBC treatment with gemcitabine and BCG bladder instillation based on the FAERS database.

OBJECTIVE: To explore safety differences and perform a gender-based analysis of adverse events related to gemcitabine and Bacillus Calmette-Guérin (BCG) vaccine using the U.S. FDA Adverse Event Reporting System (FAERS) database. METHODS: Using the Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) methods, adverse events associated with gemcitabine and BCG were mined from FAERS database reports spanning from Q1 2004 to Q3 2023. RESULTS: The study extracted 37,855 reports with gemcitabine and 5,455 reports with BCG as the primary suspected drugs. Adverse events were more prevalent in males (male-to-female ratio: gemcitabine 1.10, BCG 4.25). Differences in high-frequency adverse events among the top 20 signals were detected for both drugs. Both drugs affected similar organ systems, including potential pulmonary, ocular, and renal toxicity, with gemcitabine showing a broader range of adverse events. Gender analysis revealed fewer adverse reactions to gemcitabine in females, while males had fewer adverse reactions to BCG. CONCLUSION: Differences in high-frequency adverse events between gemcitabine and BCG, including some not listed on drug labels, were observed. Both drugs affect similar organ systems, with gemcitabine showing a broader range of adverse events. Gender differences in adverse events were notable.

Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA.

OBJECTIVES: There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. MATERIALS AND METHODS: The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. RESULTS: One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. CONCLUSION: Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.

Optimizing control efficiency in discrete-time multi-agent systems via event-triggered containment techniques combining disturbance handling and input delay management.

The goal of this paper is to mitigate disturbances and input delays while optimizing controller actuation updates for discrete-time multi-agent systems through the use of an event-triggered confinement control system, especially in resource-constrained scenarios. This approach when combined with event-triggered control techniques, then every follower in the system adjusts its condition at specified times based on an event-triggered condition that is suggested. The containment control system issue in the presence of disturbances and input delays was tackled by using both decentralized and centralized event-triggered control systems. Using matrix theory and the Lyapunov technique, convergence analysis is conducted to show that the proposed strategy stays free of zeno phenomena. Numerical boosts are used to further illustrate the impact of theoretical results.