Pleural Fluid-to-Blood BNP Ratio May Contribute to Prognosis in Malignant Pleural Mesothelioma.

BACKGROUND: Brain natriuretic peptide (BNP) seems to be produced from malignant mesothelial cells other than cardiomyocytes. We aimed to evaluate whether an increased pleural fluid-to-blood BNP ratio in patients with malignant pleural mesothelioma (MPM) could facilitate prognosis beyond diagnosis. MATERIALS AND METHODS: Patients with MPM were included (observational study). One- and two-year survival and factors affecting it were tested. To evaluate the prognostic significance of the natriuretic peptide precursor B (NPPB) gene expression in MPM, we constructed a survival curve from data derived from The Cancer Genome Atlas. RESULTS: Nineteen consecutive patients with MPM were included (age: 67 (61, 80), male 78.9%). One- and two-year survival were 52.6% and 31.6%, respectively. Age, performance status, and the other variables tested did not differ between survivors and non-survivors. Non-survivors presented higher pleural fluid BNP in two years (699 (210, 5000) vs. 379.5 (5, 567), p = 0.036) and BNP ratios than survivors (1-year: 28.75 (4.05, 150.24) vs. 3.49 (0.3, 26) p = 0.001, 2-years: 22.8 (2.42, 150.24) vs. 3.49 (0.3, 7.76), p = 0.001). One- and two-year survival rates in patients with BNP ratios above/equal to the median value (8.82) were 20% and 0%, and 88.9% and 66.7%, respectively, in patients with BNP ratios below 8.82 (p = 0.006 and p = 0.002, respectively). MPM patients with low NPPB expression presented significantly higher survival rates compared to patients with higher expressions (p = 0.032). CONCLUSION: A high pleural fluid/blood BNP ratio, an easily performed in everyday practice, costless biomarker seems to predict poorer survival better than the commonly reported prognostic factors in MPM.

Chios Hospital Information System Assessment.

A very important aspect for organizations that provide healthcare services is to have fully functional and successful information systems. A successful hospital information system can contribute to high quality healthcare services provided to the patients of the hospital. In this paper, is presented the evaluation of the information system of Chios Hospital, "Skylitsio". The survey was conducted using a questionnaire which consists demographic questions and questions that measure the factors of the DeLone & McLean success model. The participants of the survey were 71 users of the clinical information system. Cronbach's alpha reliability test, descriptive statistics, and further data analyses to investigate the relations between the factors of the DeLone & McLean success model were performed. Based on the results, the users of the information system are satisfied with it, as well as they find the system useful and easy to use. The average value of the "information quality" is 3.78 out of 5, the "system quality" is 3.61, the "service quality" is 3.45, the "use" is 3.83, the "user satisfaction" is 3.46, and the "user benefit" is 3.76. The research concludes with a validation of the DeLone & McLean success model and it seems that the information system of the General Hospital of Chios is successful based on the users' opinions.

How to Utilize My App Reviews? A Novel Topics Extraction Machine Learning Schema for Strategic Business Purposes.

Acquiring knowledge about users' opinion and what they say regarding specific features within an app, constitutes a solid steppingstone for understanding their needs and concerns. App review utilization helps project management teams to identify threads and opportunities for app software maintenance, optimization and strategic marketing purposes. Nevertheless, app user review classification for identifying valuable gems of information for app software improvement, is a complex and multidimensional issue. It requires foresight and multiple combinations of sophisticated text pre-processing, feature extraction and machine learning methods to efficiently classify app reviews into specific topics. Against this backdrop, we propose a novel feature engineering classification schema that is capable to identify more efficiently and earlier terms-words within reviews that could be classified into specific topics. For this reason, we present a novel feature extraction method, the DEVMAX.DF combined with different machine learning algorithms to propose a solution in app review classification problems. One step further, a simulation of a real case scenario takes place to validate the effectiveness of the proposed classification schema into different apps. After multiple experiments, results indicate that the proposed schema outperforms other term extraction methods such as TF.IDF and χ2 to classify app reviews into topics. To this end, the paper contributes to the knowledge expansion of research and practitioners with the purpose to reinforce their decision-making process within the realm of app reviews utilization.

Citizens' Opinions About a Digital Health Insurance Record.

An Electronic Health Insurance Record (EHIR) could give all the information needed to the insured citizens, informing them about the history of benefits and the health expenses. The aim of this work is to evaluate a Digital Health Insurance Record system as well as to explore the benefits of using this system, both for society and for each citizen individually. A quantitative survey was carried out using a questionnaire shared among 180 people in Greece in 2019. The questionnaire consisted of 25 closed-ended questions, 3 of which related to demographics and the remaining 22 related to the use and benefits of use of the EHIR system. Most of all people who took part in this study believe that EHIR can contribute positively giving both social benefits and benefits for the patients. An important finding of the study is the concern expressed by respondents about the security of the system in the management of sensitive personal data. Based on citizens' opinions a Digital Health Insurance Record can provide a lot of benefits to citizens and to the society as well as to the national health insurance system.

Malignant mesothelioma cells secrete natriuretic peptides: Data and diagnostic clinical implications.

BACKGROUND AND OBJECTIVE: Mesothelial cells and cardiomyocytes have shared embryonic mesodermal origin. Cardiomyocytes release BNP under stretch. We searched whether malignant mesothelioma cells also secrete BNP and if so, this has a meaningful impact. METHODS: Part I: Prospectively, patients with pleural lesions on CT having malignant mesothelioma effusions (MME, n = 13) were compared to patients with malignant effusions with pleural lesions (MEa, n = 14). Age-matched patients with ME without pleural lesions (MEb, n = 16) and non-malignant effusions (NME, n = 25) were analysed. Part II: Retrospectively, samples from patients with mesothelioma (n = 14), lung cancer (n = 8) or heart failure (n = 9) were used. BNP was measured in pleural fluid and blood/plasma. Part III: BNP was assessed in the culture supernatants of benign (MeT-5A) and malignant mesothelioma cell lines (M14K-epithelioid, MSTO-biphasic and ZL34-sarcomatoid) (n = 10 per cell line in three different biological replicates). RESULTS: In vitro, BNP concentration was significantly higher in the supernatant of all malignant cell lines than benign ones (P < 0.01), denoting BNP's production from the former. The pleural fluid to blood BNP ratio in MME was extremely high in Part I and Part II subjects (28.3 ± 12.1 and 25.9 ± 8.6, respectively) versus 1.1 ± 0.3 and 0.4 ± 0.1 in Part I ME and NME, respectively (P < 0.0001), and 0.8 ± 0.1 and 0.4 ± 0.1 in Part II ME and NME, respectively (P < 0.0001). BNP ratio ≥2.11 in Part I had 92% sensitivity and 94.5% specificity for MME (P < 0.0001). CONCLUSION: BNP is secreted from malignant mesothelial cells. In clinical practice, the pleural fluid to blood BNP ratio can help in the diagnosis of malignant mesothelioma.

Distribution-free monitoring schemes based on order statistics: a general approach.

In this article, we establish a new class of distribution-free Shewhart-type monitoring schemes based on order statistics. The setup of the proposed family of nonparametric control charts is presented in detail. Specific monitoring schemes, already introduced in the literature, are confirmed to be members of the new class. In addition, a new nonparametric monitoring scheme that belongs to the class is established, while explicit formulae for its basic characteristics are reached. The numerical study carried out reveals that the proposed scheme achieves adversarial in-control and out-of-control performance.

A minor experimental stenosis in porcine descending thoracic aorta affects the spectral content of pressure pulse wave.

OBJECTIVE: To carry out research into the possible changes of the spectral content of pressure pulse wave after the creation of an experimentally induced stenosis in the pig descending thoracic aorta. METHODS: Eight healthy, normotensive Landrace pigs were subjected to thoracotomy under sterile conditions. At the upper segment of the descending thoracic aorta, a 5-mm-long circumferential symmetric constriction was imposed and stabilized; hence, a 15-20 mm Hg pressure gradient was established. Pressure tip catheters were used in order to monitor the pressure gradient. Blood flow disturbances were recorded through a bidirectional Doppler flow meter at pre- and poststenotic areas (A and B, respectively). Measurements were carried out before, 10 min after, and 90 days after the creation of the stenosis. The recorded waveforms were analyzed mathematically by using Fourier Transform, in order to determine their spectral component. Eight sham-operated pigs were used as controls. RESULTS: Fourier Transform analysis showed a significant increase (P < 0.05) of spectral content in A and B areas. Also, the "relative" harmonic amplitudes in nonstenotic subjects were higher than in stenotic animals (P < 0.05). CONCLUSIONS: A minor experimental constriction located at the level of the descending thoracic aorta increased the spectral content of the pressure pulse wave, indicating that spectral analysis may detect slight flow disturbances before developing remarkable signs of an impaired circulation system.