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It remains unclear whether recent changes in the prognosis and management of patients with trisomy 13 impact patient survival. We investigated changes in survival of patients with trisomy 13 in Japan. Data from the Vital Statistics Database in Japan was retrieved to examine the association of sex, surgical history, and years of birth and death with changes in survival patterns in 1164 patients with trisomy 13 between 1995 and 2021. The rates of deaths due to trisomy 13 increased from 9.8% to 23.1% in those over 1 year of age and from 7.3% to 19.2% in those within 24 h of birth between 1995 and 2021. The median survival time was longer in 2009–2021 than in 1996–2008 (40 vs. 84 days, p < 0.001). The median survival time and the rate of patients with surgical history increased from 91 days and 16.0% in 1996–2008 to 179 days and 28.0% in 2009–2021, respectively. Median survival time among patients with trisomy 13 has increased over the last 26 years, with almost 1 in 3 patients currently surviving for more than 1 year. The increased surgical intervention rate might have contributed to this improvement. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to verify if intraoperative radiotherapy (IORT) can achieve the same survival outcome as whole‐breast external beam radiotherapy (EBRT) in early breast cancer after breast‐conserving surgery (BCS), and to explore the suitable candidates that can safely receive IORT after BCS. Methods: Eligible post‐BCS patients who received IORT or EBRT were included in the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2018. Risk factors that affected 5‐year overall survival (OS) or breast cancer specific survival (BCSS) were identified by Cox proportional hazards regression analysis. Clinical characteristics, OS, and BCSS were comparatively analyzed between the two treatment modalities. Results: The survival analysis after propensity score matching confirmed that patients who received IORT (n = 2200) had a better 5‐year OS than those who received EBRT (n = 2200) (p = 0.015). However, the two groups did not differ significantly in 5‐year BCSS (p = 0.381). This feature persisted even after multivariate analyses that took into account numerous clinical characteristics. Although there was no significant difference in BCSS between different subgroups of patients treated with IORT or EBRT, patients over 55 years of age, with T1, N0, non‐triple negative breast cancers, hormone receptor‐positive, and histologic grade II showed a better OS after receiving IORT. Conclusion: In low‐risk, early‐stage breast cancer, IORT was not inferior to EBRT considering 5‐year BCSS and OS. Considering the equivalent clinical outcome but less radiotoxicity, IORT might be a reasonable alternative to EBRT in highly selective patients undergoing BCS. [ABSTRACT FROM AUTHOR]

Background and Aims: Severe acute malnutrition remains a significant health challenge, particularly in low‐ and middle‐income countries. The aim of this study was to determine the survival time of under‐five children with severe acute malnutrition. Methods: A retrospective cohort study was conducted at a hospital, focusing on under‐five children with severe acute malnutrition. The study included 322 inpatients admitted to the Chiro hospital in Chiro, Ethiopia, between September 2019 and August 2020, whose data was obtained from medical records. Survival functions were analysed using Kaplan‒Meier plots and log‐rank tests. The survival time of severe acute malnutrition was further analysed using the Cox proportional hazards model and Bayesian parametric survival models, employing integrated nested Laplace approximation methods. Results: Among the 322 patients, 118 (36.6%) died as a result of severe acute malnutrition. The estimated median survival time for inpatients was found to be 2 weeks. Model selection criteria favored the Bayesian Weibull accelerated failure time model, which demonstrated that age, body temperature, pulse rate, nasogastric (NG) tube usage, hypoglycemia, anemia, diarrhea, dehydration, malaria, and pneumonia significantly influenced the survival time of severe acute malnutrition. Conclusions: This study revealed that children below 24 months, those with altered body temperature and pulse rate, NG tube usage, hypoglycemia, and comorbidities such as anemia, diarrhea, dehydration, malaria, and pneumonia had a shorter survival time when affected by severe acute malnutrition under the age of five. To reduce the death rate of children under 5 years of age, it is necessary to design community management for acute malnutrition to ensure early detection and improve access to and coverage for children who are malnourished. [ABSTRACT FROM AUTHOR]

Resilience, measured by the distribution of passage times between alternate states, indicates persistence of a state in stochastic dynamic systems such as blooms of cyanobacteria in lakes. We used high‐frequency datasets to compare the resilience of low and high states of phycocyanin, a pigment indicator of cyanobacteria, in Lake Mendota, Wisconsin, USA, for three growing seasons that ranged sevenfold in external phosphorus (P) load. Each year we observed 139–265 passage times across the unstable threshold that separated the low‐ from high‐phycocyanin states. Each sample of passage times is highly skewed with low median, larger mean, much larger SD, and wide tails extending to long lifetimes of a state. About 25% of events, whether low or high phycocyanin, lasted a day or more. Among these 3 years of contrasting external P load, there were no discernible differences in the resilience of either ecosystem state. We attribute this lack of contrast to the sustained recycling of P from sediments and the high stochasticity of phycocyanin in this lake. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced cancer who misunderstand their prognosis and chance of cure tend to overestimate the likely benefits of palliative systemic therapy. Aim: To determine patient perceptions of palliative systemic therapy benefits in advanced cancer. Methods: We surveyed 104 outpatients with advanced cancer receiving systemic anticancer therapy and their treating oncologists. Patients recorded their understanding of treatment impact on chance of cure and symptoms. Life expectancy was estimated by patients and oncologists. A visual analogue scale (0–10) was used to record how patients and oncologists valued quality of life (QOL) and length of life (LOL) (<4 QOL most important; 4–7 QOL and LOL equal; >7 LOL most important). Patient‐oncologist discordance was defined as a ≥4‐point difference. Results: The main reasons patients selected for receiving treatment were to live longer (54%) and cure their cancer (36%). Most patients reported treatment was very/somewhat likely to prolong life (84%) and improve symptoms (76%), whereas 20% reported treatment was very/somewhat likely to cure their cancer. 42% of patients selected a timeframe for life expectancy (choice of four timeframes between <1 year and ≥5 years); of these, 62% selected a longer timeframe than their oncologist. When making treatment decisions, 71% of patients (52% of oncologists) valued QOL and LOL equally. Patient‐oncologist discordance was 21%, mostly because of oncologists valuing QOL more than their patients (70%). Conclusion: At least 20% of patients receiving systemic therapy for advanced cancer reported an expectation of cure. Most patients and oncologists value QOL and LOL equally when making treatment decisions. [ABSTRACT FROM AUTHOR]

Wild salmonid fish are faced with the challenge of infections from the ectoparasitic salmon louse, which thus dictates the management of salmon aquaculture in areas where farms and wild populations co‐exist. The mortality risk of wild Atlantic salmon is used as an indicator of threat levels when monitoring wild populations, and therefore the aim of this study was to robustly investigate the effect of infection intensity on probability of mortality in salmon of wild origin. To assess critical infection levels, recently‐smoltified Atlantic salmon were infected with intensities ranging from 0 to 2.5 lice g−1 and exposed to a 48‐h simulated migration. The first mortalities occurred when preadults appeared and ceased as lice became adults. Infection intensity negatively affected mortality probability and survival time, whereas the simulated migration had no influence on the probability of mortality. Individual‐level effects of infection on host mortality is difficult to quantify in the field; however, the correlation between louse load and mortality probability obtained in this study can facilitate indirect estimates of mortality risk of wild salmon populations and contribute to conservation efforts associated with this parasite. [ABSTRACT FROM AUTHOR]

Background and Objective: Among cancers, gastric cancer has the fifth highest incidence worldwide and is the third most common mortality factor, which may have been due to inadequate knowledge of its molecular pathogenesis. The retinoblastoma gene (RB1), a tumor suppressor gene, may have a role in gastric cancer. This research aims to assess Rb expression as a prognostic marker to obtain more insight regarding gastric cancer. Methods: This retrospective analytical study was done on 61 patients (45 males and 16 females) with gastric adenocarcinoma admitted from 2010 to 2012 in Shahid Sadoughi and Mortaz hospitals, Yazd, Iran. Demographic data, including age, gender, clinical signs and symptoms, and pathology reports, were retrieved from patients' hospital folders. Then, the altered Retinoblastoma gene expression was evaluated by immunohistochemistry studies. Acquired data were analyzed by SPSS software v.16. p < 0.05 was statistically considered meaningful. Results: In this study, the ratio of men to women was higher (2.81:1), and the mean age of patients was 62.44 years. About 90.2% of patients died during the study. There was no meaningful relationship between the presence of pRb, the intensity of staining, the percentage of staining with patients' age, gender, tumor grading, and survival rate (p > 0.05). There was only a meaningful relationship between the grade of tumors and survival rate (p = 0.039). Conclusion: Altered pRB expression is not common in gastric cancer and does not impact the survival and grading of tumors. Poorly differentiated tumors had an ominous outcome with the lowest survival time. [ABSTRACT FROM AUTHOR]

Objectives: To estimate median survival time until the appearance of anomalies indicating a potential implant failure associated with fluid ingress in implanted cochlear implant (CI) devices of the initial version of Advanced Bionics HiRes Ultra and HiRes Ultra 3D series. Study Design: Retrospective review. Methods: Cochlear implantation was performed in a standard fashion. Implant integrity was tested at follow-up visits by measuring impedance and electrically evoked compound action potential (ECAP). Additional tests such as electrical field imaging (EFI) were conducted by the manufacturer. Based on these tests, the presence or absence of an anomaly was classified. Results: Of the 349 devices implanted at this institution, 181 showed anomalies in accordance with the special failure mode and for this reason, 120 implants were already explanted. The median survival time without anomalies was 1062 days. So far, the suspicion of device failures has been confirmed in all cases in which a post-implantation analysis was already available. Conclusions: Regular tests at the follow-up visits are necessary to monitor the integrity of CIs. [ABSTRACT FROM AUTHOR]

Objective: A comprehensive study of the survival and causes of death of people with clinically diagnosed Dementia with Lewy bodies (DLB) were few. The aim of our study was to investigate the survival and causes of death of DLB.Methods: The patients diagnosed with probable DLB were consecutively enrolled from five memory clinics in China across a 5-year period (2017-2021) with mortality data updated to December 2021. The endpoint was all-cause death. Survival analysis including Cox regression by groups (time both from disease onset and the first visit to death) and causes of death were evaluated.Results: Of the 108 patients with DLB, 54 (50%) were men and the time from onset of disease to the first visit to the memory clinic (lag time) was 24 (12-48) months. During follow-up, 28.7% (n = 31) of the patients died. The median survival time both from disease onset and the first visit were 81 (95% cognitive impairment (CI) 69.09-92.91) and 45 (95% CI 34.78-55.22) months, respectively. The use of antipsychotic drugs (HR 0.15, 95% CI: 0.03-0.75), moderate to severe dementia (Clinical Dementia Rating [CDR]) at the first visit (HR 0.22, 95% CI 0.78 to 0.62) and the longer lag time (HR 0.943, 95% CI 0.92-0.97) predicted a shorter survival. Failure to thrive (stopped eating, drinking) or multiple organ dysfunction syndrome (MODS) maybe the most common cause of death (41.7%), followed by pneumonia or aspiration (29.2%).Conclusions: The factors associated with survival time were disease severity level, antipsychotic drug use and lag time to seek medical advice. Failure to thrive or MODS and pneumonia were probably the most common cause of death. The long-term outcomes of DLB patients may be helpful to guide clinicians counseling patients and caregivers. [ABSTRACT FROM AUTHOR]

Background: The interaction between the left ventricle (LV) and systemic arterial systems, known as left ventricular‐arterial coupling (VAC), has been evaluated based on the effective arterial elastance (Ea) to LV end‐systolic elastance (Ees) ratio (Ea/Ees). The Ea reflects the total arterial load of LV, whereas Ees reflects the LV systolic function. A recent study found that inappropriate VAC based on increased Ea/Ees estimated by echocardiography is associated with advanced disease severity in dogs with myxomatous mitral valve disease (MMVD). Hypothesis: Inappropriate VAC assessed by echocardiographic estimation of Ea/Ees is associated with a worse prognosis in dogs with MMVD. Animals Eighty‐nine dogs with MMVD. Methods: Prospective cohort study. Dogs underwent echocardiographic examinations at enrollment. The Ea was estimated using the formula: mean blood pressure/(forward stroke volume/body weight). The Ees was estimated using the formula: mean blood pressure/(LV end‐systolic volume/body weight). The Ea/Ees was calculated. Results: By end of study, 22 dogs died of cardiac‐related causes with 67 dogs censored. Dogs with increased Ea/Ees (Ea/Ees >0.34; median survival time, 527 days; 95% confidence interval [CI], 322 days‐not determinable) had a shorter survival time (P <.0001) than those without increased Ea/Ees (Ea/Ees ≤0.34; median survival time, >1112 days; 95% CI, not determinable). Multivariate Cox proportional hazard analysis showed that Ea/Ees, body weight, peak systolic mitral annular velocity, and the peak early diastolic transmitral velocity‐to‐peak early diastolic mitral annular velocity ratio were independent predictors of cardiac‐related death among echocardiographic indices. Conclusions and Clinical Importance: Inappropriate VAC assessed based on echocardiographically‐estimated Ea/Ees is associated with a worse prognosis in dogs with MMVD. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: Hepatitis C virus (HCV) was reported to associate with head and neck squamous cell carcinoma (HNSCC) in many studies. However, its correlation with prognosis of non‐human papillomavirus (HPV) associated HNSCC remains unknown. Here, we sought to investigate clinical significance of HCV RNA transcript in non‐HPV associated HNSCC by analyzing corresponding RNA‐seq data. Study Design: A retrospective cohort study. Methods: Four hundred and forty‐eight non‐HPV associated HNSCC patients with aligned RNA‐seq and clinical follow‐up data were included and divided into two groups: low‐HCV and high‐HCV. Means of continuous variables and proportions of categorical variables were compared using independent sample t‐test and chi‐square test, respectively. Survival data were compared using Cox regression analysis, Kaplan–Meier curves, and log‐rank test. Expression of genome‐wide mRNAs and abundance of immune cells were compared using volcano plot and cell signature estimated score analysis. Results: HCV RNA transcript negatively correlates with pathologic (P =.028) and clinical‐stage (P =.023), clinical N stage (P =.025), and nodal extracapsular spread (P =.042) and is an independent prognosis factor in non‐HPV associated HNSCC (HR = 1.488; 95% CI: 1.004–2.206; P =.048). Elevated expression of HCV improved 5‐year overall survival (43.6% vs. 53.2%; P =.035) in all non‐HPV associated HNSCC patients, the same as in male (46.6% vs. 58.7%; P =.049), clinical M0 stage (42.8% vs. 52.9%; P =.036), white (42.9% vs. 55.9%; P =.010), and histologic grade 1 to 2 subgroups (42.1% vs. 57.2%; P =.043). The expression of several immune‐related genes and abundance of some immune cells significantly changed with the increase of HCV RNA transcript, while HCV‐related oncogenes and tumor suppressor gene did not. Conclusions: HCV RNA transcript is an independent favorable factor for prognosis of non‐HPV associated HNSCC. Levels of Evidence: 4 Laryngoscope, 131:1774–1781, 2021 [ABSTRACT FROM AUTHOR]

Monitoring surgical outcome quality by risk‐adjusted control charts has attracted wide attention. The hidden medical errors may cause increasing of adverse events such as infection, rehospitalization, and even death. Quickly and timely detecting abnormal changes of surgical performance helps reduce the probability of adverse events and improve health care quality. Most existing monitoring schemes focus on the binary surgical outcomes. However, continuous survival times of patients should be considered for more accurate monitoring. In this paper, a new exponentially weighted moving average (EWMA) control chart is proposed for monitoring continuous surgical outcomes. To describe surgical performance, a patient's actual survival time and predicted mortality are combined in an illustrative and interpretable way. Performance of the proposed chart is evaluated with different chart parameters under different shifts by a simulation study. We compare our chart with the risk‐adjusted survival time cumulative sum chart, and the simulation results demonstrate that the proposed monitoring scheme has better efficiency. The implementation of the proposed chart is illustrated by a real example. Besides an analysis of the entire dataset, the surgical performance of each surgeon is monitored, because each of them has patients with different risk levels. [ABSTRACT FROM AUTHOR]

Summary: The Revised International Staging System (R‐ISS) stratifies patients affected by Multiple Myeloma (MM) into three distinct risk groups: R‐ISS I [ISS Stage I, Standard‐Risk cytogenetics and normal Lactase DeHydrogenase (LDH)], R‐ISS III (ISS stage III and either high‐risk cytogenetics or high LDH) and R‐ISS II (any other characteristics). With the aim to verify whether the three R‐ISS groups could be divided into subgroups with different prognostic factors based on the detection of Circulating Plasma Cells (CPCs) at diagnosis, in this retrospective analysis, we evaluated 161 patients with MM treated at our centre between 2005 and 2017. In all, 57 patients (33·9%) were staged as R‐ISS III, 98 (58·3%) as R‐ISS II and six (3·6%) as R‐ISS I. CPCs were detected in 125 patients (74·4%), while in 43 patients (25·6%) no CPCs were seen. Our analysis revealed that Overall Survival (OS) and progression‐free survival (PFS) rates in R‐ISS II patients were higher in the subgroup without CPCs compared to the subgroup with ≥1 CPCs (OS: 44·7% vs. 16·3%, P = 0·0089; PFS: 27·8% vs. 8·1%, P = 0·0118). Our present findings suggest that the detection of CPCs at diagnosis may be used as a further prognostic biomarker to improve the risk stratification of patients with MM staged as R‐ISS II. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV‐infected individuals. We compared host and tumour characteristics between HIV‐infected and HIV‐uninfected Nigerians with HCC and examined the impact of HIV on survival. Methods: This prospective observational study was conducted at Jos University Teaching Hospital in Jos, Nigeria, among adults (>18 years) with HCC enrolled between September 2015 and September 2017 and followed until April 2019. Demographics, tumour characteristics and survival were compared between HCC subjects with and without HIV. Results: 101 (10 HIV‐infected and 91 HIV‐uninfected) subjects were enrolled [male 72%; median age 48 (IQR 35–60)]. 60% HIV‐infected subjects were receiving ART; 90% had CD4 counts ≥ 200/mm3 at HCC diagnosis, and 20% had HIV RNA levels < 20 copies/mL. 57.4% were infected with chronic HBV (HBsAg+). The duration of symptoms was shorter in HIV‐infected vs. HIV‐uninfected subjects [93 (IQR 54–132) vs. 155 (93–248] days; p = 0.02]. At the end of follow‐up, 99 of 101 (98.0%) subjects were confirmed to have died: 9 of 10 (90.0%) HIV‐infected and 90 of 91 (98.9%) HIV‐uninfected. The probability of survival at three months was 22% and 47% in HIV‐infected and HIV‐uninfected subjects, respectively (P = 0.02). Median time to death was significantly shorter in HIV‐infected vs. HIV‐uninfected subjects [24 days (IQR 16–88) vs. 85 days (IQR 34–178), respectively (P = 0.03)]. Conclusions: High early mortality was observed in this cohort of Nigerian adults with HCC. HIV infection was associated with a faster clinical presentation and shorter survival. More aggressive HCC surveillance may be warranted in HIV‐infected subjects, particularly if they are co‐infected with chronic HBV. [ABSTRACT FROM AUTHOR]

Background: People with incurable cancer require information about their prognosis to make informed decisions about their future. Aims: To determine the frequency, form and documentation of prognostic discussions between oncologists and their patients with incurable cancer. Methods: We surveyed medical oncologists in Australia and New Zealand about their practices communicating prognosis. Results: A total of 206 medical oncologists completed the survey. Respondent characteristics were: median age 40 years (range 27–75), female 51%, trainee 22%; and 71% had completed specific training on communicating prognosis. Respondents reported discussing prognosis with a patient a median of 10 times per month (interquartile range 4–15); 88% reported explaining that 'the cancer is incurable' to all their patients with incurable cancer and 84% reported always or usually providing a quantitative estimate of survival time. The preferred method for explaining expected survival time (EST) was providing 'multiple ranges of time with probabilities, for example best‐case, typical and worst‐case scenarios' (52% of respondents). The most frequently reported barriers to discussing EST were: 'family members requesting that prognostic information not be discussed' (57% of respondents), and 'not knowing the EST' (46% of respondents). Twenty percent reported always documenting prognostic discussions and the EST in the patient's medical record, and 11% reported always documenting this information in their letters to other doctors. Conclusions: Most oncologists reported providing quantitative estimates of EST to their patients with incurable cancer, but very few reported documenting this information. Methods to help oncologists estimate, explain and document survival time are needed to improve communication of prognosis. [ABSTRACT FROM AUTHOR]

When a patient is operated on, the surgical outcome depends on two major factors: (i) the patient's health condition and (ii) the surgical process comprising the surgeon, the supporting staff, operating environment, and equipment. An outcome is usually represented by one if a patient dies within 30 days of an operation and zero otherwise. Another method of measuring the outcome is to use survival time with truncation on the 30th day for monitoring purposes. In order to monitor a surgical process effectively, the health condition of a patient must be taken into consideration. This is usually done using a log-likelihood ratio statistic based on an outcome, that is, risk adjusted according to the health condition of the patient. The 30-day wait results in delay in signaling when a deterioration occurs. The consequence of having to wait even though a death has occurred is the potential loss of lives because of delay in signaling. Regular updating of patients' information can improve the sensitivity of a charting procedure. The main objective of this article is to develop and study the class of risk-adjusted cumulative sum procedures that are updated on a regular basis based on patients' current conditions, without having to wait 30 days. Our study shows that these charts do in fact signal earlier and there are differences among the various updating techniques and monitoring statistics. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by variable progression. The prealbumin (PA) is a parameter in a routine blood biochemistry examination. We sought to investigate the prognostic value in IPF patients. Objectives: To evaluate the prognosis value in patients with IPF. Methods: Blood biochemistry examination, demographics, pulmonary function data from patients with IPF consulted in Beijing Chao‐Yang Hospital and China‐Japan Friendship Hospital between July 2012 and December 2016 were collected. Infection, liver and kidney dysfunction and lung transplantation are excluded from the cohort. Results: The result of multivariate Cox analysis showed that PA was significant prognostic indicator of survival along with BMI, FVC, serum albumin protein and serum global protein. The patients with PA concentration <0.2 mg/L had shorter survival compared with those whose PA were normal. Although the survival had no significant difference between the patients with PA concentration < 0.2 mg/L and albumin < 35 g/L and those with PA concentration < 0.2 mg/L, the average survival time of patients with PA concentration < 0.2 mg/L and albumin < 35 g/L were shorter. Conclusions: Our study indicated that IPF patients with PA concentration < 0.2 mg/L have poorer outcome. Further studies are warranted to indentify PA as a predictor for IPF patients outcomes and explore the role of PA in the pathogenesis of IPF. [ABSTRACT FROM AUTHOR]

Global warming is expected to result in earlier emergence of tree seedlings that may experience higher damages and mortality due to late frost in spring. We monitored emergence, characteristics, and survival of seedlings across ten tree species in temperate mixed deciduous forests of Central Europe over one and a half year. We tested whether the timing of emergence represents a trade‐off for seedling survival between minimizing frost risk and maximizing the length of the growing period. Almost two‐thirds of the seedlings died during the first growing period. The timing of emergence was decisive for seedling survival. Although seedlings that emerged early faced a severe late frost event, they benefited from a longer growing period resulting in increased overall survival. Larger seedling height and higher number of leaves positively influenced survival. Seedlings growing on moss had higher survival compared to mineral soil, litter, or herbaceous vegetation. Synthesis. Our findings demonstrate the importance of emergence time for survival of tree seedlings, with early‐emerging seedlings more likely surviving the first growing period. [ABSTRACT FROM AUTHOR]

Summary: What is known and objective: Several researchers in the statistical and medical communities have noted the overestimation of the treatment effect when a trial is stopped early in the interim analysis for efficacy; however, methods to reduce this overestimation are rarely used because the overestimation mechanisms are not well understood by many in clinical trial practice. A trial design that leads to less overestimation is needed. Methods: A computer simulation of hypothetical clinical trials is used to visually explain why the overestimation occurs. A quantitative evaluation of the magnitude of the overestimation is made according to the characteristics of the trial design, such as the total number of events, number of events in the interim analysis, proportion of the number of events to total events and the type of α‐spending function. Results and discussion: When the total number of events was more than or equal to 300 and the proportion of the interim events was larger than 50%, the overestimation was acceptable. Moreover, even if the total number of events was 150, the overestimation was sufficiently small when the proportion of the interim events was >70% and a Pocock type α‐spending function was used. The overestimation decreased when the total number of events and the proportion of the number of events in the interim analysis increased. In addition, the overestimation of the Pocock type α‐spending function was smaller in comparison with that of the O'Brien‐Fleming type, which is widely accepted for confirmatory trials. What is new and conclusion: We recommend setting the proportion of events in the interim analysis at 50% when the O'Brien‐Fleming type α‐spending function is used in confirmatory trials to reduce the risk of overestimation. In contrast, the Pocock type boundary could be used in explanatory trials. A quantitative evaluation of the magnitude of the overestimation is made according to the characteristics of the trial design, such as the total number of events, number of events in the interim analysis, proportion of the number of events to total events, and the type of α‐spending function. When the total number of events was more than or equal to 300 and the proportion of the interim events was larger than 50%, the overestimation was acceptable. [ABSTRACT FROM AUTHOR]

Purpose: After marsupialization of benign tumors and jawbone cysts, insertion of an obturator prosthesis maintains the surgical opening and improves hygiene. To date, there have been no reports clarifying the relationship between the obturator design and treatment outcomes. The purpose of this study was to examine the survival rate of three types of obturator, and to investigate the factors that expedite the removal of the obturator. Materials and Methods: The subject group comprised 100 patients who had an obturator inserted after marsupialization at Kagoshima University Hospital between May 31, 2012 and March 31, 2015; 73 patients with lesions in the mandible were eligible. Three types of mandibular obturator were designed and inserted, considering the teeth missing, the anteroposterior position of the lesion, and the buccolingual direction of marsupialization. The endpoint of this study was defined as the removal of the obturator. The analyzed predictor values for the endpoint were age, gender, remaining teeth, nature of primary disease, anteroposterior location of primary disease, buccolingual direction of marsupialization, type of obturator, and dates of insertion and removal. Results: No significant differences were found in the cumulative survival rate among the three types of obturator. Early obturator removal was more frequent in patients with cysts, anterior lesions, and/or marsupialization from the occlusal direction Conclusions: Because obturator design had minimal effect on the ability of the appliance to maintain the surgical opening, it is preferable to use the least invasive design. Our findings also suggest that the follow‐up examination should account for the type of primary disease, the anteroposterior location of the lesion, and the buccolingual direction of marsupialization. [ABSTRACT FROM AUTHOR]

Background: The associations between an anti-inflammatory diet and both all-cause and cause-specific mortality have been studied previously; however, the influence of an anti-inflammatory diet on survival time has not been investigated. Moreover, the potential modification of these associations by smoking status remains unclear.Objective: The aims of this study were to examine the associations between an anti-inflammatory diet index (AIDI) and all-cause and cause-specific mortality, to determine the association between the AIDI and differences in survival time and to assess effect modification by smoking status.Methods: The study population included 68 273 Swedish men and women (aged 45-83 years) at baseline. The anti-inflammatory potential of the diet was estimated using the validated AIDI, which includes 11 potential anti-inflammatory and five potential pro-inflammatory foods. Cox proportional hazards and Laplace regression were used to estimate hazard ratios and differences in survival time.Results: During 16 years of follow-up (1 057 959 person-years), 16 088 deaths [5980 due to cardiovascular disease (CVD) and 5252 due to cancer] were recorded. Participants in the highest versus lowest quartile of the AIDI had lower risks of all-cause (18% reduction, 95% CI: 14-22%), CVD (20%, 95% CI: 14-26%) and cancer (13%, 95% CI: 5-20%) mortality. The strongest inverse associations between the highest and lowest quartiles of AIDI and risk of mortality were observed in current smokers: 31%, 36% and 22% lower risks of all-cause, CVD and cancer mortality, respectively. The difference in survival time between current smokers in the lowest AIDI quartile and never smokers in the highest quartile was 4.6 years.Conclusion: Adherence to a diet with high anti-inflammatory potential may reduce all-cause, CVD and cancer mortality and prolong survival time especially amongst smokers. [ABSTRACT FROM AUTHOR]

Multiple sharp force injuries in a victim make it difficult to distinguish between homicide and suicide. Forensic pathologists also may be unable to determine the total survival time and the survival time with physical activity due to lack of evidence. The authors report here on a case of nineteen stab wounds of the neck, which led to an initial suspicion of homicide. The scene was however captured on surveillance video, which provided a precise description of the wound mechanism and led to the injuries being reclassified as suicidal. No other description of a suicide with such a high number of severe stab wounds has been documented in the literature. The video footage provided additional information concerning survival time. Physical activity was well documented during at least 4 min after the last stab wound and the total survival period was at least 6 min, despite the perforation of both jugular veins and the trachea. Vein injuries are less rapidly lethal than artery injuries. Injuries of the major airways are not immediately lethal and do not lead to immediate incapacitation. The benefit of the video evidence is to highlight wound features that may suggest a suicidal manner and inform forensic pathologists about survival intervals after severe stab wounds to the neck. [ABSTRACT FROM AUTHOR]

Clinical trials in the era of precision medicine require assessment of biomarkers to identify appropriate subgroups of patients for targeted therapy. In a biomarker-stratified design (BSD), biomarkers are measured on all patients and used as stratification variables. However, such a trial can be both inefficient and costly, especially when the prevalence of the subgroup of primary interest is low and the cost of assessing the biomarkers is high. Efficiency can be improved and costs reduced by using enriched biomarker-stratified designs, in which patients of primary interest, typically the biomarker-positive patients, are oversampled. We consider a special type of enrichment design, an auxiliary variable-enriched design (AEBSD), in which enrichment is based on some inexpensive auxiliary variable that is positively correlated with the true biomarker. The proposed AEBSD reduces the total cost of the trial compared with a standard BSD when the prevalence rate of true biomarker positivity is small and the positive predictive value (PPV) of the auxiliary biomarker is larger than the prevalence rate. In addition, for an AEBSD, we can immediately randomize the patients selected in the screening process without waiting for the result of the true biomarker test, reducing the treatment waiting time. We propose an adaptive Bayesian method to adjust the assumed PPV while the trial is ongoing. Numerical studies and an example illustrate the approach. An R package is available. [ABSTRACT FROM AUTHOR]

Abstract: In this study, a superabsorbent polymer (SAP; Super‐AB‐A‐200) was used for the amendment of the water‐holding capacity of soil on a steep surface. Three concentrations of SAP [0.20, 0.40 and 0.60% (w w−1)] and a control (0%) were blended with sandy soil. This study aimed to evaluate the evaporation rate, water retention capacity and saturated water content of polymer‐treated soils for determining plant survival and seed germination rate through cylinder and steep surface experiments. The results demonstrated that sandy soil treated with SAP showed significantly enhanced soil water holding compared with the controls. Furthermore, the seed germination rate was significantly higher in polymer‐treated soils than in the controls. The survival times of grass and ligneous plants were lengthened under water stress conditions. Finally, treatment with 0.40% SAP was the optimum selection for sandy soil amendment on steep surfaces. [ABSTRACT FROM AUTHOR]

The modified Glasgow Prognostic Score ( mGPS) assigns a numerical value (0-2) from pre-treatment serum concentrations of C-reactive protein ( CRP) and albumin to predict patient outcome. CRP and albumin were evaluated in 77 untreated dogs with lymphoma to determine the relationship of mGPS to clinicopathological parameters and whether it could predict progression-free ( PFS) and overall survival ( OS) in treated dogs. mGPS distribution was significantly associated with clinical stage, substage b, weight loss, gastrointestinal disturbances and lethargy at presentation. On univariate analysis, mGPS was significantly associated with OS and PFS, with shorter median survival times for mGPS 2 compared to mGPS 0 and 1 combined. Hypoalbuminaemia significantly reduced OS and PFS, however increased CRP had no effect. Only clinical stage was significantly associated with OS and PFS on both univariate and multivariate analysis. mGPS has potential prognostic value for canine lymphoma , but further studies are needed. [ABSTRACT FROM AUTHOR]

Background: The impact of multiple healthy lifestyle factors on survival time is unclear.Objective: The aim of this study was to examine differences in survival time associated with a healthy lifestyle versus a less healthy lifestyle.Methods: This study consisted of 33 454 men (Cohort of Swedish Men) and 30 639 women (Swedish Mammography Cohort) aged 45-83 years and free of cancer and cardiovascular disease at baseline. The healthy lifestyle factors included the following: (i) nonsmoking; (ii) physical activity at least 150 min per week; (iii) alcohol consumption of 0-14 drinks per week; (iv) and healthy diet defined as a modified Dietary Approaches to Stop Hypertension Diet score above the median. Cox proportional hazards regression models and Laplace regression were used to estimate, respectively, hazard ratios of all-cause mortality and differences in survival time.Results: During follow-up from 1998 through 2014, 8630 deaths amongst men and 6730 deaths amongst women were ascertained through linkage to the Swedish Cause of Death Register. Each of the four healthy lifestyle factors was inversely associated with all-cause mortality and increased survival time. Compared with individuals with no or one healthy lifestyle factor, the multivariable hazard ratios of all-cause mortality for individuals with all four health behaviours were 0.47 (95% 95% confidence interval [CI]: 0.44-0.51) in men and 0.39 (95% CI: 0.35-0.44) in women. This corresponded to a difference in survival time of 4.1 (95% CI: 3.6-4.6) years in men and 4.9 (95% CI: 4.3-5.6) years in women.Conclusion: Adopting healthy lifestyle behaviours may markedly increase lifespan. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is a major, complicated disease in patients with dementia. However, the influence of pneumonia on the prognosis of patients with varying types of dementia has not been fully evaluated. Methods: We retrospectively analyzed the data from medical and autopsy reports. All study patients had been hospitalized and underwent brain autopsy in a hospital in Toyohashi, Japan, between 2005 and 2014. The patients with subtypes of dementia, specifically Alzheimer's disease (AD), dementia with Lewy bodies (DLB), or vascular dementia (VaD), were neuropathologically diagnosed and examined. Pneumonia incidence, cause of death, and the clinical time ‐ course of dementia were compared among the dementia subtypes. The time to death from dementia onset (survival time) was compared by the Kaplan – Meier method among subtypes of dementia with or without pneumonia. Risk factors for survival time on all study patients were analyzed with the Cox proportional hazard model. Results: Of the 157 eligible patients, 63 (40.1%) had AD, 42 (26.8%) had DLB, and 52 (33.1%) had VaD. Pneumonia complication was observed with high incidence in each subtype of dementia, especially in DLB (90.5%). The median total duration from dementia onset to death was 8 years in AD and DLB, and 5 years in VaD. The VaD subtype had more male patients than AD or DLB (P = 0.010), and age of death in this group was the youngest among the three groups (P = 0.018). A significant difference was observed in the survival time by the Kaplan – Meier method among the three groups (P < 0.001) and among the groups with pneumonia (P = 0.002). The factors associated with shorter survival time were male gender, pneumonia complications, diabetes mellitus, age of dementia onset ≥ 75 years, and VaD. Conclusions: Pneumonia complications shortened the survival time of patients with AD, DLB, and VaD. [ABSTRACT FROM AUTHOR]

Background: Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital.Methods: This multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services.Results: Among the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days' prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P = .006) and in the weeks' prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P = .007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months' prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P < .01) and adjusted models (HR, 0.87; 95% CI, 0.77-0.97; P = .01).Conclusions: In comparison with cancer patients who died in a hospital, cancer patients who died at home had similar or longer survival. Cancer 2016;122:1453-1460. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND The objective of this study was to determine the efficacy and safety of locoregional therapy (LRT) combined with arsenic trioxide (As2O3) treatment in primary hepatocellular carcinoma (HCC) patients. METHODS One hundred twenty-five primary HCC patients were recruited for a randomized controlled study. Patients were randomly divided into group A (n = 61) and group B (n = 64). All patients received transarterial chemoembolization. Group A patients were given As2O3 at 10 mg/d for 4 courses (21 days per course) with a 2-week interval between courses. Survival times, therapeutic responses, extrahepatic metastases, and adverse events were recorded. RESULTS A better therapeutic response was found in group A patients, as shown by higher objective response rate (ORR) and clinical benefit rate (CBR) values in group A versus group B (ORR, 81.96% [95% confidence interval (CI), 72.32%-91.62%] vs 59.37% [95% CI, 47.34%-71.41%], χ2 = 7.650, P < .05; CBR, 95.08% [95% CI, 89.66%-100.00%] vs 81.25% [95% CI, 71.69%-90.81%], χ2 = 5.659, P < .05). There were fewer patients with extrahepatic metastases in group A versus group B (group A, 6 cases or 9.84% [95% CI, 2.36%-17.31%]; group B, 12 cases or 18.75% [95% CI, 9.19%-28.31%]). The survival rate for group A patients was significantly higher than that for group B patients ( P < .05). No significant differences were found between the 2 groups in terms of hematology or digestive system, liver, or kidney dysfunction except for facial and limb edema. CONCLUSIONS LRT combined with As2O3 treatment prevents extrahepatic metastasis and prolongs the survival time for primary HCC patients. Cancer 2015;121:2917-2925. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

In cost-effectiveness analyses of drugs or health technologies, estimates of life years saved or quality-adjusted life years saved are required. Randomised controlled trials can provide an estimate of the average treatment effect; for survival data, the treatment effect is the difference in mean survival. However, typically not all patients will have reached the endpoint of interest at the close-out of a trial, making it difficult to estimate the difference in mean survival. In this situation, it is common to report the more readily estimable difference in median survival. Alternative approaches to estimating the mean have also been proposed. We conducted a simulation study to investigate the bias and precision of the three most commonly used sample measures of absolute survival gain - difference in median, restricted mean and extended mean survival - when used as estimates of the true mean difference, under different censoring proportions, while assuming a range of survival patterns, represented by Weibull survival distributions with constant, increasing and decreasing hazards. Our study showed that the three commonly used methods tended to underestimate the true treatment effect; consequently, the incremental cost-effectiveness ratio (ICER) would be overestimated. Of the three methods, the least biased is the extended mean survival, which perhaps should be used as the point estimate of the treatment effect to be inputted into the ICER, while the other two approaches could be used in sensitivity analyses. More work on the trade-offs between simple extrapolation using the exponential distribution and more complicated extrapolation using other methods would be valuable. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The dramatic increase in the complexity of flow cytometric datasets requires new computational approaches that can maximize the amount of information derived and overcome the limitations of traditional gating strategies. Herein, we present a multivariate computational analysis of the HIV-infected flow cytometry datasets that were provided as part of the FlowCAP-IV Challenge using unsupervised and supervised learning techniques. Out of 383 samples (stimulated and unstimulated), 191 samples were used as a training set (34 individuals whose disease did not progress, and 157 individuals whose disease did progress). Using the results from the training set, the participants in the Challenge were then asked to predict the condition and progression time of the remaining individuals (45 'nonprogressors' and 147 'progressors'). To achieve this, we first scaled down data resolution and then excluded doublet cells from the analysis using Expectation Maximization approaches. We then standardized all samples into histograms and used Genetic Algorithm-Neural Network to extract feature sets from the datasets, the reliability of which were examined using WEKA-implemented classifiers. The selected feature set resulted in a high sensitivity and specificity for the discrimination of progressors and nonprogressors in the training set (average True Positive Rate = 1.00 and average False Positive Rate = 0.033). The capacity of the feature set to predict real-time survival time was better when using data from the 'unstimulated' training set ( r = 0.825). The P-values and 95% confidence interval log-rank ratios between actual and predicted survival time in the test set were 0.682 and 0.9542 ± 0.24 for the unstimulated dataset, and 0.4451 and 0.9173 ± 0.23 for the stimulated dataset. Our analytic strategy has demonstrated a promising capacity to extract useful information from complex flow cytometry datasets, despite a significance imbalance and variation between the training and test sets. © 2015 International Society for Advancement of Cytometry [ABSTRACT FROM AUTHOR]

This study investigated the correlation between KIT gene expression determined by immunohistochemistry and real-time polymerase chain reaction ( RT-PCR) and the rate of tumour recurrence and tumour-related deaths in dogs affected with mast cell tumour ( MCT). Kaplan-Meier curves were constructed to compare tumour recurrence and tumour-related death between patients. The log-rank test was used to check for significant differences between curves. KIT-I, KIT-II and KIT-III staining patterns were observed in 9 (11.11%), 50 (61.73%) and 22 (27.16%) tumours, respectively. Tumour recurrence rates and tumour-related deaths were not associated with KIT staining patterns ( P = 0278, P > 0.05), KIT ( P = 0.289, P > 0.05) or KIT ligand ( P = 0.106, P > 0.05) gene expression. Despite the lack of association between KIT staining pattern and patient survival time, the results suggest a correlation between aberrant KIT localization and increased proliferative activity of MCTs. RT-PCR seems to be a sensible method for quantitative detection of KIT gene expression in canine MCT, although expressions levels are not correlated with prognosis. [ABSTRACT FROM AUTHOR]

Background Survival times of women starting first-line chemotherapy for metastatic breast cancer ( MBC) in routine clinical practice were determined and compared with those from a systematic review of randomised clinical trials. Methods We identified women with MBC starting first-line chemotherapy from June 2003 to February 2011 and recorded their demographics, tumour and treatment characteristics, and survival times from the start of chemotherapy. Their survival distribution was summarised by the following percentiles (represented scenarios for survival): 90th (worst-case), 75th (lower-typical), 25th (upper-typical) and 10th (best-case), which were compared with the same percentiles from our systematic review of first-line chemotherapy trials. Results The 273 women had a median age of 56 years, and a median time from diagnosis of MBC of 3 months. Eastern Cooperative Oncology Group performance status was 0-1 in 80%. Tumours were hormone receptor positive in 69%, human epidermal growth factor receptor 2 ( HER2)-positive in 27% and triple negative in 13%. Survival times in months in routine clinical practice (vs the systematic review) were: 90th percentile 4 (6); 75th percentile 9 (12); median 20 (22); 25th percentile 36 (36) and 10th percentile 61 (56). Independent predictors of overall survival included HER2-positive disease (hazard ratio ( HR) 0.49, P = 0.0002), hormone receptor positive disease ( HR 0.51, P = 0.0004), Eastern Cooperative Oncology Group performance status 0-1 ( HR 0.36, P < 0.0001) and adjuvant chemotherapy ( HR 1.86, P = 0.0002). Conclusion Median and better survival times in routine practice were similar to those from randomised clinical trials; however, survival times worse than the median were shorter, likely reflecting patient selection in trials. Oncologists should adjust trial-based survival estimates for patients not meeting typical trial eligibility criteria. [ABSTRACT FROM AUTHOR]

Gender-related risk factors in the survival of transplanted teeth with complete root formation have not yet been identified. The purpose of this study was to investigate gender differences in tooth autotransplantation at dental clinics. We asked participating dentists to provide information on transplantations they had undertaken from 1 January 1990 to 1931 December 2010. The data were screened to exclude patients who underwent more than one transplantation, smokers or those whose smoking habits were unknown, patients under 30 or who were 70 years old and over, cases where the transplanted teeth had incomplete root formation or multiple roots and those with fewer than 20 present teeth post-operation. We analysed 73 teeth of 73 males (mean age, 47·2 years) and 106 teeth of 106 females (mean age, 45·3 years) in this study. The cumulative survival rate and mean survival time were calculated using the Kaplan-Meier method. The cumulative survival rate for males was 88·3% at the 5-year mark, 64·8% at 10 years and 48·6% at 15 years; for females, it was 97·2% at the 5-year mark, 85·9% at 10 years and 85·9% at 15 years. A log-rank test indicated the difference between males and females to be significant ( P = 0·011). There was also a significant difference in the main causes for the loss of transplanted teeth: males lost more transplanted teeth due to attachment loss than females ( P < 0·05). These results indicate that males require more attention during the autotransplantation process, particularly at the stage of pre-operation evaluation and that of follow-up maintenance. [ABSTRACT FROM AUTHOR]

Cocaine-related fatalities can pose forensic challenges, particularly when accompanied by excited delirium (ED) syndrome and interventions by law enforcement and medical personnel. A recent report concluded that elevated heat shock protein 70 (HSP70) expression in autopsy brain samples constitutes a reliable forensic biomarker for the identification of ED as a cause of death. The present study quantified the abundance of both HSPA1A and HSPA1B gene (HSP70-encoding) transcripts in midbrain specimens from a series of cocaine-related fatalities and matched drug-free control subjects. HSP70 expression was increased significantly in cocaine abusers as a group compared to control subjects, irrespective of the presence or absence of ED. Furthermore, elevated HSP70 expression was predictive of a period of survival between cocaine use and death that included medical and/or police intervention. The present data do not support the assertion that HSP70 expression is a reliable brain biomarker for identifying ED as a cause of death. [ABSTRACT FROM AUTHOR]

This work focuses on the assessment of the discrimination ability of a binary marker to identify patients that will relapse in time. We consider the cumulative definition of sensitivity and dynamic definition of specificity at a time horizon, that is, the probability of a positive marker in the population that will relapse ( cases) and that will not relapse ( controls). In the presence of censoring, sensitivity and specificity cannot be estimated by proportions because it is not known whether censored subjects should be considered as cases or controls. The solutions proposed do not enable to obtain asymptotic confidence intervals. We explore the use of inverse probability of censoring weighting/imputation (borrowed from the methodology used to correct for verification bias) to adjust the classification matrix for the presence of censoring. The adjustment based on weights estimated conditional on the marker turned to be equivalent to the adjustment based on imputation. These approaches, which address for the presence of marker-dependent censoring, showed a better performance than the adjustment based on weights estimated on the entire sample, even in the case of marker-independent censoring. We derived single intervals and confidence region for sensitivity and 1-specificity using the delta method. The confidence region is particularly useful for a binary marker because the marker has some ability to discriminate among cases and controls only if the region does not intersect the first quadrant bisector. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary The aim of this study was to investigate the usage of tooth autotransplantation in dental clinics which offer the treatment and evaluate its practicality. Participating dentists were requested to provide information on transplantations they had undertaken from 1 January 1990 to 31 December 2010. A total of 614 teeth from 552 patients (37 dentists) ranging in age from 17 to 79 (mean age: 44·1) were examined. Cumulative survival rate and mean survival time were calculated using the Kaplan-Meier method, and log rank test was used for analysis of factors. The mean number of autotransplantation patients per clinic per year was 1·4. Upper third molars constituted 36·8% of donor teeth, while 37·1% were lower third molars. The lower first molar region was the most common recipient site at 32·6%, followed by the lower second molar region (28·0%). Prosthodontic treatment of transplanted teeth involved coverage with a single crown (72·5%) and abutment of bridge (18·9%). A total of 102 transplanted teeth were lost owing to complications such as attachment loss (54·9%) and root resorption (25·7%). The cumulative survival rate in cases where donor teeth had complete root formation was 90·1% at 5 years, 70·5% at 10 years and 55·6% at 15 years. The mean survival time was 165·6 months. Older age was a significant risk factor ( P < 0·05) for survival. In cases where suitable donor teeth are available, autotransplantation of teeth may be a plausible treatment option for dealing with missing teeth in dental clinics. [ABSTRACT FROM AUTHOR]

Tumour size is considered one of the most important determinants of clinical staging in cancer patients. The aim of this study was to assess the value of tumour size as an indicator of the differentiation of mammary neoplasias in female dogs. The tumour, nodes metastates (TNM) system, based on primary lesion size, the extent of its dissemination to regional lymph nodes and the presence or absence of distant metastases, was applied to 120 female dogs diagnosed with mammary neoplasias. Paraffin blocks from 38 cases were selected and studied by immunohistochemical staining for prognostic and predictive markers of breast cancer. The Kaplan–Meier survival curve was estimated for 110 female dogs. Larger tumours (T3) were mostly malignant and showed lower expression of progesterone receptor and higher expression of cellular proliferation markers. Global survival time was shorter in female dogs with large tumour masses. This study highlights the importance of tumour size as a prognostic indicator of mammary neoplasias in female dogs. [ABSTRACT FROM AUTHOR]

Introduction: The attributable fraction (AF) is used for quantifying the fraction of diseased ascribable to one or more exposures. The methodology and software for its estimation has undergone a considerable development during the last decades. Objectives: To introduce methods for: (i) apportioning excess risk to multiple exposures, groups of exposures and subpopulations; (ii) graphical description; and (iii) survival data. Results: Adjusted, sequential and average AFs are reasonable measures obtainable with standard software. The latter two both sum up to the combined AF for a set of exposures. The average AFs are independent of the exposures' ordering. For an ordered, preventive strategy, scaled sample space cubes illustrate the effects on the risk of disease from stepwise exposure removal. Pie charts illustrate the portions of the total risk ascribed to different exposures or risk-profiles. Attributable hazard fraction, AF before time t, and AF within study incorporate time to disease and interventions. Conclusions: The practice of crude calculations of AFs in epidemiology should be abandoned. Further development of methods for AFs with survival data and possibly linking it to causal modelling is of interest. Please cite this paper as: Eide GE. Attributable fractions for partitioning risk and evaluating disease prevention: a practical guide. The Clinical Respiratory Journal 2008; 2: 92–103. [ABSTRACT FROM AUTHOR]

Immunohistochemistry staining for β-amyloid precursor protein (β-APP) is a sensitive method to detect early axonal damage in traumatic brain injury, which was previously estimated to be of minimum 60–90 min after head injury. We present seven cases of well-documented posttraumatic survival of 35–60 min where β-APP detects early axonal damage. Cases were selected from routine work where documentation about survival is judged to be accurate. These are divided into three groups: group 1: severe head injury ( n = 7) with documented survival between 35 and 60 min. Group 2: severe head injury ( n = 4) with documented survival of less than 30 min. Group 3: cases ( n = 4) where death was not due to head injury but survival is documented between 45 and 109 min. The brains were fixed in formalin for 4 weeks and six regions (frontal lobe with anterior corpus callosum, parietal lobe with deep white matter, basal ganglia with posterior limb of internal capsule, cerebellum with white matter and middle cerebellar peduncle and pons with basis pontis and superior cerebellar peduncle) were sampled. All blocks were stained for haematoxylin and eosin and β-APP and selected ones for CD68, using antigen retrieval method. In group 1 sections revealed β-APP immunoreactivity in forms of small globules and granules and occasionally as thin and short filaments. These were detected in the pons, corpus callosum, internal capsule and cerebral white matter, with some variation in localization and intensity. In groups 2 and 3 all the sections were negative for β-APP staining. None of the cases showed evidence of severe brain swelling, increased intracranial pressure, ischaemia or infection. Using the antigen retrieval method, β-APP immunohistochemistry can detect axonal damage within 35 min after severe head injury. These results may have an implication in the consideration of minimal survival time after traumatic head injury in medico-legal practice. [ABSTRACT FROM AUTHOR]

The biological activity of the Ireland strain of Choristoneura fumiferana (Clem) nucleopolyhedrovirus (CfMNPV) propagated in different hosts was determined to provide the basis upon which genetically modified CfMNPV, or other naturally occurring isolates, should be compared. Occlusion bodies (OB) derived from CF-203 cells were significantly larger and more pathogenic than those propagated in vivo when tested against the fifth larval instar of C fumiferana (Clem) and C occidentalis Freeman. The dose-responses (LD50 and LD95, expressed as occlusion bodies per larva) of C fumiferana larvae to in vitro-propagated OBs were 274 and 5785, respectively. The values of LD50 and LD95 to C occidentalis larvae were 19 and 118, respectively. There were no significant differences in pathogenicity or size when OBs propagated in C fumiferana larvae were tested against either insect species, nor were there significant differences for OBs propagated in C occidentalis larvae. The LD50 and LD95 of in vivo- produced OBs to C fumiferana were 925 and 61 988, respectively. The LD50 and LD95 to C occidentalis were 50 and 453, respectively. OBs propagated in vitro had a mean volume of 13.13 µm3, whereas those propagated in vivo ranged from 0.84 to 1.41 µm3. The median survival time-responses (ST50) of fifth-instar C fumiferana or C occidentalis larvae to OBs propagated in vivo were not significantly different from those propagated in vitro at the dosage levels tested. Values of ST50 of C fumiferana larvae to in vitro- and in vivo-produced OBs at dosages causing less than 50% mortality ranged from 9.6 to 9.8 days post-lnoculation (dpi), whereas a LD95 dose resulted in ST50 values ranging from 7.3 to 7.7 days. ST50 values of C occidentalis larvae at dosages causing less than 50% mortality ranged from 9.8 to... [ABSTRACT FROM AUTHOR]

The authors report a case of a transvestite found murdered near his automobile with several lacerated contused wounds to the face and cranial fractures. Autopsy revealed that the cause of death was a serious head trauma with subdural and subarachnoidal hemorrhages. In order to identify the crime weapon, a scanning electron microscopy (SEM) was used which revealed metallic residue on the skin fragments with the same molecular composition of the car paint. As for survival time, antibody anti-beta-amyloid precursor protein (APP) was applied to brain fragments and brainstem tissue, allowing for axonal varicosities (which form 2 to 3 h following death) to be observed under the optic microscope. So, by using SEM we understood that the fatal cranial-encephalic lesions were the result of the victim’s head being repeatedly struck against the car door while anti-betaAPP led to the understanding that the time elapsed between injury and death was less than 2 to 3 h. [ABSTRACT FROM AUTHOR]