Introduction: Landmark ISCHEMIA (ISCH) trial provided unique information, but the generalizability of its results into myocardial revascularization guidelines and practice has been met by unprecedented debate. Hypothesis: We aimed to compare the 5 year all-cause mortality (5y Mt) in our ISCH trial like patients (pts) with results in ISCH. Methods: After applying ISCH study inclusion/exclusion criteria we identified 854 pts from our prospective database of 2455 consecutive pts who had the first isolated CABG in 2012-2015 with complex CAD with 100% follow up (F-up) of 5y Mt. Results: Comparative characteristics of ISCH like and actual ISCH pts are presented in Table 1. Аll our pts underwent CABG, contrary to ISCH where CABG and PCI were used in 538 and 1532 pts, consecutively. Although in ISCH pts had high diversity of ethnicity, were older, had more DM2 (but less insulin dependent), and had previous PCI or CABG in 25%, our pts were strikingly sicker (lower LVEF, higher proportion of 3VD and proximal LAD, higher NYHA as well as more comorbidities) 5-year mortality was 8.9% compared to 9% in the Invasive arm of ISCH. Of note 48 h mortality from MI type 5 (post CABG) was 1.67% in ISCH, and 30-day Mt in our study was 1.30%, with complete revascularization in 95%. As expected by the disease severity treated by CABG early Mt was higher in our than ISCH pts (Figure 1). Conclusion: The present study findings outline that translation of results from the ISCHEMIA trial with practice-changing implications into recommendations for a local Heart Team discussion to advise the best treatment decision for patients with more complex forms of CAD is uncertain and requires further research activities.

Thymic epithelial tumors (TET) are a group of rare neoplasms of the anterior mediastinum comprising thymomas and thymic carcinomas. The carcinogenesis of TET is mostly unknown. Many studies, mostly retrospective case series, have tried to establish prognostic factors in TET. TET is a very heterogeneous group of tumors with many subtypes for which diagnosis and treatment remains a very challenging task. Despite the disparities among retrospective studies, there are some prognostic factors that are more pertinent such as the completeness of resection, TNM stage and the Masaoka‐Koga classification. On the other hand, the identification of different genetic pathways that result in the pathogenesis of TET represents a fascinating field of study that could possibly lead to the development of new targeted therapies. The aim of this review is to discuss the different prognostic factors and genetic markers of TET. The meticulous use of national and international databases could provide sufficient number of patients in order to draw more valid conclusions.

Introduction: Women are less likely than men to be promptly diagnosed with acute coronary syndrome (ACS) and have worse post-ACS outcomes. These diagnostic failures are partially due to ACS findings on surface ECG manifesting differently in women, which may result in unnecessary delays in treatment. To narrow health disparities, we aim to investigate the sex-specific signatures of ACS as they appear on ECGs. Methods: This was a prospective observational cohort study of chest-pain patients evaluated for suspected ACS at 3 UPMC-affiliated tertiary care hospitals. After featurization, all ECG data were separately fed into 7 machine learning classifiers to predict ACS. We examined the results by sex. We also investigated two other methods: (1) building two independent models based respectively on the female and male subgroups and (2) building a model based on the initial total sample supplemented by the patients’ sex. We used Shapley values to explain the decision-making criteria of the models. We report the results for random forest, the best performing classifier. Results: Our sample consisted of 4132 patients (Age 59 ± 16; 47% female; 15% ACS). Machine learning models continue to disproportionately underperform in females across all classifiers evaluated. The sensitivity, specificity and false negative rate in the global model blinded to sex were 82.89%, 76.22% and 17.11% for men, and 67.39%, 74.16% and 32.61% for women (p<0.0001). This statistically significant gap could not be alleviated by building sex-specific models or feeding sex to the input of the model. Indeed, the rate of false negatives in sex-specific models and global models with sex as input were 14.67% and 18.42% for men, and 34.04% and 32.61% for women (p<0.0001). The explainability analysis of the sex-specific models revealed that STT configuration in lateral leads is most informative in women, whereas STT configuration in all leads and particularly in anterolateral leads most informative in men. Conclusions: Machine learning models display crucial sex differences in the ACS signatures on the ECG that consistently put women in a detrimental situation. The alternative methods investigated here are not adequate solutions for this disparity. Thus, further investigations should be conducted.

INTRODUCTION: This study was created to analyze dynamic alterations in coagulation, hematological and biochemical parameters and their association with mortality of COVID-19 patients. To identify the most sensitive biomarkers as predictors of mortality more research is required. METHODS: The present study was a prospective, one-year-long observational study conducted on all critically ill, COVID–19 patients with respiratory failure. The following data were collected: demographic and clinical characteristics of the study population, comorbidities, coagulation, biochemical and hematological parameters. The primary outcome was the proportion of patients who died. RESULTS: 91 patients with median age 60 (50–67), 76.9% male, met the acute respiratory distress syndrome criteria. It was tested whether dynamic change (delta-Δ) of parameters that were found to be predictors of mortality is independently associated with poor outcome. Adjusted (multivariate) analysis was used, where tested parameters were corrected for basic and clinical patients characteristics. The only inflammatory parameter which dynamic change had statistically significant odds ratio was ΔCRP (p < 0.005), while among coagulation parameters statistically significant OR was found for Δ fibrinogen (p < 0.005) in predicting mortality. CONCLUSION: Monitoring of coagulation, hematological and biochemical parameters abnormalities and their dynamical changes can potentially improve management and predict mortality in critically ill COVID –19 patients.

The horseshoe prior is known to possess many desirable properties for Bayesian estimation of sparse parameter vectors, yet its density function lacks an analytic form. As such, it is challenging to find a closed-form solution for the posterior mode. Conventional horseshoe estimators use the posterior mean to estimate the parameters, but these estimates are not sparse. We propose a novel expectation-maximisation (EM) procedure for computing the MAP estimates of the parameters in the case of the standard linear model. A particular strength of our approach is that the M-step depends only on the form of the prior and it is independent of the form of the likelihood. We introduce several simple modifications of this EM procedure that allow for straightforward extension to generalised linear models. In experiments performed on simulated and real data, our approach performs comparable, or superior to, state-of-the-art sparse estimation methods in terms of statistical performance and computational cost.

Introduction: Dental fear and anxiety (DFA) is a ubiquitous entity among dental patients in terms of their prevalence and incidence. It is among the major clinical problems in dentistry. In addition, the differences in DFA prevalence were present considering the age and gender of patients and over time, but with some opposite reports. The aim of this study is to examine the prevalence of DFA presence in children concerning their age, gender, and over time. Methods: The survey sample comprised 200 of 9–12-year-old children. The DFA presence was determined twice by the modified version of the CFSS-DS scale (CFSS-DS-mod scale) during a 6-months long period between the first and the subsequent dental appointment due to the need for restorative dental treatment. The scale was applied before the restorative treatment started on both occasions. Results: The prevalence of DFA was 17.5% in the study sample and decreased over time. It was slightly higher in girls. Conclusions: The DFA prevalence in 9–12-year-old children is decreasing over time. Latent manifestations of DFA presence should be considered for evaluation in the future.

The operating speed is the average value of the speed of traffic flow under normal conditions, i.e., the conditions of mutual interference of traffic participants. The operating speed serves as a gauge for how well a given roadway is performing under the applicable traffic conditions. All key decisions in the management of the growth and utilization of a road network, including planning, designing, evaluating, and implementing road projects, depend on accurate measures of capacity and level of service. This paper aims to develop a recommended model for operating speed on two-lane roads under local conditions by analyzing the operating speeds of the traffic flow on representative sections of such roads. Through the modeling process, the values of the 85th percentile of the operating speed were determined, and compared with relevant studies. The results show that the authors have successfully modeled operating speeds as a function of longitudinal gradient in local conditions on two-lane roads.

BACKGROUND: Questions remain regarding optic nerve (ON) physiology, mechanical compliance, and microvasculature, particularly surgical outcomes and atypical visual field defects associated with sellar/parasellar pathology (eg, tumors and aneurysms). OBJECTIVE: To study the microsurgical/histological anatomy of each ON segment and corresponding microvasculature, calculate area of optic-carotid space at each decompression stage, and measure ON tension before/after compression. METHODS: Five cadaveric heads (10 sides) underwent sequential dissection: (1) intradural (arachnoidal) ON dissection; (2) falciform ligament opening; (3) anterior clinoidectomy, optic canal decompression, and ON sheath release. At each step, we pulled the nerve superiorly/laterally with a force meter and measured maximal mobility/mechanical tension in each position. RESULTS: Cisternal ON microvasculature was more superficial and less dense vs the orbital segment. ON tension was significantly lower with higher mobility when manipulated superiorly vs lateromedially. Optic-carotid space significantly increased in size at each decompression stage and with ON mobilization both superiorly and laterally, but the increase was statistically significant in favor of upward mobilization. At decompression step, upward pull provided more space with less tension vs side pull. For upward pull, each step of decompression provided added space as did side pull. CONCLUSION: Opening the optic canal, falciform ligament, and arachnoid membrane decompresses the ON for safer manipulation and provided a wider optic-carotid surgical corridor to access sellar/parasellar pathology. When tailoring decompression, the ON should be manipulated superiorly rather than lateromedially, which may guide surgical technique, help prevent intraoperative visual deterioration, facilitate postoperative visual improvement, and help understand preoperative visual field deficits based on mechanical factors.

Objective − The aim of this research was to evaluate the physical and mental health of emerging adults who lost a parent before the age of 18, and to examine the predictors of satisfaction with physical and mental health. Materials andMethods − The subjects who participated in this study were emerging adults (18-29 years of age) from Bosnia and Herzegovina and Croatia. For this study, the equivalent pairs method was used - participants who had experienced the death of a parent were matched with those who had not experienced such a loss in relation to the variables of sex, age, and socioeconomic status, comprising a sample of 29 pairs, i.e., 58 subjects - 50 women and 8 men. The research was conducted via an online questionnaire. Participants completed the Psychosomatic Symptoms Questionnaire, CORE-OM questionnaire for evaluation of general psychopathological difficulties, and were asked to rate their satisfaction with their physical and mental health.Results − The results show no statistically significant difference between the two groups in the levels of satisfaction with physical health, the presence of physical symptoms, and the presence of general psychopathological difficulties. A statistically significant difference was found between the groups in the level of satisfaction with mental health - those who had experienced the loss of a parent reported lower satisfaction with their mental health. The experience of the loss of a parent explained their mental health satisfaction level, above the results of the standardized measures of mental health.Conclusion − The results indicate the need for assessing levels of satisfaction with mental health beyond the assessment of levels of general psychopatological symptoms when working with adults who experienced the early death of a parent.