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This paper presents the individual parameters of the selected railway corridors in the selected country. Particularly, it describes the specific features of selected corridors in this country, summarizes their capacity, as well as proposes the methodology in order to specify the capacity of given railway section. The outcome is represented by the calculation of the appropriate railway section capacity implemented on the particular railway corridor in the selected EU country.

The Stryker Exeter stem (Stryker, Kalamazoo, MI) has been in service for over 50 years and remains the most widely used cemented stem. Stem fracture is a rare complication, with recently reported rates of 1 in 10,000. We present a case of Exeter stem fracture 25 years following initial implantation as well as a large periacetabular defect secondary to osteolysis. A revision total hip arthroplasty was performed, including periacetabular bone grafting for extensive osteolysis along with retention of a stable acetabular component. This case highlights the rare complication of Exeter stem fracture as well as the technique of bone grafting a large periacetabular defect with a retained acetabular component. This is of particular interest given the rarity of this event and the resurgence in North America of cemented femoral components in total hip arthroplasty.

Gastrointestinal stromal tumors (GIST) are the most common type of soft tissue sarcoma that occur throughout the gastrointestinal tract. Most of these tumors are caused by oncogenic activating mutations in the KIT or PDGFRA genes. The NCCN Guidelines for GIST provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with these tumors. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised systemic therapy options for unresectable, progressive, or metastatic GIST based on mutational status, and updated recommendations for the management of GIST that develop resistance to specific tyrosine kinase inhibitors.

Soft tissue sarcomas (STS) are rare malignancies of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Soft Tissue Sarcoma provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as retroperitoneal/intra-abdominal STS, desmoid tumors, and rhabdomyosarcoma. This portion of the NCCN Guidelines discusses general principles for the diagnosis and treatment of retroperitoneal/intra-abdominal STS, outlines treatment recommendations, and reviews the evidence to support the guidelines recommendations.

Introduction: This investigation assessed whether the following factors were associated with radiographic local progression in bone metastases from renal cell carcinoma (RCC): (1) high-risk histologic features (2) lesional surgery (3) biologically effective dose (BED) of radiation therapy. Methods and materials: A single-institution database identified all patients who underwent surgery and radiation therapy for bone metastases from RCC to the appendicular skeleton and pelvis from 2006 to 2016. Thirty-six patients underwent radiotherapy for 80 metastases. While all patients had surgical stabilization, 17/36 also had lesional surgery to address the metastatic lesion. Progression of each individual lesion was determined using the application of RECIST criteria to imaging at last follow-up. Results: The rate of progressive disease was 8/25 (32%) in the high-risk group versus 5/55 (9%) in the standard-risk group (p ​= ​0.019). The rate of progression among high-risk metastases undergoing lesional surgery was 0/9 versus 8/16 (50%) having non-lesional surgery (p ​= ​0.0218). The rate of progression among standard-risk metastases undergoing lesional surgery was 1/16 (6%) versus 4/39 (10%) with non-lesional surgery (p ​= ​1.00). High-risk histologic features (OR: 10.592, 95% confidence interval: 1.347–83.271, p ​= ​0.025) and as well as a reduction in risk with every additional Gray of BED (OR: 0.902, 95% confidence interval: 0.827–0.984, p ​= ​0.021) were found to predict progressive disease. Conclusions: Bone metastases from renal cell carcinoma with high-risk histologic features are associated with less favorable response to radiotherapy than those with standard-risk histology. Delivery of a higher BED was associated with lower odds of progression.

In this study, ultrasound (US) was evaluated for As, Cd, Pb, Mn, Sr and V extraction from seaweed samples. The following parameters of ultrasound-assisted extraction (UAE) using an US bath were: frequency (25 to 130 kHz), amplitude (30 to 100%), temperature (30 to 80 °C), sample mass (50 to 200 mg), extractant concentration (1 to 3 mol L−1 of HNO3) and treatment time (5 to 30 min). Acoustic density and power density distribution were calculated using the calorimetric method and mapping of the acoustic pressure distribution was also evaluated. The optimized UAE conditions were 200 mg of sample in 10 mL of 2 mol L−1 HNO3 and 30 min of sonication in a 25 kHz US bath (37.2 ± 4.0 W L−1) at 70% of amplitude and 70 °C. Analytes were quantified using inductively coupled plasma mass spectrometry and results were compared with values obtained using “silent” conditions (magnetic or mechanical stirring at 500 rpm, and without stirring), and a reference method based on microwave-assisted wet digestion (MAWD). The UAE method demonstrated the best extraction efficiency (higher than 95%) for all analytes, especially for As, Cd and V, with lower standard deviations (up to 5%) and lower blank values in comparison with the silent conditions. The proposed UAE method was more advantageous than the reference method, being faster, simpler, safer, more environmentally friendly, and with higher detectability (lower limits of quantification, from 0.0033 to 1.34 µg g−1). In addition, negligible blank values were obtained for UAE and no interference were observed in the determination step. Furthermore, the optimized UAE method was applied for Antarctic seaweed samples and comparison with results obtained by MAWD was satisfactory. In this sense, UAE is demonstrated to be a suitable option for sample preparation of seaweed samples and further determination of environmentally critical elements avoiding the use of concentrated reagents as in the MAWD reference method.

PurposeConventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility.MethodsA multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively.ResultsSignificant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively.ConclusionMedian survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).

BackgroundBreast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM).MethodsA retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the BCBM.ResultsThe overall receptor discordance rate was 132/316 (42%), and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors-nonetheless, median survival (MS) improved but did not reach statistical significance (HR, 17-28 mo, P = 0.12; HER2, 15-19 mo, P = 0.39). MS for patients who lost receptors was worse (HR, 27-18 mo, P = 0.02; HER2, 30-18 mo, P = 0.08).ConclusionsReceptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost, and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly.Key points1. Receptor discordance alters subtype in 32% of BCBM patients.2. The frequency of receptor gain for HR and HER2 was 25% and 13%, respectively.3. If receptors are lost, survival suffers. If receptors are gained, consider targeted treatment.

PurposeBrain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts.Methods and materialsA multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively.ResultsMedian survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01).ConclusionsMS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.

In November 2022, OpenAI publicly launched its large language model (LLM), ChatGPT, and reached the milestone of having over 100 million users in only 2 months. LLMs have been shown to be useful in a myriad of health care–related tasks and processes. In this paper, I argue that attention to, public access to, and debate about LLMs have initiated a wave of products and services using generative artificial intelligence (AI), which had previously found it hard to attract physicians. This paper describes what AI tools have become available since the beginning of the ChatGPT revolution and contemplates how it they might change physicians’ perceptions about this breakthrough technology.

BackgroundArtificial intelligence (AI)– and machine learning (ML)–based medical devices and algorithms are rapidly changing the medical field. To provide an insight into the trends in AI and ML in health care, we conducted an international patent analysis. ObjectiveIt is pivotal to obtain a clear overview on upcoming AI and MLtrends in health care to provide regulators with a better position to foresee what technologies they will have to create regulations for, which are not yet available on the market. Therefore, in this study, we provide insights and forecasts into the trends in AI and ML in health care by conducting an international patent analysis. MethodsA systematic patent analysis, focusing on AI- and ML-based patents in health care, was performed using the Espacenet database (from January 2012 until July 2022). This database includes patents from the China National Intellectual Property Administration, European Patent Office, Japan Patent Office, Korean Intellectual Property Office, and the United States Patent and Trademark Office. ResultsWe identified 10,967 patents: 7332 (66.9%) from the China National Intellectual Property Administration, 191 (1.7%) from the European Patent Office, 163 (1.5%) from the Japan Patent Office, 513 (4.7%) from the Korean Intellectual Property Office, and 2768 (25.2%) from the United States Patent and Trademark Office. The number of published patents showed a yearly doubling from 2015 until 2021. Five international companies that had the greatest impact on this increase were Ping An Medical and Healthcare Management Co Ltd with 568 (5.2%) patents, Siemens Healthineers with 273 (2.5%) patents, IBM Corp with 226 (2.1%) patents, Philips Healthcare with 150 (1.4%) patents, and Shanghai United Imaging Healthcare Co Ltd with 144 (1.3%) patents. ConclusionsThis international patent analysis showed a linear increase in patents published by the 5 largest patent offices. An open access database with interactive search options was launched for AI- and ML-based patents in health care.

The review summarizes and analyzes the results of domestic and major foreign studies of recent years concerning gender characteristics of the epidemiology and development mechanisms of metabolic syndrome and urolithiasis as an associated disease. A deep understanding of gender aspects in the pathogenesis of these pathologies can form the basis for development of high-quality diagnostic algorithms and pathogenetically grounded approaches to treatment.

Background. Time to treatment initiation (TTI) is a quality metric in cancer care. The purpose of this study is to determine the accuracy of TTI data from a single cancer center registry that reports to the National Cancer Database (NCDB) for sarcoma diagnoses. Methods. A retrospective analysis of a single Commission on Cancer (CoC)-accredited cancer center’s tumor registry between 2006 and 2016 identified 402 patients who underwent treatment of a musculoskeletal soft tissue sarcoma and had TTI data available. Registry-reported TTI was extracted from the tumor registry. Effective TTI was manually calculated by medical record review as the number of days from the date of tissue diagnosis to initiation of first effective treatment. Effective treatment was defined as oncologic surgical excision or initiation of radiation therapy or chemotherapy. Registry-reported TTI and effective TTI values were compared for concordance in all patients. Results. In the entire cohort, 25% (99/402) of patients had TTI data discordance, all related to surgical treatment definition. For patients with a registry-reported value of TTI = 0 days, 74% (87/118) had a diagnostic surgical procedure coded as their first treatment event, with 73 unplanned incomplete excision procedures and 14 incisional biopsies. In these patients, effective TTI was on average 59 days (P0 days, only 4% (12/284) had discordant TTI values. Conclusions. Nearly three-fourths of patients with a registry-reported value of TTI = 0 days in a large, CoC-accredited cancer center registry had a diagnostic procedure coded as their first treatment event, though their effective treatment had not yet started. These data suggest that TTI is likely longer than what is reported to the NCDB. Redefinition of what constitutes surgical treatment should be considered to improve the accuracy of data used in measuring TTI in sarcoma.

In this work, a microwave-assisted ultraviolet wet digestion (MAWD-UV) protocol was used to digest polymer-based materials (e-waste, food packing, medical-care materials, and individual protection equipment) for further halogen determination. Digests were suitable for Cl, Br, and I determination by inductively coupled plasma mass spectrometry (ICP-MS) or inductively coupled plasma optical emission spectrometry (ICP-OES). Fluorine determination was performed with ion selective electrode (ISE). The power radiation and the digestion solution were evaluated. The accuracy was evaluated by comparing the results with those obtained after neutron activation analysis (NAA) for Cl and Br or using microwave-induced combustion (MIC) as sample preparation for F and I. Two certified reference materials (CRM) of low-density polyethylene (ERM EC680k and EC681k) were evaluated, and no differences were observed (t-test, 95% confidence level) between the results and the certified values. Quantitative recoveries for Cl, Br, and I were obtained using 200 mg of the sample using diluted acid solution (15 mL of 0.5 mol L−1 HNO3 plus 10.6 mol L−1 of H2O2), with a 40 min radiation program (700 W, 25 min ramp). No statistical differences (ANOVA, 95% confidence level) were observed between the MAWD-UV and ICP-MS results and the reference values for Cl, Br, and I for several samples. However, results were lower than the reference values for fluorine, indicating that digestion efficiency was poor for this analyte, which was probably as an organic molecule (likely polytetrafluoroethylene). The limit of quantification (LOQ) was 0.216 mg g−1 for Cl, 3.33 µg g−1 for Br, and 0.036 µg g−1 for I using ICP-MS. The main advantage of MAWD-UV is that it enables decomposing several polymer-based matrices using diluted acid without halogen losses. The developed method represents an important contribution to the digestion of these hard-to-digest matrices and in compliance with green analytical chemistry, thereby being an advance in sample preparation.

Ipilimumab is a monoclonal cytotoxic T-lymphocyte-associated protein 4 antibody that has demonstrated improved survival in cutaneous melanoma. Little is known about the clinical impact of combining anti-cytotoxic T-lymphocyteassociated protein 4 therapy with radiation. Here we report a case of severe cutaneous desquamation in a 70-year-old female with vaginal/vulvar melanoma receiving concurrent ipilimumab and radiation therapy. The toxicity was successfully treated with oral/topical steroids and a break from treatment. This case underscores the importance of future research on optimal strategies for combining radiation with novel anti-tumour agents.

Population growth, increasing drought, and natural resources degradation are significant global issues. Fortunately, management practices to improve soil health can address many of these issues in ways that are both good for the farmer and the environment. In 2012, the United States Department of Agriculture (USDA) Natural Resources Conservation Service initiated its “Unlock the Secrets in the Soil” campaign to assist farmers and ranchers with adopting soil health systems. Other notable efforts at the federal level include research and education projects by USDA Agricultural Research Service, National Institute of Food and Agriculture, and Sustainable Agriculture Research and Education program. The importance of improving soil health is also recognized far beyond federal government programs. The Soil Health Institute, a nonprofit charity, was established to safeguard and enhance the vitality and productivity of soil through scientific research and adoption. Crop commodity organizations are promoting soil health, such as the Soil Health Partnership. The Nature Conservancy is helping companies and private landowners incorporate soil health into their sustainability efforts. Such efforts are supported by the Foundation for Food and Agriculture Research, as well as by some of the leading global food companies such as General Mills. These are just a few of the many efforts to improve soil health in the USA. The significance of the expanding global population, natural resource challenges, and responsibilities to current and future generations truly make enhancing soil health a global imperative.

Revision total hip arthroplasty presents many challenges in regards to reconstructing or managing large amounts of bone loss and soft-tissue damage. Modern revision components, as well as techniques, have helped to address these challenges; however, the goal of any surgery is to provide the least amount of surgery with the most successful outcome. This case highlights a 74-year-old man with a Tronzo total hip arthroplasty placed over 50 years prior. He presented with subjective hip instability and radiographs demonstrating disassociation of the modular component. In an attempt to avoid more extensive and costly surgery, a custom-made all-polyethylene femoral head was used. This case illustrates the revision of likely one of the few Tronzo total hips remaining and the utility of obtaining a compassionate-use clearance from the Food and Drug Administration to create a custom piece, to minimize potential morbidity and mortality from extensive hip revision surgery.

The microwave-assisted digestion of dietary supplements using diluted nitric acid under oxygen pressure for subsequent indirect determination of phosphorus and sulfur by ion chromatography (IC) was proposed. Different concentrations of nitric acid (from 1 to 14.4 mol L−1) and oxygen pressures (from 5 to 20 bar) were evaluated. Dissolved organic carbon and residual acidity were used to choose the most suitable digestion condition. Using the proposed method, it was possible to digest up to 1350 mg of dietary supplements using only 5 mol L−1 HNO3 under 5 bar of oxygen pressure. Comparing to conventional digestion procedure it was possible to digest up to 60% higher sample mass using HNO3 around 30% more diluted. Recoveries ranging from 96 to 102% were obtained when recovery tests using a standard solution or a mixture with certificate reference material were carried out. The concentration of P and S indirectly determined by IC agreed with the results obtained by conventional microwave-assisted digestion using concentrated HNO3 and subsequent determination by inductively coupled plasma optical emission spectrometry. Keywords: Sample preparation, Digestion under oxygen pressure, Diluted acid, Ion chromatography, Food safety, Routine analysis

Background. Radiation after resection of an atypical lipomatous tumor (ALT) is controversial. This study evaluates local control and complications after the first resection of ALTs of the extremity with or without adjuvant radiation. Methods. A dual institution, retrospective review of patients treated from 1995 to 2020 with first-time resection of an ALT in the extremity was performed. In total, 102 patients underwent adjuvant radiation (XRT group) and 68 patients were treated with surgery alone (no-XRT group). The median follow-up time was 4.6 years (interquartile range (IQR) 2.0–7.3 years). The median radiation dose was 60 Gy (IQR 55–66 Gy). Univariable and multivariable analyses evaluated the association of patient, tumor, and treatment variables with recurrence and complications. Kaplan–Meier analysis evaluated local recurrence-free survival (LRFS) and time to complication. Results. The overall incidence of local recurrence was 1% (1/102) in the XRT group and 24% (16/68) in the no-XRT group p

PurposeTo report early clinical outcomes of high-dose-rate interstitial image-guided brachytherapy (BT) in the definitive management of locally advanced cervical cancer.MethodsWe retrospectively analyzed 31 locally advanced cervical cancer patients treated at our institution between January 2010 and April 2013. About 88% had advanced disease based on the International Federation of Gynecology and Obstetrics guidelines, and 87% received concurrent chemotherapy. All patients were treated with external beam radiation therapy to a median dose of 45 Gy (range, 39.6-58 Gy) before receiving BT. High-dose-rate BT was delivered in a single implant to a median dose of 6 Gy × five fractions to a CT-defined volume. Median total equivalent 2-Gy dose, dose covered by 90% of the high-risk clinical target volume (HR-CTV D90), and HR-CTV were 84, 87.4, and 49.9 cc, respectively. Kaplan-Meier method was used for actuarial survival analysis, and toxicity was graded using Common Terminology Criteria for Adverse Events, version 4.0.ResultsMedian followup was 19.3 months. Two-year actuarial local control, regional control, and distant metastasis (DM) were 90%, 93%, and 23.6%, respectively. Two-year disease-free survival was 55%. Genitourinary, gastrointestinal, or gynecologic Grade 3 toxicity was seen in 5 patients (3 T4a and 2 T3b) for crude rates of 13%, 7%, and 3%, respectively. Stratifying HR-CTV by 30 cc and then by HR-CTV D90 of 90 Gy showed that 100% of the local failures, regional failures, DM, and G3 toxicity occurred in >30 cc group. The rate of DM was also significantly higher in the >30 cc group (p = 0.036).ConclusionsAn interstitial approach can achieve excellent outcomes in cases where intracavitary and/or hybrid approaches are either not suitable or not available.

Purpose: High-dose-rate (HDR) prostate brachytherapy delivers a heterogeneous dose distribution throughout the prostate gland. There is however limited information regarding the spatial distribution of this dose heterogeneity. To this end, we analyzed the magnitude and location of intraprostatic dose heterogeneity in HDR prostate brachytherapy. Methods and Materials: Five consecutive prostate cancer patients treated with HDR were analyzed. Based on CT-simulation images, each prostate was divided into three sections (apex, base, and mid-gland). These were further subdivided into eight symmetrical sections to give a total of 24 sections. Dose-volume histograms were analyzed from V100-V200% for these 24 sections comparing the means of individual regions, left vs right, apex vs base vs mid-gland, lateral vs medial, and anterior vs posterior. A separate analysis on dose as a function of individual region volume was also performed. Results: Analyses comparing the 24 regions showed a maximum 62% difference (range, 21.9-83.9%) at V130% and 19.9% (1.9-20.8%) at V200%. Seven regions were significantly decreased and one significantly elevated from V130-V180% when compared with the mean. The means for lateral sections were 1.57-fold higher than medial sections from V110-V200% (. p < 0.0001). The dose at the base was significantly higher than the rest of the gland from V120-V200 (V150, 35.6±16.2% vs 20.9±13.1%, p < 0.0001). Conclusions: There is significant intra-prostatic dose heterogeneity in prostate HDR brachytherapy. This is most notable in the increased dose to base and lateral portions of the gland. Further studies are needed to determine the impact of heterogeneity on clinical outcomes.

PurposeTo assess the ability of multiparametric (mp) MRI (mp-MRI) to identify, stratify, and localize biopsy-proven prostate cancer lesions in a risk-stratified patient population.Methods and materialsWe retrospectively analyzed 57 patients who had mp-MRI and core needle biopsy during diagnostic prostate cancer evaluation. The MRI sequences were scored for suspicion of cancer with a previously described system. Distributions of mp-MRI scores were compared across National Comprehensive Cancer Network prostate cancer risk groups. The mp-MRI-identified lesions were compared with the location of positive core needle biopsies to assess mp-MRI localization of true lesions.ResultsThe mp-MRI scoring system identified lesions in 84% (48/57) of the patients, including 100% (12/12) in the high-risk group. Scores assigned to lesions in patients in intermediate- and high-risk groups were statistically higher than those in the low-risk group, with a relative risk of 6.72 (95% confidence interval: 2.32-19.51, p

This research aimed to examine the impact of organizational culture on employee retention, providing insights to enhance long-term engagement and satisfaction. A mixed-methods approach was used, beginning with a comprehensive literature review of organizational culture and employee retention. Surveys were conducted with a representative sample of employees across different sectors in Kosovo. The data were analyzed using regression and correlation techniques to identify quantitative relationships between organizational culture and retention. The findings reveal that organizational culture plays a significant role in employee retention. Specifically, cultures focused on employee well-being, career development, and transparency are positively associated with higher retention rates. Employees are more likely to stay with organizations that align with their values, offer support, and create a transparent working environment. Conversely, toxic cultures marked by negativity and poor leadership are linked to higher turnover. The study underscores the importance of fostering a positive, inclusive culture that prioritizes employee growth. Kosovar businesses should invest in employee development, training, and continuous feedback to build a productive environment that supports retention. [ABSTRACT FROM AUTHOR]

The aim of this work was to study changes in mechanical lung properties in cases of COPD in general and in different zones depending on the body position.Materials and methods. The research was performed in 37 patients with chronic obstructive pulmonary disease (COPD) in the vertical and horizontal positions (VP and HP).Results. The analysis of integral respiration mechanics has revealed a reduction in dynamic lung compliance and an increase in total non-elastic lung resistance during expiration (TNRexp) in HP vs. VP. At the same time, despite the increase in TNRexp in HP, the total work of breathing did not increase. Unlike healthy individuals, the COPD patients were characterized by the absence of differences in regional mechanical properties in both VP and HP. There were no differences in the respiration mechanics of the left lung, and the zones of the right lung only differed in the parameters of regional non-elastic work of breathing (NWBr ) that was increasing from top downwards: the indicators of NWBr during expiration and NWBr in the lower zone were higher as opposed to those of the upper zone in VP. As for HP, NWBr during inspiration, NWBr during expiration and NWBr were higher.Conclusion. The data obtained contradict the prevailing opinion about an escalation in regional differences in ventilation and respiration mechanics under the influence of emerging focal and diffuse inflammatorysclerotic pathological changes in lungs and emphysema.

BackgroundKi-67 is a robust predictive/prognostic marker in prostate cancer; however, tumor heterogeneity in prostate biopsy samples is not well studied.MethodsUsing an MRI/US fusion device, biopsy cores were obtained systematically and by targeting when indicated by MRI. Prostate cores containing cancer from 77 consecutive men were analyzed. The highest Ki-67 was used to determine interprostatic variation. Ki-67 range (highest minus lowest) was used to determine intraprostatic and intralesion variation. Apparent diffusion coefficient (ADC) values were evaluated in relation to Ki-67.ResultsInterprostatic Ki-67 mean ± standard deviation (SD) values for NCCN low (L), intermediate (I), and high (H) risk patients were 5.1 ± 3.8%, 7.4 ± 6.8%, and 12.0 ± 12.4% (ANOVA P = 0.013). Intraprostatic mean ± SD Ki-67 ranges in L, I, and H risk patients were 2.6 ± 3.6%, 5.3 ± 6.8%, and 10.9 ± 12.3% (ANOVA P = 0.027). Intralesion mean ± SD Ki-67 ranges in L, I, and H risk patients were 1.1 ± 0.9%, 5.2 ± 7.9%, and 8.1 ± 10.8% (ANOVA P = 0.22). ADC values at Ki-67 > and

BackgroundKi-67 is a robust predictive/prognostic marker in prostate cancer; however, tumor heterogeneity in prostate biopsy samples is not well studied.MethodsUsing an MRI/US fusion device, biopsy cores were obtained systematically and by targeting when indicated by MRI. Prostate cores containing cancer from 77 consecutive men were analyzed. The highest Ki-67 was used to determine interprostatic variation. Ki-67 range (highest minus lowest) was used to determine intraprostatic and intralesion variation. Apparent diffusion coefficient (ADC) values were evaluated in relation to Ki-67.ResultsInterprostatic Ki-67 mean ± standard deviation (SD) values for NCCN low (L), intermediate (I), and high (H) risk patients were 5.1 ± 3.8%, 7.4 ± 6.8%, and 12.0 ± 12.4% (ANOVA P = 0.013). Intraprostatic mean ± SD Ki-67 ranges in L, I, and H risk patients were 2.6 ± 3.6%, 5.3 ± 6.8%, and 10.9 ± 12.3% (ANOVA P = 0.027). Intralesion mean ± SD Ki-67 ranges in L, I, and H risk patients were 1.1 ± 0.9%, 5.2 ± 7.9%, and 8.1 ± 10.8% (ANOVA P = 0.22). ADC values at Ki-67 > and