BACKGROUND: Perioperative goal directed therapy (pGDT) using flow monitoring has been associated with improved outcomes. However, its protocols are often based on stroke volume only: as a target for fluid loading, inotropic support and vasopressors (via mathematical coupling of systemic vascular resistance). In this trial, we have tested the multi-parametric pGDT protocol based on esophageal Doppler variables (corrected flow time, peak velocity) in intermediate-to-high risk patients undergoing gastrointestinal surgery. METHODS: Intermediate-to-high risk patients undergoing gastrointestinal surgery were randomized to standard care (control) or multi-parametric pGDT (intervention). Postoperative complications and death rate as well as hospital length of stay were assessed as primary and secondary outcomes. RESULTS: Overall, 140 patients (intervention, N.=71, and control, N.=69) were included and randomized out of 197 eligible. Higher vasoactive/inotropic drug use and lower fluid balance were observed in the intervention group leading to favorable hemodynamic profile. The pGDT intervention was associated with improved primary outcome (28 days mortality and morbidity defined as occurrence of any defined complication) - 20 patients (28.2%) versus 32 (46.4%) in the control group (P=0.036); RR 0.61 (95% CI: 0.39-0.95), P=0.03. No differences in mortality and hospital length of stay were observed between groups. CONCLUSIONS: In this monocentric trial the multi-parametric pGDT protocol based on domain specific functional hemodynamic parameters was associated with lower rate of postoperative complications in intermediate-to-high risk patients undergoing scheduled gastrointestinal procedures.

• MeSH
• Digestive System Surgical Procedures methods   MeSH
• Early Goal-Directed Therapy MeSH
• Hemodynamics * MeSH
• Risk Assessment MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Complications prevention & control   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH

OBJECTIVE: Nowadays proper detection of cognitive impairment has become a challenge for the scientific community. Alzheimer's Disease (AD), the most common cause of dementia, has a high prevalence that is increasing at a fast pace towards epidemic level. In the not-so-distant future this fact could have a dramatic social and economic impact. In this scenario, an early and accurate diagnosis of AD could help to decrease its effects on patients, relatives and society. Over the last decades there have been useful advances not only in classic assessment techniques, but also in novel non-invasive screening methodologies. METHODS: Among these methods, automatic analysis of speech -one of the first damaged skills in AD patients- is a natural and useful low cost tool for diagnosis. RESULTS: In this paper a non-linear multi-task approach based on automatic speech analysis is presented. Three tasks with different language complexity levels are analyzed, and promising results that encourage a deeper assessment are obtained. Automatic classification was carried out by using classic Multilayer Perceptron (MLP) and Deep Learning by means of Convolutional Neural Networks (CNN) (biologically- inspired variants of MLPs) over the tasks with classic linear features, perceptual features, Castiglioni fractal dimension and Multiscale Permutation Entropy. CONCLUSION: Finally, the most relevant features are selected by means of the non-parametric Mann- Whitney U-test.

• Keywords
• Alzheimer's disease, deep learning, emotion analysis, innovative tools, multi-tasks, speech processing, spontaneous speech,
• MeSH
• Alzheimer Disease diagnosis   MeSH
• Early Diagnosis MeSH
• Deep Learning MeSH
• Diagnosis, Computer-Assisted * methods   MeSH
• Adult MeSH
• Cognitive Dysfunction diagnosis   MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Speech Production Measurement MeSH
• Nonlinear Dynamics MeSH
• Neuropsychological Tests MeSH
• Speech * MeSH
• Pattern Recognition, Automated * methods   MeSH
• Aged MeSH
• Speech Recognition Software MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

The study of new and innovative quasi-brittle materials offers new possibilities for use in construction, but detailed knowledge of their behavior and mechanical properties is required. The use of new materials in the design solution of a structure is usually associated with numerical methods, which has a number of both advantages and disadvantages. Sophisticated numerical methods, without a sufficiently detailed input knowledge, can provide highly variable results with little informative value. The main goal of this article is to present the procedure for the identification of fracture mechanical parameters for a specific concrete with the use of developed inverse analysis combining multi-criteria decision analysis, stochastic modelling and nonlinear analysis. Subsequently, the identified mechanical parameters of concrete are used for the parametric study of shear resistance of structural beams without shear reinforcement, as an alternative or generalized approach to the study of damage to concrete and concrete structures. This research includes an experimental program using 24 reinforced concrete beams and a detailed determination of basic and specific mechanical properties during laboratory tests. The process of inverse analysis is illustrated in detail for the solved task. The use of nonlinear analysis for detailed failure modelling is based on a 3D computational model and a fracture plastic material model for concrete. Finally, the results of the experimental program and numerical modelling are discussed, leading to a number of conclusions.

• Keywords
• beam, bending test, concrete, inverse analysis, mechanical parameters, reinforced concrete, shear, steel,
• Publication type
• Journal Article MeSH

An increasing interest in a healthy lifestyle raises questions about optimal body weight. Evidently, it should be clearly discriminated between the standardised "normal" body weight and individually optimal weight. To this end, the basic principle of personalised medicine "one size does not fit all" has to be applied. Contextually, "normal" but e.g. borderline body mass index might be optimal for one person but apparently suboptimal for another one strongly depending on the individual genetic predisposition, geographic origin, cultural and nutritional habits and relevant lifestyle parameters-all included into comprehensive individual patient profile. Even if only slightly deviant, both overweight and underweight are acknowledged risk factors for a shifted metabolism which, if being not optimised, may strongly contribute to the development and progression of severe pathologies. Development of innovative screening programmes is essential to promote population health by application of health risks assessment, individualised patient profiling and multi-parametric analysis, further used for cost-effective targeted prevention and treatments tailored to the person. The following healthcare areas are considered to be potentially strongly benefiting from the above proposed measures: suboptimal health conditions, sports medicine, stress overload and associated complications, planned pregnancies, periodontal health and dentistry, sleep medicine, eye health and disorders, inflammatory disorders, healing and pain management, metabolic disorders, cardiovascular disease, cancers, psychiatric and neurologic disorders, stroke of known and unknown aetiology, improved individual and population outcomes under pandemic conditions such as COVID-19. In a long-term way, a significantly improved healthcare economy is one of benefits of the proposed paradigm shift from reactive to Predictive, Preventive and Personalised Medicine (PPPM/3PM). A tight collaboration between all stakeholders including scientific community, healthcare givers, patient organisations, policy-makers and educators is essential for the smooth implementation of 3PM concepts in daily practice.

• Keywords
• Adults, Anorexia athletica, Anthropometrics, Artificial intelligence in medicine, BMI deviation, Big data management, Biomarker panel, Body fluids, Body weight, COVID-19, Cancers, Cardiovascular disease, Communicable, Deficits, Disease development, Elderly, Endothelin-1, Fat, Flammer syndrome, Health economy, Health policy, Healthcare, Hypoxic effects, Immune system, Individualised patient profile, Inflammation, Innovative population Screening Programme, Intentional, Manifestation, Medical imaging, Metabolic pathways, Microbiome, Modelling, Molecular patterns, Multi-level diagnostics, Multi-parametric analysis, Neurodegeneration, Neurology, Non-communicable disorders, Nutrition, Overweight, Pathology, Population health, Predictive preventive personalised medicine (3PM/PPPM), Pregnancy, Progression, ROS, Reproductive dysfunction, Sports medicine, Stroke, Systemic ischemia, Underweight, Unintentional, Vasoconstriction, Weight loss, Well-being, Wound healing, Youth,
• Publication type
• Journal Article MeSH

BACKGROUND: High-intensity focused ultrasound (HIFU) emerged as a novel approach for the treatment of localized prostate cancer (PCa). However, prospective studies on HIFU-related outcomes and predictors of treatment failure (TF) remain scarce. MATERIALS AND METHODS: We conducted a multinational prospective cohort study among patients undergoing HIFU therapy for localized, low- to intermediate-risk PCa. Follow-up data on serial prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (mpMRI), targeted/systematic biopsies, adverse events and functional outcomes were collected. The primary endpoint was TF, defined as histologically confirmed PCa requiring whole-gland salvage treatment. Uni- and multi-variable adjusted hazard ratios (HRs) were calculated using Cox proportional hazard regression models. RESULTS: At baseline, mean (standard deviation) age was 64.14 (7.19) years, with the majority of patients showing T-stage 1 (73.9%) and International Society of Urological Pathology grading system Grade 2 (58.8%). PSA nadir (median, 1.70 ng/mL) was reached after 6 months. Of all patients recruited, 16% had clinically significant PCa, as confirmed by biopsy, of which 13.4% had TF. Notably, T-stage and number of positive cores at initial biopsy were independent predictors of TF during follow-up (HR [95% CI] 1.27 [1.02-1.59] and 5.02 [1.80-14.03], respectively). Adverse events were minimal (17% and 8% early and late adverse events, respectively), with stable or improved functional outcomes in the majority of patients. CONCLUSIONS: This interim analysis of a multinational study on HIFU therapy for the management of low-to-intermediate-risk PCa reveals good functional outcomes, minimal adverse events and low incidence of TF over the short-term. Data on long-term outcomes, specifically as it relates to oncological outcomes, are awaited eagerly.

• Keywords
• focal therapy, high intensity focused ultrasound therapy, localized prostate cancer, prostate,
• MeSH
• High-Intensity Focused Ultrasound Ablation methods   MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Multiparametric Magnetic Resonance Imaging MeSH
• Prostatic Neoplasms * therapy   pathology   MeSH
• Treatment Failure MeSH
• Proportional Hazards Models MeSH
• Prospective Studies MeSH
• Prostate-Specific Antigen * metabolism   blood   MeSH
• Aged MeSH
• Neoplasm Grading MeSH
• Ultrasound, High-Intensity Focused, Transrectal MeSH
• Salvage Therapy methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

Words like yeah, okay and (al)right are fairly unspecific in their lexical semantics, and not least for this reason there is a general tendency for them to occur with highly varied and expressive prosodic patterns across languages. Here we examine in depth the prosodic forms that express eight pragmatic functions of the Czech discourse marker jasně, including resignation, reassurance, surprise, indifference or impatience. Using a collection of 172 tokens from a corpus of scripted dialogues by 30 native speakers, we performed acoustic analyses, applied classification algorithms and solicited judgments from native listeners in a perceptual experiment. There appeared to be multi-parametric differences between jasně realizations in terms of their F0, timing and intensity patterns, which gave rise to generally consistent form-function mappings. For example, resignation seems to be realized with a falling intonation contour, relatively slow tempo, long wordinitial consonant and a short word-final vowel. Although the most significant prosodic parameters used for clustering analysis involved segment durations, all pragmatic functions were expressed by patterns of multiple features.

• MeSH
• Speech Acoustics * MeSH
• Phonation physiology   MeSH
• Language * MeSH
• Communication MeSH
• Humans MeSH
• Speech Perception physiology   MeSH
• Semantics * MeSH
• Verbal Behavior physiology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Renal amyloid involvement results, especially, from AL (primary) or AA (secondary) amyloidosis. The extent of amyloid tissue deposits in the kidneys and the clinical course of amyloidosis not only depend on the type of basic process but also reflect the time of diagnosis and the ability to affect the underlying disease. We analyzed laboratory and clinical data from patients with bioptically proven renal amyloidosis. Renal amyloidosis was found in 99 patients (4.65%) from an overall number of 2,128 renal biopsies (RB) performed in our department during a period of 11 years (from 1995 to 2006). AA amyloidosis was diagnosed in 46 patients. Nephrotic syndrome was diagnosed in 27 patients (59%) with AA amyloidosis; all these patients had different degrees of proteinuria. Impaired renal function was discovered in 24 patients (52%); in three of these patients (6.5%) we had to start renal replacement therapy. Patients were treated with corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biological therapy in various regimens. Nine patients (19.5%) died during the one-year follow-up period; complications such as sepsis and cardiac failure were the leading causes of death. Median survival in the AA group was 54 months. Although for approximately half of patients different treatment regimens can lead to a partial remission or disease stabilization, the prognosis of patients with amyloidosis could be regarded as unsatisfactory.

• MeSH
• Amyloid metabolism   MeSH
• Amyloidosis diagnosis   epidemiology   MeSH
• Survival Analysis MeSH
• Antirheumatic Agents therapeutic use   MeSH
• Kidney Failure, Chronic diagnosis   epidemiology   MeSH
• Adult MeSH
• Risk Assessment MeSH
• Immunohistochemistry MeSH
• Incidence MeSH
• Biopsy, Needle MeSH
• Cohort Studies MeSH
• Drug Therapy, Combination MeSH
• Middle Aged MeSH
• Humans MeSH
• Nephrology statistics & numerical data   MeSH
• Nephrotic Syndrome diagnosis   epidemiology   MeSH
• Kidney Diseases diagnosis   drug therapy   epidemiology   MeSH
• Statistics, Nonparametric MeSH
• Prednisolone therapeutic use   MeSH
• Prognosis MeSH
• Retrospective Studies MeSH
• Sex Distribution MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• Age Distribution MeSH
• Kidney Function Tests MeSH
• Health Surveys MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Names of Substances
• Amyloid MeSH
• Antirheumatic Agents MeSH
• Prednisolone MeSH

This study is concerned with parametric radiation from an arbitrary axisymmetric planar source with a special focus on low-frequency difference-frequency fields. As a model equation accounting for nonlinearity, diffraction, and dissipation, the Westervelt equation is used. The difference-frequency-field patterns are calculated in the quasi-linear approximation by the method of successive approximations. A multi-layer integral for calculation of the acoustic field is reduced to a three-dimensional one by employing an approximate analytical description of the primary field with the use of a multi-Gaussian beam expansion. This integral is subsequently reduced in the paraxial approximation to a one-dimensional form which has previously been published in literature and which represents a means for fast calculations of secondary acoustic fields. The three-dimensional integral is calculated numerically and the numerical results predict nonzero amplitude of the low-frequency field in the vicinity of the source which is an effect that cannot be correctly encompassed in the paraxial approximation.

• MeSH
• Acoustics instrumentation   MeSH
• Algorithms MeSH
• Time Factors MeSH
• Equipment Design MeSH
• Nonlinear Dynamics MeSH
• Numerical Analysis, Computer-Assisted MeSH
• Computer Simulation MeSH
• Motion MeSH
• Models, Theoretical * MeSH
• Pressure MeSH
• Vibration MeSH
• Sound * MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

In the early twenty-first century, societies around the world are facing the paradoxal epidemic development of PCa as a non-communicable disease. PCa is the most frequently diagnosed cancer for men in several countries such as the USA. Permanently improving diagnostics and treatments in the PCa management causes an impressive divergence between, on one hand, permanently increasing numbers of diagnosed PCa cases and, on the other hand, stable or even slightly decreasing mortality rates. Still, aspects listed below are waiting for innovate solutions in the context of predictive approaches, targeted prevention and personalisation of medical care (PPPM / 3PM).A.PCa belongs to the cancer types with the highest incidence worldwide. Corresponding economic burden is enormous. Moreover, the costs of treating PCa are currently increasing more quickly than those of any other cancer. Implementing individualised patient profiles and adapted treatment algorithms would make currently too heterogeneous landscape of PCa treatment costs more transparent providing clear "road map" for the cost saving.B.PCa is a systemic multi-factorial disease. Consequently, predictive diagnostics by liquid biopsy analysis is instrumental for the disease prediction, targeted prevention and curative treatments at early stages.C.The incidence of metastasising PCa is rapidly increasing particularly in younger populations. Exemplified by trends observed in the USA, prognosis is that the annual burden will increase by over 40% in 2025. To this end, one of the evident deficits is the reactive character of medical services currently provided to populations. Innovative screening programmes might be useful to identify persons in suboptimal health conditions before the clinical onset of metastasising PCa. Strong predisposition to systemic hypoxic conditions and ischemic lesions (e.g. characteristic for individuals with Flammer syndrome phenotype) and low-grade inflammation might be indicative for specific phenotyping and genotyping in metastasising PCa screening and disease management. Predictive liquid biopsy tests for CTC enumeration and their molecular characterisation are considered to be useful for secondary prevention of metastatic disease in PCa patients.D.Particular rapidly increasing PCa incidence rates are characteristic for adolescents and young adults aged 15-40 years. Patients with early onset prostate cancer pose unique challenges; multi-factorial risks for these trends are proposed. Consequently, multi-level diagnostics including phenotyping and multi-omics are considered to be the most appropriate tool for the risk assessment, prediction and prognosis. Accumulating evidence suggests that early onset prostate cancer is a distinct phenotype from both aetiological and clinical perspectives deserving particular attention from view point of 3P medical approaches.

• Keywords
• 3PM), Adapted treatment algorithms, Adolescence, Aetiology, Age, Aggressive metastatic disease, Alcohol consumption, Androgen dependent, Apoptosis resistance, Biomarker patterns, Body mass index BMI, Bone-specific alkaline phosphatase, C-index, Castration resistant, Choline, Circulating tumour cells (CTC), Coffee, Comorbidities, Curcumin, Diet, Disease manifestation, Economy, Elderly, Ellargic acid, Ethics, Ethnicity, Family history, Fish, Folate, Fruits, Garlic, Genetic, Green tea, Gut microbiota, Human development index, Hybrid imaging, Incidence, Indicator, Individualised patient profile, Inflammation, Insulin-like growth factor, Ischemic lesions, Lactate dehydrogenase, Life quality, Lifestyle, Liquid biopsy, Lycopene, Malignancy, Meat, Microcirculation, Modifiable risk factors, Mortality, Multi-factorial systemic disease, Multi-omics, Multi-parametric analysis, Obesity, Oxidative stress, PET/MRI, PSA screening, Patient stratification, Personalised nutrition, Physical activity, Prebiotics, Predictive preventive personalised medicine (PPPM, Probiotics, Prognosis, Prostate cancer (PCa), Prostate cancer antigen 3, Quercetin, Race, Radical prostatectomy, Risk assessment, Roadmap, Saturated fat, Selenium/selenite, Sexually transmitted diseases, Sleep disorders, Smoking, Socio-economic factors, Stillbenes, Sulphorapane, Survival, Systemic hypoxic condition, Toxic environment, Trace elements, Transrectal ultrasound, Trends, Urinary tract infection, Urology, Vasectomy, Vegetables, Vitamins A, C, D, E, and K, Young population, miRNA,
• Publication type
• Journal Article MeSH
• Review MeSH

OBJECTIVE: An extension of single- and multi-channel blind deconvolution is presented to improve the estimation of the arterial input function (AIF) in quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). METHODS: The Lucy-Richardson expectation-maximization algorithm is used to obtain estimates of the AIF and the tissue residue function (TRF). In the first part of the algorithm, nonparametric estimates of the AIF and TRF are obtained. In the second part, the decaying part of the AIF is approximated by three decaying exponential functions with the same delay, giving an almost noise free semi-parametric AIF. Simultaneously, the TRF is approximated using the adiabatic approximation of the Johnson-Wilson (aaJW) pharmacokinetic model. RESULTS: In simulations and tests on real data, use of this AIF gave perfusion values close to those obtained with the corresponding previously published nonparametric AIF, and are more noise robust. CONCLUSION: When used subsequently in voxelwise perfusion analysis, these semi-parametric AIFs should give more correct perfusion analysis maps less affected by recording noise than the corresponding nonparametric AIFs, and AIFs obtained from arteries. SIGNIFICANCE: This paper presents a method to increase the noise robustness in the estimation of the perfusion parameter values in DCE-MRI.

• Keywords
• Arterial input function, Blind deconvolution, DCE-MRI,
• MeSH
• Algorithms MeSH
• Arteries pathology   MeSH
• Contrast Media chemistry   pharmacokinetics   MeSH
• Magnetic Resonance Imaging * MeSH
• Mice, Inbred C57BL MeSH
• Mice MeSH
• Perfusion MeSH
• Computer Simulation MeSH
• Image Processing, Computer-Assisted * MeSH
• Reproducibility of Results MeSH
• Image Enhancement * MeSH
• Animals MeSH
• Check Tag
• Mice MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Contrast Media MeSH