Search results for: O. Kaplan
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 73

Search results for: O. Kaplan

73 Levels and Trends of Under-Five Mortality in South Africa from 1998 to 2012

Authors: T. Motsima, K. Zuma, E Rapoo

Abstract:

Childhood mortality is a key sign of the coverage of child survival interventions, social and economic progressions. Although the level of under-five mortality has been declining, it is still unacceptably high. The primary aim of this paper is to establish and analyse the levels and trends of under-five mortality for the periods 1998, 2003 and 2012 in South Africa. Methods: The data used for analysis came from the 1998 SADHS, the 2003 SADHS and the 2012 SABSSM which collected information on the survival status of children. The Kaplan-Meier estimate of the survival function method was used to determine the probabilities of failure (death) from birth up to 59 months. Results and Conclusion: The overall U5MR declined by 28.2% from 53.1 in 1998 to 38.1 in 2012. The U5MR of male children declined from 59.2 in 1998 to 46.2 in 2003 and dropped further to 41.4 in 2012. The U5MR of children of mothers aged 40 years and older increased from 64.0 in 1998 to 89.0 in 2003 and rose further to 129.9 in 2012. The U5MR of children of mothers with education level of 12 years or more increased from 32.2 in 1998 to 35.2 in 2003 and declined substantially to 17.5 in 2012.

Keywords: demographic and health survey, Kaplan-Meier, levels and trends, under-five mortality

Procedia PDF Downloads 136
72 Early Versus Delayed Antiretroviral Therapy in HIV‐positive People with Tuberculosis

Authors: Mohhamed El Habib Labdouni

Abstract:

Introduction: Co-infection with VIH and tuberculosis poses one of the major ongoing challenges for global TB and AIDS prevention and control. The objective of this study is to raise the issue of the resurgence of TB, in People living with VIH supported in a referent center in western Algeria. Its epidemiological, clinical, biological and radiological new trends, and to compare the mortality rate between early and delayed ART. Methods: It was a prospective study, during 36 months from the 01st/01/2012 to 31st/12/2014, by identifying and analyzing cases of TB-VIH co-infection. Our population was devised in two groups/ early ART and delayed ART. The primary and secondary endpoints were analyzed with Kaplan-Meier curves and log-rank test the period of follow up, which was fixed at 300 weeks. Results: Sixty cases of co-infection TB -VIH were enrolled in our study: 78.3% had pulmonary tuberculosis associated with extra-pulmonary, 13.3% had only pulmonary tuberculosis and 08.3% presented strictly extra-pulmonary TB. The clinical particularity of this co-infection is the frequency of serious localization such us: pleural 23.3%, peritoneal 31.7%, and meningeal suffusion 13.3%.y-.biologicaly we notice the predominance both of pancytopenia and leucoanemia, hyponatremia in 38,6% and hypokalemia in 19,3%. By analyzing Kaplan-Meier survival curves, we notice that early ART initiation is associated with a significant reduction of all-cause mortality (p = 0,000), and we have identified several prognostic factors such as hypokalemia hyponatremia, leukocytosis thrombopenemia leucothrombopenia (p = 0,005). Conclusion: Our study confirms most of the results reported in the literature. Early ART initiation reduces the rate of all-cause mortality, despite the probability of the occurrence of TB-IRIS.

Keywords: TB-HIV co-infection, early ART, hyponatremia, extrapulmonary tuberculosis

Procedia PDF Downloads 182
71 Predictor Factors for Treatment Failure among Patients on Second Line Antiretroviral Therapy

Authors: Mohd. A. M. Rahim, Yahaya Hassan, Mathumalar L. Fahrni

Abstract:

Second line antiretroviral therapy (ART) regimen is used when patients fail their first line regimen. There are many factors such as non-adherence, drug resistance as well as virological and immunological failure that lead to second line highly active antiretroviral therapy (HAART) regimen treatment failure. This study was aimed at determining predictor factors to treatment failure with second line HAART and analyzing median survival time. An observational, retrospective study was conducted in Sungai Buloh Hospital (HSB) to assess current status of HIV patients treated with second line HAART regimen. Convenience sampling was used and 104 patients were included based on the study’s inclusion and exclusion criteria. Data was collected for six months i.e. from July until December 2013. Data was then analysed using SPSS version 18. Kaplan-Meier and Cox regression analyses were used to measure median survival times and predictor factors for treatment failure. The study population consisted mainly of male subjects, aged 30-45 years, who were heterosexual, and had HIV infection for less than 6 years. The most common second line HAART regimen given was lopinavir/ritonavir (LPV/r)-based combination. Kaplan-Meier analysis showed that patients on LPV/r demonstrated longer median survival times than patients on indinavir/ritonavir (IDV/r) based combination (p<0.001). The commonest reason for a treatment to fail with second line HAART was non-adherence. Based on Cox regression analysis, other predictor factors for treatment failure with second line HAART regimen were age and mode of HIV transmission.

Keywords: adherence, antiretroviral therapy, second line, treatment failure

Procedia PDF Downloads 264
70 Search for EEG Correlates of Mental States Using EEG Neurofeedback Paradigm

Authors: Cyril Kaplan

Abstract:

26 participants played 4 EEG neurofeedback (NF) games encouraged to find their strategies to control the specific NF parameter. Mixed method analysis of performance in the games and post-session interviews led to the identification of states of consciousness that correlated with success in the game. We found that increase in left frontal beta activity was facilitated by evoking interest in observed surroundings, by wondering what is happening behind the window or what lies in a drawer in front.

Keywords: EEG neurofeedback, states of consciousness, frontal beta activity, mixed methods

Procedia PDF Downloads 141
69 Comparative Efficacy of Angiotensin Converting Enzymes Inhibitors and Angiotensin Receptor Blockers in Patients with Heart Failure in Tanzania: A Prospective Cohort Study

Authors: Mark P. Mayala, Henry Mayala, Khuzeima Khanbhai

Abstract:

Background: Heart failure has been a rising concern in Tanzania. New drugs have been introduced, including the group of drugs called Angiotensin receptor Neprilysin Inhibitor (ARNI), but due to their high cost, angiotensin-converting enzymes inhibitors (ACEIs) and Angiotensin receptor blockers (ARBs) have been mostly used in Tanzania. However, according to our knowledge, the efficacy comparison of the two groups is yet to be studied in Tanzania. The aim of this study was to compare the efficacy of ACEIs and ARBs among patients with heart failure. Methodology: This was a hospital-based prospective cohort study done at Jakaya Kikwete Cardiac Institution (JKCI), Tanzania, from June to December 2020. Consecutive enrollment was done until fulfilling the inclusion criteria. Clinical details were measured at baseline. We assessed the relationship between ARBs and ACEIs users with N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels at admission and at 1-month follow-up using a chi-square test. A Kaplan-Meier curve was used to estimate the survival time of the two groups. Results: 155 HF patients were enrolled, with a mean age of 48 years, whereby 52.3% were male, and their mean left ventricular ejection fraction (LVEF) was 37.3%. 52 (33.5%) heart failure patients were on ACEIs, 57 (36.8%) on ARBs, and 46 (29.7%) were neither using ACEIs nor ARBs. At least half of the patients did not receive a guideline-directed medical therapy (GDMT), with only 82 (52.9%) receiving a GDMT. A drop in NT pro-BNP levels was observed during admission and at 1-month follow-up on both groups, from 6389.2 pg/ml to 4000.1 pg/ml for ARB users and 5877.7 pg/ml to 1328.2 pg/ml for the ACEIs users. There was no statistical difference between the two groups when estimated by the Kaplan-Meier curve, though more deaths were observed in those who were neither on ACEIs nor ARBs, with a calculated P value of 0.01. Conclusion: This study demonstrates that ACEIs have more efficacy and overall better clinical outcome than ARBs, but this should be taken under the patient-based case, considering the side effects of ACEIs and patients’ adherence.

Keywords: angiotensin converting enzymes inhibitors, angiotensin receptor blockers, guideline direct medical therapy, N-terminal pro-brain natriuretic peptide

Procedia PDF Downloads 85
68 Evaluating the Probability of Foreign Tourists' Return to the City of Mashhad, Iran

Authors: Mohammad Rahim Rahnama, Amir Ali Kharazmi, Safiye Rokni

Abstract:

The tourism industry will be the most important unlimited, sustainable source of income after the oil and automotive industries by 2020 and not only countries, but cities are striving to apprehend its various facets. In line with this objective, the present descriptive-analytical study, through survey and using a questionnaire, seeks to evaluate the probability of tourists’ return and their recommendation to their countrymen to travel to Mashhad, Iran. The population under study is a sample of 384 foreign tourists who, in 2016, arrived at Mashhad, the second metropolis in Iran and its biggest religious city. The Kaplan-Meier estimator was used to analyze the data. Twenty-six percent of the tourists are female and 74% are male. On average, each tourist has had 3.02 trips abroad and 2.1 trips to Mashhad. Tourists from 14 different countries have arrived at Mashhad. Kuwait (15.9%), Armenia (15.6%), and Iraq (10.9%) were the countries where most tourists originated. Seventy-six percent of the tourists traveled with family and 90% of the tourists arrived at Mashhad via airplane. Major purposes of tourists’ trip include pilgrimage (27.9%), treatment (22.1%) followed by pilgrimage and treatment combined (35.4%). Major issues for tourists, in the order of priority, include quality of goods and services (30.2%), shopping (18%), and inhabitants’ treatment of foreigners (15.9%). Main tourist attractions, in addition to the Holy Shrine of Imam Reza, include Torqabeh and Shandiz (Torqabeh 40.9% and Shandiz 29.9%), Neyshabour (18.2%) followed by Kalat, 4.4%. The average willingness to return among tourists is 3.13, which is higher than the mean 3, indicating satisfaction with the stay in Mashhad. Similarly, the average for tourists’ recommending to their countrymen to visit Mashhad is 3.42, which is also an indicator of tourists’ satisfaction with their presence in Mashhad. According to the findings of the Kaplan-Meier estimator, an increase in the number of tourists’ trips to Mashhad, and an increase in the number of tourists’ foreign trips, reduces the probability of recommending a trip to Mashhad by tourists. Similarly, willingness to return is higher among those who stayed at a relatives’ home compared with other patterns of residence (hotels, self-catering accommodation, and pilgrim houses). Therefore, addressing the issues raised by tourists is essential for their return and their recommendation to others to travel to Mashhad.

Keywords: international tourist, probability of return, satisfaction, Mashhad

Procedia PDF Downloads 170
67 Atmospheric Plasma Treatment to Improve Water and Oil Repellent Finishing for PET and PET/Spandex Fabrics

Authors: Mehtap Çalışkan, Nilüfer Yıldız Varan, Volkan Kaplan

Abstract:

In this study, the effects of an atmospheric plasma treatment on the durability of water and oil repellent finishes of PET and PET/Spandex fabrics were tested. Fabrics were treated with a low-frequency atmospheric pressure glow discharge. After plasma treatments, the water and oil repellent finishes were applied using pad-dry-cure method. It was observed that plasma treatments improved the durability finish for all fabrics.

Keywords: atmospheric plasma, durable coating, oil repellency, PET/spandex fabrics, water repellency

Procedia PDF Downloads 412
66 Numerical Simulation of Truck Collision with Road Blocker

Authors: Engin Metin Kaplan, Kemal Yaman

Abstract:

In this study, the crash of a medium heavy vehicle onto a designed Road blocker (vehicle barrier) is studied numerically. Structural integrity of the Road blocker is studied by nonlinear dynamic methods under the loading conditions which are defined in the standards. NASTRAN® and LS-DYNA® which are commercial software are used to solve the problem. Outer geometry determination, alignment of the inner part and material properties of the road blocker are studied linearly to yield design parameters. Best design parameters are determined to achieve the most structurally optimized road blocker. Strain and stress values of the vehicle barrier are obtained by solving the partial differential equations.

Keywords: vehicle barrier, truck collision, road blocker, crash analysis

Procedia PDF Downloads 474
65 A Study on the Water and Oil Repellency Characteristics of Plasma-Treated Pet and Pet/Elastane Fabrics

Authors: Mehtap Çalışkan, Nilüfer Yıldız Varan, Volkan Kaplan

Abstract:

New orientations have emerged in the textile sector as a result of increasing global competition and environmental problems. Under the scope of new understandings, it is required to bring forward multi-functional, simple and environmentally friendly methods that will meet tight economic and ecological demands of today. Plasma technology has become a significant alternative in this sense. This technology may provide great advantages in case it is developed, however, it does not receive adequate consideration. In this study, plasma treatment was applied by using glow discharge plasma system to 100% polyethylene terephthalate (PET) and 95% PET/5% elastane fabrics and then the effects of plasma polymerization on fabric surface was tested and analyzed using water and oil repellent finishes.

Keywords: plasma, polyester, elastane, water repellency, oil repellency

Procedia PDF Downloads 323
64 Low SPOP Expression and High MDM2 expression Are Associated with Tumor Progression and Predict Poor Prognosis in Hepatocellular Carcinoma

Authors: Chang Liang, Weizhi Gong, Yan Zhang

Abstract:

Purpose: Hepatocellular carcinoma (HCC) is a malignant tumor with a high mortality rate and poor prognosis worldwide. Murine double minute 2 (MDM2) regulates the tumor suppressor p53, increasing cancer risk and accelerating tumor progression. Speckle-type POX virus and zinc finger protein (SPOP), a key of subunit of Cullin-Ring E3 ligase, inhibits tumor genesis and progression by the ubiquitination of its downstream substrates. This study aimed to clarify whether SPOP and MDM2 are mutually regulated in HCC and the correlation between SPOP and MDM2 and the prognosis of HCC patients. Methods: First, the expression of SPOP and MDM2 in HCC tissues were detected by TCGA database. Then, 53 paired samples of HCC tumor and adjacent tissues were collected to evaluate the expression of SPOP and MDM2 using immunohistochemistry. Chi-square test or Fisher’s exact test were used to analyze the relationship between clinicopathological features and the expression levels of SPOP and MDM2. In addition, Kaplan‒Meier curve analysis and log-rank test were used to investigate the effects of SPOP and MDM2 on the survival of HCC patients. Last, the Multivariate Cox proportional risk regression model analyzed whether the different expression levels of SPOP and MDM2 were independent risk factors for the prognosis of HCC patients. Results: Bioinformatics analysis revealed the low expression of SPOP and high expression of MDM2 were related to worse prognosis of HCC patients. The relationship between the expression of SPOP and MDM2 and tumor stem-like features showed an opposite trend. The immunohistochemistry showed the expression of SPOP protein was significantly downregulated while MDM2 protein significantly upregulated in HCC tissue compared to that in para-cancerous tissue. Tumors with low SPOP expression were related to worse T stage and Barcelona Clinic Liver Cancer (BCLC) stage, but tumors with high MDM2 expression were related to worse T stage, M stage, and BCLC stage. Kaplan–Meier curves showed HCC patients with high SPOP expression and low MDM2 expression had better survival than those with low SPOP expression and high MDM2 expression (P < 0.05). A multivariate Cox proportional risk regression model confirmed that a high MDM2 expression level was an independent risk factor for poor prognosis in HCC patients (P <0.05). Conclusion: The expression of SPOP protein was significantly downregulated, while the expression of MDM2 significantly upregulated in HCC. The low expression of SPOP and high expression. of MDM2 were associated with malignant progression and poor prognosis of HCC patients, indicating a potential therapeutic target for HCC patients.

Keywords: hepatocellular carcinoma, murine double minute 2, speckle-type POX virus and zinc finger protein, ubiquitination

Procedia PDF Downloads 144
63 Pre-Service Teachers’ Opinions on Disabled People

Authors: Sinem Toraman, Aysun Öztuna Kaplan, Hatice Mertoğlu, Esra Macaroğlu Akgül

Abstract:

This study aims to examine pre-service teachers’ opinions on disabled people taking into consideration various variables. The participants of the study are composed of 170 pre-service teachers being 1st year students of different branches at Education Department of Yıldız Technical, Yeditepe, Marmara and Sakarya Universities. Data of the research was collected in 2013-2014 fall term. This study was designed as a phenomenological study appropriately qualitative research paradigm. Pre-service teachers’ opinions about disabled people were examined in this study, open ended question form which was prepared by researcher and focus group interview techniques were used as data collection tool. The study presents pre-service teachers’ opinions about disabled people which were mentioned, and suggestions about teacher education.

Keywords: pre-service teachers, disabled people, teacher education, teachers' opinions

Procedia PDF Downloads 458
62 An Improved Ant Colony Algorithm for Genome Rearrangements

Authors: Essam Al Daoud

Abstract:

Genome rearrangement is an important area in computational biology and bioinformatics. The basic problem in genome rearrangements is to compute the edit distance, i.e., the minimum number of operations needed to transform one genome into another. Unfortunately, unsigned genome rearrangement problem is NP-hard. In this study an improved ant colony optimization algorithm to approximate the edit distance is proposed. The main idea is to convert the unsigned permutation to signed permutation and evaluate the ants by using Kaplan algorithm. Two new operations are added to the standard ant colony algorithm: Replacing the worst ants by re-sampling the ants from a new probability distribution and applying the crossover operations on the best ants. The proposed algorithm is tested and compared with the improved breakpoint reversal sort algorithm by using three datasets. The results indicate that the proposed algorithm achieves better accuracy ratio than the previous methods.

Keywords: ant colony algorithm, edit distance, genome breakpoint, genome rearrangement, reversal sort

Procedia PDF Downloads 344
61 Customizable Sonic EEG Neurofeedback Environment to Train Self-Regulation of Momentary Mental and Emotional State

Authors: Cyril Kaplan, Nikola Jajcay

Abstract:

We developed purely sonic, musical based, highly customizable EEG neurofeedback environment designed to administer a new neurofeedback training protocol. The training protocol concentrates on improving the ability to switch between several mental states characterized by different levels of arousal, each of them correlated to specific brain wave activity patterns in several specific regions of neocortex. This paper describes the neurofeedback training environment we developed and its specificities, thus can be helpful as a manual to guide other neurofeedback users (both researchers and practitioners) interested in our editable open source program (available to download and usage under CC license). Responses and reaction of first trainees that used our environment are presented in this article. Combination of qualitative methods (thematic analysis of neurophenomenological insights of trainees and post-session semi-structured interviews) and quantitative methods (power spectra analysis of EEG recorded during the training) were employed to obtain a multifaceted view on our new training protocol.

Keywords: EEG neurofeedback, mixed methods, self-regulation, switch-between-states training

Procedia PDF Downloads 227
60 The Effects of Agricultural Waste Compost Applications on Soil Properties

Authors: Ilker Sönmez, Mustafa Kaplan

Abstract:

The wastes that come out as a result of agricultural productions are disposed randomly and always by burning. Agricultural wastes have a great volume and agricultural wastes cause environmental pollution. Spent mushroom compost and cut flower carnation wastes have a serious potential in Turkey and especially in Antalya. One of the best evaluation methods of agricultural wastes is composting methods and so agricultural wastes transformed for a new product. In this study, agricultural wastes were evaluated the effects of compost and organic material on soil pH, EC, soil organic matter, and macro-micro nutrient contents of soil that it growth carnation. The effects of compost applications on soils were found to be statistically significant. Organic material applications have caused an increase in all physical and chemical parameters except for pH that pH decreased with compost added in soils. The best results among the compost applications were determined R1 compost that R1 compost included %75 Carnation Wastes + %25 Spent Mushroom Compost. The structural properties of soils can be improved with reusing of agricultural wastes by composting so it can be provided that decreasing the harmful effects of organic wastes on the environment.

Keywords: agricultural wastes, carnation wastes, composting, organic material, spent mushroom compost

Procedia PDF Downloads 383
59 The Effects of External Daminozide (ALAR) Application on Nutrient Contents in Memecik Olive Trees

Authors: Sahriye Sonmez, Salih Ulger, Mustafa Kaplan, Mustafa Karhan

Abstract:

The objective of this study was to investigate the effects of external ALAR application on nutrients contents in leaf and node in ‘on (bearing)’ and ‘off (non-bearing)’ years in Memecik olive trees. For this purpose; 2000 mg L-1 ALAR was externally applied to Memecik olive trees, and leaf and node samples from olive trees were taken during the induction, initiation and differentiation periods in ‘on’ and ‘off’ years. Nutrients contents (N, P, K, Ca, Mg, Fe, Mn, Zn and Cu) in leaf and node samples were determined. The K, Ca, Mg, Fe, Mn, Zn and Cu contents were determined by atomic absorption spectrophotometry, Nitrogen by Kjeldahl procedure, and P by a spectrophotometric method. The results showed that the N, Ca, Mg, Fe, Mn, Zn and Cu contents in ‘on’ year were higher than ‘off’ year while the K contents in ‘on’ year were lower than ‘off ‘ year, but the P content was not different. The N, Ca, Mg, Fe and Mn contents in leaf samples were higher in the node samples except for K while the P, Zn and Cu contents were not different. The N, K, Ca, Fe, Mn, Zn and Cu contents were lowest during the initiation period while the P content was highest in this period. The Mg content was not different in all period.

Keywords: bearing, differentiation period, induction period, initiation period, non bearing, olive

Procedia PDF Downloads 453
58 The Determinants of the Operational Performance in Airline Industry: A Case of a Turkish Airline Company

Authors: Mustafa K. Yilmaz, Ahmet Kaplan, Murat Guven, Vildan Kesici

Abstract:

Aviation industry influences the social and economic growth across the countries. Further, airline companies are highly affected by social, political, and financial crises and show a high degree of cyclicity in operational performance. Hence, this paper investigates the effects of available seat kilometers (ASK), revenue per kilometer (RPK), passenger load factor (PLF) as well as socio-political crisis on the number of passengers carried (PC) by Turkish Airlines company over the period of 2010M1-2018M12. To conduct the analysis, we employ fully modified ordinary least squares (FMOLS), dynamic ordinary least squares (DOLS), and canonical cointegration regression (CCR) techniques using monthly data. We use ASK, RPK, PLF as independent variables to identify the determinants of the PC, as a dependent variable. We also test the effect of the socio-political crisis. The results reveal that there is a significant and negative relationship between ASK and PC, while the relationship between RPK and PC is positive and significant. We also find that there is an insignificant relationship between PLF and PC. Further, we also find a negative effect of the crisis on the PC. These findings show although the crisis had an immediate effect on the operational performance of Turkish Airlines, the company recovered from the crisis and cope with the situation very promptly. Thus, this proves the resilience and agile management ability of the company.

Keywords: airline industry, operational performance, air traffic, socio-political crisis

Procedia PDF Downloads 176
57 Frames as Interests and Goals: The Case of MedTech Entrepreneurs' Capital Raising Strategies in Australia

Authors: Joelle Hawa, Michael Gilding

Abstract:

The role of interest as a driver of action has been an on-going debate in the sociological sciences. This paper shows evidence as to how economic actors frame their environment in terms of interests and goals to take action. It introduces the concept of 'dynamic actor compass', a cognitive tool that is socially contingent and allows economic actors to navigate their environment, evaluate the level of alignment of interests and goals with other players, and decide whether or not they are willing to rely on, collaborate or partner with others in the field. The paper builds on Kaplan’s model of framing contests and integrates Max Weber’s interests, and ideas construct as well as Beckert’s concept of fictional expectations. The author illustrates this conceptual framework in the case of MedTech entrepreneurs’ capital raising activities in Australia. The study adopts a grounded theory methodology, running in-depth interviews with 24 MedTech entrepreneurs in order to examine their decision-making processes and actions to finance their innovation trajectory. The findings show that participants take into account material and ideal interests and goals that they impose adapt or negotiate with other actors in their environment. These interactions affect the way MedTech entrepreneurs perceive other funders in the field, influencing their capital raising strategies.

Keywords: expectations, financing innovation, frames, goals, interest-oriented action, managerial cognition

Procedia PDF Downloads 141
56 The Comparison of Primary B-Cell and NKT-Cell Non-Hodgkin Lymphomas in Nasopharynx, Nasal Cavity, and Paranasal Sinuses

Authors: Jiajia Peng, Jianqing Qiu, Jianjun Ren, Yu Zhao

Abstract:

Background: We aimed to compare clinical and survival differences between B-cell (B-NHL) and NKT-cell non-Hodgkin lymphomas (NKT-NHL) located in the nasal cavity, nasopharynx and paranasal sinuses, which are always categorized as one sinonasal type. Methods: Patients diagnosed with primary B-NHL and NKT-NHL in the nasal cavity, nasopharynx, and paranasal sinuses from the SEER database were included. We identified these patients based on histological types and anatomical sites and subsequently conducted univariate and multivariate Cox regression and Kaplan–Meier analyses to examine cancer-special survival (CSS) outcomes. Results: Overall, most B-NHL cases originated from the nasopharynx, while the majority of NKT-NHL cases occurred in the nasal cavity. Notably, the CSS outcomes improved significantly in all sinonasal B-NHL cases over time, whereas no such improvement trend was observed in each sinonasal NKT-NHL type. Additionally, increasing age was linked with an elevated risk of death in B-NHL, particularly in the nasal cavity (HR:3.37), rather than in NKT-NHL. Compared with B-NHL, the adverse effect of the higher stage on CSS was more evident in NKT-NHL, particularly in its nasopharynx site (HR: 5.12). Furthermore, radiotherapy was beneficial for survival in patients with sinonasal B-NHL and NKT-NHL, except in those with NKT-NHL in the nasopharynx site. However, chemotherapy has only been beneficial for CSS in patients with B-NHL in paranasal sinuses (HR: 0.42) since 2010, rather than in other types of B-NHL or NKT-NHL. Conclusions: Although B-NHL and NKT-NHL in the nasal cavity, nasopharynx and paranasal sinuses have similar anatomical locations, their clinic demographics and prognoses are largely different and should be treated and studied as distinct diseases.

Keywords: B-cell non-Hodgkin lymphomas, NKT-cell non-Hodgkin lymphomas, nasal cavity lymphomas, nasal sinuses lymphomas, nasopharynx lymphomas

Procedia PDF Downloads 106
55 High-Dose-Rate Brachytherapy for Cervical Cancer: The Effect of Total Reference Air Kerma on the Results of Single-Channel and Tri-Channel Applicators

Authors: Hossain A., Miah S., Ray P. K.

Abstract:

Introduction: Single channel and tri-channel applicators are used in the traditional treatment of cervical cancer. Total reference air kerma (TRAK) and treatment outcomes in high-dose-rate brachytherapy for cervical cancer using single-channel and tri-channel applicators were the main objectives of this retrospective study. Material and Methods: Patients in the radiotherapy division who received brachytherapy, chemotherapy, and external radiotherapy (EBRT) using single and tri-channel applicators were the subjects of a retrospective cohort study from 2016 to 2020. All brachytherapy parameters, including TRAK, were calculated in accordance with the international protocol. The Kaplan Meier method was used to analyze survival rates using a log-rank test. Results and Discussions: Based on treatment times of 15.34 (10-20) days and 21.35 (6.5-28) days, the TRAK for the tri-channel applicator was 0.52 cGy.m² and for the single-channel applicator was 0.34 cGy.m². Based on TRAK, the rectum, bladder, and tumor had respective Pearson correlations of 0.082, 0.009, and 0.032. The 1-specificity and sensitivity were 0.70 and 0.30, respectively. At that time, AUC was 0.71. The log-rank test showed that tri-channel applicators had a survival rate of 95% and single-channel applicators had a survival rate of 85% (p=0.565). Conclusions: The relationship between TRAK and treatment duration and Pearson correlation for the tumor, rectum, and bladder suggests that TRAK should be taken into account for the proper operation of single channel and tri-channel applicators.

Keywords: single-channel, tri-channel, high dose rate brachytherapy, cervical cancer

Procedia PDF Downloads 101
54 A Collective Intelligence Approach to Safe Artificial General Intelligence

Authors: Craig A. Kaplan

Abstract:

If AGI proves to be a “winner-take-all” scenario where the first company or country to develop AGI dominates, then the first AGI must also be the safest. The safest, and fastest, path to Artificial General Intelligence (AGI) may be to harness the collective intelligence of multiple AI and human agents in an AGI network. This approach has roots in seminal ideas from four of the scientists who founded the field of Artificial Intelligence: Allen Newell, Marvin Minsky, Claude Shannon, and Herbert Simon. Extrapolating key insights from these founders of AI, and combining them with the work of modern researchers, results in a fast and safe path to AGI. The seminal ideas discussed are: 1) Society of Mind (Minsky), 2) Information Theory (Shannon), 3) Problem Solving Theory (Newell & Simon), and 4) Bounded Rationality (Simon). Society of Mind describes a collective intelligence approach that can be used with AI and human agents to create an AGI network. Information theory helps address the critical issue of how an AGI system will increase its intelligence over time. Problem Solving Theory provides a universal framework that AI and human agents can use to communicate efficiently, effectively, and safely. Bounded Rationality helps us better understand not only the capabilities of SuperIntelligent AGI but also how humans can remain relevant in a world where the intelligence of AGI vastly exceeds that of its human creators. Each key idea can be combined with recent work in the fields of Artificial Intelligence, Machine Learning, and Large Language Models to accelerate the development of a working, safe, AGI system.

Keywords: AI Agents, Collective Intelligence, Minsky, Newell, Shannon, Simon, AGI, AGI Safety

Procedia PDF Downloads 91
53 Prospective Study to Determine the Efficacy of Day Hospital Care to Improve Treatment Adherence for Hospitalized Schizophrenic Patients

Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

Abstract:

Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

Procedia PDF Downloads 353
52 MAGE-A3 and PRAME Gene Expression and EGFR Mutation Status in Non-Small-Cell Lung Cancer

Authors: Renata Checiches, Thierry Coche, Nicolas F. Delahaye, Albert Linder, Fernando Ulloa Montoya, Olivier Gruselle, Karen Langfeld, An de Creus, Bart Spiessens, Vincent G. Brichard, Jamila Louahed, Frédéric F. Lehmann

Abstract:

Background: The RNA-expression levels of cancer-testis antigens MAGE A3 and PRAME were determined in resected tissue from patients with primary non-small-cell lung cancer (NSCLC) and related to clinical outcome. EGFR, KRAS and BRAF mutation status was determined in a subset to investigate associations with MAGE A3 and PRAME expression. Methods: We conducted a single-centre, uncontrolled, retrospective study of 1260 tissue-bank samples from stage IA-III resected NSCLC. The prognostic value of antigen expression (qRT-PCR) was determined by hazard-ratio and Kaplan-Meier curves. Results: Thirty-seven percent (314/844) of tumours expressed MAGE-A3, 66% (723/1092) expressed PRAME and 31% (239/839) expressed both. Respective frequencies in squamous-cell tumours and adenocarcinomas were 43%/30% for MAGE A3 and 80%/44% for PRAME. No correlation with stage, tumour size or patient age was found. Overall, no prognostic value was identified for either antigen. A trend to poorer overall survival was associated with MAGE-A3 in stage IIIB and with PRAME in stage IB. EGFR and KRAS mutations were found in 10.1% (28/311) and 33.8% (97/311) of tumours, respectively. EGFR (but not KRAS) mutation status was negatively associated with PRAME expression. Conclusion: No clear prognostic value for either PRAME or MAGE A3 was observed in the overall population, although some observed trends may warrant further investigation.

Keywords: MAGE A3, PRAME, cancer-testis gene, NSCLC, survival, EGFR

Procedia PDF Downloads 382
51 Dual Set Point Governor Control Structure with Common Optimum Temporary Droop Settings for both Islanded and Grid Connected Modes

Authors: Deepen Sharma, Eugene F. Hill

Abstract:

For nearly 100 years, hydro-turbine governors have operated with only a frequency set point. This natural governor action means that the governor responds with changing megawatt output to disturbances in system frequency. More and more, power system managers are demanding that governors operate with constant megawatt output. One way of doing this is to introduce a second set point in the control structure called a power set point. The control structure investigated and analyzed in this paper is unique in the way that it utilizes a power reference set point in addition to the conventional frequency reference set point. An optimum set of temporary droop parameters derived based on the turbine-generator inertia constant and the penstock water start time for stable islanded operation are shown to be also equally applicable for a satisfactory rate of generator loading during its grid connected mode. A theoretical development shows why this is the case. The performance of the control structure has been investigated and established based on the simulation study made in MATLAB/Simulink as well as through testing the real time controller performance on a 15 MW Kaplan Turbine and generator. Recordings have been made using the labVIEW data acquisition platform. The hydro-turbine governor control structure and its performance investigated in this paper thus eliminates the need to have a separate set of temporary droop parameters, one valid for islanded mode and the other for interconnected operations mode.

Keywords: frequency set point, hydro governor, interconnected operation, isolated operation, power set point

Procedia PDF Downloads 367
50 The Clinical and Survival Differences between Primary B-Cell and T/NK-Cell Non-Hodgkin Lymphomas in the Nasopharynx, Nasal Cavity, and Nasal Sinus: A Population-Based Study of 3839 Cases in the Seer Database

Authors: Jiajia Peng, Danni Cheng, Jianqing Qiu, Yufang Rao, Minzi Mao, Ke Qiu, Junhong Li, Fei Chen, Feng Liu, Jun Liu, Xiaosong Mu, Wenxin Yu, Wei Zhang, Wei Xu, Yu Zhao, Jianjun Ren

Abstract:

Background: Currently, primary B-cell non-Hodgkin lymphoma (B-NHL) and T/NK-cell non-Hodgkin lymphoma (NKT-NHL) originated from the nasal cavity (NC), nasopharynx (NP) and nasal sinus (NS) distinguished unclearly in the clinic. Objective: We sought to compare the clinical and survival differences of B-NHL and NKT-NHL that occurred in NC, NP, and NS, respectively. Methods: Retrospective data of patients diagnosed with nasal cavity lymphoma (NCL), nasopharyngeal lymphoma (NPL), and nasal sinus lymphoma (NSL) between 1975 and 2017 from the Surveillance, Epidemiology, and End Results (SEER) database were collected. We identified the B/NKT-NHL patients based on the histological type and performed univariate, multivariate, and Kaplan-Meier analyses to investigate the survival rates. Results: Of the identified 3,101 B-NHL and 738 NKT-NHL patients, those with B-NHL in NP were the majority (43%) and had better cancer-specific survival than those in NC and NS from 2010 to 2017 (5-year-CSS, NC vs. NP vs. NS: 81% vs. 83% vs. 82%). In contrast, most of the NKT-NHL originated from NC (68%) and had the highest CSS rate in the recent seven years (2010-2017, 5-year-CSS: 63%). Additionally, the survival outcomes of patients with NKT-NHL-NP (HR: 1.34, 95% CI: 0.62-2.89, P=0.460) who had received surgery were much worse than those of patients with NKT-NHL-NC (HR: 1.07, 95% CI: 0.75-1.52, P=0.710) and NKT-NHL-NS (HR: 1.11, 95% CI: 0.59-2.07, P=0.740). NKT-NHL-NS patients who had radiation performed (HR: 0.38, 95% CI: 0.19-0.73, P=0.004) showed the highest survival rates, while chemotherapy performed (HR: 1.01, 95% CI: 0.43-2.37, P=0.980) presented opposite results. Conclusions: Although B-NHL and NKT-NHL originating from NC, NP and NS had similar anatomical locations, their clinical characteristics, treatment therapies, and prognoses were different in this study. Our findings may suggest that B-NHL and NKT-NHL in NC, NP, and NS should be treated as different diseases in the clinic.

Keywords: nasopharyngeal lymphoma, nasal cavity lymphoma, nasal sinus lymphoma, B-cell non-Hodgkin lymphoma, T/NK-cell non-Hodgkin lymphoma

Procedia PDF Downloads 184
49 The Role of HPV Status in Patients with Overlapping Grey Zone Cancer in Oral Cavity and Oropharynx

Authors: Yao Song

Abstract:

Objectives: We aimed to explore the clinicodemographic characteristics and prognosis of grey zone squamous cell cancer (GZSCC) located in the overlapping or ambiguous area of the oral cavity and oropharynx and to identify valuable factors that would improve its differential diagnosis and prognosis. Methods: Information of GZSCC patients in the Surveillance, Epidemiology, and End Results (SEER) database was compared to patients with an oral cavity (OCSCC) and oropharyngeal (OPSCC) squamous cell carcinomas with corresponding HPV status, respectively. Kaplan-Meier method with log-rank test and multivariate Cox regression analysis were applied to assess associations between clinical characteristics and overall survival (OS). A predictive model integrating age, gender, marital status, HPV status, and staging variables was conducted to classify GZSCC patients into three risk groups and verified internally by 10-fold cross validation. Results: A total of 3318 GZSCC, 10792 OPSCC, and 6656 OCSCC patients were identified. HPV-positive GZSCC patients had the best 5-year OS as HPV-positive OPSCC (81% vs. 82%). However, the 5-year OS of HPV-negative/unknown GZSCC (43%/42%) was the worst among all groups, indicating that HPV status and the overlapping nature of tumors were valuable prognostic predictors in GZSCC patients. Compared with the strategy of dividing GZSCC into two groups by HPV status, the predictive model integrating more variables could additionally identify a unique high-risk GZSCC group with the lowest OS rate. Conclusions: GZSCC patients had distinct clinical characteristics and prognoses compared with OPSCC and OCSCC; integrating HPV status and other clinical factors could help distinguish GZSCC and predict their prognosis.

Keywords: GZSCC, OCSCC, OPSCC, HPV

Procedia PDF Downloads 75
48 Survival Pattern of Under-five Mortality in High Focus States in India

Authors: Rahul Kumar

Abstract:

Background: Under-FiveMortality Rate(U5MR)ofanationiswidelyacceptedandlong-standing indicators of well-beingofherchildren.They measuredtheprobability of dying before theageoffive(expressedper1000livebirths).TheU5MRisanappropriate indicator of the cumulative exposure totheriskofdeathduringthefirstfiveyearsoflife, and accepted globalindicator ofthehealthandsocioeconomicstatusofagiven population.Itisalsousefulforassessing theimpactofvariousintervention programmes aimed at improving child survival.Under-fivemortalitytrendsconstitutealeadingindicatorofthelevel ofchildhealthandoveralldevelopmentincountries. Objectives: The first aim of our research is to study the level, trends, and Pattern of Under-five mortality using different sources of data. The second objective is to examine the survival pattern of Under-five mortality by different background characteristics. Data Source and Methodology: SRS and NFHS data have been used forobservingthelevelandtrendofUnder-Five mortality rate. Kaplan Meier Estimate has been used to understand the survival Pattern of Under-five mortality. Result: WefindthatallmostallthestatesmadesomeprogressbyreducingU5MRin recent decades.During1992-93highestU5MR(per thousand live birth) was observed in Assam(142)followed by up(141),Odisha(131),MP(130),andBihar(127.5).While the least U5MR(perthousandlive birth)wasobservedinRajasthan(102). The highestU5MR(per thousandlive birth)isobservedinUP(78.1), followed by MP(64.9)and Chhattisgarh(63.7)which are far away from the national level(50). Among them, Uttarakhand(46.7)hadleastU5MR(perthousandlivebirth), followed by Odisha(48.6). TheU5MR(perthousandlivebirth)ofcombinedhighfocusstateis63.7whichisfar away fromthenationallevel(50). Weidentified thatthesurvivalprobability ofunder-fivechildrenfromadolescentmotherislessin comparisontootherchildrenbornby differentagegroupofmothers. thatduringneonatalperiodusually male mortality exceedsthefemale mortality butthisdifferentialreversedinthepostneonatalperiod. Astheirageincreasesand approachingtofiveyears,weidentifiedthatthesurvivalprobability ofbothsexdecreasesbut female’s survival probabilitydecrement is more than male as their ageincreases. The poorer children’s survival probability is minimum. Children using improved toilet facility has more survival probability throughout thefiveyearsthan who uses unimproved. The survival probability of children under five who got Full ANCis more than the survival probability of children under five who doesn’t get any ANC. Conclusions: Improvement of maternal education is an urgent need to improve their health seeking behavior and thus the health of their children. Awareness on reproductive health and environmental sanitation should be strengthened.

Keywords: under-five mortality, survival pattern, ANC, trend

Procedia PDF Downloads 132
47 Predicting High-Risk Endometrioid Endometrial Carcinomas Using Protein Markers

Authors: Yuexin Liu, Gordon B. Mills, Russell R. Broaddus, John N. Weinstein

Abstract:

The lethality of endometrioid endometrial cancer (EEC) is primarily attributable to the high-stage diseases. However, there are no available biomarkers that predict EEC patient staging at the time of diagnosis. We aim to develop a predictive scheme to help in this regards. Using reverse-phase protein array expression profiles for 210 EEC cases from The Cancer Genome Atlas (TCGA), we constructed a Protein Scoring of EEC Staging (PSES) scheme for surgical stage prediction. We validated and evaluated its diagnostic potential in an independent cohort of 184 EEC cases obtained at MD Anderson Cancer Center (MDACC) using receiver operating characteristic curve analyses. Kaplan-Meier survival analysis was used to examine the association of PSES score with patient outcome, and Ingenuity pathway analysis was used to identify relevant signaling pathways. Two-sided statistical tests were used. PSES robustly distinguished high- from low-stage tumors in the TCGA cohort (area under the ROC curve [AUC]=0.74; 95% confidence interval [CI], 0.68 to 0.82) and in the validation cohort (AUC=0.67; 95% CI, 0.58 to 0.76). Even among grade 1 or 2 tumors, PSES was significantly higher in high- than in low-stage tumors in both the TCGA (P = 0.005) and MDACC (P = 0.006) cohorts. Patients with positive PSES score had significantly shorter progression-free survival than those with negative PSES in the TCGA (hazard ratio [HR], 2.033; 95% CI, 1.031 to 3.809; P = 0.04) and validation (HR, 3.306; 95% CI, 1.836 to 9.436; P = 0.0007) cohorts. The ErbB signaling pathway was most significantly enriched in the PSES proteins and downregulated in high-stage tumors. PSES may provide clinically useful prediction of high-risk tumors and offer new insights into tumor biology in EEC.

Keywords: endometrial carcinoma, protein, protein scoring of EEC staging (PSES), stage

Procedia PDF Downloads 220
46 Interaction of Racial and Gender Disparities in Salivary Gland Cancer Survival in the United States: A Surveillance Epidemiology and End Results Study

Authors: Sarpong Boateng, Rohit Balasundaram, Akua Afrah Amoah

Abstract:

Introduction: Racial and Gender disparities have been found to be independently associated with Salivary Gland Cancers (SGCs) survival; however, to our best knowledge, there are no previous studies on the interplay of these social determinants on the prognosis of SGCs. The objective of this study was to examine the joint effect of race and gender on the survival of SGCs. Methods: We analyzed survival outcomes of 13,547 histologically confirmed cases of SGCs using the Surveillance Epidemiology and End Results (SEER) database (2004 to 2015). Multivariable Cox regression analysis and Kaplan-Meier curves were used to estimate hazard ratios (HR) after controlling for age, tumor characteristics, treatment type and year of diagnosis. Results: 73.5% of the participants were whites, 8.5% were blacks, 10.1% were Hispanics and 58.5% were males. Overall, males had poorer survival than females (HR = 1.16, p=0.003). In the adjusted multivariable model, there were no significant differences in survival by race. However, the interaction of gender and race was statistically significant (p=0.01) in Hispanic males. Thus, compared to White females (reference), Hispanic females had significantly better survival (HR=0.53), whiles Hispanic males had worse survival outcomes (HR=1.82) for SGCs. Conclusions: Our results show significant interactions between race and gender, with racial disparities varying across the different genders for SGCs survival. This study indicates that racial and gender differences are crucial factors to be considered in the prognostic counseling and management of patients with SGCs. Biologic factors, tumor genetic characteristics, chemotherapy, lifestyle, environmental exposures, and socioeconomic and dietary factors are potential yet proven reasons that could account for racial and gender differences in the survival of SGCs.

Keywords: salivary, cancer, survival, disparity, race, gender, SEER

Procedia PDF Downloads 201
45 Place of Radiotherapy in the Treatment of Intracranial Meningiomas: Experience of the Cancer Center Emir Abdelkader of Oran Algeria

Authors: Taleb L., Benarbia M., Boutira F. M., Allam H., Boukerche A.

Abstract:

Introduction and purpose of the study: Meningiomas are the most common non-glial intracranial tumors in adults, accounting for approximately 30% of all central nervous system tumors. The aim of our study is to determine the epidemiological, clinical, therapeutic, and evolutionary characteristics of a cohort of patients with intracranial meningioma treated with radiotherapy at the Emir Abdelkader Cancer Center in Oran. Material and methods: This is a retrospective study of 44 patients during the period from 2014 to 2020. The overall survival and relapse-free survival curves were calculated using the Kaplan-Meier method. Results and statistical analysis: The median age of the patients was 49 years [21-76 years] with a clear female predominance (sex ratio=2.4). The average diagnostic delay was seven months [2 to 24 months], the circumstances of the discovery of which were dominated by headaches in 54.5% of cases (n=24), visual disturbances in 40.9% (n=18), and motor disorders in 15.9% (n=7). The seat of the tumor was essentially at the level of the base of the skull in 52.3% of patients (n=23), including 29.5% (n=13) at the level of the cavernous sinus, 27.3% (n=12) at the parasagittal level and 20.5% (n=9) at the convexity. The diagnosis was confirmed surgically in 36 patients (81.8%) whose anatomopathological study returned in favor of grades I, II, and III in respectively 40.9%, 29.5%, and 11.4% of the cases. Radiotherapy was indicated postoperatively in 45.5% of patients (n=20), exclusive in 27.3% (n=12) and after tumor recurrence in 27.3% of cases (n=18). The irradiation doses delivered were as follows: 50 Gy (20.5%), 54 Gy (65.9%), and 60 Gy (13.6%). With a median follow-up of 69 months, the probabilities of relapse-free survival and overall survival at three years are 93.2% and 95.4%, respectively, whereas they are 71.2% and 80.7% at five years. Conclusion: Meningiomas are common primary brain tumors. Most often benign but can also progress aggressively. Their treatment is essentially surgical, but radiotherapy retains its place in specific situations, allowing good tumor control and overall survival.

Keywords: diagnosis, meningioma, surgery, radiotherapy, survival

Procedia PDF Downloads 100
44 Systematic Review and Meta-Analysis of Mid-Term Survival, and Recurrent Mitral Regurgitation for Robotic-Assisted Mitral Valve Repair

Authors: Ramanen Sugunesegran, Michael L. Williams

Abstract:

Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

Procedia PDF Downloads 82