Low level microsatellite instability may be associated with reduced cancer specific survival in sporadic stage C colorectal carcinoma

Background: Colorectal cancers (CRCs) may be categorised according to the degree of microsatellite instability (MSI) exhibited, as MSI-high (MSI-H), MSI-low (MSI-L), or microsatellite stable (MSS). MSI-H status confers a survival advantage to patients with sporadic CRC. Aims: To determine if low levels of MSI are related to the clinicopathological features and prognosis of sporadic stage C CRC. Patients: A total of 255 patients who underwent resection for sporadic stage C CRC were studied. No patient received chemotherapy. Minimum follow up was five years. Methods: DNA extracted from archival malignant and non-malignant tissue was amplified by polymerase chain reaction using a panel of 11 microsatellites. MSI-H was defined as instability at greater than or equal to40% of markers, MSS as no instability, and MSI-L as instability at >0% but,40% of markers. Patients with MSI-H CRC were excluded from analysis as they have previously been shown to have better survival. Results: Thirty three MSI-L and 176 MSS CRCs were identified. There was no difference in biological characteristics or overall survival of MSI-L compared with MSS CRC but MSI-L was associated with poorer cancer specific survival (hazard ratio 2.0 (95% confidence interval 1.1-3.6)). Conclusions: Sporadic MSI-L and MSS CRCs have comparable clinicopathological features. Further studies are required to assess the impact of MSI-L on prognosis.

A Bayesian neural network algorithm identifies patients in whom post-EVAR surveillance may be unnecessary

Lifelong surveillance is not cost-effective after endovascular aneurysm repair (EVAR), but is required to detect aortic complications which are fatal if untreated (type 1/3 endoleak, sac expansion, device migration). Aneurysm morphology determines the probability of aortic complications and therefore the need for surveillance, but existing analyses have proven incapable of identifying patients at sufficiently low risk to justify abandoning surveillance. This study aimed to improve the prediction of aortic complications, through the application of machine-learning techniques. Patients undergoing EVAR at 2 centres were studied from 2004–2010. Aneurysm morphology had previously been studied to derive the SGVI Score for predicting aortic complications. Bayesian Neural Networks were designed using the same data, to dichotomise patients into groups at low- or high-risk of aortic complications. Network training was performed only on patients treated at centre 1. External validation was performed by assessing network performance independently of network training, on patients treated at centre 2. Discrimination was assessed by Kaplan-Meier analysis to compare aortic complications in predicted low-risk versus predicted high-risk patients. 761 patients aged 75 +/− 7 years underwent EVAR in 2 centres. Mean follow-up was 36+/− 20 months. Neural networks were created incorporating neck angu- lation/length/diameter/volume; AAA diameter/area/volume/length/tortuosity; and common iliac tortuosity/diameter. A 19-feature network predicted aor- tic complications with excellent discrimination and external validation (5-year freedom from aortic complications in predicted low-risk vs predicted high-risk patients: 97.9% vs. 63%; p < 0.0001). A Bayesian Neural-Network algorithm can identify patients in whom it may be safe to abandon surveillance after EVAR. This proposal requires prospective study.

Neural Networks in Bankruptcy Prediction - A Comparative Study on the Basis of the First Hungarian Bankruptcy Model

The article attempts to answer the question whether or not the latest bankruptcy prediction techniques are more reliable than traditional mathematical–statistical ones in Hungary. Simulation experiments carried out on the database of the first Hungarian bankruptcy prediction model clearly prove that bankruptcy models built using artificial neural networks have higher classification accuracy than models created in the 1990s based on discriminant analysis and logistic regression analysis. The article presents the main results, analyses the reasons for the differences and presents constructive proposals concerning the further development of Hungarian bankruptcy prediction.

Application of support vector machines on the basis of the first Hungarian bankruptcy model

In our study we rely on a data mining procedure known as support vector machine (SVM) on the database of the first Hungarian bankruptcy model. The models constructed are then contrasted with the results of earlier bankruptcy models with the use of classification accuracy and the area under the ROC curve. In using the SVM technique, in addition to conventional kernel functions, we also examine the possibilities of applying the ANOVA kernel function and take a detailed look at data preparation tasks recommended in using the SVM method (handling of outliers). The results of the models assembled suggest that a significant improvement of classification accuracy can be achieved on the database of the first Hungarian bankruptcy model when using the SVM method as opposed to neural networks.

Vezetőkkel szemben támasztott munkaerő-piaci kompetenciaelvárások a Heti Világgazdaság és a The Economist álláshirdetéseinek elemzése alapján (Job market competency requirements for managers on the basis of the analysis of job advertisements in the Heti Világgazdaság and The Economist)

A szervezet dolgozói között kiemelt fontosságúak a vezetők, hiszen döntéseikkel, működésükkel a szervezet életét közvetlenül, és sokszor hosszú távra befolyásolják. Annak a vállalatnak, mely megtartani, növelni szeretné piaci pozícióját, különös hangsúlyt kell fektetnie vezetőinek kiválasztására, a későbbiekben pedig fejlesztésére. A szerző cikkében azt mutatja be, hogy a közgazdászképzettséggel rendelkező vezetők iránti munkaerő-piaci kereslet (a HVG-hirdetések elemzése alapján) milyen minőségi jellemzőket mutatott 2000–2009 között. A szerző részletesen ismerteti az eredményeket, melyek értelmezéséhez a Spencer és munkatársai által kidolgozott kompetenciamodell saját továbbfejlesztett változatát használja fel. Kitekintés céljával a magyar eredmények mellett bemutatja, hogy egy más gazdasági struktúrával, kultúrával rendelkező országban hogyan alakultak a vezetőkkel szemben támasztott kompetencia-elvárások. Az eredmények – melyeket más hazai felmérések is alátámasztanak – azt tükrözik, hogy a magyar vezetőkkel szemben támasztott munkaerő-piaci kompetencia-elvárások eltérnek a szakmai várakozásoktól és élesen eltérő képet mutatnak a The Economist hirdetéselemzésének eredményétől. _________ The thesis that the most important factor which determines the competitiveness of future companies is the quality of human resources has received increasingly more emphasis in the literature on management. The managers of organizations have a key role since they can directly influence the life of the organization by their decisions and work, often for a long term. Therefore, a company which intends to maintain or improve its market position should place special emphasis on the selection, and later on the development of its managers. In the present paper the author presents the characteristic features of job market demand for managers with qualifications in economics between 2000 and 2009 (on the basis of the analysis of job advertisements published in the economic weekly paper Heti Világgazdaság). The author gives a detailed analysis of the results using the competence model developed by Spencer et al. and further developed by the author. In addition to the Hungarian results, the paper also provides an overview of how managers are selected in a country with a different economic structure and culture. The results – also supported by other surveys conducted in Hungary – demonstrate that the competence expectations of the job market for Hungarian managers fail to meet professional expectations; the picture is sharply different from what the analysis of job advertisements published in The Economist show, and the competence expectation changed very little, though quite strikingly, over the period under discussion.

Cognitive Performance May be Impaired by Exercise in a Hot, Humid Environment: A Preliminary Investigation

The purpose of this study was to examine the effects of acute active dehydration by exercise in a hot, humid environment on cognitive performance. Our findings were inconclusive compared to previous studies that reported decreased cognitive performance in manual laborers and military personnel working in extreme environmental conditions.

Central Park Be-In on Easter Sunday

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

Central Park Be-In on Easter Sunday

Inscriptions: Verso: [stamped] Credit must be given to Leinwand from Monkmeyer Press Photo Service].

Central Park Be-In on Easter Sunday

Inscriptions: Verso: [stamped] Credit must be given to Leinwand from Monkmeyer Press Photo Service].

Central Park Be-In on Easter Sunday

Inscriptions: Verso: [stamped] Credit must be given to Freda Leinwand from Monkmeyer Press Photo Service…

The role of oxidative stress as an underlying mechanism in life-history trade-offs

A key aspect underpinning life-history theory is the existence of trade-offs. Trade-offs occur because resources are limited, meaning that individuals cannot invest in all traits simultaneously, leading to costs for traits such as growth and reproduction. Such costs may be the reason for the sub-maximal growth rates that are often observed in nature, though the fitness consequences of these costs would depend on the effects on lifetime reproductive success. Recently, much attention has been given to the physiological mechanism that might underlie these life-history trade-offs, with oxidative stress (OS) playing a key role. OS is characterised by a build-up of oxidative damage to tissues (e.g. protein, lipids and DNA) from attack by reactive species (RS). RS, the majority of which are by-products of metabolism, are usually neutralised by antioxidants, however OS occurs when there is an imbalance between the two. There are two main theories linking OS with growth and reproduction. The first is that traits like growth and reproduction, being metabolically demanding, lead to an increase in RS production. The second involves the diversion of resources away from self-maintenance processes (e.g. the redox system) when individuals are faced with enhanced growth or reproductive expenditure. Previous research investigating trade-offs involving growth or reproduction and self-maintenance has been equivocal. One reason for this could be that associations among redox biomarkers can vary greatly so that the biomarker selected for analysis can influence the conclusion reached about an individual’s oxidative status. Therefore the first aim of my thesis was to explore the strength and pattern of integration of five biomarkers of OS (three antioxidants, one damage and one general oxidation measure) in wild blue tit (Cyanistes caeruleus) adults and nestlings (Chapter 2). In doing so, I established that all five biomarkers should be included in future analyses, thus using this collection of biomarkers I explored my next aims; whether enhanced growth (Chapters 3 and 4) or reproductive effort (Chapter 5) can lead to increased OS levels, if these traits are traded off against self-maintenance. I accomplished these aims using both a meta-analytic and experimental approach, the latter involving manipulation of brood size in wild blue tits in order to experimentally alter growth rate of nestlings and provisioning rate (a proxy for reproductive expenditure) of adults. I also investigated the potential for redox integration to be used as an index of body condition (Chapter 2), allowing predictions about future fitness consequences of changes to oxidative state to be made. A growth – self-maintenance trade off was supported by my meta-analytic results (Chapter 4) which found OS to be a constraint on growth. However, when faced with experimentally enhanced growth, animals were typically not able to adjust this trade-off so that oxidative damage resulted. This might support the idea that energetically expensive growth causes resources to be diverted away from the redox system; however, antioxidants did not show an overall reduction in response to growth in the meta-analysis suggesting that oxidative costs of growth may result from increased RS production due to the greater metabolism needed for enhanced growth. My experimental data (Chapter 3) showed a similar pattern, with raised protein damage levels (protein carbonyls; PCs) in the fastest growing blue tit chicks in a brood, compared with their slower growing sibs. These within-brood differences in OS levels likely resulted from within-brood hierarchies and might have masked any between-brood differences, which were not observed here. Despite evidence for a growth – self-maintenance trade off, my experimental results on blue tits found no support for the hypothesis that self-maintenance is also traded off against reproduction, another energetically demanding trait. There was no link between experimentally altered reproductive expenditure and OS, nor was there a direct correlation between reproductive effort and OS (Chapter 5). However, there are various factors that likely influence whether oxidative costs are observed, including environmental conditions and whether such costs are transient. This emphasises the need for longitudinal studies following the same individuals over multiple years and across a wide range of habitats that differ in quality. This would allow investigation into how key life events interact; it might be that raised OS levels from rapid early growth have the potential to constrain reproduction or that high parental OS levels constrain offspring growth. Any oxidative costs resulting from these life-history trade-offs have the potential to impact on future fitness. Redox integration of certain biomarkers might prove to be a useful tool in making predictions about fitness, as I found in Chapter 2, as well as establishing how the redox system responds, as a whole, to changes to growth and reproduction. Finally, if the tissues measured can tolerate a given level of OS, then the level of oxidative damage might be irrelevant and not impact on future fitness at all.

Cost-free feed-in tariffs for renewable energy deployment in Spain

Feed-in-tariff (FIT) schemes have been widely employed to promote renewable energy deployment. While FITs may be perceived by consumers as an extra cost, renewable energies cause a noticeable price reduction in wholesale electricity markets. We analyse both effects for the case of the Spanish electricity market during 2010. In particular, we examine the level of FITs that makes savings and extra costs to be similar on an hourly basis. Results are obtained for a wide range of renewable generation scenarios. It is found that FITs with null extra costs for consumers are in the range of 50–80 €/MWh. Some of the side-effects of a high penetration of renewable energy in the market are analysed in detail and discussed.

Very low risk ST-segment elevation myocardial infarction? It exists and may be easily identified

Early discharge protocols have been proposed for ST-segment elevation myocardial infarction (STEMI) low risk patients despite the existence of few but significant cardiovascular events during mid-term follow-up. We aimed to identify a subgroup of patients among those considered low-risk in which prognosis would be particularly good. We analyzed 30-day outcomes and long-term follow-up among 1.111 STEMI patients treated with reperfusion therapy. Multivariate analysis identified seven variables as predictors of 30-day outcomes: Femoral approach; age > 65; systolic dysfunction; postprocedural TIMI flow < 3; elevated creatinine level > 1.5 mg/dL; stenosis of left-main coronary artery; and two or higher Killip class (FASTEST). A total of 228 patients (20.5%), defined as very low-risk (VLR), had none of these variables on admission. VLR group of patients compared to non-VLR patients had lower in-hospital (0% vs. 5.9%; p < 0.001) and 30-day mortality (0% vs. 6.25%: p < 0.001). They also presented fewer in-hospital complications (6.6% vs. 39.7%; p < 0.001) and 30-day major adverse events (0.9% vs. 4.5%; p = 0.01). Significant mortality differences during a mean follow-up of 23.8 ± 19.4 months were also observed (2.2% vs. 15.2%; p < 0.001). The first VLR subject died 11 months after hospital discharge. No cardiovascular deaths were identified in this subgroup of patients during follow-up. About a fifth of STEMI patients have VLR and can be easily identified. They have an excellent prognosis suggesting that 24–48 h in-hospital stay could be a feasible alternative in these patients.

Gastroenterology training in Latin America

Latin America is characterized by ethnic, geographical, cultural, and economic diversity; therefore, training in gastroenterology in the region must be considered in this context. The continent's medical education is characterized by a lack of standards and the volume of research continues to be relatively small. There is a multiplicity of events in general gastroenterology and in sub-disciplines, both at regional and local levels, which ensure that many colleagues have access to information. Medical education programs must be based on a clinical vision and be considered in close contact with the patients. The programs should be properly supervised, appropriately defined, and evaluated on a regular basis. The disparity between the patients' needs, the scarce resources available, and the pressures exerted by the health systems on doctors are frequent cited by those complaining of poor professionalism. Teaching development can play a critical role in ensuring the quality of teaching and learning in universities. Continuing professional development programs activities must be planned on the basis of the doctors' needs, with clearly defined objectives and using proper learning methodologies designed for adults. They must be evaluated and accredited by a competent body, so that they may become the basis of a professional regulatory system. The specialty has made progress in the last decades, offering doctors various possibilities for professional development. The world gastroenterology organization has contributed to the speciality through three distinctive, but closely inter-related, programs: Training Centers, Train-the-Trainers, and Global Guidelines, in which Latin America is deeply involved. (C) 2011 Baishideng. All rights reserved.