Search Results (2,804)

This dataset presents a real-world lipidomics resource for developing and benchmarking quality control methods, batch effect detection algorithms, and data validation workflows. The data originates from a cross-sectional clinical study of psoriatic arthritis (PsA) patients (n = 81) and healthy controls (n = 26), matched for age, sex, and body mass index, which was collected at a tertiary university rheumatology center. Subtle laboratory irregularities were detected only through advanced unsupervised analysis, after passing conventional quality control and standard analytical methods. Blood samples were processed using standardized protocols and analyzed using high-resolution and tandem mass spectrometry platforms. Both targeted and untargeted lipid assays captured lipids of several classes (including carnitines, ceramides, glycerophospholipids, sphingolipids, glycerolipids, fatty acids, sterols and esters, endocannabinoids). The dataset is organized into four comma-separated value (CSV) files: (1) Box–Cox-transformed and imputed lipidomics values; (2) outlier-cleaned and imputed values on the original scale; (3) metadata including clinical classifications, biological sex, and batch information for all assay types and control sample processing dates; and (4) a variable-level description file (readme.csv). The 292 lipid variables are named according to LIPID MAPS classification and standardized nomenclature. Complete batch documentation and FAIR-compliant data structure make this dataset valuable for testing the robustness of analytical pipelines and quality control in lipidomics and related omics fields. This unique dataset does not compete with larger lipidomics quality control datasets for comparisons of results but provides a unique, real-life lipidomics dataset displaying traces of the laboratory sample processing schedule, which can be used to challenge quality control frameworks. Full article

Introduction: Conservative or upfront radical management for high- and very high-risk non-muscle-invasive bladder cancer continues to be debated, particularly for cases with adverse pathological features. We aimed to compare survival outcomes among NMIBC patients treated with transurethral resection of bladder tumour (TURBT) followed by either Bacillus Calmette–Guérin (BCG), sequential BCG plus electromotive administration of mitomycin C (EMDA-MMC), or upfront radical cystectomy (RC). Materials and Methods: High- and- very high-risk NMIBC cases undergoing TURBT followed by BCG, BCG plus EMDA-MMC, or RC at two international tertiary referral centres between 2009 and 2024 were retrospectively reviewed. Recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier methods. Multivariable Cox regression models were applied to identify factors independently associated with survival outcomes. Results: A total of 1178 patients were included: 852 received BCG, 249 received BCG/EMDA-MMC, and 77 underwent upfront RC. Kaplan–Meier analysis revealed no significant differences in RFS or PFS between the BCG and BCG/EMDA-MMC groups, nor in OS between the three treatment strategies. According to multivariable analysis, concomitant carcinoma in situ (CIS) and increasing T stage at TURBT were independently associated with poorer RFS (HR 1.39; 95% CI 1.05–1.85), PFS (HR 1.95; 95% CI 1.36–2.82), and OS (HR 2.28; 95% CI 1.60–3.25). A second resection conferred a protective effect on PFS (HR 0.72; 95% CI 0.54–0.95). Treatment modality (BCG, BCG/EMDA-MMC, or upfront RC) was not significantly associated with any survival endpoint. Conclusions: In this large multicentre series of patients with high- and very high-risk NMIBC undergoing TURBT, survival outcomes were primarily influenced by clinical–pathological characteristics rather than the adjuvant treatment of choice. Full article

Background/Objectives: Patients admitted to intensive care units (ICUs) are confronted with complex clinical situations that impact their physical condition and psychological well-being. Psycho-emotional disorders such as pain, anxiety and post-traumatic stress are highly prevalent in this context, significantly affecting both the patient’s experience and the quality of care provided. Effective communication can help manage patients’ psycho-emotional states and prevent post-ICU disorders. To evaluate the effectiveness of the CONECTEM communicative intervention in improving the psycho-emotional well-being of critically ill patients admitted to the intensive care unit, regarding pain, anxiety, and post-traumatic stress symptoms. Methods: A quasi-experimental study employed a pre–post-test design with both a control group and an intervention group. The study was conducted in two ICUs in a tertiary Hospital in Spain. A total of 111 critically ill patients and 180 nurse–patient interactions were included according to the inclusion/exclusion criteria. Interactions were classified according to the level of the patient’s consciousness into three groups: G1 (Glasgow 15), G2 (Glasgow 14–9), and G3 (Glasgow < 9). Depending on the patient’s communication difficulties, nurses selected one of three communication strategies of the CONECTEM intervention (AAC low teach, pictograms, magnetic board, and musicotherapy). Pain was assessed using the VAS or BPS scale, anxiety using the STAI, and symptoms of PTSD using the IES-R. The RASS scale was utilized to evaluate the degree of sedation and agitation in critically ill patients receiving mechanical ventilation. Data analysis was performed using repeated ANOVA measures for the pre–post-test, as well as Pearson’s correlation test and Mann–Whitney U or Kruskal–Wallis statistical tests. Results: The results showed pre–post differences consistent with pain after the intervention in patients with Glasgow scores of 15 (p < 0.001) and 14–9 (p < 0.001) and in anxiety (p = 0.010), reducing this symptom by 50% pre-test vs. 26.7% post-test. Patients in the intervention group with levels of consciousness (Glasgow 15–9) tended to decrease their post-traumatic stress symptoms, with reductions in the mean IES scale patients with a Glasgow score of 15 [24.7 (±15.20) vs. 22.5 (±14.11)] and for patients with a Glasgow score of 14–9 [(Glasgow 14–9) [30.2 (±13.56) 27.9 (±11.14)], though this was not significant. Given that patients with a Glasgow score below 9 were deeply sedated (RASS-4), no pre–post-test differences were observed in relation to agitation levels. Conclusions: The CONECTEM communication intervention outcomes differed between pre- and post-intervention assessments in patients with a Glasgow Coma Scale score of 15–9 regarding pain. These findings are consistent with a potential benefit of the CONECTEM communication intervention, although further studies using designs that allow for stronger causal inference are needed to assess its impact on the psycho-emotional well-being of critically ill patients. Full article

Significant volumes of wastewater and solid by-products are produced by olive oil industries worldwide, posing serious environmental challenges. This study presents an innovative circular economy and environmental sustainability approach that simultaneously valorizes liquid (olive mill wastewater, OMW) and solid by-products (crushed olive pits) rom olive oil production through hydroponic lettuce cultivation. The OMW was pretreated and supplemented with nutrients (OMW-N) to create a hydroponic solution for lettuce (Lactuca sativa) cultivation using crushed olive pits as growing substrate. A hydroponic system fed with a nutritive solution was used as a control. Lettuces grown in the OMW-N system achieved a 100% survival rate with no signs of phytotoxicity, although they exhibited a significant reduction in fresh mass (approx. 66%) and size, compared to the control. The sensory analysis revealed no significant differences in consumer acceptance, except for slightly lower color intensity, with 40% of participants explicitly indicating a purchase preference for the OMW-N lettuce, validating its commercial feasibility. Results demonstrated that OMW-N system functioned as a tertiary treatment, achieving additional removal of nutrients. Overall, integrating treated OMW and olive pits into hydroponics is a feasible strategy to convert agro-industrial waste into value-added food products, reducing the environmental footprint of the olive sector. Full article

Background/Objectives: Acute calculous cholecystitis remains one of the most frequent surgical emergencies, ranging from mild inflammation to gangrenous forms associated with necrosis and sepsis. Early differentiation between these stages is essential for timely surgical management. This study aimed to evaluate the diagnostic and prognostic value of hematological inflammatory indices—the Aggregate Index of Systemic Inflammation (AISI), the Systemic Immune-Inflammation Index (SII), and the Systemic Inflammation Response Index (SIRI)—in predicting the gangrenous evolution of acute calculous cholecystitis. Methods: A retrospective study was conducted on 435 patients who underwent cholecystectomy between 2016 and 2024 at a tertiary care center. Patients were divided into gangrenous (n = 145) and chronic (n = 290) cholecystitis groups. Preoperative hematological parameters were used to calculate AISI, SII, and SIRI. After histopathological confirmation, patients with GC (gangrenous calculous cholecystitis) were identified, and for each case, two age- and sex-matched controls with chronic CC (calculous cholecystitis) were selected, maintaining a GC:CC ratio of 1:2. Preoperative hematological parameters were used to calculate AISI, SII, and SIRI. Results: All three indices were significantly higher in the gangrenous group (p < 0.001). Logistic regression identified SIRI as the strongest independent predictor of gangrenous cholecystitis (OR = 1.976, p < 0.001). ROC analysis demonstrated excellent discriminative capacity for all markers (AUC > 0.8), with SII achieving the highest diagnostic accuracy (AUC = 0.889, sensitivity 79.5%, specificity 86.3%). Conclusions: AISI, SII, and SIRI represent reliable, easily obtainable, and noninvasive biomarkers for assessing inflammatory severity and predicting gangrenous transformation in acute calculous cholecystitis. Their integration into preoperative evaluation could improve early risk stratification, surgical planning, and patient outcomes. Full article

Objective: To identify risk factors for intrapartum cesarean delivery (CD) among women with obesity (BMI ≥ 30) and to evaluate whether a machine learning model (XGBoost) can improve prediction of this outcome compared with a previously developed regression-based risk score. Methods: A retrospective cohort study at a single university-affiliated tertiary medical center was conducted. All women with a pre-pregnancy BMI ≥ 30 who initiated a trial of labor between 2012 and 2024 were included. Women who underwent elective CD or had missing outcome data were excluded. Maternal, obstetric, and intrapartum characteristics were compared between women who delivered vaginally and those who required an intrapartum CD. Predictors were evaluated using extreme gradient boosting (XGBoost), and model performance was assessed using receiver operating characteristic (ROC) analysis and SHAP-based interpretability. Results: Among 146,999 women who delivered during the study period, 10,248 (7.0%) had a pre-pregnancy BMI ≥ 30. A total of 7236 obese women attempted a trial of labor, of whom 1031 (14.5%) underwent an intrapartum CD. Key predictors included limited cervical dilatation at admission, epidural anesthesia, nulliparity, maternal BMI and age, oxytocin use, birthweight, inflammatory markers (white blood count and neutrophils to lymphocytes ratio), and previous cesarean scar. The XGBoost model demonstrated excellent discriminatory ability with an AUC of 0.945 (95%CI 0.930–0.960, DeLong), and exceeded the performance of our previous regression-based score, and provided detailed insight into nonlinear effects through SHAP analysis. In a secondary analysis restricted to variables available at admission, a pre-labor model retained a strong discriminatory performance across BMI categories, supporting its applicability for early risk stratification prior to labor onset. Conclusions: A machine learning-based model accurately predicts intrapartum cesarean delivery in women with obesity and may serve as a valuable tool to support individualized counseling and delivery planning. Full article

Objectives: This study aimed to characterize the types and frequencies of sex chromosome aneuploidies (SCAs) detected through invasive prenatal testing, evaluate the concordance between non-invasive prenatal testing (NIPT) and confirmatory diagnostic methods, and assess the challenges faced during genetic counseling following SCA diagnosis. Study Design: A retrospective review was conducted on 842 prenatal samples collected between 2020 and 2024 in a tertiary private medical center. Samples included amniotic fluid, chorionic villi, and products of conception. Testing involved rapid QF-PCR for aneuploidy detection, followed by SNP-based chromosomal microarray analysis (CMA). NIPT results with high risk for sex chromosomes aneuploidies were correlated with invasive testing outcomes in 19 cases. Results: Sex chromosome aneuploidies were identified in 67 cases (7.96%), with Turner syndrome (45, X) being the most frequent (23 cases, including six mosaics), followed by Klinefelter syndrome (18 cases), 47, XYY (14 cases), and trisomy X (12 cases). Among 19 NIPT-tested cases, 10 were true positives, 5 false positives, and 4 false negatives, including two mosaic Turner syndrome cases undetected by NIPT. Discordances were attributed to factors such as mosaicism and placental anomalies. Conclusions: Prenatal diagnosis of SCAs via invasive testing remains crucial due to NIPT’s limited sensitivity for mosaicism and false positives. Comprehensive genetic counseling is essential to navigate diagnostic uncertainties and optimize prenatal management and postnatal outcomes. Full article

SF3B1-mutated myelodysplastic syndrome (MDS) is a distinct entity associated with a favorable prognosis. Recent data suggest that certain SF3B1 variants portend a worse prognosis. Our study aims to (1) describe SF3B1-MDS patients from a single tertiary center in Singapore and (2) determine if variant type holds prognostic value. We identified MDS patients with SF3B1 variants via next-generation sequencing (NGS) performed from 1 November 2021 to 31 October 2025 at Singapore General Hospital. Extracted genomic material from marrow or blood samples was amplified. Libraries were prepared, sequenced, and analyzed, and the hematological parameters, mutation profiles, and outcomes were evaluated. Twenty-five patients had SF3B1-MDS. Ten SF3B1 variants were found, and the three most prevalent were K700E (42%), K666N (19%), and R625C (7.7%). The median variant allele frequency (VAF) was 30% (IQR: 11–36%). Twelve patients (48%) had ≥1 co-mutations. Variant type and VAF had no impact on disease progression; only the presence of ≥1 co-mutations increased the progression chances. In our study, the analysis of SF3B1 variant type was inconclusive and showed no demonstrable statistical association with disease progression. However, the number of co-mutations affected the prognosis of patients. As SF3B1-MDS is heterogenous, further studies are needed to capture its diversity and identify features required to improve risk stratification and personalized treatment. Full article

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35–127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28–136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20–1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings. Full article

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a major cause of bloodstream infections and poses serious challenges to clinical management because treatment options are limited. This study aimed to characterize antimicrobial resistance, virulence-associated features, and molecular epidemiology of CRKP bloodstream isolates using integrated phenotypic and genomic approaches. A total of 74 non-duplicate CRKP isolates were collected from bloodstream infections at three tertiary-care hospitals in Riyadh, Saudi Arabia, between 2022 and 2024. All isolates showed classical Klebsiella pneumoniae phenotypic characteristics, including intrinsic resistance to natural and aminopenicillins, and were classified as either multidrug-resistant (MDR) or extensively drug-resistant (XDR). Resistance to imipenem was universal, and resistance to other β-lactams and fluoroquinolones was high. Carbapenemase genes were detected in 96.0% of isolates using the GeneXpert^® Carba-R assay, with bla_OXA-48-like and bla_NDM being most common. Whole-genome sequencing demonstrated predominance of Ambler class D carbapenemases, particularly bla_OXA-232, with additional contributions from bla_NDM-1 and bla_NDM-5. Co-occurrence of carbapenemase genes was observed in a subset of isolates. Virulence analysis showed that 37.8% of isolates exhibited a hypermucoviscous phenotype, and more than half carried at least one virulence-associated determinant linked to capsule regulation or iron acquisition. In contrast, most isolates showed weak or no biofilm-forming capacity. Multilocus sequence typing revealed substantial genetic diversity but clear dominance of high-risk lineages, particularly ST147 and the emerging ST2096, both closely associated with bla_OXA-232 and bla_OXA-48-like genes. Capsular and O-antigen analysis showed a non-random distribution dominated by KL64 and O1/O2. Phylogenetic analysis was consistent with clonal expansion and suggested intra-hospital spread, with the intensive care unit serving as a key reservoir and dissemination to other wards. In conclusion, CRKP bloodstream infections in this setting are largely associated with a limited number of epidemic clones that combine extensive antimicrobial resistance with virulence-associated traits. These findings support the need for ongoing genome-based surveillance, strengthened infection control measures, and antimicrobial stewardship to limit the spread of high-risk K. pneumoniae lineages in healthcare settings. Full article

Background: Persistent infection with high-risk human papillomavirus (HPV) is the key driver of cervical carcinogenesis and post-treatment recurrence. Although excisional treatment effectively removes dysplastic tissue, it does not directly target viral persistence. While HPV vaccination is well established in primary prevention, its potential role as an adjuvant strategy in HPV-positive women, particularly with respect to viral clearance, remains incompletely defined. Methods: This retrospective cohort study included HPV-positive women with at least 12 months of follow-up who were managed at a tertiary gynecology clinic. Patients were stratified according to HPV vaccination status with the nonavalent vaccine (Gardasil 9) and excisional treatment status with loop electrosurgical excision procedure (LEEP). HPV clearance at 12 months was defined as the primary outcome, while histological outcomes were evaluated as secondary and independent endpoints. Analyses were performed in the overall cohort and stratified by LEEP status. Multivariable logistic regression was used to identify factors independently associated with HPV persistence, adjusting for baseline disease severity and clinical covariates. Results: A total of 935 HPV-positive women were included in the final analysis. Completion of the three-dose HPV vaccination schedule was associated with significantly higher HPV clearance rates at 12 months compared with no vaccination. This association was consistently observed in women who underwent LEEP as well as in those managed without excisional treatment. In multivariable analysis, HPV vaccination emerged as an independent protective factor against HPV persistence, whereas LEEP status itself was not independently associated with viral clearance after adjustment for baseline histological severity. Histological outcomes differed according to baseline disease severity and did not demonstrate a direct one-to-one relationship with HPV clearance. Conclusions: Adjuvant vaccination with the nonavalent HPV vaccine is independently associated with increased HPV clearance in HPV-positive women at 1-year follow-up, irrespective of excisional treatment status. HPV clearance and histological regression represent related but distinct biological processes and should be evaluated as independent outcomes. These findings support a broader role for HPV vaccination beyond primary prevention and suggest potential clinical benefit of vaccination as an adjunctive strategy in the management of HPV-positive women. Full article

Objective: In this study, we aimed to develop and internally validate a clinically applicable nomogram for predicting live birth following in vitro fertilization (IVF) using routinely available clinical and embryological parameters. Methods: This retrospective study was conducted at a single tertiary IVF center. Women undergoing IVF/ICSI were included if their baseline demographic and clinical data were available, they had undergone at least one fresh or frozen–thawed embryo transfer, and they had a known live birth outcome. Women with cycles without embryo transfer and those missing key outcome data were excluded from the analysis. As a result, a total of 2119 IVF/ICSI treatment cycles resulting in embryo transfer were included in the analysis. To identify independent predictors of live birth, multivariable logistic regression analysis was performed. Results: Among the 2119 treatment cycles analyzed, 541 resulted in live birth (25.5%). Multivariable logistic regression with backward stepwise selection identified female age (OR: 0.959, p < 0.001), high embryo quality (OR: 2.752, p < 0.001), day of embryo transfer (day 5 vs. day 3, OR: 1.427, p = 0.001), and endometrial thickness on the day of transfer as independent predictors of live birth (OR: 1.086, p < 0.001). These variables were incorporated into a nomogram (the Zübeyde Hanim IVF Nomogram) to estimate individualized live birth probability. The model demonstrated acceptable discrimination, with a bootstrap-corrected area under the receiver operating characteristic curve (AUC) of 0.64 (95%CI: 0.61–0.66), and it showed satisfactory calibration across deciles of predicted risk. Conclusions: The Zubeyde Hanim IVF Nomogram provides an individualized and clinically practical tool for predicting live birth following IVF treatment. Based on routinely available parameters, this model may assist clinicians in patient counseling and treatment planning. Full article

Tertiary mathematics teaching is predominantly face-to-face, yet large, diverse cohorts and limited contact hours constrain opportunities for individually paced practice and timely feedback. We developed three bespoke, self-paced online numeracy modules, each targeting a specific mathematical concept and disciplinary context. Module design was informed by learning theory (constructivist, active learning, Universal Design for Learning, inclusive learning practices). We ran a qualitative pilot study to gain insight into user perceptions of modules in terms of engagement and perceived learning support, conducting semi-structured interviews with undergraduate science students (n = 11) and educators (n = 7). We applied thematic analysis to interview data, which generated the following insights. Students—many reporting high mathematics anxiety—responded positively, valuing low-stakes iterative practice, clear stepwise scaffolding, multimodal presentation, contextualized examples aligned to their course, and a supportive instructor voice. These features were described as reducing anxiety, reframing errors as part of learning, and supporting inclusion, despite prevalent math avoidance in the cohort. Staff feedback was more cautious, recognizing similar strengths but focusing on areas for improvement. We argue that bespoke, contextualized modules can augment face-to-face instruction by delivering individualized pacing and immediate feedback at scale, while contributing to the creation of an accessible, inclusive, supportive learning environment. Future work should quantify learning outcomes, track affective changes longitudinally, and isolate contributions of specific design features across diverse cohorts and disciplines. Full article

Foreign direct investment (FDI) has often been cast as a straightforward engine of growth, yet its record across Central and Eastern Europe tells a more tangled story where outcomes hinge on the interplay of education, governance, and the timing of external shocks. This study embeds fixed effects panel econometrics within a systems framework, treating FDI as a subsystem of socio-economic dynamics. Using a long-run panel of eleven economies from 2000 to 2023, the analysis models path dependence and regime shifts through interaction terms and period-specific dummies set against a systems-thinking backdrop. The analysis shows that for the average CEE economy, FDI’s contribution has waxed and waned: it dragged on growth during the early transition years (2000–2007), settled into a neutral role after the global financial crisis, and proved unpredictable in the pandemic era. Romania stands out, however, with a marked “FDI premium” quantified as approximately 0.7 pp of growth per pp of FDI that seems to stem from reinforcing loops between rising tertiary enrolment and productivity spillovers. Mapping these feedbacks brings to light virtuous circles where human capital and resilience make or break the benefits of foreign capital. The policy message is plain: nurture the positive loops through investment in skills and firm linkages, keep institutions nimble enough to adapt, and watch for early warning signs of systemic strain. Full article

Background/Objectives: The ratio of percentage of prostate cancer (PCa) biopsy-positive cores (BPC) to prostate volume as the index density factor (Id-BPC) was used to predict the risk of high tumour grades in the surgical specimens of European Association of Urology (EAU) intermediate-risk patients treated with robotic surgery. Methods: From January 2013 to December 2021, we evaluated 651 patients without any prior treatment for PCa. In the surgical specimen, tumour grades were classified as indolent (International Society of Urological Pathologists Classification (ISUP) 1), significant (ISUP 2/3), and lethal (ISUP 4/5). Associations with the risk of significant and lethal cancers were assessed by the multinomial logistic regression model. Results: Tumour grade was clinically significant (ISUP 2/3) in 522 (80.2%) cases and lethal (ISUP 4/5) in 99 (15.2%), while the results were not significant (ISUP 1) in 30 (4.6%) subjects. The association of Id-BPC was always stronger than BPC for ISUP 1 vs. 4/5 (OR = 0.284; 95% CI: 0.128–0.632; p = 0.002), ISUP 2/3 vs. 4/5 (OR = 0.744; 95% CI: 0.586–0.946; p = 0.016), and ISUP 1 vs. 2/3 (OR = 0.382; 95% CI: 0.176–0.828; p = 0.015), and this trend held after adjusting for clinical factors. Conclusions: Accordingly, Id-BPC was positively associated with lethal disease, as, when it increased or decreased, it was more or less likely, respectively, to find ISUP 4/5 in the surgical specimens of the operated subjects, who could have been stratified according to Id-BPC risk levels. Full article