Miracle-dz/UniFAR-FTUs huggingface dataset:
The frozen elephant trunk treatment is the operation of choice for all kinds of arch disease.

BACKGROUND Frozen elephant trunk (FET) is considered to be the treatment of choice in complex multi-segmental thoracic aortic disease involving the distal arch. Institutional results of FET technique are presented. METHODS From January 2005 to October 2017, 286 patients underwent FET surgery in our department. Patients (mean age 59±11 years) were operated for acute type I (55%) aortic dissection (AD), chronic AD (23%) and aneurysm (22%). Arch repair was performed with the E-vita Open prosthesis under with selective cerebral perfusion and hypothermic circulatory arrest. Zone 2 arch repair was applied in combination with debranching of the left subclavian artery. Redo-surgery after previous sternotomy underwent 52 patients. RESULTS Distal FET was moved from Zone 3 (36%) to Zone 2 (64%) during the past 10 years. Thirty-day mortality was 11% and similar in patients after first or redo-sternotomy (P=1.000). Proximalization of the anastomosis in Zone 2 improved permanent cerebral (4% vs. 8%, P=0.285) as wells as spinal events (2% vs. 4%, P=0.256) though not yet statistically significant. However, postoperative renal (26% vs. 43%, P=0.004) and pulmonary failure (19% vs. 42%, P<0.001) could be decreased significantly. Five-year survival was 75% and also improved with Zone 2 arch repair (P=0.022). Distal aortic arch pathology was excluded in all but one patient. Freedom from re-intervention downstream was 81% and was improved in acute AD compared to chronic AD and aneurysm (P=0.001). Not a single endoleak type I was encountered with this surgical-endovascular approach. CONCLUSIONS FET is the surgical treatment option of choice to achieve lasting results down to the stent-graft end for all comers with all kinds of arch disease and facilitates additional endovascular or surgical treatment downstream, if required. FET in combination with debranching enabling Zone 2 arch repair improved the results. However, FET remains major surgery and less invasive techniques including complete endovascular arch repair methods are welcome to increase our treatment armamentarium especially in frail multi-morbid patients.
Association of Human Papillomavirus Status at Head and Neck Carcinoma Subsites With Overall Survival

Importance Data are limited on the prognostic value of human papillomavirus (HPV) status for head and neck carcinoma subsites. Objective To determine whether HPV positivity at each head and neck subsite is associated with improved overall survival. Design, Setting, and Participants This retrospective population-based cohort study used the National Cancer Database to identify patients diagnosed with head and neck squamous cell carcinomas from January 1, 2010, to December 31, 2014. Patients were classified according to the location of their primary malignancy into 1 of the 6 main subsites of the upper aerodigestive tract: oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, and sinonasal tract. Patients were also classified by their HPV status. Data collection for this study took place from January 1, 2010, to December 31, 2014. Data analysis was conducted from August 1, 2017, to September 30, 2017. Main Outcomes and Measures The difference in 5-year overall survival between patients with HPV-positive status and those with HPV-negative status in various head and neck carcinoma subsites; the role of HPV status in an unadjusted Cox multivariate regression model. Results Of the 175 223 total number of patients identified (129 634 [74.0%] male; 45 589 [26.0%] female; mean [SD] age, 63.1 [11.9] years), 133 273 (76.1%) were ineligible and 41 950 (23.9%) were included in the sample. This sample included 16 644 patients (39.7%) with HPV-positive tumors and 25 306 (60.3%) with HPV-negative tumors. Patients with an HPV-positive status were more likely to be younger, be white, be male, present with local T category tumors, and have poor differentiation on histologic examination. HPV-positive status was associated with survival at 4 tumor subsites: oral cavity (hazard ratio [HR], 0.76; 95% CI, 0.66-0.87), oropharynx (HR, 0.44; 95% CI, 0.41-0.47), hypopharynx (HR, 0.59; 95% CI, 0.45-0.77), and larynx (HR, 0.71; 95% CI, 0.59-0.85). The HPV status was the greatest factor in survival outcome between the HPV-positive and -negative cohorts at the oropharynx subsite (77.6% vs 50.7%; survival difference, 26.9%; 95% CI, 25.6%-28.2%) and hypopharynx subsites (52.2% vs 28.8%; survival difference, 23.4%; 95% CI, 17.5%-29.3%). For the nasopharynx (HR, 1.03; 95% CI, 0.75-1.42) and sinonasal tract (HR, 0.63; 95% CI, 0.39-1.01) subsites, HPV-positive status was not an independent prognostic factor. Conclusions and Relevance Human papillomavirus positivity was associated with improved survival in 4 subsites (oropharynx, hypopharynx, oral cavity, and larynx), and the largest survival difference was noted in the oropharynx and hypopharynx subsites. In the nasopharynx and sinonasal tract subsites, HPV positivity had no association with overall survival. Given these results, routine testing for HPV at the oropharynx, hypopharynx, oral cavity, and larynx subsites may be warranted.
Performance Analysis of UAV Enabled Disaster Recovery Networks: A Stochastic Geometric Framework Based on Cluster Processes

In this paper, we develop a comprehensive statistical framework to characterize and model large-scale unmanned aerial vehicle-enabled post-disaster recovery cellular networks. In the case of natural or man-made disasters, the cellular network is vulnerable to destruction resulting in coverage voids or coverage holes. Drone-based small cellular networks (DSCNs) can be rapidly deployed to fill such coverage voids. Due to capacity and back-hauling limitations on drone small cells (DSCs), each coverage hole requires a multitude of DSCs to meet the shortfall coverage at a desired quality-of-service. Moreover, ground users also tend to cluster in hot-spots in a post-disaster scenario. Motivated by this fact, we consider the clustered deployment of DSCs around the site of a destroyed BS. Joint consideration partially operating BSs and deployed DSCs yields a unique topology for such public safety networks. Borrowing tools from stochastic geometry, we develop a statistical framework to quantify the down-link performance of a DSCN. Our proposed clustering mechanism extends the traditional Matern and Thomas cluster processes to a more general case, where cluster size is dependent upon the size of the coverage hole. We then employ the newly developed framework to find closed-form expressions (later verified by Monte-Carlo simulations) to quantify the coverage probability, area spectral efficiency, and the energy efficiency for the down-link mobile user. Finally, we explore several design parameters (for both of the adopted cluster processes) that address optimal deployment of the network (i.e., number of drones per cluster, drone altitudes, and transmit power ratio between the traditional surviving base stations and the drone base stations).
A 550,000-year record of East Asian monsoon rainfall from 10Be in loess

Forcing the East Asian summer monsoon What factors have controlled the intensity of the East Asian summer monsoon over the recent geological past? To answer this key question requires a robust proxy for rainfall amounts. Beck et al. measured the beryllium isotopic content of loess from China, from which they reconstructed a 550,000-year-long record of rainfall. Rainfall correlated with orbital precession and global variations in ice volume. This finding suggests that the monsoon is governed by low-latitude interhemispheric gradients in solar radiation levels, rather than by high-northern-latitude solar radiation levels as previously suggested. Science, this issue p. 877 The East Asian summer monsoon has been controlled by low-latitude factors over the past half-million years. Cosmogenic 10Be flux from the atmosphere is a proxy for rainfall. Using this proxy, we derived a 550,000-year-long record of East Asian summer monsoon (EASM) rainfall from Chinese loess. This record is forced at orbital precession frequencies, with higher rainfall observed during Northern Hemisphere summer insolation maxima, although this response is damped during cold interstadials. The 10Be monsoon rainfall proxy is also highly correlated with global ice-volume variations, which differs from Chinese cave δ18O, which is only weakly correlated. We argue that both EASM intensity and Chinese cave δ18O are not governed by high-northern-latitude insolation, as suggested by others, but rather by low-latitude interhemispheric insolation gradients, which may also strongly influence global ice volume via monsoon dynamics.
Evaluation of the Effect of the Sulcus Angle and Lateral to Medial Facet Ratio of the Patellar Groove on Patella Tracking in Aging Subjects with Stable Knee Joint

Purpose To determine whether the sulcus angle and the lateral to medial facet ratio correlate with patella lateral displacement and tilt in patients without patella instability. Methods Computed tomography images of the lower limb of 64 patients without known arthropathy were collected. Three-dimensional models of the lower limb with a unified coordinate system were rebuilt by using Mimics software. The sulcus angle, lateral to medial facet ratio, lateral trochlear inclination of the patellar groove, tibial tuberosity-trochlear groove (TT-TG) distance, bisect offset index, and lateral tilt of the patella were measured. Pearson's correlation test was used to determine the relationship between the aforementioned parameters. Results Data from 51 patients were analyzed. The sulcus angle was negatively correlated with lateral tilt inclination (p < 0.001, r = 0.8406) and positively correlated with the bisect offset index (p = 0.003, r = 0.634) and patellar tilt (p = 0.03, r = 0.551); the lateral to medial facet ratio was positively correlated with TT-TG distance (p = 0.003, r = 0.643) and bisect offset index (p = 0.026, r = 0.559). Conclusion The sulcus angle and lateral to medial facet ratio of the patellar groove can influence patella tracking in patients with stable knee joints.
Sleep Disorders Associated With Alzheimer's Disease: A Perspective

Sleep disturbances, as well as sleep-wake rhythm disturbances, are typical symptoms of Alzheimer's disease (AD) that may precede the other clinical signs of this neurodegenerative disease. Here, we describe clinical features of sleep disorders in AD and the relation between sleep disorders and both cognitive impairment and poor prognosis of the disease. There are difficulties of the diagnosis of sleep disorders based on sleep questionnaires, polysomnography or actigraphy in the AD patients. Typical disturbances of the neurophysiological sleep architecture in the course of the AD include deep sleep and paradoxical sleep deprivation. Among sleep disorders occurring in patients with AD, the most frequent disorders are sleep breathing disorders and restless legs syndrome. Sleep disorders may influence circadian fluctuations of the concentrations of amyloid-β in the interstitial brain fluid and in the cerebrovascular fluid related to the glymphatic brain system and production of the amyloid-β. There is accumulating evidence suggesting that disordered sleep contributes to cognitive decline and the development of AD pathology. In this mini-review, we highlight and discuss the association between sleep disorders and AD.
Medical Therapy As Compared To Surgical Device Exchange for Left Ventricular Assist Device Thrombosis: A Systematic Review and Meta-Analysis

Pump thrombosis is a major adverse event in patients supported on continuous-flow left ventricular assist devices (CF-LVAD). The aim of this systematic review and meta-analysis was to determine the outcomes of various treatment approaches for pump thrombosis, including surgical as compared to medical therapy. Electronic search was performed to identify all studies in the English literature addressing surgical and medical management of pump thrombosis in the modern CF-LVAD era. All identified articles were systematically assessed for inclusion and exclusion criteria. In the meta-analysis, because of significant overlap of the data, reports based on trials, registries, and individual cohort studies were analyzed separately. Forty-three studies were included in the analysis (2 trials, 4 registry reports, and 37 individual cohort studies). 2,281/28,728 (10.6%) patients developed pump thrombosis, of which 44.4% and 55.1% were supported on the HeartWare and HeartMate II, respectively. To avoid overlap in studies and to seek more granular data, pooled individual cohort studies were found to be representative of the entire population, and further in-depth analysis of this category was performed. Of the 610/5,545 (11.8%) patients with pump thrombosis in these individual cohort studies, 225 patients had surgical pump exchange, and 186 were treated medically. Surgical therapy resulted in higher success as compared to medical therapy (81.3% vs. 45.4%; p < 0.001), lower 30 day mortality rate (16.7% vs. 34.5%; p = 0.013) and recurrence rate (11.8% vs. 38.3%; p < 0.001). Meta-regression of all studies demonstrates a possible temporal increase of pump thrombosis rate (p = 0.040). Surgical pump exchange is superior to medical therapy with a higher success rate of pump thrombosis resolution, lower mortality rate, and lower recurrence rate. Randomized controlled prospective studies are needed to compare these clinical approaches and their resultant outcomes to guide decision-making for the management of CF-LVAD thrombosis.
Accumulation of Heavy Metals in Roadside Soil in Urban Area and the Related Impacting Factors

Heavy metal contamination in roadside soil due to traffic emission has been recognized for a long time. However, seldom has been reported regarding identification of critical factors influencing the accumulation of heavy metals in urban roadside soils due to the frequent disturbances such as the repair of damaged roads and green belt maintanance. Heavy metals in the roadside soils of 45 roads in Xihu district, Hangzhou city were investigated. Results suggested the accumulation of Cu, Pb, Cd, Cr, and Zn in roadside soil was affected by human activity. However, only two sites had Pb and Zn excessing the standards for residential areas, respectively, according to Chinese Environmental Quality Standards for soils. The concentrations of Cu, Pb, Cd, and Zn were significantly and positively correlated to soil pH and organic matter. An insignificant correlation between the age of the roads or vegetation cover types and the concentration of heavy metals was found although they were reported closely relating to the accumulation of heavy metals in roadside soils of highways. The highest Pb, Cd, and Cr taking place in sites with heavy traffic and significant differences in the concentrations of Cu, Pb, Cd, and Zn among the different categories of roads suggested the contribution of traffic intensity. However, it was difficult to establish a quantitative relationship between traffic intensity and the concentrations of heavy metals in the roadside soil. It could be concluded that impaction of traffic emission on the accumulation of heavy metals in roadside soils in urban area was slight and soil properties such as pH and organic matters were critical factors influencing the retention of heavy metals in soils.
Pregnancy management in prognosis for pregnant patients with systemic lupus erythematosus

Objective: To study the effects of pregnancy management in prognosis for pregnant patients with systemic lupus erythematosus (SLE). Methods: 217 pregnant patients who were diagnosed with SLE were divided into two groups, the control group and the intervention group. The intervention group was treated with routine treatment and nursing with additional pregnancy management, while the control group was treated with only routine treatment and nursing. Additionally, 195 normal pregnant women in the same period were selected as the healthy control. Regular laboratory tests were conducted for all subjects. Statistical analysis on changes of related disease indexes in each group was also performed. All information of maternal and neonatal outcomes was collected to record SLE activity rate, incidence of pregnancy induced hypertension (PIH), premature and fetal loss, neonatal weight and incidence of neonatal complications. Results: Increased ANA titer and dsDNA, lower immunoglobulin complement, renal damage, blood system damage, increased SLEDAI score and BILAG score were observed in the control group and the invention group compared with the healthy control. Both the control group and the intervention group showed significant increase in the incidences of PIH, premature delivery, fetal loss and neonatal complications as well as significant decrease in neonatal weight compared with the healthy control. SLE activity rate and incidences of PIH, premature delivery and neonatal complications were significantly decreased while neonatal weight was greatly increased in the intervention group compared with the control group. Results of logistic analysis showed that low immunoglobulin complement, renal damage, increased dsDNA, increased dsDNA and low immunoglobulin complement were independent risk factors for increased SLE activity rate, fetal loss, premature delivery and neonatal complications, respectively. Conclusion: The present study indicates that pregnancy management for pregnant SLE patients can significantly improve maternal and neonatal outcomes.
Leptospirosis in Coastal South India: A Facility Based Study

Background Leptospirosis is a major neglected public health problem and is highly underreported in India. The spectrum of clinical features ranges from subclinical infection to multiorgan failure. The burden of leptospirosis is more in developing countries. Objective The present study was designed to assess the sociodemographic characteristics, clinical feature, and outcome of leptospirosis patients. Methods This record based retrospective study was conducted in hospitals affiliated to Kasturba Medical College, Mangalore. The registries of the leptospirosis patients during the period of four years between January 2011 and December 2014 were reviewed and the information on demographic and clinical profile of the leptospirosis patients was recorded in the data capture sheet. The information obtained was analyzed using SPSS version 11.5. Results The study included 202 leptospirosis victims. The mean age of the study population was 40.48 (±14.8) years. Majority of the patients presented with fever (92.1%) at the time of admission. Acute renal failure was found to be the most common complication (79.2%). Case fatality rate was found to be 3.5%. Conclusion High proportion of cases indirectly reflects the endemic nature of the disease in the study setting. The clinical presentation of the leptospirosis is highly protean and may vary from a mild illness to life-threatening complications as evident from the current study.
Contribution of basal and postprandial hyperglycaemia in type 2 diabetes patients treated by an intensified insulin regimen: Impact of pump therapy in the OPT2mise trial

The relative contribution of basal hyperglycaemia (BHG) and postprandial hyperglycaemia (PPHG) in type 2 diabetes patients treated with multiple daily injections (MDI) of insulin is poorly documented. In this study, the BHG and PPHG of patients from the OPT2mise study who were initially treated with MDI were assessed before randomization and again after 6 months of continuous subcutaneous insulin infusion (CSII).
Mosses Are Better than Leaves of Vascular Plants in Monitoring Atmospheric Heavy Metal Pollution in Urban Areas

Mosses and leaves of vascular plants have been used as bioindicators of environmental contamination by heavy metals originating from various sources. This study aims to compare the metal accumulation capabilities of mosses and vascular species in urban areas and quantify the suitability of different taxa for monitoring airborne heavy metals. One pleurocarpous feather moss species, Haplocladium angustifolium, and two evergreen tree species, Cinnamomum bodinieri Osmanthus fragrans, and substrate soil were sampled in the urban area of different land use types in Wuhan City in China. The concentrations of Ag, As, Cd, Co, Cr, Cu, Mn, Mo, Ni, V, Pb, and Zn in these samples were analyzed by inductively coupled plasma mass spectrometry. The differences of heavy metals concentration in the three species showed that the moss species was considerably more capable of accumulating heavy metals than tree leaves (3 times to 51 times). The accumulated concentration of heavy metals in the moss species depended on the metal species and land use type. The enrichment factors of metals for plants and the correlations of metals in plants with corresponding metals in soil reflected that the accumulated metals in plants stemmed mostly from atmospheric deposition, rather than the substrate soil. Anthropogenic factors, such as traffic emissions from automobile transportation and manufacturing industries, were primarily responsible for the variations in metal pollutants in the atmosphere and subsequently influenced the metal accumulation in the mosses. This study elucidated that the moss species H. angustifolium is relatively more suitable than tree leaves of C. bodinieri and O. fragrans in monitoring heavy metal pollution in urban areas, and currently Wuhan is at a lower contamination level of atmospheric heavy metals than some other cities in China.
RMapCS: Radio Map Construction From Crowdsourced Samples for Indoor Localization

Fingerprint crowdsourcing has recently been promoted as a promising solution for fingerprinting-based indoor localization systems to relieve the burden of site survey. When constructing an indoor localization map from crowd-sourced samples, the following challenges should be addressed: inaccurate sample annotation, unequal sample dimensionality, measurement device diversity, and nonuniform spatial distribution. In this paper, we propose the radio map construction from crowd-sourced sample (RMapCS) scheme to handle these challenges. The RMapCS consists of four main modules: outlier detection, source selection, fingerprint interpolation, and device calibration. For each device in each grid, we first propose an improved clustering algorithm to remove outliers and use a threshold-based approach to select only those important signal sources. For a grid without enough samples, we propose a fingerprint interpolation algorithm to construct its device-specific fingerprints. Then, we propose a device calibration algorithm to fuse samples from different devices to obtain grid fingerprints. We also propose a two-step online positioning algorithm consisting of both set comparison and similarity computation. We conduct field measurements and experiments to examine the localization performance. Results show that the proposed RMapCS can achieve significant improvements over the peer schemes and the average localization error can achieve around 1.5 m by using only the received signal strength-based fingerprints.
Effect of Cardiac Rehabilitation on Quality of Life, Depression and Anxiety in Asian Patients

This study explored the effect of cardiac rehabilitation on quality of life, depression, and anxiety in Asian patients in Singapore. Out of the 194 patients who were recruited into the study, 139 patients (71.6%) completed both the pre- and post-cardiac rehabilitation questionnaires. Their ages ranged from 28 to 80 (M = 56.66, SD = 8.88), and 103 patients (74.1%) were males and 21 patients (15.1%) were females. As hypothesized, there was a statistically significant difference between the pre- and post-cardiac rehabilitation scores on the combined dependent variables, F (4, 135) = 34.84, p < 0.001; Wilks’ Lambda = 0.49; partial eta squared = 0.51. An inspection of the mean scores indicated that patients reported higher levels of physical and mental quality of life and lower levels of depression post-cardiac rehabilitation. The findings were discussed in regards to implications in cardiac rehabilitation in Singapore.