bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Support Design in Weak Rock Drift Using a Systematic Approach
Authors: Zhao Xingdong , Zhang Shujing , Li Huaibin , Chen Guoju , Zhang Pengqiang
Published: September 2020

The aim of this study is to develop a systematic approach for support design of weak rock drift based on empirical, analytical, and numerical method, which is employed to estimate weak rock support demand and design support system. Detailed engineering geological investigations and rock mechanics test have been carried out in weak rock drift. The Q‐system and GSI‐system were used to determine the primary support design and rock mass properties, respectively. The numerical model of RS2 finite element program has been calibrated by analyzing the relation of falling height observed in the field to the frictional angles obtained from empirical method, rock mechanics test, and calculated rock mass parameters, respectively. In an attempt to check the validity of sophisticated support, support suggested by Q‐system, and the combination support system proposed by analytical approach, the RS2 program was employed to analyze the depth of plastic zone and total displacement surrounding the weak rock drift. Numerical results show that the depths of plastic zone and total deformation surrounding the weak rock drift supported by the combination support system significantly descended 87% and 90% of those of sophisticated support. In particular, the rock bolt and cable bolt provide enough frictional and interlocked forces to resist weak rock falling which change the weak rock mechanicals properties and the surface holding function reinforced by the shotcrete, wire mesh, and steel strap. The factor of safety (FOS) of 8.28 of the combination support system is much more than the FOS of 1.5 for permanent drift. The combination support system with rock bolts, cable bolt, shotcrete, wire mesh, and steel straps has been applied to stabilize the weak rock drift and found to be successful to prevent further deformations surrounding the drift.
Acute Coronary Syndrome in Acute Myeloid Leukemia with Maturation Accompanying Megakaryocytic Differentiation
Authors: Odani Kentaro , Abe Junya , Tsuyuki Yoshiaki , Yanagita Soshi , Shiogama Kazuya , Tachibana Mitsuhiro , Tsutsumi Yutaka
Published: September 2020

An autopsy case (85-year-old Japanese male) of myeloperoxidase- (MPO-) positive acute myeloid leukemia with maturation (M1) accompanying megakaryocytic differentiation is presented. The patient manifested acute coronary syndrome. Even after emergent percutaneous coronary intervention, his performance status remained poor, so no chemotherapy against leukemia was given. The final white blood cell count reached 291,700/μL, and the platelet count was elevated to 510,000/μL. No cytogenetic studies were performed. He died at the 25th day of hospitalization. Autopsy revealed marked leukemic infiltration to the endocardium and subendocardial myocardium. Subendocardial myonecrosis was surrounded or replaced by the leukemic blasts, and neither granulation tissue reaction nor fibrosis was observed. In the cardiovascular lumen, lard-like blood clots were formed and microscopically consisted of leukemic blasts and platelets (leukemic thrombi). Infiltration of leukemic blasts was seen in the body cavities and systemic organs including the lung. The MPO-positive blasts lacked azurophilic granules and expressed the stem cell markers, CD34 and CD117 (c-kit). No features of myelofibrosis were seen in the 100% cellular marrow. In the endocardium, liver, lymph nodes, and bone marrow, megakaryocytic cells (CD42b/CD61+, MPO-) were distributed, while the small-sized blastic cells in the blood and tissues predominantly expressed MPO. The blasts lacked expression of CD42b/CD61. Megakaryocytic differentiation might be stimulated by certain tissue factors. AML accompanying megakaryocytic differentiation in certain tissues and organs should be distinguished from acute megakaryoblastic leukemia. The mechanisms provoking acute coronary syndrome in acute myeloid leukemia are discussed.
Antihypernociceptive, Anxiolytic, and Antidepressant Properties of Aqueous and Ethanol Extracts ofDissotis tholloniiCogn. (Melastomataceae) in Mice
Authors: Djuichou Nguemnang Stephanie Flore , Tsafack Eric Gonzal , Mbiantcha Marius , Ateufack Gilbert , Yousseu Nana William , Atsamo Albert Donatien , Adjouzem Carine Flore , Matah Marthe Mba Vanessa , Ben Besong Egbe
Published: September 2020

Diabetic neuropathy, which affects 7 to 9% of the world’s population and that is usually accompanied by anxiety and depression, is chronic pain that results from impaired function of the central or peripheral nervous system. This study aimed at evaluating the antihypernociceptive, antiallodynic, anxiolytic, and antidepressant effects ofDissotis tholloniiextracts. Diabetic neuropathy was induced by intraperitoneal injection of streptozotocin (200 mg/kg) in mice. The aqueous and ethanol extracts (250 and 500 mg/kg) were administered orally. Hyperalgesia (thermal and chemical), allodynia (mechanical and thermal), anxiety (high plus labyrinth, light-dark box, and social interaction), and depression (open field test, suspension test tail, and forced swimming test) were evaluated, and then the levels of some cytokines and growth factors were determined. The aqueous and ethanol extracts ofDissotis tholloniidemonstrated significant antihypernociceptive (inhibition of hyperalgesia and allodynia), anxiolytic, and antidepressant activities in mice made diabetic by STZ. The extracts also significantly inhibited (p<0.001) the levels of TNF-α, IL-1β, and IL-6 in the blood as well as the levels of TNF-α, IL-1β, IL-6, IGF, and NGF in the sciatic nerve. This study shows that the extracts ofDissotis tholloniihave antihypernociceptive and neuroprotective effects which could be linked to the inhibition of proinflammatory cytokines and growth factors in the blood and the sciatic nerve.
Research on Stress Threshold of Deep Buried Coal Rock under Quasi‐Static Strain Rate Based on Acoustic Emission
Authors: Hao Qijun , Liu Xiaohui , Hu Ankui , Zheng Yu , Zhao Xiaoping
Published: September 2020

The deformation and failure process of coal rock under different strain rates is a significant challenge which must be solved in dynamic excavation. It is important to study the influence of strain rate on the evolution of coal rock crack. The triaxial compression tests and acoustic emission tests under the strain rate of 10−5 s−1 to 10−3 s−1 were conducted on coal rock using MTS 815 hydraulic servo‐control testing machine. During the loading process, acoustic emission energy and spatial distribution have obvious stage characteristics. The damage variable is defined by acoustic emission energy, and the rate of damage evolution is obviously affected by the strain rate. Based on stage characteristics of acoustic emission energy, spatial distribution, and damage evolution, the use of damage evolution curve to determine stress threshold is proposed. In order to verify the rationality of the damage evolution method, the stress threshold values determined by damage evolution method and existing method are compared and analyzed. In order to study the effect of strain rate and confining pressure on the stress threshold, the stress thresholds under uniaxial and triaxial stress states at different strain rates were analyzed.
Review of Compounds and Pharmacological Effects of Delphinium
Authors: Chen Sitan , Meng Lijun , El-Demerdash Fatma M. , Zhou Li , Rizvi Syed Arif Hussian , Cui Lili , Kang Wenyi
Published: September 2020

Plants of Delphinium are herbal medicine used in the Tibet region with whole grass as a drug, which have the effects of analgesic, antibacterial, antipyretic, and anticancer. The main bioactive compounds are alkaloids, flavonoids, and sterols. This review summarized the compounds and pharmacological effects of Delphinium and provides a reference for further research on Delphinium.
A Novel 5G LTE Antenna Design for Portable Devices
Authors: Jhang Wei-Chiang , Sun Jwo-Shiun
Published: September 2020

This paper presents the low profile, planar, and small-size antenna design for WWAN, LTE, and 5G (5th generation wireless systems) for use in portable communication equipment. The antenna occupies only 65 × 13 × 0.4 mm3, and the antenna is combined with a 200 × 260 mm2 copper plate to simulated system ground plane. In the low band, a direct-fed right-side arm and a coupled-fed arm implemented can excite a 1/4 λ fundamental resonant mode at 0.85 and 0.76 GHz to cover 0.698–0.96 GHz and upper 3/4 λ and 5/4 λ resonant modes are controlled by L-shaped element at 2.34, 2.69, 3.4, and 4.0 GHz to cover 1.71–2.69 GHz and 3.2–4.2 GHz. The direct-fed left-side arm produced 1/4 λ to cover 5.15–5.85 GHz. In far-field measured, peak gain and efficiency in low, middle, and high bands are 0.43–5.67 dBi and 55–86%. Finally, experiments demonstrate that the present antenna exhibits a good performance for portable devices.
Triplet Therapy with Palbociclib, Taselisib, and Fulvestrant inPIK3CA-Mutant Breast Cancer and Doublet Palbociclib and Taselisib in Pathway-Mutant Solid Cancers
Authors: Pascual Javier , Lim Joline S.J. , Macpherson Iain R. , Armstrong Anne C. , Ring Alistair , Okines Alicia F.C. , Cutts Rosalind J. , Herrera-Abreu Maria Teresa , Garcia-Murillas Isaac , Pearson Alex , Hrebien Sarah , Gevensleben Heidrun , Proszek Paula Z. , Hubank Michael , Hills Margaret , King Jenny , Parmar Mona , Prout Toby , Finneran Laura , Malia Jason , Swales Karen E. , Ruddle Ruth , Raynaud Florence I. , Turner Alison , Hall Emma , Yap Timothy A. , Lopez Juanita S. , Turner Nicholas C.
Published: September 2020

Cyclin-dependent kinase 4/6 (CDK4/6) and PI3K inhibitors synergize in PIK3CA-mutant ER-positive HER2-negative breast cancer models. We conducted a phase Ib trial investigating the safety and efficacy of doublet CDK4/6 inhibitor palbociclib plus selective PI3K inhibitor taselisib in advanced solid tumors, and triplet palbociclib plus taselisib plus fulvestrant in 25 patients with PIK3CA-mutant, ER-positive HER2-negative advanced breast cancer. The triplet therapy response rate in PIK3CA-mutant, ER-positive HER2-negative cancer was 37.5% [95% confidence interval (CI), 18.8–59.4]. Durable disease control was observed in PIK3CA-mutant ER-negative breast cancer and other solid tumors with doublet therapy. Both combinations were well tolerated at pharmacodynamically active doses. In the triplet group, high baseline cyclin E1 expression associated with shorter progression-free survival (PFS; HR = 4.2; 95% CI, 1.3–13.1; P = 0.02). Early circulating tumor DNA (ctDNA) dynamics demonstrated high on-treatment ctDNA association with shorter PFS (HR = 5.2; 95% CI, 1.4–19.4; P = 0.04). Longitudinal plasma ctDNA sequencing provided genomic evolution evidence during triplet therapy.

SIGNIFICANCE:

The triplet of palbociclib, taselisib, and fulvestrant has promising efficacy in patients with heavily pretreated PIK3CA-mutant ER-positive HER2-negative advanced breast cancer. A subset of patients with PIK3CA-mutant triple-negative breast cancer derived clinical benefit from palbociclib and taselisib doublet, suggesting a potential nonchemotherapy targeted approach for this population.

This article is highlighted in the In This Issue feature, p. 1
Preoperative Magnetic Resonance Image Quality in Motion Disorder Patients Scheduled for Deep Brain Stimulation Surgery
Authors: Ronde Elsa M. , Silvasti-Lundell Marja , Pekkola Johanna , Tallgren Minna , Kivisaari Riku
Published: September 2020

Background: To obtain magnetic resonance (MR) images of good quality for accurate target localization in deep brain stimulation (DBS) surgery, sedation or anesthesia may be used, although their usefulness has not been proven. Objective: To assess whether sedation or general anesthesia (GA) improve the quality of MR imaging (MRI). Methods: The records of DBS procedures for Parkinson’s disease (PD), dystonia, and essential tremor in our tertiary neurosurgical unit between January 2011 and June 2016 were reviewed. Adult patients with preoperative MR images were included. Patient records concerning MRI, surgery, adverse events, and clinical outcome were retrospectively scrutinized and analyzed. MR image quality was assessed by two independent radiologists. Results: A total of 215 preoperative MR images for 177 DBS procedures were analyzed. The MRI sequences performed under GA were superior to those performed without anesthesia or under sedation (p < 0.01). Virtually all images captured under GA were of good quality, while the proportions among those captured with sedation or without anesthesia were <65%. Good image quality was not associated with better clinical outcome (>50% improvement in the Unified Parkinson’s Disease Rating Scale III score) among patients with PD. Conclusion: GA was associated with better MRI sequences than intravenous sedation or no anesthesia.
A Potential Predictive Biomarker for Miller/Payne Grading: PD-L1 Expression before Neoadjuvant Chemotherapy in Breast Cancer
Authors: Li Cheng , Ma Rui-Zhong , Han Gui-Yan , Guo Ying-Hua , Zhang Ya-Nan , Zhang Ya-Ting , Wang Hui , Zhang Yu-Ping , Chen Fang-Ming , Zhang Shi-Geng , Wang Ming-Chen , Hao Fu-Rong , Zhang Yun-Xiang
Published: September 2020

Background and Objective: The aim of this study was to investigate the value of programmed death ligand 1 (PD-L1) expression as a predictive biomarker for Miller/Payne grading before neoadjuvant chemotherapy (NACT) in breast cancer. Patients and Methods: The expression of PD-L1 in pretreatment biopsies of breast cancer was assessed by immunohistochemistry in tissue microarrays. The results were analyzed using SPSS 22.0 statistical software. Results: Of 53 female patients, 10 (18.9%) patients had a grade 5 (G5) response, and 12 (22.6%) patients showed PD-L1 expression, including 7 (13.2%) patients with staining in tumor cells (TCs) and 8 (15.1%) patients with staining in peritumoral lymphocytes (PTLCs). Logistic regression analysis revealed that G5 response to NACT was significantly associated with TCs or PTLCs PD-L1 positivity, whether with univariate analysis (TCs PD-L1: p = 0.00, OR 20.50, 95% CI 3.11–134.94; PTLCs PD-L1: p = 0.02, OR 6.50, 95% CI 1.27–33.20) or with multivariate analysis (TCs PD-L1: p = 0.00, OR 42.23, 95% CI 3.36–530.90; PTLCs PD-L1: p = 0.02, OR 9.07, 95% CI 1.37–60.02). The same trend was found in the luminal subgroup analysis (TCs PD-L1: p = 0.02, OR 23.43, 95% CI 1.66–331.58; PTLCs PD-L1: p = 0.01, OR 47.89, 95% CI 2.47–927.41). Conclusion: G5 response to NACT in breast cancer was significantly associated with TCs or PTLCs PD-L1-positive expression in pretreatment biopsies; it can be expected that PD-L1 will become a new independent biomarker of response to NACT in breast cancer.
Quantitative Polymerase Chain Reaction Detection of Microchimerism in Female Transplant Renal Recipients
Authors: Villari Donata , Salvianti Francesca , Zanazzi Maria , Martini Alberto , Spatafora Pietro , Caroassai Grisanti Simone , Sebastianelli Arcangelo , Nicita Giulio , Serni Sergio , Pinzani Pamela
Published: September 2020

Introduction: Microchimerism (MC) is the presence of a small amount of foreign cells or DNA within a person’s circulation or tissues. It has been identified also in recipients of solid organ transplants where it seems to be critical for the development and maintenance of immunological tolerance. Nevertheless, natural and/or iatrogenic MC can be acquired prior to transplantation, through pregnancy and/or blood transfusion. Objective: The aim of this study was to detect the presence of MC in women after renal transplantation from male cadaveric donors and its relationship with graft outcomes. Methods: We studied by qPCR the presence of the DYS14 gene sequence of the Y chromosome in 12 females who received a kidney graft from a male donor before transplantation (T0), after 15 days (T1) and 1 year of transplantation (T2). We found the sequence in all recipients after renal transplantation. Results: All the women were negative for this sequence prior to transplantation (T0). Mean (SD) Y-related DNA quantity was 0.80 (0.69) ng/mL plasma and 0.15 (0.26) ng/mL plasma at T1 and T2, respectively. No acute rejection was observed, and mean (SD) estimated Cr clearance was 68.8 (16.9) mL/min within 1 year from transplantation. Conclusions: Presence of MC was associated with good kidney graft outcomes after 1 year of transplantation, but further studies will be needed to investigate the relationship between clinical outcomes and the development of MC in renal transplant recipient.
Economic Impact of the Introduction of Outpatient Medical Specialist Care (ASV) of Gastrointestinal Cancer Patients from a German Hospital Management Perspective
Authors: Jakobs Florian , Drost Ruben M.W.A. , Kron Anna , Heinen Julia , Hallek Michael , Reinhardt Hans Christian , Zander Thomas , Kron Florian
Published: September 2020

Introduction: The treatment of cancer patients in Germany is characterized by sectoral separation of the in- and outpatient care accompanied by 2 separate reimbursement systems. By introducing the Guideline of Outpatient Medical Specialist Care in accordance with §116b SGB V (ASV) in 2014, the German legislation empowers office-based physicians and hospitals to jointly provide medical care in the ambulatory setting. Methods: A 1-year period each before and after the introduction of ASV was compared by means of data from the Center for Integrated Oncology Cologne at the University Hospital of Cologne. Only adults with a reliable diagnosis of gastrointestinal tumor (GIT) were considered. Results: Overall, 1,872 cases were considered in the analysis showing significant (p < 0.001) higher median values of revenues across ICD-subgroups for ASV (EUR 427.46) compared to Ambulatory Treatments in Hospitals (EUR 234.21). The exemplary analysis of revenues in neoplasms of the pancreas shows EUR 173.69 on average which are only invoiceable through ASV: flat rate incl. surcharges (EUR 117.79; 68%), structure lump sum (EUR 29.49; 17%), positron-emission tomography (PET)/CT (EUR 13.53; 18%), and ASV consultation hour (EUR 12.89; 7%). Discussion/Conclusion: ASV leads to significant higher revenues across different ICD-subgroups for patients suffering from severe GIT. The collaboration of hospital and office-based physicians ensures patient-centered care with accumulated expertise and avoidance of double examinations. Thus, the inclusion of additional services in the Uniform Value Scale (invoiceable for ASV) is legitimated and enables cost-covering care for the involved parties.
Dietary Vitamin E Intake Was Inversely Associated with Hyperuricemia in US Adults: NHANES 2009–2014
Authors: Zhang Lixia , Shi Xiaoyan , Yu Jinran , Zhang Peipei , Ma Ping , Sun Yongye
Published: September 2020

Introduction: Current evidence on the association between dietary vitamin E intake and hyperuricemia risk is limited and conflicting. Objective: The aim of the study was to assess the association of dietary vitamin E intake with hyperuricemia in US adults. Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey, 2009–2014. Dietary vitamin E intake was evaluated through two 24-h dietary recall interviews. Logistic regression and restricted cubic spline models were used to examine the association between dietary vitamin E intake and hyperuricemia. Results: Overall, 12,869 participants were included. The prevalence of hyperuricemia was 19.35%. After adjustment for age, gender, BMI, race, educational level, smoking status, alcohol consumption, physical activity, total daily energy intake, total cholesterol, protein intake, glomerular filtration rate, serum Cr, use of uric acid drugs, and drug abuse, the odds ratio (95% confidence interval) of hyperuricemia for the highest tertile of dietary vitamin E intake was 0.77 (0.63–0.96) compared with that of the lowest tertile. In men, dietary vitamin E intake and hyperuricemia were negatively correlated. In stratified analyses by age (20–39, 40–59, and ≥60 years), dietary vitamin E intake was inversely associated with hyperuricemia only among participants aged ≥60 years. Dose-response analyses showed that dietary vitamin E intake was inversely associated with hyperuricemia in a nonlinear manner. Conclusion: Dietary vitamin E intake was negatively correlated with hyperuricemia in US adults, especially among males and participants aged ≥60 years.
Vectorcardiography Findings Are Associated with Recurrent Ventricular Arrhythmias and Mortality in Patients with Heart Failure Treated with Implantable Cardioverter-Defibrillator Device
Authors: Chaudhry Uzma , Cortez Daniel , Platonov Pyotr G. , Carlson Jonas , Borgquist Rasmus
Published: September 2020

Background: There is a need for refined risk stratification of sudden cardiac death and prediction of ventricular arrhythmias to correctly identify patients who are expected to benefit the most from implantable cardioverter-defibrillator (ICD) therapy. Methods: We conducted a registry-based retrospective observational study on patients with either ischemic (ICMP) or nonischemic dilated cardiomyopathy (NICMP) treated with ICD between 2002 and 2013 at a tertiary referral center. We evaluated 3 vectorcardiography (VCG) indices; spatial QRS-T angle, QRS vector magnitude (QRSvm), and T-wave vector magnitude (Twvm), and their association with all-cause mortality and ventricular arrhythmias. The VCG indices were automatically computed from resting 12-lead electrocardiograms before ICD implantation. Results: 178 patients were included in the study; 53.4% had ICMP, 79.2% were male, and mean ejection fraction was 27.4%. During the follow-up (median 89 months), 40 patients (23%) died; 31% had appropriate ICD therapy. In multivariate analysis with dichotomized variables, QRS-T angle >152° and Twvm <0.38 mV were significantly associated with increased mortality: HR 2.64 (95% CI 1.14–6.12, p = 0.02) and HR 5.30 (95% CI 2.31–12.11, p < 0.001), respectively. QRSvm <1.54 mV was borderline significant with mortality outcome (p = 0.10). The composite score of all 3 VCG indices, a score of 3, conferred an increased risk of mortality (including heart failure mortality) in multivariate analysis: HR 13.80 (95% CI 3.44–55.39, p < 0.001). Conclusion: The spatial QRS-T angle and Twvm are emerging VCG indices which are independently associated with mortality in patients with reduced left ventricular ejection fraction due to ICMP or NICMP. Using a composite score of all 3 vector indices, a maximum score was associated with poor long-term survival.
Successful Transfemoral Transcatheter Aortic Valve Replacement in a Patient with Double Aortic Arch: An Interesting Imaging Case
Authors: Patel Raj D. , Ghadiam Harshavardhan R. , Desai Anjali R , Patel Puja , Vanka Varun , Mungee Sudhir
Published: September 2020

Transcatheter aortic valve replacement (TAVR) has become a mainstay of treatment in the management of severe aortic stenosis. It is a challenging procedure that requires expertise in obtaining proper access, delivery of catheters to and beyond the aortic valve, and finally accurate deployment of the aortic bioprosthesis. Patients with aortic anomalies portend an added challenge in performing TAVR procedures. We present the case of a patient incidentally found to have a right dominant double aortic arch who underwent successful TAVR for severe aortic stenosis.
Ethnic Differences in Access to Stroke Reperfusion Therapy in Northern New Zealand
Authors: Samuels Isaac , Wang Michael T.M. , Chong Kar Po , Davis Alan , Ranta Annemarei , Barber P. Alan ,   on behalf of the Northern Region Stroke Network
Published: September 2020

Background: In New Zealand, Māori and Pacific people have higher age-adjusted stroke incidence rates, younger age at first stroke, and higher mortality at 12 months than other ethnic groups. We aimed to determine if access to acute stroke reperfusion therapy with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) is equitable among ethnic groups. Methods: Data were obtained from the Northern Region component of the New Zealand Stroke Registry over the 21 months between January 1, 2018 and September 30, 2019. Data recorded included demographic details, self-identified ethnicity, treatment times, and clinical outcomes. National hospital discharge coding of patients admitted with ischemic stroke and stroke unspecified was used to determine the proportion of patients treated by ethnic group. Results: There were 537 patients normally resident in the Northern Region who received reperfusion therapy: 281 received IVT alone, 123 received EVT after bridging IVT, and 133 received EVT alone. Of the 537 patients treated with IVT or EVT, there were 81 (15.1%) Māori, 78 (14.5%) Pacific, 57 (10.6%) Asian, and 341 (63.5%) NZ European/other ethnicity patients. There were no ethnic differences in treatment process times. When compared with NZ European/others, Māori and Pacific people were younger, and Māori had worse neurological impairment at admission. A higher proportion of Māori were treated with EVT with a trend to higher proportion treated with IVT. Day 90 modified Rankin Scale (mRS) for EVT-treated patients was similar apart from Asian patients who had worse outcome when compared with NZ European/others (mRS 3 vs. 2; p = 0.03). Conclusions: This study has shown equitable access to acute stroke reperfusion therapies and largely similar outcomes in different ethnic groups in northern New Zealand.
Trends in Recurrent Coronary Heart Disease After Myocardial Infarction Among US Women and Men Between 2008 and 2017
Authors: Peters Sanne A.E. , Colantonio Lisandro D. , Dai Yuling , Zhao Hong , Bittner Vera , Farkouh Michael E. , Dluzniewski Paul , Poudel Bharat , Muntner Paul , Woodward Mark
Published: September 2020

Background:

Rates for recurrent coronary heart disease (CHD) events have declined in the United States. However, few studies have assessed whether this decline has been similar among women and men.

Methods:

Data were used from 770 408 US women and 700 477 US men <65 years of age with commercial health insurance through MarketScan and ≥66 years of age with government health insurance through Medicare who had a myocardial infarction (MI) hospitalization between 2008 and 2017. Women and men were followed up for recurrent MI, recurrent CHD events (ie, recurrent MI or coronary revascularization), heart failure hospitalization, and all-cause mortality (Medicare only) in the 365 days after MI.

Results:

From 2008 to 2017, age-standardized recurrent MI rates per 1000 person-years decreased from 89.2 to 72.3 in women and from 94.2 to 81.3 in men (multivariable-adjusted
P
interaction by sex <0.001). Recurrent CHD event rates decreased from 166.3 to 133.3 in women and from 198.1 to 176.8 in men (
P
interaction <0.001). Heart failure hospitalization rates decreased from 177.4 to 158.1 in women and from 162.9 to 156.1 in men (
P
interaction=0.001). All-cause mortality rates decreased from 403.2 to 389.5 in women and from 436.1 to 417.9 in men (
P
interaction=0.82). In 2017, the multivariable-adjusted rate ratios comparing women with men were 0.90 (95% CI, 0.86–0.93) for recurrent MI, 0.80 (95% CI, 0.78–0.82) for recurrent CHD events, 0.99 (95% CI, 0.96–1.01) for heart failure hospitalization, and 0.82 (95% CI, 0.80–0.83) for all-cause mortality.

Conclusions:

Rates of recurrent MI, recurrent CHD events, heart failure hospitalization, and mortality in the first year after an MI declined considerably between 2008 and 2017 in both men and women, with proportionally greater reductions for women than men. However, rates remain very high, and rates of recurrent MI, recurrent CHD events, and death continue to be higher among men than women.
Carotid‐Femoral Pulse Wave Velocity as a Risk Marker for Development of Complications in Type 1 Diabetes Mellitus
Authors: Tougaard Ninna Hahn , Theilade Simone , Winther Signe Abitz , Tofte Nete , Ahluwalia Tarunveer Singh , Hansen Tine Willum , Rossing Peter , Frimodt-Møller Marie
Published: September 2020

Background

The value of carotid‐femoral pulse wave velocity (cfPWV) as risk factor for development of complications in type 1 diabetes mellitus remains to be determined. We investigated associations between cfPWV and renal outcomes, cardiovascular events, and all‐cause mortality in people with type 1 diabetes mellitus.

Methods and Results

cfPWV was measured with SphygmoCor in 633 people with type 1 diabetes mellitus. Median (interquartile range) follow‐up was 6.2 (5.8−6.7) years. End points included progression in albuminuria group, decline in estimated glomerular filtration rate (eGFR) ≥30%, end‐stage kidney disease, cardiovascular event, mortality, and a composite renal end point. Hazard ratios (HRs) were calculated per 1‐SD increase in cfPWV. Adjustments included age, sex, hemoglobin A1c, mean arterial pressure, body mass index, low‐density lipoprotein cholesterol, smoking, urine albumin excretion rate, and eGFR. The cohort included 45% women, mean (SD) age was 54 (13) years, mean (SD) eGFR was 83.2 (27.9) mL/min per 1.73 m
2
, and mean (SD) cfPWV was 10.4 (3.3) m/s. Median (interquartile range) albumin excretion rate was 17 (17‐63) mg/24 h. After adjustment, higher cfPWV was associated with increased hazard of progression in albuminuria (HR, 1.59; 95% CI, 1.10−2.32); decline in eGFR ≥30% (HR, 1.38; 95% CI, 1.06−1.79); cardiovascular event (HR, 1.31; 95% CI, 1.01−1.70); mortality (HR, 1.36; 95% CI, 1.00−1.85); and the composite renal end point (HR, 1.30; 95% CI, 1.04−1.63), but not with end‐stage kidney disease (HR, 1.18; 95% CI, 0.62−2.26). Higher cfPWV was associated with steeper yearly increase in albumin excretion and steeper yearly decline in eGFR after adjustment (
P
=0.002 and
P
=0.01, respectively).

Conclusions

cfPWV was associated with increased hazard of renal outcomes, cardiovascular event, and mortality. cfPWV may be suited for risk stratification in type 1 diabetes mellitus.
Rationale, Design, and Implementation of Intensive Risk Factor Treatment in the CREST2 Trial
Authors: Turan Tanya N. , Voeks Jenifer H. , Chimowitz Marc I. , Roldan Ana , LeMatty Todd , Haley William , Lopes-Virella Maria , Chaturvedi Seemant , Jones Michael , Heck Donald , Howard George , Lal Brajesh K. , Meschia James F. , Brott Thomas G.
Published: September 2020

Background and Purpose:

The CREST2 trial (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis) is comparing intensive medical management (IMM) alone to IMM plus revascularization with carotid endarterectomy or transfemoral carotid artery stenting for preventing stroke or death within 44 days after randomization or ipsilateral ischemic stroke thereafter. There are extensive clinical trial data on outcomes after revascularization of asymptomatic carotid stenosis, but not for IMM. As such, the experimental treatment in CREST2 is IMM, which is described in this article.

Methods:

IMM consists of aspirin 325 mg/day and intensive risk factor management, primarily targeting systolic blood pressure <130 mm Hg (initially systolic blood pressure <140 mm Hg) and LDL (low-density lipoprotein) cholesterol <70 mg/dL. Secondary risk factor targets focus on tobacco smoking, non-HDL (high-density lipoprotein), HbA1c (hemoglobin A1c), physical activity, and weight. Risk factor management is performed by site personnel and a lifestyle coaching program delivered by telephone. We report interim risk factor data on 1618 patients at baseline and last follow-up through 24 months.

Results:

The mean baseline LDL of 80.5 mg/dL improved to 66.7 mg/dL. The mean baseline systolic blood pressure of 139.7 mm Hg improved to 130.3 mm Hg. The proportion of patients in-target improved from 43% to 61% for systolic blood pressure <130 mm Hg and from 45% to 67% for LDL<70 mg/dL (both changes
P
<0.001).

Conclusions:

The rigorous multimodal approach to intensive stroke risk factor management in CREST2 has resulted in significant improvements in risk factor control that will enable a comparison of cutting-edge medical care to revascularization in patients with asymptomatic carotid stenosis.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02089217.
Practice in Color: Gisèle Freund in Paris
Authors: Yoon Hyewon
Published: September 2020

This essay examines the work of German-French photographer Gisèle Freund during the interwar years, with special focus on her volte-face from black-and-white depictions of the collective subject of political demonstrations in pre-exile Frankfurt to color portraits of individual French intellectuals after her arrival in Paris. Pivoting around the short period between 1938 and 1940, when using color became the standard rhetorical maneuver of Freund's portrait series, this essay will trace the photographer's change in practice as a response to the mounting crisis within France's Popular Front and its aesthetic strategies in the face of the rise of fascism. One of the essay's claims is that Freund turned color photography from a material and commercial commodity into the emblem of an alternative, mass-mediated culture—the culture of Americanism—that she, like many European intellectuals of the 1920s, imagined capable of competing with and ultimately countering the fascist mobilization of spectacle.
Task-Oriented Dialogue as Dataflow Synthesis
Authors: Andreas Jacob , Bufe John , Burkett David , Chen Charles , Clausman Josh , Crawford Jean , Crim Kate , DeLoach Jordan , Dorner Leah , Eisner Jason , Fang Hao , Guo Alan , Hall David , Hayes Kristin , Hill Kellie , Ho Diana , Iwaszuk Wendy , Jha Smriti , Klein Dan , Krishnamurthy Jayant , Lanman Theo , Liang Percy , Lin Christopher H. , Lintsbakh Ilya , McGovern Andy , Nisnevich Aleksandr , Pauls Adam , Petters Dmitrij , Read Brent , Roth Dan , Roy Subhro , Rusak Jesse , Short Beth , Slomin Div , Snyder Ben , Striplin Stephon , Su Yu , Tellman Zachary , Thomson Sam , Vorobev Andrei , Witoszko Izabela , Wolfe Jason , Wray Abby , Zhang Yuchen , Zotov Alexander
Published: September 2020

We describe an approach to task-oriented dialogue in which dialogue state is represented as a dataflow graph. A dialogue agent maps each user utterance to a program that extends this graph. Programs include metacomputation operators for reference and revision that reuse dataflow fragments from previous turns. Our graph-based state enables the expression and manipulation of complex user intents, and explicit metacomputation makes these intents easier for learned models to predict. We introduce a new dataset, SMCalFlow, featuring complex dialogues about events, weather, places, and people. Experiments show that dataflow graphs and metacomputation substantially improve representability and predictability in these natural dialogues. Additional experiments on the MultiWOZ dataset show that our dataflow representation enables an otherwise off-the-shelf sequence-to-sequence model to match the best existing task-specific state tracking model. The SMCalFlow dataset, code for replicating experiments, and a public leaderboard are available at https://www.microsoft.com/en-us/research/project/dataflow-based-dialogue-semantic-machines .
Radiographic features of COVID-19 based on an initial cohort of 96 patients in Singapore
Authors: Khoo HW , Hui TCH , Haja Mohideen SM , Lee YS , Liew CJY , Kok SSX , Young BE , Ong SWX , Kalimuddin S , Tan SY , Loh J , Chan LP , Poh ACC , Wong SBS , Leo YS , Lye DC , Kaw GJL , Tan CH
Published: September 2020

INTRODUCTION Chest radiographs (CXRs) are widely used for the screening and management of COVID-19. This article describes the radiographic features of COVID-19 based on an initial national cohort of patients. METHODS This is a retrospective review of swab-positive patients with COVID-19 who were admitted to four different hospitals in Singapore between 22 January and 9 March 2020. Initial and follow-up CXRs were reviewed by three experienced radiologists to identify the predominant pattern and distribution of lung parenchymal abnormalities. RESULTS In total, 347 CXRs of 96 patients were reviewed. Initial CXRs were abnormal in 41 (42.7%) out of 96 patients. The mean time from onset of symptoms to CXR abnormality was 5.3 ± 4.7 days. The predominant pattern of lung abnormality was ground-glass opacity on initial CXRs (51.2%) and consolidation on follow-up CXRs (51.0%). Multifocal bilateral abnormalities in mixed central and peripheral distribution were observed in 63.4% and 59.2% of abnormal initial and follow-up CXRs, respectively. The lower zones were involved in 90.2% of initial CXRs and 93.9% of follow-up CXRs. CONCLUSION In a cohort of swab-positive patients, including those identified from contact tracing, we found a lower incidence of CXR abnormalities than was previously reported. The most common pattern was ground-glass opacity or consolidation, but mixed central and peripheral involvement was more common than peripheral involvement alone.
Bridging the Mozambique Channel: first record of Dombeya rosacea (Dombeyoideae, Malvaceae) for Mayotte (Comoros Archipelago, Indian Ocean)

Authors: LE PÉCHON TIMOTHÉE , TRACLET SEBASTIEN , BARTHELAT FABIEN , DIMASSI ABASSI , GIGORD LUC D. B. , HAMIDOU ANRIF , JOURDAIN-FIEVET LUCILE , VISCARD GUILLAUME , BOULLET VINCENT
Published: September 2020

In this study, we used an integrative approach combining morphological and molecular data with ecology, in order to clarify the identity of a Dombeya newly recorded as occurring in Mayotte. Morphological and molecular evidence are in agreement and convincingly show that specimens of this newly recorded species can be confidently assigned to D. rosacea, previously known only from four herbarium sheets from Madagascar. The new populations of this species in the Comoros significantly expand the extant area of occupancy of D. rosacea. Ecological preferences are also discussed, as populations of D. rosacea were found in greatly contrasting sub-humid habitats. This newly reported geographical disjunction between the Comoros and Madagascar strengthens the evidence for a biogeographic connection between the floras of these two regions.
Taxonomy and nomenclature of Kalanchoe ×laetivirens (Crassulaceae subfam. Kalanchooideae), a further invasive nothospecies from Madagascar

Authors: SMITH GIDEON F.
Published: September 2020

The status of Kalanchoe laetivirens (Crassulaceae subfam. Kalanchooideae), which was recently for the first time recorded as naturalised beyond its native Madagascar, is changed to that of nothospecies as evidence indicates that it is of hybrid origin. An amplified description is provided for K. ×laetivirens and the nothospecies is illustrated.
New Neotropical species of Marilia Müller (Trichoptera: Odontoceridae)
Authors: CAMARGOS LUCAS M. , PES ANA MARIA , HAMADA NEUSA
Published: September 2020

Five new species of the caddisfly genus Marilia Müller 1880 are described from the Neotropics, Marilia cabocla sp. nov., Marilia caipira sp. nov., Marilia cunhaporanga sp. nov., Marilia manicorei sp. nov., and Marilia muelleri sp. nov. Larvae and pupae of new species are also described, in addition to the immature stages of M. fasiculata Banks 1913 and M. huamantincoae Dumas & Nessimian 2009; an updated description of M. siolii Marlier 1964 male is provided. This work raises the number of species of this genus from 46 to 51 for the Neotropical Region.
The taxonomic status of grass snake, Natrix natrix (Linnaeus, 1758 (Squamata: Colubridae), with designation of a neotype
Authors: NORÉN MICHAEL , ÅHLANDER ERIK
Published: September 2020

As part of an investigation into the status of the near threatened Gotland grass snake, Natrix natrix gotlandica Nilson & Andrén, 1981, endemic to the island of Gotland, we discovered that Linnaeus’ type series of the common grass snake, Natrix natrix (Linnaeus, 1758), is comprised of specimens from three different currently recognized species.                To stabilize the usage of the name Coluber natrix, we investigate Linnaeus’ type series, and a specimen which Linnaeus in 1741 examined west of the Swedish city of Nyköping is designated lectotype. The lectotype has since been lost, and a newly collected specimen from the same locality is designated neotype for Coluber natrix. The neotype is deposited in the herpetology collection of the Swedish Museum of Natural History in Stockholm, Sweden, catalog number NRM 8260.
Transports and Net Fluxes of Surface Wave Energy and Momentum inside Tropical Cyclones: Spectrum Computation and Modeling
Authors: Hwang Paul A.
Published: September 2020

Transports and net fluxes of surface wave energy and momentum inside tropical cyclones (TCs) are analyzed with wave spectra acquired by hurricane hunters. Previous analyses of dominant wave properties show a primary feature of sinusoidal azimuthal variation. Transports calculated from directional wave spectra are also primarily sinusoidal, which is modeled as a harmonic series. The result reveals that forward transport peaks are in the right-front quarter relative to the TC heading, and somewhat weaker valleys of backward transports are in the left-back quarter. Rightward transport peaks are in the right-back quarter and stronger leftward transport valleys are in the left-front quarter. Net fluxes are derived analytically from the gradients of transports. Their azimuthal variations are primarily biharmonic with forward trend confined in a slightly left-tilted parallel channel about a width two to three radius of maximum wind (RMW) on each side of the TC center. Leftward net fluxes are in a parallel channel of similar size and normal to that of the forward net fluxes. In vectors, the right-back quarter is a region of net influxes of energy and momentum. The TC central region has strong local fluxes that lead to bifurcation of the flux lines into leftward and forward paths. This may play a role in stabilizing the TC propagation. The net fluxes are a small fraction of the expected energy and momentum inputs from local wind except near the eye region. Within about 30 km from the TC center the local wind speed may exceed 30 m s−1 and the net fluxes can exceed 50% of the expected local wind input.
What Does a Convection-Allowing Ensemble of Opportunity Buy Us in Forecasting Thunderstorms?
Authors: Roberts Brett , Gallo Burkely T. , Jirak Israel L. , Clark Adam J. , Dowell David C. , Wang Xuguang , Wang Yongming
Published: September 2020

The High Resolution Ensemble Forecast v2.1 (HREFv2.1), an operational convection-allowing model (CAM) ensemble, is an “ensemble of opportunity” wherein forecasts from several independently designed deterministic CAMs are aggregated and postprocessed together. Multiple dimensions of diversity in the HREFv2.1 ensemble membership contribute to ensemble spread, including model core, physics parameterization schemes, initial conditions (ICs), and time lagging. In this study, HREFv2.1 forecasts are compared against the High Resolution Rapid Refresh Ensemble (HRRRE) and the Multiscale data Assimilation and Predictability (MAP) ensemble, two experimental CAM ensembles that ran during the 5-week Spring Forecasting Experiment (SFE) in spring 2018. The HRRRE and MAP are formally designed ensembles with spread achieved primarily through perturbed ICs. Verification in this study focuses on composite radar reflectivity and updraft helicity to assess ensemble performance in forecasting convective storms. The HREFv2.1 shows the highest overall skill for these forecasts, matching subjective real-time impressions from SFE participants. Analysis of the skill and variance of ensemble member forecasts suggests that the HREFv2.1 exhibits greater spread and more effectively samples model uncertainty than the HRRRE or MAP. These results imply that to optimize skill in forecasting convective storms at 1–2-day lead times, future CAM ensembles should employ either diverse membership designs or sophisticated perturbation schemes capable of representing model uncertainty with comparable efficacy.
Optimal Resources for Rural Surgery
Authors: Musgrove Kelsey A. , Abdelsattar Jad M. , LeMaster Stephanie J. , Ballou Marguerite C. , Kappel David A. , Borgstrom David C.
Published: September 2020

Background

Timely access to emergency general surgery services, including trauma, is a critical aspect of patient care. This study looks to identify resource availability at small rural hospitals in order to improve the quality of surgical care.

Methods

Forty-five nonteaching hospitals in West Virginia were divided into large community hospitals with multiple specialties (LCHs), small community hospitals with fewer specialties (SCHs), and critical access hospitals (CAHs). A 58-question survey on optimal resources for surgery was completed by 1 representative surgeon at each hospital. There were 8 LCHs, 18 SCHs, and 19 CAHs with survey response rates of 100%, 83%, and 89%, respectively.

Results

One hundred percent of hospitals surveyed had respiratory therapy and ventilator support, computerized tomography (CT) scanner and ultrasound, certified operating rooms, lab support, packed red blood cells (PRBC), and FFP accessible 24/7. Availability of cryoprecipitate, platelets, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) decreased from LCHs to CAHs. The majority had board-certified general surgeons; however, only 86% LCHs, 53% SCHs, and 50% CAHs had advanced trauma life support (ATLS) certification. One hundred percent of LCHs had operating room (OR) crew on call within 30 minutes, emergency cardiovascular equipment, critical care nursing, on-site pathologist, and biologic/synthetic mesh, whereas fewer SCHs and CAHs had these resources. One hundred percent of LCHs and SCHs had anesthesia availability 24/7 compared to 78% of CAHs.

Discussion

Improving access to the aforementioned resources is of utmost importance to patient outcomes. This will enhance rural surgical care and decrease emergency surgical transfers. Further education and research are necessary to support and improve rural trauma systems.
Does Distance to Treatment Affect Mortality Rate for Surgical Oncology Patients?
Authors: Garstka Meghan , Monlezun Dominique , Kandil Emad
Published: September 2020

Introduction

Using the National Cancer Database (NCDB), we seek to analyze the relationship of patient distance to hospital of treatment on mortality trends after surgery, since patients often travel large distances to referral centers.

Methods

A retrospective cohort study of the NCDB from 2004 to 2013 was performed, and patients with gastrointestinal, melanoma, and head and neck primary site tumors who underwent surgery were included. We excluded cases with no recorded mortality status or distance from the hospital. A multivariable logistic regression was conducted with adjustments for population density, treating facility location, age, race, gender, education, income, insurance, comorbidities (Charlson-Deyo score), days from diagnosis to treatment, positive margin, tumor stage and grade, and lymph or vascular invasion.

Results

A total of 1 424 482 patients were included. Overall median distance to hospital was 9.7 miles (range 4.2-23.7 miles); 696 647 (48.91%) of the sample traveled a distance greater than 10 miles to the institution where the procedure was performed. The multivariable regression analysis demonstrated overall lower mortality for those patients travelling a longer distance to care for multiple tumor types, including: liver (OR .87, .77-.99, P = .032), pancreas (OR .82, .76-.89, P < .001), colon (OR .92, .89-.95, P < .001), rectum (OR .90, .83-.96, P = .003), melanoma (OR .83, .79-.88, P < .001), and tumors of the larynx (OR .80, .69-.94, P = .005).

Discussion

Increased distance traveled for surgical treatment has a significant correlation with decreased odds of mortality for multiple cancers, highlighting the importance of centralized referral patterns for oncology care.