bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada
Authors: Gregory Anne B. , Lester Kendra K. , Gregory Deborah M. , Twells Laurie K. , Midodzi William K. , Pearce Neil J.
Published: September 2016

Background and Aim. Obesity (BMI ≥ 30 kg/m2) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent. Newfoundland and Labrador (NL) has the highest rate of obesity in Canada. The aim of the study was to examine the relationship between BMI and vascular and nonvascular complications in patients undergoing PCI in NL.Methods. We studied 6473 patients identified in the APPROACH-NL database who underwent PCI from May 2006 to December 2013. BMI categories included normal, 18.5 ≤ BMI < 25.0 (n=1073); overweight, 25.0 ≤ BMI < 30 (n=2608); and obese, BMI ≥ 30.0 (n=2792).Results. Patients with obesity were younger and had a higher incidence of diabetes, hypertension, and family history of cardiac disease. Obese patients experienced less vascular complications (normal, overweight, and obese: 8.2%, 7.2%, and 5.3%,p=0.001). No significant differences were observed for in-lab (4.0%, 3.3%, and 3.1%,p=0.386) or postprocedural (1.0%, 0.8%, and 0.9%,p=0.725) nonvascular complications. After adjusting for covariates, BMI was not a significant factor associated with adverse outcomes.Conclusion. Overweight and obesity were not independent correlates of short-term vascular and nonvascular complications among patients undergoing PCI.
Nonlinear Alignment and Its Local Linear Iterative Solution
Authors: Zhang Sumin , Ma Zhengming , Zhan Zengrong
Published: September 2016

In manifold learning, the aim of alignment is to derive the global coordinate of manifold from the local coordinates of manifold’s patches. At present, most of manifold learning algorithms assume that the relation between the global and local coordinates is locally linear and based on this linear relation align the local coordinates of manifold’s patches into the global coordinate of manifold. There are two contributions in this paper. First, the nonlinear relation between the manifold’s global and local coordinates is deduced by making use of the differentiation of local pullback functions defined on the differential manifold. Second, the method of local linear iterative alignment is used to align the manifold’s local coordinates into the manifold’s global coordinate. The experimental results presented in this paper show that the errors of noniterative alignment are considerably large and can be reduced to almost zero within the first two iterations. The large errors of noniterative/linear alignment verify the nonlinear nature of alignment and justify the necessity of iterative alignment.
Osteosarcopenic Obesity Syndrome: What Is It and How Can It Be Identified and Diagnosed?
Authors: Ilich Jasminka Z. , Kelly Owen J. , Inglis Julia E.
Published: September 2016

Conditions related to body composition and aging, such as osteopenic obesity, sarcopenia/sarcopenic obesity, and the newly termed osteosarcopenic obesity (triad of bone muscle and adipose tissue impairment), are beginning to gain recognition. However there is still alack of definitive diagnostic criteriafor these conditions. Little is known about the long-term impact of these combined conditions of osteoporosis, sarcopenia, and obesity in older adults. Many may go undiagnosed and progress untreated. Therefore, the objective of this research is to creatediagnostic criteriafor osteosarcopenic obesity in older women. The proposeddiagnostic criteriaare based ontwo types of assessments: physical,via body composition measurements, andfunctional,via physical performance measures. Body composition measurements such asT-scores for bone mineral density, appendicular lean mass for sarcopenia, and percent body fat could all be obtained via dual energy X-ray absorptiometry. Physical performance tests: handgrip strength, one-leg stance, walking speed, and sit-to-stand could be assessed with minimal equipment. A score could then be obtained to measure functional decline in the older adult. Fordiagnosing osteosarcopenic obesityand other conditions related to bone loss and muscle loss combined with obesity, a combination of measures may more adequately improve the assessment process.
Cottonseed Oilcake Extract Mediated Green Synthesis of Silver Nanoparticles and Its Antibacterial and Cytotoxic Activity
Authors: Govarthanan Muthusamy , Cho Min , Park Jung-Hee , Jang Jum-Suk , Yi Young-Joo , Kamala-Kannan Seralathan , Oh Byung-Taek
Published: September 2016

Agroindustrial byproduct mediated green synthesis of silver nanoparticles was carried out using cottonseed oilcake (CSOC) extract. The aqueous silver nitrate formed stable silver nanoparticles with CSOC extract as a reducing agent for Ag+to Ag0. The synthesized nanoparticles were characterized using energy dispersive X-ray spectroscopy (EDS), transmission electron microscopy (TEM), Fourier transform infrared (FTIR) spectroscopy, and X-ray diffraction (XRD) techniques. The synthesized silver nanoparticles (AgNPs) (4 mM) significantly inhibited the growth of phytopathogens,Pseudomonas syringaepv.actinidiaeandRalstonia solanacearum. Further, cytotoxicity of AgNPs was evaluated using rat splenocyte cells. The splenocyte viability was decreased according to the increasing concentration of AgNPs and 90% of cell death was observed at 100 μg/mL.
Management Index Systems and Energy Efficiency Diagnosis Model for Power Plant: Cases in China
Authors: Wang Jing-Min , Ge XiaoJie , Zhang LiLi , Zhang Hang
Published: September 2016

In recent years, the energy efficiency of thermal power plant largely contributes to that of the industry. A thorough understanding of influencing factors, as well as the establishment of scientific and comprehensive diagnosis model, plays a key role in the operational efficiency and competitiveness for the thermal power plant. Referring to domestic and abroad researches towards energy efficiency management, based on Cloud model and data envelopment analysis (DEA) model, a qualitative and quantitative index system and a comprehensive diagnostic model (CDM) are construed. To testify rationality and usability of CDM, case studies of large-scaled Chinese thermal power plants have been conducted. In this case, CDM excavates such qualitative factors as technology, management, and so forth. The results shows that, compared with conventional model, which only considered production running parameters, the CDM bears better adaption to reality. It can provide entities with efficient instruments for energy efficiency diagnosis.
Florid Cystic Endosalpingiosis (Müllerianosis) in Pregnancy
Authors: Morales-Roselló José , Pamplona-Bueno Loida , Montero-Balaguer Beatriz , Desantes-Real Domingo , Perales-Marín Alfredo
Published: September 2016

Cystic endosalpingiosis refers to the existence of heterotopic cystic müllerian tissue resembling structures of the fallopian tubes. We report a case of florid cystic endosalpingiosis discovered in a pregnant woman during a scheduled cesarean section and review the current knowledge of this disease. A 30-year-old woman with a twin pregnancy attended the hospital day unit at term. The first twin was in a breech presentation and a cesarean section was scheduled. During the procedure the uterine fundus and part of the body were seen completely seeded with multitude of cyst-like structures resembling hydatids of Morgagni. The immunohistochemistry analysis showed a positive expression for PAX8 (Box-8), CK7, and estrogen and progesterone receptors. The lesions did not disappear after pregnancy. Cystic endosalpingiosis should be always borne in mind, even in pregnancy, when it comes to making the differential diagnosis of a pelvic or systemic multicystic mass.
Fuzzy Multicriteria ABC Supplier Classification in Global Supply Chain
Authors: Kefer Petar , Milanovic Dragan D. , Misita Mirjana , Zunjic Aleksandar
Published: September 2016

The determination of the optimal purchasing strategy in enterprise that is a part of global supply chain could be performed in two steps. In step one, a classification of potential suppliers is performed in order to determine the optimal portfolio of suppliers. This is delivered by using the fuzzy multicriteria proposed ABC classification method. Uncertainties in relative importance of criteria and their values are described by linguistic expressions. Modelling of linguistic expressions is based on the fuzzy sets theory. In the second step, ranking of optimal portfolio of suppliers is performed by using the modified ELECTRE method. The obtained results represent valuable input for determining the long time purchasing strategy and building partnership with the best suppliers. The developed two-step model is verified on real life data. The obtained results indicate good compliance with the opinions management in this type of industry. It is worth to mention that the proposed model can be easily extended and adopted to the analysis of other issues of management which could be applicable in different research areas.
A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions
Authors: Akgul Erol , Onan Hasan Bilen , Balli Huseyin Tugsan , Cetinalp Nuri Eralp
Published: September 2016

The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone.
Sakuranetin Inhibits Inflammatory Enzyme, Cytokine, and Costimulatory Molecule Expression in Macrophages through Modulation of JNK, p38, and STAT1
Authors: Kim Ki-Young , Kang Hee
Published: September 2016

Sakuranetin is flavonoid phytoalexin that serves as a plant antibiotic and exists in Prunus and several other plant species. Recently, we identified the anti‐inflammatory effect of Prunus yedoensis and found that there were few studies on the potential anti‐inflammatory activity of sakuranetin, one of the main constituents of Prunus yedoensis. Here, we isolated peritoneal macrophages from thioglycollate‐injected mice and examined whether sakuranetin affected the response of the macrophages in response to lipopolysaccharide (LPS) plus interferon‐ (IFN‐) γ or LPS only. Sakuranetin suppressed the synthesis of iNOS and COX2 in LPS/IFN‐γ stimulated cells and the secretion of TNF‐α, IL‐6, and IL‐12 in LPS stimulated cells. The surface expression of the costimulatory molecules, CD86 and CD40, was also decreased. Among the LPS‐induced signaling molecules, STAT1, JNK, and p38 phosphorylation was attenuated. These findings are evidence that sakuranetin acts as anti‐inflammatory flavonoid and further study is required to evaluate its in vivo efficacy.
Thymic Stromal Chemokine TSLP Acts through Th2 Cytokine Production to Induce Cutaneous T-cell Lymphoma
Authors: Takahashi Naomi , Sugaya Makoto , Suga Hiraku , Oka Tomonori , Kawaguchi Makiko , Miyagaki Tomomitsu , Fujita Hideki , Sato Shinichi
Published: September 2016

Thymic stromal lymphopoietin (TSLP) activates dendritic cells to induce Th2-mediated inflammation. Periostin, an extracellular matrix protein produced by fibroblasts, induces chronic inflammation by stimulating TSLP production. Recently, a reinforcing cycle linking Th2-type immune responses with periostin-induced keratinocyte activation has been proposed in atopic dermatitis pathogenesis. In this study, we investigated the role of TSLP and periostin in the development of cutaneous T-cell lymphoma (CTCL), where Th2 cytokines and chemokines are also dominant. TSLP and periostin mRNA expression levels were elevated in CTCL lesional skin, both of which correlated with IL4 expression levels. In vitro and ex vivo, IL4 or IL13 stimulated periostin expression by dermal fibroblasts, and fibroblasts from CTCL lesional skin expressed higher levels of periostin than those from control skin. Serum periostin levels of CTCL patients were also significantly higher than those of healthy individuals. Hut78 and MJ, CTCL cell lines, and peripheral blood mononuclear cells from leukemic CTCL patients expressed the TSLP receptor. TSLP induced production of IL4 and IL13 by Hut78 and MJ cells through the activation of STAT5. Moreover, TSLP induced proliferation of CTCL cells both in vitro and in vivo. These data suggest that periostin-mediated TSLP production by keratinocytes directly stimulates CTCL tumor cell growth in addition to inducing a Th2-dominant tumor environment in CTCL. Cancer Res; 76(21); 6241–52. ©2016 AACR.
Neoadjuvant Chemotherapy of Ovarian Cancer Results in Three Patterns of Tumor-Infiltrating Lymphocyte Response with Distinct Implications for Immunotherapy
Authors: Lo Charlotte S. , Sanii Sanaz , Kroeger David R. , Milne Katy , Talhouk Aline , Chiu Derek S. , Rahimi Kurosh , Shaw Patricia A. , Clarke Blaise A. , Nelson Brad H.
Published: September 2016

Purpose: Some forms of chemotherapy can enhance antitumor immunity through immunogenic cell death, resulting in increased T-cell activation and tumor infiltration. Such effects could potentially sensitize tumors to immunotherapies, including checkpoint blockade. We investigated whether platinum- and taxane-based chemotherapy for ovarian cancer induces immunologic changes consistent with this possibility.

Experimental Design: Matched pre- and post-neoadjuvant chemotherapy tumor samples from 26 high-grade serous carcinoma (HGSC) patients were analyzed by immunohistochemistry (IHC) for a large panel of immune cells and associated factors. The prognostic significance of post-chemotherapy TIL patterns was assessed in an expanded cohort (n = 90).

Results: Neoadjuvant chemotherapy was associated with increased densities of CD3+, CD8+, CD8+ TIA-1+, PD-1+ and CD20+ TIL. Other immune subsets and factors were unchanged, including CD79a+ CD138+ plasma cells, CD68+ macrophages, and MHC class I on tumor cells. Immunosuppressive cell types were also unchanged, including FoxP3+ PD-1+ cells (putative regulatory T cells), IDO-1+ cells, and PD-L1+ cells (both macrophages and tumor cells). Hierarchical clustering revealed three response patterns: (i) TILhigh tumors showed increases in multiple immune markers after chemotherapy; (ii) TILlow tumors underwent similar increases, achieving patterns indistinguishable from the first group; and (iii) TILnegative cases generally remained negative. Despite the dramatic increases seen in the first two patterns, post-chemotherapy TIL showed limited prognostic significance.

Conclusions: Chemotherapy augments pre-existing TIL responses but fails to relieve major immune-suppressive mechanisms or confer significant prognostic benefit. Our findings provide rationale for multipronged approaches to immunotherapy tailored to the baseline features of the tumor microenvironment. Clin Cancer Res; 23(4); 925–34. ©2016 AACR.
Multiple Autoantibodies and Neuromyelitis Optica Spectrum Disorders
Authors: Chen Chen , Xiaobo Sun , Yuge Wang , Yaqing Shu , Ling Fang , Lisheng Peng , Zhengqi Lu , Wei Qiu
Published: September 2016

Objective: To investigate the relationship between neuromyelitis optica spectrum disorder (NMOSD) and autoantibodies. Methods: Blood samples of 108 NMOSD patients and 38 controls were collected from January 2012 to August 2014. Immunological parameters, including anti-aquaporin 4, antinuclear, anti-ribonucleoprotein, anti-SM, anti-SSA/Ro, anti-SSB/La and anti-ribosomal P-protein autoantibodies were examined. Results: The NMOSD group exhibited a significantly higher percentage of anti-aquaporin 4 antibodies compared with the control group (76.9 vs. 0.0%, p = 0). The positive rates for antinuclear and anti-SSA antibodies in the NMOSD group were also higher than in the control group (35.2 vs. 11.8%, p = 0.001; 13.0 vs. 0.0%, p = 0.044). In total, 36.1% of the patients in the NMOSD group were seropositive for autoantibodies but only 8.3% were diagnosed with definite systemic autoimmune disorders. Conclusions: NMOSD is closely associated with elevated autoantibodies, particularly antinuclear and anti-SSA/Ro antibodies. NMOSD rarely coexists with organ-specific autoimmune diseases.
Quality of Life Impairment in Children and Adults with Vitiligo: A Cross-Sectional Study Based on Dermatology-Specific and Disease-Specific Quality of Life Instruments
Authors: Catucci Boza Juliana , Giongo Natalia , Machado Priscilla , Horn Roberta , Fabbrin Amanda , Cestari Tania
Published: September 2016

Background: Vitiligo can negatively affect a patient's quality of life (QoL). A specific questionnaire has been developed and validated in the English language: the vitiligo-specific quality-of-life instrument (VitiQoL). The instrument was translated, culturally adapted and validated into Brazilian Portuguese (VitiQoL-PB). Objective: The aim of this study was to assess the QoL in adult patients through the VitiQoL and Dermatology Life Quality Index (DLQI) and in pediatric patients through the Children's Dermatology Life Quality Index (CDLQI) in a sample of patients with vitiligo. Methods: Subjects were selected from a dermatological outpatient clinic and from a private practice in Porto Alegre. The QoL of pediatric patients was evaluated using the CDLQI questionnaire. In adult patients we used the VitiQoL-PB and the DLQI. Results: A strong correlation between the scores of the total VitiQoL and DLQI was observed (r = 0.81; p < 0.001). The factor that most contributed to the final score of VitiQoL was stigma. In our sample, women had higher scores than men (p < 0.05). Psychiatric problems were associated with lower QoL. In the pediatric population, the median score of the CDLQI was 3 (interquartile range 1.3-7.3). There was a statistically significant correlation between the child's age and the CDLQI score (rs = 0.41, p = 0.044). Conclusion: This study confirms that the VitiQoL is easy to administer and adds important information about the impact of vitiligo on a South American population. Stigmatization is very present in the disease. There are groups of patients that are more vulnerable, like women, patients with psychiatric diseases and adolescents.
Let the Individuals Directly Concerned Decide: A Solution to Tragic Choices in Genetic Risk Information
Authors: Oliveri Serena , Pravettoni Gabriella , Fioretti Chiara , Hansson Mats G.
Published: September 2016

Health-care systems as well as legislators and society seem largely unprepared to face and manage the massive production of genetic risk information. Ethics committees and professional bodies usually do not involve the individuals directly concerned in defining guidelines for genetic risk communication. Therefore, they do not always reflect people's needs and preferences. We argue in this article that we currently experience a cultural shift in medicine where individuals' concerns and preferences regarding genetic risk information are playing a more significant role than before, and that this should have some normative implications. We are going toward a situation where individual citizens are approached as consumers by personal genomics companies [Prainsack: Account Res 2011;18:132-147]. In clinical and research contexts, individuals are also increasingly informed about their own responsibilities for counterbalancing their genetic risk by making individual health care and lifestyle choices. In this situation, communication of genetic risk information may rather be regulated like traffic and markets in which consumers' decision-making power has a fundamental role in the management and regulation of how a service should be provided, as well as in the creation of policy and legislation. We acknowledge that markets may be different depending on different genetic conditions. For example, genetic risk communication for rare diseases, where a close relationship with clinicians is of paramount significance, should be differently regulated than personal genetic profiles of complex diseases, where contributing risk factors related to lifestyle are modifiable by the individual.
Magnetic Resonance Characterization of Cardiac Adaptation and Myocardial Fibrosis in Pulmonary Hypertension Secondary to Systemic-To-Pulmonary Shunt
Authors: Pereda Daniel , García-Lunar Inés , Sierra Federico , Sánchez-Quintana Damián , Santiago Evelyn , Ballesteros Constanza , Encalada Juan F. , Sánchez-González Javier , Fuster Valentín , Ibáñez Borja , García-Álvarez Ana
Published: September 2016

Background—

Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are strong predictors of morbidity and mortality among patients with congenital heart disease. Early detection of RV involvement may be useful in the management of these patients. We aimed to assess progressive cardiac adaptation and quantify myocardial extracellular volume in an experimental porcine model of PH because of aorto-pulmonary shunt using cardiac magnetic resonance (CMR).

Methods and Results—

To characterize serial cardiac adaptation, 12 pigs (aorto-pulmonary shunt [n=6] or sham operation [n=6]) were evaluated monthly with right heart catheterization, CMR, and computed tomography during 4 months, followed by pathology analysis. Extracellular volume by CMR in different myocardial regions was studied in 20 animals (aorto-pulmonary shunt [n=10] or sham operation [n=10]) 3 months after the intervention. All shunted animals developed PH. CMR evidenced progressive RV hypertrophy and dysfunction secondary to increased afterload and left ventricular dilatation secondary to volume overload. Shunt flow by CMR strongly correlated with PH severity, left ventricular end-diastolic pressure, and left ventricular dilatation. T1-mapping sequences demonstrated increased extracellular volume at the RV insertion points, the interventricular septum, and the left ventricular lateral wall, reproducing the pattern of fibrosis found on pathology. Extracellular volume at the RV insertion points strongly correlated with pulmonary hemodynamics and RV dysfunction.

Conclusions—

Prolonged systemic-to-pulmonary shunting in growing piglets induces PH with biventricular remodeling and myocardial fibrosis that can be detected and monitored using CMR. These results may be useful for the diagnosis and management of congenital heart disease patients with pulmonary overcirculation.
Neonatal Arterial Morphology Is Related to Body Size in Abnormal Human Fetal Growth
Authors: Olander Rasmus F.W. , Sundholm Johnny K.M. , Ojala Tiina H. , Andersson Sture , Sarkola Taisto
Published: September 2016

Background—

Restriction in fetal growth is associated with cardiovascular disease in adulthood. It is unclear whether abnormal intrauterine growth influences arterial morphology during the fetal or neonatal stage. The objective was to study the regional arterial morphology with respect to gestational age and abnormal fetal body size.

Methods and Results—

We studied body anthropometrics and arterial morphology and physiology in 174 neonates born between 31 and 42 weeks of gestation, including neonates with birth weights appropriate, small, and large for age, with very high resolution vascular ultrasound (35–55 MHz). In simple linear regressions, parameters of body size (body weight, body surface area, and organ circumference) and gestational age were statistically significantly associated with common carotid, brachial, femoral arterial parameters (lumen diameter [LD], wall layer thickness [intima-media thickness and intima-media-adventitia thickness], and carotid artery wall stress [CAWS]). Male sex was statistically significantly associated with LD and CAWS. In multiple linear regression models, body size, gestational age, and sex explained a large proportion of the arterial variance (

R
 2

range, 0.37–0.47 for LD; 0.09–0.35 for intima-media thickness; 0.21–0.41 for intima-media-adventitia thickness; and 0.23 for CAWS; all models
P
<0.001). Arterial wall layer thickness, LDs, and CAWS were independently and strongly predicted by body size, and no effect of maternal disease was observed when added to the models. Gestational age and male sex were also independently but more weakly associated with arterial LDs and CAWS (
P
<0.01), but not with arterial wall layers.

Conclusions—

These results indicate that the intrauterine growth of fetal arterial LD and wall layer thickness are primarily attributed to body growth overall. LD and CAWS show weaker association with gestational age and sex.
Insights Into Timing, Risk Factors, and Outcomes of Stroke and Transient Ischemic Attack After Transcatheter Aortic Valve Replacement in the PARTNER Trial (Placement of Aortic Transcatheter Valves)
Authors: Kapadia Samir , Agarwal Shikhar , Miller D. Craig , Webb John G. , Mack Michael , Ellis Stephen , Herrmann Howard C. , Pichard Augusto D. , Tuzcu E. Murat , Svensson Lars G. , Smith Craig R. , Rajeswaran Jeevanantham , Ehrlinger John , Kodali Susheel , Makkar Raj , Thourani Vinod H. , Blackstone Eugene H. , Leon Martin B.
Published: September 2016

Background—

Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events.

Methods and Results—

From April 2007 to February 2012, 2621 patients, aged 84±7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry. Stroke and TIA were identified by protocol and adjudicated by a Clinical Events Committee. Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58 [3.8%]; TA 29 [2.7%];
P
=0.09), 85% within 1 week. Instantaneous stroke risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2 weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10 [0.67%]; TA 3 [0.27%];
P
>0.17). Stroke and TIA were associated with lower 1-year survival than expected (TF 47% after stroke versus 82%, and 64% after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA versus 83%). Risk factors for early stroke after TA-TAVR included more postdilatations, pure aortic stenosis without regurgitation, and possibly more pacing runs, earlier date of procedure, and no dual antiplatelet therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke early after TF-TAVR.

Conclusions—

Risk of stroke or TIA is highest early after TAVR and is associated with increased 1-year mortality. Modifications of TAVR, emboli-prevention devices, and better intraprocedural pharmacological protection may mitigate this risk.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00530894.
Differences in Short- and Long-Term Outcomes Among Older Patients With ST-Elevation Versus Non–ST-Elevation Myocardial Infarction With Angiographically Proven Coronary Artery Disease
Authors: Vora Amit N. , Wang Tracy Y. , Hellkamp Anne S. , Thomas Laine , Henry Timothy D. , Goyal Abhinav , Roe Matthew T.
Published: September 2016

Background—

Among older patients with acute myocardial infarction (MI), it remains uncertain whether there is a time-dependent difference in the risk of recurrent mortality and nonfatal cardiovascular and cerebrovascular events for those with ST-segment–elevation MI (STEMI) compared with those with non–ST-segment–elevation MI.

Methods and Results—

Older patients ≥65 years with acute MI and significant coronary artery disease identified with coronary angiography from the ACTION Registry-GWTG (Get With the Guidelines) were linked to Medicare claims data from 2007 to 2010. We examined the unadjusted cumulative incidence of each outcome studied from hospital discharge through 2 years with log-rank tests and then performed a piece-wise proportional hazards modeling with 2 time periods: discharge to 90 days and 90 days to 2 years. Among the 46 199 patients linked with Medicare data, 17 287 (37.4%) presented with STEMI. Through 2 years, the unadjusted cumulative incidence of all-cause mortality (16.0% versus 19.8%;
P
<0.001) and the composite outcome (21.9% versus 27.9%;
P
<0.001) was lower for STEMI patients. Within the first 90 days, unadjusted rates of mortality (5.5% versus 5.3%) and the composite outcome (7.9% versus 8.1%) were similar but diverged from 90 days to 2 years (mortality, 11.1% versus 15.4%;
P
<0.001; composite outcome, 15.2% versus 21.5%;
P
<0.001). After multivariable adjustment, the adjusted risks of mortality and the composite outcome through 90 days were higher for STEMI patients, whereas risks of mortality and the composite outcome were attenuated from 90 days through 2 years.

Conclusions—

Among older acute MI patients with angiographically confirmed coronary artery disease discharged alive, STEMI patients (compared with non–ST-segment–elevation MI patients) were found to have a lower frequency of unadjusted postdischarge mortality and composite cardiovascular and cerebrovascular outcomes through 2 years after hospital discharge. This analysis provides unique insight into differential short- and long-term risks of ischemic cardiovascular and cerebrovascular outcomes by MI classification among older MI patients with confirmed coronary artery disease surviving to hospital discharge.
Potassium Supplementation Prevents Sodium Chloride Cotransporter Stimulation During Angiotensin II Hypertension
Authors: Veiras Luciana C. , Han Jiyang , Ralph Donna L. , McDonough Alicia A.
Published: September 2016

Angiotensin II (AngII) hypertension increases distal tubule Na-Cl cotransporter (NCC) abundance and phosphorylation (NCCp), as well as epithelial Na
+
channel abundance and activating cleavage. Acutely raising plasma [K
+
] by infusion or ingestion provokes a rapid decrease in NCCp that drives a compensatory kaliuresis. The first aim tested whether acutely raising plasma [K
+
] with a single 3-hour 2% potassium meal would lower NCCp in Sprague–Dawley rats after 14 days of AngII (400 ng/kg per minute). The potassium-rich meal neither decreased NCCp nor increased K
+
excretion. AngII-infused rats exhibited lower plasma [K
+
] versus controls (3.6±0.2 versus 4.5±0.1 mmol/L;
P
<0.05), suggesting that AngII-mediated epithelial Na
+
channel activation provokes K
+
depletion. The second aim tested whether doubling dietary potassium intake from 1% (A1K) to 2% (A2K) would prevent K
+
depletion during AngII infusion and, thus, prevent NCC accumulation. A2K-fed rats exhibited normal plasma [K
+
] and 2-fold higher K
+
excretion and plasma [aldosterone] versus A1K. In A1K rats, NCC, NCCpS71, and NCCpT53 abundance increased 1.5- to 3-fold versus controls (
P
<0.05). The rise in NCC and NCCp abundance was prevented in the A2K rats, yet blood pressure did not significantly decrease. Epithelial Na
+
channel subunit abundance and cleavage increased 1.5- to 3-fold in both A1K and A2K; ROMK (renal outer medulla K
+
channel abundance) abundance was unaffected by AngII or dietary K
+
. In summary, the accumulation and phosphorylation of NCC seen during chronic AngII infusion hypertension is likely secondary to potassium deficiency driven by epithelial Na
+
channel stimulation.
Influence of Device Choice on the Effect of Intra-Arterial Treatment for Acute Ischemic Stroke in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)
Authors: Dippel Diederik W. , Majoie Charles B. , Roos Yvo B. , van der Lugt Aad , van Oostenbrugge Robert J. , van Zwam Wim H. , Lingsma Hester F. , Koudstaal Peter J. , Treurniet Kilian M. , van den Berg Lucie A. , Beumer Debbie , Fransen Puck S. , Berkhemer Olvert A. ,   for the MR CLEAN Investigators
Published: September 2016

Background and Purpose—

Intra-arterial treatment by means of retrievable stents has been proven safe and effective. In MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the choice of the type of thrombectomy device was left to the discretion of the interventionist. The aim of this study was to explore the differences in functional outcome, neurological recovery, reperfusion, extent of infarction, and adverse events according to stent type and make.

Methods—

The primary outcome was functional outcome at 90 days, assessed with the modified Rankin Scale (mRS). Neuroimaging outcomes included occlusion on computed tomographic angiography at 24 hours, infarct volume at 5 to 7 days, and modified thrombolysis in cerebral infarction scores. Safety outcomes included death within 90 days and any symptomatic intracerebral hemorrhage. We analyzed possible interactions between stent type and treatment with multiple regression models. Treatment effects were adjusted for patient age, stroke severity, and collateral score.

Results—

Of the 500 patients included in the trial, 233 were allocated to intervention. Of these, 124 (53%) were first treated with Trevo (adjusted common odds ratio for shift on the mRS [acOR, 1.98; 95% confidence interval, 1.30–2.92]), 31 (13%) with Solitaire (acOR, 1.90; 95% confidence interval, 0.97–3.73), 40 (17%) with other retrievable stents or mechanical devices (acOR, 0.96; 95% confidence interval, 0.51–3.93], and 38 (16%) could not be treated. There was no interaction between device and treatment effect on functional outcome and all other secondary and safety outcomes.

Conclusions—

We found no evidence for a differential effect of thrombectomy for acute ischemic stroke by type of stent.

Clinical Trial Registration—

URL:
http://www.isrctn.com
. Unique identifier: ISRCTN10888758.
Port State Jurisdiction over Labour Conditions: A Private International Law Perspective on Extra-territoriality
Authors: Piñeiro Laura Carballo
Published: September 2016

Whereas flag states are primarily responsible for living and labour conditions on board ships flying their flag, port state jurisdiction on board foreign-flagged ships is still uncertain from both a public and a private international law perspective. This paper focuses on the latter, to ascertain in which cases port state courts and domestic employment legislation decide on maritime employment contract matters. This may help to establish to what extent the extra-territorial exercise of port state jurisdiction is reasonable: adjudicatory jurisdiction and conflict-of-laws rules are construed on the basis of the proximity principle and thus strive to point out the state with the strongest link to the case at stake. However, the establishment of the port state legal system as the closest one to maritime employment usually amounts to setting the flag state aside, meaning that the subsidiarity principle takes over in determining the extra-territorial application of port state jurisdiction.
The Shaky Foundations of the fao Port State Measures Agreement: How Watertight Is the Legal Seal against Access for Foreign Fishing Vessels?
Authors: Serdy Andrew
Published: September 2016

The Port State Measures Agreement aims to influence fishing vessels’ high seas activities, normally under the exclusive jurisdiction of their flag States, by withholding access to parties’ ports to unload catch and resupply. This works inter partes, but many flag States are unlikely to become party to it. The Agreement assumes States may nonetheless exclude foreign vessels from their ports, giving parties leverage to impose conditions derived from it on vessels of non-parties seeking access. But this assumption is valid only if the port State retains its right to exclude; many have bargained it away, in old bilateral treaties or as World Trade Organization members with freedom of transit obligations. The settlement on terms favourable to the European Union of both the Swordfish and Herring disputes, representing the flag State in one and port States in the other, suggests that market power vulnerable to abuse, not jurisdictional authority, may have been the decisive factor.
Port State Jurisdiction Relating to the Safety of Shipping and Pollution from Ships—What Degree of Extra-territoriality?
Authors: Churchill Robin
Published: September 2016

The aim of this article is to consider the extent to which the exercise by a port State of jurisdiction over foreign ships in relation to safety and the prevention of pollution is extra-territorial in nature. This aim is pursued by addressing two main issues. The first is the question of whether a port State may prescribe and enforce measures relating to the construction, design, equipment and manning of ships (including measures that go beyond international (International Maritime Organization) standards) in respect of foreign ships calling at its ports; and if so, whether that involves an element of extra-territorial jurisdiction. The second issue is the question of how far a port State may exercise jurisdiction over the conduct of foreign ships relating to shipping safety and the prevention of pollution before such ships enter its ports, and whether that is an exercise of extra-territorial jurisdiction.
The Exclusive Jurisdiction of Flag States: A Limitation on Pro-active Port States?
Authors: Honniball Arron N.
Published: September 2016

The loosely phrased, and undefined, ‘exclusive flag state jurisdiction’ principle of the United Nations Law of the Sea Convention Article 92, has arguably proved to be a red herring for states and academia, in its being raised as a limiting factor to extra-territorial prescription by non-flag states. This has extended to port state jurisdiction discussions, and was raised by analogy for aircraft, before the European Court of Justice, in relation to the limits of jurisdiction over high seas overflight. This paper argues for a limited scope to the term ‘jurisdiction’ in Article 92. It concludes that far from being a limiting factor, the principle of flag state exclusivity is solely concerned with the enforcement jurisdiction of states on the high seas. The increasing use of port state prescriptive jurisdiction, particularly those practices with extra-territorial effect, provides further evidence that this is the correct interpretation.
Description of a new hygrobatid genus from Chile (Acari, Hydrachnidia: Hygrobatidae)
Authors: TUZOVSKIJ PETR V. , STOLBOV VITALY A.
Published: September 2016

This paper describes a new genus of the water mite family Hygrobatidae. The material was collected by V. Stolbov in 2014 and A. Prokin in 2015 in running waters in Chile. The material was sampled with a common hand net with 250 µm mesh size. The water mites were fixed in 75% ethanol.
Toward Reduced Representation of Mixing State for Simulating Aerosol Effects on Climate
Authors: Riemer Nicole , Bond Tami C.
Published: September 2016

Atmospheric aerosols affect Earth’s energy budget, and hence its climate, by scattering and absorbing solar radiation and by altering the radiative properties and the lifetime of clouds. These two major aerosol effects depend on the optical properties and the cloud-nucleating ability of individual particles, which, in turn, depend on the distribution of components among individual particles, termed the “aerosol mixing state.” Global models have moved toward including aerosol schemes to represent the evolution of particle characteristics, but individual particle properties cannot be resolved in global-scale simulations. Instead, models approximate the aerosol mixing state. The errors in climate-relevant aerosol properties introduced by such approximations may be large but have not yet been well quantified. This paper quantitatively addresses the question of to what extent the aerosol mixing state must be resolved to adequately represent the optical properties and cloud-nucleating properties of particle populations. Using a detailed benchmarking model to simulate gas condensation and particle coagulation, we show that, after the particles evolve in the atmosphere, simple mixing-state representations are sufficient for modeling cloud condensation nuclei concentrations, and we quantify the mixing time scale that characterizes this transformation. In contrast, a detailed representation of the mixing state is required to model aerosol light absorption, even for populations that are fully mixed with respect to their hygroscopic properties.
Radiation Fluxes in a Business District of Shanghai, China
Authors: Ao Xiangyu , Grimmond C. S. B. , Liu Dongwei , Han Zhihui , Hu Ping , Wang Yadong , Zhen Xinrong , Tan Jianguo
Published: September 2016

Radiative fluxes are key drivers of surface–atmosphere heat exchanges in cities. Here the first yearlong (December 2012–November 2013) measurements of the full radiation balance for a dense urban site in Shanghai, China, are presented, collected with a CNR4 net radiometer mounted 80 m above ground. Clear-sky incoming shortwave radiation K↓ (median daytime maxima) ranges from 575 W m−2 in winter to 875 W m−2 in spring, with cloud cover reducing the daily maxima by about 160 W m−2. The median incoming longwave radiation daytime maxima are 305 and 468 W m−2 in winter and summer, respectively, with increases of 30 and 15 W m−2 for cloudy conditions. The effect of air quality is evident: haze conditions decrease hourly median K↓ by 11.3%. The midday (1100–1300 LST) clear-sky surface albedo α is 0.128, 0.141, 0.143, and 0.129 for winter, spring, summer, and autumn, respectively. The value of α varies with solar elevation and azimuth angle because of the heterogeneity of the urban surface. In winter, shadows play an important role in decreasing α in the late afternoon. For the site, the bulk α is 0.14. The Net All-Wave Radiation Parameterization Scheme/Surface Urban Energy and Water Balance Scheme (NARP/SUEWS) land surface model reproduces the radiation components at this site well, which is a promising result for applications elsewhere. These observations help to fill the gap of long-term radiation measurements in East Asian and low-latitude cities, quantifying the effects of season, cloud cover, and air quality.
Projected Changes in Precipitation Extremes for Western Canada based on High-Resolution Regional Climate Simulations
Authors: Erler Andre R. , Peltier W. Richard
Published: September 2016

An analysis of changes in precipitation extremes in western Canada is presented, based upon an ensemble of high-resolution regional climate projections. The ensemble is composed of four independent, identically configured Community Earth System Model (CESM) integrations that were dynamically downscaled to 10-km resolution, using the WRF Model in two different configurations. Only the representative concentration pathway 8.5 (RCP8.5) scenario is considered. Changes in extremes are found to generally follow changes in the (seasonal) mean, but changes in mean and extreme precipitation differ strongly between seasons and regions (where extremes are defined as the seasonal maximum of daily precipitation). At the end of the twenty-first century, the highest projected increase in precipitation extremes is approximately 30% in winter away from the coast and in fall at the coast. Changes in winter are consistent between models; however, changes in summer are not: CESM is characterized by a decrease in summer precipitation (and extremes), while one WRF configuration shows a significant increase and another no statistically significant change. Nevertheless, the fraction of convective precipitation (extremes) in summer increases by 20%–30% in all models. There is also evidence that the climate change signal in summer is sensitive to the choice of the convection scheme. A comparison of CESM and WRF shows that higher resolution clearly improves the representation of winter precipitation (extremes), while summer precipitation does not appear to be sensitive to resolution (convection is parameterized in both models). To increase the statistical power of the extreme value analysis that has been performed, a novel method for combining data from climatologically similar stations was employed.
Processes Governing Water Vapor Isotope Composition in the Indo-Pacific Region: Convection and Water Vapor Transport
Authors: Cai Zhongyin , Tian Lide
Published: September 2016

In an effort to understand the mechanisms controlling water vapor isotope composition in the Indo-Pacific region, encompassing southeastern Asia, this study investigates the spatial and interannual patterns in summer [June–September (JJAS)] water vapor isotopologues retrieved from the Tropospheric Emission Spectrometer (TES), especially those patterns associated with convection and water vapor transport. Both precipitation and water vapor isotope values exhibit a V-shaped longitudinal pattern in their spatial variations, reflecting the gradual rainout and increase in convective intensity along water vapor transport routes. On the temporal scale, compared with the 2006–10 JJAS mean conditions, TES water vapor δD over the eastern Indian Ocean and southeastern Asia (R_W120; 10°S–30°N, 80°–120°E) is higher in the 2009 JJAS El Niño event when convective activity is reduced and lower in the 2010 JJAS La Niña event when convective activity is enhanced. This is consistent with the direct response of water vapor δD to deep convection. In contrast, TES water vapor δD over the western Pacific (R_WP; 10°S–30°N, 120°–140°E) is higher in the La Niña year than in the El Niño year, although convective activity in R_WP varies in the same manner as in R_W120. A comparison of water vapor δD values with convection and water vapor transport suggests that the westward transport of water vapor–isotopic anomalies and changes in the flux of water vapor transported from the central to the western Pacific lead to such an opposite response in the R_WP. These findings help interpret what causes the interannual variations recorded by Indo-Pacific water isotopologues.