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Early diagnosis of patients with dilated cardiomyopathy (DCM) remains challenging. Cardiac MR can correlate myocardial changes with their pathological basis. There have been some previous studies on the effect of T1 mapping in DCM, but there is limited data on the incremental value of T2 mapping for DCM in routine clinical practice. This study will examine whether the combination of MRI T1 and T2 mapping offers greater advantages in the diagnosis of DCM. The study included 28 patients with DCM and 21 healthy controls. CMR evaluation included late gadolinium enhancement (LGE), T1 mapping, extracellular volume (ECV) fraction and T2 mapping. The DCM group was divided into LGE (+) and LGE (−) subgroups. The main modes of LGE are subendocardial, midwall, subepicardial, or transmural. T1 values, T2 values, and ECV in the 16 segments myocardial levels were measured by post-processing software. Student's t-tests or Mann–Whitney U test was used to compare between two groups, and one-way ANOVA or Kruskal–Wallis H test was used to compare between multiple groups, with p values corrected by Bonferroni. The difference was considered statistically significant at P < 0.05. ROC curve analysis was used to compare the area under the curve (AUC) of each index and its combined value, and the cut-off value, sensitivity and specificity were determined by Jordan's index. Mean native myocardial T1, ECV and T2 were significantly higher in the DCM group compared to controls (p ≤ 0.001, respectively). The best cut-off values for T1, T2 and ECV to discriminate DCM from controls were 1184 ms, 40.9 ms and 29.2%, respectively. The AUC of T1, ECV and T2 were 0.87, 0.89, and 0.83, respectively. The combined AUC of the three values was 0.96. Native T1 value and ECV overcome some of the limitations of LGE, and the T2 helps to understand the extent of myocardial damage. The combination of T1 and T2 mapping techniques can reveal fibrotic and oedematous changes in the early stages of DCM, providing a more comprehensive assessment of DCM and better guidance for individualised clinical management of patients. We suggest that the addition of T2 mapping to the routine CMR examination of patients with suspected DCM, and the combined assessment of T1mapping and T2 mapping can provide complementary information about the disease and improve the early diagnosis of DCM. [ABSTRACT FROM AUTHOR]

The aim of this study was to propose a treatment strategy for intraglandular submandibular calculi based on calculus site. Seventy-three consecutive patients with impalpable intraglandular submandibular calculi were enrolled retrospectively. The calculi were classified as either post-hilar type, central type, or superficial type. Treatment approaches included transoral duct slitting (TDS), interventional basket retrieval (IBR), intraductal laser lithotripsy (ILL), and transcervical lithotomy (TCL). Complete calculus removal with gland preservation was achieved in 64 patients (87.7%). The success rate for post-hilar, central, and superficial calculi was 86.4% (51/59), 90.9% (10/11), and 100% (3/3), respectively. The treatment approach applied in patients with treatment success was TDS in 32 cases, IBR in 20, ILL in nine, and TCL in three. During follow-up (median 17.3 months), one patient experienced gland atrophy and three had ductal stenosis; the remaining 60 patients (93.8%, 60/64) had good clinical outcomes. In the eight failure cases operated by TDS, the deeply situated calculi could not be detached despite the parenchymal incision in five cases, while the procedure was ceased due to the patient's inability to cooperate in the other three cases. In the remaining failure case, the submandibular gland was sacrificed after calculus extraction via TCL. Application of the proposed treatment algorithm might help preserve gland function in patients with intraglandular submandibular calculi. [ABSTRACT FROM AUTHOR]

Many meta-analyses have assessed the efficacy of preventive interventions against ventilator-associated pneumonia (VAP) in critically ill patients. However, there has been no comprehensive analysis of the strength and quality of evidence to date. Systematic reviews of randomized and quasi-randomized controlled trials, which evaluated the effect of preventive strategies on the incidence of VAP in critically ill patients receiving mechanical ventilation for at least 48 h, were included in this article. We identified a total of 34 interventions derived from 31 studies. Among these interventions, 19 resulted in a significantly reduced incidence of VAP. Among numerous strategies, only selective decontamination of the digestive tract (SDD) was supported by highly suggestive (Class II) evidence (risk ratio (RR)=0.439, 95% CI: 0.362–0.532). Based on data from the sensitivity analysis, the evidence for the efficacy of non-invasive ventilation in weaning from mechanical ventilation (NIV) was upgraded from weak (Class IV) to highly suggestive (Class II) (RR=0.32, 95% CI: 0.22–0.46). All preventive interventions were not supported by robust evidence for reducing mortality. Early mobilization exhibited suggestive (Class III) evidence in shortening both intensive length of stay (LOS) in the intensive care unit (ICU) (mean difference (MD)=-0.85, 95% CI: -1.21 to -0.49) and duration of mechanical ventilation (MD=-1.02, 95% CI: -1.41 to -0.63). In conclusion, SDD and NIV are supported by robust evidence for prevention against VAP, while early mobilization has been shown to significantly shorten the LOS in the ICU and the duration of mechanical ventilation. These three strategies are recommendable for inclusion in the ventilator bundle to lower the risk of VAP and improve the prognosis of critically ill patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to comparatively evaluate the indications and treatment outcomes of two transcutaneous approaches for the removal of impacted parotid stones. Sixty-eight consecutive patients with impacted parotid stones underwent endoscopy-assisted lithotomy via a direct mini-incision or a peri-auricular flap. Clinical safety and outcomes were evaluated. Complete stone extraction was achieved in all patients. In the mini-incision group (52 patients), the stones were in the middle third of the main duct in 31 patients, at the hilum in 16, and in the intraglandular duct in five. In the flap group (16 patients), they were in the middle third of the main duct in one patient, at the hilum in seven, and in the intraglandular duct in eight. Salivary fistula occurred in five mini-incision group patients (9.6%) and four flap group patients (25%). The clinical outcome in the mini-incision group (47 patients, median 25 months of follow-up) was good in 28 patients, fair in 13, and poor in six (12.8%). The clinical outcome in the flap group (16 patients, median 84 months of follow-up) was good in nine patients, fair in five, and poor in two (12.5%). The direct mini-incision approach was found to be safe and effective for impacted stones in the middle third, hilum, and proximal third of the main duct, while the peri-auricular approach would be best reserved for deeper intraglandular stones. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the gland function of patients following endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton's duct. The study cohort comprised 115 patients who had undergone successful endoscopy-assisted lithotomy for hilo-parenchymal stones (mean diameter 7.7 mm). Gland function was evaluated at a mean 12 months after surgery using ultrasonography, sialography, and/or sialometry. Postoperative ultrasonography of 51 affected glands revealed a regular gland size in 58.8%, normal parenchyma density in 51.0%, and ductal ectasia in 80.4%. Postoperative sialograms of 109 affected glands were scored as type I (approximately normal) in 13 cases, type II (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and no contrast retention) in 64, type III (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and mild contrast retention) in 23, and type IV (poor shape of the main duct with evident contrast retention) in nine cases. The existence of ductal ectasia corresponded well to larger stone cases (P = 0.002). In the postoperative sialometry of 35 patients with unilateral stones, differences between the two sides were insignificant (P > 0.05). For patients with hilo-parenchymal submandibular gland stones, endoscopy-assisted surgery and extended postoperative follow-up help preserve the gland with good function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to clarify the differences in the diagnosis and treatment outcomes between radioactive iodine-induced sialadenitis (RAIS) and chronic obstructive parotitis (COP). The study cohort comprised 47 consecutive patients diagnosed with RAIS and 50 patients with COP. All patients were treated by interventional endoscopy. Clinical, sialography, and endoscopy characteristics and treatment outcomes were compared between the two groups. Compared with the COP group, the RAIS group included more females (male:female ratio 1:8.4 vs 1:2.1; P = 0.011) and had a younger onset age (42 vs 50 years; P = 0.001) and shorter disease duration prior to hospital visit (5.4 vs 34.8 months; P < 0.001). In the RAIS group, sialography revealed obliteration of the main duct (20.4% vs 0%; P < 0.001), non-visualization of the main gland (23.7% vs 0%; P < 0.001), and incomplete contrast filling of the main gland (19.4% vs 6.4%; P = 0.008), which were scarcely observed in the COP group. Endoscopy revealed a higher percentage of duct atresia in RAIS compared to COP (20.4% vs 0%; P < 0.001). During follow-up, a higher percentage of RAIS patients had duct atresia and gland atrophy (49.5% vs 1.1%, P < 0.001). Compared with COP, RAIS more commonly involves younger females and has a shorter disease duration. Atresia of the main duct and atrophy of the gland parenchyma occur more often despite the use of interventional endoscopy. [ABSTRACT FROM AUTHOR]

We simulated bottom resuspension events in Lake Erie, using a coupled three-dimensional hydrodynamic and water quality model. Key parameters in the model, including critical bottom shear stress (τ cr ) and resuspension rate (α) were calibrated and validated by comparing the model output to observations. These included total suspended solid (TSS) concentrations in the bottom boundary layer (RMSE = 0.74 mg L -1) and water column (RMSE = 0.81 mg L -1), and to time series of acoustic backscatter signal (R2 > 0.8) and turbidity (R2 ≈ 0.4) from long-term moorings near the lakebed in 2008–09 and 2013. Signals from phytoplankton, in spring and summer, caused discrepancies between modeled TSS and the observed turbidity data. Although common practice, we show that literature-based or field-observed critical shear stress should not be directly applied in large-scale Reynolds-averaged sediment model as this will likely underestimate resuspension. In agreement with the literature, the model reproduced more frequent and intensive surface-wave driven resuspension in the shallow regions (< ~20 m), particularly in the western basin, compared to the deeper central and eastern basins, where bottom stresses induced by mean currents (τ c) were comparable with those due to surface waves (τ w). However, on the north-shore of the eastern basin, τ c often predominated over τ w. We simulated thermocline motion, including up- and down-welling events and swashing of the internal Poincaré wave, to contribute to τ c in the central basin and form nepheloid layers. [ABSTRACT FROM AUTHOR]

This article reports the surgical resection of clinically benign tumours in the maxillomandibular deep lobe of the parotid gland via sternocleidomastoid muscle–parotid space (SPS) approach. The use of maxillary–mandibular planes to subdivide the deep lobe of the parotid gland in order to establish the tumour location and accessibility is introduced. This approach, which does not raise a skin flap, may preserve the superficial lobe. Ten patients with clinically benign tumours in the maxillomandibular deep lobe of the parotid gland were treated via the SPS approach. The patients were followed up for 3–5 years and the surgical outcomes were analysed. All tumours were completely enucleated via the SPS approach with an optimal aesthetic outcome. No permanent facial weakness or tumour recurrence was identified during the 3–5 years of follow-up. The SPS approach to surgical resection is an ideal option for clinically benign tumours in the maxillomandibular deep lobe of the parotid gland and demonstrates good results. [ABSTRACT FROM AUTHOR]

Objective: Osteoarthritis (OA) is a serious joint disease with no disease-modifying medical treatment. To develop treatments targeting synovium, we must improve our understanding of the effects of OA-related changes in synovial physiology on joint tissue outcomes. The aim of this study was to investigate the effects of synovial pathology due to post-traumatic OA (PTOA) on articular chondrocyte physiology.Methods: We first developed and validated a novel joint tissue co-culture system to model the biological interactions between synovium and articular chondrocytes. Whole-joint synovial tissue from a surgical rat model of PTOA vs sham and surgical-naïve controls was placed into a co-culture system with adult primary articular chondrocytes (n = 4-5). The effects of PTOA synovium on chondrocyte anabolic, inflammatory, and catabolic gene expression and sulfated glycosaminoglycan (sGAG) secretion and aggrecan synthesis were tested, and results from early and later stages of PTOA development were compared.Results: Synovial injury by arthrotomy (sham surgery) alone decreased primary chondrocyte expression of genes including Col2a1 (0.36 ± 0.15-fold) and Acan (0.41 ± 0.28-fold). Early PTOA synovium rescued the suppression of Acan, induced increased sGAG secretion (3.94 ± 0.44 μg/mL vs surgery-naïve 2.41 ± 0.55 and sham 2.92 ± 0.73 μg/mL controls), and upregulated Mmp3 (3.73 ± 2.62-fold) and Prg4 (4.93 ± 4.29-fold). These effects were lost with later stage PTOA synovium.Conclusions: Early PTOA synovium induces transient anabolic responses in articular chondrocytes rather than pro-inflammatory responses that would require inhibition. These results suggest that PTOA synovium plays at least a partially protective role and that loss of these protective effects may contribute to PTOA progression. [ABSTRACT FROM AUTHOR]

Classic formulas of traditional Chinese medicine (TCM) have been used for digestive diseases for more than 1 000 years. To determine whether TCM formulas used in modern clinical activities were effective to treat chronic gastritis (CG), we assessed the clinical evidence and potential mechanisms of TCM supplemental treatment on stable CG patients through a systematic review and meta-analysis of clinical trials. Relevant studies were identified by searching for papers published from January 2005 to August 2022 in the following databases: Cochrane Library, PubMed, and EMBASE, China National Knowledge Infrastructure, Wan Fang Database, and Chinese Scientific Journals Database, without language restrictions. The authors of the identified papers were contacted for additional information if necessary. A total of 2 215 CG participants from 30 clinical randomised controlled trials of chronic superficial gastritis, chronic atrophic gastritis, chronic bile reflux gastritis, and chronic erosion gastritis were published in recent years. This meta-analysis showed that TCM could significantly alleviate the clinical symptoms and curative effects of chronic gastritis patients. Furthermore, the mechanisms of single- and two-medicinal combinations and the formula of the included studies are also summarised. The methodological quality of the included randomised controlled trials may limit the conclusions that indicate that TCM could alleviate the clinical symptoms and promising curative effect of CG patients; some further rigorous designed and well-conducted research should be needed. • Totally 2 215 chronic gastritis participants from 30 clinical randomised controlled were studied. • We found that traditional Chinese medicine could significantly alleviate the clinical symptoms and curative effect of chronic gastritis patients. • Furthermore, the mechanisms of the included studies are also summarised to better serve clinical doctors and chronic gastritis patients. [ABSTRACT FROM AUTHOR]

Understanding the spatial ecology and habitat-use of Lake Erie's commercially important walleye (Sander vitreus) population is imperative due to their large-scale seasonal migrations (>400 km) exposing them to five different jurisdictions in the USA and Canada. The objective of this study was to determine the habitat selected by walleye throughout the year and across Lake Erie. Here, we used acoustic telemetry to estimate walleye occurrence at three lake depth categories that were pertinent to biology (e.g., spawning) and management (e.g., quota allocation). Detection data from 851 adults during five continuous years identified consistent seasonal fluctuations in habitat selection across western (WB) and eastern (EB) basin walleye stocks. Sex-specific differences were also found during spawning periods (March-May) when males showed a stronger affinity to shallow waters <6 m than females. Also, EB stocks selected these shallow waters longer than WB stocks, likely due to differences in thermal patterns between basins. Deep water (>13 m) was readily selected between spring and winter (>6 months/year) for most WB and EB walleye despite stock-specific migration patterns. This study provides novel information about the space use patterns of one of the most economically important fish in North America at spatial and temporal scales relevant to management. [ABSTRACT FROM AUTHOR]

• Intestinal parasitic infections are likely going to be increasingly common even in developed countries. • While most of the infections are mild, severe cases can result in high morbidity and mortality. • Primary care physicians seeing patients with risk factors for intestinal parasitic infections should be vigilant. • If the clinical suspicion is high, physicians should consider further investigations or empirical anti-parasitic treatment Intestinal parasitic infections are a health burden to developing countries, but can also become more prevalent worldwide, even in developed countries, with the advent of globalization. While most of these infections are benign, some may be associated with acute infections with high morbidity and mortality rates. A 36 years old patient presented with toxic megacolon with poly-helminthic infections, likely a result of raw food ingestion. She subsequently required multiple surgeries with a total colectectomy and small bowel resection, and ended up with an end-ileostomy. Intestinal polyparasitism has been reported in undeveloped countries, but it appears that such a trend can be found in developed countries as well. Clinicians, especially those practicing in countries with large expatriate or immigrant worker populations, should be aware of this trend and adjust treatment protocols accordingly. Even in countries whereby intestinal parasitic infections are not common, clinicians should have a heightened awareness of the possibility for such infections to be present, especially in returning travellers, expatriate or immigrant populations. [ABSTRACT FROM AUTHOR]

Objective: In this study, the role of inflammation in traumatic heterotopic ossification around temporomandibular joint (THO-TMJ), as well as the preventive and treatment effect of celecoxib in THO-TMJ both in vivo and in vitro were explored.Design: A surgically-induced THO-TMJ mouse model and a co-culture model of ATDC-5 or MC3T3-E1 and RAW-264.7 cells were used in this study for in vivo and in vitro research.Results: A series of inflammatory factors, such as CD3, CD68, CD20, IL-10, IL-6 and TNF-α, were activated 48 h after trauma in a THO-TMJ model. Local trauma initiated systemic inflammatory responses as well as T cell- and macrophage-mediated local inflammatory responses around TMJ. In addition, expression of COX-2 was significantly elevated. The findings also showed that local injection of celecoxib could effectively alleviate the inflammatory response around TMJ at the early stage of trauma and inhibit the formation of THO-TMJ in vivo. Meanwhile, celecoxib could inhibit chondrogenic differentiation of ATDC-5 and osteogenic differentiation of MC3T3-E1 under inflammatory condition in vitro. Furthermore, celecoxib could inhibit the expression of Bmpr1b in the injured condylar cartilage at the initiation stage of THO-TMJ, which implied that Bmpr1b expressed by the residual condylar cartilage might be related to the pathogenesis of THO-TMJ.Conclusions: Inflammation played a crucial role in the pathogenesis of THO-TMJ, and anti-inflammation might be a possible choice to inhibit THO-TMJ, which provided scientific clues for the mechanisms, pharmacotherapy and molecular intervention of THO-TMJ. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the morphology of proximal tibiofibular joint (PTFJ) is associated with increased risk of incident radiographic osteoarthritis (iROA) over 4 years in the OA Initiative (OAI) study.Methods: A nested matched case-control study design was used to select participants from OAI study. Case knees were defined as those with iROA. Control knees were matched one-to-one by sex, age and radiographic status with case knees. T2-weighted MR images were assessed at P0 (the visit when incident ROA was found on radiograph), P1 (1 year prior to P0) and at OAI baseline. The contacting area of PTFJ (S) and its projection areas onto the horizontal (load-bearing area, Sτ), sagittal (lateral stress-bolstering area, Sφ) and coronal plane (posterior stress-bolstering area, Sυ) were assessed, respectively.Results: 354 case knees and 354 matched control knees were included, with a mean age of 60 and a mean body mass index (BMI) of 28 kg/m2. Baseline PTFJ morphological parameters (S, Sτ and Sυ) were significantly associated with iROA over 4 years, and these associations remained unchanged after adjustment for BMI, number of knee bending activities, self-reported knee injury and surgery. S, Sτ and Sυ were also significantly associated with iROA at P1 and P0. In subgroup analysed, S, Sτ and Sυ were associated with risks of incident joint space narrowing in the medial, but not the lateral tibiofemoral compartment.Conclusion: Greater contacting area, load-bearing area and posterior stress-bolstering area of PTFJ were associated with increased risks of iROA, largely in the medial tibiofemoral compartment. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) anterior disc displacement and condylar remodelling for sagittal fracture of the mandibular condyle (SFMC) in children. Disc displacement was observed in 20 patients with 24 SFMCs (age 4–12 years) via magnetic resonance imaging. After 6 months of closed treatment (T1), the joints were categorized based on the displaced disc status as complete reduction (DCR) or incomplete reduction (DICR). Moreover, condylar remodelling was compared between the groups using cone beam computed tomography images of the TMJ obtained at T1 and at the 1-year follow-up (T2; 15 patients with 18 displaced SFMCs). At T1, 17 of 24 joints with SFMC were assigned to the DCR group and six to the DICR group; one unilateral SFMC case developed ankylosis. Condylar depth and height differed significantly between the groups at T1, but not at T2. Intra-group comparison exhibited significant changes in the condylar depth and height over time in the DICR group. Thus, most of the anteriorly displaced discs (17/24, 70.8%) achieved reduction following closed treatment. Although sustained anterior disc displacement was associated with an increased depth and reduced height of the condyle, no clinical impairment was noted unless ankylosis developed. [ABSTRACT FROM AUTHOR]

Pathological expansion of the paranasal sinus by air is rare, and may cause severe deformation of the overlying bone and tissue. We present two cases of young adults with maxillary pneumocoeles that were diagnosed by computed tomography, and discuss the differential aetiology. [ABSTRACT FROM AUTHOR]

Objectives: Selenium (Se) plays pivotal roles in maintaining optimal health. Nevertheless, how Se influences the metabolism of extracellular matrix (ECM) in cartilage remains unclear. The aim of the present study was to observe protein dimethylation by certain Se-sensitive PRMT and to elucidate its effects on the key transcriptional factor in cartilage.Methods: We observed the expression of selenoproteins and markers of ECM metabolism in chondrocytes and articular cartilage of the rats under Se-deficiency by RT-qPCR, immunoblotting and immunohistochemistry. Then, we analyzed the expression of total dimethylated protein by using specific antibody under different Se statuses. After Se sensitive PRMT was identified, we used siRNA or PRMT inhibitor or stably overexpressing vector to intervene in the PRMT expression and identified the key transcriptional factor. Co-immunoprecipitation was applied to verify the interaction between PRMT and the key transcriptional factor. Finally, we measured the half-life time of the key transcriptional factor by immunoblotting after cycloheximide treatment.Results: In chondrocytes and cartilage of the rats with Se deficiency, we found an aberrant metabolism manifesting decreased expression of Col2a1 and increased expression of Mmp-3. Then, we identified that PRMT5 was the unique type II PRMT, sensitive to Se status. PRMT5 upregulation led to the increased COL2A1 expression but decreased MMP-3 expression in chondrocytes. Furthermore, we revealed that PRMT5 improved SOX9 stability by dimethylating the protein, which contributed to maintain the matrix metabolic homeostasis of the chondrocytes.Conclusions: Se-sensitive PRMT5 increases the half-life of SOX9 protein via PTM and helps to maintain ECM homeostasis of the articular cartilage. [ABSTRACT FROM AUTHOR]

Background and Aims: Elevated resting heart rate (RHR) is associated with risk of type 2 diabetes mellitus (T2DM). However, the association of change in RHR (ΔRHR) and incident T2DM is not fully elucidated. We aimed to assess the dose-response association between 6-year ΔRHR and T2DM.Methods and Results: A total of 12155 non-T2DM participants ≥18 years old were enrolled during 2007-2008 and followed up during 2013-2014. ΔRHR was calculated by subtracting the baseline RHR from the RHR value at 6-year follow-up. Age-, sex-, and RHR-specific relative risks (RRs) and 95% confidence intervals (CIs) for the effect of ΔRHR on incident T2DM were calculated by using modified Poisson regression models. As compared with ΔRHR of 0 beats/min, the adjusted risk of T2DM was significantly increased with RHR increment and reduced with RHR reduction. ΔRHR was positively associated with future risk of T2DM [RR per unit increase: 1.03 (1.03-1.04)]. As compared with stable change in RHR group (-5<ΔRHR<5 beats/min), for ΔRHR ≤ -10 beats/min, -10<ΔRHR ≤ -5 beats/min, 5≤ΔRHR<10 beats/min, and ΔRHR ≥10 beats/min groups, the pooled adjusted RR (95% CI) of T2DM was 0.69 (0.55-0.86), 0.90 (0.73-1.11), 1.31 (1.07-1.61), and 1.90 (1.59-2.26), respectively. This significant association still existed on subgroup analyses based on age, sex, and baseline RHR and sensitivity analyses.Conclusions: Dynamic RHR change was significantly associated with incident T2DM. Our study suggests that RHR may be a non-invasive clinical indicator for interventions aiming to reduce incident T2DM in the general population. [ABSTRACT FROM AUTHOR]

Background and Aim: Many studies have shown increased risk of stroke with greater adiposity as measured by body mass index (BMI), but questions remain about the shape of the dose-response relation. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose-response relation between BMI and risk of stroke.Methods and Results: PubMed and Embase databases were searched for articles published up to May 11, 2018. Random-effects generalized least-squares regression models were used to estimate study-specific dose-response association, and restricted cubic splines were used to model the association. We included reports of 44 prospective cohort studies describing 102 466 incident cases among 4 432 475 participants. With a 5-unit increment in BMI, the summary relative risk for stroke incidence was 1.10 (95% confidence interval, 1.06 to 1.13; I2 = 88.0%). The dose-response relation was J-shaped (Pnon-linearity <0.001). The risk was not increased at the low BMI range (<24 kg/m2), but was increased within the high BMI range (>25 kg/m2).Conclusion: Both overweight and obesity increase the risk of stroke with a J-shaped dose-response relation, and the nadir of the curve was observed at BMI 23-24 kg/m2. [ABSTRACT FROM AUTHOR]

Background and Aims: Several studies have reported increased cardiovascular risks in normal weight obesity (NWO) populations. We aimed to investigate the prevalence of NWO and its relationships with cardiometabolic risks in Chinese patients.Methods and Results: The data were from the 2007-2008 China National Diabetes and Metabolic Disorders Study. The body fat (BF) was measured using the biological impedance method. NWO was defined as a normal BMI (18.5-23.9 kg/m2) but with excess BF% (BF% ≥ 24% for men and ≥33% for women). 23,748 people (9633 males and 14,115 females) were enrolled and the prevalence of NWO was 9.5% for men, 6.06% for women. The prevalence risks of diabetes (odds ratio [OR]1.519, 95% confidence interval [CI] 1.262-1.828), Framingham risk score (FRS) ≥10% (OR 1.973, 95% CI 1.596-2.439), hypertension (OR 1.525, 95% CI 1.333-1.745), and metabolic syndrome Mets (OR 2.175, 95% CI 1.920-2.463) significantly increased in the NWO group compared with the normal group. Subgroup analyses showed that, after ruling out participants with abnormal waist circumference, the male group had similar findings to the overall population; but in the female group, the prevalence risks of FRS ≥10%, hypertension, and Mets increased, although the risk of diabetes did not.Conclusion: NWO is in a relatively high prevalence in Chinese population, and the prevalence of NWO is higher in Chinese men compared to Chinese women. Cardiometabolic risks significantly increase in an NWO population, and such risks persist after excluding the effect of abdominal obesity. [ABSTRACT FROM AUTHOR]

• Anal adenocarcinoma is more common in the Asian population than previously thought • Treatment of ilioinguinal lymph node metastasis from anal canal squamous cell carcinoma has been well described, but the management for primary adenocarcinoma is less so • Groin dissection for recurrent ilioinguinal lymph node metastasis from primary anal adenocarcinoma is a reasonable approach • Medical Officer, Department of General Surgery Changi General Hospital, 2 Simei Street 3, S529889, Republic of Singapore Anal canal tumors are uncommon amongst gastrointestinal tumors or anorectal tumors. While the majority of them seem to be squamous cell carcinoma in nature, adenocarcinoma may be equally as common amongst the Asian population. Recurrent nodal metastasis from a primary anal malignancy is not a rare occurrence in view of the anatomy of the anal canal. A 70 year-old patient underwent surgery for synchronous sigmoid and anal adenocarcinoma in 2015. He then re-presented 2 years later with recurrence in the right inguinal lymph nodes. He subsequently underwent a right ilio-inguinal lymph node block dissection with a Sartorius flap creation. As most anal canal tumors are squamous cell carcinomas, the optimal treatment for recurrent ilioinguinal lymph node disease has been well-established. This usually involves groin dissection as surgical treatment, with consideration for adjuvant combined chemoradiotherapy. Such an approach is likely to be beneficial for ilioinguinal lymph node disease from primary anal canal adenocarcinomas as well. Physicians caring for patients with primary anal adenocarcinoma should be vigilant for possible ilioinguinal lymph node metastasis as this is not a rare occurrence. Surgical treatment appears to be a reasonable approach, with consideration for adjuvant therapy. [ABSTRACT FROM AUTHOR]

X-ray emission from laser irradiating solid target is an important X-ray source for various potential applications. Counter-propagating (C-P) laser beams configuration is proposed to enhance the laser to X-ray conversion efficiency (CE) from laser irradiating solid targets. One-dimensional radiation hydrodynamics simulations show that the total X-ray CE for the C-P lasers case is as high as 65%, which has a 13% improvement compared with the single laser case. The improvement is mainly caused by the enlarged radiation region, and the enhancement of X-ray emission is from soft X-ray. Detailed energy term distributions and influences of the foil thickness on the X-ray CEs for both cases are presented. It is found that the enhancement of radiation is attributed to lower thermal and kinetic energy of the C-P lasers scheme. [ABSTRACT FROM AUTHOR]

During the 2015–2016 fruit production season, a papaya bunchy top (PBT) disease was observed in a papaya production farm located at Region de Piura, northern Peru. Affected plants exhibited symptoms of excessive proliferation of auxiliary shoots at the top or near top of the main stem, shortening of internodes, leaf yellowing, and necrosis of leaf veins. The symptom syndrome suggested possible infection by a phytoplasma, and the recent discovery of a phytoplasmal disease in a nearby vineyard also indicated that a phytoplasma reservoir and potential vector(s) were present in the area. Molecular diagnostic assays for phytoplasma detection were therefore employed. Nested polymerase chain reactions and subsequent nucleotide sequence analysis confirmed that phytoplasma infection did occur in the papaya production farm. The phytoplasma strains found to be associated with the PBT disease are affiliated with ‘ Candidatus Phytoplasma brasiliense’, a species that had previously never been implicated in a papaya disease anywhere in the world. We provide molecular evidence to suggest that the papaya-infecting phytoplasma strains identified in this study are closely related to a phytoplasma associated with the first grapevine yellows (GY) disease that we recently identified in Peru. The results of our study indicate that these PBT and GY phytoplasma strains in Peru represent an emerging geographic lineage that is distinct from those of all other known ‘ Ca. Phytoplasma brasiliense’ strains in the Americas. [ABSTRACT FROM AUTHOR]

During the period from 2011 to 2013, several plant diseases repeatedly occurred in vegetable crops grown in Yuanmou County, Yunnan Province, China. Affected plants included cowpea, sword bean, string bean, tomato, lettuce, and water spinach. The diseased plants exhibited symptoms of witches'-broom growth and floral deformations, linking each disease to phytoplasmal infection. Phylogenetic and virtual RFLP analyses of the phytoplasmal 16S rRNA gene sequences amplified from DNA of diseased plants revealed that all of the individual strains present in the diverse vegetable plants were affiliated with a single ‘ Candidatus Phytoplasma’ species (‘ Ca. Phytoplasma aurantifolia’) and a single ribosomal subgroup (16SrII-A). While presence of subgroup 16SrII-A phytoplasma in this geographic region was reported previously, such widespread infections in diverse plant hosts are unveiled for the first time in this study. In pursuing the source of the infections, we found that areas surrounding the affected vegetable fields were extensively invaded by parthenium weeds ( Parthenium hysterophorus ); and many of the weed plants exhibited abnormal morphologies that were suspicious of, and later diagnosed with, phytoplasmal infections. Results from genotyping of 16S rRNA and lineage-specific immunodominant membrane protein genes revealed that the vegetable-infecting phytoplasmas and the parthenium weed phytoplasma belong to the same genetic lineage. The findings indicate that parthenium weed poses a substantial risk as a reservoir of phytoplasmal infection of nearby agricultural crops in the geographic region since the ecosystems of Yuanmou are insect-rich, and parthenium weed is known to attract diverse leafhoppers. Further studies are warranted to assess the impact of farmland invasions by the noxious weed and to devise practical measures for improved weed control. [ABSTRACT FROM AUTHOR]

Introduction Intraductal papillary mucinous neoplasm (IPMN) is a field defect disease of pancreas that has malignant potential. Many studies have recommended surgery as the preferred treatment. We investigated whether a total pancreatectomy (TP) can improve patient prognosis compared to a pancreatoduodenectomy (PD) and the indications for each approach. Patients and methods We obtained data of 548 malignant IPMN patients who underwent either a TP or a PD from SEER database. The survival rates were analyzed using the Kaplan–Meier method and a Cox regression model. Cases were subdivided to investigate the advantages of each procedure. Results The surgical procedures (PD and TP) did not significantly affect either cancer-specific survival (CSS) times or overall survival (OS) times in both Kaplan–Meier analysis and Cox regression (Kaplan–Meier: P CSS = 0.919, P OS = 0.996; Cox: P CSS = 0.735, P OS = 0.820). In the subgroup analyses, patients in stage T4 and AJCC stage III in the TP group had a longer survival time than did those in the PD group (33 months vs 14 months), but not significant (T4: P CSS = 0.124, AJCC III: P CSS = 0.102). In addition, PD had the trend to be better for poorly differentiated patients (P os = 0.055) and older patients. Conclusion TP did not offer any significant OS and CSS benefits as compared to PD. However, for patients in stage T4 and AJCC stage III, TP may extend survival time in some degree. In older or histologically poorly differentiated patients, PD may be preferable to TP. The results are rational, but still warrant further verification due to limited sample volumes of specific subgroups. [ABSTRACT FROM AUTHOR]

Due to their significant energy demand, buildings are critical in efforts towards attaining the much needed operational flexibility in electrical power grid occasioned by increased decentralized renewable energy integration. In a departure from past studies which are often biased towards power systems performance, this paper presents key building performance implications when used within the context of electricity demand-side management (DSM) programs to provide power systems flexibility services to the smart-grid. Focusing on office buildings and using an average-sized office building as test-bed, their potential as a source of demand-side flexibility in terms of building specific parameters such as power demand, energy consumption, limits of operational flexibilities, systems’ response times, indoor comfort, comfort recovery time and availability are evaluated and discussed. Analysis of field study data demonstrates that office buildings could effectively serve as a source of power flexibility. However, variation in indoor air quality and thermal comfort performance across various zones within the building may complicate estimation of demand side flexibility potential, its acceptability and operation at building level. This emphasizes the need of taking into consideration case study based specifics when using buildings to service power flexibility requirement. [ABSTRACT FROM AUTHOR]

Background Although aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy (PDT) is an effective FDA-approved therapy for actinic keratosis (AK), a substantial fraction of patients (up to 25%) do not respond to treatment. This study examined the feasibility of using pre-treatment measurements of PpIX concentration in AK lesions to predict response of ALA-PpIX PDT. Methods A non-invasive fiber-optic fluorescence spectroscopy system was used to measure PpIX concentration in patients undergoing standard-of-care ALA-PDT for AK. All patients provided assessments of pain at the time of treatment ( n = 70), and a subset reported pain and erythema 48–76 h after treatment ( n = 13). Results PpIX concentration was significantly higher in lesions of patients reporting high levels of pain (VAS score ≥5) immediately after treatment vs. patients reporting pain scores below VAS = 5 ( p < 0.022) ( n = 70). However, pain was not an exclusive indicator of PpIX concentration as many patients with low PpIX concentration reported high pain. In a subpopulation of patients surveyed in the days after treatment ( n = 13), PpIX concentration measured on the day of treatment was uncorrelated with pain-reported immediately after treatment ( r = 0.17, p < 0.57), but positive correlations were found between PpIX concentration and patient-reported pain ( r = 0.55, p < 0.051) and erythema ( r = 0.58, p < 0.039) in the 48–72 h following treatment. Conclusions These data suggest that in vivo optical measurements of PpIX concentration acquired before light delivery may be an objective predictor of response to ALA-PpIX PDT. Identification of non-responding patients on the day of treatment could facilitate the use of interventions that may improve outcomes. [ABSTRACT FROM AUTHOR]

The approach of low or zero carbon building (L/ZCB) has attracted increasing attention in both academic and professional fields as the carbon emissions attributable to buildings kept increasing in the past decades. However, there exist challenges with modeling the carbon emissions of high-rise buildings in high-density urban environments. The aim of this paper is to examine the challenges and develop strategies for modeling carbon emissions in high-rise public residential buildings within the context of Hong Kong. The paper first reviews the challenges facing the modeling of the carbon emissions of high-rise buildings both generally and in Hong Kong, and examines their relevant implications for building design decision making. The approaches to establishing reference building models, e.g. example, real and theoretical reference building, are investigated drawing on the regulatory and practical guidance for carbon emission modeling in Hong Kong. The paper then develops a simulation approach to analyzing the obstacles to building energy modeling for typical high-rise public residential buildings in Hong Kong. Considering the urban environmental factors that may contribute to biased results for energy simulation, this paper is focused on the technical issues during the conversion of data from BIM model to energy simulation software. Thermal zones and user behavior are also addressed since technical and subjective assumptions could lead the simulation to a wrong direction. Understanding of such challenges enables the energy simulation to perform smoothly and also informs carbon emission modeling for high-rise L/ZCBs in other urban settings. [ABSTRACT FROM AUTHOR]

There is a trend in the world to adopt low or zero carbon building design principles and technologies. However, energy performance gap is a significant barrier to the development of low or zero carbon buildings. A predominant reason of the performance gap is the insufficient consideration of residents’ needs, which may lead to subsequent inappropriate user behaviours. Previous research on energy-related occupant behaviour is built either on statistical analysis from post-occupancy evaluations or stochastic models. There is a lack of pre-occupancy measurement of the interaction between occupant behaviour and building design alternatives. This paper aims to develop an innovative analytic approach using virtual reality (VR) technology to help building designers (architects, system engineers and interior designers) to identify the design pattern which guides the occupants to behave in the most energy-efficient way, so as to closing the energy performance gap resulting from occupants’ misconduct. The paper presents a VR-assisted innovative occupant-engaged framework in building energy design based on Design with Intent (DwI) method. Then the approach is validated by a case study on lighting control design for a sample residential building project in Hong Kong. The combination with decision-making is recommended for further research. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is widely used for cesarean section, but the factors that affect the spread of the block in pregnant patients are still not fully explained. This study was designed to investigate the effect of postural changes on sensory block level.Methods: Thirty patients scheduled for elective cesarean section under combined spinal-epidural anesthesia were randomly allocated into three groups. After intrathecal injection of 0.5% plain bupivacaine 7.5mg, patients in group S were immediately placed in the supine position with left tilt, patients in group L5 were kept lateral for 5 min and then turned to the supine position with left tilt, and patients in group L10 were kept lateral for 10 min and then turned to the supine position with left tilt.Results: At 5 min, median cephalad level of sensory block was lower in groups L5 and L10 compared with group S (corrected P<0.001); at 10 min, median cephalad sensory block level was lower in group L10 compared with group S (corrected P<0.001) and group L5 (corrected P<0.001), and lower in group L5 compared with group S (corrected P=0.033); at 15 min, median cephalad level of sensory block was lower in group L10 compared with group S (corrected P=0.003) and group L5 (corrected P=0.015).Conclusions: In our population, using 0.5% plain bupivacaine 7.5mg, postural change from the lateral position to the supine position is an important mechanism enhancing cephalic spread of spinal anesthesia during late pregnancy. [ABSTRACT FROM AUTHOR]

Objective The aim was to study the risk factors associated with symptomatic pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) in the lower limbs treated by catheter directed thrombolysis (CDT) without inferior vena cava filter (IVCF) placement. Methods A total 266 patients with acute/subacute ilio-femoral, ilio-femoropopliteal, and femoropopliteal thrombosis confirmed by computed tomography venography or ultrasound Doppler were studied. All patients were treated with CDT. CTPA (computed tomography pulmonary angiography) examination was performed in all patients before thrombolysis. Patients with clinically suspected symptomatic PE were confirmed by repeated CTPA after treatment. The major outcome of this study was the occurrence of symptomatic PE events during CDT. Results During CDT, the incidence of symptomatic PE events was 4.9% (13/266). Patients with silent PE had a higher risk of developing symptomatic PE (10/110, 9.1%) than those who had no prior PE (3/156, 1.9%); multivariate analysis confirmed this difference (OR 4.018, 95% CI 1.048–15.402). It was also found that patients with previous heart disease had a higher risk of developing symptomatic PE (11/90, 12.2%) than those with no prior heart disease (2/176, 1.1%). Multivariate analysis confirmed that previous heart disease increased the risk of developing symptomatic PE (OR 10.407, 95% CI 2.228–48.617). One patient who suffered from heart failure and silent PE before CDT died of symptomatic PE (1/13, 7.7%). Conclusion The risk of developing symptomatic PE is most markedly increased in patients with previous silent PE and heart disease. Selective rather than routine IVCF placement is an appropriate approach. [ABSTRACT FROM AUTHOR]

Background The adverse effects of hyperglycemia may be potentiated when it is accompanied with hypertension and dyslipidemia. This study assessed the effects of high dose thiamine on blood pressure, serum lipids and C-reactive protein (hs-CRP) in individuals with impaired glucose metabolism. Methods This was a double-blind, randomised trial, where 12 hyperglycemic subjects (10 cases of impaired glucose tolerance and 2 new cases of type 2 diabetes mellitus) received both placebo and thiamine capsules (3 × 100 mg/day) for six weeks in a cross-over manner. Anthropometric measurements, systolic and diastolic blood pressure (SBP & DBP), serum cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, hs-CRP and thiamine status were evaluated at the start, after three weeks and on the completion of each arm. Results DBP was significantly decreased in participants consuming thiamine supplements for six weeks (67.9 ± 5.8 mm Hg) relative to baseline (71.4 ± 7.4 mm Hg, p = 0.005) and week 3 (70.9. ± 5.8 mm Hg, p = 0.02). This was accompanied with a tendency toward a lower SBP at week six relative to baseline (116.5 ± 11.0 vs. 120.7 ± 15.3 mm Hg, p = 0.06). Also, mean arterial pressure (MAP) determined in the supplement arm after six weeks was significantly lower than baseline (84.1 ± 6.5 vs. 87.8 ± 9.0, p = 0.005). These variables did not change in the placebo arm. No significant change was detected in the supplement or placebo arms when lipid profile and hs-CRP were assessed. Conclusion/interpretation High dose thiamine supplementation may have beneficial effects on the blood pressure of individuals with hyperglycemia at early stages, and may have a role in the prevention of further vascular complications. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000051943 [ABSTRACT FROM AUTHOR]

Objective To evaluate the safety and efficacy of adjuvant intensity-modulated radiotherapy (IMRT) with concurrent paclitaxel and cisplatin (TP) in early stage cervical cancer patients with high risk factors after radical hysterectomy. Methods Patients who underwent radical hysterectomy for FIGO stage IB–IIA cervical cancer and had high risk factors for recurrence were recruited. One cycle of TP was delivered before and after concurrent chemoradiotherapy, respectively. Concurrent chemoradiotherapy began 21 days after the start of the initial cycle of the chemotherapy with two cycles of TP delivered on day 1 and day 29 of radiotherapy. Primary endpoints were overall survival (OS) and relapse-free survival (RFS), with toxicities, local-regional control (LC) and distant failure (DF) rate as secondary endpoints. Results Between 2008 and 2012, 67 patients were evaluable. The 2 and 4-year RFS rates were 98.2% and 92.9%. Corresponding OS rates were 100%, and 98.0%, respectively. The 4-year LC and DF rates were 98.0% and 5.2%, respectively. Grade 3–4 acute leucopenia, neutropenia and thrombocytopenia occurred in 25.4%, 11.9% and 1.5% of patients, respectively. There were 89.6% and 59.7% patients experienced acute vomiting and diarrhea, but only 6.0% and 6.0% patients were grade 3, respectively. No case of chronic toxicity exceeded grade 2. Conclusion Adjuvant concurrent IMRT with paclitaxel plus cisplatin are safe and effective in early stage cervical cancer patients with high risk factors for recurrence following radical hysterectomy. [ABSTRACT FROM AUTHOR]

Introduction Maternal spiral artery remodeling after embryo implantation is a crucial process for successful pregnancy and rely on well-controlled trophoblast functions. Ephrin-B2 is found to be of great importance in various cell functions in both benign human tissue and tumors. However, its role in the regulation of trophoblast remains unknown. This study is conducted to investigate the role of ephrin-B2-induced trophoblast functions related to artery remodeling. Methods Trophoblast cell line HTR-8/SVneo was used to investigate the effects of ephrin-B2 inhibition on cell proliferation, apoptosis, migration, invasion and tube formation. Placental-decidual co-culture (PDC) system was conducted to verify ephrin-B2-induced trophoblast functions ex vivo . Factors involving in artery remodeling process, such as matrix metalloproteinases (MMPs), placental growth factors (PlGF) and vascular endothelial growth factor (VEGF) were tested at transcriptional level. Results Inhibition of ephrin-B2 suppressed cell proliferation and induced cell apoptosis in HTR-8/SVneo cells. Down-regulation of ephrin-B2 impaired migration/invasion capabilities of HTR-8/SVneo cells and significantly decreased gene expression of MMPs. Also, a worse tube formation and a decrease in gene expression of PlGF was observed after down-regulation of ephrin-B2. However gene expression of VEGF-A did not show significantly statistical difference. These effects were further confirmed by PDC system showing an inadequate trophoblast invasion and spiral artery remodeling. Discussion Ephrin-B2 might be act as a positive regulator in maternal artery remodeling via both trophoblast invasion and endovascular formation. [ABSTRACT FROM AUTHOR]