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While del Nido (DN) cardioplegia is increasingly used in cardiac surgery, knowledge is limited in its safety profile for operations with prolonged crossclamp time (CCT). We have introduced a unique redosing strategy for aortic surgery: all operations use DN with a 1000-mL initiation dose (750 mL antegrade, 250 mL retrograde) composed of 1:4 blood:DN crystalloid. At 90 minutes CCT and every 30 minutes thereafter, a 250-mL dose was introduced retrograde in a 4:1 ("reverse") ratio. Additionally, at 90 minutes CCT and every 90 minutes thereafter, a reverse ratio dose of approximately 100 to 400 mL was introduced via the right coronary artery. Here, we analyze the outcomes of our unique redosing strategy used.In total, 440 patients underwent aortic surgery between January 2015 and March 2021 under a single surgeon and received DN. Our primary end points were change in left ventricular ejection fraction (LVEF) and right ventricular systolic function based on echocardiography. Multivariable linear regression was used to analyze the relationship between CCT and outcomes.The median was 61 years old (interquartile range, 51-69), and 23% were female. Indication was aneurysm in 65% and dissection in 24%. Median preoperative LVEF was 60% (55%-62%). Median CCT and cardiopulmonary bypass times were 135 minutes (93-165 minutes) and 181 minutes (142-218 minutes), respectively. In-hospital mortality occurred in 3%. Multivariable linear regression showed CCT was not associated with change in LVEF or change in right ventricular systolic function.Our unique method of redosing DN cardioplegia appears to provide safe and effective myocardial protection for aortic surgery.

Purpose To compare the relative number of retinal pixels and retinal area imaged using the Optos P200DTx (Optos PLC) and Zeiss Clarus 500 (Carl Zeiss Meditec AG) ultra-widefield (UWF) fundus cameras. Design Single-center retrospective cross-sectional analysis. Participants Seventy-eight eyes of 46 patients. Methods Eyes were imaged with Optos P200DTx, single-capture, and Zeiss Clarus 500, 2 capture montages when possible, UWF fundus cameras. Relative number of pixels encompassing all foveal-centered retinal quadrants were measured. Retinal area was measured with Zeiss Clarus 500 images that were registered to the Optos P200DTx images. Patients and technicians were asked for preferences between the machines. Imaging session times were recorded. Main Outcome Measures Relative number of retinal pixels and retina area captured by each fundus camera. Results Optos P200DTx consistently captured more relative pixels compared with Zeiss Clarus 500: 510.4 versus 355.6 (P Conclusions In the current study, the Optos P200DTx captured statistically significantly more retinal area in all 4 quadrants compared with the Zeiss Clarus 500. No statistically significant difference was found in patient or technician preference or image acquisition time between devices.

Background: Administration of iodinated contrast is common but may be associated with contrast-induced acute kidney injury (CI-AKI), particularly in at-risk patients. There is no recent systematic review of potentially modifiable risk factors. Methods: We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews (to 30th June 2019) for observational studies assessing risk factors associated with CI-AKI. Twelve potentially modifiable risk factors were finally included in this thematic review and meta-analysis. Random or fixed meta-analysis was performed to derive the adjusted odds ratio (aOR), and the population attributable risk (PAR) was calculated for each risk factor globally and by region. Findings: We included 157 studies (2,297,863 participants). Most studies had a low risk of bias. The global incidence of CI-AKI was 5.4%. The potentially modifiable risk factors included high contrast volume (PAR 33%), eight cardiovascular risk factors (diuretic use, multivessel coronary artery disease, acute coronary syndrome, hypertension, hypotension, heart failure, reduced left ventricular ejection fraction and intra-aortic balloon pump use) (combined PAR 76.2%) and three noncardiovascular risk factors (renal dysfunction, diabetes mellitus and anaemia) (combined PAR 47.4%) with geographical differences. In Asia, the PAR of high contrast agent volume ranks first with limited data, while diuretic use ranks first in Europe and North America. The PAR of heart failure was higher in Europe, as was renal insufficiency in North America and hypertension in Africa and Latin America. Interpretation: Prevention and treatment strategies targeting these potentially modifiable risk factors or patients with risk factors, especially cardiovascular disorders, may reduce the incidence of CI-AKI and should be evaluated in future studies. Funding Statement: The study is supported by the Science and Technology Planning Project of Guangdong Province (grant no. 2014B070706010), the National Science Foundation of China (grant no. 81670339 and 81970311), and the Beijing Lisheng Cardiovascular Pilot Foundation (grant no. LHJJ201612127). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: (PROSPERO register number: CRD42019121534).

Objectives: Many women are affected by stress urinary incontinence (SUI). Due to investigations of the safety of synthetic mesh slings, there has been renewed interest in autologous slings. The aim of this study is to evaluate whether different sling material affects outcomes and patient satisfaction. Methods: A retrospective review was performed of patients who underwent sling placement between May 2011 and April 2017 for SUI or stress-predominant mixed urinary incontinence. Patients were divided based on the sling material used: vaginal wall sling (VWS), rectus fascia sling (RFS), and soft polypropylene sling (SPS). Outcomes were compared using a Likert scale, the validated SEAPI score system, Incontinence Impact Questionnaire 7 (IIQ-7), and Incontinence Symptom Severity Index (ISSI). Results: There were 228 patients that underwent sling placement with 94 receiving VWS, 62 RFS, and 72 SPS. Mean follow-up was 14 months. There was no statistical difference in postoperative pad usage or satisfaction score between the groups. All three groups had a statistically significant postoperative improvement in subjective SEAPI scores and daily pad use. The VWS and RFS groups had significant improvement in their ISSI. The VWS group also had postoperative improvement in IIQ-7 score. Complication rates were rare and similar between all three groups. Conclusions: Patient satisfaction and outcomes were overall similar between all three sling materials. Based on our outcomes, we continue to use the VWS as a treatment option for patients with SUI and redundant vaginal wall tissue that are opposed to synthetic mesh slings.

Direct numerical simulation (DNS) has been performed for a spatially develop- ing 90 bend pipe ow to investigate the unsteady ow motions downstream of the bend. A recycling method is implemented to generate a fully-developed turbulent in ow condition. The Reynolds number of the pipe ow is ReD = 5300 and the bend curvature is = 0:4. A long straight pipe section (40D) is attached in the downstream of the bend to allow the ow to develop. Flow oscillations downstream of the bend are measured using several methods, and the corresponding oscillation frequencies are estimated. It is found that di erent characteristic frequencies are obtained from various ow measurements. The stagnation point movement and single-point velocity measurements may not be good measures to determine the swirl-switching frequency. The oscillations of the lateral pressure force on the pipe wall and half-sided mass ow rate are proposed to be a more unambiguous measure of the unsteady ow motions downstream of the bend.

Sonic Hedgehog (Shh) signaling plays key regulatory roles in embryonic development and postnatal homeostasis and repair. Modulation of the Shh pathway is known to cause malformations and malignancies associated with dysregulated tissue growth. However, our understanding of the molecular mechanisms by which Shh regulates cellular proliferation is incomplete. Here, using mouse embryonic fibroblasts, we demonstrate that the Forkhead box gene Foxd1 is transcriptionally regulated by canonical Shh signaling and required for downstream proliferative activity. We show that Foxd1 deletion abrogates the proliferative response to SHH ligand while FOXD1 overexpression alone is sufficient to induce cellular proliferation. The proliferative response to both SHH ligand and FOXD1 overexpression was blocked by pharmacologic inhibition of cyclin-dependent kinase signaling. Time-course experiments revealed that Shh pathway activation of Foxd1 is followed by downregulation of Cdkn1c, which encodes a cyclin-dependent kinase inhibitor. Consistent with a direct transcriptional regulation mechanism, we found that FOXD1 reduces reporter activity of a Fox enhancer sequence in the second intron of Cdkn1c. Supporting the applicability of these findings to specific biological contexts, we show that Shh regulation of Foxd1 and Cdkn1c is recapitulated in cranial neural crest cells and provide evidence that this mechanism is operational during upper lip morphogenesis. These results reveal a novel Shh-Foxd1-Cdkn1c regulatory circuit that drives the mitogenic action of Shh signaling and may have broad implications in development and disease.

The statistical characteristics of the internal shear layers (ISL) and the coherent structures around the ISLs in turbulent pipe flows are examined using direct numerical simulation data at four Reynolds numbers Re τ = 180 , 360, 500 and 1000. The ISLs are defined by the peaks on the velocity gradients with no ad hoc filter applied on the ISL selection. This is different from the previous studies where uniform momentum zones (UMZs) are identified first using a velocity histogram and then the ISL is defined as an UMZ interface. In this study, ISLs are ranked by both their strength and location. The signature behaviours of the ISL including an abrupt streamwise velocity jump and a sharp decrease in velocity fluctuation across the ISL are confirmed. Both the positive and the negative ISLs are stronger towards the wall. The local imbalance between ejections and sweeps are observed around ISLs. Near-wall ISLs have stronger ejections while ISLs in the pipe centre have stronger sweeps. The balance between ejection and sweep is achieved approximately at 0.55 - 0.6 of the pipe radius for the range of Reynolds numbers studied. The flow structures around an ISL have been identified via 3D conditional sampling. The average positive ISL is located between the high-speed streak above and the low-speed streak below. The low-speed streak is associated with a pair of counter-rotating streamwise vortices which result in a strong ejection around the ISL.

High-resolution large-eddy simulations (LES) are performed for an incompressible turbulent circular jet impinging upon a vibrating heated wall supplied with a constant heat flux. The present work serves to understand the flow dynamics and thermal characteristics of a turbulent jet under highly dynamic flow and geometric conditions. The baseline circular vibrating-wall jet impingement configuration undergoes a forced vibration in the wall-normal direction at the frequency, f = 100 Hz. The jet Reynolds number is R e = D V b / ν = 23,000 and the nozzle-exit is at y / D = 2 where the wall vibrates between 0 and 0.5 D with amplitude of vibration, A = 0.25 D . The configuration is assembled through validation of sub-systems, in particular the method for generating the turbulent jet inflow and the baseline circular jet impingement configuration. Both time-mean and phase-averaged results are presented. The mean radial velocity increases upon positive displacement of the wall and decreases upon negative displacement but this correlation changes with increased radial distance from the stagnation point. Vortical structures are shown to play a major role in convective heat transfer even under the vibrating conditions of the impingement wall. Periodic shifts in the secondary Nusselt number peak are observed that depend upon the travelling eddy location and strength of large-eddy structures. Enhancement in heat transfer is seen in the stagnation region but this beneficial effect of vibration on heat transfer is confined to the impingement region, r / D

Purpose The Expanded Prostate Cancer Index Composite (EPIC) instrument was designed to assess a range of health-related quality-of-life issues specifically relevant to patients with prostate cancer. This study examined the validity and reliability of Chinese versions of the 26-item EPIC and of the 16-item EPIC for Clinical Practice (EPIC-CP) in Chinese patients with prostate cancer. Materials and Methods A Chinese version of the 26-item EPIC and the 16-item EPIC-CP were self-completed by 252 Chinese patients with prostate cancer who were recruited from three community-based cancer service centers. Confirmatory factors analysis assessed the factor structures of the EPIC and the EPIC-CP. Internal consistency and construct and clinical validities of the factor structures were assessed. Results Confirmatory factor analysis revealed that the original factor structure of both EPIC-26 and EPIC-CP showed good fit to this sample. A correlated model was superior to a hierarchical model in both EPIC-26 and EPIC-CP supporting the utility of the domain scores over the total scores. Cronbach α ranged from 0.55 to 0.91 for EPIC-26 and 0.44 to 0.67 for EPIC-CP. Construct validity was supported by correlations between EPIC-26/EPIC-CP and psychological distress measures. Clinical validity was supported by differentiation between patients with and without prostatectomy. Conclusions These Chinese versions of the five-factor EPIC-26 and the EPIC-CP are valid and practical measures for assessing a range of health-related quality-of-life issues related to the diagnosis and treatment of prostate cancer, highlighting their utility in assessing health-related quality of life for patients diagnosed with prostate cancer.

Recent advances in pediatric urinary tract imaging include development of alternative imaging methods without use of ionizing radiation; evolving understanding of the relationship of urinary tract infection, vesicoureteral reflux, and renal scarring, including the important role of dysfunctional voiding; development of a consensus nomenclature and risk-based classification for fetal and antenatal urinary tract dilation; advances in the understanding of sporadic and inherited renal cystic disease; and a proposed modification of the Bosniak criteria for distinguishing complex renal cysts from cystic renal tumors in children.

Intravenous (IV) ascorbic acid (AA) improves organ function and reduces inflammation in sepsis, an inflammatory state similar to post-hematopoietic cell transplant (HCT) milieu. This salutary effect is mediated by antioxidant activity as well transcriptional modulation by AA. We evaluated the safety and efficacy of IV AA in ameliorating the inflammatory milieu following myeloablative conditioning and allogeneic HCT. Methods: Patients with advanced hematologic malignancies (CML, AML, ALL, MDS) were enrolled in an IRB approved prospective phase 2 clinical trial (NCT03613727). IV AA 50mg/kg/d divided in 3 doses was given on days 1-14 after HCT followed by oral AA 500mg bid from day 15 until 6 months post HCT (IND 138924). The treatment regimens included myeloablative fludarabine & melphalan, or cyclophosphamide with either busulfan or total body irradiation. GVHD prophylaxis included ATG. FDA mandated safety lead-in cohort enrollment for the trial is complete with ongoing accrual to target primary end point of reducing 1-year non-relapse mortality. Cytokines were measured at various time points following HCT. Results: As of October 2019 21 patients have received IV AA: these include HLA-MRD (n=5), and 10/10 or 9/10 HLA-MUD (12 & 4 respectively) recipients. Graft source was either peripheral blood (19) or bone marrow (2). Median age was 56 years; males (11). All patients enrolled were deficient in AA at day 0, median 0.3 mg/dL (range: 0.1-0.5), day 14, post AA infusion level was normal at 1.6 (1.2-5.7). Neutrophil recovery was by 11 days (9-15 days) and platelets by 12 (9-19) with sustained donor engraftment. Median absolute CD3+ cell count at day 30 was 390/mL (55-2288) with 100% donor chimerism. Pro-inflammatory cytokines IL-1b, IL-2, IL-6, IL-12, TNF-α, IFN-γ, as well as soluble thrombomodulin remained unchanged between day 0 and day 14 & day 30 after HCT (P=NS for all comparisons Figure 1). At a median follow up of 201 days (13-335) there is a 95% survival observed (Figure 2). There was no VOD and no attributable grade 3 and 4 toxicities to AA. Mucositis was mild and TPN was required in only 43% of patients. The cumulative incidences of grades II–IV and grades III–IV acute GVHD were 33% and 9% respectively, and moderate chronic GVHD 21%. No severe cGVHD has been observed, only one relapse has occurred. Conclusions: In patients undergoing myeloablative allogeneic HCT the administration of IV ascorbic acid is safe and does not negatively impact myeloid engraftment or immune reconstitution. Pro-inflammatory cytokines and endothelial injury markers remain around baseline levels, with no VOD and low rates of GVHD observed. IV AA requires further investigation in HCT given its safety, and low cost (∼$450 for 14 day infusion in a 80 KG recipient) and potential for worldwide use.

Background: Maternal sleep position on the back or right side has been associated with adverse pregnancy outcomes, leading to recommendations to always sleep on the left side and maternal anxiety about sleep. However, available data are from case-control studies, which are subject to recall bias. Our objective was to examine the relationship between prospectively assessed sleep position and subsequent adverse pregnancy outcomes. Methods: This was a secondary analysis of a prospective observational multicenter cohort study of nulliparous women with singleton gestations. Participants prospectively completed in-depth sleep questionnaires between 6+0 and 13+6 week's gestation (V1) and 22+0 and 29+6 week's gestation (V3). At each visit, women were asked in what position they went to sleep last night and on average during the past week. A subset of women also underwent level 3 home sleep tests using the Embletta Gold device. The primary outcome was a composite of adverse pregnancy outcomes including stillbirth, small for gestational age fetus (SGA), and gestational hypertensive disorders. Results: 8,706 (of 10,038 total) women had data from at least one sleep questionnaire and for pregnancy outcomes, and they comprised the population for this analysis. There was no association between reported non-left lateral or supine sleep during the last week at V1 or V3 and the composite or any individual outcome, except for an apparent protective effect for stillbirth at V3. Women with objectively measured supine sleep position for > 50% of the time were no more likely than those in the supine position ≤ 50% of the time to have the composite adverse outcome. Conclusions: Going to sleep in the supine or right lateral position, as self reported prior to the development of pregnancy outcome and objectively assessed through 30 weeks gestation was not associated with an increased risk of stillbirth, SGA fetus or gestational hypertensive disorders. Trial Registration: clinicaltrials.gov (NCT01322529) Funding Statement: This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): U10 HD063036, RTI International; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, University of Pittsburgh; U10 HD063020, Northwestern University; U10 HD063046, University of California Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah. In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108) and University of California Irvine (UL1TR000153). Declaration of Interests: No conflicts of interest to declare or report. Ethics Approval Statement: The study was approved by the Institutional Review Boards at each clinical site and the Data Coordinating Center, and all participants gave written informed consent.

A pseudo two-dimensional (P2D) electro-chemical lithium-ion battery model is presented in this paper to study the capacity fade under cyclic charge-discharge conditions. The Newman model [1,2] has been modified to include a continuous solvent reduction reaction responsible for the capacity fade and power fade. The temperature variation inside the cell is accurately predicted using a distributed thermal model coupled with the internal chemical heat generation. The model is further improved by linking the porosity variation with the electrolyte partial molar concentration, thereby proving a stronger coupling between the battery performance and the chemical properties of electrolyte. The solid electrolyte interface (SEI) layer growth is estimated for different cut-off voltages and charging current rates. The results show that the convective heat transfer coefficient as well as the porosity variation influences the SEI layer growth and the battery life significantly. The choice of an electrolyte decides the conductivity and partial molar concentration, which is found to have a strong influence on the capacity fade of the battery. The present battery model integrates all essential electro-chemical processes inside a lithium-ion battery under a strong implicit algorithm, proving a useful tool for computationally fast battery monitoring system.\ud \ud

When 3D sensors such as Light Detection and Ranging (LIDAR) are employed in targeting and recognition of human actions from both ground and aerial platforms, the corresponding point clouds of body shape often comprise low-resolution, disjoint, and irregular patches of points resulted from self-occlusions and viewing angle variations. Many existing 3D shape descriptors designed for shape query and retrieval cannot work effectively with these degenerated point clouds because of their dependency on dense and smooth full-body scans. In this paper, a new degeneracy-tolerable, multi-scale 3D shape descriptor based on the discrete orthogonal Tchebichef moment is proposed as an alternative for single-view partial point cloud representation and characterization. To evaluate the effectiveness of our descriptor, named Tchebichef moment shape descriptor (TMSD), in human shape retrieval, we built a multi-subject pose shape baseline to produce simulated LIDAR captures at different viewing angles and conducted experiments of nearest neighbor search and point cloud reconstruction. The query results show that TMSD performs significantly better than the Fourier descriptor and is slightly better than the wavelet descriptor but more flexible to construct. In addition, we proposed a voxelization scheme that can achieve translation, scale, and resolution invariance, which may be less of a concern in the traditional full-body shape analysis but are crucial requirements for meaningful partial point cloud retrievals. New 3D Tchebichef moment shape descriptor for shape query of point cloud patches.New voxelization scheme achieving translation, scale, and resolution invariance.New simulated human pose shape dataset for performance assessment per viewing angle.Demonstrated that native 3D shape analysis is superior to 2D depth image analysis.

The performance of two 1,2,4-triazole derivatives bearing an alkyl chain of variable length named 5-octylsulfanyl-1,2,4-triazole (TR8) and 5-decylsulfanyl-1,2,4-triazole (TR10) against mild steel (MS) corrosion in 1.0 M HCl was first evaluated utilizing experimental methods such as weight loss (WL), electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PDP) techniques. Then, theoretical methods like Density Functional Theory (DFT) and molecular dynamics (MD) simulations were used to explore corrosion inhibition mechanisms. Effect of molecules on the MS surface was analyzed by scanning electron microscope (SEM) and atomic force microscopy (AFM). A correlation between corrosion inhibition properties and physicochemical and electronic properties as determined by DFT and MD was demonstrated. 1,2,4-triazole derivatives behave as effective inhibitors for MS corrosion in HCl at all concentrations tested with better efficacy at an optimal concentration of 10−3 M. The maximum inhibition efficiencies (based on EIS results) were obtained 92% and 88% for TR10 and TR8, respectively. The adsorption is following the Langmuir isotherm model. Theoretical studies clearly showed that differences in carbon chain length alter inhibition performances of inhibitors and were found to be compatible with experimental results.

Material corrosion is one of the outstanding challenging problems in the industry, and it strongly influences refining and petrochemical plants lifetime. Therefore, prevention of the corrosion of different metals and alloys is imperative in the viewpoint of industrial safety and productivity. For this purpose, the application of suitable corrosion inhibitors is one of the most applicable solutions. The present paper focuses on the anticorrosive properties of three biologically active chalcones, namely (E)-2-(4-(3-(2,5 dimethoxyphenyl)acryloyl) phenoxy)acetic acid (AA-3), 2-(4-(3-(4-methoxyphenyl)propanoyl)phenoxy)acetic acid (AA-2) and (E)-2-(4-(3-(p-tolyl)acryloyl)phenoxy)acetic acid (AA-1) for mild steel in hydrochloric acid at temperature range 303−333 K. The corrosion inhibition performances of chalcones were evaluated by electrochemical tests, gravimetrical method, SEM, molecular orbital theory and molecular dynamics (MD) simulations. Results show that at the concentration of 5 × 10−3 molL-1, chalcone derivatives show high corrosion inhibition activities. All compounds are found to act via adsorption at the metal/solution interface, and their adsorption follows Langmuir isotherm model. Electrochemical tests indicate that the three chalcones act as mixed-type inhibitors. The thermodynamic data of adsorption were determined and discussed. Density Functional Theory (DFT) and MD simulations were used to assess the active sites of adsorption of the three inhibitors and their interaction with the iron surface, respectively. Scanning electron microscope (SEM) was used to analyze the surface morphological changes that chalcones induce in the corroded mild steel. The comparison of experimental results with theoretical data indicates that methoxy functional groups have a considerable influence on the anticorrosive properties of tested chalcones.

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Spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME) is an extremely rare disorder related to the lysosomal storage disease, Farber lipogranulomatosis. Both disorders are autosomal recessive conditions caused by mutations in the ASAH1 gene encoding acid ceramidase. Farber disease is associated with joint deformities, lipomatous skin nodules, and often is fatal by 2-3 years of age; while SMA-PME is characterized by childhood-onset motor neuron disease and progressive myoclonic epilepsy. We report a case of SMA-PME with a novel mutation in the ASAH1 gene encoding acid ceramidase. The proband presented with childhood-onset of diffuse muscle atrophy and hypotonia. He also had diffuse weakness with greater proximal than distal involvement. Tongue fasciculations were present and his reflexes were either diminished or absent. He ambulated with an unsteady and hesitant gait. He subsequently developed myoclonic epilepsy along with other associated features including tremor, polymyoclonus, and sensorineural hearing loss. Neurophysiological studies revealed a motor neuron disorder and generalized epilepsy. Exome sequencing analysis identified compound heterozygous variants and biochemical analysis indicated acid ceramidase activity was approximately 12 percent of normal controls. Our proband was phenotypically similar to other cases of SMA-PME, albeit with somewhat lesser severity, slower progression, and greater longevity. As lysosomal disorders are sometimes amendable to early interventions, it is important to make early diagnoses in these cases. The combination of motor neuron disease and progressive myoclonic epilepsy should prompt genetic evaluation of ASAH1.

Across six studies conducted in Mainland China and South Korea, the present research extended prior findings showing that pride is comprised of two distinct conceptual and experiential facets in the U.S.: a pro-social, achievement-oriented “authentic pride”, and an arrogant, self-aggrandizing “hubristic pride”. This same two-facet structure emerged in Chinese participants’ semantic conceptualizations of pride (Study 1), Chinese and Koreans’ dispositional tendencies to experience pride (Studies 2, 3a, and 3b), Chinese and Koreans’ momentary pride experiences (Studies 3a, 3b, and 5), and Americans’ pride experiences using descriptors derived indigenously in Korea (Study 4). Together, these studies provide the first evidence that the two-facet structure of pride generalizes to cultures with highly divergent views of pride and self-enhancement processes from North America.Keywords: Authentic pride, Hubristic pride, Causal attributions, Self-conscious emotions, Cultural psychology

Introduction Therapeutic hypothermia (TH) after cardiac arrest (CA) resuscitation is the first therapy proven to increase survival to discharge and neurologic recovery. Methods for neurologic and mortality prognostication after CA resuscitation have been called into question because they were developed based on evidence that was developed prior to the advent of TH. This study examines the relationship between electroencephalogram (EEG) patterns and mortality and neurologic outcomes in post-CA patients undergoing TH. Methods Eighty-three of 732 patients who had continuous EEG (cEEG) monitoring during TH were included. Continuous EEG tracings were classified as isoelectric, low voltage, burst suppression, epileptic form, and diffuse slowing. Primary outcomes are survival to discharge and Cerebral Performance Categories (CPCs) at hospital discharge. Results Among patients with favorable neurologic outcomes (CPC1 and CPC2), the duration cardiopulmonary resuscitation and time until return of spontaneous circulation were shorter than observed in patients with poorer neurologic outcomes (CPC3, CPC4, and CPC5). The time to target temperature was equivalent among neurologic outcome groups (499.5 minutes vs 431.0 minutes, P = .09). Favorable neurologic outcome was associated with initial presentation with ventricular tachycardia or ventricular fibrillation and had cEEG patterns suggestive of diffuse slowing and epileptiform waves. Discussion The use of cEEG can provide prognostication information otherwise not obtainable by clinical examination. Specific cEEG patterns predicted probability of mortality for patients according to their initial rhythm of CA as a function of cardiopulmonary resuscitation time.

Insight of thermal behaviour of lithium-ion batteries under various operating conditions is crucial for the development of battery management system (BMS). Although battery thermal behaviour has been studied by published models, the reported modelling normally addresses either normal operation or thermal runaway condition. A comprehensive electro-thermal model which can capture heat generation, voltage and current variation during the whole process from normal cycling to thermal runaway should be of benefit for BMS by evaluating critical factors influencing potential transition to thermal runaway and investigating the evolution process under different cooling and environment conditions. In this study, such a three-dimensional model has been developed within the frame of open source computational fluid dynamics (CFD) code OpenFOAM to study the electrical and thermal behaviour of lithium-ion batteries (LIBs). The equations governing the electric conduction are coupled with heat transfer and energy balance within the cell. Published and new laboratory data for LiNi 0.33 Co 0.33 Mn 0.33 O 2 /Li 1.33 Ti 1.67 O 4 (LNCMO/LTO) cells from normal cycling to thermal runaway have been used to provide input parameters as well as model validation. The model has well captured the evolution process of a cell from normal cycling to abnormal behaviour until thermal runaway and achieved reasonably good agreement with the measurements. The validated model has then been used to conduct parametric studies of this particular type of LIB by evaluating the effects of discharging current rates, airflow quantities, ambient temperatures and thickness of airflow channel on the response of the cell. Faster function losses, earlier thermal runaway and higher extreme temperatures were found when cells were discharged under higher current rates. The airflow with specific velocity was found to provide effective mitigation against over-heating when the ambient temperature was below 370 K but less effective when the ambient temperature was higher than the critical value of 425 K. The thickness of airflow channel was also found to have critical influence on the cell tolerance to elevated temperatures. These parametric studies demonstrate that the model can be used to predict potential LIB transition to thermal runaway under various conditions and aid BMS.

Background Infectious endocarditis (IE) in febrile injection drug users (IDUs) is a critical diagnosis to identify in the emergency department (ED). A decision tool that identifies patients at very low risk for endocarditis using readily available clinical data could reduce admissions and cost. Objective To evaluate the diagnostic performance of a previously derived decision instrument to rule out endocarditis in febrile IDUs (Prediction Rule for Endocarditis in Injection Drug Users [PRE-IDU]) and to develop a prediction model for likelihood of endocarditis for those who are not ruled out by PRE-IDU. Methods Febrile IDUs admitted to rule out endocarditis were prospectively enrolled from 2 urban EDs in June 2007 to March 2011. Clinical data from ED presentation (first 6 hours) and outcome data from inpatient records were recorded and reviewed by 2 independent investigators. Diagnosis of IE was based on modified Duke criteria and discharge summaries. The diagnostic performance of PRE-IDU, which combines tachycardia, cardiac murmur, and absence of skin infection, was determined using recursive partitioning and logistic regression modeling. Results Of the 249 subjects, 18 (7%) had IE. Recursive partitioning yielded an instrument with 100% sensitivity (95% confidence interval [CI], 84%-100%) and 100% negative predictive value (95% CI, 91%-100%), but low specificity (13%; 95% CI, 12%-13%). Multiple logistic regression modeling with the 3 clinical predictors allowed risk stratification with posttest probabilities ranging from 3% to 20%. Conclusion The PRE-IDU instrument predicted IE with high sensitivity and ruled out IE with high negative predictive value. Our logistic regression model provided posttest probabilities ranging from 3% to 20%. The PRE-IDU instrument and the associated model may help guide hospital admission and diagnostic testing in evaluation of febrile IDUs in the ED.

Hand grip strength (HGS) has been found to respond to nutrition deprivation and repletion but few studies have investigated its use as an independent nutrition assessment tool. We conducted an observational study to determine if HGS can predict nutrition status independently of other factors.The Patient Generated Subjective Global Assessment (PG-SGA) was used to determine nutrition status. PG-SGA and HGS measures were collected from 217 well nourished and malnourished hospital patients for cross-sectional analysis. Of the 217, 18 patients had these assessments repeated two weeks (±3 days) later to assess change. Correlation, and multiple linear and binary regression analyses were conducted.HGS and PG-SGA score were significantly correlated (r = 0.292, P0.01). HGS was a significant independent predictor of PG-SGA score and category (P0.01), accounting for 4% and 9% of variability respectively. Change-in-HGS was an independent predictor of change-in-PG-SGA score (P = 0.04) and category (P = 0.06) over two weeks, accounting for 47% and 42% of variability respectively.Our results suggest that HGS can independently predict nutrition status and change in nutrition status defined by PG-SGA score and category, although future longer term research is required to confirm the use of HGS as an early detection tool for malnutrition risk.

Clinical outcomes following hematopoietic cell transplant (HCT) are considered stochastic with different outcomes despite uniformity in characteristics between patients. However, immune reconstitution following SCT has features of a dynamical system, making it likely that clinical outcomes are partially deterministic. We hypothesized that early cessation of mycophenolate mofetil (MMF) in reduced intensity conditioning (RIC) transplants will hasten T cell reconstitution without adversely impacting clinical outcomes. This idea is being tested in a randomized phase 2 clinical trial comparing GVHD prophylaxis using a regimen of tacrolimus & MMF 15 mg/kg q 12 h for 30 days in the control (MMF30) vs. 15 days in the study cohort (MMF15). The MMF15 patients received GM-CSF to promote early monocyte recovery; MMF 30 got G-CSF. All patients underwent reduced intensity conditioning with ATG 1.7 mg/kg/d given on days -9 thru -7 & 450 cGy total body irradiation on d-1 & 0. Patients were stratified based on diagnosis and donor type (8/8 or 7/8 HLA MRD or MUD). A response-adaptive randomization scheme was used to increase the probability that patients were allocated to the treatment regimen which yields superior donor-derived CD3+ (ddCD3) cell count by 8 weeks; primary endpoint is relapse free, DLI free survival. Preliminary results from the first 21 evaluable patients are presented. Patients baseline characteristics are summarized in table 1. Mean ddCD3 count at 8 weeks post HCT favored the MMF group (461 vs. 329), which led to more patients allocated to MMF15 cohort. Median myeloid engraftment at day 60 was 100% in both cohorts. Mean absolute lymphocyte count, CD3+ and CD4+ T-cell counts were higher in the MMF15 cohort on day 30 (500 vs 200/mL−1, P=0.005; 254 vs. 71/mL−1, P=0.0188; 107 vs. 25/mL−1, P=0.0036 respectively). There was a trend for higher ddCD3 cell count in the MMF15 cohort (Fig. 1). Despite this there were no significant differences noted on in lymphoid recovery at later time points. Despite a shorter course of MMF there was no significant difference in the rates of acute and chronic GVHD, relapse and patient survival between the two cohorts (Fig 2). In conclusion these early data demonstrate that a shorter 15-day course of MMF plus GM-CSF led to rapid, early T cell reconstitution post HCT without a significant increase in the risk of acute or chronic GVHD, or disease relapse. This effect is consistent with immune reconstitution post HCT being a dynamical rather than a stochastic process, which may be modified in real-time by adjustments in the intensity of GVHD prophylaxis.

Humans can self-monitor errors without explicit feedback, resulting in behavioral adjustments on subsequent trials such as post-error slowing (PES). The error-related negativity (ERN) is a well-established macroscopic scalp EEG correlate of error self-monitoring, but its neural origins and relationship to PES remain unknown. We recorded in the frontal cortex of patients performing a Stroop task and found neurons that track self-monitored errors and error history in dorsal anterior cingulate cortex (dACC) and pre-supplementary motor area (pre-SMA). Both the intracranial ERN (iERN) and error neuron responses appeared first in pre-SMA, and ~50 ms later in dACC. Error neuron responses were correlated with iERN amplitude on individual trials. In dACC, such error neuron-iERN synchrony and responses of error-history neurons predicted the magnitude of PES. These data reveal a human single-neuron correlate of the ERN and suggest that dACC synthesizes error information to recruit behavioral control through coordinated neural activity.

Cancer is among the most prevalent and serious health problems worldwide. Therefore, there is an urgent need for novel cancer biomarkers with high sensitivity and specificity for early detection and management of the disease. The cancer secretome, encompassing all the proteins that are secreted by cancer cells, is a promising source of biomarkers as the secreted proteins are most likely to enter the blood circulation. Moreover, since secreted proteins are responsible for signaling and communication with the tumor microenvironment, studying the cancer secretome would further the understanding of cancer biology. Latest developments in proteomics technologies have significantly advanced the study of the cancer secretome. In this review, we will present an overview of the secretome sample preparation process and summarize the data from recent secretome studies of six common cancers with high mortality (breast, colorectal, gastric, liver, lung and prostate cancers). In particular, we will focus on the various platforms that were employed and discuss the clinical applicability of the key findings in these studies. This article is part of a Special Issue entitled: An Updated Secretome.

Purpose Cyclic ocular deviations are relatively uncommon and are seldom seen in adults. We report 3 adult patients with cyclic hypotropia that has clinical characteristics similar to neuromyotonia, suggesting a possible common etiology. Methods Three consecutive patients with 48-hour cyclic hypotropia underwent full neuro-ophthalmologic, oculoplastics, and orthoptic evaluations as well as appropriate medical and neurologic studies. Examinations were arranged on consecutive days on multiple visits to document the cyclic pattern. Results All 3 patients had sustained contraction of a vertically acting extraocular muscle lasting 24 hours and demonstrated characteristics of ocular neuromyotonia. The contraction was absent for the next 24 hours. Two of the patients had thyroid eye disease; the third patient had unilateral ophthalmoparesis and had subsequent frameless robotic radiosurgery for a cavernous sinus schwannoma. Regular cycles lasting 6, 9, or 14 months were documented by all 3 patients. In 2 patients, treatment with carbamazepine and gabapentin effectively reduced or eliminated the cycle. The cyclic deviation in the third patient resolved spontaneously. Conclusions On the basis of the response of these patients to membrane-stabilizing medications and the behavior noted as the cycle broke each day, we propose that cyclic vertical strabismus and ocular neuromyotonia may be related conditions with similar underlying physiology.