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Background The mechanisms underlying angiotensin receptor-neprilysin inhibitor (ARNi) suppression of ventricular arrhythmia (VA) are unclear. This study aimed to investigate the mechanism of ARNi-related suppression of VA in a heart failure (HF) model. Methods New Zealand white rabbits (n = 6 per group) were assigned to normal, HF [4 weeks of left ascending artery (LAD) ligation], angiotensin receptor blocker (ARB, valsartan at 27 mg/kg/day for 3 weeks after 1 week of LAD ligation), and ARNi (sacubitril at 34 mg/kg/day and valsartan at 27 mg/kg/day for 3 weeks after 1 week of LAD ligation) groups. Experiments involving echocardiogram, optical mapping, histological of trichrome stain and immunostain, and flow cytometry were performed. Results HF group had larger left ventricular (LV) internal dimensions in diastole and systole, and lower LV ejection fraction and fractional shortening than normal, ARB, and ARNi groups. HF group had a prolonged action potential duration (APD) and decreased conduction velocity (CV), which was mitigated in ARB and ARNi groups. HF group had a prolonged QRS duration, QT and QTc intervals, which was reversed in ARB and ARNi groups. HF group had a steeper maximum slope of APD restitutions, which was attenuated in normal, ARB, and ARNi groups. HF group had increased number of phase singularities (PSs) and VA inducibility than normal, ARB, and ARNi groups. A higher content of fibrosis was found in HF group than that in normal, ARB, and ARNi groups. Compared to ARB group, ARNi had a lower context of fibrosis. HF group had more peripheral blood CD4+ and CD8+ cells count than normal, ARB, and ARNi group. Conclusions In a rabbit model of ischemic HF, ventricular arrhythmogenesis could be suppressed by ARNi treatment. This appears to be mediated by reversing changes in the APD, CV, maximum slope of the APDR, PSs, fibrosis, and inflammation.

This article proposes a novel bidirectional isolated dc–dc converter with high voltage gain and wide input voltage, which can be applied to bidirectional power conversion systems. The proposed topology is composed of a bidirectional buck-boost converter and a forward-flyback converter; it has the advantage of higher voltage gain and has continuous current characteristic of the low-side port in step-up and step-down mode. In addition, the proposed topology also has the function of leakage inductance energy recovery, which can improve the efficiency of the converter, reduce the voltage surges on switches, and have the characteristics of zero voltage switching on certain switches. Finally, this paper implements a 500-W bidirectional dc–dc converter to verify the feasibility of the proposed topology. The low-side voltage of the proposed topology is 24, 48, and 55 V; the maximum efficiency in step-up mode are 94.2%, 95.6% and 96.9%, and the maximum efficiency are 92.6%, 94.2% and 94.5% in the step-down mode, respectively.

Integrated photonics based on silicon has drawn a lot of interests, since it is able to provide compact solution for functional devices, and its fabrication process is compatible with the mature complementary metal-oxide-semiconductor (CMOS) fabrication technology. In the meanwhile, silicon material itself has a few limitations, including an indirect bandgap of 1.1 eV, transparency wavelength of >1.1 μm, and insignificant second-order nonlinear optical property. Aluminum nitride (AlN), as a CMOS-compatible material, can overcome these limitations. It has a wide bandgap of 6.2 eV, a broad transparency window covering from ultraviolet to mid-infrared, and a significant second-order nonlinear optical effect. Furthermore, it also exhibits piezoelectric and pyroelectric effects, which enable it to be utilized for optomechanical devices and pyroelectric photodetectors, respectively. In this review, the recent research works on integrated AlN photonics in the past decade have been summarized. The related material properties of AlN have been covered. After that, the demonstrated functional devices, including linear optical devices, optomechanical devices, emitters, photodetectors, metasurfaces, and nonlinear optical devices, are presented. Last but not the least, the summary and future outlook for the AlN-based integrated photonics are provided.

Objectives To preliminarily evaluate the clinical effectiveness and safety of computed tomography (CT) image-guided irreversible electroporation (IRE) for the treatment of recurrent hepatocellular carcinoma (HCC) after surgical resection. Methods From January 2016 to February 2018, 18 patients diagnosed with recurrent HCC after surgical resection received IRE under CT image guidance for 22 tumors. Patients were enrolled for IRE when ineligible for thermal ablation due to tumor location. Clinical records and imaging data were reviewed to assess complete ablation rate, local tumor progression free rate (LTPFR), local tumor progression free survival (LTPFS) and complications after a median follow-up time of 14 months. Results Successful complete ablations were achieved in 20/22 (90.1%) tumors. Mean LTPFS was 10.5 ​± ​9.4 months. Overall 3-, 6- and 12-months LTPFR in 22 tumors following IRE were 68.2% (95% confidence interval [CI]: 45%–83%), 59.1% (95% CI: 33%–76%) and 36.4% (95% CI: 17%–56%), respectively. Complications included pneumothorax (2/18, 11.1%), localized pain (3/18, 16.7%), bile duct dilation (1/18, 5.6%) and transient hypertension (1/18, 5.6%). No major complications or treatment-related deaths were observed. The alpha-fetoprotein levels of two patients decreased to the normal range at 3 and 4 months, respectively. Conclusions This study showed that percutaneous CT image-guided IRE can serve as a safe and effective treatment for recurrent HCC not suitable for thermal ablation.

Previously published photoplethysmography-(PPG) based non-invasive blood glucose (NIBG) measurements have not yet been validated over 500 subjects. As illustrated in this work, we increased the number subjects recruited to 2538 and found that the prediction accuracy (the ratio in zone A of Clarke’s error grid) reduced to undesirable 60.6%. We suspect the low prediction accuracy induced by larger sample size might arise from the physiological diversity of subjects, and one possibility is that the diversity might originate from medication. Therefore, we split the subjects into two cohorts for deep learning: with and without medication (1682 and 856 recruited subjects, respectively). In comparison, the cohort training for subjects without any medication had approximately 30% higher prediction accuracy over the cohort training for those with medication. Furthermore, by adding quarterly (every 3 months) measured glycohemoglobin (HbA1c), we were able to significantly boost the prediction accuracy by approximately 10%. For subjects without medication, the best performing model with quarterly measured HbA1c achieved 94.3% prediction accuracy, RMSE of 12.4 mg/dL, MAE of 8.9 mg/dL, and MAPE of 0.08, which demonstrates a very promising solution for NIBG prediction via deep learning. Regarding subjects with medication, a personalized model could be a viable means of further investigation.

This study aimed to investigate the electromechanical function detected by acoustic cardiography before and after radiofrequency ablation therapy (RFA) in paroxysmal AF (PAF) patients with preserved left ventricular ejection fraction (LVEF). Seventy-five symptomatic PAF patients and 69 patients without arrhythmia were enrolled. Thirty-seven PAF patients received RFA therapy. Acoustic cardiographic exam was performed to check S3 and S4 heart sound, electromechanical activation time (EMAT), LV systolic time percentage (LVST), and systolic dysfunction index (SDI) in all participants. Furthermore, 37 PAF patients also received follow-up acoustic cardiography postRFA. PAF had impaired electromechanical systolic function compared with health participants (%EMAT 14.69 ± 3.62 vs. 10.84 ± 2.62; %LVST 40.83 ± 5.14 vs. 36.70 ± 3.87; SDI 4.75 ± 1.61 vs. 3.26 ± 0.96 all p

Background To summarize the incidence and management strategy of vascular lake (VL) during the treatment of hepatocellular carcinoma (HCC) using transarterial chemoembolization (TACE) with CalliSpheres drug-eluting beads (DEBs), and to analyze its relationship with tumor response rate (RR). The etiology and clinical significance of VL were also analyzed based on the available literature. Methods The clinical data of 92 HCC patients who were treated with chemoembolization using CalliSpheres DEBs (DEB-TACE) in two centers were retrospectively analyzed. All 92 patients were treatment-naïve and treated by DEB-TACE. The incidence of VL and its clinical treatment during the first embolization session were summarized. The lesions were divided into a VL group and a non-VL group to analyze the relationship between VL and tumor RR. Results The embolization was successful in 98.9% of patients (91/92). A total of 33 VLs (18.4%; including 15 stable and 18 unstable VLs) were found among the 179 nodules treated. The unstable VLs were further embolized with embolic agent. One patient with unstable VL developed bleeding due to hepatic rupture and died. During the follow-up, residual tumors were found around 2 stable VLs, 2 lesions in 2 patients were treated with CT-guided radiofrequency ablation. The tumor RR was 84.4% in VL group, which was significantly higher than that (58.9%) in the non-VL group (P=0.007). Conclusions VL is a unique phenomenon during DEB-TACE. It may be accompanied by residual tumors and bleeding due to rupture. Therefore, VL should be cautiously managed in clinical practice.

To develop a prognostic nomogram based on the albumin–bilirubin (ALBI) grade for prediction of the long-term survival of patients with intermediate-stage hepatocellular carcinoma (HCC) after transarterial chemoembolization combined with microwave ablation (TACE-MWA). We retrospectively studied 546 consecutive patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer guidelines who underwent TACE-MWA between January 2000 and December 2016. Overall survival (OS) and progression-free survival (PFS) were analyzed. The predictive value of the ALBI grade was investigated. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. After a median follow-up of 35.0 months (range, 4.0–221.0 months), 380 patients had died. The median OS was 35.0 months (95% confidence interval (CI), 30.84–39.16 months), and the median PFS was 6.5 months (95% CI, 6.13–6.87 months). The ALBI grade was validated as an independent predictor of OS (p

Rare earth is a non-renewable and important strategic resource, and China is rich in rare earth resources. However, the process of massive exploitation has caused the migration, diffusion transformation and accumulation of pollution sources, which in turn has a profound impact on the ecological environment of mining areas. Accurate evaluation of resource and environmental carrying capacity (RECC) is important for the green development of mining areas. In this paper, the fuzzy comprehensive evaluation method based on AHP and entropy combination assignment method is used to study the RECC of mine area in terms of both support capacity and pressure. The Bayan Obo mine in Inner Mongolia; Longnan mine in Jiangxi; Weishan mine in Shandong; Mianning mine in Sichuan; Pingyuan mine in Guangdong; and Chongzuo mine in Guangxi, which have typical representatives, were selected for the horizontal comparison. The results show that, with the exception of Bayan Obo, the support index is greater than the pressure from mining and human activities in all the mining areas. The RECC index ranks for each mining area were: Bayan Obo > Longnan > Mianning > Pingyuan > Weishan > Chongzuo. In addition, an obstacle degree model was used to identify and extract the main factors affecting the ecological quality of the mine site. The ratio of investment in environmental pollution control to GDP is the most important factor limiting the improvement of the mine support index. The results of this paper were given for the different evolutionary processes and differences of RECC in typical rare earth mining areas, which could provide valuable references for achieving the green and comprehensive development of rare earth industry.

CO 2 gas sensing responses are measured using our in-house fabricated CMOS-MEMS ScAlN-based pyroelectric detector with 12% Sc doped concentration. Leveraging on mid-IR absorption behavior of CO 2 gas caused by interaction of CO 2 with light at 4.26 µm wavelength, our ScAlN-based pyroelectric detector successfully detect CO 2 gas response ranging from CO 2 concentrations of 5000 ppm down to 200 ppm. Gas channel lengths are varied from 6 cm to 10 cm and their respective CO 2 responses are measured. Finally, with N2 as the reference gas, we calculate the gas response percentage change of CO 2 gas at different gas channel lengths and concentration.

Jia-Yan Ni,1–3 Hong-Liang Sun,1,2 Jiang-Hong Luo,1,2 Xiong-Ying Jiang,1,2 Dong Chen,1,2 Wei-Dong Wang,1,2 Yao-Ting Chen,1,2 Jin-Hua Huang,3 Lin-Feng Xu1,2 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province 510120, People’s Republic of China; 2Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province 510120, People’s Republic of China; 3Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Guangzhou, Guangdong Province 510060, People’s Republic of ChinaCorrespondence: Jin-Hua HuangDepartment of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, Guangdong Province 510060, People’s Republic of ChinaTel +86-20-87343447Email huangjh_sysucc@163.comLin-Feng XuGuangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road West, Guangzhou, Guangdong Province 510120, People’s Republic of ChinaTel +86-20-34078680Email xu_lin_feng@163.comPurpose: The aim of this study was to investigate the safety and efficacy of transarterial chemoembolization and sorafenib (TACE-S) combined with microwave ablation (TACE-S-MWA) for the treatment of patients with advanced primary hepatocellular carcinoma (HCC).Methods: Between January 2015 and December 2018, 152 consecutive advanced HCC patients, who underwent TACE-S-MWA (MWA group, n=77) or TACE-S (Non-MWA group, n=75), were investigated. Overall survival (OS), time to progression (TTP) and safety were compared between the two groups. Prognostic factors were analyzed using the Cox proportional hazard regression model.Results: Baseline patient characteristics were balanced between the two groups. MWA group was associated with a higher OS (median, 19.0 vs 13.0 months; P

BACKGROUND The corrected QT interval (QTc) predicts prognosis for the general population and patients with coronary artery disease (CAD). Growth differentiation factor-15 (GDF-15) is a biomarker of myocardial fibrosis and left ventricular (LV) remodelling. The interaction between these two parameters is unknown. SUBJECTS AND METHODS This study included 487 patients with angiographically confirmed CAD. QTc was calculated using the Bazett formula. Multiple biochemistries and GDF-15 levels were measured. The primary endpoint was total mortality, and the secondary endpoints comprised the combination of total mortality, myocardial infarction and hospitalisation for heart failure and stroke. RESULTS The mean follow-up period was 1029 ± 343 days (5-1692 days), during which 21 patients died and 47 had secondary endpoints. ROC curve analysis for the optimal cut-off value of primary endpoint is 1.12 ng/mL for GDF-15 (AUC = 0.787, P = 9.0 × 10-6 ) and 438.5 msec for QTc (AUC = 0.698, P = .002). Utilising linear regression, QTc has a positive correlation with Log-GDF-15 (r = .216, P = 1.0 × 10-6 ). Utilising Kaplan-Meier analysis, both QTc interval and GDF-15 level are significant predictors for primary end point (P = .000194, P = 2.0 × 10-6 , respectively) and secondary endpoint (P = .00028, P = 6.15 × 10-8 , respectively). When combined these two parameters together, a significant synergistic predictive power was noted for primary and secondary endpoint (P = 2.31 × 10-7 , P = 1.26 × 10-8 , respectively). This combined strategy also showed significant correlation with the severity of CAD (P

Gas sensors have wide applications including industrial process control, environment monitoring, safety control, etc. The distribution of these sensors enables data generation for the emerging trend of big data and internet of things. In this work, chip-based non-dispersive infrared (NDIR) gas sensors are demonstrated. Silicon substrate-integrated hollow waveguide (Si-iHWG), which is formed through silicon wafer etching and bonding, is used as optical channel and gas cell. A high sensitivity of 50 ppm for CO2 sensing is demonstrated. The Si-iHWG chip-based sensor with compactness, low cost, versatility, and robustness provides a promising platform for miniaturized gas sensing in various application scenarios.

We present the optical and electrical properties of AlN-based and 12% doped ScAlN-based pyroelectric detectors fabricated on 8-inch wafers respectively. Both AlN and ScAlN materials are deposited at a temperature of ~200oC, making them potential candidates for CMOS compatible MEMS pyroelectric detectors. FTIR spectroscopy is used to measure the absorption of these pyroelectric detectors over the wavelength range of ~2–14 μm and the results show absorption improvement up to ~75% for ScAlN-based pyroelectric detectors compared to that of AlN-based pyroelectric detectors at the wavelength of 4.26 μm where CO2 gas absorption of IR radiation is anticipated. Higher output current (~3-fold increase) is also observed from ScAlN-based pyroelectric detectors. Other than pyroelectric coefficient that contributes to improved performance for ScAlN-based pyroelectric detectors, we believe that absorptivity of the device also plays a major role in the performance of pyroelectric IR detectors. The results obtained from the study of the electrical and optical properties of AlN-based and ScAlN-based CMOS compatible MEMS pyroelectric detectors will bring forth potential applications of these detectors onto multi-functional integrable and monolithic platforms.

A thermal emitter fabricated on complementary metal-oxide-semiconductor (CMOS)-compatible facilities is a key component for low-cost mid-infrared gas sensing. While conventional thermal emitters have broad spectrum and wide emission angle, which limit the sensing performance. In this work, a microelectromechanical system (MEMS)-based thermal emitter with photonic crystal has been designed and fabricated using CMOS-compatible technology. The photonic crystal enables the emission wavelength selectivity within mid-infrared regime. By engineering photonic crystal dimension, the emission enhancement wavelength can be matched to the fingerprint wavelength of chemical gas for efficient chemical gas sensing purpose.

For high speed multiplier implementation, the recursive architecture is a parallel and modular approach with low complexity. However, compared to the conventional array multiplier, it costs more ar...

Background Premature ventricular contractions (PVCs) induced by subtle cardiac dysfunction are missed by echocardiography. We evaluated acoustic cardiography for detection of early electromechanical dysfunction in patients with idiopathic PVCs and normal left ventricular ejection fraction (LVEF), and investigated the impact of radiofrequency ablation (RFA) in reversing this adverse effect. Methods Eighty-six patients with PVCs and 33 normal controls having normal LVEF were studied. Fifty PVC patients were in the ablation group and 36 in the nonablation group. %Electromechanical activation time (%EMAT), %left ventricular systolic time (%LVST), third (S3) and fourth heart sound (S4), and systolic dysfunction index (SDI) during sinus rhythm (SR) were measured by acoustic cardiography (Audicor, Inovise Medical, Inc., Beaverton, OR, USA) pre- and postablation. In 28 patients, acoustic parameters were compared during SR without PVCs, and SR with single PVC, ≥ 2 PVCs, or ventricular tachycardia over 10-second Audicor recording in a single patient at different times. Twenty-four-hour acoustic cardiographic and acoustic cardiographic Holter recording were used to assess the impact of PVC burden on electromechanical function in 41 patients. Results %EMAT, S3, S4, and SDI showed significant worsening in the PVC versus control group. %EMAT and SDI were worsened with increasing PVC number in a 10-second strip. %EMAT showed significant linear increment with increasing PVC burden. There was a significant improvement in %EMAT, %LVST, S3, S4, and SDI postablation in patients with PVCs. Conclusion Acoustic cardiography can detect PVC-induced minor electromechanical dysfunction in patients with normal LVEF. RFA can reverse this adverse effect.

Text readability assessment is a challenging interdisciplinary endeavor with rich practical implications. It has long drawn the attention of researchers internationally, and the readability models since developed have been widely applied to various fields. Previous readability models have only made use of linguistic features employed for general text analysis and have not been sufficiently accurate when used to gauge domain-specific texts. In view of this, this study proposes a latent-semantic-analysis (LSA)-constructed hierarchical conceptual space that can be used to train a readability model to accurately assess domain-specific texts. Compared with a baseline reference using a traditional model, the new model improves by 13.88% to achieve 68.98% of accuracy when leveling social science texts, and by 24.61% to achieve 73.96% of accuracy when assessing natural science texts. We then combine the readability features developed for the current study with general linguistic features, and the accuracy of leveling social science texts improves by an even higher degree of 31.58% to achieve 86.68%, and that of natural science texts by 26.56% to achieve 75.91%. These results indicate that the readability features developed in this study can be used both to train a readability model for leveling domain-specific texts and also in combination with the more common linguistic features to enhance the efficacy of the model. Future research can expand the generalizability of the model by assessing texts from different fields and grade levels using the proposed method, thus enhancing the practical applications of this new method.

We quantified cytomegalovirus (CMV) antiviral use and hospital length of stay (LOS) associated with CMV infection in a contemporary cohort of conventional (CONV) and CD34-selected (T cell–depleted) hematopoietic cell transplantation (HCT) recipients managed by preemptive therapy (PET) in a single US center. Adults who received first allogeneic HCT at Memorial Sloan Kettering Cancer Center from June 2010 through December 2014 were analyzed. Days on PET, number of readmissions, and readmission LOS by day 180 post-HCT were summarized. Estimated unit value (EUV) was defined as the expected number of PET days for a cohort of 100 HCT with characteristics as the analyzed cohort. Standardized incidence ratio was calculated as the ratio of observed outcomes of patients with CMV viremia over the outcomes of patients without CMV viremia. Of 318 patients, 88 received CONV and 230 CD34-selected HCT. Rates of CMV viremia were 26.3% for CONV and 41.9% for CD34-selected (P = .003). Among patients with viremia 68.2% CONV and 97.9% CD34-selected received PET. EUV for PET was 852 days and 2821 days for CONV and CD34-selected, respectively. The standardized incidence ratios for number of readmission and readmission LOS were 1.7 (95% confidence interval [CI], 1.4 to 2.1) and 1.2 (95% CI, 1.1 to 1.3), respectively, for CONV HCT and 1.7 (95% CI, 1.3 to 2.1) and 1.6 (95% CI, 1.5 to 1.7), respectively, for CD34-selected HCT. Overall survival was similar between patients with and without CMV viremia by HCT type. CMV end-organ disease was associated with lower overall survival only in CD34-selected HCT (P = .0007). CMV infection managed by PET requires substantial antiviral use and is associated with longer readmission LOS more, particularly among CD34-selected HCT.

In recent years, vancomycin-resistant Enterococcus (VRE) colonization is being increasingly encountered in transplant recipients, and VRE has become one of the leading causes of bacteremia early after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data are sparse on the effect of empiric VRE therapy for febrile, neutropenic allo-HSCT recipients colonized with VRE. All allo-HSCT recipients aged ≥18years who developed VRE bacteremia (VREB) between 2005 and 2014 were identified and categorized as to whether they received empiric or directed VRE therapy. There were 434 (33%) VRE-colonized and 872 (67%) non-VRE-colonized patients during the study period, and 172 of the 434 (40%) VRE-colonized patients received empiric therapy. There was no significant difference in incidence of VREB among colonized patients who did or did not receive empiric therapy (28 of 172 [16%] vs 55 of 262 [21%]; P = .22). There were 95 patients with VREB, of which the majority (83 of 95; 87%) was known to be VRE-colonized. Of the 95 VREB episodes, 29 (31%) were treated with empiric VRE therapy, whereas 66 (69%) were treated with directed therapy. No significant differences in clinical outcomes, including median duration of bacteremia (2 days vs 2 days; P = .39), recurrent VREB (3 of 29 [10%] vs 5 of 66 [8%]; P = .65), 30-day all-cause mortality (1 of 29 [3%] vs 4 of 66 [6%]; P = .62), or VRE-attributable mortality (1 of 29 [3%] vs 1 of 66 [2%]; P = .55), were observed between the empiric therapy and directed therapy groups. Kaplan-Meier curve analysis showed no significant difference in survival at 30days in allo-HSCT recipients with VREB who received empiric therapy and those who received directed therapy (97% vs 94%; P = .62). Based on our data, we recommend against empiric use of VRE-active agents for fever and neutropenia in VRE-colonized patients undergoing allo-HSCT.

Pretesting is the most commonly used method for estimating test item difficulty because it provides highly accurate results that can be applied to assessment development activities. However, pretesting is inefficient, and it can lead to item exposure. Hence, an increasing number of studies have invested considerable effort in researching the automated estimation of item difficulty. Language proficiency tests constitute the majority of researched test topics, while comparatively less research has focused on content subjects. This paper introduces a novel method for the automated estimation of item difficulty for social studies tests. In this study, we explore the difficulty of multiple-choice items, which consist of the following item elements: a question and alternative options. We use learning materials to construct a semantic space using word embedding techniques and project an item's texts into the semantic space to obtain corresponding vectors. Semantic features are obtained by calculating the cosine similarity between the vectors of item elements. Subsequently, these semantic features are sent to a classifier for training and testing. Based on the output of the classifier, an estimation model is created and item difficulty is estimated. Our findings suggest that the semantic similarity between a stem and the options has the strongest impact on item difficulty. Furthermore, the results indicate that the proposed estimation method outperforms pretesting, and therefore, we expect that the proposed approach will complement and partially replace pretesting in future.

Summary Objectives To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS). Methods Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan–Meier analysis. Results From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12–20] for micafungin and 13 [IQR 6–16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms. Conclusions Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS.

Pyroelectric IR detector is fabricated using ScAlN with 12% doped Sc as the pyroelectric sensing material. Dielectric layers that act as absorber are added on top of the ScAlN to help in IR absorption. This ScAlN-based pyroelectric detector is characterized by illumination from a MEMS thermal emitter with a sinusoidal input waveform. D* is measured to be as high as 1.87 x 107 (cm√Hz)/W at a frequency of 13 Hz. The optical absorptance of this device at 4.26 μm CO 2 gas absorption wavelength is around 0.75, measured using FTIR. CO 2 gas sensing measurement detects electrical signal changes of ~50-100 μV.

CMOS-MEMS pyroelectric detectors based on 12%-doped ScAlN are fabricated using 8-inch MEMS wafer technology and characterized. The ScAlN pyroelectric material is deposited at a low temperature of ~200oC. The results show D* as high as 4.3 x 107 (cm√Hz)/W and NEP as low as 1.26 x 10-9 W/√Hz. This is the first demonstration of a functional CMOS-MEMS pyroelectric detector using ScAlN as the pyroelectric sensing material. Compared to AlN that usually presents D* in the range of 105-106, Sc-doped AlN brings on the promise of better performing CMOS-MEMS pyroelectric detectors that could be miniaturized, integrated with CMOS circuits and provide wider applications.

Functionalizing granular materials to render them hydrophobic allows their use in ground infrastructure to delay or restrict water infiltration and thus prevent their failure and long-term degradation. These materials with adjustable wetting properties offer several advantages over conventional ones (e.g., they are less intrusive) and enable ground infrastructures to adapt to extreme climatic conditions. However, hydrophobicity being a surface property results in a number of challenges that need to be addressed when used in ground infrastructure, such as transportation embankments or waste storage. The overarching aim of this paper is to provide an introduction and review of recent research on hydrophobized granular materials for ground infrastructure; this includes sample preparation, characterization, properties, and applications of hydrophobized granular materials.

This paper introduces an evaluation method of mechanical performance of portal crane main steel structure. The risk factors of portal crane are investigated from five aspects of strength, stiffness, corrosion, crack and local stability. Through quantification, each evaluation index is transformed into a quantitative value that is easy to identify, which directly reflects the state of the steel structure of the crane. Scientific and reasonable evaluation results are beneficial to maintenance and use of portal crane, and it can save energy and reduce emission, reduce cost and increase efficiency.

This paper introduces the purpose and significance of safety evaluation of hoisting machinery, summarizes various evaluation method, and discusses the advantages and disadvantages of various safety evaluation methods, analyzes the current situation of safety evaluation of hoisting machinery in China, and puts forward corresponding suggestions on energy saving and emission reduction of hoisting machinery through the evaluation.

Infrared gas sensors hold great promise in the internet of things and artificial intelligence. Making infrared light sources with miniaturized size, reliable and tunable emission is essential but remains challenging. Herein, we present the tailorability of radiant power and the emergence of new emission wavelength of microelectromechanical system (MEMS)-based thermal emitters with nickel oxide (NiO) films. The coating of NiO on emitters increases top surface emissivity and induces the appearance of new wavelengths between 15 and 19 µm, all of which have been justified by spectroscopic methods. Furthermore, a sensor array is assembled for simultaneous monitoring of concentrations of carbon dioxide (CO2), methane (CH4), humidity, and temperature. The platform shows selective and sensitive detection at room temperature toward CO2 and CH4 with detection limits of around 50 and 1750 ppm, respectively, and also shows fast response/recovery and good recyclability. The demonstrated emission tailorability of MEMS emitters and their usage in sensor array provide novel insights for designing and fabricating optical sensors with good performance, which is promising for mass production and commercialization. Agency for Science, Technology and Research (A*STAR) National Research Foundation (NRF) Published version Agency for Science, Technology and Research (IAF-PP A1789a0024); National Research Foundation Singapore (NRF-CRP18-2017-02).

We demonstrate NDIR CO2 gas sensing using CMOS compatible MEMS ScAlN-based pyroelectric detectors. The ScAlN-based pyroelectric detectors are fabricated using 8-inch wafer level technology with 12 % Sc-doped AlN deposited at a temperature of ∼200 °C. Together with a blackbody thermal emitter, a 10 cm long enclosed gas channel with only inlet and outlet holes connected to tubings, and testing using 2 different reference gases (N2 and synthetic air), measurements show voltage signal drop due to CO2 gas absorption at the 4.26 μm wavelength at CO2 gas concentrations ranging from 5000 ppm down to 25 ppm. The signal change due to the CO2 gas response ranges from ∼2% at 100 ppm CO2 concentration to ∼40 % at 5000 ppm CO2 gas concentration for both CO2 gas measured in N2 and in synthetic air. CO2 gas response times are also measured for CO2 gas in N2 and in synthetic air at concentrations of 5000 ppm, 1000 ppm and 400 ppm. The gas response times measured around 2 s and lower. Introduction of humidity show some minor effect (

Jia-Yan Ni,1,* Shan-Shan Liu,2,* Hong-Liang Sun,1 Wei-Dong Wang,1 Ze-Long Zhong,1 Si-Nan Hou,1 Yao-Ting Chen,1 Lin-Feng Xu1 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, Guangdong Province, People’s Republic of China; 2Department of Public Health, Sushe Community Health Service Center, Guangzhou 510220, Guangdong Province, People’s Republic of China *These authors contributed equally tothiswork Objective: To compare the clinical efficacy and safety of transcatheter hepatic arterial infusion chemotherapy (HAIC) with those of sorafenib in the treatment of patients with hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage C. Methods: Potentially relevant studies comparing the clinical efficacy and safety of HAIC with those of sorafenib were searched using Medline, PubMed, Embase, Cochrane Library, and Chinese databases (Wanfang Data and China National Knowledge Infrastructure). Overall survival rate (OSR), tumor response rate, disease control rate (DCR), and serious adverse events (SAEs) were compared and analyzed. Pooled ORs with 95% CIs were calculated using either the fixed-effects model or the random-effects model. All statistical analyses were conducted using Review Manager (version 5.3) from the Cochrane Collaboration. Results: A total of 1,264 patients were included in this meta-analysis. The results of this study showed that HAIC was associated with significantly higher 1-, 2-, and 3-year OSRs than sorafenib (OR 1.88, 95% CI1-year: [1.27–2.78], P1-year=0.002; OR 2.15, 95% CI2-year: [1.06–4.37], P2-year=0.03; OR 7.90, 95% CI3-year: [2.12–29.42], P3-year=0.002). Compared to sorafenib, HAIC was associated with superior complete response (CR), partial response (PR), and objective response rate (ORR) (OR 3.90, 95% CICR: [1.89–8.03], PCR =0.0002; OR 3.47, 95% CIPR: [2.31–5.24], PPR

In order to confine waves beyond the diffraction limit, advances in fabrication techniques have enabled subwavelength structuring of matter, achieving near-field control of light and other types of waves. The price is often expensive fabrication needs and the irreversibility of device functionality, as well as the introduction of impurities, a major contributor to losses. In this Letter, we propose temporal inhomogeneities, such as a periodic drive in the electromagnetic properties of a surface which supports guided modes, to circumvent the need for subwavelength fabrication in the coupling of propagating waves to evanescent modes across the light line, achieving the temporal counterpart of the Wood anomaly. We show analytically and numerically how this concept is valid for any material platform and at any frequency, and propose and model a realistic experiment in graphene to couple terahertz radiation to plasmons with unit efficiency, demonstrating that time-modulation of material properties could be a tunable, lower-loss and fast-switchable alternative to the subwavelength structuring of matter for near-field wave control., 5 pages, 4 figures

Observing activeness of patients and elderly for long time at private space is a desired metric for elderly care. Many state-of-the-art mechanisms require either using wearable sensors, assists by medical staffs, or observation at designated location. Consequently, it is difficult, if not impossible, to acquire long term trend. Thermal sensors are not sensitive to illumination and can detect heat sources under low lightness. Moreover, it is not trivial to identify an individual from thermal images. However, a low cost and effective solution remain open. Low-resolution thermal sensors cost less but suffer from noisy reading. In this work, we fuse multiple low-resolution thermal images to reconstruct higher resolution thermal images to identify human activities. The evaluation results show that the accuracy of activity recognition while using low resolution thermal images are 96% of that while using high resolution thermal images, which requires 80 times of data and ten times of hardware cost.

Infrared gas sensors have been proven promising for broad applications in Internet of Things and Industrial Internet of Things. However, the lack of miniaturized light sources with good compatibility and tunable spectral features hinders their widespread utilization. Herein, a strategy is proposed to increase the radiated power from microelectromechanical-based thermal emitters by coating with graphene oxide (GO). The radiation can be substantially enhanced, which partially stems from the high emissivity of GO coating demonstrated by spectroscopic methods. Moreover, the sp2 structure within GO may induce plasmons and thus couple with photons to produce blackbody radiation and/or new thermal emission sources. As a proof-of-concept demonstration, the GO-coated emitter is integrated into a multifunctional monitoring platform and evaluated for gas detection. The platform exhibits sensitive and highly selective detection toward CO2 at room temperature with a detection limit of 50 ppm and short response/recovery time, outperforming the state-of-the-art gas sensors. This study demonstrates the emission tailorability of thermal emitters and the feasibility of improving the associated gas sensing property, offering perspectives for designing and fabricating high-end optical sensors with cost-effectiveness and superior performance. NRF (Natl Research Foundation, S’pore) ASTAR (Agency for Sci., Tech. and Research, S’pore) Accepted version

Purpose: To compare the predictive value of albumin-bilirubin (ALBI) grade, platelet-ALBI (PALBI) grade and Child-Turcotte-Pugh (CTP) class in patients with large hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) combined with microwave ablation (TACE-MWA). Methods: A total of 349 consecutive HCC patients (89.1% male; mean [± SD] age 53.4 ± 12.27 years) from three medical centers, who underwent TACE-MWA for up to 3 HCCs with maximum diameters of 5.1–8.0 cm between January 2000 and June 2018, were investigated. Overall survival (OS) and progression-free survival (PFS) were analyzed. The prognostic performances of ALBI grade, PALBI grade and CTP class were compared. Results: TACE procedures were performed using lobaplatin (20–50 mg), epirubicin (30–60 mg), lipiodol (5–25 mL) and gelatin sponge particles (350–560 μm). The end point of the TACE procedure was stasis of blood flow in the feeder artery. The median follow-up duration was 28.0 months, the median OS was 28.0 months (95% confidence interval [CI] 23.55–32.45 months), and the median PFS was 4.8 months (95% CI 4.26–5.34 months). Patients with a ablation margin size of 11–15 mm experienced better PFS than those with a margin size of 6–10 or 0–5 mm (median, 6.5 versus [vs] 4.0 vs 2.3 months; p

Traditionally, the visual analogue scale (VAS) has been proposed to overcome the limitations of ordinal measures from Likert-type scales. However, the function of VASs to overcome the limitations of response styles to Likert-type scales has not yet been addressed. Previous research using ranking and paired comparisons to compensate for the response styles of Likert-type scales has suffered from limitations, such as that the total score of ipsative measures is a constant that cannot be analyzed by means of many common statistical techniques. In this study we propose a new scale, called the Visual Analogue Scale for Rating, Ranking, and Paired-Comparison (VAS-RRP), which can be used to collect rating, ranking, and paired-comparison data simultaneously, while avoiding the limitations of each of these data collection methods. The characteristics, use, and analytic method of VAS-RRPs, as well as how they overcome the disadvantages of Likert-type scales, ranking, and VASs, are discussed. On the basis of analyses of simulated and empirical data, this study showed that VAS-RRPs improved reliability, response style bias, and parameter recovery. Finally, we have also designed a VAS-RRP Generator for researchers' construction and administration of their own VAS-RRPs.

There are few reports describing ventricular arrhythmias (VAs) from the crux and the corresponding endocardial site, i.e., the basal inferior segment of the interventricular septum (IVS). We aimed to investigate a distinct clinical group of VAs arising from the endocardium at this area in patients with structural heart diseases (SHD). We included 17 patients with SHD and clinically documented VAs. Thirteen patients underwent endocardial mapping only. Three patients underwent both epicardial and endocardial approaches and one had only epicardial mapping. Eighteen VAs were identified, 14 focal and 4 reentrant VAs, confirmed by entrainment. There were 2 VAs from the crux, 5 VAs from the corresponding endocardial site in the right ventricle (RV), and 11 from the site in the left ventricle (LV). Compared with the VAs from RV endocardium, VAs from LV endocardium had a higher R wave in V3 than V2 (V2R/V3R ratio, 1.83 ± 0.84 vs. 0.86 ± 0.38, P = 0.008) and a higher V3 transition ratio percentage (2.16 ± 2.07 vs. 0.58 ± 0.62, P = 0.008). Combining all 16 patients with endocardial mapping, there were also lower bipolar voltages (1.21 ± 1.05 vs. 3.10 ± 2.65 mv, P

Nonischemic cardiomyopathies (NICMs) are composed of variable disease entities, including primary and secondary cardiomyopathies. Determining the etiology of NICM provides pivotal roles of not only the understanding of the individual pathogenesis, but also the clinical management, such as risk stratification, pharmacological treatment, and intervention therapies. Despite the diverse causes of NICM, these cases mostly require clinical attention owing to progressive myocardial injury, resulting in ventricular dysfunction and heart failure. The interaction between the diseased ventricular substrates and systemic/neurophysiological factors contributes to the cornerstones responsible for ventricular arrhythmogenesis and sudden cardiac death (SCD). Prevention of SCD and diminishing ventricular tachyarrhythmias are the important mainstays for the management of NICM patients. Given the understanding of the abnormal ventricular substrates and advancement of navigation systems, radiofrequency catheter ablation (RFCA) has become an adjunctive or alternative strategy for NICM patients who experience drug‐refractory ventricular tachycardias (VTs). Successful ablation can frequently be achieved at the expense of an epicardial intervention. A recent study has proven the survival benefits for NICM patients who are free from recurrent VTs after a successful RFCA, regardless of the New York Heart Association (NYHA) functional class status or left ventricular ejection fraction. Additionally, recent evidence has highlighted the better delineation of a diseased myocardium through the incorporation of cardiovascular magnetic resonance imaging (CMRI) and 3D mapping systems, which can facilitate the identification of critical ventricular arrhythmogenic substrates in NICM patients.

Background For patients receiving palliative home care, the need to visit the emergency department is considered to be an indicator of poor quality care. The situation can be particularly distressing when it occurs outside of normal hours of palliative home care service. The aim of this study was to investigate the factors for emergency department use during out-of-hours periods of palliative home care service among advanced cancer patients in Taiwan. Methods This case-control study was based on a retrospective medical chart review (January 2010 to December 2012) of advanced cancer patients who were receiving palliative home care in a community hospital in south Taiwan. The use of emergency medical services by these patients was dichotomized into either normal hours (8 a.m. to midnight, Monday to Friday, excluding public holidays) of palliative home care or outside normal hours. Logistic regression analyses were performed to evaluate factors associated with emergency services use during out-of-hours period of palliative home care. Results: Of the 94 patients receiving palliative home care, 65 had used emergency services at least once during the 3-year study period. Of these 65 patients, 40% used emergency services during out-of-hours of palliative home care. Patients with distressing conditions (defined as the occurrence of any two conditions of dyspnea, change of consciousness, or gastrointestinal bleeding) were significantly more likely to use emergency services during out-of-hours of palliative home care. Conclusions Patients at risk of developing dyspnea, change of consciousness, or gastrointestinal bleeding should be provided with relevant information regarding these symptoms and signs.

Background and Purpose— The risk of stroke in patients with short-run atrial tachyarrhythmia (AT) remains unclear. This study aimed to investigate the relationship between short-run AT and the stroke and the use of the CHA 2 DS 2 -VASc score for the risk stratification. Methods— From the registry of 24-hour Holter monitoring, 5342 subjects without known atrial fibrillation or stroke were enrolled. Short-run AT was defined as episodes of supraventricular ectopic beats Results— There were 1595 subjects (29.8%) with short-run AT. During the median follow-up period of 9.0 years, 494 subjects developed new-onset stroke. Patients with short-run AT had significantly higher stroke rates compared with patients without short-run AT (11.4% versus 8.3%; P 2 DS 2 -VASc score of 0 and 1 were 0.23 and 0.67, respectively. However, the number of them for patients with CHA 2 DS 2 -VASc score of 2, 3, 4, and ≥5 were 1.62, 1.89, 1.30, and 2.91, respectively. In patients with CHA 2 DS 2 -VASc score of 0 or 1, age (>61 years old) and burden of premature atrial contractions (>25 beats/d) independently predicted the risk of stroke. In subgroup analyses, short-run AT patients were divided into 3 groups based on their CHA 2 DS 2 -VASc scores: low score (score of 0 [men] or 1 [women]; n=324), intermediate score (score of 1 [men] or 2 [women]; n=275), and high score (score of ≥2 [men] or ≥3 [women]; n=996). When compared with low score, intermediate and high scores were independent predictors for stroke (hazard ratio, 6.165; P P Conclusions— Short-run AT increases the risk of stroke. Therefore, the CHA 2 DS 2 -VASc score could be used for the risk stratification. Age and burden of premature atrial contractions were independent predictors for stroke in patients with CHA 2 DS 2 -VASc score of 0 or 1.

This study aimed to examine the relationship between measurements related to heart sounds and the origin of ventricular arrhythmia. We retrospectively evaluated 45 patients undergoing catheter ablation with contemporaneous digital acoustic cardiography of the first heart sound (S1) and the second heart sound (S2). The patients with baseline wide QRS morphology (>120 ms or aberrant conduction), heart failure, valvular heart disease, chronic pulmonary disease, and obesity were excluded. Ventricular arrhythmias from the left ventricle had an increased S1 complexity score and S1 duration in comparison to adjacent sinus beats. On the other hand, ventricular arrhythmia from right ventricle had decreased S1 complexity score and S1 duration in comparison to adjacent sinus beats. The difference of S1 (ΔS1) parameters between premature ventricular complex and sinus beat was significantly smaller in right ventricular arrhythmia group compared with and left ventricular arrhythmia group. For predicting the origin of ventricular arrhythmia, the ΔS1 duration provide better predictive accuracy (sensitivity: 100%, specificity: 100%, cutoff value: −1.28 ms) in comparison to ΔS1 complexity score (sensitivity 71.4%, specificity 75.0%, cutoff value: −0.13). The change of S1 complexity and duration determined from acoustic cardiography could accurately predict the ventricular arrhythmia origin.

Background Alcohol consumption is known to increase the risk of atrial fibrillation (AF). Whether the genotypes of alcohol-metabolizing genes (alcohol dehydrogenase [ADH1B]) are associated with the risk of AF recurrence after catheter ablation remains unclear. Methods and results The ADH1B genotypes of 281 patients who received catheter ablation for AF were examined. We followed this group of patients to monitor their AF recurrence. Alcohol consumption levels of this cohort were evaluated before and after catheter ablation. There was no difference in the underlying diseases presented by the patients with different ADH1B genotypes. Regardless of the ADH1B genotypes, the amount of alcohol consumption was the only factor associated with left atrial dilatation. The ADH1B*2 alleles (hazard ratio: ADH1B*1/*2 vs *1/*1: 2.64; ADH1B*2/*2 vs *1/*1: 1.80, P = 0.02) and the levels of alcohol consumption were independently associated with AF recurrence in the patients with paroxysmal AF after catheter ablation. ADH1B polymorphisms were not associated with AF recurrence in the patients with nonparoxysmal AF. We also found that the association of increased AF recurrence with alcohol consumption and the ADH1B genotypes cannot be explained by mechanisms of systemic inflammation. Conclusions ADH1B*2/*2 genotype and amount of alcohol consumption increase the risk of AF recurrence after catheter ablation.

(1) Background: Elizabethkingia spp. is an emerging nosocomial pathogen which causes mostly blood stream infection and nosocomial pneumonia. Among Elizabethkingia species, Elizabethkingia anophelis is the major pathogen, but misidentification as Elizabethkingia meningoseptica is a common problem. Elizabethkingia also possesses broad antibiotic resistance, resulting in high morbidity and mortality of the infection. The aim of our study was to review Elizabethkingia intra-abdominal infections and investigate resistance mechanisms against TMP/SMX in Elizabethkingia anophelis by whole genome sequencing. (2) Methods: We retrospectively searched records of patients with Elizabethkingia intra-abdominal infection between 1990 and 2019. We also conducted whole genome sequencing for a TMP/SMX-resistant Elizabethkingia anophelis to identify possible mechanisms of resistance. (3) Results: We identified a total of nine cases of Elizabethkingia intra-abdominal infection in a review of the literature, including our own case. The cases included three biliary tract infections, three CAPD-related infection, two with infected ascites, and two postoperation infections. Host factor, indwelling-catheter, and previous invasive procedure, including surgery, play important roles in Elizabethkingia infection. Removal of the catheter is crucial for successful treatment. Genomic analysis revealed accumulated mutations leading to TMP/SMX-resistance in folP. (4) Conclusions: Patients with underlying disease and indwelling catheter are more susceptible to Elizabethkingia intra-abdominal infection, and successful treatment requires removal of the catheter. The emerging resistance to TMP/SMX may be related to accumulated mutations in folP.

The safety assessment index system is formulated for portal cranes according to the operation features of this type of crane. The comprehensive assessment matrix and subsequent assessment results are finalized for all levels of index according to the variable weight analytic hierarchy process (AHP). The safety assessment software system is developed for portal cranes on the basis of above outcomes. Relying on C# programming language, the software has enabled the functions of data acquisition and result processing. In addition, it shows a remarkable utility value of the safety assessment of portal cranes and is capable of the safety assessment for the portal cranes in service.

Fatigue damage is always the main cause of the crane damage. The prediction method of fatigue life take far reaching impact on the design and service life of the crane. Therefore, it is extremely important to study the fatigue life prediction method of crane. In this paper, the existing fatigue life prediction methods are summarized systematically. And the fatigue life research was involved in metal material, mechanics, vibration mechanics, fatigue theory, fracture mechanics and so on, which made a difference between the predicted result and the actual life. The emergence and application of new technologies promote the development of the fatigue life evaluation methods, which could debase the risk of portal crane in use significantly.

Background The changes of signal averaged ECG (SAECG) in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) undergoing radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) remains unknown. Methods Between 2010 and 2014, a total of 81 ARVD/C patients underwent endocardial and/or epicardial RFCA for drug-refractory VAs. Seventy patients (mean age 46.2±14.1years, 37 males) achieving acute procedure success (negative inducibility) were enrolled. Baseline characteristics, non-invasive examinations and SAECG (before and 3months after RFCA) were collected retrospectively. Results After successful RFCA, the electrical parameters of SAECG changed in 39 patients (55.7%), including 28 patients (40%) with electrical regression (group 1), and 11 patients (15.7%) with electrical progression (group 3). Thirty-one patients (44.3%) showed no significant SAECG change (group 2). During a mean follow-up of 17.8±10.7months, 23 patients (32.9%) had VA recurrences, including 4 in group 1, 12 in group 2, and 7 in group 3. In comparisons with groups 2 and 3, group 1 patients had a significantly better VA recurrence-free survival ( P =0.02). In multivariable Cox regression analysis, electrical regression was found to be associated with fewer VA recurrences ( P =0.02, OR: 0.28, 95% CI: 0.10–0.83). Conclusions Electrical regression of SAECG after RFCA in ARVD/C was found to be associated with fewer VA recurrences.

Background Fever is associated with the manifestation of Brugada phenotype and ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with Brugada syndrome (BrS). The thermal effect on the pathogenesis of functional substrates in BrS remains unknown. Objective This study aimed to elucidate the thermal effect on BrS phenotype, VT/VF, and electrophysiological characteristics of epicardial functional substrates in BrS. Methods We consecutively studied 15 patients with BrS receiving radiofrequency catheter ablation for drug-refractory ventricular tachyarrhythmias. Baseline characteristics, electrocardiographic features, and changes in epicardial functional substrates before and after epicardial warm water instillation (n = 6) were recorded and analyzed. Results A total of 15 male patients (mean age 41.3 ± 10.3 years) with type 1 BrS presenting with ventricular tachyarrhythmias were consecutively enrolled. Epicardial mapping in 11 patients demonstrated a significantly larger epicardial scar/low-voltage zone (LVZ) area within the right ventricular outflow tract and anterior right ventricular free wall than within the endocardium (6.32 ± 12.74 cm2 vs 52.91 ± 45.25 cm2; P = .007). Epicardial warm water instillation in 6 patients led to a significant enlargement of the functional scar/LVZ area (123.83 ± 35.26 cm2 vs 63.53 ± 40.57 cm2; P = .03), accelerated conduction velocity of the endocardium and epicardium without scar/LVZ area, and increased VT/VF inducibility (16.7% vs 100%; P = .02). Ablation by targeting premature ventricular complexes and/or epicardial abnormal substrates rendered noninducibility of VT/VF and prevented the recurrences of VT/VF. Conclusion Epicardial warm water instillation enhanced functional epicardial substrates, which contributed to the increased inducibility of ventricular tachyarrhythmias in BrS. Ablation by targeting the triggers and abnormal epicardial substrates provided an effective strategy for preventing ventricular tachyarrhythmia recurrences in BrS.

Objective Oral cancer (OC) is a leading cause of death from cancer in men between the ages of 25 and 44 years in Taiwan. The overall 5-year survival rates for the four OC stages (I–IV) in Taiwan are approximately 70%, 30%, 20%, and 10%, respectively, indicating the importance of the early diagnosis of oral potentially malignant disorders (OPMDs). Previous studies indicated an association between the OC incidence and certain environmental heavy metal concentrations. If these associations do exist for OC, they may also be observed for OPMD. The purpose of this study is to explore the association between the development of OPMD to OC and environmental heavy metals. Oral submucous fibrosis (OSF) and oral leukoplakia (OL) are two major types of OPMD in Taiwan. Materials and methods A retrospective cohort study was conducted by Changhua Christian Hospital, the sole medical center in Changhua County, where 2725 male adult patients diagnosed with either OSF or OL between 2000 and 2014 were recruited. Data were analyzed by Cox regression and adjusted for smoking and betel-quid chewing. Results and discussion OPMD patients who resided in areas with high nickel concentrations (polluted levels) exhibited hazard ratios of 1.8–2 for OC relative to those who lived in areas with low nickel levels ( P 0.01). Meanwhile, smokers with OPMDs had a hazard ratio of 2.8–2.9 relative to non-smokers. Betel-quid chewers had a 2.2–2.3 hazard ratio relative to non-chewers. Smoking, betel-quid chewing, and environmental nickel exposure are associated with an increased risk of OC development in OPMD patients. This study provides valuable findings on the environmental effects of heavy metals on human health. Enhanced surveillance of the condition of OPMD patients who have been exposed to high nickel concentrations may be crucial for OC prevention.

Aims Whether the distribution of scar in arrhythmogenic right ventricular cardiomyopathy (ARVC) plays a role in predicting different types of ventricular arrhythmias is unknown. This study aimed to investigate the prognostic value of scar distribution in patients with ARVC. Methods and results We studied 80 consecutive ARVC patients (46 men, mean age 47 ± 15 years) who underwent an electrophysiological study with ablation. Thirty-four patients receive both endocardial and epicardial mapping. Abnormal endocardial substrates and epicardial substrates were characterized. Three groups were defined according to the epicardial and endocardial scar gradient ( 20%: horizontal, as groups 1, 2, and 3, respectively). Sinus rhythm electrograms underwent a Hilbert-Huang spectral analysis and were displayed as 3D Simultaneous Amplitude Frequency Electrogram Transformation (SAFE-T) maps, which represented the arrhythmogenic potentials. The baseline characteristics were similar between the three groups. Group 3 patients had a higher incidence of fatal ventricular arrhythmias requiring defibrillation and cardiac arrest during the initial presentation despite having fewer premature ventricular complexes. A larger area of arrhythmogenic potentials in the epicardium was observed in patients with horizontal scar. The epicardial-endocardial scar gradient was independently associated with the occurrence of fatal ventricular arrhythmias after a multivariate adjustment. The total, ventricular tachycardia, and VF recurrent rates were higher in Group 3 during 38 ± 21 months of follow-up. Conclusion For ARVC, the epicardial substrate that extended in the horizontal plane rather than transmurally provided the arrhythmogenic substrate for a fatal ventricular arrhythmia circuit.