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A high-resolution nonhydrostatic numerical model, the Advanced Regional Prediction System (ARPS), was used to simulate Typhoon Morakot (2009) as it made landfall over Taiwan, producing record rainfall totals. In particular, the mesoscale structure of the typhoon was investigated, emphasizing its associated deep convection, the development of inner rainbands near the center, and the resultant intense rainfall over western Taiwan. Simulations at 15- and 3-km grid spacing revealed that, following the decay of the initial inner eyewall, a new, much larger eyewall developed as the typhoon made landfall over Taiwan. Relatively large-amplitude wave structures developed in the outer eyewall and are identified as vortex Rossby waves (VRWs), based on the wave characteristics and their similarity to VRWs identified in previous studies. Moderate to strong vertical shear over the typhoon system produced a persistent wavenumber-1 (WN1) asymmetric structure during the landfall period, with upward motion and deep convection in the downshear and downshear-left sides, consistent with earlier studies. This strong asymmetry masks the effects of WN1 VRWs. WN2 and WN3 VRWs apparently are associated with the development of deep convective bands in Morakot's southwestern quadrant. This occurs as the waves move cyclonically into the downshear side of the cyclone. Although the typhoon track and topographic enhancement contribute most to the record-breaking rainfall totals, the location of the convective bands, and their interaction with the mountainous terrain of Taiwan, also affect the rainfall distribution. Quantitatively, the 3-km ARPS rainfall forecasts are superior to those obtained from coarser-resolution models. [ABSTRACT FROM AUTHOR]

Estimated glomerular filtration rate (eGFR) is an important topic in patients with primary aldosteronism (PA). However, the relationship between left ventricular structure and eGFR is unclear. We conducted a prospective, observational, and cross-sectional study to analyze 168 patients with PA and 168 propensity score-matched patients with essential hypertension (EH) as the control group, matched by age, gender, and systolic blood pressure. In the patients with PA, the eGFR was not correlated with left ventricular mass index (LVMI; r=-0.065, p=0.404), while in the patients with EH, the eGFR was negatively correlated with LVMI (r=-0.309, p<0.001). To test whether eGFR had a non-linear relationship with LVMI among the patients with PA, we stratified the patients with PA according to the tertile of eGFR (low, medium, and high tertile). The medium tertile of patients had a significantly lower LVMI than those in the other two tertiles (LVMI: 143.5±41.6, 120.5±40.5, and 133.1±34.3 g/m 2 , from the lowest to highest tertile of eGFR; analysis of covariance p=0.032). The medium tertile of eGFR is associated with lowest LVMI. Patients with PA with high and low eGFR were associated with higher LVMI. The findings implied that the reasons for an increased LVMI in patients with PA may be different to those in patients with EH., Competing Interests: Competing interests: None declared., (© American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this study was to investigate the long-term outcome of unprotected left main coronary artery disease (LMCA) with different therapeutic modalities in Chinese patients., Background: Coronary artery bypass graft (CABG) has been considered standard therapy for patients with LMCA disease. Percutaneous coronary intervention (PCI) has recently been alternative choice for unprotected LMCA. Nevertheless, the effects on the long-term outcome of unprotected LMCA by the above-mentioned management in Chinese remains unknown., Methods: Patients with unprotected LMCA were enrolled at National Taiwan University Hospital from January 1996 to June 2006. Survival outcomes were obtained by the Bureau of National Health Insurance and clinical results were obtained by chart record review and telephone interview., Results: A total of 620 patients with a mean age of 67 +/- 10 years were enrolled and followed up for 1,587 +/- 1,136 days. Of these, 136 were treated with medical therapy, 336 with CABG and 148 with PCI. Clinical outcome of patients receiving medical therapy was the worst. There was no significant difference between the PCI and CABG group in the risk of cardiovascular death. Cox regression analysis showed that cardiovascular mortality was significantly associated with age (P < 0.001), diabetes mellitus (P = 0.004), LVEF (P = 0.001). In high-risk left ventricular dysfunction, the elderly and renal insufficiency patients, the long-term survival was statistically significantly better in the CABG group., Conclusion: For Chinese patients with unprotected left main coronary artery disease, a significant higher risk of cardiovascular death was noted in the medical therapy group. Overall the long-term cardiovascular survival was similar in LMCA patients treated with either PCI or CABG, but CABG provided better survival outcome in high-risk subgroup patients.