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Contains fulltext : 286832.pdf (Publisher’s version ) (Open Access) BACKGROUND: Direct evaluation of vascular inflammation in patients with COVID-19 would facilitate more efficient trials of new treatments and identify patients at risk of long-term complications who might respond to treatment. We aimed to develop a novel artificial intelligence (AI)-assisted image analysis platform that quantifies cytokine-driven vascular inflammation from routine CT angiograms, and sought to validate its prognostic value in COVID-19. METHODS: For this prospective outcomes validation study, we developed a radiotranscriptomic platform that uses RNA sequencing data from human internal mammary artery biopsies to develop novel radiomic signatures of vascular inflammation from CT angiography images. We then used this platform to train a radiotranscriptomic signature (C19-RS), derived from the perivascular space around the aorta and the internal mammary artery, to best describe cytokine-driven vascular inflammation. The prognostic value of C19-RS was validated externally in 435 patients (331 from study arm 3 and 104 from study arm 4) admitted to hospital with or without COVID-19, undergoing clinically indicated pulmonary CT angiography, in three UK National Health Service (NHS) trusts (Oxford, Leicester, and Bath). We evaluated the diagnostic and prognostic value of C19-RS for death in hospital due to COVID-19, did sensitivity analyses based on dexamethasone treatment, and investigated the correlation of C19-RS with systemic transcriptomic changes. FINDINGS: Patients with COVID-19 had higher C19-RS than those without (adjusted odds ratio [OR] 2·97 [95% CI 1·43-6·27], p=0·0038), and those infected with the B.1.1.7 (alpha) SARS-CoV-2 variant had higher C19-RS values than those infected with the wild-type SARS-CoV-2 variant (adjusted OR 1·89 [95% CI 1·17-3·20] per SD, p=0·012). C19-RS had prognostic value for in-hospital mortality in COVID-19 in two testing cohorts (high [≥6·99] vs low [

We investigated the preventive effect of nicorandil on contrast-induced nephropathy (CIN) in patients with moderate renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 250 patients with a creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to either a nicorandil group (nicorandil 10 mg 3 times/d and hydration; n = 125) or a control group (hydration only; n = 125). The first end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or ≥25% within 72 hours after exposure to the contrast medium. The secondary end points were (1) changes in Scr, blood urea nitrogen, and crCl and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 1.6% (2/125) in the nicorandil group and 9.6% (12/125) in the control group ( P = .011). There was no obvious difference in the incidence of major adverse events during hospitalization between the nicorandil and the control group (4.0% vs 4.8%, P = 1.000). Multivariate logistic regression analysis showed that nicorandil was a protective factor for CIN (odds ratios = 0.126, 95% confidence interval: −19.996 to −0.932, P = .012). Prophylactic administration of nicorandil may prevent against CIN in patients with moderate renal insufficiency undergoing PCI.

We investigated the preventive effect of alprostadil on contrast-induced nephropathy (CIN) in patients with renal insufficiency undergoing percutaneous coronary intervention (PCI). A total of 300 patients with creatinine clearance (crCl) ≤60 mL/min undergoing PCI were randomly assigned to alprostadil or a control group. The primary end point was the incidence of CIN defined as an increase in serum creatinine (Scr) levels by ≥0.5 mg/dL or≥ 25% after administration of the contrast media within 72 hours. The secondary end points were (1) changes in Scr and crCl within 72 hours and (2) the incidence of major adverse events during hospitalization. The incidence of CIN was 2.7% (4/150) in the alprostadil group, and 8.7% (13/150) in the control group (χ2 = 5.05, P = .043).There was no difference regarding the incidence of major adverse events during hospitalization between the alprostadil group and control groups (2.7% vs 4.0%, P = .750). Multivariate logistic regression analysis showed that alprostadil was an independent protective factor for CIN (odds ratio = 0.136, 95% confidence interval: 0.020-0.944, P = .044). Prophylactic administration of alprostadil may prevent CIN in patients with renal insufficiency undergoing PCI.

To investigate the preventive effect of probucol combined with hydration on contrast-induced nephropathy (CIN) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). A total of 641 patients undergoing PCI were randomly assigned to either a probucol group (probucol 500 mg twice daily and hydration; n = 321) or a control group (hydration only; n = 320). The primary endpoint was the incidence of CIN, defined as an increase in serum creatinine (Scr) by ≥ 44.2 μmol/L or ≥ 25% within 72 h after the administration of contrast agent. Secondary endpoints were changes in Scr, cystatin-C (Cys-C), creatinine clearance rate (Ccr), C-reactive protein (CRP), superoxide dismutase (SOD), and glutathione (GSH) within 72 h, and major adverse events during hospitalization or the 14-day follow-up period. The incidence of CIN was 4.0% (13/321) in the probucol group and 10.9% (35/320) in the control group. The probucol group had lower Cys-C and higher Ccr at 48 and 72 h after PCI compared with the control group. At 48 and 72 h following the operation, Cys-C and CRP were lower in the probucol group compared with the control group, but Ccr, SOD, and GSH were higher. There were no differences in the incidence of major adverse events during hospitalization or the 14-day follow-up between the groups. Multivariate logistic regression analysis showed that probucol was an independent protective factor for CIN. Probucol combined with hydration more effectively decreased the incidence of CIN in patients with coronary heart disease undergoing PCI compared with hydration alone.

Background The role of alprostadil on the prevention of contrast-induced nephropathy (CIN) still remains controversial. The purpose of this study was to examine the effects of short-term alprostadil on the incidence of CIN in patients undergoing elective percutaneous coronary intervention (PCI). Methods A total of 480 patients with coronary heart disease undergoing PCI were enrolled in our study and randomly assigned to two groups. The control group (n = 240) was given only hydration therapy and the alprostadil group (n = 240) received intravenous administration of 20 ug/day (diluted with 100 ml normal saline) from 0.5∼1 hr before to 3 days after operation on the basis of hydration. The primary endpoint of the study was the incidence of CIN, which was defined as an increase in SCr concentration ≥ 44.2 umol/l or ≥25% above baseline within 48 hr∼72 hr after exposure of contrast media. Results The incidence of CIN was significantly lower in the alprostadil group than that in the control group (6.25% vs 11.67%, P = 0.038). Multivariate logistic regression analysis showed that alprostadil was the protective factor of CIN (OR = 0.699, 95% CI 0.542–0.902, P = 0.006). The benefits against CIN were consistent in prespecified high-risk patients with diabetes mellitus (P = 0.003). In addition, we also found that hs-CRP and blood homocysteine values after PCI were significantly lower in the alprostadil group than those in the control group. Conclusion Prophylactic administration of alprostadil may prevent against CIN in coronary heart disease patients undergoing elective PCI, particularly in high-risk patients with diabetes mellitus.

Background: Atrial AutoCapture™ (ACap™) was a new technological development that confirmed atrial capture by analyzing evoked response (ER) with a new method – paced depolarization integral ER detection – and optimized energy output to changes in the stimulation threshold. The purpose of this study was to evaluate the clinical performance of ACap™ function. Methods: This was a prospective, observational, nonrandomized two-center study. Between November 2008 and August 2014, 102 patients were enrolled from two different institutions. Data were collected by case report forms at enrollment, hospital discharge, and in-office follow-ups scheduled at 1, 2, 3, 6, and 12 months postimplantation. Results: Ambulatory ACap™ function started to become available for 20.6% of patients at 1 day, then progressed to 30.4% at 7 days, 38.6% at 1 month, 41.6% at 2 months, 47.5% at 3 months, 53.5% at 6 months, and 63.4% at 1 year. The cause of the unsuccessful attempts to perform ACap™ threshold was ER/polarization

Recently, deep neural network models have achieved promising results in image captioning task. Yet, "vanilla" sentences, only describing shallow appearances (e.g., types, colors), generated by current works are not satisfied netizen style resulting in lacking engagements, contexts, and user intentions. To tackle this problem, we propose Netizen Style Commenting (NSC), to automatically generate characteristic comments to a user-contributed fashion photo. We are devoted to modulating the comments in a vivid "netizen" style which reflects the culture in a designated social community and hopes to facilitate more engagement with users. In this work, we design a novel framework that consists of three major components: (1) We construct a large-scale clothing dataset named NetiLook, which contains 300K posts (photos) with 5M comments to discover netizen-style comments. (2) We propose three unique measures to estimate the diversity of comments. (3) We bring diversity by marrying topic models with neural networks to make up the insufficiency of conventional image captioning works. Experimenting over Flickr30k and our NetiLook datasets, we demonstrate our proposed approaches benefit fashion photo commenting and improve image captioning tasks both in accuracy and diversity., Comment: The Web Conference (WWW) 2018

A new type of ionic ferroelectric based on a chiral salen-type Schiff base erbium(III) complex (ErL) was synthesized by the reaction of erbium nitrate with the ligand N,N′-bis(3,5-dichlorosalicylidene)-(1S,2S)-1,2-cyclohexylenediamine (L). The structures of the ligand L and the complex ErL were determined by single-crystal X-ray diffraction. The results indicated that ErIII not only acts as central metal atom to coordinate with two Schiff base ligands, but also as Lewis acid catalyst to promote the partial decomposition of another salen-type Schiff base ligand. The central ErIII atom adopts an octacoordinate square antiprismatic arrangement with Λ absolute configuration, coordinating with all nitrogen and oxygen atoms of two ligands due to the influence of the strong electron-withdrawing group on the Schiff base ligand. The complex ErL exhibits good SHG and ferroelectric properties. The results provide a simple and effective approach to construct rare earth complexes coordinated with nitrogen and oxygen atoms of salen-type Schiff base ligands with technologically important properties such as SHG activity and ferroelectricity.

Happiness, an important factor in maintaining health, not only enhances the abilities of self-control, self-regulation, and coping but also promotes mental health. Mindfulness therapy has been increasingly used in recent years. Therefore, the purpose of the present article is to introduce the concepts of mindfulness and to describe the relationship between mindfulness and happiness. Further, we provide brief introductions to mindfulness-based stress reduction and mindfulness cognitive therapy as well as present the current evidence related to the effects of mindfulness programs and therapies in clinical patient care. The information in the present article may be referenced and used by nurses in patient care and may be referenced by health professionals to promote their own mental health in order to maintain optimal fitness for providing high-quality patient care.正念在快樂與心理健康促進之應用.快樂是維持身心健康不可或缺之要素，快樂能使個體具自我控制、自我調節與因應等能力，並促進心理健康。近年來，正念治療（mindfulness therapy）成為促進快樂的心理治療介入措施。本文旨在介紹正念的概念，說明正念與快樂和心理健康的關係，並簡介以正念為基礎的心理治療介入措施，如正念減壓療法與正念認知治療等，同時提供正念介入措施於臨床應用的實證資料，以作為護理人員未來照護病人之參考；亦可作為自己平時的專業和自我成長的練習，促進自我心理健康，以最佳的身心狀況照護病人。.

Background and Purpose— Large artery intracranial occlusive disease (LAICOD) is a predominant cause of ischemic stroke in China. Carotid intima-media thickness (CIMT) and presence of carotid plaque are also related to subsequent ischemic stroke. However, the correlation between these and LAICOD is less clear. Methods— This was a community-based cross-sectional study. All subjects underwent carotid duplex ultrasonography and transcranial Doppler. Mean CIMT value of bilateral common carotid arteries was used. Plaque was defined as a focal CIMT of >1.5 mm. LAICOD in transcranial Doppler was defined by peak systolic velocity and age, and presence of turbulence or musical sound was also considered. Results— For the 537 subjects studied (mean age, 54.7±10.1 years; 46.9% males), mean CIMT was 0.74±0.12 mm, with the 75th percentile of 0.80 mm. CIMT ≥1.0 mm was identified in 13 subjects (2.4%). Plaques were detected in 79 subjects (14.7%). Compared with those without LAICOD, the 48 subjects (8.9%) with LAICOD had greater CIMTs (0.77±0.09 versus 0.73±0.12 mm; P =0.044), more with CIMT of higher quartiles ( P =0.007), and more with carotid plaques (25.0% versus 13.7%; P =0.035). However, after adjusting for confounding factors, CIMT and presence of carotid plaque were not significantly associated with LAICOD. Conclusions— The results suggest that CIMT and presence of carotid plaque probably are not independently correlated with LAICOD in Chinese community residents, which supported the existence of pathologic and pathophysiologic differences in atherogenesis of intra- and extracranial arteries.

Riemerella anatipestifer is the causative agent of polyserositis of ducks and geese. We have previously reported that a 3.9-kb plasmid, pCFC1, carries protein genes (vapD1 and vapD2) that are similar to virulence-associated genes of other bacteria. In the present study, we report the complete sequence of a second plasmid of 5.6 kb, pCFC2. pCFC2 has a 28% G-C content and three large open reading frames (ORFs). One of the ORFs (designated asVapD1) encodes a polypeptide that shares 53.9, 53.9, 48.3, 48.3 and 46.1% identity with virulence-associated proteins of Dichelobacter nodosus, Actinobacillus actinomycetemcomitans, Neisseria gonorrhoeae, Helicobacter pylori and Haemophilus influenzae, respectively. The second ORF encodes a putative DNA replication protein (RepA3) with 309 amino acids and a molecular mass of approximately 36 kDa. A novel insertion sequence (IS) element, designated ISRa1, was found on the plasmid pCFC2. ISRa1 was flanked by 15-bp imperfect inverted repeats (only one mismatched nucleotide). ISRa1 contained an ORF encoding a putative transposase of 292 amino acids. Southern blot analysis indicated that in R. anatipestifer strains examined, ISRa1 was present with 2-20 copies (at least). ISRa1 displayed a sequence approximately 35% homologous to the putative IS982 and RSBst-alpha from Lactococcus lactis ssp. cremoris SK11 and Bacillus stearothermophilus CU21. Three hybridization patterns of genomic DNA of eight R. anatipestifer strains with an ISRa1 probe indicated that ISRa1 might be a useful tool for epidemiological studies.

Background: External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion but the optimal use of ECP in ischemic stroke has not been well documented. We aim to investigate the effects of increasing ECP treatment pressure on cerebral blood flow and blood pressure (BP). Methods: We recruited 38 acute ischemic stroke patients with large artery occlusive disease and 20 healthy elderly. Mean cerebral blood flow velocities (CBFV) of bilateral middle cerebral artery were monitored using transcranial dopper. Continuous beat-to-beat BP was measured via finger cuffs. We started ECP treatment pressure from 150mmHg, then gradually increased to 187.5mmHg, 225mmHg and 262.5mmHg. CBFV and BP were recorded before ECP and during each pressure increment respectively for 3 minutes. CBFV data of patients was analyzed based on whether it was ipsilateral or contralateral to the infarct. Results: Median NIHSS of stroke patients was 5.5 and mean time after stroke onset was 5.24 days. Mean BP was significantly elevated from baseline in both groups after ECP started. BP increase percentages of two groups similarly kept augmented following raised ECP pressure and reach maximium at 262.5mmHg (patients 16.9% vs. controls 16.52% compared with baseline). Under different ECP pressures, ipsilateral mean CBFV of stroke patients increased 5.15% (150mmHg), 4.35% (187.5mmHg), 4.55% (225mmHg) and 3.52% (262.5mmHg) from baseline. All were significantly higher than baseline but did not differ among different pressures. Contralateral mean CBFV changed likewise (5.16%, 4.02%, 3.7% and 3.34% increase from baseline). Mean CBFV of controls under ECP pressures did not increase from baseline. Conclusion: The increasing treatment pressure of external counterpulsation continuously augments blood pressure but not cerebral blood flow velocity of ischemic stroke patients with large artery occlusive disease. Cerebral blood flow velocity of stroke patients significantly increases from baseline under ECP pressure of 150mmHg but it reaches a plateau as ECP pressure further raises. Among 4 ECP pressures above, 150mmHg is the optimal treatment pressure for ischemic stroke due to higher risks of hypertension-related complications in acute stroke with higher ECP pressure.

Carotid atherosclerosis should not be neglected as a cause for stroke in China, despite its low prevalence. This study was performed to evaluate the association between ultrasonographic markers for different stages of carotid atherosclerosis and metabolic syndrome.This was a community-based study in Hong Kong. Metabolic syndrome was defined as having three or more of the following conditions or receiving specific treatment for these conditions: Abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension, and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4(th) quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of1.5 mm. A carotid plaque obstructing ≥50% of vessel lumen was considered as carotid stenosis.A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. Metabolic syndrome was found in 188 (28.8%) subjects (30.8% in males and 27.0% in females). Mean CIMT was 0.74±0.12 mm. Increased CIMT, carotid plaque, and carotid stenosis were detected in 163 (25.0%), 95 (14.5%), and 6 (1.4%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of metabolic syndrome components (P0.001). In multivariate logistic regression analysis, metabolic syndrome was independently associated with increased CIMT [odds ratio (OR) 1.17; 95% confidence interval (CI) 1.11-2.64; P=0.014), but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108).Metabolic syndrome may be independently associated with the early stage but not the later and advanced stages of carotid atherosclerosis in community residents in China.

Background and Purpose— An ethnic extraintracranial difference in atherosclerosis has been well reported, whereas the potential mechanism remains unclear. We aimed to investigate neurovascular coupling in healthy whites and Asians. Methods — Twenty volunteers of each ethnicity were recruited to perform a functional transcranial Doppler examination with standardized checkerboard patterns as visual stimulation (3×4, 6×8, and 12×16 checks subtending a visual field section of 18°×24°, flicker rate 1 Hz). Hemodynamic responses in both posterior cerebral arteries were evaluated with a control system approach. Results— The rate time, that is, the initial speed of flow velocity adaptation, was significantly lower in Asians leading to an approximately 2-second delayed hemodynamic adaptation. The other hemodynamic parameters and the dependency of hemodynamic responses in regard to the complexity degree of the stimulus were similar between groups. Conclusion— The constellation suggests a greater initial mismatch between functionally increased metabolic demand of neurons and adjusted cerebral blood flow in Asians.

Storm beach buffer, being different from the coastal set back currently in place in many countries in the world, is the provision of a sufficient beach width to safe guard against the onslaught of a fierce storm. The extent of this requirement is tentatively assessed using the SBEACH module in the CEDAS package. The inputs for the SBEACH module include berm width, medium sand grain diameter, beach slope, design water level and wave conditions; while the outputs consist of a range of characteristic parameters for the change in beach profile, especially berm erosion and bar formation resulting from a storm of different return periods. After having systematically performed a series of numerical studies, we may conclude that: (1) Berm erosion increases and bar becomes further offshore as the storm return period increases on a beach with identical sand grain size (i.e., non-dimensional fall velocity), or as sand grain dimension reduces; (2) Higher storm waves result in a larger bar to form quicker and cause wave breaking on the bar crest which could reduce the wave energy and limit the extent of the subsequent berm erosion; (3) Empirical equations can be derived to calculate the storm beach buffer width; and (4) A larger buffer is required for a beach with smaller sand grain, in order to effectively absorb the storm wave energy. The results presented in this paper can be used to assist in a beach nourishment project for shore protection and the design of a recreational beach.