Bipedal Robot Gait Generation Using Bessel Interpolation

This paper introduces a novel approach to bipedal robot gait generation by proposing a higher-order form through the parameter equation of first-order Bessel interpolation. The trajectory planning for the bipedal robot, specifically for stepping up or down stairs, is established based on a three-dimensional interpolation equation. The experimental prototype, Roban, is utilized for the study, and the structural sketch of a single leg is presented. The inverse kinematics expression for the leg is derived using kinematic methods. Employing a position control method, the angle information is transmitted to the robot's joints, enabling the completion of both downstairs simulation experiments and physical experiments with the Roban prototype. The analysis of the experimental process reveals a noticeable phenomenon of hip and ankle joint tilting in the robot. This observation suggests that low-cost bipedal robots driven by servo motors exhibit low stiffness characteristics in their joints.

Ultra-Short-Term Offshore Wind Power Prediction Based on PCA-SSA-VMD and BiLSTM

In order to realize the economic dispatch and safety stability of offshore wind farms, and to address the problems of strong randomness and strong time correlation in offshore wind power forecasting, this paper proposes a combined model of principal component analysis (PCA), sparrow algorithm (SSA), variational modal decomposition (VMD), and bidirectional long- and short-term memory neural network (BiLSTM). Firstly, the multivariate time series data were screened using the principal component analysis algorithm (PCA) to reduce the data dimensionality. Secondly, the variable modal decomposition (VMD) optimized by the SSA algorithm was applied to adaptively decompose the wind power time series data into a collection of different frequency components to eliminate the noise signals in the original data; on this basis, the hyperparameters of the BiLSTM model were optimized by integrating SSA algorithm, and the final power prediction value was obtained. Ultimately, the verification was conducted through simulation experiments; the results show that the model proposed in this paper effectively improves the prediction accuracy and verifies the effectiveness of the prediction model.

An AAM-Based Identification Method for Ear Acupoint Area

Ear image segmentation and identification is for the "observation" of TCM (traditional Chinese medicine), because disease diagnoses and treatment are achieved through the massaging of or pressing on some corresponding ear acupoints. With the image processing of ear image positioning and regional segmentation, the diagnosis and treatment of intelligent traditional Chinese medicine ear acupoints is improved. In order to popularize ear acupoint therapy, image processing technology has been adopted to detect the ear acupoint areas and help to gradually replace well-trained, experienced doctors. Due to the small area of the ear and the numerous ear acupoints, it is difficult to locate these acupoints based on traditional image recognition methods. An AAM (active appearance model)-based method for ear acupoint segmentation was proposed. The segmentation was illustrated as 91 feature points of a human ear image. In this process, the recognition effects of the ear acupoints, including the helix, antihelix, cymba conchae, cavum conchae, fossae helicis, fossae triangularis auriculae, tragus, antitragus, and earlobe, were divided precisely. Besides these, specially appointed acupoints or acupoint areas could be prominent in ear images. This method made it possible to partition and recognize the ear's acupoints through computer image processing, and maybe own the same abilities as experienced doctors for observation. The method was proved to be effective and accurate in experiments and can be used for the intelligent diagnosis of diseases.

Calcification circumference, area, and location are associated with carotid stent expansion rate: high-resolution magnetic resonance vessel wall imaging study

Background

The plaque imaging findings associated with the stent expansion rate (SER) of the carotid artery are not well known. The purpose of this study was to investigate the imaging findings associated with SER.

Methods

It was a retrospective investigation. Based on the kind of carotid stents used, retrospective data from 89 patients who had carotid artery stenting (CAS) for atherosclerotic carotid stenosis were gathered and divided into two groups: open-cell stents and closed-cell stents. Patients underwent preoperative carotid high-resolution magnetic resonance vessel wall imaging (HR-VWI). Use HR-VWI to quantitatively evaluate carotid wall thickness and plaque components. Calculate SER using digital subtraction angiography (DSA). All patients' baseline and HR-VWI imaging features were retrospectively analyzed. Simple and multivariable linear regression analysis was used to determine the imaging findings associated with SER of open-cell and closed-cell stents.

Results

A total of 89 patients (mean age, 70±8 years; 69 men) were included in the final analysis. Among 89 patients, 35 patients were treated with open-cell stents. Fifty-four patients were treated with closed-cell stents. In the open-cell stents group, the Maximum single-slice calcification circumference score, maximum wall thickness (WT_max), and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that only the Maximum single-slice calcification circumference score (β=-9.35; 95% CI: -18.15 to -0.56; P=0.03) was associated with SER of open-cell stents. In the closed-cell stents group, the Maximum single-slice calcification circumference score, WT_max, maximum area percentage of calcification, calcification volume, and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that the Maximum area percentage of calcification (β=-0.67; 95% CI: -1.29 to -0.05; P=0.03), Maximum single-slice calcification circumference score (β=-8.43; 95% CI: -13.36 to -3.49; P=0.001) and total calcification location score (β=-0.37; 95% CI: -1.08 to 0.09; P=0.02) were associated with SER of closed-cell stents.

Conclusions

Calcified plaques are associated with SER of the carotid artery. Calcification circumference correlates with SER of open-cell stents. Calcification circumference, calcification area, and calcification location are related to SER of closed-cell stents, which may provide a new consideration for clinicians when choosing carotid artery stents.

A Novel Underwater Image Enhancement Using Optimal Composite Backbone Network

Continuous exploration of the ocean has made underwater image processing an important research field, and plenty of CNN (convolutional neural network)-based underwater image enhancement methods have emerged over time. However, the feature-learning ability of existing CNN-based underwater image enhancement is limited. The networks were designed to be complicated or embed other algorithms for better results, which cannot simultaneously meet the requirements of suitable underwater image enhancement effects and real-time performance. Although the composite backbone network (CBNet) was introduced in underwater image enhancement, we proposed OECBNet (optimal underwater image-enhancing composite backbone network) to obtain a better enhancement effect and shorten the running time. Herein, a comprehensive study of different composite architectures in an underwater image enhancement network was carried out by comparing the number of backbones, connection strategies, pruning strategies for composite backbones, and auxiliary losses. Then, a CBNet with optimal performance was obtained. Finally, cross-sectional research of the obtained network with the state-of-the-art underwater enhancement network was performed. The experiments showed that our optimized composite backbone network achieved better-enhanced images than those of existing CNN-based methods.

A Spring Compensation Method for a Low-Cost Biped Robot Based on Whole Body Control

At present, the research and application of biped robots is more and more popular. The popularity of biped robots can be better promoted by improving the motion performance of low-cost biped robots. In this paper, the method of the Linear Quadratic Regulator (LQR) is used to track a robot's center of mass (COM). At the same time, the whole-body-control method and value function generated in the process of tracking COM are used to construct the quadratic programming (QP) model of a biped robot. Through the above method, the torque feedforward of the robot is obtained in the Drake simulation platform. The torque feedforward information of the robot is transformed into position feedforward information by spring compensation. In this paper, open loop control and spring compensation are used, respectively, to make the robot perform simple actions. Generally, after the compensation method of spring compensation is adopted, the roll angle and pitch angle of the upper body of the robot are closer to 0 after the robot performs an action. However, as the selected motion can introduce more forward and lateral motions, the robot needs more spring clearance compensation to improve performance. For improving the motion performance of a low-cost biped robot, the experimental results show that the spring compensation method is both reasonable and effective.

Defect Severity Identification for a Catenary System Based on Deep Semantic Learning

A variety of Chinese textual operational text data has been recorded during the operation and maintenance of the high-speed railway catenary system. Such defect text records can facilitate defect detection and defect severity analysis if mined efficiently and accurately. Therefore, in this context, this paper focuses on a specific problem in defect text mining, which is to efficiently extract defect-relevant information from catenary defect text records and automatically identify catenary defect severity. The specific task is transformed into a machine learning problem for defect text classification. First, we summarize the characteristics of catenary defect texts and construct a text dataset. Second, we use BERT to learn defect texts and generate word embedding vectors with contextual features, fed into the classification model. Third, we developed a deep text categorization network (DTCN) to distinguish the catenary defect level, considering the contextualized semantic features. Finally, the effectiveness of our proposed method (BERT-DTCN) is validated using a catenary defect textual dataset collected from 2016 to 2018 in the China Railway Administration in Chengdu, Lanzhou, and Hengshui. Moreover, BERT-DTCN outperforms several competitive methods in terms of accuracy, precision, recall, and F1-score value.

Optical Rail Surface Crack Detection Method Based on Semantic Segmentation Replacement for Magnetic Particle Inspection

Railway damage detection is of great significance in ensuring railway safety. The cracks on the rail surface play a key role in studying the formation and development process of rail damage, predicting the occurrence of rail defects, and then improving the service life of the rail. However, due to the small shape of the cracks, the typical detection method is relatively complicated, and the speed is quite slow. Although traditional magnetic particle inspection technology is fairly accurate at detection, it is costly and inconvenient to carry and install, while also limiting the detection speed and affecting the system's operation. In this paper, a semantic segmentation detection method is developed by using various collected rail surface crack data and deep learning through a neural network. By comparing the inspection of the same rail surface with magnetic particle inspection technology, only inexpensive cameras are used and the inspection speed is increased while maintaining relatively high accuracy. In addition, the method can achieve fast detection speeds if it is extended to be combined with high-frequency cameras. It is an economical, efficient, and environmentally friendly method for future rail surface detection.

Anion-coordination-driven single-double helix switching and chiroptical molecular switching based on oligoureas

Synthetic foldamers with helical conformation are widely seen, but controllable interconversion amongst different geometries (helical structure and sense) is challenging. Here, a family of oligourea (tetra-, penta-, and hexa-) ligands bearing stereocenters at both ends are designed and shown to switch between single and double helices with concomitant inversion of helical senses upon anion coordination. The tetraurea ligand forms a right-handed single helix upon chloride anion (Cl-) binding and is converted into a left-handed double helix when phosphate anion (PO4 3-) is coordinated. The helical senses of the single and double helices are opposite, and the conversion is further found to be dependent on the stoichiometry of the ligand and phosphate anion. In contrast, only a single helix is formed for the hexaurea ligand with the phosphate anion. This distinction is attributed to the fact that the characteristic phosphate anion coordination geometry is satisfied by six urea moieties with twelve H-bonds. Our study revealed unusual single-double helix interconversion accompanied by unexpected chiroptical switching of helical senses.

Study on Mechanical Characteristics of Segmental Joints of a Large-Diameter Shield Tunnel under Ultrahigh Water Pressure

At present, there is no clear design standard for segmental joints of large-diameter shield tunnels under high water pressure. In this paper, a theoretical calculation model for the bending stiffness of segmental joints under high water pressure is proposed. The numerical simulation method is used to investigate the failure and crack formation processes of single-layer and double-layer lining segments under large axial forces. The effects of axial force, bolt strength, and concrete strength on the bending stiffness of joints are then studied using a theoretical calculation model of segmental joints. The results show that under extremely high water pressure, the influence of double lining on joint stiffness is limited. It is more rational and safe to compute the bending stiffness of segmental joints using this theoretical model rather than the numerical simulation method. The parameter analysis reveals that increasing the bolt strength has a minor impact on bending stiffness and deformation, whereas increasing the concrete strength has the opposite effect. The influence of ultimate bearing capacity and deformation decreases non-linearly as the axial force increases.

The Efficacy of Transcarotid Artery Revascularization With Flow Reversal System Compared to Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Background: Carotid artery stenosis has long been a critical cause of stroke and death, and it can seriously affect the life quality. Transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) are both feasible therapies for this disease. This systematic review and meta-analysis aim to evaluate if the efficacy of the two approaches is comparable.

Methods: Clinical studies up to March 2021 were searched through PubMed, Embase, and Scopus from a computer. The screening process was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Newcastle-Ottawa Scale (NOS) was used for methodological quality assessment of works of literature meeting the inclusion criteria, and Review Manager 5.4 was used for data synthesis. The I² statistic was performed to measure the heterogeneity, and M-H/I-V fixed or random model was utilized depending on the I² value. The evidence evaluation was accomplished based on grades of recommendation, assessment, development, and evaluation (GRADE) online tool.

Results: A total of 14,200 subjects (six comparative studies) were finally included in this pooled study. There is no statistical discrepancy between the two treatments on reducing stroke/death/myocardial infarction (odds ratio [OR] 0.85, 95% CI 0.67–1.07), stroke (OR 1.03, 95% CI 0.77–1.37), or death (OR 1.14, 95% CI 0.67–1.94). Besides, TCAR is associated with a lower incidence of myocardial infarction (P = 0.004), cranial nerve injury (P < 0.00001), and shorter procedure time (P < 0.00001) than CEA among the overall cohort.

Conclusions: TCAR is a rapidly developing treatment that reaches a comparable prognosis to CEA and significantly reduces the risk of myocardial infarction under the well-matched condition, which is a dependable choice for patients with carotid stenosis.

Paediatric Ulcerative Colitis Is a Fibrotic Disease and Is Linked with Chronicity of Inflammation

BACKGROUND AND AIMS

Intestinal fibrosis has recently been characterised in adult ulcerative colitis and may affect motility, diarrhoea, and the symptom of urgency. We aimed to charactersze the presence of fibrosis in paediatric patients with ulcerative colitis, and its link to severity and chronicity of mucosal inflammation, as well as clinical factors of severity.

METHODS

We performed a single-centre cross-sectional study in children ages 1-18 years with ulcerative colitis, undergoing colectomy or proctocolectomy. Tissue cross-sections were derived from proximal, mid, and distal colon and rectum, and inflammation and fibrosis were graded based on previously developed scores. Clinical data were collected prospectively.

RESULTS

From 62 patients, 205 intestinal sections were evaluated. Median age at diagnosis was 13 years, 100% had extensive colitis, and all resections were done for refractory disease. The presence, chronicity, and degree of inflammation were linked with the presence of fibrosis. Thickness of the muscularis mucosa was also linked with presence and chronicity of inflammation. The overall submucosal fibrosis burden was associated with prior anti-tumour necrosis factor use.

CONCLUSIONS

Paediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlate with the presence, chronicity, and degree of mucosal inflammation. Fibrosis should be recognised as a complication of paediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease.

Real-Time Closed-Loop Detection Method of vSLAM Based on a Dynamic Siamese Network

As visual simultaneous localization and mapping (vSLAM) is easy disturbed by the changes of camera viewpoint and scene appearance when building a globally consistent map, the robustness and real-time performance of key frame image selections cannot meet the requirements. To solve this problem, a real-time closed-loop detection method based on a dynamic Siamese networks is proposed in this paper. First, a dynamic Siamese network-based fast conversion learning model is constructed to handle the impact of external changes on key frame judgments, and an elementwise convergence strategy is adopted to ensure the accurate positioning of key frames in the closed-loop judgment process. Second, a joint training strategy is designed to ensure the model parameters can be learned offline in parallel from tagged video sequences, which can effectively improve the speed of closed-loop detection. Finally, the proposed method is applied experimentally to three typical closed-loop detection scenario datasets and the experimental results demonstrate the effectiveness and robustness of the proposed method under the interference of complex scenes.

Growth differentiation factor 15 predicts poor prognosis in patients with heart failure and reduced ejection fraction and anemia: results from RED-HF

Aims

We aimed to assess the value of GDF-15, a stress-responsive cytokine, in predicting clinical outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and anemia

Methods and results

Serum GDF-15 was assessed in 1582 HFrEF and mild-to-moderate anemia patients who where followed for 28 months in the Reduction of Events by Darbepoetin alfa in Heart Failure (RED-HF) trial, an overall neutral RCT evaluating the effect darbepoetin alfa on clinical outcomes in patients with systolic heart failure and mild-to-moderate anemia. Association between baseline and change in GDF-15 during 6 months follow-up and the primary composite outcome of all-cause death or HF hospitalization were evaluated in multivariable Cox-models adjusted for conventional clinical and biochemical risk factors. The adjusted risk for the primary outcome increased with (i) successive tertiles of baseline GDF-15 (tertile 3 HR 1.56 [1.23–1.98] p < 0.001) as well as with (ii) a 15% increase in GDF-15 levels over 6 months of follow-up (HR 1.68 [1.38–2.06] p < 0.001). Addition of change in GDF-15 to the fully adjusted model improved the C-statistics (p < 0.001). No interaction between treatment and baseline or change in GDF-15 on outcome was observed. GDF-15 was inversely associated with several indices of anemia and correlated positively with ferritin.

Conclusions

In patients with HF and anemia, both higher baseline serum GDF-15 levels and an increase in GDF-15 during follow-up, were associated with worse clinical outcomes. GDF-15 did not identify subgroups of patients who might benefit from correction of anemia but was associated with several indices of anemia and iron status in the HF patients.

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s00392-021-01944-6.

Evaluation of Endovascular Therapy for Unilateral Atherosclerotic Renal Artery Stenosis Using Measurements of Differential Renal Function

Background

To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may affect the renal function.

Methods

A retrospective analysis was made on 60 patients with &gt;70% unilateral arteriosclerotic renal artery stenosis who underwent renal artery stent implantation. Serum creatinine, urea nitrogen, renal artery color Doppler ultrasonography, and renal dynamic imaging results were obtained before and after 1 year of operation. A regression model was used to analyze the influencing factors.

Results

All patients underwent balloon dilatation and stenting of the affected renal artery. The immediate intervention success rate was 100%. The residual stenosis of the affected renal artery was less than 20%. No serious complications occurred during the perioperative period. After operation, systolic blood and diastolic blood pressures were improved (P &lt; 0.01), the serum creatinine was stable (P = 0.25), and the degree of renal artery stenosis of the affected side was relieved significantly (P &lt; 0.01). One year after operation, the patency rate of renal artery stent was 85%. Based on the changes of differential glomerular filtration rate of the affected side, 40 patients (66.7%) were improved while 20 patients (33.3%) were not. A linear regression analysis showed that the renal insufficiency of the affected side before operation was the only significant influencing factor (B = 0.50, P &lt; 0.01).

Conclusions

Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis. One-year patency rate is 85%. Two-thirds of the patients have an improved renal function after operation. The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.

Effectiveness of collateral arteries embolization before endovascular aneurysm repair to prevent type II endoleaks: A systematic review and meta-analysis

OBJECTIVES

This study aimed to evaluate the effect of preventive collateral arteries embolization before endovascular aneurysm repair (EVAR) to reduce type II endoleaks (T2EL), aneurysm enlargement, and re-interventions.

METHODS

A comprehensive search of PubMed, MEDLINE, Web of Science, and Embase was conducted to identify articles in English, related to preventive collateral arteries embolization before EVAR, published until October 2020.

RESULTS

A total of 12 relevant studies, including 11 retrospective studies and one randomized controlled trial, were identified and fulfilled the specified inclusion criteria. A total of 1706 patients in 11 studies were involved in the meta-analysis. The overall incidence of T2EL was 17.3% in the embolization group vs. 34.5% in the control group (OR 0.36, p < 0.01). The incidence of persistent T2EL was 15.3% vs. 30.0% (OR 0.37, p < 0.01). Five studies reported the incidence of sac enlargement, with the rate 10.2% vs. 24.9% (OR 0.25, p < 0.01). Nine studies reported T2EL related re-interventions, and it was 1.3% in the embolization group and 10.4% in control (OR 0.14, p < 0.01). The technical success of collateral arteries embolization was 92.1% (455/494) in the 12 studies. 1.2% (10/829) patients suffered a mild complication of collateral arteries embolization, and 2/829 patients died because of the embolization.

CONCLUSION

Collateral arteries embolization is a promising measure to prevent the occurrence of T2EL, sac enlargement, and re-intervention. High-quality studies need to be conducted to provide stronger evidence-based medical suggestions about the embolize operation.

Severe gastroparesis is associated with an increased incidence of slow-transit constipation as measured by wireless motility capsule

BACKGROUND

Dysmotility in one region of the gastrointestinal tract has been found to predispose patients to developing motility disorders in other gastrointestinal segments. However, few studies have evaluated the relationship between gastroparesis and constipation.

METHODS

Retrospective review of 224 patients who completed 4-hour, solid-phase gastric emptying scintigraphy (GES), and wireless motility capsule (WMC) testing to evaluate for gastroparesis and slow-transit constipation, respectively. When available, anorectal manometry data were reviewed to evaluate for dyssynergic defecation. Patients were divided into two groups based on the results of the GES: 101 patients with normal gastric emptying and 123 patients with gastroparesis (stratified by severity). Differences in constipation rates were compared between the groups.

KEY RESULTS

Slow-transit constipation was more common in the gastroparesis group, but statistical significance was not reached (42.3% vs 34.7%, p = 0.304). Univariate logistical regression analysis found no association between slow-transit constipation and gastroparesis (OR 1.38, 95% CI 0.80-2.38, p = 0.245) nor dyssynergic defecation and gastroparesis (OR 0.88, 95% CI 0.29-2.70, p = 0.822). However, when stratifying gastroparesis based on severity, slow-transit constipation was found to be associated with severe gastroparesis (OR 2.45, 95% CI 1.20-5.00, p = 0.014). This association was strengthened with the exclusion of patients with diabetes mellitus (OR 3.5, 95% CI 1.39-8.83, p = 0.008) - a potential confounder.

CONCLUSIONS & INFERENCES

Patients with severe gastroparesis (>35% gastric retention at the 4-hour mark on solid-phase GES) have an increased likelihood of having underlying slow-transit constipation. Dyssynergic defecation does not appear to be associated with gastroparesis (of any severity).

Hypertension and Hypercholesterolemia Modify Dementia Risk in Relation to APOEɛ4 Status

BACKGROUND

There is significant interest in understanding the role of modifiable vascular risk factors contributing to dementia risk across age groups.

OBJECTIVE

Risk of dementia onset was assessed in relation to vascular risk factors of hypertension and hypercholesterolemia among cognitively normal APOEɛ4 carriers and non-carriers.

METHODS

In a sample of prospectively characterized longitudinal cohort from the National Alzheimer's Coordinating Center database, 9,349 participants met criteria for normal cognition at baseline, had a CDR-Global (CDR-G) score of zero, and had concomitant data on APOEɛ4 status and medical co-morbidities including histories of hypertension and hypercholesterolemia. Multivariable Cox proportional hazards models adjusted for well-known potential confounders were used to compare dementia onset among APOEɛ4 carriers and non-carriers by young (≤65 years) and old (> 65 year) age groups.

RESULTS

519 participants converted to dementia within an average follow up of 5.97 years. Among older APOEɛ4 carriers, hypercholesterolemia was related to lower risk of dementia (HR (95% CI), 0.68 (0.49-0.94), p = 0.02). Among older APOEɛ4 non-carriers, hypertension was related to higher risk of dementia (HR (95% CI), 1.44 (1.13-1.82), p = 0.003). These results were corroborated among a subset with autopsy data characterizing underlying neuropathology. Among younger participants, vascular risk factors did not impact dementia risk, likely from a lower frequency of vascular and Alzheimer's as etiologies of dementia among this cohort.

CONCLUSION

A history of hypercholesterolemia related to a lower risk of dementia among older APOEɛ4 carriers, while hypertension related to a higher risk of dementia among older APOEɛ4 non-carriers.

Systematic review with meta-analysis: efficacy of balloon-assisted enteroscopy for dilation of small bowel Crohn's disease strictures

BACKGROUND

Evidence for endoscopic balloon dilation of small intestinal strictures in Crohn's disease (CD) using balloon-assisted enteroscopy is scarce.

AIM

To evaluate endoscopic balloon dilation for the treatment of small intestinal CD strictures using balloon-assisted enteroscopy.

METHODS

Citations in Embase, MEDLINE, and Cochrane were systematically reviewed. In a meta-analysis of 18 studies with 463 patients and 1189 endoscopic balloon dilations, technical success was defined as the ability to dilate a stricture. Individual data were also obtained on 218 patients to identify outcome-relevant risk factors.

RESULTS

In the pooled per-study analysis, technical success rate of endoscopic balloon dilation was 94.9%, resulting in short-term clinical efficacy in 82.3% of patients. Major complications occurred in 5.3% of patients. During follow-up, 48.3% of patients reported symptom recurrence, 38.8% were re-dilated and 27.4% proceeded to surgery. On the per-patient-based multivariable analysis, that patients with disease activity in the small intestine had lower short-term clinical efficacy (odds ratio 0.32; 95% confidence interval 0.14-0.73, P = 0.007). Patients with concomitant active disease in the small and/or large intestine had an increased risk to proceed toward surgery (hazard ratio 1.85; 95% confidence interval 1.09-3.13, P = 0.02 and hazard ratio 1.77; 95% confidence interval 1.34-2.34, P < 0.001).

CONCLUSIONS

Balloon-assisted enteroscopy for dilatation of CD-associated small intestinal strictures has high short-term technical and clinical efficacy and low complication rates. However, up to two-thirds of patients need re-dilation or surgery.

Emerging predictors of femoral artery occlusion after pediatric cardiac catheterization

The Objective was to review the prevalence of femoral artery occlusion (FAO) after cardiac catheterization in children up to 12 years old from two centers in China and identify its related risk factors. After collecting clinical data from patients who had undergone pediatric cardiac catheterization, univariate and multivariate analysis were used to evaluate the correlations between FAO and clinical factors, including sex, age, height, weight, sheath size, operation time, therapeutic strategy, sheath/age, sheath/height and sheath/weight. The ROC curve was also used to assess the influence of risk factors to predict FAO. FAO occurred in 19 (0.9%) out of 2,084 children following cardiac catheterization. Patients with younger age, lower height, longer operation time, electrophysiological (EP) diagnosis or/and therapy for arrhythmias, higher Sheath/Age, higher Sheath/Height and higher Sheath/Weight ratios had higher risk for FAO compared to their respective control groups (p < 0.05). In the multivariate analysis, sheath/age and operation time were independent risk factors for FAO. Patients with operation time > 77.5 min or sheath/age > 0.5334 had a significantly higher risk for FAO. Operation time and sheath/age were confirmed as significant and independent risk factors associated with FAO. Operation time > 77.5 min and sheath/age > 0.5334 could effectively predict high risk of FAO after pediatric cardiac catheterization.

Inflammatory pathway analytes predicting rapid cognitive decline in MCI stage of Alzheimer's disease

OBJECTIVE

To determine the inflammatory analytes that predict clinical progression and evaluate their performance against biomarkers of neurodegeneration.

METHODS

A longitudinal study of MCI-AD patients in a Discovery cohort over 15 months, with replication in the Alzheimer's Disease Neuroimaging Initiative (ADNI) MCI cohort over 36 months. Fifty-three inflammatory analytes were measured in the CSF and plasma with a RBM multiplex analyte platform. Inflammatory analytes that predict clinical progression on Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) and Mini Mental State Exam scores were assessed in multivariate regression models. To provide context, key analyte results in ADNI were compared against biomarkers of neurodegeneration, hippocampal volume, and CSF neurofilament light (NfL), in receiver operating characteristic (ROC) analyses evaluating highest quartile of CDR-SB change over two years (≥3 points).

RESULTS

Cerebrospinal fluid inflammatory analytes in relation to cognitive decline were best described by gene ontology terms, natural killer cell chemotaxis, and endothelial cell apoptotic process and in plasma, extracellular matrix organization, blood coagulation, and fibrin clot formation described the analytes. CSF CCL2 was most robust in predicting rate of cognitive change and analytes that correlated to CCL2 suggest IL-10 pathway dysregulation. The ROC curves for ≥3 points change in CDR-SB over 2 years when comparing baseline hippocampal volume, CSF NfL, and CCL2 were not significantly different.

INTERPRETATION

Baseline levels of immune cell chemotactic cytokine CCL2 in the CSF and IL-10 pathway dysregulation impact longitudinal cognitive and functional decline in MCI-AD. CCL2's utility appears comparable to biomarkers of neurodegeneration in predicting rapid decline.

Fault diagnosis for three-phase PWM rectifier based on deep feedforward network with transient synthetic features

Three-phase PWM rectifiers are adopted extensively in industry because of their excellent properties and potential advantages. However, while the IGBT has an open-circuit fault, the system does not crash suddenly, the performance will be reduced for instance voltages fluctuation and current harmonics. A fault diagnosis method based on deep feedforward network with transient synthetic features is proposed to reduce the dependence on the fault mathematical models in this paper, which mainly uses the transient phase current to train the deep feedforward network classifier. Firstly, the features of fault phase current are analyzed in this paper. Secondly, the historical fault data after feature synthesis is employed to train the deep feedforward network classifier, and the average fault diagnosis accuracy can reach 97.85% for transient synthetic fault data, the classifier trained by the transient synthetic features obtained more than 1% gain in performance compared with original transient features. Finally, the online fault diagnosis experiments show that the method can accurately locate the fault IGBTs, and the final diagnosis result is determined by multiple groups results, which has the ability to increase the accuracy and reliability of the diagnosis results.

Efficacy of digital single-operator cholangioscopy and factors affecting its accuracy in the evaluation of indeterminate biliary stricture

BACKGROUND AND AIMS

Indeterminate biliary stricture remains a significant diagnostic challenge. The current method of ERCP with bile duct brush cytology has substantial room for improvement. We aimed to determine the efficacy of a digital single-operator cholangioscopy (DSOC) in evaluation of indeterminate biliary stricture.

METHODS

An observational cohort study was conducted among the patients who underwent DSOC for the indication of indeterminate biliary stricture at a tertiary academic medical center. The outcomes of interests were the accuracy of DSOC in visual interpretation and bile duct sample and identification of any factor(s) that could influence its effectiveness.

RESULTS

One hundred five patients were included. The overall accuracy of DSOC in visual interpretation was 89.5%, whereas the accuracy of bile duct sample was 83.2%. The sensitivities of visual impression and bile duct sample were 89.1% and 69.8% and their specificities were 90% and 97.9%, respectively. The degree of endoscopists' experience with fewer than 25 cases and the severity of hyperbilirubinemia negatively impacted the accuracy of DSOC. Among 55 patients with definitive diagnosis of malignant stricture, the sensitivity of combined intraductal forceps biopsy sampling and brush cytology was 80.6%, whereas the sensitivity of brush cytology alone was 47.1%.

CONCLUSIONS

DSOC augments ERCP in evaluating indeterminate biliary stricture. The acquisition of intraductal forceps biopsy samples should be a requisite in evaluation of indeterminate biliary stricture with DSOC. Discovery of modifiable factors such as the degree of endoscopists' expertise and the severity of hyperbilirubinemia, which can influence the accuracy of DSOC, warrants further studies on patient preprocedure optimization and an endoscopic training program that will cultivate procedural competency.

Pulmonary cryptococcosis characteristics in immunocompetent patients-A 20-year clinical retrospective analysis in China

Background

Pulmonary cryptococcosis (PC) is not considered an rare, opportunistic infection anymore. The immunocompetent population accounts for an increasing proportion of the morbidity.

Objective

This study investigated the clinical characteristics of PC patients spanning 20 years, in a referral centre of China.

Patients/Methods

We retrospectively investigated the clinical data of 99 patients with PC who were diagnosed at Peking Union Medical College Hospital (PUMCH) from January 1998 to December 2017.

Results

Pulmonary cryptococcosis incidence in PUMCH has seen sharp increase in two decades. There were 40.4% (40/99), 17.2% (17/99) and 42.4% (42/99) immunocompetent, mildly immunocompromised and severe immunocompromised patients, respectively. Significantly higher (P = .035) male predominance in immunocompetent and mildly immunocompromised groups (68.4%, 39/57) compared with severe immunocompromised group (45.2%, 19/42) was found. Overall, 27.5% (11/40) immunocompetent patients reported a significant difference (P = .02) in history of more than weekly drinking, higher than mildly or severe immunocompromised. No significant difference occurred in symptoms and radiographic characteristics among the groups. In pulmonary computerised tomography findings, the non‐air pathway feature was the dominant distribution characteristics in all patients with PC (P = .002). The gap in body dissemination frequency between immunocompetent combined with mildly immunocompromised (5.26%, 3/57) and severe immunocompromised (19.0%, 8/42) was marginally significant (P = .05).

Conclusions

Gender and alcohol drinking could be PC risk factors of concern in patients without severe immunodeficiency. No significant difference occurred in symptoms or radiographic characteristics between patients with different levels of immune status. The unique radiographic non‐air pathway distribution in the lung may be the feature of Cryptococcus invasion that may enhance accurate diagnosis.

[Clinical analysis of peri-operative gastrointestinal complications after endovascular and open repair of abdominal aortic aneurysm]

Objective: To investigate the etiology, treatment method and prevention of gastrointestinal complications(GCs) after endovascular and open repair of abdominal aortic aneurysm (AAA). Methods: The clinical data of 716 cases who were diagnosed as AAA and underwent endovascular(EVAR) or open repair (OR) from Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University April 2009 to March 2017 were collected and analyzed retrospectively. There were 608 males (84.9%)and 108 females(15.1%), aging of 69.4 years (range: 52-86 years). There were 539 cases(75.3%) underwent EVAR and 177 cases(24.7%) underwent OR. The morbidity of GCs and mortality of GCs, such as acute pancreatitis, cholecystitis, ischemic colitis, intestinal obstruction and peptic ulcer, between EVAR and OR group were compared. The treatment of the GCs and the prognosis of the patients were reported. Results: The morbidity of GCs in EVAR and OR group were 4.6%(25/539)and 35.0%(62/177), respectively. There were 10 cases and 28 cases suffering from acute pancreatitis in EVAR and OR group, respectively; 4 cases and 6 cases suffering from cholecystitis in the two groups; 6 cases and 13 cases suffering from ischemic colitis in the two groups; 5 cases suffering from intestinal obstruction in OR group; 5 cases and 10 cases suffering from peptic ulcer in the two groups. Two patients died in EVAR group, and the peri-operative mortality was 0.37%, one died of ischemic colitis with acute myocardial infarction, the other died of ischemic colitis with septic shock. Six patients died in OR group, and the peri-operative mortality was 3.39%, two patients died of acute pancreatitis with intestinal necrosis, one patient died of cholangitis with peritonitis and septic shock, three patients died of ischemic colitis with acute renal failure or septicemia. Conclusions: The etiology of peri-operative GCs after AAA repair may include inferior mesenteric artery occlusion or ligation, pancreas injury, organ hypoperfusion and so on.

[Analysis of risk factors for cerebrovascular complications after carotid endarterectomy]

Objective: To evaluate the related risk factors of cerebrovascular complications after carotid endarterectomy (CEA) and to improve the efficacy of CEA in the treatment of ischemic stroke. Methods: The clinical data of 295 patients with atherosclerotic carotid artery stenosis who underwent CEA in the Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2013 to March 2017 were retrospectively analyzed. Results: As the results of the single-factor analysis of logistics, severe lower limb artery stenosis (RR=5.667, P=0.017), systolic blood pressure before the carotid artery clamping (RR=6.659, P=0.010), diastolic blood pressure before the carotid artery clamping (RR=3.981, P=0.046), stump pressure (RR=5.359, P=0.021), diastolic blood pressure after surgery (RR=9.550, P=0.002), diastolic blood pressure of the first day after surgery (RR=7.932, P=0.005) were influencing factors of postoperative cerebrovascular complications after CEA. The results of multi-factor analysis of logistic regression indicated that diastolic blood pressure before the carotid artery clamping (RR=0.953, P=0.024) and stump pressure to basic systolic blood pressure index (SSI)>0.25 (RR=0.086, P=0.049) were independent risk factors for postoperative cerebrovascular complications after CEA. Conclusion: Systolic blood pressure before carotid artery clamping and SSI>0.25 are independent risk factors for postoperative cerebrovascular complications after CEA. Close follow-up and drug treatment for patients after CEA might be beneficial to reduce postoperative carotid artery restenosis.

Derivation and Validation of a Model to Predict 30-Day Readmission in Surgical Patients Discharged to Skilled Nursing Facility

OBJECTIVES

To identify factors associated with 30-day all-cause readmission rates in surgical patients discharged to skilled nursing facilities (SNFs), and derive and validate a risk score.

DESIGN

Retrospective cohort.

SETTING AND PARTICIPANTS

Patients admitted to 1 tertiary hospital's surgical services between January 1, 2011, and December 31, 2014 and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital. The first 2 years were used for the derivation set and the last 2 for validation.

METHODS

Data were collected on 30-day all cause readmissions, patient demographics, procedure and surgical service, comorbidities, laboratory tests, and prior health care utilization. Multivariate regression was used to identify risk factors for readmission.

RESULTS

During the study period, 2405 surgical patients were discharged to 110 SNFs, and 519 (21.6%) of these patients experienced readmission within 30 days. In a multivariable regression model, hospital length of stay [odds ratio (OR) per day: 1.03, 95% confidence interval (CI) 1.02-1.04], number of hospitalizations in past year (OR 1.24 per hospitalization, 95% CI 1.18-1.31), nonelective surgery (OR 1.33, 95% CI 1.18-1.65), low-risk service (orthopedic/spine service) (OR 0.32, 95% CI 0.25-0.42), and intermediate-risk service (cardiothoracic surgery/urology/gynecology/ear, nose, throat) (OR 0.69, 95% CI 0.53-0.88) were associated with all-cause readmissions. The model had a C index of 0.71 in the validation set. Using the following risk score [0.8 × (hospital length of stay) + 7 × (number of hospitalizations in past year) +10 for nonelective surgery, +36 for high-risk surgery, and +20 for intermediate-risk surgery], a score of >40 identified patients at high risk of 30-day readmission (35.8% vs 12.6%, P < .001).

CONCLUSIONS/IMPLICATIONS

Among surgical patients discharged to an SNF, a simple risk score with 4 parameters can accurately predict the risk of 30-day readmission.

Development of a Risk Prediction Model to Estimate the Probability of Malignancy in Pulmonary Nodules Being Considered for Biopsy

BACKGROUND

Malignancy probability models for pulmonary nodules (PN) are most accurate when used within populations similar to those in which they were developed. Our goal was to develop a malignancy probability model that estimates the probability of malignancy for PNs considered high enough risk to recommend biopsy.

METHODS

This retrospective analysis included training and validation datasets of patients with PNs who had a histopathologic diagnosis of malignant or benign. Radiographic and clinical characteristics associated with lung cancer were collected. Univariate logistic regression was used to identify potential predictors. Stepdown selection and multivariate logistic regression were used to build several models, each differing according to available data.

RESULTS

Two hundred malignant nodules and 101 benign nodules were used to generate and internally validate eight models. Predictors of lung cancer used in the final models included age, smoking history, upper lobe location, solid and irregular/spiculated nodule edges, emphysema, fluorodeoxyglucose-PET avidity, and history of cancer other than lung. The concordance index (C-index) of the models ranged from 0.75 to 0.81. They were more accurate than the Mayo Clinic model (P < .05 for four of the models), and each had fair to excellent calibration. In an independent sample used for validation, the C-index for our model was 0.67 compared with 0.63 for the Mayo Clinic model. The ratio of malignant to benign nodules within each probability decile showed a greater potential to influence clinical decisions than the Mayo Clinic model.

CONCLUSIONS

We developed eight models to help characterize PNs considered high enough risk by a clinician to recommend biopsy. These models may help to guide clinicians' decision-making and be used as a resource for patient communication.

Real-time parallel 3D multiple particle tracking with single molecule centrifugal force microscopy

Real-time tracking of multiple particles is key for quantitative analysis of dynamic biophysical processes and materials science via time-lapse microscopy image data, especially for single molecule biophysical techniques, such as magnetic tweezers and centrifugal force microscopy. However, real-time multiple particle tracking with high resolution is limited by the current imaging processes or tracking algorithms. Here, we demonstrate 1 nm resolution in three dimensions in real-time with a graphics-processing unit (GPU) based on a compute unified device architecture (CUDA) parallel computing framework instead of only a central processing unit (CPU). We also explore the trade-offs between processing speed and size of the utilized regions of interest and a maximum speedup of 137 is achieved with the GPU compared with the CPU. Moreover, we utilize this method with our recently self-built centrifugal force microscope (CFM) in experiments that track multiple DNA-tethered particles. Our approach paves the way for high-throughput single molecule techniques with high resolution and efficiency. LAY DESCRIPTION: Particles are widely used as probes in life sciences through their motions. In single molecule techniques such as optical tweezers and magnetic tweezers, microbeads are used to study intermolecular or intramolecular interactions via beads tracking. Also tracking multiple beads' motions could study cell-cell or cell-ECM interactions in traction force microscopy. Therefore, particle tracking is of key important during these researches. However, parallel 3D multiple particle tracking in real-time with high resolution is a challenge either due to the algorithm or the program. Here, we combine the performance of CPU and CUDA-based GPU to make a hybrid implementation for particle tracking. In this way, a speedup of 137 is obtained compared the program before only with CPU without loss of accuracy. Moreover, we improve and build a new centrifugal force microscope for multiple single molecule force spectroscopy research in parallel. Then we employed our program into centrifugal force microscope for DNA stretching study. Our results not only demonstrate the application of this program in single molecule techniques, also indicate the capability of multiple single molecule study with centrifugal force microscopy.

Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine

This study assesses the association between antibiotic prescribing for respiratory tract infections and satisfaction ratings among patients using a direct-to-consumer telemedicine platform.

Patterns of Use and Correlates of Patient Satisfaction with a Large Nationwide Direct to Consumer Telemedicine Service

BACKGROUND

Despite its rapid expansion, little is known about use of direct to consumer (DTC) telemedicine.

OBJECTIVE

To characterize telemedicine patients and physicians and correlates of patient satisfaction DESIGN: Cross-sectional study PARTICIPANTS: Patients and physicians of a large nationwide DTC telemedicine service MAIN MEASURES: Patient characteristics included demographics and whether or not they reported insurance information. Physician characteristics included specialty, board certification, and domestic versus international medical training. Encounter characteristics included time of day, wait time, length, coupon use for free or reduced-cost care, diagnostic outcome, prescription receipt, and patient/physician geographic concordance. Patients rated satisfaction with physicians on scales of 0 to 5 stars and reported where they would have sought care had they not used telemedicine. Logistic regression was used to assess factors associated with 5-star physician ratings.

KEY RESULTS

The analysis included 28,222 encounters between 24,040 patients and 277 physicians completed between January 2013 and August 2016. Sixty-five percent of patients were under 40 years and 32% did not report insurance information. Family medicine was the most common physician specialty (47%) and 16% trained at a non-US medical school. Coupons were used in 24% of encounters. Respiratory infections were diagnosed in 35% of encounters and 69% resulted in a prescription. Had they not used telemedicine, 43% of patients reported they would have used urgent care/retail clinic, 29% would have gone to the doctor's office, 15% would have done nothing, and 6% would have gone to the emergency department. Eighty-five percent of patients rated their physician 5 stars. High satisfaction was positively correlated with prescription receipt (OR 2.98; 95%CI 2.74-3.23) and coupon use (OR 1.47; 95%CI 1.33-1.62).

CONCLUSIONS

Patients were largely satisfied with DTC telemedicine, yet satisfaction varied by coupon use and prescription receipt. The impact of telemedicine on primary care and emergency department use is likely to be small under present usage patterns.

Pro-gastrin-releasing peptide and outcome in patients with heart failure and anaemia: results from the RED-HF study

Aims

Neuroendocrine activation is associated with poor outcome in heart failure (HF). The neuropeptide gastrin‐releasing peptide (GRP), derived from the precursor proGRP1‐125 (proGRP), has recently been implicated in inflammation and wound repair. We investigated the predictive value of proGRP on clinical outcomes in HF patients with reduced ejection fraction.

Methods and results

The association between plasma proGRP (time‐resolved immunofluorometric assay) and the primary endpoint of death from any cause or first hospitalization for worsening of HF was evaluated using multivariable Cox proportional hazard models in 1541 patients with systolic HF and mild to moderate anaemia, enrolled in the Reduction of Events by Darbepoetin alfa in Heart Failure (RED‐HF) trial. Median proGRP levels in the RED‐HF cohort were markedly increased [95 ng/L (25th, 75th percentile, 69–129 ng/L)] with 64% patients above the 80 ng/L reference limit. Baseline proGRP correlated with estimated glomerular filtration rate (r = 0.52), N terminal pro brain natriuretic peptide (r = 0.33), troponin T (r = 0.34), and haemoglobin (r = 0.16) (all P < 0.001). The incidence outcome increased with increasing tertiles of baseline proGRP (primary endpoint third tertile vs. the lowest tertile; hazard ratio 1.91; 95% confidence interval 1.60–2.28, P < 0.001). However, these associations were markedly attenuated and non‐significant in adjusted models. No interaction between baseline proGRP and the effect of darbepoetin alfa treatment was detected. Moreover, no significant association between changes in proGRP during 6 month follow‐up and outcome was observed.

Conclusions

Pro‐gastrin‐releasing peptide is increased in patients with HF with reduced ejection fraction and anaemia, in particular in patients with poor renal function. However, proGRP adds little as a prognostic marker on top of conventional HF risk factors.

T cell and monocyte/macrophage activation markers associate with adverse outcome, but give limited prognostic value in anemic patients with heart failure: results from RED-HF

BACKGROUND

Activated leukocytes may contribute to the development and progression of heart failure (HF). We investigated the predictive value of circulating levels of stable and readily detectable markers reflecting both monocyte/macrophage and T-cell activity, on clinical outcomes in HF patients with reduced ejection fraction (HFrEF).

METHODS

The association between baseline plasma levels of soluble CD163 (sCD163), macrophage migration inhibitory factor (MIF), granulysin, soluble interleukin-2 receptor (sIL-2R), and activated leukocyte cell adhesion molecule (ALCAM) and the primary endpoint of death from any cause or first hospitalization for worsening of HF was evaluated using multivariable Cox proportional hazard models in 1541 patients with systolic HF and mild to moderate anemia, enrolled in the Reduction of Events by darbepoetin alfa in Heart Failure (RED-HF) trial. Modifying effects and interaction with darbepoetin alfa treatment were also assessed.

RESULTS

All leukocyte markers, except granulysin, were associated with the primary outcome and all-cause death in univariate analysis (all p < 0.01) and remained significantly associated in multivariable analysis adjusting for conventional clinical variables (e.g. age, gender, BMI, NYHA class, creatinine, LVEF, etiology) and CRP. However, after final adjustment for TnT and NT-proBNP no associations were found with outcomes. No interaction with darbepoetin alpha treatment was observed for any marker.

CONCLUSIONS

Leukocyte activation markers sCD163, MIF, sIL-2R, and ALCAM were associated with adverse outcome in patients with HFrEF, but add little as prognostic markers on top of established biochemical risk markers.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT00358215 .

Determining the optimal screening interval for type 2 diabetes mellitus using a risk prediction model

Background

Progression to diabetes mellitus (DM) is variable and the screening time interval not well defined. The American Diabetes Association and US Preventive Services Task Force suggest screening every 3 years, but evidence is limited.

The objective of the study was to develop a model to predict the probability of developing DM and suggest a risk-based screening interval.

Methods

We included non-diabetic adult patients screened for DM in the Cleveland Clinic Health System if they had at least two measurements of glycated hemoglobin (HbA1c), an initial one less than 6.5% (48 mmol/mol) in 2008, and another between January, 2009 and December, 2013. Cox proportional hazards models were created.

The primary outcome was DM defined as HbA1C greater than 6.4% (46 mmol/mol). The optimal rescreening interval was chosen based on the predicted probability of developing DM.

Results

Of 5084 participants, 100 (4.4%) of the 2281 patients with normal HbA1c and 772 (27.5%) of the 2803 patients with prediabetes developed DM within 5 years. Factors associated with developing DM included HbA1c (HR per 0.1 units increase 1.20; 95%CI, 1.13–1.27), family history (HR 1.31; 95%CI, 1.13–1.51), smoking (HR 1.18; 95%CI, 1.03–1.35), triglycerides (HR 1.01; 95%CI, 1.00–1.03), alanine aminotransferase (HR 1.07; 95%CI, 1.03–1.11), body mass index (HR 1.06; 95%CI, 1.01–1.11), age (HR 0.95; 95%CI, 0.91–0.99) and high-density lipoproteins (HR 0.93; 95% CI, 0.90–0.95). Five percent of patients in the highest risk tertile developed DM within 8 months, while it took 35 months for 5% of the middle tertile to develop DM. Only 2.4% percent of the patients in the lowest tertile developed DM within 5 years.

Conclusion

A risk prediction model employing commonly available data can be used to guide screening intervals. Based on equal intervals for equal risk, patients in the highest risk category could be rescreened after 8 months, while those in the intermediate and lowest risk categories could be rescreened after 3 and 5 years respectively.

Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients

Chronic pulmonary aspergillosis (CPA) has recently been recognized as a significant global health burden. In China, the diagnosis of CPA is still unfamiliar to most doctors. The aim of this study was to demonstrate the clinical manifestations and diagnoses of CPA in China.A multidisciplinary team of doctors retrospectively screened 690 records of patients diagnosed with pulmonary aspergillosis from January 2000 to December 2016 at Peking Union Medical College Hospital, Beijing, China. Of these, 69 patients were diagnosed with CPA. The patients' clinical characteristics were then retrieved and analyzed. Demographic, laboratory, and radiological data for these patients were compared by CPA type.Of the 69 patients diagnosed with CPA, 10 patients were diagnosed with chronic cavitary pulmonary aspergillosis (CCPA), 15 patients with semi-invasive aspergillosis (SAIA), 41 patients with simple aspergilloma, and 3 patients with Aspergillus nodule. Further, 53.3% of the SAIA patients were obviously immunocompromised, and 60% of the CCPA patients, 26.7% of the SAIA patients, 7.3% of the simple aspergilloma cases were mildly immunocompromised. Previous underlying lung abnormalities were observed in 20% of CCPA patients, 53.3% of SAIA patients, and 80.5% of simple aspergilloma patients. The most common symptoms in the CPA patients were cough (92.8%), hemoptysis (63.8%), chronic sputum (23.2%), and fever (17.4%). The most common computerized tomography abnormalities were cavities (94.2%), nodule (84.1%), consolidation (4.3%), pleural thickening (2.9%), and infiltration (2.9%). CCPA, SAIA and simple aspergilloma patients were significantly different with respect to their course before diagnosis, constitutional symptoms, fever, hemoptysis, breathlessness, white blood cell count, erythrocyte sedimentation rate, high-sensitivity C-reactive protein count, presence of nodule, and presence of a solitary lesion (all P < .05). Furthermore, SAIA patients had a significantly shorter course before diagnosis and a significantly higher white blood cell count compared with CCPA patients (both P < .01).In China, underlying systemic immunocompromising conditions and lung diseases with mechanical impediments contribute to CPA. Simple aspergillosis was the most common diagnosis in CPA patients. The imaging characteristics of simple aspergillosis and Aspergillus nodules were quite discriminable, while CCPA, and SAIA were similar in their clinical and radiological features. Distinguishing between CCPA and SAIA depends mainly on the physician's clinical judgment.

Prognostic importance of emerging cardiac, inflammatory, and renal biomarkers in chronic heart failure patients with reduced ejection fraction and anaemia: RED-HF study

Aims

To test the prognostic value of emerging biomarkers in the Reduction of Events by Darbepoetin Alfa in Heart Failure (RED‐HF) trial.

Methods and results

Circulating cardiac [N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), and high‐sensitivity troponin T (hsTnT)], neurohumoral [mid‐regional pro‐adrenomedullin (MR‐proADM) and copeptin], renal (cystatin C), and inflammatory [high‐sensitivity C‐reactive protein (hsCRP)] biomarkers were measured at randomization in 1853 participants with complete data. The relationship between these biomarkers and the primary composite endpoint of heart failure hospitalization or cardiovascular death over 28 months of follow‐up (n = 834) was evaluated using Cox proportional hazards regression, the c‐statistic and the net reclassification index (NRI). After adjustment, the hazard ratio (HR) for the composite outcome in the top tertile of the distribution compared to the lowest tertile for each biomarker was: NT‐proBNP 3.96 (95% CI 3.16–4.98), hsTnT 3.09 (95% CI 2.47–3.88), MR‐proADM 2.28 (95% CI 1.83–2.84), copeptin 1.66 (95% CI 1.35–2.04), cystatin C 1.92 (95% CI 1.55–2.37), and hsCRP 1.51 (95% CI 1.27–1.80). A basic clinical prediction model was improved on addition of each biomarker individually, most strongly by NT‐proBNP (NRI +62.3%, P < 0.001), but thereafter was only improved marginally by addition of hsTnT (NRI +33.1%, P = 0.004). Further addition of biomarkers did not improve discrimination further. Findings were similar for all‐cause mortality.

Conclusion

Once NT‐proBNP is included, only hsTnT moderately further improved risk stratification in this group of chronic heart failure with reduced ejection fraction patients with moderate anaemia. NT‐proBNP and hsTnT far outperform other emerging biomarkers in prediction of adverse outcome.

Network meta-analysis of balloon angioplasty, nondrug metal stent, drug-eluting balloon, and drug-eluting stent for treatment of infrapopliteal artery occlusive disease

PURPOSE

We aimed to conduct a network meta-analysis of mixed treatments for the infrapopliteal artery occlusive disease.

METHODS

We searched randomized controlled trials (RCTs) regarding balloon angioplasty (BA), nondrug metal stent (NDMS), drug-eluting balloon (DEB), or drug-eluting stent (DES) in PubMed, Embase, CENTRAL, Ovid, Sinomed, and other relevant websites. We selected and assessed the trials that met the inclusion criteria and conducted a network meta-analysis using the ADDIS software.

RESULTS

We included 11 relevant trials. We analyzed data of 1322 patients with infrapopliteal artery occlusive disease, of which 351 were in the NDMS vs. DES trials, 231 in the NDMS vs. BA trials, 490 in the BA vs. DEB trials, 50 in the DEB vs. DES trials, and 200 in the BA vs. DES trials. The network meta-analysis indicated that with NDMS as the reference, DES had a better result with respect to restenosis (odds ratio [OR], 5.16; 95% credible interval [CI], 1.58-18.41; probability of the best treatment, 84%) and amputation (OR, 2.50; 95% CI, 0.81-7.11; probability of the best treatment, 61%) and DEB had a better result with respect to target lesion revascularization (TLR; OR, 3.74; 95% CI, 0.78-17.05; probability of the best treatment, 57%). Moreover, with BA as the reference, NDMS had a better result with respect to technical success (OR, 0.10; 95% CI, 0.00-1.15; probability of the best treatment, 86%).

CONCLUSION

Our meta-analysis revealed that DES is a better treatment with respect to short-term patency and limb salvage rate, NMDS may provide a better technical success, and DEB and DES are good choices for reducing revascularization.

Impact of a Connected Care Model on 30-Day Readmission Rates from Skilled Nursing Facilities

BACKGROUND

About one-fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post-acute care. Readmissions are common but interventions to reduce readmissions are scarce.

OBJECTIVE

To assess the impact of a connected care model on 30-day hospital readmission rates among patients discharged to SNFs.

DESIGN

Retrospective cohort.

SETTING

SNFs that receive referrals from an academic medical center in Cleveland, Ohio.

PARTICIPANTS

All patients admitted to Cleveland Clinic main campus between January 1, 2011 and December 31, 2014 and subsequently discharged to 7 intervention SNFs or 103 control SNFs.

INTERVENTIONS

Hospital-employed physicians and advanced practice professionals (nurse practitioners and physician assistants) visited SNF patients 4 to 5 times per week.

RESULTS

During the study period, 13,544 patients were discharged to SNFs within a 25-miles radius of Cleveland Clinic main campus. Of these, 3334 were discharged to 7 intervention SNFs and 10,201 were discharged to 103 usualcare SNFs. During the intervention phase (2013-2014), adjusted 30-day readmission rates declined at the intervention SNFs (28.1% to 21.7%, P < 0.001), while there was a slight increase at control SNFs (27.1 % to 28.5%, P < 0.001). The absolute reductions ranged from 4.6% for patients at low risk for readmission to 9.1% for patients at high risk, and medical patients benefited more than surgical patients.

CONCLUSIONS

A program of frequent visits by hospital employed physicians and advanced practice professionals at SNFs can reduce 30-day readmission rates. Journal of Hospital Medicine 2017;12:238-244.

Mediating effect of coping styles on the association between psychological capital and psychological distress among Chinese nurses: a cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Studies show that psychological capital (PsyCap) is a protective factor against psychological distress, such as depressive symptoms. However, few have attempted to address the role of coping styles in the relationship between PsyCap and psychological distress. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Our study found moderate levels of PsyCap among nurses in China. Among the subcategories of PsyCap, optimism and hope were most highly correlated with psychological distress. Psychological distress was positively associated with negative coping and negatively associated with positive coping. This study confirmed the partial mediating effect of coping styles in PsyCap and psychological distress among Chinese nurses. In other words, this study found direct and indirect effects of PsyCap on psychological distress mediated via coping styles. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The significant mediating effect of negative and positive coping styles between PsyCap and psychological distress has implications for hospital administrators, especially nurse leaders. Effective strategies should be implemented to improve PsyCap and coping styles among Chinese nurses, and alleviate psychological distress. Optimism and hope should be emphasized in PsyCap investment. Different styles of coping are influenced and modified by teaching and experience. Therefore, it is essential that nurse managers organize educational and training programmes to provide nurses with relative coping knowledge and techniques, and improve their coping ability. Several studies suggest that coping styles are affected by social support. Thus, nurse managers should assist nurses with social support and enhance coping strategies to reduce psychological distress.

ABSTRACT

Introduction PsyCap includes four categories namely self-efficacy, hope, optimism and resilience. Research has demonstrated that PsyCap and coping styles affect current psychological distress. Nevertheless, few studies have explored the role of coping styles in PsyCap and psychological distress. Aim This study investigated the role of coping styles as a mediator in PsyCap and psychological distress among Chinese nurses. Methods Participants included 538 nurses who completed self-report questionnaires assessing PsyCap, coping styles and psychological distress. Linear regression analyses were used to explore the role of coping styles. Results PsyCap, coping styles and psychological distress were significantly correlated. Among the subcategories of PsyCap, optimism and hope were most highly correlated with psychological distress. Coping styles is a partial mediator of PsyCap and psychological distress. Implications for mental health nursing The significant role of negative and positive coping styles in PsyCap and psychological distress has implications for hospital administrators, especially nurse leaders. Effective strategies should be implemented to improve PsyCap and coping styles among Chinese nurses, to alleviate psychological distress. Optimism and hope should be the focus of the improvement. Different styles of coping are developed from education and experience. Therefore, it is necessary for nurse managers to organize educational and training programmes to improve coping skills among nurses. Studies suggest that coping styles are affected by social support. Thus, nurse managers should also assist nurses with social support and enhance coping strategies to reduce psychological distress.

Long Noncoding RNA Expression Signatures of Abdominal Aortic Aneurysm Revealed by Microarray

OBJECTIVE

This study is aimed at observing the role of long noncoding RNAs (lncRNAs) in the pathogenesis of abdominal aortic aneurysm (AAA).

METHODS

LncRNA and mRNA expression signatures of AAA tissues and normal abdominal aortic tissues (NT) were analyzed by microarray and further verified by Real-time quantitative reverse-transcription PCR (qRT-PCR). The lncRNAs-mRNAs targeting relationships were identified using computational analysis. The effect of lnc-ARG on 5-lipoxygenase (ALOX5) expression was tested in HeLa cells.

RESULTS

Differential expressions of 3,688 lncRNAs and 3,007 mRNAs were identified between AAA and NT tissues. Moreover, 1,284 differentially expressed long intergenic noncoding RNAs and 206 differentially expressed enhancer-like lncRNAs adjacent to protein-coding genes were discerned by bioinformatics analysis. Some differentially expressed lncRNAs and mRNAs between AAA and normal tissue samples were further verified using qRT-PCR. A co-expression network of coding and noncoding genes was constructed based on the correlation analysis between the differentially expressed lncRNAs and mRNAs. In addition, the lnc-ARG located within the upstream of ALOX5 was sorted as a noncoding transcript by analyzing the protein-coding potential using computational analysis. Furthermore, we found that lnc-ARG can decrease the mRNA level of ALOX5 and reactive oxygen species production in HeLa cells.

CONCLUSION

This study revealed new lncRNA candidates are related to the pathogenesis of AAA.

Validation of a Postoperative Nomogram Predicting Recurrence in Patients with Conventional Clear Cell Renal Cell Carcinoma

BACKGROUND

Clear cell renal cell carcinoma (RCC) continues to be the most commonly diagnosed subtype and is associated with more aggressive behavior than papillary and chromophobe RCC. Predicting disease recurrence after surgical extirpation is important for counseling and targeting those at high risk for adjuvant therapy clinical trials.

OBJECTIVE

To validate a postoperative nomogram predicting 5-yr recurrence-free probability (RFP) for clinically localized clear cell RCC.

DESIGN, SETTING, AND PARTICIPANTS

We identified all patients who underwent nephrectomy for clinically localized clear cell RCC from 1990 to 2009 at Memorial Sloan Kettering Cancer Center. After excluding patients with bilateral renal masses, familial RCC syndromes, and T3c or T4 tumors due to the limited number, 1642 participants were available for analysis.

INTERVENTIONS

Partial or radical nephrectomy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Disease recurrence was defined as any new tumor after nephrectomy or kidney cancer-specific mortality, whichever occurred first. A postoperative nomogram was used to calculate the predicted 5-yr RFP, and these values were compared with the actual 5-yr RFP. Nomogram performance was evaluated by concordance index and calibration plot.

RESULTS AND LIMITATIONS

Median follow-up was 39 mo (interquartile range: 14-79 mo), and disease recurrence was observed in 50 patients. The nomogram concordance index was 0.81. The calibration curve showed that the nomogram underestimated the actual 5-yr RFP. We updated the nomogram by including the entire patient population, which maintained performance and significantly improved calibration.

CONCLUSIONS

The updated clear cell RCC postoperative nomogram performed well in the combined cohort. Underestimation of actual 5-yr RFP by the original nomogram may be due to increased surgeon experience and other unknown variables.

PATIENT SUMMARY

We updated a valuable prediction tool used for assessing the disease recurrence probability after nephrectomy for clear cell renal cell carcinoma.

A Nomogram Derived by Combination of Demographic and Biomarker Data Improves the Noninvasive Evaluation of Patients at Risk for Bladder Cancer

BACKGROUND

Improvements in the noninvasive clinical evaluation of patients at risk for bladder cancer would be of benefit both to individuals and to health care systems. We investigated the potential utility of a hybrid nomogram that combined key demographic features with the results of a multiplex urinary biomarker assay in hopes of identifying patients at risk of harboring bladder cancer.

METHODS

Logistic regression analysis was used to model the probability of bladder cancer burden in a cohort of 686 subjects (394 with bladder cancer) using key demographic features alone, biomarker data alone, and the combination of demographic features and key biomarker data. We examined discrimination, calibration, and decision curve analysis techniques to evaluate prediction model performance.

RESULTS

Area under the receiver operating characteristic curve (AUC) analyses revealed that demographic features alone predicted tumor burden with an accuracy of 0.806 [95% confidence interval (CI), 0.76-0.85], while biomarker data had an accuracy of 0.835 (95% CI, 0.80-0.87). The addition of molecular data into the nomogram improved the predictive performance to 0.891 (95% CI, 0.86-0.92). Decision curve analyses showed that the hybrid nomogram performed better than demographic or biomarker data alone.

CONCLUSION

A nomogram construction strategy that combines key demographic features with biomarker data may facilitate the accurate, noninvasive evaluation of patients at risk of harboring bladder cancer. Further research is needed to evaluate the bladder cancer risk nomogram for potential clinical utility.

IMPACT

The application of such a nomogram may better inform the decision to perform invasive diagnostic procedures. Cancer Epidemiol Biomarkers Prev; 25(9); 1361-6. ©2016 AACR.