Laboratory Evaluation of Storage Stability for Asphalt Binder Modified with Crumb Rubber and Styrene-Isoprene-Styrene Depending on Evaluation Factors and Blending Condition

Modified asphalt binders are still considered important in asphalt pavement. However, the comprehensive use of various modifiers is limited due to storage stability issues. Moreover, there is a scarcity of detailed analyses regarding the degree of separation for asphalt binders among each method despite the utilization of various methods to assess the storage stability of binders. Therefore, a comprehensive analysis was conducted to assess the storage stability of asphalt binder modified with a crumb rubber modifier (CRM) and styrene-isoprene-styrene (SIS), utilizing five evaluation factors following the ASTM D7173 guidelines based on four mixing methods (A: high-shear mixing method, B: low-speed agitating method, C: high-shear mixing method + low mixing method, D: low-speed agitating method + low mixing method). To produce the modified asphalt binder, the proportions of the CRM were 5% and 10% for each binder, and 10% SIS was added to all binders. The results in this study convey that (1) the addition of the modifier led to an increase in G*/sin δ with different mixing methods, but using mixing methods (C and D) for a relatively long time resulted in a lower G*/sin δ, indicating suboptimal performance; (2) through the multiple stress creep recovery (MSCR), rheological properties of Jnr and % rec exhibited trends similar to G*/sin δ evaluation, highlighting an improved elastic recovery with a higher modifier content; (3) storage stability assessment revealed consistent trends in high-shear mixing groups (A and C), while low-speed mixing groups (B and D) exhibited an elevated separation index (SI), suggesting a sensitivity to modification conditions; (4) evaluation using the MSCR method indicated that % rec with a 3.2 kPa load is effective for the sensitive assessment of binder storage stability and Jnr showed a limited sensitivity across varying loads, advocating for % rec for precise evaluation; and (5) despite permitting various tests, achieving consistent results remains challenging. Future research should explore diverse modifiers and optimal evaluation methods to enhance knowledge of binder behavior and separation dynamics.

The Macromolecular Design of Poly(styrene-isoprene-styrene) (SIS) Copolymers Defines their Performance in Flexible Electrothermal Composite Heaters

Electric cars are desirable for their environmental and economic benefits yet face limitations in range in cold weather due to the increased energy demands for cabin heating. To provide efficient heating for vehicles, flexible composite electrothermal heaters offer a viable solution owing to their lightweight design, efficiency, and adaptability for use within and beyond vehicle interiors. The current study aims to improve electrothermal heater stability and performance by understanding the impact of the polymer structure on composite properties. We explore how the presence and molecular structure of olefinic bonds within the polyisoprene block of styrenic triblock copolymers affect thermal stability and performance. Composite electrothermal heaters were fabricated by dispersing carbon black (CB) as the heating material in three triblock copolymer matrices, poly(styrene-1,4-isoprene-styrene) (1,4-SIS), poly(styrene-3,4-isoprene-styrene) (3,4-SIS), and its hydrogenated version poly(styrene-ethylene-propylene-styrene) (SEPS). The chemical structure and thermal properties of each copolymer were linked to electrothermal performance measurements of composite heaters to establish structure-function relationships. Notably, 3,4-SIS with 28 wt % CB demonstrated the highest thermal and electrical conductivity, resulting in uniform heat distribution. The outcomes unambiguously demonstrate that the olefinic structure of SIS copolymers enhances the electric and thermal conductivity, leading to enhanced electrothermal performance of prototype heaters compared to that of the hydrogenated copolymer.

Monthly sampling reveals seasonal fine sediment fluctuations and riverine invertebrate community responses

Managing the impacts of anthropogenically enhanced deposited fine sediment levels in lotic ecosystems requires understanding of how catchment land-use changes have altered the natural sediment regime (erosion, transport, deposition) of rivers. Unfortunately, no existing studies have employed an appropriate sampling frequency over a period encompassing the full range of seasonal flow conditions expected to influence in-stream sediment dynamics. We determined the short-term (monthly) dynamics of deposited fine sediment and invertebrate communities over 12-months in 15 fourth- and fifth-order rivers draining catchments of low, medium and high land-use intensity in Southland, New Zealand to determine when and where fine sediment threatens stream health. We compared the Quorer resuspension method (suspendable inorganic sediment, SIS) and the in-stream visual sediment cover assessment method, and evaluated the effectiveness of four commonly-used invertebrate stream health metrics against their newly developed sediment-specific counterparts. Monthly variability in SIS was substantial across all land-use categories, but became more pronounced as land-use intensity increased. All 15 sites experienced a prolonged period of relatively stable flow which coincided with the largest short-term increase in SIS at 14 of the 15 sites. However, variability in SIS was not mirrored in macroinvertebrate metrics. These findings suggest that controlling inputs of fine sediment to rivers and streams will be most effective when targeted at periods of prolonged stable flow, particularly within high land-use intensity catchments. The resuspension method consistently outperformed visual estimates when considering its relationship with macroinvertebrate metrics, while sediment-specific metrics demonstrated a stronger association with fine sediment than commonly employed metrics e.g. (%EPT). We conclude that restoration/mitigation practices cannot be based solely on short-term, or even long-term, reductions in fine sediment, or on physical measures alone, but should be based on long-term recoveries of sediment-impacted invertebrate communities using concurrent measurements of both biotic and abiotic conditions.

Minerals and fatty acid profile of small indigenous fish species from homestead ponds within a Sub-tropical coastal region

Malnutrition has emerged as a noticeable obstruction to the socio-economic advancement of rural areas along the coastal regions of Bangladesh. Small indigenous fish species (SIS) have the potential to alleviate the malnutrition issue because of having higher nutritional compositions. However, prior research has overlooked the detailed nutritional value of SIS originating from coastal regions. Consequently, the current investigation sought to analyze the mineral and fatty acid composition of twelve SIS obtained from coastal homestead ponds. The findings indicated that the mineral composition in SIS exhibited the following descending order: calcium (Ca) > phosphorus (P) > potassium (K) > magnesium (Mg) > iron (Fe) > zinc (Zn). Furthermore, when considering the overall mineral content in SIS, it ranked in the following decreasing order: A. testudineus, M. tengara, C. punctatus, N. nandus, P. sophore, C. fasciatus, A. mola, C. batrachus, H. fossilis, P. sarana, M. aculeatus, and O. pabda. The analysis of the fatty acid profile further revealed that SIS is a rich source of palmitic acid, linoleic acid, oleic acid, stearic acid, myristic acid, palmitoleic acid, and linolenic acid. The saturated fatty acid content of the SIS varied between 42.66 % and 63.37 %, and the highest content was found in A. mola whereas the lowest was in A. testudineus. On the other hand, the total monounsaturated fatty acid content of the SIS ranged from 26.49 % (A. mola) to 46.12 % (P. sarana), and the total PUFAs contents among the fish species ranged from 5.7 % (A. mola) to 16.54 % (H. fossilis). Therefore, SIS could be a key source of minerals and essential fatty acids for human well-being. This can help fulfill nutrient requirements and reduce malnutrition among coastal populations. It can be said that, if these fishes are introduced in the culture systems, it will be used for consumption as well as support the livelihood of coastal people.

Asymmetric adhesive SIS-based wound dressings for therapeutically targeting wound repair

Severe tissue injuries pose a significant risk to human health. Conventional wound dressings fall short in achieving effective tissue regeneration, resulting in suboptimal postoperative healing outcomes. In this study, an asymmetric adhesive wound dressing (marked as SIS/PAA/LAP) was developed, originating from acrylate acid (AA) solution with laponite (LAP) nanoparticles polymerization and photo-crosslinked on the decellularized extracellular matrix small intestinal submucosa (SIS) patch. Extensive studies demonstrated that the SIS/PAA/LAP exhibited higher tissue adhesion strength (~ 33 kPa) and burst strength (~ 22 kPa) compared to conventional wound dressings like Tegaderm and tissue adhesive products. Importantly, it maintained favorable cell viability and demonstrated robust angiogenic capacity. In animal models of full-thickness skin injuries in rats and skin injuries in Bama miniature pigs, the SIS/PAA/LAP could be precisely applied to wound sites. By accelerating the formation of tissue vascularization, it displayed superior tissue repair outcomes. This asymmetrically adhesive SIS-based patch would hold promising applications in the field of wound dressings.

Prognostic Value of Systemic Inflammation Score for Esophageal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-Analysis

OBJECTIVE

The link between inflammation and cancer survival has been the subject of substantial research. The goal of this review is to summarize the evidence on the prognostic value of systemic inflammation score (SIS) in esophageal cancer patients undergoing surgical intervention.

METHODS

PubMed, Scopus, Embase, and Web of Science were searched for relevant articles published until 30^th June 2022. We pooled adjusted data on overall survival (OS) and disease-free survival (DFS) using a random-effects meta-analysis model. The review was pre-registered on PROSPER (No. CRD42022340717).

RESULTS

Eight studies were included. All studies were conducted either in China or Japan. Six studies showed that patients with SIS of 1-2 had poor OS as compared to those with scores of 0 (HR:1.42 95% CI: 1.24, 1.62 I²=25%). SIS of 1 (HR:1.45 95% CI: 1.18, 1.78 I²=0%) and 2 (HR:1.94 95% CI: 1.49, 2.53 I²=0%) were also associated with poor OS. Two studies compared the SIS score of 2 vs 0-1. Meta-analysis indicated that poor OS was associated with SIS of 2 (HR:1.80 95% CI: 1.25, 2.58). Data from three studies showed that the SIS score did not predict DFS (HR:1.40 95% CI: 0.82, 2.39 I²=91%).

CONCLUSION

SIS can be a novel prognostic indicator for esophageal cancer patients undergoing surgical intervention. Higher SIS is associated with a poor OS, but it does not predict DFS. Future studies are needed to strengthen the current evidence.

Single-Cell Detection of Erwinia amylovora Using Bio-Functionalized SIS Sensor

Herein, we developed a bio-functionalized solution-immersed silicon (SIS) sensor at the single-cell level to identify Erwinia amylovora (E. amylovora), a highly infectious bacterial pathogen responsible for fire blight, which is notorious for its rapid spread and destructive impact on apple and pear orchards. This method allows for ultra-sensitive measurements without pre-amplification or labeling compared to conventional methods. To detect a single cell of E. amylovora, we used Lipopolysaccharide Transporter E (LptE), which is involved in the assembly of lipopolysaccharide (LPS) at the surface of the outer membrane of E. amylovora, as a capture agent. We confirmed that LptE interacts with E. amylovora via LPS through in-house ELISA analysis, then used it to construct the sensor chip by immobilizing the capture molecule on the sensor surface modified with 3'-Aminopropyl triethoxysilane (APTES) and glutaraldehyde (GA). The LptE-based SIS sensor exhibited the sensitive and specific detection of the target bacterial cell in real time. The dose-response curve shows a linearity (R2 > 0.992) with wide dynamic ranges from 1 to 107 cells/mL for the target bacterial pathogen. The sensor showed the value change (dΨ) of approximately 0.008° for growing overlayer thickness induced from a single-cell E. amylovora, while no change in the control bacterial cell (Bacillus subtilis) was observed, or negligible change, if any. Furthermore, the bacterial sensor demonstrated a potential for the continuous detection of E. amylovora through simple surface regeneration, enabling its reusability. Taken together, our system has the potential to be applied in fields where early symptoms are not observed and where single-cell or ultra-sensitive detection is required, such as plant bacterial pathogen detection, foodborne pathogen monitoring and analysis, and pathogenic microbial diagnosis.

Star-Shaped Thermoplastic Elastomers Prepared via RAFT Polymerization

Styrene-based thermoplastic elastomers (TPEs) demonstrate excellent overall performance and account for the largest industrial output. The traditional methods of preparation styrene-based thermoplastic elastomers mainly focused on anionic polymerization, and strict equipment conditions were required. In recent years, controlled/living radical polymerization (CRP) has developed rapidly, enabling the synthesis of polymers with various complex topologies while controlling their molecular weight. Herein, a series of core crosslinked star-shaped poly(styrene-b-isoprene-b-styrene)s (SISs) was synthesized for the first time via reversible addition-fragmentation chain transfer (RAFT) polymerization. Meanwhile, linear triblock SISs with a similar molecular weight were synthesized as a control. We achieved not only the controlled/living radical polymerization of isoprene but also investigated the factors influencing the star-forming process. By testing the mechanical and thermal properties and characterizing the microscopic fractional phase structure, we found that both the linear and star-shaped SISs possessed good tensile properties and a certain phase separation structure, demonstrating the characteristics of thermoplastic elastomers.

Functional Law of Large Numbers and PDEs for Epidemic Models with Infection-Age Dependent Infectivity

We study epidemic models where the infectivity of each individual is a random function of the infection age (the elapsed time since infection). To describe the epidemic evolution dynamics, we use a stochastic process that tracks the number of individuals at each time that have been infected for less than or equal to a certain amount of time, together with the aggregate infectivity process. We establish the functional law of large numbers (FLLN) for the stochastic processes that describe the epidemic dynamics. The limits are described by a set of deterministic Volterra-type integral equations, which has a further characterization using PDEs under some regularity conditions. The solutions are characterized with boundary conditions that are given by a system of Volterra equations. We also characterize the equilibrium points for the PDEs in the SIS model with infection-age dependent infectivity. To establish the FLLNs, we employ a useful criterion for weak convergence for the two-parameter processes together with useful representations for the relevant processes via Poisson random measures.

Silk fibroin bioscaffold from Bombyx mori and Antheraea assamensis elicits a distinct host response and macrophage activation paradigm in vivo and in vitro

Biomaterials composed of silk fibroin from both mulberry and non-mulberry silkworm varieties have been investigated for their utility in tissue engineering and drug delivery, but these studies have largely excluded any evaluation of host immune response. The present study compares the macrophage activation response towards mulberry (Bombyx mori, BM) and non-mulberry (Antheraea assamensis, AA) silk types, individually and as a blend (BA) in a partial thickness rat abdominal wall defect model and in vitro primary murine bone marrow-derived macrophage (BMDM) assay. Biologic materials composed of liver extracellular matrix (LECM) and small intestinal submucosa (SIS) ECM that are recognized for constructive tissue remodeling, and polypropylene mesh that is associated with pro-inflammatory macrophage phenotype activation are used as controls in the animal model. The AA silk graft shows a host response similar to SIS with few foreign body multinucleate giant cells, vascularization, high CD206 expression, and high M2-like: M1-like macrophage phenotype ratio. Exposure to AA silk degradation products in vitro induces a higher arginase: iNOS ratio in both naive BMDM and pro-inflammatory activated BMDM; and higher Fizz1: iNOS ratio in pro-inflammatory activated BMDM. These data suggest that the AA silk supports a pro-remodeling macrophage response with potential therapeutic applications.

The moderating role of caregiver preparedness on the relationship between depression and stroke-specific quality of life in stroke dyads: a longitudinal study

AIMS

To examine the moderating role of caregiver preparedness on the association between stroke survivors' depression and stroke-specific quality of life dimensions.

METHODS AND RESULTS

We used a multilevel modelling approach to analyse trajectories of change in the eight Stroke Impact Scale 3.0 subscales [i.e. strength, communication, mobility, activities of daily living (ADL)/instrumental activities of daily living (IADL), memory, emotion, hand function, participation] using Hierarchical Linear Modeling. Caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor communication (B = -0.95, P < 0.01), mobility (B = -0.60, P < 0.05), and ADL/IADL (B = -0.73, P < 0.01) at baseline; linear change for strength (B = 0.83, P < 0.05) and communication (B = 0.66, P < 0.05); and quadratic change for strength (B = -0.19, P < 0.01). Although caregiver preparedness did not significantly moderate the association between survivor depressive symptoms and strength at baseline, there was a significant moderating effect for change over time. Higher levels of caregiver preparedness were significantly associated with higher survivor scores of emotion, hand function, and participation at baseline.

CONCLUSIONS

Including immediate caregivers in the care process, through a psycho-educational training, would mean having better-prepared caregivers and consequently more-healthy stroke survivors. Given that preparedness includes coping with stress, responding and managing emergencies, assessing help and information may require tailored interventions aimed at improving the caregivers' skills and knowledge about stroke survivors' management.

Small intestinal submucosa-derived extracellular matrix as a heterotopic scaffold for cardiovascular applications

Structural cardiac lesions are often surgically repaired using prosthetic patches, which can be biological or synthetic. In the current clinical scenario, biological patches derived from the decellularization of a xenogeneic scaffold are gaining more interest as they maintain the natural architecture of the extracellular matrix (ECM) after the removal of the native cells and remnants. Once implanted in the host, these patches can induce tissue regeneration and repair, encouraging angiogenesis, migration, proliferation, and host cell differentiation. Lastly, decellularized xenogeneic patches undergo cell repopulation, thus reducing host immuno-mediated response against the graft and preventing device failure. Porcine small intestinal submucosa (pSIS) showed such properties in alternative clinical scenarios. Specifically, the US FDA approved its use in humans for urogenital procedures such as hernia repair, cystoplasties, ureteral reconstructions, stress incontinence, Peyronie's disease, penile chordee, and even urethral reconstruction for hypospadias and strictures. In addition, it has also been successfully used for skeletal muscle tissue reconstruction in young patients. However, for cardiovascular applications, the results are controversial. In this study, we aimed to validate our decellularization protocol for SIS, which is based on the use of Tergitol 15 S 9, by comparing it to our previous and efficient method (Triton X 100), which is not more available in the market. For both treatments, we evaluated the preservation of the ECM ultrastructure, biomechanical features, biocompatibility, and final bioinductive capabilities. The overall analysis shows that the SIS tissue is macroscopically distinguishable into two regions, one smooth and one wrinkle, equivalent to the ultrastructure and biochemical and proteomic profile. Furthermore, Tergitol 15 S 9 treatment does not modify tissue biomechanics, resulting in comparable to the native one and confirming the superior preservation of the collagen fibers. In summary, the present study showed that the SIS decellularized with Tergitol 15 S 9 guarantees higher performances, compared to the Triton X 100 method, in all the explored fields and for both SIS regions: smooth and wrinkle.

Investigation on Some Algal Extracts as Appropriate Stabilizers for Radiation-Processed Polymers

This study presents the appropriate solution, algal extracts, for the improvement of polymer durability when the material is subjected to acute oxidation damage. The investigated support, styrene-isoprene-styrene (SIS), is modified by three algal extracts: Chlorella vulgaris, Spirulina platensis, and Ascophyllum nodosum (Kelp) with a low concentration (1 wt%). The presence of polyhedral oligomeric silsesquioxane (POSS) ensures the growth of stability with respect to the pristine polymer. The thermal performances of the host polymer, indicated by chemiluminescence, reveal the essential contribution of an additive to the improvement in oxidation strength. The stability of the polymer adjusted by algal extracts is proved by the activation energy values, which increase from 49 kJ mol^-1 to 89 kJ mol^-1 for the same polymer modified with Ascophyllum nodosum. This main important characteristic is the consequence of the highly efficient activity of the polyphenol components of algal extracts and the effect of the three natural additives on the favorably changed kinetic parameters (oxidation induction time and onset oxidation temperature). The exposure of the polymer matrix to the damaging action of γ-rays does not affect the proper contributions to the fast delay in material ageing. The irradiation of 100 kGy, a usual technological dose, may be successfully applied in the radiation processing of a polymer stabilized with algal extracts due to the efficient protection of the additive as the chain-breaking agents.

Prognostic Value of the Perioperative Systemic Inflammation Score for Patients With Curatively Resected Gastric Cancer

BACKGROUND/AIM

The systemic inflammation score (SIS) is a promising tool for the evaluation of prognosis. The present study aimed to evaluate the clinical impact of the preoperative SIS status in gastric cancer (GC) patients who underwent curative resection.

PATIENTS AND METHODS

This study retrospectively analyzed 258 patients with primary gastric cancer who received curative treatment at Yokohama City University. The SIS was evaluated before surgery as determined by the lymphocyte-to-monocyte ratio (cut-off value=4.44) and serum albumin level (cut-off value=4.0 g/dl).

RESULTS

A high SIS was identified as an independent predictor of overall survival [hazard ratio (HR)=1.784, p<0.05] and multivariate analysis showed marginal significance for recurrence-free survival (HR=1.710, p<0.05).

CONCLUSION

The preoperative SIS score was correlated with both the OS and RFS of GC patients, as well as the clinical course of adjuvant chemotherapy. Thus, the SIS score is a promising prognostic factor for GC.

Pandemic effects in the Solow growth model

We show how diseases can affect economic growth in a Solow growth model, with population growth and no technical progress, but modified to include a saving rate that depends on the individual health status. We successively insert this model into the SIS (susceptible-infected-susceptible) and SIR (susceptible-infected-recovered) models of disease spreading. In these two models, the spread of the infection proceeds according to the so-called basic reproductive number. This number determines in which of the two possible equilibria, the disease-free or the pandemic equilibrium, the economy ends. We show that output per capita is always lower in the pandemic steady state, which implies a contraction in the economy's production possibilities frontier.

High-Dimensional Mediation Analysis Based on Additive Hazards Model for Survival Data

Mediation analysis has been extensively used to identify potential pathways between exposure and outcome. However, the analytical methods of high-dimensional mediation analysis for survival data are still yet to be promoted, especially for non-Cox model approaches. We propose a procedure including "two-step" variable selection and indirect effect estimation for the additive hazards model with high-dimensional mediators. We first apply sure independence screening and smoothly clipped absolute deviation regularization to select mediators. Then we use the Sobel test and the BH method for indirect effect hypothesis testing. Simulation results demonstrate its good performance with a higher true-positive rate and accuracy, as well as a lower false-positive rate. We apply the proposed procedure to analyze DNA methylation markers mediating smoking and survival time of lung cancer patients in a TCGA (The Cancer Genome Atlas) cohort study. The real data application identifies four mediate CpGs, three of which are newly found.

The social instability stress paradigm in rat and mouse: A systematic review of protocols, limitations, and recommendations

BACKGROUND

Social stress is an important environmental risk factor for the development of psychiatric disorders, including depression and anxiety disorders. Social stress paradigms are commonly used in rats and mice to gain insight into the pathogenesis of these disorders. The social instability stress (SIS) paradigm entails frequent (up to several times a week) introduction of one or multiple unfamiliar same-sex home-cage partners. The subsequent recurring formation of a new social hierarchy results in chronic and unpredictable physical and social stress.

PURPOSE

We compare and discuss the stress-related behavioral and physiological impact of SIS protocols in rat and mouse, and address limitations due to protocol variability. We further provide practical recommendations to optimize reproducibility of SIS protocols.

METHODS

We conducted a systematic review in accordance with the PRISMA statement in the following three databases: PubMed, Web of Science and Scopus. Our search strategy was not restricted to year of publication but was limited to articles in English that were published in peer-reviewed journals. Search terms included "social* instab*" AND ("animal" OR "rodent" OR "rat*" OR "mice" OR "mouse").

RESULTS

Thirty-three studies met our inclusion criteria. Fifteen articles used a SIS protocol in which the composition of two cage mates is altered daily for sixteen days (SIS16D). Eleven articles used a SIS protocol in which the composition of four cage mates is altered twice per week for 49 days (SIS49D). The remaining seven studies used SIS protocols that differed from these two protocols in experiment duration or cage mate quantity. Behavioral impact of SIS was primarily assessed by quantifying depressive-like, anxiety-like, social-, and cognitive behavior. Physiological impact of SIS was primarily assessed using metabolic parameters, hypothalamus-pituitary-adrenal axis activity, and the assessment of neurobiological parameters such as neuroplasticity and neurogenesis.

CONCLUSION

Both shorter and longer SIS protocols induce a wide range of stress-related behavioral and physiological impairments that are relevant for the pathophysiology of depression and anxiety disorders. To date, SIS16D has only been reported in rats, whereas SIS49D has only been reported in mice. Given this species-specific application as well as variability in reported SIS protocols, additional studies should determine whether SIS effects are protocol duration- or species-specific. We address several issues, including a lack of consistency in the used SIS protocols, and suggest practical, concrete improvements in design and reporting of SIS protocols to increase standardization and reproducibility of this etiologically relevant preclinical model of social stress.

Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging

BACKGROUND AND AIMS

Cardiac computed tomographic angiography (CCTA) - derived measures of coronary artery disease (CAD) burden have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a cohort with high prevalence of risk factors undergoing both tests.

METHODS

Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Stenosis severity and segment involvement score (SIS - number of segments with plaque irrespective of stenosis) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) RESULTS: A total of 956 patients were included (mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥50%, all other coronary segments ≥70%) and ischemia were observed in a similar number of patients (14%). In multivariable Cox regression models, SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.15, p ≤ 0.001; Harrel's C 0.74, p = 0.008) and SPECT ischemia (HR 1.14, p < 0.001; Harrel's C 0.76, p = 0.019).

CONCLUSIONS

Our results suggest that in patients with suspected CAD and a high prevalence of risk-factors, plaque burden adds incremental prognostic value over established CCTA and SPECT measures to predict incident cardiovascular outcomes.

Prognostic significance of systemic inflammation score in patients who undergo hepatic resection for hepatocellular carcinoma

PURPOSE

Systemic inflammation score (SIS) is a novel prognostic score (0, 1, or 2) for various cancers, based on preoperative serum albumin level and lymphocyte-to-monocyte ratio (LMR); modified SIS (mSIS) uses a different LMR cutoff value and was thought to be a more accurate predictor for cancer prognosis. Here, we assessed the prognostic value of SIS and mSIS in patients who receive hepatic resection for hepatocellular carcinoma (HCC).

METHODS

We retrospectively evaluated SIS and mSIS of 314 patients after hepatic resection for HCC, against their clinicopathological factors and outcomes, using receiver operating characteristics (ROC) analysis over time.

RESULTS

Among patients with preoperative SIS 2, significantly more HCC specimens were poorly differentiated (P = 0.0281), larger (P = 0.0006), and had more microscopic vascular invasion (P = 0.0136) than the SIS 0-1 group; the mSIS 2 group also had significantly larger tumors (P = 0.0039) than the mSIS 0-1 group. In ROC analysis, SIS was a better predictor of overall survival (OS) and recurrence-free survival (RFS) than mSIS. The SIS 2 group had shorter OS (P = 0.0015) and RFS (P = 0.0065) than other patients. In multivariate analysis, SIS 2 was an independent risk factor for shorter OS (hazard ratio (HR) 1.53, P = 0.0497) and RFS (HR 1.58, P = 0.0053).

CONCLUSION

SIS is superior to mSIS in predicting prognosis of patients with HCC. mSIS is not a great predictor of prognosis in resected HCC.

The Prognostic Prediction Value of Systemic Inflammation Score and the Development of a Nomogram for Patients With Surgically Treated Breast Cancer

Background: Systemic inflammation score (SIS) has been verified as a novel prognostic indicator in several cancer types. However, its prognostic value in breast cancer remains unknown. Furthermore, a nomogram based on SIS is yet to be constructed for breast cancer. We conducted this study to explore the association between SIS and prognosis of breast cancer, and to construct a good prognostic nomogram model. Methods: A total of 1,180 breast cancer patients who underwent curative surgery between December 2010 and January 2013 were recruited. They were randomly assigned to the training set (n = 944) or the validation set (n = 236). All patient blood samples were collected within 1 week prior to operation. According to previous reports, SIS was calculated for all patients, who were then classified into two groups: high-SIS and low-SIS. The Kaplan-Meier method was employed for survival analyses, and univariate and multivariate analyses (Cox proportional hazards regression model) were used for prognostic assessment. A nomogram was constructed based on the results of multivariate analysis. Calibration curves and concordance index (C-index) were compiled to determine predictive and discriminatory capacity. Results: In the training set, the median follow-up time was 6.07 years. Patients in the high-SIS group had an average OS time of 68.05 months, which is shorter than that of the low-SIS group (72.87 months; P = 0.033). Patients in the high-SIS group had average RFS and DMFS times of 56.04 and 54.46 months, respectively, which are shorter than those of the low-SIS group (60.85 and 59.47 months, respectively; P = 0.247 and P = 0.032). Univariate and multivariate analyses revealed SIS to be an independent prognostic factor for OS and DMFS time. The nomogram for the training set indicated OS and DMFS C-indexes of 0.794 (95% CI, 0.772-0.816) and 0.712 (95% CI, 0.684-0.740), respectively. In the validation set, the OS and DMFS C-indexes were 0.889 (95% CI, 0.845-0.933) and 0.696 (95%. CI, 0.611-0.781), respectively. Conclusions: SIS was confirmed as an independent prognostic predictor among patients with breast cancer who had undergone surgery with curative intent. Higher preoperative SIS may indicate higher risk of metastasis and shorter overall survival time. The prognostic nomogram based on SIS was dependable for breast cancer patients who underwent curative surgery.

Differences in the support needs of children with developmental disabilities among groups of medical and behavioral needs

Background/Aims

Medical and behavioral needs are relevant in organizing and providing support strategies that improve the quality of life for children, along with their families. The present study aims to examine the impact of medical and behavioral needs on the need for support of children with disabilities.

Methods

Health and education professionals were interviewed using the Supports Intensity Scale-Children’s version to estimate the support needs of 911 children and adolescents (5–16 years) with an intellectual disability, including 55.32% with an additional disability. For data analysis, a model for measuring support needs was specified, consisting of seven support needs factors and three method factors. In estimating the model, four groups of medical and behavioral needs were considered. The factor scores’ means of the groups were compared through t-tests.

Results

Medical and behavioral needs had an impact on overall support needs. Differences were found in all support domains for medical needs. The greatest influence of behavioral needs was found in the Social and School participation areas but was indistinguishable between the mild and moderate levels of needs.

Conclusions

Medical and behavioral needs greatly affect the need for support in a child’s daily life, so they need to be considered a priority for support services. The importance of standardized assessments is emphasized to help develop support strategies.

Effects of Thoracic Mobilization and Extension Exercise on Thoracic Alignment and Shoulder Function in Patients with Subacromial Impingement Syndrome: A Randomized Controlled Pilot Study

Introduction: Thoracic kyphosis commonly occurs in subacromial impingement syndrome. This pilot study investigated the effect of thoracic joint mobilization and extension exercise on improving thoracic alignment and shoulder function. Methods: In total, 30 patients with subacromial impingement syndrome were recruited and randomly assigned to three groups, the joint mobilization group (n = 10), exercise group (n = 10), and combination group (n = 10). After four weeks of treatment, the measured outcomes included thoracic kyphosis using a manual inclinometer; pectoralis major (PM) and upper trapezius (UT) muscle tone and stiffness using the MyotonPRO^®; affected side passive range of motion (ROM) using the goniometer (flexion, abduction, medial rotation, and lateral rotation); and shoulder pain and disability index (SPADI). Results: All three groups had significant improvements in all variables (p < 0.05). Thoracic kyphosis; UT muscle tone; and flexion, medial rotation, and lateral rotation ROM and SPADI were all significantly improved in the combination group compared to the mobilization and exercise groups (p < 0.05). Conclusions: The combination therapy of thoracic mobilization and extension exercise can be regarded as a promising method to improve thoracic alignment and shoulder function in patients with subacromial impingement syndrome.

Novel extra cellular-like matrices to improve human ovarian grafting

PURPOSE

To investigate if human ovarian grafting with pure virgin human recombinant collagen type-1 from bioengineered plant lines (CollPlant™) or small intestine submucosa (SIS) yields better implantation results for human ovarian tissue and which method benefits more when combined with the host melatonin treatment and graft incubation with biological glue + vitamin E + vascular endothelial growth factor-A.

METHODS

Human ovarian tissue wrapped in CollPlant or SIS was transplanted into immunodeficient mice with/without host/graft treatment. The tissue was assessed by follicle counts (including atretic), for apoptosis evaluation by terminal deoxynucleotidyl transferase assay and for immunohistochemical evaluation of neovascularization by platelet endothelial cell adhesion molecule (PECAM) expression, and for identification of proliferating granulosa cells by Ki67 expression.

RESULTS

Human ovarian tissue transplanted with CollPlant or SIS fused with the surrounding tissue and promoted neovascularization. In general, implantation with CollPlant even without additives promoted better results than with SIS: significantly higher number of recovered follicles, significantly fewer atretic follicles, and significantly more granulosa cell proliferation. Moreover, results with CollPlant alone seemed to be at least as good as those after host and graft treatments.

CONCLUSIONS

CollPlant is a biomaterial without any potential risks, and grafting ovarian tissue with CollPlant is easy and the procedure may be easily modified, with limited or no foreseeable risks, for auto-transplantation in cancer survivors. Further studies are needed using other novel methods capable of enhancing neovascularization and reducing apoptosis and follicle atresia.

Compartmental Models of the COVID-19 Pandemic for Physicians and Physician-Scientists

As the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads globally, physicians and physician-scientists are confronted with an enlarging body of literature about the nature of this pandemic. Understanding the current epidemiological models for disease spread, mortality, and recovery is more important than ever before. One of the most relevant mathematical models relating to the spread of a pandemic is the susceptible-infectious-removed (SIR) model. Other models worth exploring are the susceptible-exposed-infectious-removed (SEIR) and the susceptible-unquarantined-quarantined-confirmed (SUQC) model.

Cellular damage, including wounding, drives C. elegans stress-induced sleep

Across animal phyla, sleep is associated with increased cellular repair, suggesting that cellular damage may be a core component of sleep pressure. In support of this notion, sleep in the nematode Caenorhabditis elegans can be triggered by damaging conditions, including noxious heat, high salt, and ultraviolet light exposure. It is not clear, however, whether this stress-induced sleep (SIS) is a direct consequence of cellular damage, or of a resulting energy deficit, or whether it is triggered simply by the sensation of noxious conditions. Here, we show that thermosensation is dispensable for heat-induced sleep, that osmosensation is dispensable for salt-induced sleep, and that wounding is also a sleep trigger, together indicating that SIS is not triggered by sensation of noxious environments. We present evidence that genetic variation in cellular repair pathways impacts sleep amount, and that SIS involves systemic monitoring of cellular damage. We show that the low-energy sensor AMP-activated protein kinase (AMPK) is not required for SIS, suggesting that energy deficit is not the primary sleep trigger. Instead, AMPK-deficient animals display enhanced SIS responses, and pharmacological activation of AMPK reduces SIS, suggesting that ATP-dependent repair of cellular damage mitigates sleep pressure.

A Study on Herd Immunity of COVID-19 in South Korea: Using a Stochastic Economic-Epidemiological Model

Vaccination is an effective measure to control the diffusion of infectious disease such as COVID-19. This paper analyzes the basic reproduction number in South Korea which enables us to identify a necessary level of vaccine stockpile to achieve herd immunity. An susceptible-infected-susceptible model is adopted that allows a stochastic diffusion. The result shows that the basic reproduction number of South Korea is approximately 2 which is substantially lower than those of the other regions. The herd immunity calculated from economic-epidemiological model suggests that at least 62% of the susceptible population be vaccinated when COVID-19 vaccine becomes available.

Assessing support needs in children with intellectual disability and motor impairments: measurement invariance and group differences

BACKGROUND

This study assessed the equivalence of the measurement of support needs between children with intellectual disability (ID) and children with intellectual and motor disabilities (IMD) and compared both groups in the different domains of support.

METHOD

The Supports Intensity Scale-Children's Version was used to assess the support needs of 713 children with ID and 286 children with IMD, mainly associated with cerebral palsy.

RESULTS

The results supported measurement invariance between the group of ID and IMD, which allowed to conduct comparison between them. Children with IMD scored higher on support needs than did children without IMD, suggesting that children with IMD needed more support than their peers without motor impairments. Furthermore, the ID levels interacted with motor impairments: at the highest levels of ID, groups tended to be similar in support needs, with high scores and low variability. The greatest differences were found in the domains of Home and Community activities.

CONCLUSIONS

This study points to the across-condition of the construct of support needs in populations with intellectual and developmental disabilities. However, additional mobility impairments should be considered during the evaluation and planning of systems of support. In this regard, the Supports Intensity Scale-Children's Version might have limitations when discriminating between samples with high support needs.

Systemic inflammation score in locally advanced rectal cancer patients following total mesorectal excision

Objective

The objective of the study was to evaluate whether any association exists between systemic inflammation score (SIS) and adverse events (AEs) and survival of locally advanced rectal cancer patients treated with total mesorectal excision (TME) followed by adjuvant chemoradiotherapy.

Patients and methods

All of the 109 rectal cancer patients recruited between May 2008 and June 2015 were treated with TME followed by adjuvant chemoradiotherapy. The prognostic ability of SIS for overall survival (OS) was calculated by the receiver operating characteristic (ROC) curves.

Results

According to the classification of the SIS, 22 (20.2%), 59 (54.1%) and 28 (25.7%) patients were classified as a score of 2, 1 and 0, respectively. With an area under the curve (AUC) of 0.616, the SIS score of 1 was defined as the optimal cut-off value. Therefore, we divided the patients into the SIS-low group (SIS score of 1 or 0, n=87) and SIS-high group (SIS score of 2, n=22). Multivariate analysis indicated that SIS was associated with OS (HR 0.390, 95% CI 0.186–0.817, P=0.012). The 5-year OS rate in patients without adjuvant chemotherapy was lower than the patients with adjuvant chemotherapy (53.3% vs 75.8%, P=0.010). Multivariate analysis showed that adjuvant chemotherapy was associated with OS (HR 0.217, 95% CI 0.089–0.529, P=0.001). A marginal statistically significant difference was observed in terms of leukopenia during adjuvant chemoradiotherapy between the SIS-low group and the SIS-high group (P=0.05).

Conclusion

These results suggest that SIS might serve as an independent biomarker for predicting AEs and prognosis in locally advanced rectal cancer treated with TME followed by adjuvant chemoradiotherapy. Strengthening treatment may be administered to locally advanced rectal cancer with high SIS score obtained before adjuvant chemoradiotherapy.

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Systemic inflammation score is a prognostic marker after curative resection in gastric cancer

Background

The systemic inflammation score (SIS), as calculated from preoperative serum albumin level and lymphocyte‐to‐monocyte ratio, has been demonstrated to be a prognostic marker in cancer. The present study intended to investigate the prognostic role of SIS in gastric cancer patients after curative gastrectomy in comparison with other prognostic markers.

Methods

Preoperative SIS was retrospectively calculated in patients who underwent curative gastrectomy between 2007 and 2011 in Fudan University Shanghai Cancer Center. The prognostic accuracy of each score was compared utilizing time‐dependent receiver operating characteristics analysis.

Results

The higher SIS score was associated with older age, larger tumour size, a more advanced tumour‐nodes‐metastasis stage and lymph node status, deeper tumour invasion, the presence of lymphovascular invasion and a poorer overall survival and disease‐free survival. In time‐dependent receiver operating characteristics analysis, the SIS had a higher area under the curve for the prediction of 5‐year overall survival than the neutrophil lymphocyte ratio. The SIS maintained the predictive accuracy superiority throughout the observation period.

Conclusion

The SIS is a useful prognostic marker in gastric cancer patients after curative gastrectomy.

An extracellular matrix graft (Oasis® wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial

AIM

The purpose of the study was to evaluate clinical safety and effectiveness of Oasis^® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care.

METHODS

A total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures.

RESULTS

The proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037).

CONCLUSIONS

The results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone.

Development of xeno-free epithelial differentiation media for adherent, non-expanded adipose stromal vascular cell cultures

INTRODUCTION

Reconstruction of respiratory epithelium is critical for the fabrication of bioengineered airway implants. Epithelial differentiation is typically achieved using bovine pituitary extract (BPE). Due to the xenogenic nature and undefined composition of BPE, an alternative for human clinical applications, devoid of BPE, must be developed. The goal of this study was to develop two different BPE-free media, with and without select pituitary hormone (PH), which could initiate epithelial differentiation for use in human implantation.

METHODS

The ability of the two BPE-free media to initiate epithelial differentiation of adherent, non-expanded stromal-vascular cells grown on porcine small intestinal submucosa was compared to traditional BPE-containing media (M1). Nanostring^® was used to measure differences in gene expression of stemness (MSC), basal cell (basal), and ciliated markers (muco-cil), and staining was performed support the gene data.

RESULTS

Compared to baseline, both BPE-free media upregulated epithelial and stemness genes, however this was to a lower degree than BPE-containing media. In general, the expression of basal cell markers (COL17A1, DSG3, ITGA6, KRT6A, LOXL2) and secreted mucous proteins (PLUNC, MUC5B, SCGB2A1) was upregulated. The gene expression of ciliated markers C9orf24, TUBA3 and DNCL2B but not of the key transcription factor for cilagenesis FOXJ1 were upregulated, indicating that mucus-secreting cell differentiation occurs more rapidly than ciliogenesis. The ability of the adherent stromal vascular cells to upregulate gene expression of both epithelial and stemness markers suggests maintenance of the self-renewal capacity of undifferentiated and/or basal cell-like cells contributing to proliferation and ensuring a persisting source of cells for regenerative medicine applications.

CONCLUSION

This study provides the initial step to defining a BPE-free epithelial differentiation medium for clinical translation. Thus, either of the proposed BPE-free medium are viable alternatives to BPE-containing medium for partial epithelial differentiation for human translational applications.

Twenty-gene-based prognostic model predicts lung adenocarcinoma survival

Introduction

Lung adenocarcinoma (LAC) accounts for more than a half of non-small cell lung cancer with high morbidity and mortality. Progression of treatment has not accelerated the improvement of its prognosis. Hence, it is an urgent need to develop novel biomarkers for its early diagnosis and treatment.

Materials and methods

In this study, we proposed to identify LAC survival-related genes through comprehensive analysis of large-scale gene expression profiles. LAC gene expression data sets were obtained from The Cancer Genome Atlas (TCGA). Identification of differentially expressed genes (DEGs) in LAC compared with adjacent normal lung tissues was first performed followed by univariate Cox regression analysis to obtain genes that are significantly associated with LAC survival (SurGenes). Then, we conducted sure independence screening (SIS) for SurGenes to identify more reliable genes and the prognostic signature for LAC survival prediction. Another two lung cancer data sets from TCGA and Gene Expression Omnibus (GEO) were used for the validation of prognostic signature.

Results

A total of 20 genes were obtained, which were significantly associated with the overall survival (OS) of LAC patients. The prognostic signature, a weighted linear combination of the 20 genes, could successfully separate LAC samples with high OS from those with low OS and had robust predictive performance for survival (training set: p-value <2.2×10⁻¹⁶; testing set: p-value =2.04×10⁻⁵, area under the curve (AUC) =0.615). Combined with GEO data set, we obtained four genes, that is, FUT4, SLC25A42, IGFBP1, and KLHDC8B that are found in both the prognostic signature and DEGs of LAC in GEO data set.

Discussion

The prognostic signature combined with multi-gene expression profiles provides a moderate OS prediction for LAC and should be helpful for appropriate treatment method selection.

Mixing and diffusion in a two-type population

The outbreak of epidemics, the rise of religious radicalization or the motivational influence of fellow students in classrooms are some of the issues that can be described as diffusion processes in heterogeneous groups. Understanding the role that interaction patterns between groups (e.g. homophily or segregation) play in the diffusion of certain traits or behaviours is a major challenge for contemporary societies. Here, we study the impact on diffusion processes of mixing (or, alternatively, segregating) two groups that present different sensitivities or propensities to contagion. We find non-monotonic effects of mixing and inefficient segregation levels, i.e. situations where a change in the mixing level can benefit both groups, e.g. where an increase in the mixing level can reduce the expected contagion levels in both groups. These findings can have fundamental consequences for the design of inclusion policies.

Surface heparinization and blood compatibility modification of small intestinal submucosa (SIS) for small-caliber vascular regeneration

OBJECTIVES

This study aims to investigate the small intestinal submucosal (SIS) surface after heparinization with the hypothermia plasma technique, to improve the blood compatibility of SIS, and to explore the possibility of construction of small-caliber vascular grafts with modified SIS scaffolds in vivo.

METHODS

SIS films prepared from jejunums of pigs were processed for surface treatment at different time periods with the argon plasma initiation technique under vacuum, and were then immediately immersed in 4% (m/v) heparin sodium solution for 24-h heparinization. The surface morphologies of heparinized SIS were observed under a scanning electron microscope (SEM). The antithrombogenicity of the modified SIS films was tested by measuring the water contact angle, blood coagulation time, activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and observation of platelet adherence by SEM. Heparinized SIS films were sewn into a small caliber (3-mm) tube and implanted into the defect of a canine femur by anastomosis as a vascular graft. The efficiency of the SIS graft was evaluated according to the patency for the circulation of blood with Doppler color ultrasonography and hematoxylin-eosin staining.

RESULTS

Heparinized SIS showed a significantly different surface morphology compared with that of untreated SIS. The SIS surface resembles wrinkled film, but the heparinized SIS surface is uniformly coated with microdots, and appears to have a layer of heparin adhesion.

CONCLUSION

Heparin was attached to the SIS surface after hypothermia plasma treatment. Hydrophilicity and antithrombogenicity of heparinized SIS were clearly increased. The heparinized SIS vascular graft showed great potential for replacement of defective small-caliber vessels.

Comparative outcomes of combined corticosteroid with low volume compared to high volume of local anesthetic in subacromial injection for impingement syndrome: systematic review and meta-analysis of RCTs

Subacromial impingement syndrome (SIS) is one of the most frequent pathologies of the shoulder, which may cause serious restriction of daily activities and lifestyle changes. Corticosteroid injection (CI) into the subacromial space is a palliative treatment option. Currently, there have been no studies that compare between the different volumes of CI injection. We have conducted a systematic review and meta-analysis to answer our specific study questions: Are high volume (< 5 ml) better than low volume (≥ 5 ml) of CI injection with respect to pain reduction? This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Relevant studies were identified from Medline and Scopus from inception to May 11, 2017 that reported American shoulder and elbow surgeons (ASES) function score, pain visual analog score (VAS), and postoperative complications of either group. Fifteen studies were included for the analysis of high volume (more than or equal 5 ml), and 5 studies were included for analysis of low volume (less than 5 ml). Overall, there were 1101 patients (732 in the high-volume group and 369 in the low-volume group). A pooling of mean VAS and ASES function score was (N = 557) 2.02 (95% CI 1.52, 2.53), (N = 190) 82.59 (95% CI 76.92, 88.27) in high-volume group and (N = 179) 2.60 (95% CI 1.94, 3.26), (N = 95) 84.65 (95% CI 81.64, 86.82) in low-volume group, respectively. The unstandardized mean difference of ASES and VAS of high volume was - 0.58 (95% confidence interval (CI): - 1.38, 0.22) and - 2.06 (95% CI - 8.35, 4.23) scores lower than low-volume CI in SIS patients, but without statistical significance. A total of 11 studies in the high-volume group and 4 studies in the low-volume group reported adverse effects. The total complication rate per patient was 6.2% (2.3, 10.1%) in the high-volume group and 11.7% (0.3, 12%) in the low-volume group (p = 0.091). No significant differences were noted for complications. In subacromial impingement syndrome, the corticosteroid injection had acceptable pain and functional outcomes. Higher volume had a lower ASES, VAS, and risk of having complication when compared to lower volume. However, there are no statistically significant differences between groups. Larger, randomized noninferiority or equivalent trial studies are needed to confirm these findings as the current literature is still insufficient. Level of evidence I.

Association of Systemic Inflammation Score With Atrial Fibrillation: A Case-Control Study With Propensity Score Matching

BACKGROUND

Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). We developed a novel systemic inflammation score (SIS) based on integration of biomarkers used routinely in clinical settings. We aim to explore the association between SIS and AF.

METHODS

A matched case-control study with 376 pairs of AF cases and controls was performed using a propensity score matching system. The SIS was developed by integrating albumin (ALB), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio (LMR). Univariate and multivariate analyses were performed to examine the association of each marker and SIS with AF.

RESULTS

The conditional multivariate logistic regression analysis showed that elevated levels of ALB and LMR were significantly associated with decreased risk of AF with an OR of 0.74 (95% CI: 0.65, 0.85) and 0.73 (95% CI: 0.64, 0.83), respectively. Patients with elevated SIS had a significantly higher risk of AF. Compared to the patients with SIS equal to 1, the patients with SIS equal to 3 and 4 had an OR of 2.16 (95% CI: 1.40 3.32), and 2.55 (95% CI: 1.66, 3.92), respectively. The SIS was positively correlated with left atrial diameter and right atrial diameter in patients with AF.

CONCLUSIONS

In conclusion, this study provides further clinical epidemiological evidence that systemic inflammatory status was correlated with AF. The SIS, as an index to evaluate the intensity of systemic inflammatory status, could be useful for early prediction of AF development and understanding of AF mechanism.

Irritability in Huntington's Disease: Factor Analysis of Snaith's Irritability Scale

BACKGROUND

Elevated levels of irritability are reported to occur in a number of neurological conditions, including Huntington's disease (HD), a genetic neurodegenerative disorder. Snaith's Irritability Scale (SIS) is used within HD research, but no psychometric evaluation of this instrument has previously been undertaken. Therefore, the current study aimed to analyze the factor structure of this scale among an HD population.

METHODS

Exploratory and confirmatory factor analysis were used to examine the structural properties of SIS using responses from 1,264 HD gene expansion carriers, across 15 European countries, who were engaged in the REGISTRY 3 study.

RESULTS

An exploratory factor analysis of a subsample of the data suggested a two-factor interpretation of the data comprising "temper" and "self-harm." Eight possible models were tested for goodness of fit using confirmatory factor analysis. Two bifactor models, testing general and group factors in the structure of the scale, provided an equivocal "good" fit to the data. The first comprised a general irritability factor and two group factors (as originally proposed using SIS): outward irritability and inward irritability. The second comprised a general irritability factor and two group factors (as proposed by the exploratory factor analysis): temper and self-harm. The findings from both models suggested that the loadings of items were higher on the general factor.

CONCLUSIONS

Bifactor models are proposed to best consider the structure of the SIS, with findings suggesting that an overall score should be used to measure irritability within HD populations.

Bicentric prospective evaluation of corporoplasty with porcine small intestinal submucosa (SIS) in patients with severe Peyronie's disease

INTRODUCTION

Advanced Peyronie's disease (PD) with severe penile deviation demands grafting procedures following plaque incision or partial plaque excision in order to avoid penile shortening and to improve quality of life of affected patients. Small intestinal submucosa (SIS) is an established xenograft. The objective of the present study was to validate external results in a bicentric prospective manner.

METHODS

Patient selection criteria, surgical technique and standards for pre- and postoperative care were defined. Consecutively, patients with severe penile deviation in stable disease and sufficient erectile function were included between 2007 and 2015. After plaque incision, grafting was performed using SIS in a standardized manner. The postoperative evaluation using a non-validated questionnaire included complications, correction of curvature, pre- and postoperative erectile function, change in penile length and general satisfaction with the procedure.

RESULTS

Forty-three patients underwent surgery between 2007 and 2015. The mean degree of preoperative curvature was 73.8° (range 60-90°). No intraoperative or major postoperative complications were reported. After a mean follow-up of 33.0 months (range 10-59), complete straightening of the penis was achieved in 74.4%. 88.4% of all patients were able to achieve satisfying sexual intercourse (67.4% unaided, 21.0% with assistance). The IIEF-5 score was improved in 69.8% (mean improvement 4.0 points). Overall 86.0% were satisfied with the surgical treatment.

CONCLUSION

Corporoplasty with SIS in patients with PD and severe penile curvature is a safe approach and shows good long-term results. A thorough patient selection and a standardized pre-, intra- and postoperative procedure are decisive for a satisfying outcome.

Modeling epidemics on adaptively evolving networks: A data-mining perspective

The exploration of epidemic dynamics on dynamically evolving ("adaptive") networks poses nontrivial challenges to the modeler, such as the determination of a small number of informative statistics of the detailed network state (that is, a few "good observables") that usefully summarize the overall (macroscopic, systems-level) behavior. Obtaining reduced, small size accurate models in terms of these few statistical observables--that is, trying to coarse-grain the full network epidemic model to a small but useful macroscopic one--is even more daunting. Here we describe a data-based approach to solving the first challenge: the detection of a few informative collective observables of the detailed epidemic dynamics. This is accomplished through Diffusion Maps (DMAPS), a recently developed data-mining technique. We illustrate the approach through simulations of a simple mathematical model of epidemics on a network: a model known to exhibit complex temporal dynamics. We discuss potential extensions of the approach, as well as possible shortcomings.

Living scaffolds: surgical repair using scaffolds seeded with human adipose-derived stem cells. Hernia. 2016;20:161-170. [PMID: 26545361 DOI: 10.1007/s10029-015-1415-0]

BACKGROUND

Decellularized porcine small intestinal submucosa (SIS) is a biological scaffold used surgically for tissue repair. Here, we demonstrate a model of SIS as a scaffold for human adipose-derived stem cells (ASCs) in vitro and apply it in vivo in a rat ventral hernia repair model.

STUDY DESIGN

ASCs adherence was examined by confocal microscopy and proliferation rate was measured by growth curves. Multipotency of ASCs seeded onto SIS was tested using adipogenic, chondrogenic, and osteogenic induction media. For in vivo testing, midline abdominal musculofascial and peritoneal defects were created in Sprague-Dawley rats. Samples were evaluated for tensile strength, histopathology and immunohistochemistry.

RESULTS

All test groups showed cell adherence and proliferation on SIS. Fibronectin-treated scaffolds retained more cells than those treated with vehicle alone (p < 0.05). Fresh stromal vascular fraction (SVF) pellets containing ASCs were injected onto the SIS scaffold and showed similar results to cultured ASCs. Maintenance of multipotency on SIS was confirmed by lineage-specific markers and dyes. Histopathology revealed neovascularization and cell influx to ASC-seeded SIS samples following animal implantation. ASC-seeded SIS appeared to offer a stronger repair than plain SIS, but these results were not statistically significant. Immunohistochemistry showed continued presence of cells of human origin in ASC-seeded repairs at 1 month postoperation.

CONCLUSION

Pretreatment of the scaffold with fibronectin offers a method to increase cell adhesion and delivery. ASCs maintain their immunophenotype and ability to differentiate while on SIS. Seeding freshly isolated SVF onto the scaffold demonstrated that minimally manipulated cells may be useful for perioperative surgical applications within the OR suite. We have shown that this model for a "living mesh" can be successfully used in abdominal wall reconstruction.

Characterizing the Three-Dimensional Structure of Block Copolymers via Sequential Infiltration Synthesis and Scanning Transmission Electron Tomography

Understanding and controlling the three-dimensional structure of block copolymer (BCP) thin films is critical for utilizing these materials for sub-20 nm nanopatterning in semiconductor devices, as well as in membranes and solar cell applications. Combining an atomic layer deposition (ALD)-based technique for enhancing the contrast of BCPs in transmission electron microscopy (TEM) together with scanning TEM (STEM) tomography reveals and characterizes the three-dimensional structures of poly(styrene-block-methyl methacrylate) (PS-b-PMMA) thin films with great clarity. Sequential infiltration synthesis (SIS), a block-selective technique for growing inorganic materials in BCPs films in an ALD tool and an emerging technique for enhancing the etch contrast of BCPs, was harnessed to significantly enhance the high-angle scattering from the polar domains of BCP films in the TEM. The power of combining SIS and STEM tomography for three-dimensional (3D) characterization of BCP films was demonstrated with the following cases: self-assembled cylindrical, lamellar, and spherical PS-b-PMMA thin films. In all cases, STEM tomography has revealed 3D structures that were hidden underneath the surface, including (1) the 3D structure of defects in cylindrical and lamellar phases, (2) the nonperpendicular 3D surface of grain boundaries in the cylindrical phase, and (3) the 3D arrangement of spheres in body-centered-cubic (BCC) and hexagonal-closed-pack (HCP) morphologies in the spherical phase. The 3D data of the spherical morphologies was compared to coarse-grained simulations and assisted in validating the simulations' parameters. STEM tomography of SIS-treated BCP films enables the characterization of the exact structure used for pattern transfer and can lead to a better understating of the physics that is utilized in BCP lithography.

Generalizing PFD formulas of IEC 61508 for KooN configurations

Detailed formulas are given in IEC 61508 for calculating Probability of Failure on Demand for 1oo1, 1oo2, 2oo2, 2oo3 and 1oo3 systems. Simplified PFD formulas are also derived for general k-out-of-n combinations, without incorporating all the elements utilized in IEC 61508 formulas. While there have been other studies on IEC 61508 formulas and the simplified k-out-of-n equations, none have proposed an inclusive generalized form of IEC 61508 formulas to replicate all the specific combinations covered by the standard. This paper uses a detailed analysis to derive a generalized PFD formula based on IEC 61508.6-2011 that can be applied to all k-out-of-n combinations. The proposed formula is verified against both IEC 61508 and the simplified formulas, and its application is demonstrated by a real life example.

Evaluation of decellularization protocols for production of tubular small intestine submucosa scaffolds for use in oesophageal tissue engineering

Small intestine submucosa (SIS) has emerged as one of a number of naturally derived extracellular matrix (ECM) biomaterials currently in clinical use. In addition to clinical applications, ECM materials form the basis for a variety of approaches within tissue engineering research. In our preliminary work it was found that SIS can be consistently and reliably made into tubular scaffolds which confer certain potential advantages. Given that decellularization protocols for SIS are applied to sheet-form SIS, it was hypothesized that a tubular-form SIS would behave differently to pre-existing protocols. In this work, tubular SIS was produced and decellularized by the conventional peracetic acid-agitation method, peracetic acid under perfusion along with two commonly used detergent-perfusion protocols. The aim of this was to produce a tubular SIS that was both adequately decellularized and possessing the mechanical properties which would make it a suitable scaffold for oesophageal tissue engineering, which was one of the goals of this work. Analysis was carried out via mechanical tensile testing, DNA quantification, scanning electron and light microscopy, and a metabolic assay, which was used to give an indication of the biocompatibility of each decellularization method. Both peracetic acid protocols were shown to be unsuitable methods with the agitation-protocol-produced SIS, which was poorly decellularized, and the perfusion protocol resulted in poor mechanical properties. Both detergent-based protocols produced well-decellularized SIS, with no adverse mechanical effects; however, one protocol emerged, SDS/Triton X-100, which proved superior in both respects. However, this SIS showed reduced metabolic activity, and this cytotoxic effect was attributed to residual reagents. Consequently, the use of SIS produced using the detergent SD as the decellularization agent was deemed to be the most suitable, although the elimination of the DNase enzyme would give further improvement.

Epidemic control analysis: designing targeted intervention strategies against epidemics propagated on contact networks

In cases where there are limited resources for the eradication of an epidemic, or where we seek to minimise possible adverse impacts of interventions, it is essential to optimise the efficacy of control measures. We introduce a new approach, Epidemic Control Analysis (ECA), to design effective targeted intervention strategies to mitigate and control the propagation of infections across heterogeneous contact networks. We exemplify this methodology in the context of a newly developed individual-level deterministic Susceptible-Infectious-Susceptible (SIS) epidemiological model (we also briefly consider applications to Susceptible-Infectious-Removed (SIR) dynamics). This provides a flexible way to systematically determine the impact of interventions on endemic infections in the population. Individuals are ranked based on their influence on the level of infectivity. The highest-ranked individuals are prioritised for targeted intervention. Many previous intervention strategies have determined prioritisation based mainly on the position of individuals in the network, described by various local and global network centrality measures, and their chance of being infectious. Comparisons of the predictions of the proposed strategy with those of widely used targeted intervention programmes on various model and real-world networks reveal its efficiency and accuracy. It is demonstrated that targeting central individuals or individuals that have high infection probability is not always the best strategy. The importance of individuals is not determined by network structure alone, but can be highly dependent on the infection dynamics. This interplay between network structure and infection dynamics is effectively captured by ECA.

An engineered 3D human airway mucosa model based on an SIS scaffold

To investigate interrelations of human obligate airway pathogens, such as Bordetella pertussis, and their hosts test systems with high in vitro/in vivo correlation are of urgent need. Using a tissue engineering approach, we generated a 3D test system of the airway mucosa with human tracheobronchial epithelial cells (hTEC) and fibroblasts seeded on a clinically implemented biological scaffold. To investigate if hTEC display tumour-specific characteristics we analysed Raman spectra of hTEC and the adenocarcinoma cell line Calu-3. To establish optimal conditions for infection studies, we treated human native airway mucosa segments with B. pertussis. Samples were processed for morphologic analysis. Whereas our test system consisting of differentiated epithelial cells and migrating fibroblasts shows high in vitro/in vivo correlation, hTEC seeded on the scaffold as monocultures did not resemble the in vivo situation. Differences in Raman spectra of hTEC and Calu-3 were identified in distinct wave number ranges between 720 and 1662 cm(-1) indicating that hTEC do not display tumour-specific characteristics. Infection of native tissue with B. pertussis led to cytoplasmic vacuoles, damaged mitochondria and destroyed epithelial cells. Our test system is suitable for infection studies with human obligate airway pathogens by mimicking the physiological microenvironment of the human airway mucosa.

To Evaluate the Accuracy of Saline Infusion Sonohysterography (SIS) for Evaluation of Uterine Cavity Abnormalities in Patients with Abnormal Uterine Bleeding

OBJECTIVE

To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for detection of uterine cavity abnormalities in patients with abnormal uterine bleeding (AUB) taking hysteroscopy as the gold standard.

METHODS

This was a prospective study done in the department of Obstetrics and Gynecology of a tertiary care academic hospital. Sixty premenopausal and postmenopausal women who presented with AUB underwent TVS, SIS, and hysteroscopy. The presence of focal abnormality and the type of abnormality, i.e., polyp, submucous myoma, and endometrial hyperplasia, were noted. The results of TVS and SIS were compared with hysteroscopy.

RESULTS

On hysteroscopy, 76.67 % (n = 46) patients were diagnosed with intra cavity abnormalities. SIS showed sensitivity, specificity, PPV, and NPV of 89.1, 100, 100, and 73.7 %, respectively. In comparison, TVS showed sensitivity, specificity, PPV, and NPV of 43.48, 78.57, 86.96, and 29.73 %, respectively.

CONCLUSIONS

SIS was found to be more sensitive and specific than TVS in detection of intra cavity abnormalities.

First experience with the use of a collagen fistula plug to treat enterocutaneous fistulas

This report describes the authors' first experiences with the use of the Biodesign Enterocutaneous Fistula Plug (EFP). Six patients presented with intraperitoneal abscess and associated chronic bowel fistulas. The fistulas were treated by delivering an EFP by using radiologic guidance. The EFP placement procedure was successfully performed in all patients. All fistulas were closed within 2 weeks. Fistula recurrence occurred in two patients (33%) at 9 and 12 months after the procedure. One recurrence was associated with an adverse reaction to chemotherapy. The other was associated with the silicone flange migrating out of the bowel lumen. The Biodesign EFP offers a promising new approach for the treatment of enterocutaneous fistulas.

The low dose gamma ionising radiation impact upon cooperativity of androgen-specific proteins

The paper deals with effects of the ionising radiation (γ-IR, 0.5 Gy) upon serum testosterone (T), characteristics of testosterone-binding globulin (TeBG) and androgen receptor (AR) in parallel with observation of androgen (A) responsive enzyme activity - hexokinase (HK). The interdependence or relationships of T-levels with parameters of the proteins that provide androgenic regulation are consequently analyzed in post-IR dynamics. The IR-stress adjustment data reveal expediency of TeBG- and AR-cooperativity measurements for more precise assessments of endocrine A-control at appropriate emergencies.

Biochemical and biomechanical characterization of porcine small intestinal submucosa (SIS): a mini review

Porcine small intestinal submucosa (SIS [Oasis(®)]) is an acellular, biological extracellular matrix (ECM) that has been found to significantly improve the healing of difficult-to-heal or chronic wounds in humans. Like dermal ECM, SIS contains collagen, elastin, glycosaminoglycans, proteoglycans, and growth factors that play important roles in healing. Preclinical studies have shown that numerous cell types attach to SIS, proliferate and migrate into the matrix, and differentiate. In addition, SIS can reduce the activity of matrix metalloproteinases (MMPs)-endogenous proteolytic enzymes whose levels and activities are increased in chronic wounds. Compared to the original single-layer SIS, multi-layer SIS has stronger mechanical properties and is more slowly degraded in wounds. Together, these SIS products provide flexibility in the selection of biologically-active ECMs that may be useful for the repair of diverse wound types.

Using SPMDs to monitor the seawater concentrations of PAHs and PCBs in marine protected areas (Western Mediterranean)

Aqueous concentrations of individual polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) were determined in coastal sites of two marine protected areas (MPAs), that is, Asinara and the La Maddalena Archipelago, in Sardinia (Western Mediterranean Sea). The use of semi-permeable membrane devices (SPMDs) enabled the detection of dissolved PAHs and PCBs, even in very low concentrations of (pgL(-1)), in seawater. The results reveal significant differences between the two sampling areas relative to the concentration of the individual PAHs, which provide information concerning the pollution sources affecting relatively pristine environments. The PCBs were generally observed at levels below the detection limits of the utilised method.