Outcomes of Patients Transferred to Tertiary Care Centers for Treatment of Cardiogenic Shock: A Cardiogenic Shock Working Group Analysis.

BACKGROUND: Consensus recommendations for cardiogenic shock (CS) advise transfer of patients in need of advanced options beyond the capability of "spoke" centers to tertiary/"hub" centers with higher capabilities. However, outcomes associated with such transfers are largely unknown beyond those reported in individual health networks. OBJECTIVES: To analyze a contemporary, multicenter CS cohort with the aim of comparing characteristics and outcomes of patients between transfer (between spoke and hub centers) and nontransfer cohorts (those primarily admitted to a hub center) for both acute myocardial infarction (AMI-CS) and heart failure-related HF-CS. We also aim to identify clinical characteristics of the transfer cohort that are associated with in-hospital mortality. METHODS: The Cardiogenic Shock Working Group (CSWG) registry is a national, multicenter, prospective registry including high-volume (mostly hub) CS centers. Fifteen U.S. sites contributed data for this analysis from 2016-2020. RESULTS: Of 1890 consecutive CS patients enrolled into the CSWG registry, 1028 (54.4%) patients were transferred. Of these patients, 528 (58.1%) had heart failure-related CS (HF-CS), and 381 (41.9%) had CS related to acute myocardial infarction (AMI-CS). Upon arrival to the CSWG site, transfer patients were more likely to be in SCAI stages C and D, when compared to nontransfer patients. Transfer patients had higher mortality rates (37% vs 29%, < 0.001) than nontransfer patients; the differences were driven primarily by the HF-CS cohort. Logistic regression identified increasing age, mechanical ventilation, renal replacement therapy, and higher number of vasoactive drugs prior to or within 24 hours after CSWG site transfer as independent predictors of mortality among HF-CS patients. Conversely, pulmonary artery catheter use prior to transfer or within 24 hours of arrival was associated with decreased mortality rates. Among transfer AMI-CS patients, BMI > 28 kg/m2, worsening renal failure, lactate > 3 mg/dL, and increasing numbers of vasoactive drugs were associated with increased mortality rates. CONCLUSION: More than half of patients with CS managed at high-volume CS centers were transferred from another hospital. Although transfer patients had higher mortality rates than those who were admitted primarily to hub centers, the outcomes and their predictors varied significantly when classified by HF-CS vs AMI-CS.

The prognostic value of splenic abnormalities in pretreatment 18F-FDG PET/CT in patients with complete response diffuse large B-cell lymphoma.

AIM: To investigate whether spleen imaging characteristics of baseline 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/computed tomography (CT) can help to predict the clinical outcome in complete response (CR) diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS: Three hundred and six patients with DLBCL were enrolled in the study and divided into recurrence and non-recurrence groups. The splenic abnormalities were compared using the chi-square test and quantitative indexes were compared using the t-test. The Cox proportional hazard regression model was used for univariate and multivariate analysis. Kaplan-Meier curves and log-rank tests were used to compare progression-free survival (PFS). Propensity score matching (PSM) was used to match patients with and without splenic abnormalities according to age, gender, and initial Ann Arbor stage at a 1:2 ratio (52:104); then the recurrence and PFS results were compared again. RESULTS: Age, international prognostic index (IPI), stage, splenomegaly, and focal splenic lesions were significantly different between the recurrence and non-recurrence groups. IPI, stage, baseline spleen mean standard uptake value (SUVmean)/liver SUVmean, splenomegaly, and focal lesions were selected by Cox single-factor analysis, and only focal lesions showed a statistical difference in terms of Cox multivariate analysis (p=0.022, hazard ratio [HR]: 2.843). After PSM, focal splenic lesions (n=20) were still statistically different (p=0.003) between the recurrence and non-recurrence groups, and this played an essential role in PFS forecasting (p=0.0004, HR: 3.767). CONCLUSION: Focal splenic lesions were identified as an independent risk factor for the prognosis of DLBCL. Pretreatment splenomegaly and focal splenic lesions appeared to be related to the relapse and PFS of DLBCL patients. Focal splenic lesions still showed meaningful predictive value even with propensity matching.

Reactive cutaneous capillary endothelial proliferation predicted the efficacy of camrelizumab in patients with recurrent/metastatic head and neck squamous cell carcinoma.

BACKGROUND: Reactive cutaneous capillary endothelial proliferation (RCCEP), a special adverse event (AE) only observed in patients treated with camrelizumab, was reported to be correlated with the efficacy of camrelizumab in patients with advanced hepatocellular carcinoma. This study to analyze the possible correlation between the occurrence of RCCEP and efficacy of camrelizumab in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). MATERIAL AND METHODS: In this study, we retrospectively analyzed the efficacy and RCCEP occurrence of camrelizumab in 58 patients with R/M HNSCC in the Shanghai Ninth People's Hospital affiliated to Shanghai JiaoTong University School of Medicine between January 2019 and June 2022. Kaplan-Meier analysis was used to assess the correlation between the occurrence of RCCEP and the survival of enrolled patients, and COX multifactor analysis was adopted to evaluate associated factors that affected the efficacy of camrelizumab immunotherapy. RESULTS: A significant correlation between the incidence of RCCEP and a higher objective response rate was observed in this study (p=0.008). The occurrence of RCCEP was associated with better median overall survival (17.0 months vs. 8.7 months, p<0.0001, HR=5.944, 95% CI:2.097-16.84) and better median progression-free survival (15.1 months vs. 4.0 months, p<0.0001, HR=4.329,95% CI:1.683-11.13). In COX multifactor analysis, RCCEP occurrence was also an independent prognostic factor affecting OS and PFS in patients with R/M HNSCC. CONCLUSIONS: The occurrence of RCCEP can show a better prognosis, it could be used as a clinical biomarker to predict the efficacy of camrelizumab treatment.

[Differential diagnosis model of benign and malignant breast BI-RADS category 4 nodules based on serum SP70 and conventional laboratory indicators].

Objective: To develop a nomogram model for the differential diagnosis of benign and malignant breast BI-RADS (Breast Imaging Reporting and Data System) category 4 nodules based on serum tumor specific protein 70 (SP70) and conventional laboratory indicators and validate its predictive efficacy. Methods: A case-control study design was used to retrospectively analyze the data of 429 female patients diagnosed with BI-RADS category 4 breast nodules by breast color doppler flow imaging at the First Affiliated Hospital of Nanjing Medical University from January 2021 to April 2022 with an age range of 16 to 91 years and a median age of 50 years, and the patients were divided into a training cohort (314 patients) and a validation cohort (115 patients) according to the inclusion time successively. Using postoperative pathological findings as the"gold standard", univariate and multivariate logistic regression analyses were used to identify the predictor variables used for the model. The nomogram, receiver operating characteristic (ROC) curves and calibration curves were drawn for the prediction model, and the discrimination and calibration of the model were evaluated using the consistency index (C-index) and calibration plots. Results: The postoperative pathological results showed that 286 (66.7%) were malignant nodules and 143 (33.3%) were benign nodules of 429 breast BI-RADS category 4 nodules. The serum SP70 (OR=1.227,95%CI: 1.033-1.458,P=0.020), NLR (OR=1.545,95%CI: 1.047-2.280,P=0.028), LDL-C (OR=2.215, 95%CI: 1.354-3.622, P=0.002), GLU (OR=2.050,95%CI:1.222-3.438,P=0.007), PT (OR=1.383,95%CI: 1.046-1.828,P=0.023), nodule diameter (OR=1.042, 95%CI: 1.008-1.076, P=0.015) and age (OR=1.062,95%CI: 1.011-1.116,P=0.016) were independent risk factors which could be used to distinguish benign and malignant breast BI-RADS category 4 nodules (P<0.05). The nomogram was plotted by the above seven independent variables, and the concordance index (C-index) for the training cohort and validation cohort were 0.842 (95%CI:0.786-0.898) and 0.787 (95%CI:0.687-0.886), respectively. The sensitivity and specificity of using this model to identify benign and malignant breast BI-RADS category 4 nodules in the training and validation cohort were 83.5%, 72.5% and 79.2%, 73.6%, respectively. The calibration curves showed good agreement between the predicted and actual values in the nomogram. Conclusions: This study combined serum SP70, conventional laboratory indicators and breast color doppler flow imaging to develop a nomogram model for the differential diagnosis of benign and malignant breast BI-RADS category 4 nodules. The model may have good predictive efficacy and may provide a basis for clinical treatment options, which is beneficial for guiding breast cancer screening and prevention.

Remote versus early corticosteroid wean outcomes in heart transplant recipients in the contemporary era.

PURPOSE: The risks and benefits of remote corticosteroid weaning in heart transplant recipients more than 2 years post-transplant are unknown. We compared outcomes in patients undergoing early and remote steroid weaning after heart transplantation. METHODS: We performed a retrospective study (range 09, 1991-04, 2017). Primary outcomes included short-term and long-term mortality, allograft dysfunction, and burden of rejection. Secondary outcomes included impact on hemoglobin A1c, lipid panel, bone scan T-score, and body mass index. RESULTS: 63 patients underwent corticosteroid weaning between 2012 and 2017. Outcomes of patients weaned early (n = 34; median time from transplant = 1.1 years) were compared with those weaned late (n = 29; median time from transplant = 4.4 years). 52 (82.5%) patients were successfully weaned off corticosteroids. No statistically significant difference in outcomes was found between the early and late weaning groups (p = .20). There were no differences in allograft function (p-value = .16), incidence of rejection (p = .46), or mortality (p = .15). Improvement in metabolic profile was seen in both groups but was not statistically significant. CONCLUSIONS: In heart transplant recipients, remote vs early weaning of corticosteroids is not associated with significant differences in graft function or the incidence of rejection after 1-year follow-up. Moreover, there were no significant differences in survival up to 3 years between the two groups.

A Robust Road Vanishing Point Detection Adapted to the Real-world Driving Scenes.

Vanishing point (VP) provides extremely useful information related to roads in driving scenes for advanced driver assistance systems (ADAS) and autonomous vehicles. Existing VP detection methods for driving scenes still have not achieved sufficiently high accuracy and robustness to apply for real-world driving scenes. This paper proposes a robust motion-based road VP detection method to compensate for the deficiencies. For such purposes, three main processing steps often used in the existing road VP detection methods are carefully examined. Based on the analysis, stable motion detection, stationary point-based motion vector selection, and angle-based RANSAC (RANdom SAmple Consensus) voting are proposed. A ground-truth driving dataset including various objects and illuminations is used to verify the robustness and real-time capability of the proposed method. The experimental results show that the proposed method outperforms the existing motion-based and edge-based road VP detection methods for various illumination conditioned driving scenes.

[Functional Characterization of ZmHAK1 Promoter and Its Regulatory Transcription Factors in Maize].

Potassium (K^(+)) deficiency in the soil may seriously affect the yield and quality of plants, which usually satisfy their potassium requirements by engaging their K^(+) transporters and/or channels. High-affinity potassium transporter (ZmHAK) family members play crucial role in the uptake and distribution of K^(+) in maize (Zea mays L.). Here, we describe the function of ZmHAK1 promoter and its upstream regulatory transcription factors in maize. In this plant, HAK gene family includes 34 protein-encoding members, with their phylogenetic tree analysis showing both evolutionary conservativeness and diversity. ZmHAK1 gene promoter contains many functional elements related to abiotic stress. Reporter construct pCambia1301:ProZmHAK1:GUS shows that the ZmHAK1 gene is active in the roots, stems, and leaves. Using yeast one-hybrid experiment, we showed that the ZmHAK1 promoter interacts with the transcription factors ZmRAP2.11 and ZmARF2, and that these interactions occur on different fragments of the ZmHAK1 promoter. Transcription factor ZmRAP2.11 localizes in the nucleus, while ZmARF2 is found both in the nucleus and in the cell cytoplasm. In conclusion, our results suggest that the ZmHAK1 regulation has an important role in the process of absorbing potassium ions, and possibly in the response of maize to abiotic stress.

Nanoscale heat transport through the hetero-interface of SrRuO3 thin films.

A SrRuO3 thin film has been widely used as a metal electrode in electronic devices based on transition metal oxides, and hence it is important to understand its thermal transport properties to minimize a thermal degradation problem during the device operation. Using the time-domain thermoreflectance measurement technique, we investigate the cross-plane thermal conductivity of the SrRuO3 thin films with a thickness variation from 1 µm to 8 nm. We find that the thermal conductivity is reduced from about 6 W m-1 K-1 for the 1 µm thick film to about 1.2 W m-1 K-1 for the 8 nm thick film, and attribute this behavior to the boundary scattering of thermal carriers which originally have the mean free path of about 20 nm in a bulk state. Also, we observe a clear dip behavior of the thermal conductivity in the intermediate thickness around 30 nm which suggests an existence of a strong scattering source other than the film boundary. We explain this result by considering an additional interfacial scattering at the tetragonal-orthorhombic phase boundary which is formed during the strain relaxation with an increase of the film thickness.

Improvement in postoperative pain control by combined use of intravenous dexamethasone with intravenous dexmedetomidine after interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled trial.

BACKGROUND: Intravenous dexamethasone or dexmedetomidine is reported to prolong the duration of analgesia after single-shot interscalene brachial plexus block (ISBPB). However, the effect of co-administration of these agents on the duration of analgesia has not been evaluated. OBJECTIVES: We evaluated the difference in time to first rescue analgesic request between patients receiving co-administered intravenous dexamethasone and dexmedetomidine and patients receiving intravenous dexamethasone alone after single-shot ISBPB for arthroscopic shoulder surgery. DESIGN: A randomised controlled study. SETTING: A single tertiary care centre, study period from August 2017 to January 2018. PATIENTS: Sixty-six patients undergoing arthroscopic shoulder surgery with ISBPB with 15 ml of 0.5% ropivacaine with 1 : 200 000 epinephrine. INTERVENTIONS: We randomly assigned the patients to one of three groups: intravenous 0.9% saline (control), intravenous dexamethasone 0.11 mg kg (D1 group), or co-administered intravenous dexamethasone 0.11 mg kg and intravenous dexmedetomidine 1.0 µg kg (D2 group). MAIN OUTCOME MEASURES: The primary outcome was the time to first rescue analgesic request. RESULTS: The median [interquartile range] time to first rescue analgesic request was significantly longer for the D2 group (66.3 h [23.3 to 72]) than the D1 (17.4 h [14.9 to 36], P = 0.002) and control (10.9 h [10.1 to 12.2], P < 0.001) groups. The D1 and D2 groups both had reduced pain scores, reduced postoperative opioid consumption, less sleep disruption and improved patient satisfaction compared with the control group. There were no significant elevations in blood glucose concentrations in patients receiving dexamethasone (D1 and D2 groups) compared with the control group at postoperative day 1. CONCLUSION: Co-administration of intravenous dexamethasone (0.11 mg kg) with dexmedetomidine (1.0 µg kg) significantly prolonged the time to first rescue analgesic request after single-shot ISBPB in patients undergoing arthroscopic shoulder surgery. TRIAL REGISTRATION: Clinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0002569.

Traffic Light Recognition Based on Binary Semantic Segmentation Network.

A traffic light recognition system is a very important building block in an advanced driving assistance system and an autonomous vehicle system. In this paper, we propose a two-staged deep-learning-based traffic light recognition method that consists of a pixel-wise semantic segmentation technique and a novel fully convolutional network. For candidate detection, we employ a binary-semantic segmentation network that is suitable for detecting small objects such as traffic lights. Connected components labeling with an eight-connected neighborhood is applied to obtain bounding boxes of candidate regions, instead of the computationally demanding region proposal and regression processes of conventional methods. A fully convolutional network including a convolution layer with three filters of (1 × 1) at the beginning is designed and implemented for traffic light classification, as traffic lights have only a set number of colors. The simulation results show that the proposed traffic light recognition method outperforms the conventional two-staged object detection method in terms of recognition performance, and remarkably reduces the computational complexity and hardware requirements. This framework can be a useful network design guideline for the detection and recognition of small objects, including traffic lights.

Asymmetric Encoder-Decoder Structured FCN Based LiDAR to Color Image Generation.

In this paper, we propose a method of generating a color image from light detection and ranging (LiDAR) 3D reflection intensity. The proposed method is composed of two steps: projection of LiDAR 3D reflection intensity into 2D intensity, and color image generation from the projected intensity by using a fully convolutional network (FCN). The color image should be generated from a very sparse projected intensity image. For this reason, the FCN is designed to have an asymmetric network structure, i.e., the layer depth of the decoder in the FCN is deeper than that of the encoder. The well-known KITTI dataset for various scenarios is used for the proposed FCN training and performance evaluation. Performance of the asymmetric network structures are empirically analyzed for various depth combinations for the encoder and decoder. Through simulations, it is shown that the proposed method generates fairly good visual quality of images while maintaining almost the same color as the ground truth image. Moreover, the proposed FCN has much higher performance than conventional interpolation methods and generative adversarial network based Pix2Pix. One interesting result is that the proposed FCN produces shadow-free and daylight color images. This result is caused by the fact that the LiDAR sensor data is produced by the light reflection and is, therefore, not affected by sunlight and shadow.

Analysis of the binding mode of a novel HIF1α inhibitor through molecular modelling.

Hypoxia inducible factor-1 (HIF1) is an important transcription factor related with tumor metastasis. As a subunit of HIF1, HIF1α plays an important role in regulation of the hypoxic response. HIF1α inhibitor could be a promising treatment for certain cancers. In the present study, we try to model the binding mode of the recent reported new series of HIF1α inhibitors with the purpose of further improving the performance of these inhibitors. Molecular docking was first employed to predict the binding modes of the protein-ligand complexes, followed by molecular dynamics simulations and MMGBSA free energy calculations. According to the predicted binding modes, these molecules form two important hydrogen bonds with HIF1α. Moreover, if the molecules could form a stable π-π interaction with HIF1α, the potency of the inhibitors can be greatly improved. Hydrophobic interactions between the molecules and HIF1α are also a key factor, especially the interactions between the hydrophobic groups (benzimidazole) of the molecules and the hydrophobic residues inside the binding cave. Molecular modeling could be a useful method in the future drug design. In this study, our calculation can help to design and develop high potent HIF1α inhibitors in future.

Average Accumulative Based Time Variant Model for Early Diagnosis and Prognosis of Slowly Varying Faults.

Early detection of slowly varying small faults is an essential step for fault prognosis. In this paper, we first propose an average accumulative (AA) based time varying principal component analysis (PCA) model for early detection of slowly varying faults. The AA based method can increase the fault size as well as decrease the noise energy. Then, designated component analysis (DCA) is introduced for developing an AA-DCA method to diagnose the root cause of the fault, which is helpful for the operator to make maintenance decisions. Combining the advantage of the cumulative sum (CUSUM) based method and the AA based method, a CUSUM-AA based method is developed to detect faults at earlier times. Finally, the remaining useful life (RUL) prediction model with error correction is established by nonlinear fitting. Once online fault size defined by detection statistics is obtained by an early diagnosis algorithm, real-time RUL prediction can be directly estimated without extra recursive regression.

Ventricular Assist Device Therapy in Older Patients With Heart Failure: Characteristics and Outcomes.

BACKGROUND: Limited data exist on outcomes in patients ≥70 years of age supported with the use of continuous-flow left ventricular assist devices (LVADs). METHODS: Data on 1149 continuous-flow LVAD recipients was queried from the Mechanical Circulatory Support Research Network. Groups were assigned based on age: ≥70 years ("older patients") and <70 years. The primary outcome was survival at one-year based on age grouping. RESULTS: Compared with younger patients (54.3 ± 11.2 y; n = 986), older patients (73.4 ± 3.0 y) constituted only 14% of LVAD implants. Older patients had similar rates of device thrombosis (P = .47) and stroke (P = .44), but survival-free of gastrointestinal bleeding (GIB) at 1 year was lower compared with younger patients (58% vs 69%; P < .01). Unadjusted survival at 1 year in older patients was 75% compared with 84% in younger patients, and at 2 years 65% versus 73% (P = .18). Age ≥70 years was not associated with increased mortality (adjusted hazard ratio [aHR] 0.94, 95% confidence interval [CI] 0.70-1.26; P = .67). Preoperative creatinine (aHR 1.57, 95% CI: 1.30-1.89, P < .0001), bilirubin (aHR 1.22, 95% CI 1.05-1.42; P = .010), and ischemic cardiomyopathy (aHR 1.43, 95% CI 1.11-1.84; P = .005) portended increased risk of death. In older patients, the only predictor of mortality was creatinine (HR 2.1, 95% CI 1.2-3.4; P = .007). Creatinine ≥1.4 mg/dL was associated with a 1-year survival of 65%, compared with 84% when the creatinine was <1.4 mg/dL (P = .009). CONCLUSION: Age >70 years is an important consideration when assessing LVAD risk, but other correlates may be more predictive of LVAD survival. Older patients without renal dysfunction have survival similar to younger patients. Older patients should be counseled about age-correlated risks, including higher rates of GIB.

Half-dose ganciclovir preemptive treatment of cytomegalovirus infection after pediatric allogeneic hematopoietic stem cell transplantation.

BACKGROUND: Ganciclovir (GCV) has been widely used as preemptive therapy after hematopoietic stem cell transplantation (HSCT), although bone marrow suppression is a known accompaniment, with secondary infection or bleeding as potential complications. Our aim was to evaluate clinical outcomes in pediatric patients with low cytomegalovirus (CMV) antigenemia levels using half the dosage of GCV generally given preemptively. METHODS: Patients received half doses of intravenous GCV (5 mg/kg once daily, 6 days/week) at CMV antigenemia levels <10/200,000 cells. At higher levels of CMV antigenemia, conventional doses of GCV (5 mg/kg every 12 h) were administered. RESULTS: A total of 130 patients were evaluated, detecting CMV antigenemia in 87 (66.9%). Of these patients, 74 (85.1%) were treated preemptively with half-dose GCV, which proved effective as sole therapy in 51 (68.9%). CMV retinitis developed in 4 patients, 2 of whom initially were given half-dose GCV. All infections resolved successfully, with no CMV-related deaths. CMV seropositivity in recipients was the only significant risk factor for positive CMV antigenemia (hazard ratio [HR] = 10.05, P = 0.046). Compared with half-dose GCV administration, conventional GCV dosing resulted in a higher rate of severe neutropenia, defined as absolute neutrophil count <0.5 × 10(9) /L (HR = 4.30, P = 0.015). CONCLUSION: Half-dose GCV therapy at CMV antigenemia levels <10/200,000 cells is an effective and safe means of preemptively treating pediatric CMV infection after HSCT.

Coagulation Abnormalities in Heart Failure: Pathophysiology and Therapeutic Implications.

Heart failure (HF) represents a heterogeneous condition characterized by vulnerabilities in the blood, vasculature, and impaired flow dynamics that predispose to both arterial and venous thrombosis. Despite evidence-based advances in the medical and device management of chronic HF, it remains a leading cause of morbidity and mortality in the USA due to repeat hospitalizations and comorbid conditions such as atrial fibrillation (AF) and stroke. The presence of platelet activation and hypercoagulability in HF has been well documented. Anticoagulation is effective in HF when comorbidities such as AF and prior venous thromboembolism exist. However, data is less clear for HF in sinus rhythm. Moreover, there is a paucity of data regarding antiplatelet therapy in HF. No consensus guidelines exist regarding the precise role of antiplatelet or antithrombotic therapy in HF. This review addresses the pathophysiology of coagulation abnormalities in HF, examines the available evidence regarding the use of anticoagulants and antiplatelet agents in HF, and discusses its therapeutic implications.