3-Dimensional computed tomographic assessment predicts conduction block and paravalvular leakage after rapid-deployment aortic valve replacement.

OBJECTIVES: Complications like complete atrioventricular block (CAVB) and paravalvular leakage (PVL) following rapid deployment aortic valve (AV) replacement (RDAVR) remain unresolved. Selecting an optimal size of the valve might be important to minimize the incidence of these complications. We sought to determine the impact of prosthesis size relative to the anatomic profile of the AV on the occurrence of CAVB or PVL after RDAVR. METHODS: Preoperative computed tomographic (CT) images were evaluated in patients receiving RDAVR (INTUITY ELITE) between February 2016 and December 2019. The occurrence of CAVB requiring permanent pacemaker implantation and PVL (≥ mild) was evaluated. The relative size of implants against the cross-sectional dimensions of recipients' AV annulus and left ventricular outflow tract (LVOT) were calculated. RESULTS: Among 187 eligible patients, CAVB and PVL (≥ mild) occurred in 12 (6.4%) and 11 patients (5.9%), respectively. CAVB was associated with oversized RDAVR (RDAVR frame width minus average diameter of LVOT calculated from the cross-sectional area [ΔLVOTarea]: odds ratio, 2.05; 95% confidence interval, 1.28-3.30): this was with an area under the curve of 0.78 (P = 0.005). The projected probability of CAVB was <3% when the ΔLVOTarea was <1.3. In contrast, PVL was associated with under-sized RDAVR (RDAVR size divided by the longest diameter of AV annulus [index Annlong]: odds ratio, 0.64; 95% confidence interval, 0.51-0.79): This was with an area under curve of 0.94 (P < 0.001). CONCLUSIONS: CT parameters of the AV annulus and LVOT are highly reliable in the prediction of CAVB or PVL after RDAVR. Our data might justify CT-based sizing of prosthesis for RDAVR.

Methyl p­hydroxycinnamate exerts anti­inflammatory effects in mouse models of lipopolysaccharide­induced ARDS.

Methyl p­hydroxycinnamate (MH), an esterified derivative of p­Coumaric acid exerts anti­inflammatory effects on lipopolysaccharide (LPS)­stimulated RAW264.7 macrophages. Based on these effects, the present study investigated the protective role of MH in a mouse model of LPS­induced acute respiratory distress syndrome (ARDS). The results demonstrated that administration of LPS (5 mg/kg intranasally) markedly increased the neutrophil/macrophage numbers and levels of inflammatory molecules (TNF­α, IL­6, IL­1ß and reactive oxygen species) in the bronchoalveolar lavage fluid (BALF) of mice. On histological examination, the presence of inflammatory cells was observed in the lungs of mice administered LPS. LPS also notably upregulated the secretion of monocyte chemoattractant protein­1 and protein content in BALF as well as expression of inducible nitric oxide synthase in the lungs of mice; it also caused activation of p38 mitogen­activated protein kinase (MAPK) and NF­κB signaling. However, MH treatment significantly suppressed LPS­induced upregulation of inflammatory cell recruitment, inflammatory molecule levels and p38MAPK/NF­κB activation, and also led to upregulation of heme oxygenase­1 (HO­1) expression in the lungs of mice. In addition, the ability of MH to induce HO­1 expression was confirmed in RAW264.7 macrophages. Taken together, the findings of the present study indicated that MH may exert protective effects against airway inflammation in ARDS mice by inhibiting inflammatory cell recruitment and the production of inflammatory molecules.

Process design and techno-economic analysis of 2'-fucosyllactose enriched distiller's dried grains with solubles production in dry grind ethanol process using genetically engineered Saccharomyces cerevisiae.

2'-fucosyllactose (2'-FL) has been linked positively with piglet gut health. Genetically engineered Saccharomyces cerevisiae strains producing 2'-FL can be used in the dry grind process to enrich Distiller's dried grains with solubles (DDGS) with 2'-FL and supplement swine diets with 2'-FL. The objectives of our study were to modify dry grind ethanol process for 2'-FL enriched DDGS production and evaluate the techno-economic feasibility of the process. Concentrations of 19.8 g 2'-FL/kg dry DDGS were achieved in the dry grind process using engineered strain without negatively affecting the ethanol yield. Process models for conventional and modified dry grind processes producing 2'-FL enriched DDGS (1150 MT corn/day capacity) were developed using SuperPro Designer. Capital and ethanol production costs for modified dry grind processes were higher than the conventional process. The internal rate of return for the modified processes was higher than the conventional process for $300/MT 2'-FL enriched DDGS selling price.

Assessment of rapidly advancing bone age during puberty on elbow radiographs using a deep neural network model.

OBJECTIVES: Bone age is considered an indicator for the diagnosis of precocious or delayed puberty and a predictor of adult height. We aimed to evaluate the performance of a deep neural network model in assessing rapidly advancing bone age during puberty using elbow radiographs. METHODS: In all, 4437 anteroposterior and lateral pairs of elbow radiographs were obtained from pubertal individuals from two institutions to implement and validate a deep neural network model. The reference standard bone age was established by five trained researchers using the Sauvegrain method, a scoring system based on the shapes of the lateral condyle, trochlea, olecranon apophysis, and proximal radial epiphysis. A test set (n = 141) was obtained from an external institution. The differences between the assessment of the model and that of reviewers were compared. RESULTS: The mean absolute difference (MAD) in bone age estimation between the model and reviewers was 0.15 years on internal validation. In the test set, the MAD between the model and the five experts ranged from 0.19 to 0.30 years. Compared with the reference standard, the MAD was 0.22 years. Interobserver agreement was excellent among reviewers (ICC: 0.99) and between the model and the reviewers (ICC: 0.98). In the subpart analysis, the olecranon apophysis exhibited the highest accuracy (74.5%), followed by the trochlea (73.7%), lateral condyle (73.7%), and radial epiphysis (63.1%). CONCLUSIONS: Assessment of rapidly advancing bone age during puberty on elbow radiographs using our deep neural network model was similar to that of experts. KEY POINTS: • Bone age during puberty is particularly important for patients with scoliosis or limb-length discrepancy to determine the phase of the disease, which influences the timing and method of surgery. • The commonly used hand radiographs-based methods have limitations in assessing bone age during puberty due to the less prominent morphological changes of the hand and wrist bones in this period. • A deep neural network model trained with elbow radiographs exhibited similar performance to human experts on estimating rapidly advancing bone age during puberty.

Geometric inequalities for warped product bi-slant submanifolds with a warping function.

In this paper, we prove that the squared norm of the second fundamental form for bi-slant submanifolds with any codimension of nearly trans-Sasakian manifolds is bounded below by the gradient of a warping function and also find the conditions on which the equality holds. Some related examples are also provided.

Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior.

In this cross-sectional study, we aimed to identify distinguishing factors between populations with suicidal ideation recruited from hospitals and communities to make an efficient allocation of limited anti-suicidal resources according to group differences. We analyzed the baseline data from 120 individuals in a community-based cohort (CC) and 137 individuals in a hospital-based cohort (HC) with suicidal ideation obtained from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study. First, their sociodemographic factors, histories of medical and psychiatric illnesses, and suicidal behaviors were compared. Second, diagnosis by the Korean version of the Mini International Neuropsychiatric Interview, scores of psychometric scales were used to assess differences in clinical severity between the groups. The results revealed that the HC had more severe clinical features: more psychiatric diagnosis including current and recurrent major depressive episodes (odds ratio [OR], 4.054; P < 0.001 and OR, 11.432; P < 0.001, respectively), current suicide risk (OR, 4.817; P < 0.001), past manic episodes (OR, 9.500; P < 0.001), past hypomanic episodes (OR, 4.108; P = 0.008), current alcohol abuse (OR, 3.566; P = 0.020), and current mood disorder with psychotic features (OR, 20.342; P < 0.001) besides significantly higher scores in depression, anxiety, alcohol problems, impulsivity, and stress. By comparison, old age, single households, and low socioeconomic status were significantly associated with the CC. These findings indicate the necessity of more clinically oriented support for hospital visitors and more socioeconomic aid for community-dwellers with suicidality.

Echocardiographic assessment of mitral durability in the late period following mitral valve repair: minithoracotomy versus conventional sternotomy.

OBJECTIVE: To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. METHODS: A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. RESULTS: There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P = .68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% (P = .63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P = .67). CONCLUSIONS: A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair.

Bayesian nonparametric inference on quantile residual life function: Application to breast cancer data.

There is often an interest in estimating a residual life function as a summary measure of survival data. For ease in presentation of the potential therapeutic effect of a new drug, investigators may summarize survival data in terms of the remaining life years of patients. Under heavy right censoring, however, some reasonably high quantiles (e.g., median) of a residual lifetime distribution cannot be always estimated via a popular nonparametric approach on the basis of the Kaplan-Meier estimator. To overcome the difficulties in dealing with heavily censored survival data, this paper develops a Bayesian nonparametric approach that takes advantage of a fully model-based but highly flexible probabilistic framework. We use a Dirichlet process mixture of Weibull distributions to avoid strong parametric assumptions on the unknown failure time distribution, making it possible to estimate any quantile residual life function under heavy censoring. Posterior computation through Markov chain Monte Carlo is straightforward and efficient because of conjugacy properties and partial collapse. We illustrate the proposed methods by using both simulated data and heavily censored survival data from a recent breast cancer clinical trial conducted by the National Surgical Adjuvant Breast and Bowel Project.

Late improvement in graft patency after coronary artery bypass grafting: Serial assessment with multidetector computed tomography in the early and late postoperative settings.

OBJECTIVE: Grafts initially showing poor patency after coronary artery bypass grafting have occasionally shown improvement on serial multidetector computed tomography. This study analyzed possible factors associated with this phenomenon. METHODS: Between September 2003 and July 2007, 512 patients underwent multidetector computed tomography within 1 month of isolated coronary artery bypass grafting. Among them, 1720 distal anastomoses were made with 1042 arterial and 302 venous conduits. Of these, 95 grafts (in 73 patients) were faint (n = 67) or nonvisualized (n = 28). Seventy-three of these grafts (in 56 patients) had follow-up multidetector computed tomographic evaluation 1 year after surgery and comprised the study group. RESULTS: Improvement in graft patency (faint to patent or nonvisualization to visualization) occurred in 44 grafts (60.3%). Multivariate analysis revealed proximal target vessel stenosis of at least 90% (relative risk, 3.81; P = .009), larger target coronary size (relative risk, 1.72; P = .002), and radial artery graft use (relative risk, 4.44; P = .003) to be significantly associated with the graft patency restoration. Graft patency restoration was most commonly observed in a group of 28 radial artery grafts that were anastomosed to target vessel with proximal stenosis of at least 90%; of these grafts, 24 (85.7%) showed improved graft patency on follow-up. CONCLUSIONS: A large proportion of radial artery grafts initially showing poor opacification after coronary artery bypass grafting demonstrated patency restoration on serial multidetector computed tomography. Larger target vessel size and target vessel stenosis of at least 90% were significant correlative factors.

Evaluation of waste mushroom logs as a potential biomass resource for the production of bioethanol.

In order to investigate the possibility of using waste mushroom logs as a biomass resource for alternative energy production, the chemical and physical characteristics of normal wood and waste mushroom logs were examined. Size reduction of normal wood (145 kW h/tone) required significantly higher energy consumption than waste mushroom logs (70 kW h/tone). The crystallinity value of waste mushroom logs was dramatically lower (33%) than normal wood (49%) after cultivation by Lentinus edodes as spawn. Lignin, an enzymatic hydrolysis inhibitor in sugar production, decreased from 21.07% to 18.78% after inoculation of L. edodes. Total sugar yields obtained by enzyme and acid hydrolysis were higher in waste mushroom logs than in normal wood. After 24h fermentation, 12 g/L ethanol was produced on waste mushroom logs, while normal wood produced 8 g/L ethanol. These results indicate that waste mushroom logs are economically suitable lignocellulosic material for the production of fermentable sugars related to bioethanol production.

Bootstrap tests for overdispersion in a zero-inflated Poisson regression model.

Ridout, Hinde, and Demétrio (2001, Biometrics 57, 219-223) derived a score test for testing a zero-inflated Poisson (ZIP) regression model against zero-inflated negative binomial (ZINB) alternatives. They mentioned that the score test using the normal approximation might underestimate the nominal significance level possibly for small sample cases. To remedy this problem, a parametric bootstrap method is proposed. It is shown that the bootstrap method keeps the significance level close to the nominal one and has greater power uniformly than the existing normal approximation for testing the hypothesis.