This study was conducted to elucidate the association between clinical and angiographic characteristics and stroke types in adult Moyamoya disease that has been rarely evaluated.
We analyzed the ...clinical and radiologic data obtained from a retrospective adult Moyamoya disease cohort with acute strokes, which were classified into 7 categories: large-artery infarct, hemodynamic infarct, perforator infarct, deep intracerebral hemorrhage, lobar intracerebral hemorrhage, intraventricular hemorrhage, and SAH. With conventional angiography, which was performed in the hemispheres with acute strokes, the Suzuki angiographic stage, intracranial aneurysm, major artery occlusion, and collateral vessel development were confirmed within 1 month of stroke onset.
This study included 79 patients with acute ischemic stroke and 96 patients with acute hemorrhagic stroke. The angiographic stage had a strong tendency to be more advanced in the hemorrhagic than the ischemic patients (P = .061). Intracranial aneurysms were more frequently found in the hemorrhagic than ischemic or control hemispheres (P = .002). Occlusions of the anterior cerebral artery and development of fetal-type posterior cerebral artery were more frequently observed in the hemorrhagic than the ischemic (P = .001 and .01, respectively) or control hemispheres (P = .011 and .013, respectively). MCA occlusion (P = .039) and collateral flow development, including the ethmoidal Moyamoya vessels (P = .036) and transdural anastomosis of the external carotid artery (P = .022), occurred more often in the hemorrhagic than the ischemic hemispheres. Anterior cerebral artery occlusion occurred more frequently in patients with deep intracerebral hemorrhage or intraventricular hemorrhage than with lobar intracerebral hemorrhage (P = .009).
In adult Moyamoya disease, major artery occlusion and collateral compensation occurred more often in the hemorrhagic than in the ischemic hemispheres. Thus, anterior cerebral artery occlusion with or without MCA occlusion and intracranial aneurysms may be the main contributing factors to hemorrhagic stroke in adult patients with Moyamoya disease.
commonly colonizes the skin of atopic dermatitis (AD) patients and contributes to the development and exacerbation of AD. Multiple factors are associated with colonization of AD skin by
, including ...the strength of
-corneocyte adhesion, deficiency of antimicrobial peptides, decreased levels of filaggrin and filaggrin degradation products, overexpressed Th2/Th17 cytokines, microbial dysbiosis and altered lipid profiles.
colonization on AD skin causes skin barrier dysfunction through virulence factors such as superantigens (toxins), enzymes and other proteins. Furthermore, colonization of AD skin by
exacerbates AD and may contribute to microbial dysbiosis, allergen sensitization, Th2/Th17 polarization, development of atopic march and food allergy in AD patients. Skin colonization of
, particularly methicillin-resistant
(MRSA), is one of the major challenges commonly encountered in the management of AD. Bleach bath, and topical or systemic antibiotics could be used to control
infection on AD skin. However, careful use of antibiotics is required to control the occurence of MRSA. Recently, various strategies, including microbiome transplant, monoclonal antibodies against virulent toxins, vaccines and recombinant phage endolysin, have been studied to control
infection on AD skin. Further advances in our understanding of
could provide us with ways to manage
colonization more effectively in AD patients.
We evaluated the efficacy of adjuvant durvalumab after neoadjuvant concurrent chemoradiotherapy (CCRT) in patients with esophageal squamous cell carcinoma (ESCC).
This randomized, double-blind, phase ...II study included patients with ESCC who underwent curative surgery after neoadjuvant CCRT. Patients were randomized to receive either durvalumab (20 mg/kg/i.v. every 4 weeks for 12 months) or placebo in a 1:1 ratio and were stratified by age and pathologic tumor stage. The primary endpoint was disease-free survival (DFS).
Between March 2016 and June 2018, 86 patients were randomized to the durvalumab (n = 45) or placebo (n = 41) arm. The median follow-up duration was 38.7 months. There was no difference in DFS hazard ratio (HR) 1.18, 95% confidence interval (CI) 0.62-2.27, P = 0.61 or overall survival (HR 1.08, 95% CI 0.52-2.24, P = 0.85) between the two arms. Subgroup analysis was performed for patients for whom the post-CCRT programmed death-ligand 1 (PD-L1) expression profile could be assessed (n = 54). In the PD-L1-positive group, based on tumor proportion score ≥1%, durvalumab was associated with longer overall survival compared with the placebo (36-month survival rate: 94% versus 64%; HR 0.42, 95% CI 0.10-1.76), while in the PD-L1-negative group, it was associated with shorter overall survival (42% versus 55%; HR 1.53, 95% CI 0.48-4.83), showing the tendency of interaction between post-CCRT PD-L1 status and adjuvant durvalumab therapy for overall survival (interaction P = 0.18).
We failed to demonstrate that adjuvant durvalumab improved survival after neoadjuvant CCRT in patients with ESCC. However, post-CCRT PD-L1 expression could predict the survival of patients who receive adjuvant durvalumab after neoadjuvant CCRT, which needs to be validated.
•The adjuvant durvalumab therapy failed to demonstrate the survival benefit in ESCC who underwent neoadjuvant CCRT.•This is the first report on the role of adjuvant immunotherapy in both pathologic complete response (ypCR) and non-ypCR.•The post-CCRT PD-L1 expression seems more useful than pre-CCRT PD-L1 expression in predicting the survival.•The benefit of adjuvant durvalumab seems to be greater in patients without ypCR than in those with ypCR.
A condition monitoring system (CMS) plays a critical role in tapping the maximum potential of wind energy through wind turbine by minimizing the downtime. It has been proved that the CMS-based ...maintenance, compared to scheduled and corrective maintenance, is more suitable in many aspects with few disadvantages. The cost of CMS design and installation is substantial in comparison to other maintenance approaches but in the longer run CMS provides benefits surpassing the costs. There are such important parameters as the identification of most sensitive, less sensitive components, replacement costs accompanied with certain components that should be taken into consideration when designing the CMS. In this paper, we have made an attempt to evaluate the viability of CMS, and important parameters in its design, system architecture and installation. The sole purpose is to highlight the overwhelming role of CMS as a better and viable option for increasing the production rate and lowering the downtime in the wind energy converter.
Although endoscopic submucosal dissection (ESD) is increasingly utilized to treat early neoplasms of the gastrointestinal tract, its use for duodenal neoplasms is limited by the thin wall and narrow ...lumen of the duodenum. We have reviewed cases where ESD was used to treat sessile, nonampullary duodenal neoplasms. To do this, we retrospectively reviewed the medical records of patients treated with ESD for adenomas of the duodenum from January 2001 to December 2010, assessing the curative outcomes and complication rates. A total of 14 cases were reviewed. Mean patient age was 56.4 years. The mean size of tumors and mean size of the specimens were 17.1 mm and 26.4 mm, respectively. The en bloc resection rate with ESD was 78.6%, and the complete (R0) resection rate was 85.7%. No patient in the study experienced major bleeding. However, second-look endoscopy revealed minor bleeding requiring endoscopic homeostasis in one case (7.1%). Perforations were observed in five cases (35.7%). Two of the five patients with perforation underwent surgery. The ESD methods yielded acceptable curative resection rates for duodenal adenomas, although ESD was associated with a higher rate of perforation. Therefore, duodenal ESD should be performed with care and only in selected patients to avoid serious complications.
This study aimed to assess the association between body mass index (BMI) and the development of severe hypoglycaemia in patients with type 2 diabetes (T2D), using nationwide data for the entire South ...Korean population.
The association between BMI and severe hypoglycaemia was retrospectively examined from claims and National Health examination data registered between 2002 and 2015. A total of 1,366,692 subjects assigned clinical codes for T2D and prescribed antihypoglycaemic agents were included. The primary outcome was an episode of severe hypoglycaemia after the baseline health examination.
A total of 37,682 subjects (2.7%) experienced a new severe hypoglycaemic event during the follow-up period (mean: 8.6 years). An inverse J-shaped association was observed between BMI and severe hypoglycaemic events. The association between low BMI and high risk of severe hypoglycaemia was similar in subjects who had never smoked, did not consume alcohol, did not use insulin and had no major comorbidities, after adjusting for multiple confounding variables. This association was also found to be intensified in men, young people aged 30–49 years, those with major comorbidities and insulin users.
BMI and severe hypoglycaemia were found to be inversely associated. Thus, those who fall into the category of having low BMI and high risk of severe hypoglycaemia should be warned about the risk of having a hypoglycaemic event and be properly informed about hypoglycaemia to minimize the risk of fatal hypoglycaemia-related outcomes.
Overview of the ITER TBM Program Giancarli, L.M.; Abdou, M.; Campbell, D.J. ...
Fusion engineering and design,
August 2012, 2012-8-00, 20120801, Letnik:
87, Številka:
5-6
Journal Article
Recenzirano
► The ITER TBM Program is the answer to the ITER mission of “testing tritium breeding module concepts that would lead in a future reactor to tritium self-sufficiency, the extraction of high grade ...heat and electricity production”. ► This paper describes the main features of the six TBSs that are presently planned for installation and operation in ITER, the main interfaces with other ITER systems and the main aspects of the TBM Program management. ► The pre-conceptual design of the six Test Blanket Systems to be tested in ITER is available and their integration in the ITER facility is currently on-going. ► For each Test Blanket System, the most important next step is the signature of the corresponding TBM Arrangement that will allow performing the TBS conceptual design review shortly after. ► Delivery and installation of the six Test Blanket Systems is planned for the initial ITER H-phase.
The objective of the ITER TBM Program is to provide the first experimental data on the performance of the breeding blankets in the integrated fusion nuclear environment. Such information is essential to design and predict the performance of DEMO and future fusion reactors. It foresees to test six mock-ups of breeding blankets, called Test Blanket Module (TBM), in three dedicated ITER equatorial ports from the beginning of the ITER operation. The TBM and its associated ancillary systems, including cooling system and tritium extraction system, forms the Test Blanket System (TBS) that will be fully integrated in the ITER machine and buildings. This paper describes the main features of the six TBSs that are presently planned for installation and operation in ITER, the main interfaces with other ITER systems and the main aspects of the TBM Program management.
In this study, we investigated the translocation characteristics of flagellar filaments (Salmonella typhimurium) and flagellin subunits through silicon nitride nanopores in tandem with optical ...microscopy analysis. Even though untagged flagella are dark to the optical method, the label-free nature of the nanopore sensor allows it to characterize both tagged (Cy3) and pristine forms of flagella (including real-time developments). Flagella were depolymerized to flagellin subunits at ∼65 °C (most commonly reported temperature), ∼70 °C, ∼75 °C, and ∼80 °C to investigate the effect of temperature (T depol) on depolymerization. The change in conductance (ΔG) profiles corresponding to T depol ∼65 °C and ∼70 °C were bracketed within the flagellin monomer profile whereas those of ∼75 °C and ∼80 °C extended beyond this profile, suggesting a change to the native protein state. The molecular radius calculated from the excluded electrolyte volume of flagellin through nanopore-based ΔG characteristics for each T depol of ∼65 °C, ∼70 °C, ∼75 °C, and ∼80 °C yielded ∼4.2 ± 0.2 nm, ∼4.3 ± 0.3 nm, ∼4.1 ± 0.2 nm, and ∼4.7 ± 0.5 nm, respectively. This, along with ΔG (plateaued values) and translocation time profiles, points to the possibility of flagellin misfolding at ∼80 °C.
The performance of activated carbon in soil washing and subsequent selective adsorption for surfactant recovery from the washed solution was investigated. Sandy loam soil contaminated with ...phenanthrene at 200
mg
kg
−1 was washed with four different nonionic surfactants: Tween 40, Tween 80, Brij 30 and Brij 35. The efficiency of soil washing was highest when using Brij 30 with the highest solubilizing ability for phenanthrene and low adsorption onto soil. In the selective adsorption step, surfactant recovery was quite effective for all surfactants ranging from 85.0 to 89.0% at 1
g
L
−1 of activated carbon (Darco 20–40
mesh). Phenanthrene removal from the solution washed with Brij 30 was only 33.9%, even though it was 54.1–56.4% with other surfactants. The selectivity was larger than 7.02 except for Brij 30 (3.60). The overall performance considering both the washing and surfactant recovery step was effective when using Tween 80 and Brij 35. The results suggest that higher solubilizing ability of surfactants is a requirement for soil washing but causes negative effects on phenanthrene removal in the selective adsorption. Therefore, if a surfactant recovery process by selective adsorption is included in soil remediation by washing, the overall performance including the two steps should be considered for properly choosing the surfactant.
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