People with sarcopenic obesity (SO) are characterized by both low muscle mass (sarcopenia) and high body fat (obesity); they have greater risks of metabolic diseases and physical disability than ...people with sarcopenia or obesity alone. Exercise and nutrition have been reported to be effective for both obesity and sarcopenia management. Thus, we aimed to investigate the effects of exercise and nutrition on body composition, metabolic health, and physical performance in individuals with SO. Studies investigating the effects of exercise and nutrition on body composition, metabolic health, and physical performance in SO individuals were searched from electronic databases up to April 2019. Fifteen studies were included in the meta-analysis. Aerobic exercise decreased body weight and fat mass (FM). Resistance exercise (RE) decreased FM and improved grip strength. The combination of aerobic exercise and RE decreased FM and improved walking speed. Nutritional intervention, especially low-calorie high-protein (LCHP) diet, decreased FM but did not affect muscle mass and grip strength. In addition to exercise training, nutrition did not provide extra benefits in outcome. Exercise, especially RE, is essential to improve body composition and physical performance in individuals with SO. Nutritional intervention with LCHP decreases FM but does not improve physical performance.
Simulated future summers (i.e., 2049–2051) and annual (i.e., 2050) average regional O3 and PM2.5 concentrations over the United States are compared with historic (i.e., 2000–2002 summers and all of ...2001) levels to investigate the potential impacts of global climate change and emissions on regional air quality. Meteorological inputs to the CMAQ chemical transport model are developed by downscaling the GISS Global Climate Model simulations using an MM5‐based regional climate model. Future‐year emissions for North America are developed by growing the U.S. EPA CAIR inventory, Mexican and Canadian emissions and by using the IMAGE model with the IPCC A1B emissions scenario that is also used in projecting future climate. Reductions of more than 50% in NOX and SO2 emissions are forecast. Impacts of global climate change alone on regional air quality are small compared to impacts from emission control‐related reductions, although increases in pollutant concentrations due to stagnation and other factors are found. The combined effect of climate change and emission reductions lead to a 20% decrease (regionally varying from −11% to −28%) in the mean summer maximum daily 8‐hour ozone levels (M8hO3) over the United States. Mean annual PM2.5 concentrations are estimated to be 23% lower (varies from −9% to −32%). Major reductions in sulfate, nitrate and ammonium PM2.5 components combined with the limited reduction in organic carbon suggests that organic carbon will be the dominant component of PM2.5 mass in the future. Regionally, the eastern United States benefits more than the rest of the regions from reductions in both M8hO3 and PM2.5, because of both spatial variations in the meteorological and emissions changes. Reduction in the higher M8hO3 concentrations is also estimated for all subregions and fewer days with M8hO3 above the air quality standards in urban sites with Atlanta in the southeast benefiting most.
Background
Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or peri-areolar incisions is a possible alternative to conventional breast surgery (CBS) for certain ...patients with breast cancer. In this study, we report the oncologic safety results of EABS compared with CBS.
Methods
Patients underwent EABS for breast cancer during the period June 2010 to March 2020 were collected from the EABS database from single institute, and another cohort of patients, who received CBS, were identified to determine the effectiveness and oncologic safety of EABS. A case-control study was conducted using propensity score matching (PSM) to prevent bias from cases selection.
Results
A total of 3426 patients were enrolled in the current study, including 405 patients receiving EABS and 3021 underwent CBS. Before PSM, patients selected for EABS tend to be smaller in tumor size, node negative, early stage, low histologic grade, and HER-2 negative. After PSM, 343 patients underwent EABS were compared with another 343 patients received CBS. The margin involved rate in EABS group is 2.6%, and 5.6% in CBS group (
p
= 0.054) after PSM. In breast conserving cases, the margin involved rates were 2% in EABS group, and 7.2% in CBS group (
p
= 0.04). In Kaplan-Meier survival curves analysis, there was no difference in local regional recurrence (
p
= 0.89), distant metastasis (
p
= 0.08), and overall survival (
p
= 0.14).
Conclusion
The preliminary oncologic safety analysis from current study showed EABS is a safe procedure and results in low margin involved rate, and no increase of locoregional recurrence, distant metastasis or mortality compared with CBS.
Left atrial (LA) function is tightly linked to several cardiovascular diseases and confers key prognostic information. Speckle tracking-based deformation as a feasible and sensitive LA mechanical ...assessment has proven its clinical significance beyond volume measures; however, the reference values remain largely unknown.
We studied 4042 participants undergoing annual cardiovascular survey. Among them, 2812 healthy participants (65% men; mean age, 47.4±9.9 years) were eligible for speckle tracking analysis. Peak atrial longitudinal systolic strain and strain rate (SR) at systolic (SRs), early diastolic (SRe), and late diastolic atrial contraction phases (SRa) were analyzed by dedicated software (EchoPAC, GE) and compared in terms of age, sex, and blood pressure. Overall, women demonstrated higher peak atrial longitudinal systolic strain (39.34±7.99% versus 37.95±7.96%; P<0.001) and showed age-dependent more pronounced peak atrial longitudinal systolic strain functional decay than those of men (P value for interaction, <0.05), with men showing higher SRs and SRa, although lower SRe (all P<0.001). Both increasing age and higher blood pressure were independently associated with deteriorated peak atrial longitudinal systolic strain, SRs, and SRe, although augmented LA SRa, even after accounting for baseline clinical covariates in multivariable models that incorporated LA volume, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or left ventricular E/e' (all P<0.001).
Our findings suggest LA mechanical functional decays in association with increasing age and higher blood pressure, which seem to be compensated for by augmentation of atrial pump function. We have also provided age- and sex-stratified reference values for strain and SR based on a large-scale Asian population.
Particle fouling mechanisms in “dead-end” microfiltration is analyzed using blocking models. The blocking index and resistance coefficient of the models during microfiltration are calculated under ...various conditions. The major factors affecting these model parameters, such as the filtration rate, the amount of particles simultaneously arriving at the membrane surface and particle accumulation, are discussed thoroughly. Instead of the four different blocking models previously proposed, a membrane blocking chart is established for relating the blocking index, filtration rate, and particle accumulation. Blocking index variation during microfiltration can be interpreted using this chart. Membrane blocking occurs during the initial filtration periods until the condition reaches a critical value; then, the blocking index suddenly drops to zero by following up the cake filtration model. Once the normalized resistance coefficient is regressed to an exponential function of the blocking index under a wide range of conditions, the blocking models can be used to quantitatively explain filtration flux attenuation by solving a unitary mathematical equation. Comparing the experimental filtration rates obtained under different conditions with the simulated results reveals a good agreement between them and demonstrates the reliability of this analysis method.
This study investigates long-term (i.e., 2007–2014) fluctuations in ambient ozone formation regimes for cities adjacent to shale plays in the Northeast United States (U.S.). Ozone air quality in many ...cities of the Northeast U.S. does not meet the U.S. National Ambient Air Quality Standards (NAAQS), and understanding ambient ozone formation regimes is essential to develop effective air pollution mitigation strategies for cities violating the air quality standards. Since 2013, the U.S. has become the world’s largest producer of tight oil and natural gas from shale rock, and previous studies show that emissions of air pollutant precursors from shale oil and gas-related activities would have the potential to affect ambient ozone air quality in adjacent cities of shale plays. This work leveraged (1) satellite-retrieved column densities of formaldehyde (HCHO) and nitrogen dioxide (NO2) from multiple instruments (i.e., Ozone Monitoring Instrument (OMI) and Global Ozone Monitoring Experiment-2 (GOME-2)); (2) photochemical air quality modeling and sensitivity analysis; and (3) ratios of satellite-retrieved air pollutant column densities to investigate ambient ozone formation regimes in neighboring cities of shale plays (i.e., Marcellus Shale) in the Northeast U.S. from 2007 to 2014. Our results show that ambient ozone formation in Boston, Pittsburgh, Philadelphia and Washington, D.C. (which are close to Marcellus Shale) was in the NOx -limited or transition regime during the period of study. Ambient ozone formation in New York City was in the transition regime during 2010–2013 and VOC -limited regime during 2007–2009 and in 2014. Based on the result of this study, we conclude that controls NOx emissions would mitigate ozone air pollution from 2007 to 2014 in most of the cities examined in this study. Controls of local VOC emissions would ease ozone air pollution in New York City during the study period. With projected increases in oil and gas production from shale plays in the Northeast U.S., air pollutant emissions from oil and gas-related activities are expected to increase in the future. The results of this study imply that controls of ozone precursor emissions from shale oil and gas-related activities could be a potential strategy for reducing ambient ozone formation in cities adjacent to the shale plays in Northeast U.S. in the future.
•We investigate ambient ozone formation regimes for cities adjacent to shale plays.•Column densities of precursors retrieved from OMI and GOME-2 are different.•NOx emission controls would reduce ozone levels in most cities in the Northeast U.S.•Ozone formation in New York was limited by VOC emissions in 2007–2009 and 2014.•Shale-related emission controls have the potential to reduce urban ozone levels.
The potential health impact of ambient ozone and PM2.5 concentrations modulated by climate change over the United States is investigated using combined atmospheric and health modeling. Regional air ...quality modeling for 2001 and 2050 was conducted using CMAQ Modeling System with meteorology from the GISS Global Climate Model, downscaled regionally using MM5, keeping boundary conditions of air pollutants, emission sources, population, activity levels, and pollution controls constant. BenMap was employed to estimate the air pollution health outcomes at the county, state, and national level for 2050 caused by the effect of meteorology on future ozone and PM2.5 concentrations. The changes in calculated annual mean PM2.5 concentrations show a relatively modest change with positive and negative responses (increasing PM2.5 levels across the northeastern U.S.) although average ozone levels slightly decrease across the northern sections of the U.S., and increase across the southern tier. Results suggest that climate change driven air quality-related health effects will be adversely affected in more than 2/3 of the continental U.S. Changes in health effects induced by PM2.5 dominate compared to those caused by ozone. PM2.5-induced premature mortality is about 15 times higher than that due to ozone. Nationally the analysis suggests approximately 4000 additional annual premature deaths due to climate change impacts on PM2.5 vs 300 due to climate change-induced ozone changes. However, the impacts vary spatially. Increased premature mortality due to elevated ozone concentrations will be offset by lower mortality from reductions in PM2.5 in 11 states. Uncertainties related to different emissions projections used to simulate future climate, and the uncertainties forecasting the meteorology, are large although there are potentially important unaddressed uncertainties (e.g., downscaling, speciation, interaction, exposure, and concentration−response function of the human health studies).
Introduction
Ventricular arrhythmia (VA) commonly originate from the left ventricular summit (LVS) and results in left ventricular (LV) dysfunction in some patients; however, factors related to LV ...cardiomyopathy have not been well elucidated. Therefore, this study aimed to investigate the risk factors for LV cardiomyopathy and the outcomes of patients with LVS VA.
Methods
Between 2013 and 2018, a total of 139 patients (60.7% men; mean age 53.2 ± 13.9 years old) underwent catheter ablation for LVS VA in two centers. Detailed patient demographics, electrocardiograms, electrophysiological characteristics, and clinical outcomes were analyzed. LV cardiomyopathy was defined as left ventricular ejection fraction (LVEF) <50%.
Results
Acute procedural success was achieved in 92.8% of patients. There were 40 patients (28.8%) with LV cardiomyopathy, and the mean LVEF improved from 37.5 ± 9.3% to 48.5 ± 10.2% after ablation (p < .001). After multivariate analysis, the independent factors of LV dysfunction were wider QRS duration (QRSd) of the VA (odds ratio OR 1.02; 95% confidence interval CI: 1.00–1.04; p = .046) and the absolute earliest activation time discrepancy (AEAD) between epicardium and endocardium (OR 1.05; 95% CI: 1.00–1.09; p = .048). After ablation, the LV function was completely recovered in 20 patients (50%). The factors for LV dysfunction without recovery included wider premature ventricular complex (PVC) QRSd (OR 1.09; 95% CI: 1.02–1.17; p = .012) and poorer LVEF (OR 0.85; 95% CI: 0.74–0.97; p = .020).
Conclusion
In patients with VA from the LVS, PVC QRSd and AEAD are factors associated with deteriorating LV systolic function. Catheter ablation can reverse LV remodeling. Narrower QRSd and better LVEF are associated with better recovery of LV function after ablation.
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