Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant ...injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% 425 of 574; mean age, 46.6 years; women, 26.0% 149 of 574; mean age, 48.9 years). χ
and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% 99 of 114; mean age, 48.6 years; women, 13.2% 15 of 114; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures.
RSNA, 2017.
Deep learning algorithms often struggle to accurately distinguish between healthy and anomalous states due to the scarcity of high-quality data in real-world applications. However, these data can be ...obtained through a physics-based simulation model. In this research, the model serves a dual purpose: detecting anomalies in industrial processes and replicating the machine’s operational behavior with high fidelity in terms of a simulated torque signal. When anomalous behaviors are detected, their patterns are utilized to generate anomalous events, contributing to the enhancement of deep neural network model training. This research proposes a method, named Simulation-Enhanced Anomaly Diagnostics (SEAD), to detect anomalies and further create high-quality data related to the diagnosed faults in the machine’s operation. The findings of this study suggest that employing a physics-based simulation model as a synthetic-anomaly signal generator can significantly improve the classification accuracy of identified anomalous states, thereby enhancing the deep learning model’s ability to recognize deviating behavior at an earlier stage when more high-quality data of the identified anomaly has been available for the learning process. This research measures the classification capability of a Long Short-Term Memory (LSTM) autoencoder to classify anomalous behavior in different SEAD stages. The validated results clearly demonstrate that simulated data can contribute to the LSTM autoencoder’s ability to classify anomalies in a peripheral milling machine. The SEAD method is employed to test its effectiveness in detecting and replicating a failure in the support element of the peripheral milling machine.
Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among ...employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression.
We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol.
We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13 and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32).
Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
ABSTRACT HCN is an important constituent in Titan's upper atmosphere, serving as the main coolant in the local energy budget. In this study, we derive the HCN abundance at the altitude range of ...960-1400 km, combining the Ion-Neutral Mass Spectrometer data acquired during a large number of Cassini flybys with Titan. Typically, the HCN abundance declines modestly with increasing altitude and flattens to a near constant level above 1200 km. The data reveal a tendency for dayside depletion of HCN, which is clearly visible below 1000 km but weakens with increasing altitude. Despite the absence of convincing anti-correlation between HCN volume mixing ratio and neutral temperature, we argue that the variability in HCN abundance makes an important contribution to the large temperature variability observed in Titan's upper atmosphere.
Febuxostat and allopurinol are urate-lowering therapies used to treat patients with gout. Following concerns about the cardiovascular safety of febuxostat, the European Medicines Agency recommended a ...post-licensing study assessing the cardiovascular safety of febuxostat compared with allopurinol.
We did a prospective, randomised, open-label, blinded-endpoint, non-inferiority trial of febuxostat versus allopurinol in patients with gout in the UK, Denmark, and Sweden. Eligible patients were 60 years or older, already receiving allopurinol, and had at least one additional cardiovascular risk factor. Those who had myocardial infarction or stroke in the previous 6 months or who had severe congestive heart failure or severe renal impairment were excluded. After a lead-in phase in which allopurinol dose was optimised towards achieving a serum urate concentration of less than 0·357 mmol/L (<6 mg/dL), patients were randomly assigned (1:1, with stratification according to previous cardiovascular events) to continue allopurinol (at the optimised dose) or start febuxostat at 80 mg/day, increasing to 120 mg/day if necessary to achieve the target serum urate concentration. The primary outcome was a composite of hospitalisation for non-fatal myocardial infarction or biomarker-positive acute coronary syndrome; non-fatal stroke; or cardiovascular death. The hazard ratio (HR) for febuxostat versus allopurinol in a Cox proportional hazards model (adjusted for the stratification variable and country) was assessed for non-inferiority (HR limit 1·3) in an on-treatment analysis. This study is registered with the EU Clinical Trials Register (EudraCT 2011-001883-23) and ISRCTN (ISRCTN72443728) and is now closed.
From Dec 20, 2011, to Jan 26, 2018, 6128 patients (mean age 71·0 years SD 6·4, 5225 85·3% men, 903 14·7% women, 2046 33·4% with previous cardiovascular disease) were enrolled and randomly allocated to receive allopurinol (n=3065) or febuxostat (n=3063). By the study end date (Dec 31, 2019), 189 (6·2%) patients in the febuxostat group and 169 (5·5%) in the allopurinol group withdrew from all follow-up. Median follow-up time was 1467 days (IQR 1029–2052) and median on-treatment follow-up was 1324 days (IQR 870–1919). For incidence of the primary endpoint, on-treatment, febuxostat (172 patients 1·72 events per 100 patient-years) was non-inferior to allopurinol (241 patients 2·05 events per 100 patient-years; adjusted HR 0·85 95% CI 0·70–1·03, p<0·0001). In the febuxostat group, 222 (7·2%) of 3063 patients died and 1720 (57·3%) of 3001 in the safety analysis set had at least one serious adverse event (with 23 events in 19 0·6% patients related to treatment). In the allopurinol group, 263 (8·6%) of 3065 patients died and 1812 (59·4%) of 3050 had one or more serious adverse events (with five events in five 0·2% patients related to treatment). Randomised therapy was discontinued in 973 (32·4%) patients in the febuxostat group and 503 (16·5%) patients in the allopurinol group.
Febuxostat is non-inferior to allopurinol therapy with respect to the primary cardiovascular endpoint, and its long-term use is not associated with an increased risk of death or serious adverse events compared with allopurinol.
Menarini, Ipsen, and Teijin Pharma Ltd.
IgA deficiency (IgAD) and common variable immunodeficiency (CVID) often co-occur in families, associating with chronic inflammatory diseases such as celiac disease (CD). ICOS (inducible ...co-stimulator) and CTLA4 (cytotoxic T-lymphocyte-associated protein-4) may be important in both disorders, as ICOS is necessary for Ig class-switching and CTLA4 negatively regulates T-cell activation. Linkage and association of CD with CTLA4-ICOS is well documented, we thus aimed to further pinpoint CD susceptibility by haplotype-tagging analysis. We genotyped 663 CD families from Finland and Hungary, 575 additional CD patients from Finland, Hungary and Italy; 275 Swedish and Finnish IgAD individuals and 87 CVID individuals for 14-18 genetic markers in CTLA4-ICOS. Association was found between CTLA4-ICOS and both IgAD (P=0.0015) and CVID (P=0.0064). We confirmed linkage of CTLA4-ICOS with CD (LOD 2.38, P=0.0005) and found association of CTLA4-ICOS with CD (P=0.0009). Meta-analysis of the IgAD, CVID and CD materials revealed intergenic association (P=0.0005). Disease-associated markers were associated with lower ICOS and higher CTLA4 expression, indicating that the risk haplotypes contain functional variants. In summary, we identified a novel shared risk locus for IgAD, CVID and CD, the first report of association between CTLA4-ICOS and IgAD. Association between CD and CTLA4-ICOS was also confirmed in a large European data set.
Exoplanets orbiting close to their host star are expected to support a large ionosphere, which extends to larger pressures than witnessed in our solar system. These ionospheres can be investigated ...with ground-based transit observations of the optical signatures of alkali metals, which are the source of the ions. However, most ground-based transit spectra do not systematically resolve the wings of the features and continuum, as needed to constrain the alkali abundances. Here we present new observations and analyses of optical transit spectra that cover the Na doublet in the atmosphere of the exoplanet XO-2b. To assess the consistency of our results, observations were obtained from two separate platforms: Gemini/GMOS and Mayall/KOSMOS. To mitigate the systematic errors, we chose XO-2, because it has a binary companion of the same brightness and stellar type, which provides an ideal reference star to model Earth's atmospheric effects. We find that interpretation of the data is highly sensitive to time-varying translations along the detector, which change according to wavelength and differ between the target and reference star. It was necessary to employ a time-dependent cross-correlation to align our wavelength bins and correct for atmospheric differential refraction. This approach allows us to resolve the wings of the Na line across five wavelength bins at a resolution of ∼1.6 nm and limit the abundance of Na. We obtain consistent results from each telescope with an Na amplitude of 521 161 and 403 186 ppm for GMOS and KOSMOS, respectively. The results are analyzed with a radiative transfer model that includes the effects of ionization. The data are consistent with a clear atmosphere between ∼1 and 100 mbar that establishes a lower limit on Na at ppm (Na/H = ), consistent with solar. However, we cannot rule out the presence of clouds at ∼10 mbar that allow for higher Na abundances, which would be consistent with the stellar metallicity measured for the host star (Na/H = 0.485 0.043).
In the present study, we investigated the role of adipocytokine leptin in the pathogenesis of osteoarthritis (OA) by measuring its effects on matrix metalloproteinase (MMP) production in human OA ...cartilage. In addition, the correlations between leptin and MMP concentrations in synovial fluid from OA patients were studied.
Cartilage tissue obtained from leftover pieces of total knee replacement surgery from patients with OA was used in the experiments. Production of collagenases MMP-1, MMP-8 and MMP-13, and stromelysin-1 (MMP-3) in the cartilage was measured by immunoassay and the signalling pathways were explored by pharmacological means. In addition, synovial fluid samples were collected from 84 OA patients undergoing knee replacement surgery. The concentrations of leptin and MMPs in synovial fluid were measured by immunoassay.
Leptin alone and in combination with IL-1β enhanced production of MMP-1, MMP-3, and MMP-13 in human OA cartilage, while MMP-8 concentrations remained undetectable. The effects of leptin on MMP-1, MMP-3 and MMP-13 production were mediated through transcription factor NF-κβ, and through protein kinase C and MAP kinase pathways. Interestingly, leptin concentrations in synovial fluid from OA patients correlated positively with MMP-3 (r=0.51, p<0.001) and MMP-1 (r=0.41, p<0.001) levels.
To our knowledge, this is the first study to show that leptin up-regulates MMP-1 and MMP-3 production in human OA cartilage and correlates positively to MMP-1 and MMP-3 in synovial fluid from OA patients. The findings suggest that leptin has catabolic effects in OA joints by increasing MMP production in cartilage.
An educator’s competence influences the implementation of evidence-based education and the overall quality of social and health care. This study aimed to identify distinct competence profiles from ...Finnish social, health and rehabilitative care educators, as well as describe which personal and professional characteristics influenced belonging to a certain profile. Data were collected from 28 educational organizations located throughout Finland using the Health and Social Care Educators’ Competence instrument. The survey was answered by 422 educators. The performed K-means cluster analysis identified three distinct educator competence profiles, which differed in terms of self-assessed expertise in various competence areas and certain background characteristics. The results highlight that educational institutions should concentrate on refining the digital competence of educators, which requires networking, collaboration, and work-related pedagogical competence. The differences in evaluation identified for the three profiles demonstrates that more experienced educators should mentor their less experienced counterparts to ensure a high quality of education.
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