Predicting maximal heart rate (MHR) in heart failure with reduced ejection fraction (HFrEF) still remains a major concern. In such a context, the Keteyian equation is the only one derived in a HFrEF ...cohort on optimized β-blockers treatment. Therefore, using the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) data set, we looked for a possible MHR equation, for an external validation of Keteyien formula and, contextually, for accuracy of the historical MHR formulas and their relationship with the HR measured at the anaerobic threshold (AT).
Data from 3487 HFrEF outpatients on optimized β-blockers treatment from the MECKI data set were analyzed. Besides excluding all possible confounders, the new equation was derived by using HR data coming from maximal cardiopulmonary exercise test. The simplified derived equation was 109-(0.5*age) + (0.5*HR rest) + (0.2*LVEF)-(5 if haemoglobin <11 g/dL). The R2 and the standard error of the estimate were 0.24 and 17.5 beats min-1 with a mean absolute percentage error (MAPE) = 11.9%. The Keteyian equation had a slightly higher MAPE = 12.3%. Conversely, the Fox and Tanaka equations showed extremely higher MAPE values. The range 75-80% of MHR according to the new and the Keteyian equations was the most accurate in identifying the HR at the AT (MAPEs = 11.3-11.6%).
The derived equation to estimate the MHR in HFrEF patients, by accounting also for the systolic dysfunction degree and anaemia, improved slightly the Keteyian formula. Both formulas might be helpful in identifying the true maximal effort during an exercise test and the intensity domain during a rehabilitation programme.
•Lava flows can erode into the surfaces (substrates) upon which they flow.•A lava flow at Momotombo volcano, Nicaragua incised 30m into the cone as it emplaced.•This flow thermo-mechanically eroded ...by heating the substrate and reducing hardness.•The substrate's glass transition temperature is the point at which erosion begins.•Levees do not bound incised parts of the channel, useful for planetary applications.
We document remarkably efficient thermo-mechanical erosion by a small-volume lava flow. Downcutting by a basaltic-andesite lava flow on the steep-sided Momotombo volcano, Nicaragua, occurred at 100 times the rate commonly reported for thermal erosion in lava flow fields, even though this flow was small-volume (0.02km3) and effused at a low rate for <1 week. The lava flow incised into the pyroclastic substrate up to 30m, with erosion depth controlled primarily by thermal reduction of substrate hardness. We show that incision depth decreases, approximately exponentially, with distance along the flow path, until erosion stopped and the flow became constructional. This transition occurs 650m from the vent on a slope averaging a 32∘ incline. Results indicate that syn-eruptive erosion is an important morphological process on some steep-sided volcanoes that are predominantly composed of layered pyroclasts. Rapid erosion and incision increased flow run-out for the 1905 flow, which in turn directed the flow and run-out of the 2015 lava flow. Mapping and understanding these features is critical for improving lava flow hazard assessments and provides insight into the construction and growth of composite cones.
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While classical nodal mantle cell lymphoma (cMCL) is often associated with involvement of multiple extranodal sites, isolated extranodal disease ...(ED) at the time of diagnosis is a rare event; data on the outcome of these forms are lacking. On behalf of the European MCL Network, we conducted a retrospective analysis on the clinical characteristics and outcomes of MCL presenting with isolated or predominant ED (MALT MCL). We collected data on 127 patients with MALT MCL diagnosed from 1998 to 2015: 78 patients (61%) were male with a median age of 65 years. The involved sites include: upper airways + Waldeyer ring (40; 32%), gastrointestinal tract (32; 25%), ocular adnexa (17; 13%), oral cavity and salivary glands (17; 13%) and others (13; 1%); 7 patients showed multiple extranodal sites. The median follow‐up was 80 months (range: 6–182), 5‐year progression‐free survival (PFS) was 45% (95% CI: 35–54) and 5‐year overall survival (OS) was 71% (95% CI: 62–79). In an explorative setting, we compared MALT MCL with a group of 128 cMCL patients: MALT MCL patients showed a significantly longer PFS and OS compared with nodal cMCL; with a median PFS of 4.5 years vs 2.8 years (p = 0.001) and median OS of 9.8 years vs 6.9 years (p = 0.018), respectively. Patients with MALT MCL at diagnosis showed a more favorable prognosis and indolent course than classical nodal type. This clinical variant of MCL should be acknowledged to avoid possible over‐treatment.
Abstract Background Fecal elastase-1(FE-1) has been suggested as an alternative to steatorrhea quantification to evaluate pancreatic insufficiency, but its diagnostic performance has not been ...compared with steatorrhea in chronic pancreatitis or after pancreatic resection. Methods The relationship between steatorrhea and FE-1 was studied in patients with chronic pancreatic disorders or pancreatic resection. Student's t test and ANOVA were used for statistical analysis, accepting 0.05 as limit for significance. Results Eighty-two patients were studied (42 non-operated; 40 previously submitted to pancreatic resection). Fat output was higher in operated than non-operated patients (29.2 ± 3.1 vs 9.9 ± 2.2 g/day, p < 0.001) FE-1 was more severely reduced in operated patients (202 ± 32.3 μg/g in non operated vs 68.6 ± 18.2 in operated patients; p < 0.001). Steatorrhea was significantly more severe in operated patients across different levels of FE-1. The relationship between FE-1 and steatorrhea was described by a power regression model, with a regression line significantly different in operated and non-operated patients ( p < 0.001). A steatorrhea of 7 g (upper limit of normal range) was calculated by this regression line when FE-1 is 15 μg/g in non-operated, but as high as 225 μg/g in operated patients. Conclusion FE-1 is useful to identify pancreatic insufficiency. Steatorrhea is anticipated in non-operated patients only when FE-1 is below the limit for a confident measurement of our assay. In operated patients, steatorrhea may be present even if FE-1 is only slightly reduced, that suggests a role for non pancreatic factors. FE1 is not useful to identify operated patients at risk of malabsorption.
Parental control and family dinners attendance may constitute protective factors against alcohol consumption during adolescence, with different patterns for boys and girls, though evidence thus far ...have produced mixed findings. The present study analyzed Health Behaviour in School-aged Children (HBSC, 2014) data from 906 adolescents living in Northern Italy (49% boys, 'M years' = 16.02, 'SD' = 2.4) to examine: (a) gender differences in alcohol consumption frequency; (b) whether greater parental control would mediate gender differences in alcohol consumption over the last 30 days; (c) whether regular attendance of family dinners would strengthen the effect of parental control in decreasing adolescents' alcohol consumption, functioning differently for boys and girls. Findings indicated that boys reported to attend family dinners more regularly, to consume alcohol more frequently, and to perceive greater paternal control, than girls. Conversely, girls perceived greater maternal control than boys. Both maternal and paternal control did mediate the relation between gender and alcohol consumption, decreasing adolescents' drinking. Unexpectedly, family dinners attendance did not significantly moderate the effect of parental control on the monthly frequency of adolescents' alcohol consumption. Results underline the protective role of parental control against adolescents' alcohol consumption in both girls and boys, regardless of their family dinners attendance.
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