Land-use intensification dominates China's land provisioning services: From the perspective of land system science

A pressing challenge to global sustainability is meeting the escalating needs of a growing population while safeguarding land resources from degradation. In recent decades, China's rapid growth, expanding population, urban sprawl, and diminishing high-quality farmland have presented a compelling case suitable for exploring solutions and challenges related to this critical issue. Therefore, there is an urgent need for comprehensive and detailed information regarding land systems. Here, we developed the first fine-scale dataset of the China Land System at a spatial resolution of 1 km, covering the period from 2000 to 2015. By leveraging this comprehensive land information, we identified five primary types of land systems and their respective subsystems, thereby delineating distinct patterns of human-environmental interaction. Land system dynamics followed diverse developmental trajectories characterized by incremental shifts toward more functionally centralized systems. Land use intensification played a significant role in increasing the population capacity and food production in China, contributing nearly 93.94% and 84.99%, respectively. In contrast, land cover changes accounted for only 4.69% and 11.43%, respectively. These findings underscore the tendency of previous studies to overestimate the impact of land cover change and underestimate the influence of land use intensification in meeting the growing demands of land-based production. This study emphasizes the importance of transcending traditional land cover-based approaches and integrating land systems into land representation and global land change scenario simulations to promote sustainability.

Mitigation Measures Could Aggravate Unbalanced Nitrogen and Phosphorus Emissions from Land-Use Activities

Socioeconomic factors and mitigation potentials are essential drivers of the dynamics of nutrient emissions, yet these drivers are rarely examined at broad spatiotemporal scales. Here, we combine material flow analysis and geospatial analysis to examine the past and future changes of nitrogen and phosphorus emissions in China. Results show that anthropogenic nitrogen and phosphorus emissions increased by 17% and 32% during 2000-2019, respectively. Meanwhile, many regions witnessed decreasing nitrogen emissions but rising phosphorus discharged to waterbody, leading to a 20% decrease in the nitrogen/phosphorus ratio. In addition to many prominent factors like fertilizer use, the increasing impervious land area around cities is a notable factor driving the emissions, indicating the urgency to limit building expansion, especially in North China Plain and other less-developed regions. Improving land-use efficiency and consuming behaviors could reduce nitrogen and phosphorus emissions by 65-77% in 2030, but the nitrogen/phosphorus ratio will increase unintendedly due to larger reduction potentials for phosphorus, which may deteriorate the aquatic ecosystem. We highlight that nitrogen and phosphorus emissions should be reduced with coordinated but differentiated measures by prioritizing nitrogen reduction through cropland and food-system management.

Asthma and clinical outcomes of COVID-19 in a community setting

OBJECTIVES

The association between asthma and COVID-19 mortality remains inconclusive. We examined the association between asthma and clinical outcomes of patients with COVID-19.

STUDY DESIGN

A case-control study based on a surveillance cohort in Harris County, Texas.

METHODS

Using the data of 21,765 patients who reported having at least one chronic health condition, we investigated the association between asthma and COVID-19 severity, characterized primarily by hospitalization and death. Unconditional logistic regression models were used to estimate the multivariable odds ratio (mOR) and its 95 % confidence interval (CI) of COVID-19 severity associated with asthma and other chronic lung diseases, adjusting for demographic and other comorbidities. A P-value < 0.005 was considered statistically significant after correcting multiple testing.

RESULTS

In total, 3034 patients (13.9 %) had asthma, and 774 (3.56 %) had other chronic lung diseases. The case death rate among patients with asthma and other chronic lung diseases was 0.75 % and 19.0 %, respectively. Compared to patients without the respective conditions, patients with asthma had lower odds of death (mOR = 0.44, 95 % CI: 0.27-0.69), while patients with other chronic lung diseases had higher odds of hospitalization (mOR = 2.02, 95 % CI: 1.68-2.42) and death (mOR = 1.95, 95 % CI: 1.52-2.49) (P-values < 0.005). Risk factors for COVID-19 mortality included older age, male gender, diabetes, obesity, hypertension, cardiovascular disease, active cancer, and chronic kidney disease.

CONCLUSIONS

The public health surveillance data suggested that preexisting asthma was inversely associated with COVID-19 mortality.

[Analysis of clinical characteristics and treatment status of atopic dermatitis in a children's hospital in Beijing from 2015 to 2019]

To analyze the clinical characteristics and treatment status of atopic dermatitis (AD) in children in the outpatient department of a children's hospital in Beijing from 2015 to 2019. This study used a cross-sectional study method to retrospectively analyze the data of AD patients who visited the Dermatology outpatient department of Beijing Children's Hospital, Capital Medical University, from April 2015 to April 2019. A total of 1 926 AD patients aged 0-17.5 years old living in Beijing and its surrounding areas were included, and the general situation, severity and distribution of AD disease, clinical characteristics and severity of AD, relevant influencing factors of AD onset, AD disease prognosis and treatment status were recorded. SAS 9.4, SPSS19.0, and R software were used for data processing, and descriptive statistical analysis, Chi-square test, Analysis of Variance, and correspondence analysis were used for statistical analysis. The results showed that the male to female ratio of AD patients in children included in this study was 1.4∶1; 79.0% (1 522/1 926), 86.1%(1 658/1 926), 91.3%(1 758/1 926), and 97.3%(1 907/1 926) of AD onset at the age of 6 months, 1 year, 2 years, and 5 years, respectively; mild of AD patients accounted for 13.2% (255/1 926)(SCORAD score 0-24), moderate of AD patients accounted for 50.1%(965/1 926) (SCORAD score 25-50), and severe of AD patients accounted for 36.7% (706/1 926)(SCORAD score>50).The age of severe AD patients were younger than mild and moderate AD patients. The face, head, trunk, and lower limbs were common areas of onset for moderate to severe AD, while the hands, feet, and ears were common areas of onset for severe AD patients. Temperature changes, hot water factors, mental and emotional states, and spring and winter were the main aggravation factors of AD;35.2% (678/1 926) aggravated and 61.8% (1 191/1 926) persistent. The more frequent bathing, the less severity of AD disease (χ2=29.791,P<0.001); 28.0% (520/1 856) of AD patients have no moisturizing habits, which were correlated with the severity of AD disease (χ2=15.908, P<0.05); the proportion of combined treatment medications in children with moderate to severe AD was significantly higher than mild AD patients. In conclusion, the patients with AD who went to specialist clinics were mainly moderate to severe patients and developed disease before the age of 5 years from 2015 to 2019.The severity of AD were mainly moderate to severe, and most of these patients had poor disease control. Traditional treatment plans had limitations. Identifying the clinical characteristics and treatment status of childhood AD would help us to carry out more targeted prevention and management work.

How does market-oriented allocation of industrial land affect carbon emissions? Evidence from China

Industrial land serves as the fundamental basis for urban economic development and significantly contributes to carbon emissions. Effective market mechanisms are crucial for reducing carbon emissions. As such, investigating the impact of market-oriented allocation of industrial land (MAIL) on carbon emissions and its pathways is of substantial practical importance for global low-carbon development. This study constructs a theoretical framework examining the influence of MAIL on carbon emissions, focusing on 285 Chinese cities from 2003 to 2020. The spatial econometric model is employed to analyze the impact of MAIL on carbon emissions. The results show that: first, from a national perspective, MAIL not only reduces carbon emissions within a region but also in neighboring regions. Higher MAIL leads to more effective carbon emission reductions, which are persistent and hysteresis in time. Path analysis demonstrates that MAIL reduces carbon emissions by promoting industrial upgrading and technological innovation. Second, there are differences in the timeliness of carbon emission reduction effects in cities of different scales and regions. For cities of different scales, the carbon reduction effect of MAIL is more stable in large and medium cities compared to megacities and small cities, but in the short term, MAIL will hinder the industrial upgrading of megacities and thus is not conducive to carbon reduction. For different regional cities, the carbon reduction effect of MAIL is more stable in other regions except northeast region, and in the short term, MAIL will inhibit technological innovation in northeast region, which is not conducive to carbon reduction. Consequently, it is essential not only to design a top-level reform plan for MAIL in China but also to establish differentiated reform policies for MAIL, tailored to the unique characteristics of cities with different scales and regions, to effectively reduce carbon emissions.

Clinical Relevance of Plaque Distribution for Basilar Artery Stenosis

BACKGROUND AND PURPOSE

There is no clear association between plaque distribution and postoperative complications in patients with basilar artery atherosclerotic stenosis. The aim of this study was to determine whether plaque distribution and postoperative complications after endovascular treatment for basilar artery stenosis are related.

MATERIALS AND METHODS

Our study enrolled patients with severe basilar artery stenosis who were scanned with high-resolution MR imaging and followed by DSA before the intervention. According to high-resolution MR imaging, plaques can be classified as ventral, lateral, dorsal, or involved in 2 quadrants. Plaques affecting the proximal, distal, or junctional segments of the basilar artery were classified according to DSA. An experienced independent team assessed ischemic events after the intervention using MR imaging. Further analysis was conducted to determine the relationship between plaque distribution and postoperative complications.

RESULTS

A total of 140 eligible patients were included in the study, with a postoperative complication rate of 11.4%. These patients were an average age of 61.9 (SD, 7.7) years. Dorsal wall plaques accounted for 34.3% of all plaques, and plaques distal to the anterior-inferior cerebellar artery accounted for 60.7%. Postoperative complications of endovascular treatment were associated with plaques located at the lateral wall (OR = 4.00; 95% CI, 1.21-13.23; P = .023), junctional segment (OR = 8.75; 95% CI, 1.16-66.22; P = .036), and plaque burden (OR = 1.03; 95% CI, 1.01-1.06; P = .042).

CONCLUSIONS

Plaques with a large burden located at the junctional segment and lateral wall of the basilar artery may increase the likelihood of postoperative complications following endovascular therapy. A larger sample size is needed for future studies.

Future climate imposes pressure on vulnerable ecological regions in China

Ecological regions of medium fragility account for 55 % of China's land. Large-scale afforestation and land reclamation have been carried out in these areas over the past few decades. However, how future climate change poses risks and challenges to them remains unclear. By establishing a multi-algorithm framework combining machine learning algorithms with multi-source dataset, our work predicts Normalized Difference Vegetation Index (NDVI, a proxy for vegetation greenness) and its variations in the 21st century under different climate scenarios. We find that vegetation greening (i.e., NDVI increase) in northern and southwestern China is unstable over four 20-year periods from 2020 to 2100. However, a strikingly prominent greening is expected to occur on the Qinghai-Tibet Plateau until the end of this century. Future warming can not only exacerbate the difficulties of vegetation conservation and restoration in vulnerable ecological regions, also threaten these new croplands, stymieing ambitions to increase crop production in China. Our results underscore the crucible that a warming climate presents to current restoration projects. We highlight the urgency of adapting to climate change to achieve ambitious goals of carbon sequestration and food security in China.

Saturation response of enhanced vegetation productivity attributes to intricate interactions

Evidence for the multifaceted responses of terrestrial ecosystems has been shown by the weakening of CO₂ fertilization-induced and warming-controlled productivity gains. The intricate relationship between vegetation productivity and various environmental controls still remains elusive spatially. Here several inherent preponderances make China a natural experimental setting to investigate the interaction and relative contributions of five drivers to gross primary productivity for the period from 1982 to 2018 (i.e., elevated atmospheric CO₂ concentrations, climate change, nutrient availability, anthropogenic land use change, and soil moisture) by coupling multiple long-term datasets. Despite a strikingly prominent enhancement of vegetation productivity in China, it exhibits similar saturation responses to the aforementioned environmental drivers (elevated CO₂ , climatic factors, and soil moisture). The CO₂ fertilization-dominated network explains the long-term variations in vegetation productivity in humid regions, but its effect is clearly attenuated or even absent in arid and alpine environments controlled by climate and soil moisture. Divergence in interactions also provides distinct evidence that water availability plays an essential role in limiting the potential effects of climate change and elevated CO₂ concentrations on vegetation productivity. Unprecedented industrialization and dramatic surface changes may have breached critical thresholds of terrestrial ecosystems under the diverse natural environment and thus forced a shift from a period dominated by CO₂ fertilization to a period with nonlinear interactions. These findings suggest that future benefits in terrestrial ecosystems are likely to be counteracted by uncertainties in the complicated network, implying an increasing reliance on human societies to combat potential risks. Our results therefore highlight the need to account for the intricate interactions globally and thus incorporate them into mitigation and adaptation policies.

Thrombectomy Using the EmboTrap Clot-Retrieving Device for the Treatment of Acute Ischemic Stroke: A Glimpse of Clinical Evidence

BACKGROUND

The EmboTrap Recanalization Device is a novel stent retriever for thrombectomy in the setting of acute ischemic stroke due to large-vessel occlusion.

PURPOSE

Our aim was to summarize the safety and efficacy of the EmboTrap Recanalization Device in acute ischemic stroke-large-vessel occlusion through a systematic review and meta-analysis.

DATA SOURCES

Medline, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were searched up to April 2022.

STUDY SELECTION

Nine observational studies using the EmboTrap Recanalization Device were selected.

DATA ANALYSIS

We adapted effect size with 95% CIs for dichotomous data. P value <.05 was statistically significant.

DATA SYNTHESIS

The estimated rate of successful recanalization (modified TICI 2b-3) was 90% (95% CI, 86%-95%; I ² = 82.4%); 90-day favorable outcome (mRS 0-2), 53% (95% CI, 42%-63%; I ² = 88.6%); modified first-pass effect, 43% (95% CI, 35%-51%; I ² = 63.7%); and first-pass effect, 36% (95% CI, 29%-46%; I ² = 10.7%). The rate of any intracerebral hemorrhage was 19% (95% CI, 16%-22%; I ² = 0.0%); symptomatic intracerebral hemorrhage, 5% (95% CI, 1%-8%; I ² = 84.6%); and 90-day mortality, 14% (95% CI, 9%-19%; I ² = 79.3%). Subgroup analysis showed higher rates of complete recanalization for EmboTrap II than for the EmboTrap System.

LIMITATIONS

The included studies are single-arm without direct comparison with other stent retrievers. Some of the studies recruited had a small sample size and were limited by the retrospective study design. In addition, the uncertain heterogeneity among studies was high.

CONCLUSIONS

The EmboTrap Recanalization Device is safe and efficient in treating acute ischemic stroke due to large-vessel occlusion.

442 A Comparison of Short-Term Outcomes in Robotic and Laparoscopic Distal Pancreatectomy

Aim

Technical limitations of laparoscopic distal pancreatectomy (LDP) may translate to high conversion postoperative complications rates. Robotic distal pancreatectomy (RDP) can potentially allow for better visualisation and greater freedom of movement, improving surgical outcomes. The aim of this retrospective observational study is to compare short term outcomes between RDP and LDP.

Method

We retrospectively analysed all RDP and LDP procedures performed at our centre by a single surgeon between December 2009 and July 2021. We recorded demographic data for 62 consecutive LDP cases and 27 RDP cases and compared the perioperative outcomes, 90-day morbidity and mortality.

Results

Both groups were comparable with respect to baseline characteristics. The conversion to open rate was significantly higher in the laparoscopic group (21.0% vs. 3.7%, p = 0.04). Operative time (176.5 min RDP vs. 156.8 min LDP, p = 0.503) and number of operations with clinically significant estimated blood loss (&gt; 500ml) (1 RDP vs. 3 LDP, p = 0.998) was comparable in both groups. For the benign conditions, the spleen preservation rate showed no significant difference between the two groups (14.8 vs. 11.3%, p = 0.729). In both groups, three patients were readmitted within 90 days. There was no 90-day mortality in either group.

Conclusions

According to our results, RDP was equivalent to LDP in nearly all short-term operative outcomes and safety but significantly reduced the risk of conversion to open resection. However, the evidence is limited, and larger multi-centre randomised trials are needed to investigate the long-term outcomes.

Artificial light pollution inhibits plant phenology advance induced by climate warming

Natural photic regime has been drastically altered by the artificial night sky luminance. Despite evidence of sufficient light brightness inducing plant physiology and affecting phenology, generalization regarding effects of light pollution on plant phenology across species and locations is less clear. Meanwhile, the relative contributions and joint effects of artificial light pollution and climate change or other anthropic stressors still remain unknown. To fill this knowledge gap, we utilized in situ plant phenological observations of seven tree species during 1991-2015 in Europe, night-time light dataset and gridded temperature dataset to investigate the impacts of the artificial light pollution on spatial-temporal shifts of plant phenological phases under climatic warming. We found 70% of the observation sites were exposed to increased light pollution during 1992-2015. Among them, plant phenological phases substantially delayed at 12-39% observation sites of leaf-out, and 6-53% of flowering. We also found plant species appeared to be more sensitive to artificial light pollution, and phenology advancement was hindered more prominently and even delay phenomenon exhibited when the color level showed stronger sky brightness. Linear mixed models indicate that although temperature plays a dominant role in shifts of plant phenological phases at the spatial scale, the inhibitory effect of artificial light pollution is evident considering the interactions. To our knowledge, this study is the first to quantitatively establish the relationship between artificial light pollution and plant phenology across species and locations. Meanwhile, these findings provide a new insight into the ecological responses of plant phenology to the potential but poorly understood environmental stressors under this warmer world and call for light pollution to be accorded the equal status as other global change phenomena.

Cardiovascular benefits outweigh risks in patients with atrial fibrillation in REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial)

Background/Introduction

REDUCE-IT, a multinational, double-blind trial, randomized 8179 statin-treated patients with controlled low density lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to icosapent ethyl (IPE) 4 grams/day or placebo. IPE reduced the primary (CV death, myocardial infarction [MI], stroke, coronary revascularization, hospitalization for unstable angina) and key secondary (CV death, MI, stroke) endpoints 25% and 26%, respectively (each p&lt;0.0001), and individual components including stroke (28%), MI (31%), cardiac arrest (48%), and sudden cardiac death (31%) (all p≤0.01). With IPE, bleeding was greater (11.8% vs 9.9%; p=0.006), serious bleeding trended higher (2.7% vs 2.1%; p=0.06), and atrial fibrillation/flutter (AF/F) hospitalization endpoints increased (3.1% vs 2.1%; p=0.004).

Purpose

To evaluate the effects of IPE on the risk of CV events and safety measures in patients by either history of AF/F or in-study occurrence of positively adjudicated AF/F hospitalization.

Methods

Conduct post hoc efficacy and safety subgroup analyses of patients with or without either baseline history of AF/F or in-study adjudicated AF/F hospitalization, including hospitalization for ≥24 hours; AF/F not meeting endpoint criteria were reported as adverse events.

Results

Patients with (n=751; 9.2%) AF/F history at baseline (vs without; n=7428; 90.8%) (Figure 1), or those with (n=211; 2.6%) positively adjudicated in-study AF/F hospitalization endpoints (vs without; n=7968; 97.4%) (Figure 2), had higher event rates of primary, key secondary, and fatal or nonfatal stroke endpoints, but relative risk reductions with IPE were not significantly different (all interaction p-values [pint]=ns). Similar reductions were observed with IPE across the prespecified endpoint testing hierarchy in patients with or without AF/F history or in-study hospitalization endpoints. Patients with baseline AF/F history had similar relative risk for in-study occurrence of AF/F hospitalization with IPE versus placebo (pint=0.21) but had greater absolute risk (12.5% vs 6.3%, IPE vs placebo) vs patients without baseline AF/F history (2.2% vs 1.6%, IPE vs placebo); i.e., recurrent AF/F in those with a prior history of AF/F was more prevalent than de novo AF/F. Serious bleeding trended higher regardless of AF/F history or in-study AF/F hospitalization endpoints (all pint=ns); absolute risk of serious bleeding was greater in patients with AF/F history at baseline (7.3% vs 6.0%) vs those without a baseline history of AF/F (2.3% vs 1.7%), and serious bleeding also trended higher in patients with in-study AF/F hospitalization (8.7% vs 6.0%) vs without (2.5% vs 2.0%) [all IPE vs placebo].

Conclusion

REDUCE-IT patients with AF/F history or in-study AF/F hospitalization endpoints had greater CV risk, but similar relative risk reduction in primary, key secondary, and fatal or nonfatal stroke endpoints with IPE.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Amarin Pharma, Inc.

Lockdown induced night-time light dynamics during the COVID-19 epidemic in global megacities

The lockdown of cities against the COVID-19 epidemic directly decreases urban socioeconomic activities. Remotely sensed night-time light (NTL) provides a macro perspective to capture these variations. Here, taking 20 global megacities as examples, we adopted the NASA's Black Marble NTL data with a daily resolution to investigate their spatio-temporal changes. We collected daily NTL products for four weeks (one month) before and after the date of lockdown in each city, which were then summarized as weekly and monthly averaged NTL images after pre-processing (cloud removing, outlier detection, etc.). Results show that NTL overall decreased after the lockdown of cities, but with regional disparities and varying spatial patterns. Asian cities experienced the most obvious reduction of NTL. Particularly, the monthly averaged NTL in Mumbai, India, decreased by nearly 20% compared to one month before. However, there was no significant decline in NTL in European cities. African cities also experienced stable changes of NTL. Spatially, city centers darkened more obviously than the urban periphery. Facing emergencies, NTL data has broad applications in monitoring socioeconomic dynamics and assessing public policies in a near real-time manner.

REDUCE-IT: outcomes by baseline statin type

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) randomized 8,179 statin-treated patients with elevated triglycerides and increased cardiovascular (CV) risk to either icosapent ethyl (IPE), a pure, stable prescription form of eicosapentaenoic acid, 4g/day or placebo. IPE significantly reduced time to first occurrence of the primary composite endpoint of major adverse CV events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) (HR 0.75, CI 0.68–0.83) and key secondary endpoint events (composite of CV death, nonfatal MI, or nonfatal stroke) (HR 0.74, CI 0.65–0.83) versus placebo (all p&lt;0.0001). A modest reduction in placebo-corrected LDL-C was observed (−6.6%; p&lt;0.0001). The mechanisms for the CV benefit of icosapent ethyl are not fully understood.

Purpose

Explore the impact of statin type and lipophilic/lipophobic category on outcomes, and on LDL-C, to further consider the possible relevance of LDL-C pathways to the observed CV benefit of icosapent ethyl.

Methods

Primary and key secondary endpoint analyses and LDL-C changes from baseline were explored by individual statin type (atorvastatin, simvastatin, rosuvastatin, or pravastatin) at baseline, and then by categorizing these statins into lipophilic (i.e., hydrophobic: atorvastatin, simvastatin) and lipophobic (i.e., hydrophilic: rosuvastatin, pravastatin) statin groups; 96.1% of patients fell within these individual statin groups.

Results

CV outcomes were similar across statin types (interaction p=0.61) and lipophilic/lipophobic categories (interaction p=0.51) (Figure). Statin type and category had a similar lack of meaningful impact on the modest placebo-corrected median LDL-C changes from baseline to one year, which ranged from −5.8 to −8.4% (all p≤0.0003).

Conclusion

No meaningful treatment differences in the primary or key secondary endpoints across statin type or lipophilic/lipophobic category were observed. A similar lack of treatment difference was observed in LDL-C changes from baseline to one year. Therefore, the LDL-C changes and CV risk reduction in REDUCE-IT appear independent of the type of concomitant statin therapy. These data provide clinicians with additional insight regarding concomitant statin therapy considerations when prescribing icosapent ethyl and suggest there are important mechanisms of action for the substantial CV risk reduction observed with icosapent ethyl that are distinct from the LDL receptor pathway.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

REDUCE-IT: accumulation of data across prespecified interim analyses to final results

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), an event-driven trial, randomized 8,179 statin-treated patients with elevated triglycerides (TGs) and increased cardiovascular (CV) risk to icosapent ethyl (IPE); pure, stable prescription eicosapentaenoic acid, 4g/day or placebo. 1,612 primary endpoint events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) projected 90% power to detect 15% relative risk reduction (5% 2-sided alpha). The key secondary composite endpoint was CV death, nonfatal MI, or nonfatal stroke. An independent data and safety monitoring committee (DMC) performed prespecified interim analyses (IAs) at ∼60% (IA1 31 May 2016 data cutoff; 2.9 y median primary endpoint follow-up) and ∼80% (IA2 01 May 2017; 3.7 y) of events; final analysis included 1,606 events (06 Sep 2018; 4.9 y median study follow-up).

Purpose

Explore REDUCE-IT efficacy and safety across prespecified IAs for insight into progression of robustness and consistency of conclusions.

Methods

The interim statistical analysis plan guided study continuation decisions by a prespecified decision-making process, including assessment of safety, treatment arm performance, primary composite endpoint formal analyses, and informal robustness analyses, with no futility or efficacy stopping requirements. Prior to DMC IA study continuation decisions, the need for a mature dataset to support the robustness of final efficacy and safety findings was discussed. Sponsor, Steering Committee, and Clinical Endpoint Committee were blinded throughout.

Results

Primary and key secondary endpoints achieved statistical significance at IA1 and IA2 that persisted at final analyses (p-value below final adjusted 2-sided alpha of 0.0437); hazard ratios also remained consistent and similar robustness was observed across individual endpoint components; clarity of findings across endpoints and subgroups improved with more events. Stopping for overwhelming efficacy was discussed at each IA; prior to IA study continuation recommendations, the DMC considered historical examples of failed CV outcome studies for TG-lowering and mixed omega-3 therapies, reflected on the potential for overestimating final demonstrated benefit using incomplete data, and weighed societal impacts of fuller datasets relative to patient therapy access.

Conclusions

Consistent, potent efficacy emerged early and persisted across the two prespecified interim and final analyses. The mature dataset demonstrated highly statistically significant reductions in the primary (25%; p=0.00000001) and key secondary (26%; p=0.0000006) endpoints and allowed robust analyses to support overall efficacy and safety conclusions. Allowing the REDUCE-IT dataset to fully mature provided clinicians with robust, consistent, and reliable data upon which to base clinical decisions for IPE in CV risk reduction.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

REDUCE-IT: total ischemic events reduced across the full range of baseline LDL cholesterol and other key subgroups

Background

REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a study of 8,179 randomized statin-treated patients with elevated triglycerides (TG) and increased cardiovascular (CV) risk followed for a median of 4.9 years, demonstrated robust results. Icosapent ethyl (IPE), a pure and stable prescription form of eicosapentaenoic acid, 4g/day reduced both time-to-first and total primary endpoint ischemic events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) by 25% (HR 0.75; 95% CI 0.68–0.83; p&lt;0.0001) and 30% (rate ratio 0.70; 95% CI 0.62–0.78; p&lt;0.0001), respectively. Similar substantial reductions in first and total key secondary endpoint ischemic events (composite of CV death, nonfatal MI, or nonfatal stroke) were also observed. Demographic and baseline disease characteristics were generally balanced across treatment groups. Time-to-first event analyses showed robust and generally consistent benefit across subgroups. Previous total event analyses by baseline TG demonstrated large, consistent, statistically significant reductions across tertiles, suggesting the CV benefit of IPE is tied primarily to non-TG factors.

Purpose

Further explore the extent to which IPE reduced total primary and key secondary events across prespecified baseline demographic, disease, treatment, and lipid/lipoprotein/inflammatory biomarker subgroups.

Methods

Total events across subgroups were assessed with the prespecified negative binomial regression method. Main outcomes were total (first and subsequent) primary and key secondary composite endpoint events.

Results

Median baseline LDL-C levels in ascending tertiles were 58, 76, and 96 mg/dL; there were large, significant relative reductions in total primary endpoint events with IPE across tertiles (35%, 28%, and 27%, respectively; interaction p=0.62), with parallel substantial absolute risk reductions. Similar, significant relative reductions of 33%, 28%, and 24% in total key secondary endpoint events were observed, along with substantial absolute risk reductions. Total events analyses of prespecified subgroups also demonstrated robust and generally consistent findings for the primary and key secondary composite endpoints.

Conclusion

REDUCE-IT demonstrated substantial reductions in first and total primary and key secondary endpoint ischemic events, with robust and generally consistent results across baseline TG and LDL-C levels, as well as other prespecified baseline biomarker, demographic, disease, and treatment subgroups. These analyses provide useful insights for clinicians considering the range of patients who may benefit from IPE therapy and suggest that mechanisms beyond the lipid/lipoprotein/inflammatory pathways tested, including mechanisms beyond the LDL receptor pathways, may contribute to the observed substantial reductions in total ischemic burden with IPE therapy.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.

1009 Sleep Apnea and Colorectal Adenoma in the Veteran Population: A Case-Control Study

Introduction

Colorectal cancer is the third most common cancer in the United States, with over half of colorectal cancers estimated to be the result of modifiable risk factors. Studies relating sleep apnea (SA) and colorectal adenoma (CRA) are limited and the findings are equivocal. The objective of this study was to examine the association between SA and risk of CRA.

Methods

This was a retrospective cross-sectional case-control study of data collected from 460 veterans, ages 50-79, seen in the colonoscopy clinic at the Michael E. DeBakey VA Medical Center between 2014 and 2018. Information on demographics, sleep history, and co-morbidities were obtained through lifestyle questionnaire. Self-reported SA was diagnosed by a prior sleep study. Cases consisted of 297 participants had pathologically confirmed adenoma (including 117 participants having advanced CRA with villous component or diameter of polyp &gt; 1 cm). Controls consisted of 173 polyp-free participants. The distribution of demographics and lifestyle factors were compared between CRA and non-CRA using the Student’s t or chi-square tests. Odds ratios (OR) and 95% confidence intervals (CI) of CRA in association with CRA were calculated using univariate and multivariate unconditional logistic regression models. The confounding factors included age, sex, ethnicity, obesity, smoking status, alcohol use, hypertension, and sleep duration.

Results

Compared with non-SA, the multivariable OR (95% CI) for CRA was 0.92 (0.58-1.48); for non-advanced CRA was 1.14 (0.68-1.91), and for advanced CRA was 0.61 (0.32-1.17) in SA participants. Adjustment of sleep duration in the model did not change the risk estimates.

Conclusion

Sleep-study diagnosed SA was not associated with development of CRA in this veteran population. Further studies are needed to confirm this observation and incorporate the severity and treatment of SA, and undiagnosed SA in risk assessment.

Support

This research is supported in part by the Gillson Longenbaugh Foundation, and Golfers Against Cancer organization (to LJ), the Cancer Prevention Research Institute of Texas (CPRIT) (RP#140767, to LJ).

Estimation of PM2.5 Concentrations in China Using a Spatial Back Propagation Neural Network

Methods for estimating the spatial distribution of PM_2.5 concentrations have been developed but have not yet been able to effectively include spatial correlation. We report on the development of a spatial back-propagation neural network (S-BPNN) model designed specifically to make such correlations implicit by incorporating a spatial lag variable (SLV) as a virtual input variable. The S-BPNN fits the nonlinear relationship between ground-based air quality monitoring station measurements of PM_2.5, satellite observations of aerosol optical depth, meteorological synoptic conditions data and emissions data that include auxiliary geographical parameters such as land use, normalized difference vegetation index, elevation, and population density. We trained and validated the S-BPNN for both yearly and seasonal mean PM_2.5 concentrations. In addition, principal components analysis was employed to reduce the dimensionality of the data and a grid of neural network models was run to optimize the model design. The S-BPNN was cross-validated against an analogous but SLV-free BPNN model using the coefficient of determination (R²) and root mean squared error (RMSE) as statistical measures of goodness of fit. The inclusion of the SLV led to demonstrably superior performance of the S-BPNN over the BPNN with R² values increasing from 0.80 to 0.89 and with the RMSE decreasing from 8.1 to 5.8 μg/m³. The yearly mean PM_2.5 concentration in China during the study period was found to be 41.8 μg/m³ and the model estimated spatial distribution was found to exceed Level 2 of the China Ambient Air Quality Standards (CAAQS) enacted in 2012 (>35 μg/m³) in more than 70% of the Chinese territory. The inclusion of spatial correlation upgrades the performance of conventional BPNN models and provides a more accurate estimation of PM_2.5 concentrations for air quality monitoring.

Towards sustainability? Analyzing changing urban form patterns in the United States, Europe, and China

Urban form characterizes the spatial structure of fixed elements within a city, which affects daily life and has significant influence on environmental sustainability. Measuring the spatiotemporal characteristics of an urban form and its relationship with sustainable development is the basis of urban planning. Taking 27 large cities in the United States, Europe and China as examples, we developed a ternary graph to quantify urban forms based on the density distribution of the built-up area. The urban forms were divided into the following classes: central-compact, central-sprawl, decentralized-compact, and decentralized-sprawl. Spatially, the cities in the three regions have experienced rapid urban growth, while the urban forms vary greatly from region to region. Urban forms are dominated by decentralized-sprawl in the United States, and central-compact in Europe and China. Temporally, approximately 80% of sample cities kept the urban form class both in 1990-2000 and 2000-2014. It is noted that 40% of sample cities in China tended to grow in a more sprawling pattern in 2000-2014 than in 1990-2000. From the land-saving aspect of urban sustainable development, compact and central spatial growth can significantly reduce per capita land consumption. Population density decreases in all sample cities, but compact and central spatial growth slowed the rate of population density reduction.

Understanding urban expansion combining macro patterns and micro dynamics in three Southeast Asian megacities

Rapid urbanization accelerates urban expansion, especially in populous areas, such as Southeast Asia. The urban forms and changes at the macro level and the dynamics at the patch level are interrelated. Considering its spatiotemporal interdependences and global-local interactions, we propose a framework to quantify urban expansion by combining macro patterns and micro dynamics. Taking three Southeast Asian megacities, Bangkok, Ho Chi Minh City (HCMC), and Manila, as examples, we calculate the urban land densities in concentric rings (macro pattern) and the proximity expansion index (PEI) of new urban patches (micro dynamic) to compare the urban form changes and expansion patterns based on Landsat imagery in 1990, 2000, and 2014. The results show that the urban form changes have close relationships with the local urban patch dynamics. The macro- and micro-level results in Bangkok and Ho Chi Minh City are interrelated and consistent and the explainable inconsistent results in Manila further reveal the necessity of combination of two scopes. The three megacities developed in different manners, thereby resulting in diverse urban forms and changes. Other methods and technologies combining macro and micro perspectives are encouraged to better understand urban expansion.

[Occupational activity disorders of extremely severe mass burn patients in recovery period after injury: a cross-sectional survey]

Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients' occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ(2)=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration: Chinese clinical trial registry, ChiCTR-OOC-16009188.

Evolution of the Kondo lattice and non-Fermi liquid excitations in a heavy-fermion metal

Strong electron correlations can give rise to extraordinary properties of metals with renormalized Landau quasiparticles. Near a quantum critical point, these quasiparticles can be destroyed and non-Fermi liquid behavior ensues. YbRh2Si2 is a prototypical correlated metal exhibiting the formation of quasiparticle and Kondo lattice coherence, as well as quasiparticle destruction at a field-induced quantum critical point. Here we show how, upon lowering the temperature, Kondo lattice coherence develops at zero field and finally gives way to non-Fermi liquid electronic excitations. By measuring the single-particle excitations through scanning tunneling spectroscopy, we find the Kondo lattice peak displays a non-trivial temperature dependence with a strong increase around 3.3 K. At 0.3 K and with applied magnetic field, the width of this peak is minimized in the quantum critical regime. Our results demonstrate that the lattice Kondo correlations have to be sufficiently developed before quantum criticality can set in.

Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation

BACKGROUND AND PURPOSE

Although the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study demonstrated a high incidence of perioperative complications for Intracranial Atherosclerotic disease (ICAD) treatments with stent placement, some studies have shown that submaximal angioplasty with an undersized balloon limits the risks of perioperative complications, suggesting that intervention may remain an alternative option for ICAD if perioperative complications are minimized. We sought to evaluate clinical and angiographic outcomes after primary angioplasty without stent placement in patients with symptomatic, high-grade intracranial stenosis and poor antegrade flow who were refractory to medical therapy.

MATERIALS AND METHODS

All cases with high-grade, symptomatic intracranial stenosis and poor antegrade flow treated with intracranial angioplasty without stent placement at Xuanwu Hospital, Capital Medical University, from January 2010 to December 2016, were retrospectively reviewed. The main outcomes included the changes in antegrade flow and residual stenosis and any stroke or death within 1 month. We also evaluated functional outcomes, stroke, and restenosis in patients on follow-up.

RESULTS

Thirty-five patients (mean age, 64.3 years) were included, and the mean follow-up time was 9.7 months. The average preprocedural stenosis was 88.4%. The immediate, average postprocedure stenosis rate was 25.3%, and the average postprocedural stenosis rate at last angiographic follow-up was 34.7%. The primary end point of major stroke or death at 30 days was observed in 1 patient (1/35, 2.9%), and no patient had intraprocedural complications. The incidence of stroke or death at the last follow-up was 2.9%, which was superior to the results of the medical and stent-placement arms of the SAMMPRIS study. Severe restenosis was observed in 3 (3/25, 12%) patients but without any symptoms.

CONCLUSIONS

In this retrospective series, primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.

[Influence of two kinds of probiotics combined with bismuth quadruple therapy for Helicobacter pylori eradication]

Objective: To investigate the efficacy and safety of Compound Lactobacillus Tablets or Saccharomyces boulardii Sachets combining with bismuth quadruple therapy for Helicobacter pylori(H.pylori) eradication. Methods: A total of 360 H. pylori- infected patients were enrolled and randomly assigned into three groups. Group A received esomeprazole 20 mg bid+ bismuth potassium citrate 220 mg bid+ amoxicillin 1 000 mg bid+ furazolidone 100 mg bid for 10 days. Group B or group C received the same quadruple therapy for 10 days as group A, as well as Compound Lactobacillus Tablets 1 000 mg tid or Saccharomyces boulardii Sachets 500 mg bid for 14 days. Drug-related side effects and adverse reactions were collected during the therapy, and H. pylori eradication results were confirmed by (13)C/(14)C-UBT at least 4 weeks after cessation of therapy. Results: The H. pylori eradication rates in group A, B and C were 81.7%, 84.2% and 85.0% by ITT analysis (P=0.768) and 92.5%, 90.1% and 93.6% by PP analysis (P=0.770), respectively. The overall side effects and adverse reactions rates (P=0.008) and occurrence of diarrhea (P<0.001) were significantly lower in group B than group A. The overall side effect rates (P=0.003) and occurrence of diarrhea (P<0.001), abdominal distension (P=0.004) and constipation(P=0.002) were significantly lower in group C than group A. There was no significant difference in side effects and adverse reactions rates between the two probiotics groups. Conclusions: Both Compound Lactobacillus Tablets and Saccharomyces boulardii Sachets, combining with bismuth quadruple therapy, reduced the overall side effects and adverse reactions rates for H. pylori eradication. Moreover, the former can reduce the incidence of diarrhea, and the latter can reduce the incidence of diarrhea, abdominal distension and constipation.

[Effect and mechanism of silibinin on the inhibition of ALK positive NSCLC cells by sensitizing crizotinib]

Objective: To explore the synergistic effect of silibinin combined with crizotinib on anaplastic lymphoma kinase positive (ALK+ ) non-small cell lung cancer (NSCLC) cells and its mechanism. Methods: H2228 and H3122 cells were treated with silibinin, crizotinib alone or in combination. Cell proliferation was measured by 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and colony formation assay. Migration or invasion ability was tested by wound healing assay or transwell assay, respectively. Expressions of E-Cadherin and vimentin protein were examined by immunofluorescence staining. The protein expressions of ALK, p-ALK, E-Cadherin and Vimentin were detected by western blotting.The anti-cancer effect of silibinin combined with crizotinib in vivo was determined by subcutaneously injecting 2×10(6) H2228 cells into immunodeficient nude mice. Results: The result of MTT assay showed that the cell viability of H2228 or H3122 treated with 100 μmol/L silibinin was (88.38±4.10)% or (72.27±3.62)%, respectively, marginally decreased compared with that of the control. The 50% inhibitory concentration (IC(50)) of H2228 cells treated with crizotinib alone or combined with 100 μmol/L silibinin was (917.10±7.75) nmol/L or (238.73±7.67) nmol/L, respectively. The IC(50) of H3122 cells treated with crizotinib alone or combined with 100 μmol/L silibinin was (472.50±15.70) nmol/L or (206.10±12.01) nmol/L, respectively. The IC(50s) of H2228 and H3122 cells were significantly decreased by combined treatment of crizotinib and silibinin compared to crizotinib treatment alone (P<0.01). When compared with the control group, colony forming ratios of H2228 cells were (83.34±2.72)% in 100 μmol/L silibinin treatment group, (69.42±3.06)% in 400 nmol/L crizotinib treatment group and (27.32±1.42)% in combined treatment group. When compared with the control group, colony forming ratios of H3122 cells were (84.45±5.67)% in 100 μmol/L silibinin treatment group, (45.02±5.83)% in 400 nmol/L crizotinib treatment group and (17.43±3.83)% in combined treatment group. Silibinin combined with crizotinib treatment significantly inhibited the colony formation ability of H2228 and H3122 cells (P<0.01). Migration and invasion results showed that combined treatment of crizotinib and silibinin markedly inhibited the migration and invasion ability of H2228 cells (P<0.01). Western blot results indicated that treated with silibinin alone or in combination of crozitinib for 48 hours, the protein level of E-cadherin in H2228 cells was upregulated, while the expressions of p-ALK and vimentin were downregulated, without obvious alteration of ALK protein expression. In the xenograft model, the mean tumor weight was (9.40±2.58)g in crizotinib treatment group and (4.58±1.07)g in the combined treatment group. The inhibitory effect of tumor growth in vivo of combined treatment was significantly superior to that of crizotinib treatment alone (P<0.05). Conclusion: Silibinin enhances the inhibitory effect of crizotinib on ALK positive NSCLC cells, which may be associated with suppression of ALK activity and mesenchymal-epithelial transition.

Additional energy scale in SmB6 at low-temperature

Topological insulators give rise to exquisite electronic properties because of their spin-momentum locked Dirac-cone-like band structure. Recently, it has been suggested that the required opposite parities between valence and conduction band along with strong spin-orbit coupling can be realized in correlated materials. Particularly, SmB6 has been proposed as candidate material for a topological Kondo insulator. Here we observe, by utilizing scanning tunnelling microscopy and spectroscopy down to 0.35 K, several states within the hybridization gap of about ±20 meV on well characterized (001) surfaces of SmB6. The spectroscopic response to impurities and magnetic fields allows to distinguish between dominating bulk and surface contributions to these states. The surface contributions develop particularly strongly below about 7 K, which can be understood in terms of a suppressed Kondo effect at the surface. Our high-resolution data provide insight into the electronic structure of SmB6, which reconciles many current discrepancies on this compound.

Multiple quantum phase transitions and superconductivity in Ce-based heavy fermions

Heavy fermions have served as prototype examples of strongly-correlated electron systems. The occurrence of unconventional superconductivity in close proximity to the electronic instabilities associated with various degrees of freedom points to an intricate relationship between superconductivity and other electronic states, which is unique but also shares some common features with high temperature superconductivity. The magnetic order in heavy fermion compounds can be continuously suppressed by tuning external parameters to a quantum critical point, and the role of quantum criticality in determining the properties of heavy fermion systems is an important unresolved issue. Here we review the recent progress of studies on Ce based heavy fermion superconductors, with an emphasis on the superconductivity emerging on the edge of magnetic and charge instabilities as well as the quantum phase transitions which occur by tuning different parameters, such as pressure, magnetic field and doping. We discuss systems where multiple quantum critical points occur and whether they can be classified in a unified manner, in particular in terms of the evolution of the Fermi surface topology.

Two-Gap Superconductivity in LaNiGa_{2} with Nonunitary Triplet Pairing and Even Parity Gap Symmetry

The nature of the pairing states of superconducting LaNiC_{2} and LaNiGa_{2} has to date remained a puzzling question. Broken time reversal symmetry has been observed in both compounds and a group theoretical analysis implies a nonunitary triplet pairing state. However, all the allowed nonunitary triplet states have nodal gap functions but most thermodynamic and NMR measurements indicate fully gapped superconductivity in LaNiC_{2}. Here we probe the gap symmetry of LaNiGa_{2} by measuring the London penetration depth, specific heat, and upper critical field. These measurements demonstrate two-gap nodeless superconductivity in LaNiGa_{2}, suggesting that this is a common feature of both compounds. These results allow us to propose a novel triplet superconducting state, where the pairing occurs between electrons of the same spin, but on different orbitals. In this case the superconducting wave function has a triplet spin component but isotropic even parity gap symmetry, yet the overall wave function remains antisymmetric under particle exchange. This model leads to a nodeless two-gap superconducting state which breaks time reversal symmetry, and therefore accounts well for the seemingly contradictory experimental results.

PSOLA: A Heuristic Land-Use Allocation Model Using Patch-Level Operations and Knowledge-Informed Rules

Optimizing land-use allocation is important to regional sustainable development, as it promotes the social equality of public services, increases the economic benefits of land-use activities, and reduces the ecological risk of land-use planning. Most land-use optimization models allocate land-use using cell-level operations that fragment land-use patches. These models do not cooperate well with land-use planning knowledge, leading to irrational land-use patterns. This study focuses on building a heuristic land-use allocation model (PSOLA) using particle swarm optimization. The model allocates land-use with patch-level operations to avoid fragmentation. The patch-level operations include a patch-edge operator, a patch-size operator, and a patch-compactness operator that constrain the size and shape of land-use patches. The model is also integrated with knowledge-informed rules to provide auxiliary knowledge of land-use planning during optimization. The knowledge-informed rules consist of suitability, accessibility, land use policy, and stakeholders’ preference. To validate the PSOLA model, a case study was performed in Gaoqiao Town in Zhejiang Province, China. The results demonstrate that the PSOLA model outperforms a basic PSO (Particle Swarm Optimization) in the terms of the social, economic, ecological, and overall benefits by 3.60%, 7.10%, 1.53% and 4.06%, respectively, which confirms the effectiveness of our improvements. Furthermore, the model has an open architecture, enabling its extension as a generic tool to support decision making in land-use planning.

Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

BACKGROUND AND PURPOSE

On the basis of the high 1-month stroke and/or death (14.7%) rates associated with stent placement in the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, modifications in patient selection and procedural aspects for intracranial stent placement have been recommended. We performed a multicenter prospective single-arm trial to determine whether such modifications would result in lower rates of periprocedural stroke and/or death.

MATERIALS AND METHODS

The study enrolled patients with recent transient ischemic attack or ischemic stroke (excluding perforator ischemic events) related to high-grade (70%-99% in severity) stenosis of a major intracranial artery. Patients were treated by using angioplasty and self-expanding stents 3 weeks after the index ischemic event at 1 of the 10 high-volume centers in China. An independent neurologist ascertained the occurrence of any stroke and/or death within 1 month after the procedure.

RESULTS

A total of 100 consecutive patients were recruited. The target lesions were located in the middle cerebral artery (M1) (n = 38, 38%), intracranial internal carotid artery (n = 17, 17%), intradural vertebral artery (n = 18, 18%), and basilar artery (n = 27, 27%). The technical success rate of stent deployment with residual stenosis of <50% was 100%. The overall 1-month stroke and/or death rate was 2% (95% confidence interval, 0.2%-7.0%). Two ischemic strokes occurred in the pontine region (perforator distribution) in patients following angioplasty and stent placement for basilar artery stenosis.

CONCLUSIONS

The results of this prospective multicenter study demonstrated that modifications in patient selection and procedural aspects can substantially reduce the 1-month stroke and/or death rate following intracranial stent placement.

Cumulative methylation alternations of gene promoters and protein markers for diagnosis of epithelial ovarian cancer

DNA methylation plays an important role in carcinogenesis and cancer development. In this study, we examined gene methylation in epithelial ovarian cancer (EOC) using cationic conjugated polymer (CCP)-based fluorescence resonance energy transfer (FRET) to evaluate the application of cumulative methylation alternations of genes associated with cancer antigen 125 for early cancer diagnosis. The methylation status of 3 genes (Ras association domain family 1 isoform A, RASSF1A; opioid-binding protein/cell adhesion molecule, OPCML; homeobox A9, HOXA9) were examined and compared in 35 EOC samples and 11 normal ovarian tissue samples using CCP-based FRET. Gene methylation levels were clustered into 3 sections and assigned a value; values for the 3 genes were summed. Although methylation of the OPCML gene was significantly associated with stage, histological types, grade, and ascites and that of RASSF1A and HOXA9 was not, the sum for the 3 genes was significantly associated with stage and ascites. The sum showed higher sensitivity (85.7%) and specificity (100%) for discriminating EOC from normal ovarian tissues than did the methylation status of RASSF1A, OPCML, and HOXA9 (48.6, 77.1, 77.1, and 100, 88.1, 100%, respectively). Combining cancer antigen 125 levels with the sum increased the sensitivity to 94.3%. The detection and analysis of a panel of genes' methylation status with the CCP-based FRET technique may be useful for diagnosis and screening of EOC; the associated cancer antigen 125 can be used to increase diagnostic sensitivity.

Value of an active surveillance policy to document clearance of meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci amongst inpatients with prolonged admissions

This article reports the impact of an active surveillance policy to identify clearance of meticillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) in known colonized inpatients with prolonged admissions in order to discontinue isolation precautions. Amongst 365 colonized patients with hospital admissions exceeding 30 days, clearance rates of 11% for MRSA and 18% for VRE were found after a median of 23 days and 26.5 days, respectively, resulting in a saving of 2152 patient-days of contact precautions over one year. This has proven to be a cost-beneficial policy.

Nin one binding protein expression as a prognostic marker in prostate carcinoma

BACKGROUND

To investigate the prognostic value of expression levels of nin one binding protein (Nob1) in prostate carcinoma.

METHODS

Nob1 protein levels were evaluated by Western blot in samples from 40 prostate carcinomas and matched adjacent non-neoplastic prostate tissues. Nob1 expression was also assessed by immunohistochemistry in samples from 300 prostate carcinoma and matched adjacent non-neoplastic prostate tissues, as well as 20 benign prostatic hyperplasia samples. The findings were compared with clinical and pathologic parameters and patient outcome.

RESULTS

Nob1 protein analysis showed significant differences between the prostate carcinomas and control groups tested. Immunohistochemical analysis showed that Nob1 positivity was higher in prostate carcinoma than that in paired adjacent non-cancerous tissues (58 vs 7 %, P < 0.001). Nob1 positivity was significantly associated with high Gleason scores and metastasis in patients. Nob1 expression was significantly associated with shorter biochemical recurrence-free survival (BCRFS). Multivariate analysis revealed that Nob1 is an independent marker for BCRFS.

CONCLUSIONS

These findings provide evidence that Nob1 is an indicator of poor prognosis in prostate carcinoma.

Tunable magnetic orders in CePd2As2-xPx

We report the successful synthesis of the polycrystalline compounds CePd2As2-xPx (0 ≤ x ≤ 2) and their physical properties by measuring transport, magnetic and thermodynamic behaviors as a function of temperature and/or magnetic field. Powder x-ray diffraction indicates that CePd2As2-xPx crystallizes in the ThCr2Si2-type tetragonal structure. CePd2As2 exhibits a moderate Sommerfeld coefficient of γ ≈ 88 mJ mol(-1) K(-2), and undergoes an antiferromagnetic (AFM) transition at the Néel temperature TN ≈ 15 K. Upon substituting As with P, the TN is nearly unchanged up to x ≃ 0.6, while a ferromagnetic (FM) transition develops below TN for x ≃ 0.4. The Curie temperature TC increases with increasing x and eventually merges with the AFM transition at x ≃ 0.6. With further increase of x, the system follows typical FM behaviors and its TC monotonically increases and reaches TC ≈ 28 K in CePd2P2. Moreover, a metamagnetic transition is observed in the As-rich samples, but vanishes for x ≥ 0.4. Such a tunable magnetic ground state may provide an opportunity to explore the possible quantum critical behavior in CePd2As2-xPx.

Analysis and discrimination of grape spoilage via volatiles: a comparison between long optical path Fourier-transform-infrared spectroscopy and sensor arrays

Infrared spectroscopy and sensor arrays have been used to differentiate the grapes in different spoilage stagesviatheir volatiles.

Sleep duration and incidence of colorectal cancer in postmenopausal women

Background:

Sleep duration is dependent on circadian rhythm that controls a variety of key cellular functions. Circadian disruption has been implicated in colorectal tumorigenesis in experimental studies. We prospectively examined the association between sleep duration and risk of colorectal cancer (CRC).

Methods:

In the Women’s Health Initiative Observational Study, 75 828 postmenopausal women reported habitual sleep duration at baseline 1993–1998. We used Cox proportional hazards regression model to estimate the hazard ratio (HR) of CRC and its associated 95% confidence interval (CI).

Results:

We ascertained 851 incident cases of CRC through 2010, with an average 11.3 years of follow-up. Compared with 7 h of sleep, the HRs were 1.36 (95% CI 1.06–1.74) and 1.47 (95% CI 1.10–1.96) for short (⩽5 h) and long (⩾9 h) sleep duration, respectively, after adjusting for age, ethnicity, fatigue, hormone replacement therapy (HRT), physical activity, and waist to hip ratio. The association was modified by the use of HRT (P-interaction=0.03).

Conclusion:

Both extreme short and long sleep durations were associated with a moderate increase in the risk of CRC in postmenopausal women. Sleep duration may be a novel, independent, and potentially modifiable risk factor for CRC.

Evaluation of nutritional status and skin condition among elderly residents in a long-term care hospital

OBJECTIVE

The availability of nutritional screening tools for older adults is limited, depending on their physical characteristics or the setting. We investigated the relationships between various nutritional indicators and skin conditions as possible screening indicators.

DESIGN

Cross-sectional study.

SETTING

A long-term care hospital in Japan.

PARTICIPANTS

90 elderly residents who were aged ≥65 years old.

MEASUREMENTS

The nutritional status of the residents was assessed by body mass index (BMI), involuntary weight loss, arm muscle area, and serum albumin and prealbumin levels. Leg skin condition was evaluated by: 1) functional factors including pH, hydration and transepidermal water loss; 2) skin color including L*, a*, b* and individual typology angle (ITA°) using a tristimulus colorimetric instrument; and 3) skin morphology. Repeated measures analysis of variance was employed, adjusted for demographic characteristics and room temperature, with measurement site as the repeated variable.

RESULTS

Among the skin indicators, b* was significantly correlated with BMI (p=0.018), and weight loss over the previous month (p=0.042) and 6 months (p=0.002). Additionally, ITA° was associated with weight loss over 1 month (p=0.013). Both b* and ITA° showed the area under the receiver operating characteristic curve of 0.64 to 0.80 for weight loss >2% over 1 month.

CONCLUSIONS

Residents with poorer nutritional status had yellower and darker skin color.