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Changjiang Liu

and 1 more

To accurately analyze and evaluate the comparison and selection of multi-index and multi-route highway route schemes and address the disadvantages of traditional scheme evaluations, we focus on the economic costs of construction and improve on previous qualitative and quantitative analysis. A comprehensive weight and intelligent selection algorithm are introduced into the optimization of highway route schemes. This paper presents an evaluation index system for highway route schemes based on the full life cycle and considering technology, the ecological environment, the social environment and the economy. We propose an evaluation system for highway route schemes based on a comprehensive weight. Additionally, an optimization method for highway route schemes based on the TOPSIS model is studied. Finally, the optimal highway route scheme is obtained by calculation. According to the results of the research, the construction of evaluation indexes directly influences the results of the scheme evaluation. When established operations, management and maintenance indexes are based on the full life cycle, the evaluation results are more accurate. In addition to avoiding the defects of a single weighting method, the comprehensive weight vector uses subjective data as well as expert opinion. In addition, the comprehensive weight vector introduces a preference coefficient so that analysers can determine a scheme based on the accuracy of subjective and objective information and requirements. This method uses a large number of evaluation populations to evaluate schemes, and the result is more objective.

Rosaria Casciaro

and 3 more

CFTR modulators (CFTRm) were introduced recently but they are already profoundly changing Cystic Fibrosis (CF) landscape. This survey was conducted in 2018 to evaluate how their perception and use evolved in Italy, with focus on factors that could influence physician treatment decisions. Response rate was 75.6% and the majority of physicians (81%) had been working in CF for over 5 years. While traditional parameters such as lung function and nutritional status remain key evaluation criteria in relation to initiation and monitoring of CFTRm, pulmonary exacerbations ranked at least at the same level of importance in both pediatric and adolescent/adult patients homozygous for F508del, as well as those with residual function mutations. Increasing interest is shown for tools that can help detect early manifestations of disease such as Lung Clearance Index and imaging. Patient-related outcomes, such as ability to conduct daily activities, are also deemed relevant in decision to start and continue CFTRm. Physician decision to initiate treatment according to clinical presentation was similar in all groups, showing that more importance was given to severity/instability of disease rather than mutation type or age range. A relatively low percentage of physicians would treat asymptomatic patients, in particular very young or those with residual function mutations, showing reluctance to treat early in some patient groups in the absence of clear manifestations of CF. Increasing experience with CFTRm will allow to gain more long term evidence and will help shape new guidelines.

Qing Liu

and 10 more

Objective: To investigate the association between maternal apolipoprotein A-1 (ApoA-1), apolipoprotein B (ApoB), ApoB/ApoA-1ratio and preterm birth (PTB). Design: Observational survey. Setting: Guangdong Women and Children Hospital, China Samples: 5986 pregnant women. Method: Data were extracted from the information system of Guangdong Women and Children Hospital. Maternal serum ApoB, ApoA-1 and ApoB/ApoA-1 ratio were categorized into tertiles. Logistic regression models were performed to evaluate the odds ratios and 95% confidence intervals for PTB. Main outcome measures: PTB (gestational age < 37 weeks) Results: Of the study participants, the rate of preterm birth was 5.7% (n= 344). Compare with individuals in the lowest tertile, the adjusted ORs of PTB was 1.41 (95% CI: 1.07-1.87) for individuals in the highest tertile of ApoB and 1.35 (95% CI: 1.03-1.78) for those in the highest tertile of ApoB/ApoA-1. The association of ApoB/ApoA-1 and PTB was more relevant among women with pre-pregnancy BMI ≤ 24 kg/m2, age at delivery ≥ 35 years or those who were multiparous. Conclusions: Elevated maternal ApoB level and ApoB/ApoA-1 ratio during mid-pregnancy were related to increased risk of PTB. Monitoring serum apolipoprotein levels may help to prevent preterm birth. Funding: The study was funded by grants 2019FYH003 from Chinese Center for Disease Control and Prevention. Keywords: Apolipoprotein A-1, Apolipoprotein B, Apolipoprotein B/Apolipoprotein A-1, Preterm birth Tweetable abstract:Maternal mid-pregnancy ApoB level and ApoB/ApoA-1 ratio were associated with PTB.

ozkan erarslan

and 4 more

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Gunter Sturm

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Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results: In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p=0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p=0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI. Conclusions: This trial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; number, NCT04269629)

Nazanin Kermani

and 12 more

Background. Patients with severe asthma may have a greater risk of dying from COVID-19 disease. Angiotensin converting enzyme-2 (ACE2) and the enzyme proteases, transmembrane protease serine 2 (TMPRSS2) and FURIN, are needed for viral attachment and invasion into host cells. Methods. We examined microarray mRNA expression of ACE2, TMPRSS2 and FURIN in sputum, bronchial brushing and bronchial biopsies of the European U-BIOPRED cohort. Clinical parameters and molecular phenotypes, including asthma severity, sputum inflammatory cells, lung functions, oral corticosteroid (OCS) use, and transcriptomic-associated clusters, were examined in relation to gene expression levels. Results. ACE2 levels were significantly increased in sputum of severe asthma compared to mild-moderate asthma. In multivariate analyses, sputum ACE2 levels were positively associated with OCS use and male gender. Sputum FURIN levels were significantly related to neutrophils (%) and the presence of severe asthma. In bronchial brushing samples, TMPRSS2 levels were positively associated with male gender and body mass index, whereas FURIN levels with male gender and blood neutrophils. In bronchial biopsies, TMPRSS2 levels were positively related to blood neutrophils. The neutrophilic molecular phenotype characterised by high inflammasome activation expressed significantly higher FURIN levels in sputum than the eosinophilic Type 2-high or the pauci-granulocytic oxidative phosphorylation phenotypes. Conclusion. Levels of ACE2 and FURIN may differ by clinical or molecular phenotypes of asthma. Sputum FURIN expression levels were strongly associated with neutrophilic inflammation and with inflammasome activation. This might indicate the potential for a greater morbidity and mortality outcome from SARS-CoV-2 infection in neutrophilic severe asthma.

Xinyi Guan

and 4 more

Fabio Ramponi

and 6 more

Coronary artery and cerebrovascular disease represent a major cause of cardiovascular morbidity and mortality worldwide. Despite technological advancements in percutaneous interventions, surgical revascularization remains the preferred strategy in patients with left main or multivessel disease and in those with complex lesions with high SYNTAX score. As a result, an increasing number of older patients with diffuse atherosclerotic extracoronary disease are referred for coronary artery bypass grafting (CABG). Cerebrovascular complications after isolated coronary surgery occurs in 1-5% of patients; the magnitude of injury ranges from overt neurologic lesions with varying degree of permanent disability to “asymptomatic” cerebral events detected by dedicated neuro-imaging, nevertheless associated with significant long term cognitive and functional decline. Thromboembolic events due to manipulation of an atherosclerotic aorta are universally recognized as the leading etiology of early postoperative stroke following CABG. Coronary bypass surgery performed on an arrested heart relies on considerable aortic instrumentation associated with significant atheroembolic risk especially in older patients presenting with diffuse aortic calcifications. Surgical techniques to deal with a calcified ascending aorta during isolated coronary surgery have evolved over the last forty years. Moving away from aggressive aortic debridement or replacement, surgeons have developed strategies aimed to minimize aortic manipulation: from pump-assisted beating heart surgery with the use of composite grafts to complete avoidance of aortic manipulation with “anaortic” off-pump coronary artery bypass grafting, a safe and effective approach in significantly reducing the risk of intraoperative stroke.

Oktay Ucer

and 3 more

Nada A. Saad

and 3 more

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