Comprehensive Adjustment Research Articles

Myocardial Contraction fraction for risk stratification in low-gradient aortic stenosis with preserved ejection fraction

Myocardial contraction fraction(MCF), the ratio of stroke volume to myocardial volume is a volumetric measure of myocardial shortening and thickening independent of left ventricular size and geometry. The prognostic value of MCF in low-gradient severe aortic stenosis with preserved ejection fraction(LGSAS-PEF) is unknown. We included 643 patients with LGSAS-PEF in whom MCF was computed at baseline and analyzed mortality during follow-up. Throughout follow-up with medical and surgical management [median: 34.9(16.1–65.3) months], lower MCF tertiles had higher mortality than the highest tertile. 80-month survival was 56 ± 4% for MCF > 41%, 41 ± 4% for MCF 30–41%, and 40 ± 4% for MCF < 30% ( P < 0.001). After comprehensive adjustment, mortality risk remained high for MCF 30–41% [HR 1.53(1.08–2.18)] and for MCF < 30% [HR 1.82(1.24–2.66)] versus MCF > 41%. The optimal MCF cut-off point for mortality prediction was 41%. Age, body mass index, Charlson index, peak aortic jet velocity, and LVEF were independently associated with mortality. MCF (chi-square to improve 10.39; P = 0.001), provided greater additional prognostic value ( P < 0.01) over the baseline parameters than SV index (chi-square to improve 5.41; P = 0.04), left ventricular mass index (Chi 2 to improve 2.15; P = 0.14) or global longitudinal strain (chi-square to improve 3.67; P = 0.06). MCF [HR 0.97(0.96–0.98), P < 0.001 per 1% MCF increment] outperformed ejection fraction for mortality prediction. When patients were classified by SV index and MCF, mortality risk was low for the subgroup with SV index ≥ 30 ml/m 2 and MCF > 41%, higher for patients with SV index ≥ 30 ml/m 2 and MCF ≤ 41% [adjusted HR 1.47 (1.05–2.07)] and extremely high for patients with SV index < 30 ml/m 2 [adjusted HR 2.29 (1.45–3.62)] ( Fig. 1 ). MCF is a valuable risk marker in LGSAS-PEF and could improve clinical decision-making, especially for patients with normal-flow. Survival curves.

Functional tricuspid regurgitation of degenerative mitral valve disease: A crucial determinant of survival

To assess functional tricuspid regurgitation (FTR) determinants, consequences and independent impact on outcome in degenerative mitral regurgitation (DMR). All patients diagnosed with isolated DMR 2003–2011, structurally normal tricuspid leaflets, prospective FTR grading, pulmonary artery pressure (sPAP) estimation by Doppler-echocardiography at diagnosis were identified and long-term outcome analysed. The 5083 DMR eligible patients (63 ± 16years, 47%female, ejection-fraction (EF) 63 ± 7% and sPAP 35 ± 13 mmHg) presented with FTR graded trivial in 45%, mild in 37%, moderate in 15%, and severe in 3%. While pulmonary hypertension (PHTN) was the most powerful FTR severity determinant, other FTR determinants were older age, female sex, DMR, and Atrial Fibrillation (P ≤ 0.002). FTR moderate/severe independently linked to worse clinical presentation. Survival throughout follow-up (70% at 10-year) was strongly associated with FTR-severity (82% for trivial, 69% for mild, 51% for moderate and 26% for severe, P < 0.0001). Excess-mortality persisted after comprehensive adjustment [HR 1.40(1.18–1.67) for moderate-FTR, 2.10(1.63–2.70) for severe-FTR, P ≤ 0.01], adjusting for sPAP/RV-function (P < 0.0001), by matching [2.08(1.50–2.89), P < 0.0001] and vs. expected survival [1.79(1.48–2.16), P < 0.0001]. Within 5-year of diagnosis surgery was performed in 73%/15% of mod/severe DMR and in only 26%/6% of mod/severe FTR. Surgery improved outcome without alleviating completely higher mortality associated with FTR (P < 0.0001) (Fig. 1). In this large DMR cohort, FTR was frequent, not only linked to PHTN and associated with worse clinical presentation. Long term, FTR is independently of all confounders, associated with considerably worse mortality. FTR moderate and severe is profoundly undertreated. Thus careful assessment, consideration for TR surgery and testing of new transcatheter therapy is warranted.

Minimum adjustment cost-based multi-stage goal programming models for consistency improving and consensus building with multiplicative reciprocal paired comparison matrices

In group decision-making with multiplicative reciprocal paired comparison matrices (MRPCMs), existing research uses iterative procedures or optimisation models to improve consistency of individual assessments and build consensus. However, they often create numerous adjustments on original assessments and fail to achieve a comprehensive minimum adjustment cost. Furthermore, the adjustments in the resulting MRPCMs may be not within the predetermined continuous scale. To settle these issues, this article first introduces a logarithmic-distance-based consensus measurement framework. Four-stage sequential goal programming models are then developed to improve consistency of MRPCMs and build consensus with individual consistency control under a continuous or discrete scale. The first stage is to minimise the deviation between original assessments and adjusted ones. The second stage is to minimise the difference between the original priority information and the adjusted priority information. The third stage is to maximise the difference ratio between adjusted assessments and the neutral judgment characterised by ratio 1. The last stage is to minimise the number of modifications on original assessments. Afterwards, the article devises an interactive consistency improving procedure and an interactive group consensus building procedure. Three illustrative examples and comparisons with existing methods are offered to show the usability and efficiency of the developed models.

Mechanism of temperature-induced zero drift on electro-hydraulic servo valve

An electro-hydraulic servo valve is objectively asymmetrical in the process of fabrication and assembly, and the zero position is the result of comprehensive adjustment. During the use of the electro-hydraulic servo valve, the rapid rise of temperature will lead to the zero drift phenomenon and the change in the flow state of the servo valve. With the change in temperature, the thicknesses of air gaps, the size of the orifice, the flow coefficient, the armature’s arm of force, the permanent magnets’ reluctances, and the polarization magnetomotive force, the stiffness of the spring tube and feedback rod will act on the property of the torque motor and the pilot stage. Considering the factors of temperature and processing assembly on the zero drift of the electro-hydraulic servo valve, a mathematical theory model describing the temperature zero drift characteristics is constructed. When the temperature range is 20–270 °C, the analysis demonstrated that the control error of the servo valve will exceed the expected 15%. The temperature has the most significant effect on the servo valve through the flow coefficient. The initial installation angle deflection is the domain route on the temperature zero drift, and other factors have less effect. Compared with the experimental results, the temperature-induced zero drift model correctly calculates the control error trend of the servo valve caused by an increase in temperature, and it will contribute to improving the control precision of the servo valve.

Sex differences on new-onset heart failure in patients with known or suspected coronary artery disease.

The impact of sex in patients with CAD has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with known or suspected CAD. We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected coronary artery disease (CAD) undergoing vasodilator stress cardiac magnetic resonance (CMR). We prospectively evaluated 5899 consecutive HF-free patients submitted to stress CMR for known or suspected CAD. Ischaemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional hazards regression model adjusted for competing events [death, myocardial infarction (MI), and revascularization]. A total of 2289 (38.8%) patients were women. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered an MI, 905 (15.3%) underwent revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs. 0.83 per 100 person-years, P = 0.001). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (hazard ratio 1.58, 95% confidence interval 1.18-2.10; P = 0.002). We found a sex-differential effect along the continuum of LVEF (P-value for interaction = 0.007). At lower LVEF, there was an increased risk in both sexes. However, compared with men, the risk of new-onset HF was higher in women with LVEF >55%. Women with known or suspected CAD are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.

Functional tricuspid regurgitation of degenerative mitral valve disease: A crucial determinant of survival

To assess functional tricuspid regurgitation (FTR) determinants, consequences and independent impact on outcome in degenerative mitral regurgitation (DMR). All patients diagnosed with isolated DMR 2003–2011, structurally normal tricuspid leaflets, prospective FTR grading and pulmonary artery pressure (sPAP) estimation by Doppler-echocardiography at diagnosis were identified and long-term outcome analysed. The 5083 DMR eligible patients [63 ± 16 years, 47%female, ejection-fraction (EF) 63 ± 7% and sPAP 35 ± 13 mmHg] presented with FTR graded trivial in 45%, mild in 37%, moderate in 15%, and severe in 3%. While pulmonary hypertension (PHTN) was the most powerful FTR-severity determinant, other strong FTR determinants were older age, female sex, DMR, and particularly atrial fibrillation (all P ≤ 0.002). FTR moderate/severe independently linked to worse clinical presentation ( P ≤ 0.01). Survival throughout follow-up (70% at 10-year) was strongly associated with FTR-severity (82% for trivial, 69% for mild, 51% for moderate and 26% for severe, P < 0.0001). Excess-mortality persisted after comprehensive adjustment (adjusted-hazard-ratio 1.40[1.18–1.67] for moderate-FTR, 2.10[1.63–2.70] for severe-FTR, P ≤0.01), adjusting for sPAP/RV-function ( P < 0.0001), by matching (2.08[1.50–2.89], P < 0.0001) and vs. expected (1.79[1.48–2.16], P < 0.0001). Within 5-year of diagnosis surgery was performed in 73% and 15% of severe and moderate-DMR and in only 26% and 6% of severe and moderate-FTR. Valvular surgery improved outcome without alleviating higher mortality associated with FTR ( P < 0.0001). In this large DMR cohort, FTR was frequent, not only linked to PHTN, and associated with worse clinical presentation. Long-term, FTR is independently associated with considerably worse mortality while FTR moderate/severe is profoundly undertreated. Thus, careful assessment, consideration for FTR surgery and testing of new transcatheter therapy is warranted.

Blood Omega-3 Fatty Acids Are Inversely Associated With Albumin-Creatinine Ratio in Young and Healthy Adults (The Omega-Kid Study).

Background: Omega-3 fatty acids are associated with a lower risk of cardiovascular disease (CVD) and with beneficial effects on CV risk factors. The albumin-creatinine ratio (ACR) is a risk factor for CVD, all-cause mortality and accelerated glomerular filtration rate (GFR) decline in the general population. We aimed to investigate the association between n-3 PUFAS and ACR in heathy individuals with preserved GFR.Design and Methods: The present cross-sectional analysis is part of the GAPP study, a population-based cohort of healthy adults aged 25–41 years. Individuals with known CVD, diabetes, or a BMI >35 kg/m2 were excluded. eGFR was calculated according to the combined Creatinine/Cystatin C CKD-EPI formula. ACR was obtained from a fasting morning urine sample. The Omega-3 Index (relative amount of EPA and DHA of total fatty acids in %) was obtained from whole blood aliquots.Results: Overall, 2001 participants (median age 37 years IQR 31; 40, 53% female) were included in this analysis. Median Omega-3 Index was 4.59 (IQR 4.06; 5.25) and median eGFR 111 ml/min/1.73 m2 (IQR 103; 118). Median ACR was 0.14 mg/mmol (IQR 0; 0.43). We found a significant inverse association of the Omega-3 Index with ACR (ratio 0.84, 95%CI 0.73–0.96; p = 0.011) which remained after comprehensive adjustment (ratio 0.86, 95%CI 0.74–1.00; p = 0.048). No association of the Omega-3 Index with eGFR was found. The adjusted difference in eGFR per 1-unit increase in Omega3-Index was −0.21 (95%CI −0.76; 0.35; p = 0.47).Conclusions: A higher Omega-3 Index was significantly associated with lower ACR in this young and healthy population with preserved eGFR. Omega-3 fatty acids may exhibit cardio- and nephroprotective effects in healthy individuals through modulation of ACR.

The Prognostic Potential of Atrial Natriuretic Peptide on the Development of Postoperative Atrial Fibrillation after Cardiac Surgery.

Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far. Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events. A total of 138 individuals (43.9%) developed POAF. Median concentrations of MR-proANP were significantly higher within the POAF group (p < 0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per 1 standard deviation (1-SD; 95% confidence interval [CI]: 1.31-2.15; p < 0.001), which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95% CI: 1.17-2.58; p = 0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (0.23 [95% CI: 0.0349-0.4193]; p = 0.022) and integrated discrimination increment (0.02 [95% CI: 0.0046-0.0397], p = 0.013). MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.

Practice and Understanding of Water Control and Tapping Potential of Small Well Spacing in Extra-high Water-cut Period

In 2010, a certain Gaotai block of Daqing Oilfield adopted a 106-metre-5-point area well pattern to implement the infilling adjustment. After years of development, the water-cut has increased from 91.29% at the initial production to 96.02%, with an average annual increase rate of 1.3%. However, due to small well spacing, high speed of injection and production, and low qualified rate of water injection, the decline rate of the block has reached more than 10%, which poses a challenge to stable production. On the basis of in-depth study of the principal contradiction issues, the development effect was significantly improved after comprehensive adjustment in accordance with the working ideas of precise geological research to clarify the direction of potential excavation, precise scheme design to find the location of potential excavation, precise technological measures to improve the effect of measures, and precise management means to improve the overall efficiency. In addition, the precise understanding of the remaining oil in the ultra-high water-cut stage, the precise policy technique and the practical experience gained in the development and adjustment are of guiding and reference significance to the control of the production decline and the rise of water-cut in the ultra-high water-cut stage.

Right Ventricular Ejection Fraction for the Prediction of Major Adverse Cardiovascular and Heart Failure-Related Events: A Cardiac MRI Based Study of 7131 Patients With Known or Suspected Cardiovascular Disease.

There is increasing evidence that right ventricular ejection fraction (RVEF) may provide incremental value to left ventricular (LV) ejection fraction for the prediction of major adverse cardiovascular events. To date, generalizable utility for RVEF quantification in patients with cardiovascular disease has not been established. Using a large prospective clinical outcomes registry, we investigated the prognostic value of RVEF for the prediction of major adverse cardiovascular events- and heart failure-related outcomes. Seven thousand one hundred thirty-one consecutive patients with known or suspected cardiovascular disease undergoing cardiovascular magnetic resonance imaging were prospectively enrolled. Multichamber volumetric quantification was performed by standardized operational procedures. Patients were followed for the primary composite outcome of all-cause death, survived cardiac arrest, admission for heart failure, need for transplantation or LV assist device, acute coronary syndrome, need for revascularization, stroke, or transient ischemic attack. A secondary, heart failure focused outcome of heart failure admission, need for transplantation/LV assist device or death was also studied. Mean age was 54±15 years. The mean LV ejection fraction was 55±14% (range 6%-90%) with a mean RVEF of 54±10% (range 9%-87%). At a median follow-up of 908 days, 870 (12%) patients experienced the primary composite outcome and 524 (7%) the secondary outcome. Each 10% drop in RVEF was associated with a 1.3-fold increased risk of the primary outcome (P<0.001) and 1.5-fold increased risk of the secondary outcome (P<0.001). RVEF was an independent predictor following comprehensive covariate adjustment, inclusive of LV ejection fraction. Patients with an RVEF<40% experienced a 3.1-fold risk of the primary outcome (P<0.001) with a 1-year cumulative event rate of 22% versus 7% above this cutoff. RVEF is a powerful and independent predictor of major adverse cardiac events with broad generalizability across patients with known or suspected cardiovascular disease. These findings support migration towards biventricular phenotyping for the classification of risk in clinical practice. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04367220.

Study on EOR method in high water cut stage of low permeability A Oilfield

By using coring, logging, testing data and dynamic data of oil and water wells, the geological recognition, drive system evaluation and remaining oil research after infilling adjustment of different well patterns are carried out, the dominant channel of water drive and the existing position of remaining oil in different well pattern periods. It can be used for reference to improve development effect and oil recovery of other low permeability oilfields in high water cut stage A Oilfield is a typical low-permeability oilfield, which has the characteristics of poor physical properties, start-up fracture gradient and natural fracture development. After more than 30 years of waterflooding development, the oilfield has achieved good development results through multiple rounds of comprehensive adjustment of water injection wells and oil well measures. But at present, the oil field has entered the high water cut stage, the remaining oil is more scattered, the effect of adjustment means is poor, and the oil recovery rate is reduced, so it is necessary to explore the technical methods to improve the development effect and further enhance the oil recovery. In this paper, the recovery of oil field is evaluated by using the results of indoor core, empirical formula method and reservoir engineering method, and the potential of readjustment of oil field is clarified. Secondly, the reservoir geological recognition and multi-disciplinary remaining oil recognition are carried out, the dominant channel of water drive is identified, the type, existing position and formation reason of remaining oil are clarified, and the comprehensive treatment countermeasures based on the corresponding adjustment and plugging at both ends of oil and water wells are put forward; the application means of periodic water injection is developed, and the cooperation with deep water adjustment and flooding is explored, so as to further expand the affected volume, Methods of EOR. The typical application well area effect has been obviously improved, which provides reference for other low permeability oil fields to improve development effect and enhance oil recovery.

Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist.

Background: Status epilepticus (SE) carries an exceedingly high mortality and morbidity, often warranting an aggressive therapeutic approach. Recently, the implementation of a ketogenic diet (KD) in adults with refractory and super-refractory SE has been shown to be feasible and effective. Methods: We describe our experience, including the challenges of achieving and maintaining ketosis, in an adult with new onset refractory status epilepticus (NORSE). Case Vignette: A previously healthy 29-year-old woman was admitted with cryptogenic NORSE following a febrile illness; course was complicated by prolonged super-refractory SE. A comprehensive work-up was notable only for mild cerebral spinal fluid (CSF) pleocytosis, elevated nonspecific serum inflammatory markers, and edematous hippocampi with associated diffusion restriction on magnetic resonance imaging (MRI). Repeat CSF testing was normal and serial MRIs demonstrated resolution of edema and diffusion restriction with progressive hippocampal and diffuse atrophy. She required prolonged therapeutic coma with high anesthetic infusion rates, 16 antiseizure drug (ASD) trials, empiric immunosuppression and partial bilateral oophorectomy. Enteral ketogenic formula was started on hospital day 28. However, sustained beta-hydroxybutyrate levels >2 mmol/L were only achieved 37 days later following a comprehensive adjustment of the care plan. KD was challenging to maintain in the intensive care unit (ICU) and was discontinued due to poor nutritional state and pressure ulcers. KD was restarted again in a non-ICU unit facilitating ASD tapering without re-emergence of SE. Discussion: There are inconspicuous carbohydrates in commonly administered medications for SE including antibiotics, electrolyte repletion formulations, different preparations of the same drug (i.e., parenteral, tablet, or suspension) and even solutions used for oral care―all challenging the use of KD in the hospitalized patient. Tailoring comprehensive care and awareness of possible complications of KD are important for the successful implementation and maintenance of ketosis.

Abstract PS7-02: The relationship of established breast cancer risk factors with breast cancer subtypes

Abstract Background: Molecular characterization of breast tumors has revealed four subtypes which differ in expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Breast cancer subtypes have different prognosis and unique risk factors. Breast cancer risk assessment models mainly reflect risk of ER/PR+ HER2- tumors, the most common subtype, and may not reflect risk of other subtypes. The study objective was to compare associations of established breast cancer risk factors across invasive breast cancer subtypes. Methods: The study population included women aged 40-84 years who had a screening mammogram at Massachusetts General Hospital, Newton Wellesley Hospital, or the University of Pennsylvania from 2006-2015. Patients completed a risk factor questionnaire and additional risk factors were ascertained from clinical records. Women with prior breast cancer, breast implants, or BRCA1/2 mutations were excluded. Women diagnosed with breast cancer within 6 months were excluded to remove those with cancer at the time of risk assessment. Tumor characteristics were obtained from linkage with hospital and state cancer registries. For invasive tumors, subtype was defined based on immunohistochemistry as ER and/or PR+ HER2-, ER and/or PR+HER2+, ER and PR- HER2+, or ER and PR and HER2- (triple negative breast cancer, TNBC). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer using time from mammogram to cancer diagnosis or censoring. Separate Cox models were fit for each subtype, and patients who developed DCIS or another subtype, died, or were alive and cancer free on December 31, 2017 were censored. Age, biopsy history, atypical hyperplasia, age at menarche, age at first live birth, family history, race, BMI, and breast density at the time of screening were included in the models. Results: The study population (N=197,836) had a mean age of 54 years and 74% of patients were white, 15% were Black, and 11% were other races. During a mean follow-up of 6.3 years, 4,510 (2.3%) women developed breast cancer. Of these cancers, 1068 (24%) were DCIS. Of the invasive cancers, 2675 (77%) were ER/PR+HER2-, 290 (8%) were ER/PR+HER2+, 108 (3%) were ER/PR-HER2+, 264 (8%) were TNBC and 105 (3%) had missing subtype. For ER/PR+HER2- cancers, all risk factors were consistent with the literature and statistically significant. Breast density was associated with increased risk of all four subtypes compared to women with less dense breasts. Atypical hyperplasia was strongly associated with HER2+ cancers (HR=2.97 CI 1.63-5.40 p&amp;lt;0.01), less strongly associated with ER/PR+HER2- cancers, and not significantly associated with TNBC. Black women had higher risk of TNBC than white women (HR=2.61 CI 1.91-3.57 p&amp;lt;0.01). Conclusion Our results highlight both similarities and heterogeneity in risk factors across breast cancer subtypes. Prior diagnosis of atypical hyperplasia was more strongly associated with HER2+ compared to HER2- tumors. While it is well known that Black women have higher risk of TNBC, it is striking that the more than two-and-a-half-fold increased risk persisted even with comprehensive adjustment for breast cancer risk factors in a screened population. These results suggest that additional factors, such as genetics, biomarkers, and environmental exposures should be included in risk assessment to better capture risk of less common breast cancer subtypes such as TNBC. Risk factors for breast cancer subtypes among 197,836 women undergoing screening mammography*ER/PR+ HER2- N=2674ER/PR+ HER2+ N=290ER/PR-HER2+ N=108ER/PR/HER2- N=264HR,95% CIpHR,95% CIpHR,95% CIpHR,95% CIpBlack vs. white unadjusted0.67,0.58-0.77&amp;lt;0.010.73,0.48-1.090.120.91,0.49-1.680.772.61,1.96-3.46&amp;lt;0.01Black vs. white multivariate*0.72,0.63-0.83&amp;lt;0.010.75,0.49-1.150.191.23,0.65-2.330.532.61,1.91-3.57&amp;lt;0.01Atypical Hyperplasia*1.38,1.02-1.870.042.77,1.42-5.42&amp;lt;0.013.89,1.03-14.70.040.43,0.06-3.140.401 FDR** vs. none1.46,1.32-1.63&amp;lt;0.011.16,0.82-1.650.391.93,1.18-3.160.011.11,0.75-1.630.602 FDR** vs. none2.12,1.67-2.71&amp;lt;0.011.17,0.44-3.150.751.90,0.47-7.760.372.81,1.44-5.49&amp;lt;0.01BMI ≥25 vs. &amp;lt;25 kg/m2*1.37,1.25-1.50&amp;lt;0.011.35,1.04-1.750.031.07,0.71-1.640.741.29,0.97-1.730.08Dense vs. non-dense breasts1.55,1.42-1.69&amp;lt;0.011.75,1.34-2.29&amp;lt;0.011.97,1.25-3.10&amp;lt;0.011.65,1.26-2.17&amp;lt;0.01*Adjusted for all factors in the table and additionally age, biopsy, age at menarche, age at first live birth**FDR= first degree relative with breast cancer Citation Format: Anne Marie McCarthy, Tara Friebel, Wei He, Michaela Welch, Sarah Ehsan, Kevin Hughes, Alan Semine, Jinbo Chen, Despina Kontos, Susan Domchek, Emily Conant, Aditya Bardia, Constance Lehman, Katrina Armstrong. The relationship of established breast cancer risk factors with breast cancer subtypes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-02.

Discussion on comprehensive adjustment technology of weak alkali ASP flooding in stage development of second-class reservoir

The application of ASP flooding development by stages and comprehensive adjustment technology plays a very important role in the development of the second-class reservoir, which is directly related to the development effect of the second-class reservoir and also improves the development effect of the reservoir to a certain extent. In this paper, the author analyzes and studies the comprehensive adjustment technology of ASP flooding in different stages. Taking SD block as an example, the development of the second-class reservoir is expounded, and the weak alkali ASP flooding technology is applied in different stages of the development of the second-class reservoir in SD block.

Research on two-stage allocation optimization technology of power grid operation and maintenance cost input considering asset scale status and efficiency fairness

The current complex internal and external situation puts forward higher requirements for the precise investment of funds for power grid companies. This paper proposes a two-stage operation and maintenance cost input optimization allocation technology based on comprehensive evaluation and Gini coefficient adjustment. This technology firstly identifies the influencing factors of operation and maintenance cost input, and combines the result of factor identification to construct an evaluation index system based on asset status and scale attributes. Through comprehensive evaluation and collection of index-related data, it determines the initial distribution coefficients and initial distribution coefficients of related enterprises based on the entropy weight method. Then combined with the principle of Gini coefficient, optimize the initial allocation plan to obtain the final investment allocation quota. This paper conducts empirical analysis with 10 companies as the research object, and the results show that the model can provide theoretical support and method reference for reasonable investment and reasonable decision-making of operation and maintenance costs of power grid companies under the requirements of precise investment management and control.

КОНЦЕПТУАЛЬНІ ЗАСАДИ СТРАТЕГІЧНОГО УПРАВЛІННЯ ПІДПРИЄМСТВАМИ ПАСАЖИРСЬКОГО СЕКТОРУ ЗАЛІЗНИЧНОГО ТРАНСПОРТУ

In the article during the research it is established that transformational changes in the world economy provoke significant changes in the environment of enterprises of the passenger sector of railway transport, which lead to a radical revision of the principles of its activity, increasing risks and uncertainty. The expediency of adapting the conceptual provisions of strategic management of passenger complex development, which should be based on the need to timely overcome problems in the industry and change management tools to respond in a timely manner to challenges and block potential problems. The analysis of the functioning of the passenger complex of railway transport of Ukraine, allowed to identify a significant number of problems (delays in reforms, fragmentary business model of passenger transport management and low quality of personnel management, critical level of wear and tear of technical and technological base and infrastructure due to difficult financial and economic situation etc.), indicating the systemic nature of the crisis. It is established that the effective implementation of strategic tools should be based on the following principles: system diagnostics and planning of key parameters of economic development of the passenger complex; urgent response to minimal deviations in the performance of the passenger complex and the manifestations of the crisis in the environment of its operation; prevention, situationally and alternative actions; adequacy of the chosen scenario of response to existing and potential manifestations of crisis situations; maximum mobilization of internal and external resources, reserves to support sustainable economic growth; targeted coordination of management actions with the strategy of development of the passenger complex of railway transport; innovation of strategic tools; comprehensive control and adjustment of crisis leveling scenarios, etc. It is substantiated that in order to overcome the negative tendencies in the activity of the enterprises of the passenger complex of railway transport it is necessary to focus on the system approach to the choice of progressive tools of strategic management of the complex in the conditions of macro environment transformation.

Left Atrial Volumetric/Mechanical Coupling Index: A Novel Predictor of Outcome in Heart Failure With Reduced Ejection Fraction.

Left atrial assessment is complex, particularly in heart failure with reduced ejection fraction due to interactions with functional mitral regurgitation (FMR). Pilot data suggest that left atrial volumetric/mechanical coupling index (LACI) may be useful, but large outcome data are lacking. We enrolled a comprehensively characterized cohort of patients in sinus rhythm with heart failure with reduced ejection fraction diagnosis at Mayo Clinic from 2007 to 2011. Routinely measured left atrial volume index and tissue-doppler-imaging a' allowed LACI calculation as (left atrial volume index)/(tissue-doppler-imaging a'). Survival was the outcome measured. The cohort's 4196 patients (69 [58-77] years, ejection fraction 40 [31-45]%) had mild FMR in 1505 and moderate-severe FMR in 1068. LACI was overall 5.06 (3.50-8.10) and increased with each FMR grade (3.86 [2.94-5.29] without FMR, 5.38 [3.80-8.02] with mild, 5.45 [1.49-8.07] with moderate/severe FMR; P<0.0001). At diagnosis, higher LACI was independently determined by more severe FMR and by higher left ventricular mass index, lower ejection fraction, higher E/e', and lower glomerular filtration rate (all P<0.0001). During follow-up 1588 (38%) patients died. In spline modeling, excess mortality appeared around LACI=6 and steeply increased thereafter (5-year survival 72±1% with LACI<6 and 49±2% with LACI ≥6, P<0.0001). Multivariable comprehensive adjustment showed LACI strong association with excess mortality (adjusted hazard ratio, 1.41 [1.23-1.61], P<0.0001 for LACI ≥6). Independent link to mortality persistent across FMR grades (adjusted hazard ratio, 1.45 [1.13-1.86], P=0.004 without FMR, 1.42 [1.16-1.77], P=0.0008 with mild FMR, and 1.38 [1.01-1.66], P=0.04 with moderate/severe FMR) without interaction (P=0.3). LACI independent impact on outcome was incremental to that of left atrial volume index, tissue-doppler-imaging a', or any other characteristic including the Meta-Analysis Global Group in Chronic-score (least significant P=0.02). In this large cohort, left atrial volumetric/mechanical coupling measured by LACI in routine practice integrates the influence of several morphological/hemodynamic determinants but displays progressive deterioration with increasing FMR severity in heart failure with reduced ejection fraction. About outcome, higher LACI is strongly, independently, and incrementally associated with excess mortality, irrespective of FMR grade and in all subsets. Hence, LACI is a novel and critical measure in heart failure with reduced ejection fraction, quantifiable in routine practice, which should be integrated in prognostication and decision-making.

Left atrial function and maximal exercise capacity in heart failure with preserved and mid-range ejection fraction.

AimsExercise intolerance is the leading manifestation of heart failure with preserved or mid‐range ejection fraction (HFpEF or HFmrEF), and left atrial (LA) function might contribute to modulating left ventricular filling and pulmonary venous pressures. We aim to assess the association between LA function and maximal exercise capacity in patients with HFpEF or HFmrEF.Methods and resultsSixty‐five patients, prospectively enrolled in the German HFpEF Registry, were analysed. Inclusion criteria were New York Heart Association functional class ≥ II, left ventricular ejection fraction > 40%, structural heart disease or diastolic dysfunction, and elevated levels of N terminal pro brain natriuretic peptide (NT‐proBNP). LA function was evaluated through speckle‐tracking echocardiography by central reading in the Charité Academic Echocardiography core lab. All patients underwent maximal cardiopulmonary exercise test and were classified according to a peak VO2 cut‐off of prognostic value (14 mL/kg/min). NT‐pro‐BNP was measured. Twenty‐nine patients (45%) reached a peak VO2 < 14 mL/kg/min (mean value 12.4 ± 1.5) and 36 patients (55%) peak VO2 ≥ 14 mL/kg/min (mean value 19.4 ± 3.9). There was no significant difference in left ventricular ejection fraction (60 ± 9 vs. 59 ± 8%), left ventricular mass (109 ± 23 vs. 112 ± 32 g/m2), LA volume index (45 ± 17 vs. 47 ± 22 mL/m2), or E/e´ (13.1 ± 4.7 vs. 13.0 ± 6.0) between these groups. In contrast, all LA strain measures were impaired in patients with lower peak VO2 (reservoir strain 14 ± 5 vs. 21 ± 9%, P = 0.002; conduit strain 9 ± 2 vs. 13 ± 4%, P = 0.001; contractile strain 7 ± 4 vs. 11 ± 6%, P = 0.02; reported lower limits of normality for LA reservoir, conduit and contractile strains: 26.1%, 12.0%, and 7.7%). In linear regression analysis, lower values of LA reservoir strain were associated with impaired peak VO2 after adjustment for age, sex, body mass index, heart rhythm (sinus/AFib), and log‐NTproBNP [β 0.29, 95% confidence interval (CI) 0.02–0.30, P = 0.02], with an odds ratio 1.22 (95% CI 1.05–1.42, P = 0.01) for peak VO2 < 14 mL/kg/min for LA reservoir strain decrease after adjustment for these five covariates. Adding left ventricular ejection fraction, it did not influence the results. On the other hand, the addition of LA strain to the adjustment parameters alone described above provided a significant increase of the predictive value for lower peak VO2 values (R 2 0.50 vs. 0.45, P = 0.02). With receiver operating characteristic curve analysis, we identified LA reservoir strain < 22% to have 93% sensitivity and 49% specificity in predicting peak VO2 < 14 mL/kg/min. Using this cut‐off, LA reservoir strain < 22% was associated with peak VO2 < 14 mL/kg/min in logistic regression analysis after comprehensive adjustment for age, sex, body mass index, heart rhythm, and log‐NTproBNP [odds ratio 95% CI 10.4 (1.4–74), P = 0.02].ConclusionsIn this HFpEF and HFmrEF cohort, a reduction in LA reservoir strain was a sensible marker of decreased peak exercise capacity. Therefore, LA reservoir strain might be of clinical value in predicting exercise capacity in patients with HFpEF or HFmrEF.

Application of principal component analysis on water flooding effect evaluation in natural edge-bottom water reservoir

Water flooding effect evaluation is considered as the basic work to formulate comprehensive adjustment measures and improve the effectiveness of oilfield development. However, natural edge-bottom water energy is seldom considered in the conventional evaluation method. So, it cannot reflect the comprehensive effect of both natural edge-bottom water and injected water. Principal component analysis is a kind of multivariate statistical analysis method, which has been widely used in social science and other fields. Based on this method, the water flooding effect of 5 edge-bottom water reservoirs is comprehensively evaluated. First, 11 indicators are selected from four aspects, including natural edge-bottom water energy, production change, water injection development and utilization, energy maintenance and deficit compensation. Then, the selection of principal components is optimized. Based on the consideration of keeping as much information as possible to get more convincing results, three principal components are obtained. Finally, take five oilfields as examples to realize comprehensive evaluation. Results indicate that the natural energy of B oilfield is quite sufficient and water injection is timely in the later stage of development. So the water flooding effect is the best among five oilfields and the comprehensive principal component value is 1.434. That of A and C oilfields are 0.527 and 1.021, respectively, ranking 3 and 2. Although D oilfield has quite sufficient natural energy, water injection is not timely. So the water flooding effect is poor and the comprehensive principal component value is 0.259. That of E oilfield is − 3.241, indicating that it has the worst water flooding effect. The ranking results of five oilfields are consistent based on principal component analysis and Tong's chart, which are both B, C, A, D and E oilfield, verifying this method’s feasibility and practicability. Additionally, compared with the single index, it can reflect the comprehensive water flooding effect of both natural edge-bottom water and injected water. Specific oilfield cases are evaluated by the proposed method, which help for better understanding its application potential for evaluating the water flooding effect of natural edge-bottom water reservoirs.

Impact of atrial fibrillation on the risk of ischemic stroke in patients on hemodialysis: BOREAS-HD3 Study.

Atrial fibrillation (AF) is an established risk factor for ischemic stroke in a general population. However, its impact in patients on hemodialysis (HD), a group with a high risk for stroke, is still controversial. Here we examined this issue in a Japanese cohort. This study was designed as a multicenter cohort study. HD patients (n = 1,067) were enrolled from 22 institutes in January 2009 and followed up for 3years. Patients with missing data (n = 196) or kidney transplantation (n = 4) were excluded, and 867 patients contributed to the analysis of the risk of new-onset of ischemic stroke. At baseline, AF was observed in 123 patients (14.2%, AF group) and not in the others (n = 744: 85.8%, non-AF group). During a follow-up period of 31.3months, the cumulative incidence rate for ischemic stroke was significantly higher in the AF group than in the non-AF group (6.5% vs. 2.9%, p < 0.05). In Cox regression analysis, AF was a significant independent risk factor for new-onset of ischemic stroke after adjustment for age, sex, prior history of ischemic stroke, use of warfarin, dialysis vintage, comorbidity of diabetic nephropathy, and interdialytic weight gain (hazard ratio 2.17-2.68). Present analyses using comprehensive adjustment for multiple confounders, including prior history of ischemic stroke, indicated that AF independently increases the risk of new-onset of ischemic stroke by more than twofold in Japanese HD patients.