Strict Definition Research Articles

REFINING THE DEFINITION OF MILIARY/DISSEMINATED TUBERCULOSIS IN CANADA

While a multi-site definition of disseminated tuberculosis (DTB) exists, there is limited evidence to support its use. Herein we sought to generate that evidence. We evaluated treatment outcomes and reporting requirements against two distinct definitions of DTB in a 15-year population-based cohort of consecutively-diagnosed TB patients in Canada. Definitions were combined in a multi-variable logistic regression to determine risk factors for TB-related death in DTB. We applied two mutually exclusive definitions of DTB to our dataset: 1. 'strict' - TB disease associated with a positive TB culture in blood/bone marrow or TB disease associated with a miliary pattern on chest imaging and a positive TB culture or, 2. 'multisite' - TB disease in two or more non-contiguous sites. Among 2877 notified TB patients, 110 (3.8%) met the 'strict' definition, while 168 (5.8%) met the 'multisite' definition. Of all 278 DTB patients only 135 (48.6%) were notified as DTB using International Classification of Disease codes, and only 66 (23.7%) were classified as DTB by Canada's Public Health Agency. DTB patients, by either definition, were less likely to achieve cure/treatment completion and more likely to die. Risk factors for a fatal outcome included extremes of age, Canadian birth, central nervous system involvement, and HIV co-infection. Our findings support the combination of both a strict and multisite definition of DTB for purposes of reporting consistency and investigational comparability.

Young Europeans’ Geo-Political Identities: A Poststructural Analysis

This study analyses the way young Europeans, aged between 10 and 20, construct their sense of identity with geo-political entities such as the nation, the state and the European Union; how these are expressed; and how young people manage the potential multiplicity of identities. It re-analyses earlier data, some 224 transcripts of young Europeans discussing their identities and sense of attachment to the geo-political entities of the state and the nation. This study looks specifically at how they discuss affiliations to a country or nation and does so within the historical context of the development of European nations in the 19th and 20th centuries and the ‘strict definition’ of nationality, as based on either birthplace or parentage. The young people’s discussions identify a wide range of reasons for attachment (or not) to one or more states: these include parentage, birthplace, passports, culture, language, residence, etc., many of which are incompatible with each other. Their response to this is often to profess multiple identities, switching to use that is most appropriate to a particular context or contingency. How does this behaviour meet the various models of identity formation, such as the psychosocial, the socio-cultural, and the poststructuralist? These young people also offer a range of qualities or values that they expect a state to uphold and deliver and are sometimes critical of states’ behaviour in this area. The combination of these attributes and qualities leads to a range of attitudes towards a polity or polities, ranging from acceptance of their status to indifference. The explanations suggested in this paper are that globalisation and migration have led to the realisation that the ‘strict definitions’ of nationality are no longer appropriate, and there are new potential attributes for identity, and secondly, that the development of supranational codification and the implementation of human rights are weakening the sovereignty of states. Together, these two factors reduce the perception of the requirement to develop a single overriding national identity. This combination of multiple identities and recognising the importance of human rights values is most commonly found amongst young people who have grown up in multicultural societies, often urban, and the corollary of this is that combination is least likely to be found among the older population in more rural, monocultural settlements.

A seroprevalence study indicates a high proportion of clinically undiagnosed MPXV infections in men who have sex with men in Berlin, Germany

IntroductionDuring the mpox outbreak in 2022, the highest number of cases in Germany were registered in Berlin, almost all of them in men who have sex with men (MSM). However, the frequency of clinically undiagnosed infections is unknown.MethodsA cross-sectional study was conducted among MSM in Berlin, Germany. Participants were recruited from private practices and community-based checkpoints specialised in HIV and STI care for MSM. They were asked to complete an online questionnaire on socio-demographic data, mpox diagnosis, vaccination history and sexual behaviour, and to provide a blood sample for serological analysis. The samples were tested for antibodies against a range of antigens to distinguish between antibodies induced by mpox infection and MVA vaccination, with pre-immune sera from childhood smallpox vaccination as a confounding factor. Associations of behavioural variables with reported and suspected mpox diagnosis as the outcome were tested using univariable and multivariable logistic regression models.ResultsBetween the 11th April and 1st July 2023, 1,119 participants were recruited in eight private practices and two community-based checkpoints in Berlin. All participants provided a blood sample for serological testing. Information for the online questionnaire was provided by 728 participants; core data on age and mpox history for participants who did not provide questionnaire data were provided by the practices for an additional 218 participants. A previous diagnosis of mpox was reported for/by 70 participants (7.4%). Using a conservative and strict case definition, we serologically identified an additional 91 individuals with suspected undiagnosed mpox infection. Individuals with reported or suspected mpox infections reported more condomless anal sex partners in the past 3 months (OR = 5.93; 95% CI 2.10-18.35 for 5–10 partners; OR = 9.53; 95% CI 2.72–37.54 for > 10 partners) and were more likely to report sexual contact with partners diagnosed with mpox (OR = 2.87; 95% CI 1.39–5.84).ConclusionA substantial proportion of mpox infections were clinically undiagnosed. The number of condomless anal sex partners was strongly associated with both confirmed and suspected undiagnosed mpox infection. Therefore, mpox control measures based on clinical diagnosis of mpox are likely to have limited effectiveness in preventing mpox transmission in outbreak situations because many infections remain unrecognised and undiagnosed.

Exome sequencing for nonimmune hydrops fetalis and clinical utility of data reanalysis.

Nonimmune hydrops fetalis (NIHF) presents as life-threatening fluid collections in multiple fetal compartments and may be led by numerous etiologies. To establish the diagnostic yield of exome sequencing for single-gene disorders in unexplained NIHF and to evaluate the clinical utility of data reanalysis. A series of 53 unexplained cases of NIHF were enrolled, including 39 cases met a strict definition of NIHF, and 14 cases with increased nuchal translucency (NT) and/or cystic hygroma in combination with other fluid collections. Trio ES from fetal samples and parental blood was performed, and clinical reports were returned by geneticists and genetic counselors. Multidisciplinary team forums were conducted for accurate diagnoses and improved patient management. The clinical follow-up assessments were conducted, and the reanalysis was performed for cases with a non-positive result. Diagnostic variants were identified in 22.6% (12/53) of the cases, and variants of potential clinical significance were detected in an additional 13.2% (7/53) of the cases. Of them, 3 possible diagnoses (3/41, 7.3%) were obtained during reanalysis. Notably, half of the diagnosed cases were from the group exhibiting only skin edema and increased nuchal translucency and/or cystic hygroma. The diagnostic rate in this group was 42.8% (6/14), while in the classically defined NIHF group, the rate was 15.4% (6/39). The pregnancy termination and live birth rates of the cases with positive genetic testing results were found to be statistically significantly different from those with negative results (91.7% vs 53.6% and 8.3% vs 36.6%, P < 0.05 for both). ES provides high incremental diagnostic yield for NIHF after standard-of-care testing, and reevaluating non-diagnostic exomes in light of updated knowledge can maximize diagnostic yield. Identifying the etiology of NIHF facilitates prenatal diagnosis, improves the management of NIHF cases, and predicts recurrence risk in future pregnancies.

New Ways to Balance Numbers

Behera and Panda defined a balancing number as a number b for which the sum of the numbers from 1 to b – 1 is equal to the sum of the numbers from b + 1 to b + r for some r. They also classified all such numbers. We define two notions of balancing numbers for Farey fractions and enumerate all possible solutions. In the stricter definition, there is exactly one solution, whereas in the weaker one all sufficiently large numbers work. We also define notions of balancing numbers for levers and mobiles, then show that these variants have many acceptable arrangements. For an arbitrary mobile, we prove that we can place disjoint consecutive sequences at each of the leaves and still have the mobile balance. However, if we impose certain additional restrictions, then it is impossible to balance a mobile.

Fatigue life prediction method for bolted joints based on equivalent structural stress under tensile–compressive loading

In this study, load amplitude–life (Fa–N) curves were obtained through tensile–compressive fatigue tests of bolted joints. It was observed that the correlation coefficient squared (R2) value of the Fa–N curve with the same geometric and pre-tightening parameters was high, but the R2 value of the Fa–N curve with all the parameters was low, indicating poor correlation and inability to meet the engineering requirements. Therefore, an equivalent structural stress model for the bolted joint was first developed based on a mechanical model with a strict mathematical definition to normalize these Fa–N curves, which considered the bolted joint loads as the input conditions and integrated the geometric and pre-tightening parameters. Subsequently, a classical beam–shell equivalent finite element model of the bolted joint was constructed. The nodal loads in the bolted connection zone were coupled with the forces and moments of the beam element nodes through finite element simulation, and the equivalent structural stress (σs) of the bolted joint was then obtained based on the equivalent structural stress model. Consequently, the equivalent structural stress–life (Ss–N) curve and probabilistic stress–life (P–Ss–N) curve normalized for different Fa–N curves were obtained by fitting the data of σs and N. Lastly, the accuracy of the fatigue life prediction method based on equivalent structural stress was verified by conducting the vibration fatigue test on the bolted joint structure of the subway antenna bracket.

The PIPER survey. II. The globular cluster systems of low surface brightness galaxies in the Perseus cluster

ABSTRACT We present Hubble Space Telescope ACS/WFC and WFC3/UVIS imaging for a sample of 50 low-surface brightness (LSB) galaxies in the $\sim 10^{15}$ M$_{\odot }$ Perseus cluster, which were originally identified in ground-based imaging. We measure the structural properties of these galaxies and estimate the total number of globular clusters (GCs) they host. Around half of our sample galaxies meet the strict definition of an ultra-diffuse galaxy (UDG), while the others are UDG-like but are either somewhat more compact or slightly brighter. A small number of galaxies reveal systems with many tens of GCs, rivalling some of the richest GC systems known around UDGs in the Coma cluster. We find the sizes of rich GC systems, in terms of their half-number radii, extending to $\sim$1.2 times the half-light radii of their host galaxy on average. The mean colours of the GC systems are the same, within the uncertainties, as those of their host galaxy stars. This suggests that GCs and galaxy field stars may have formed at the same epoch from the same enriched gas. It may also indicate a significant contribution from disrupted GCs to the stellar component of the host galaxy as might be expected in the ‘failed galaxy’ formation scenario for UDGs.

Post-contrast acute kidney injury in the super-elder patients: a CT-scan perspective.

The administration of intravenous (IV) contrast media during computed tomography (CT) examinations is essential to enhance diagnostic accuracy in various clinical scenarios. Traditionally, older age is considered a risk factor for the development of post-contrast Acute Kidney Injury (PC-AKI); however, there is limited information available for the super-elderly population (aged ≥ 85). This study aims to investigate the incidence and risk factors associated with PC-AKI in individuals aged 85 and older undergoing CT scans with IV contrast. A retrospective cohort study, including all hospitalized patients aged 85 or older who underwent CT scans between the years 2005 and 2021. Patients were categorized into IV contrast and non-IV contrast groups. Baseline demographic and clinical data, along with kidney function parameters, were collected. The final cohort included 7,078 patients who underwent CT scans, with 40% receiving IV contrast. The overall AKI occurrence within 72 h post-CT was 5.72%, slightly elevated in the non-IV contrast group (6.25% vs. 4.94%, p = 0.02). However, multivariate analysis revealed no significant difference between the groups (OR 1, CI 0.8-1.2, p = 0.92), even after stratifying by kidney function. A secondary analysis, using a less strict AKI definition, supported these findings. Baseline creatinine levels emerged as prominent risk factor associated with PC- AKI. The current study provides reassurance regarding the safety of contrast-enhanced CT scans in super-elderly patients, particularly those with baseline normal to mild kidney dysfunction. These findings may contribute to the ongoing discussion on the risk-benefit balance of contrast-enhanced CT scans in the super-elderly population.

Nonamyloidogenic TTR gene variants c.76G>A and c.337-18G>C are not associated with idiopathic small-fiber neuropathy.

Small-fiber neuropathy (SFN) affects only unmyelinated and thin myelinated fibers. It may be caused by amyloidogenic mutations of the transthyretin (TTR) gene, but not all TTR gene variants are pathogenic. The nonamyloidogenic c.76G>A (rs1800458) and c.337-18G>C (rs36204272) variants of TTR were recently reported to be associated with SFN. We investigated this putative association by analyzing TTR gene sequencing data retrospectively for two cohorts of patients, one with SFN and a control group. In this retrospective single-center study, we analyzed the frequency of the c.76G>A and c.337-18G>C TTR gene variants in a cohort of patients meeting a strict definition of SFN, with or without dysautonomia, a control cohort of patients investigated for nonneurological conditions, and the gnomAD international database. We included 55 SFN patients in this study, 17 of whom had dysautonomia. The allelic frequencies of the two variants in our cohort of 55 SFN patients were 7.27% for c.76G>A TTR and 5.25% for c.337-18G>C. The frequencies of both variants were statistically similar in the 337 control patients and the gnomAD database. The c.76G>A and c.337-18G>C TTR gene variants are not associated with SFN.

In steroid-resistant nephrotic syndrome that meets the strict definition, monogenic variants are less common than expected

BackgroundIn patients with steroid-resistant nephrotic syndrome (SRNS), the presence of monogenic variants influences therapeutic strategies. Large cohort studies reported the detection of monogenic variants in approximately 30% of patients with SRNS. However, these cohorts included many patients, such as those with symptomatic proteinuria, who did not meet the strict diagnostic criteria for pediatric nephrotic syndrome (NS). Therefore, we investigated the proportion of causative monogenic variants detected in patients who strictly met the diagnostic criteria of SRNS and explored their clinical characteristics.MethodsWe examined pediatric SRNS cases with genetic analysis conducted in our hospital. Cases satisfying all of the following criteria were included: (1) age at onset 1–18 years, (2) serum albumin at onset ≤ 2.5 g/dl, (3) persistent heavy proteinuria, and (4) no complete remission after 4 weeks of steroid monotherapy.ResultsThe proportion of detected monogenic variants was 12% (22/185) among all patients. The proportion was only 7% (9/129) in patients with edema at disease onset compared with 38% (9/24) in those without (p < 0.0001). Monogenic variants were rare in patients with acute kidney injury associated with NS (1% (1/11)) or a history of complete remission (4% (2/51)).ConclusionsOur study revealed a monogenic cause in 12% of individuals with strictly defined SRNS, a much smaller proportion than previously reported. The presence or absence of edema at the onset was an important factor to distinguish SRNS with monogenic cause from SRNS without. Our results provide further evidence of the SRNS types attributable to monogenic causes.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Control stability analysis of dynamic model with time delay for quadrotor UAV

For the first-order unstable object with time delay, the PD control parameter tuning method based on the traditional definition lacks consideration of the lower boundary of amplitude margin, resulting in a certain deviation between the result and the reality. In this paper, through analyzing the control loop of quadrotor UAV (QUAV), the integral link is moved from the controlled object to the controller, and the QUAV becomes a first-order unstable object, realizing the conversion of PD to PI in the hovering state. The system stability margin remains unchanged, and the position and attitude control objectives can be realized synchronously. By means of parameter setting method, the upper boundary of stability margin is obtained. Pade approximation is carried out for the time delay link, and then the lower margin of the amplitude margin is deduced according to Routh stability criterion, so as to obtain a more accurate reachable stability margin region. To avoid the high gain feedback of attitude angular velocity of QUAV, a numerical analytical setting formula for PD attitude control is derived to meet the requirements of gain and phase margin. The graph shows that the reachable region obtained by the strict definition of stability margin analysis decreases significantly. The proposed method can not only give the reachable region intuitively, but also give the tuning formula of the control parameters concisely, which has important engineering application value.

Optimal approach for diagnosing peripheral lung nodules by combining electromagnetic navigation bronchoscopy and radial probe endobronchial ultrasound.

Electromagnetic navigation bronchoscopy (ENB) and radial probe endobronchial ultrasound (RP-EBUS) are essential bronchoscopic procedures for diagnosing peripheral lung lesions. Despite their individual advantages, the optimal circumstances for their combination remain uncertain. This single-center retrospective study enrolled 473 patients with 529 pulmonary nodules who underwent ENB and/or RP-EBUS biopsies between December 2021 and December 2022. Diagnostic yield was calculated using strict, intermediate, and liberal definitions. In the strict definition, only malignant and specific benign lesions were deemed diagnostic at the time of the index procedure. The intermediate and liberal definitions included additional results from the follow-up period. The diagnostic yield of the strict definition was not statistically different among the three groups (ENB/Combination/RP-EBUS 63.8%/64.2%/62.6%, p = 0.944). However, the diagnostic yield was superior in the ENB + RP-EBUS group for nodules with a bronchus type II or III and a solid part <20 mm (odds ratio 1.96, 95% confidence interval 1.09-3.53, p = 0.02). In terms of complications, bleeding was significantly higher in the ENB + RP-EBUS group (ENB/Combination/RP-EBUS 3.7% /6.2/0.6%, p = 0.002), but no major adverse event was observed. The combination of ENB and RP-EBUS enhanced the diagnostic yield for nodules with bronchus type II or III and solid part <20 mm, despite a slightly elevated risk of bleeding. Careful patient selection based on nodule characteristics is important to benefit from this combined approach.

Impact of annual trend volume of low-dose computed tomography for lung cancer screening on overdiagnosis, overmanagement, and gender disparities

BackgroundWith the increasing prevalence of nonsmoking-related lung cancer in Asia, Asian countries have increasingly adopted low-dose computed tomography (LDCT) for lung cancer screening, particularly in private screening programs. This study examined how annual LDCT volume affects lung cancer stage distribution, overdiagnosis, and gender disparities using a hospital-based lung cancer database.MethodsThis study analyzed the annual utilized LDCT volume, clinical characteristics of lung cancer, stage shift distribution, and potential overdiagnosis. At the individual level, this study also investigated the relationship between stage 0 lung cancer (potential strict definition regarding overdiagnosis) and the clinical characteristics of lung cancer.ResultsThis study reviewed the annual trend of 4971 confirmed lung cancer cases from 2008 to 2021 and conducted a link analysis with an LDCT imaging examination database over these years. As the volume of lung cancer screenings has increased over the years, the number and proportion of stage 0 lung cancers have increased proportionally.Our study revealed that the incidence of stage 0 lung cancer increased with increasing LDCT scan volume, particularly during the peak growth period from 2017 to 2020. Conversely, stage 4 lung cancer cases remained consistent across different time intervals. Furthermore, the increase in the lung cancer screening volume had a more pronounced effect on the increase in stage 0 lung cancer cases among females than it had among males. The estimated potential for overdiagnosis brought about by the screening process, compared to non-participating individuals, ranged from an odds ratio of 7.617 to one of 17.114. Both strict and lenient definitions of overdiagnosis (evaluating cases of stage 0 lung cancer and stages 0 to 1 lung cancer) were employed.ConclusionsThese results provide population-level evidence of potential lung cancer overdiagnosis in the Taiwanese population due to the growing use of LDCT screening, particularly concerning the strict definition of stage 0 lung cancer. The impact was greater in the female population than in the male population, especially among females younger than 40 years.To improve lung cancer screening in Asian populations, creating risk-based prediction models for smokers and nonsmokers, along with gender-specific strategies, is vital for ensuring survival benefits and minimizing overdiagnosis.

Ultrathin Bronchoscopy Without Virtual Navigation for Diagnosis of Peripheral Lung Lesions

BackgroundThe increasing incidence of encountering lung nodules necessitates an ongoing search for improved diagnostic procedures. Various bronchoscopic technologies have been introduced or are in development, but further studies are needed to define a method that fits best in clinical practice and health care systems.Research questionHow do basic bronchoscopic tools including a combination of thin (outer diameter 4.2 mm) and ultrathin bronchoscopes (outer diameter 3.0 mm), radial endobronchial ultrasound (rEBUS) and fluoroscopy perform in peripheral pulmonary lesion diagnosis?Study Design and MethodsThis is a retrospective review of the performance of peripheral bronchoscopy using thin and ultrathin bronchoscopy with rEBUS and 2D fluoroscopy without a navigational system for evaluating peripheral lung lesions in a single academic medical center from 11/2015 to 1/2021. We used a strict definition for diagnostic yield and assessed the impact of different variables on diagnostic yield, specifically after employment of the ultrathin bronchoscope. Logistic regression models were employed to assess the independent associations of the most impactful variables.ResultsA total of 322 patients were included in this study. The median of the long axis diameter was 2.2 cm and the median distance of the center of the lesion from the visceral pleural surface was 1.9 cm. Overall diagnostic yield was 81.3% after employment of the ultrathin bronchoscope, with more detection of concentric rEBUS views (93% vs. 78%, p < 0.001). Sensitivity for detecting malignancy also increased from 60.5% to 74.7% (p = 0.033) after incorporating the ultrathin scope into practice, while bronchus sign and peripheral location of the lesion were not found to affect diagnostic yield. Concentric rEBUS view, solid appearance, upper/middle lobe location and larger size of the nodules were found to be independent predictors of successful achievement of diagnosis at bronchoscopy.Interpretation: This study demonstrates a high diagnostic yield of biopsy of lung lesions achieved by utilization of thin and ultrathin bronchoscopes. Direct visualization of small peripheral airways with simultaneous rEBUS confirmation increased localization rate of small lesions in a conventional bronchoscopy setting without virtual navigational planning.

Who Are Bilinguals? Surfacing Teacher Candidates’ Conceptions of Bilingualism

This qualitative study delved into the perceptions of “bilingualism” among 60 students in a teacher education program, drawing on survey responses at the outset of their training. Informed by the translanguaging framework, we analyzed teacher candidates’ responses to identify a range of views spanning from minimalist to maximalist and from monoglossic to heteroglossic perspectives of bilingualism. Our analysis revealed many teacher candidates had a strict and narrow definition of bilingualism based on minimalist and monoglossic standards, especially when considering their own bilingual identities, legitimizing only speakers with native-like proficiency in all language domains in two languages as true bilinguals. Interestingly, their conceptions of bilingualism, as future educators, tended to be more maximalist and heteroglossic when they considered the bilingual potential of their future students. These findings will contribute and challenge the discourses that favor and idealize perfect balanced bilingualism. Implications for research and practice for teachers and teacher educators in bilingual settings are discussed.

Load-equivalent model and loosening life prediction method of bolts under transverse loading

To establish a method for predicting the loosening life of bolts under random transverse vibration, this study first obtains the transverse displacement–loosening life (D–NL) curves of bolts under three loosening states (90 %, 80 %, and 70 % of the residual preload) through bolt-loosening tests under different transverse displacement loads. Based on the mechanical analysis model of bolt loosening with strict physical definitions, load-equivalent models of the bolt external load, screw load, and screw-tooth root stress are established by considering the transverse displacement load as the input excitation and the screw-tooth root stress as the output response; these achieve the transfer and conversion of the bolt external load and screw root stress with the screw load as the bridge. Subsequently, two types of finite element models of bolted connections are established and verification tests are performed. The equivalent relationships between the bolt external load, screw load, and screw-tooth root stress are simulated and tested, and the accuracies of the bolt-load equivalent models are verified. Finally, based on the bolt-load equivalent models, the D–NL curves for evaluating loosening using the directional macroscopic displacement load are converted to stress–loosening life (S–NL) curves to evaluate loosening using the undirected local stress. A calculation flow of the bolt-loosening life under random transverse vibrations is established, and a method of predicting bolt-loosening life based on the bolt-load equivalent relationship is developed. These findings provide a useful reference for optimizing bolted connection designs and preventing bolt loosening.

Protection of sacred traditional cultural expressions: a perspective from Taiwan

In international debates regarding the protection of traditional cultural expressions (TCEs), some propose legal instruments with stronger sui generis protection for secret and/or sacred TCEs. But what would constitute stronger protection responsive to the needs of the holders of sacred TCEs? This article takes the Lalu case in Taiwan as a starting point for considering the sui generis protection of sacred TCEs, including what should be regarded as a protectable TCE and what is the proper scope of protection of sacred TCEs. The Lalu case reveals the difficulties of protecting Indigenous peoples’ essential sacred knowledge if a strict definition of TCEs is adopted. Therefore, this article reconsiders the idea–expression dichotomy and traditional knowledge (TK)–TCEs distinction by observing the characteristics of Indigenous peoples’ sacred culture and analyzing different international instruments related to TK/TCEs protection. Criticism of these dichotomies highlights the importance of the moral right, on the basis of which TCEs can be protected as a whole and the integrity of sacred culture can be maintained. Finally, this article discusses the possibility of supporting the protection of tangible sacred places or sacred objects by enhancing the sui generis right to sacred TCEs.

Impact of left bundle branch block morphology in predicting response to left bundle branch area pacing for cardiac resynchronization therapy

Abstract Background Left bundle branch area pacing (LBBAP) is a novel pacing technique with an emerging role in resynchronization therapy [1-4]. QRS morphology has shown to significantly influence cardiac resynchronization therapy (CRT) response [5-6]. Purpose The aim of this study was to assess whether different left bundle branch block (LBBB) definitions are associated with response to LBBAP resynchronization therapy. Methods 40 consecutive CRT candidates with previously unsuccessful biventricular (BiV) pacing or in which effective CRT could not be achieved with BiV pacing based on anatomical or functional criteria were selected for this study. Both ischemic and non-ischemic heart failure (HF) patients were included. Patients were divided into two groups according to LBBB morphology. Group 1 included 20 patients (45% ischemic HF) with strict LBBB definition according to Strauss criteria [7], while 20 patients in Group 2 (55% ischemic HF) had conventional LBBB morphology. Response to CRT was defined for (1) reduction in QRS duration; (2) increase in left ventricular ejection fraction (LVEF) ≥ 5% and (3) decrease in left ventricular end systolic volume (LVESV) ≥ 15%. Results LBBAP was successfully achieved in all patients (mean age: 72.0 years; male: 29). The mean baseline QRS duration before implantation was 178.6±13.8 in the Group 1 and 170.8±29.4 in the Group 2, without a statistically significant difference. Over a mean follow-up of 5.6 months, LBBAP resulted in QRS narrowing in both groups, with a greater reduction in Group 1 (-40.6 ms) compared to Group 2 (-15.1 ms), (p 0.002). Pre-implantation ventricular systolic function did not show significant differences between the two groups, with a mean of 30.1±3.5% in the Strauss LBBB group and 31.0±6.0% in the conventional LBBB group. After implantation LVEF was 42.1±8.5 % in the true LBBB patients and 33.2±7.5 in the conventional LBBB group. Echocardiographic response was observed in 65% of patients with a statistically significant difference between Group 1 (90% of responders) and Group 2 (40% of responders), (p 0,001). HF etiology did not impact the response to LBBAP CRT. Conclusions Strict LBBB definition is associated to a greater electrocardiographic and echocardiographic response in patients receiving LBBAP CRT compared to conventional LBBB criteria.\

A Case of Unilateral Simultaneous Preauricular Sinus and Postauricular Sinus in an Adult.

Preauricular sinuses are relatively common congenital anomalies of the soft tissues of the ear. By strict definition, when they connect 2 separate spaces, they are referred to as a preauricular fistula. This clinical entity was first described by Heusinger in 1864. Most preauricular sinuses have a small opening located anterior to the root of the helix. In rare cases, they are found posterior to the tragus, near the crus of the helix, and the ear lobule. The latter is the variant type preauricular sinus, also referred to as the "postauricular sinus," as the sinus tract opens posterior to the auricle. Recurrent infections or persistent discharge may require surgical excision which is ideally performed at a time when there is no inflammation. There are a variety of techniques for excision. Regardless of the surgical approach taken, it is of critical importance to remove the subcutaneous sac completely. We present a very rare case involving the co-occurrence of a preauricular sinus and postauricular sinus in a 33-year-old woman. We report this case with a review of the literature.

Pinpointing Linguistic Emphasis in Classical Greek

Abstract Emphasis is a ubiquitous notion in classical scholarship, but its vagueness has repeatedly been criticized (and its usefulness, consequently, questioned) by Greek linguists. This brief study seeks to identify (and secure) a place for this notion in the analytical toolbox for the description of Classical Greek by applying the strict but nuanced definition of emphasis in Functional Discourse Grammar (Hengeveld and Mackenzie 2008) to the identification and classification of linguistic devices in the ancient language. In particular, this study argues for a distinction between emphasis as a rhetorical effect and emphasis as a communicative intention. In the former understanding, emphasis may be produced secondarily by a number of linguistic and rhetorical devices. Conversely, linguistic emphasis stricto sensu would only be conveyed by linguistic devices used primarily to intensify linguistic entities of any level (discourse acts, propositional contents, subacts).