Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness.

BACKGROUND: Small abdominal aortic aneurysms (AAAs; 3.0-5.4 cm in diameter) are usually asymptomatic and managed by regular ultrasound surveillance until they grow to a diameter threshold (commonly 5.5 cm) at which surgical intervention is considered. The choice of appropriate surveillance intervals is governed by the growth and rupture rates of small AAAs, as well as their relative cost-effectiveness. OBJECTIVES: The aim of this series of studies was to inform the evidence base for small AAA surveillance strategies. This was achieved by literature review, collation and analysis of individual patient data, a focus group and health economic modelling. DATA SOURCES: We undertook systematic literature reviews of growth rates and rupture rates of small AAAs. The databases MEDLINE, EMBASE on OvidSP, Cochrane Central Register of Controlled Trials 2009 Issue 4, ClinicalTrials.gov, and controlled-trials.com were searched from inception up until the end of 2009. We also obtained individual data on 15,475 patients from 18 surveillance studies. REVIEW METHODS: Systematic reviews of publications identified 15 studies providing small AAA growth rates, and 14 studies with small AAA rupture rates, up to December 2009 (later updated to September 2012). We developed statistical methods to analyse individual surveillance data, including the effects of patient characteristics, to inform the choice of surveillance intervals and provide inputs for health economic modelling. We updated an existing health economic model of AAA screening to address the cost-effectiveness of different surveillance intervals. RESULTS: In the literature reviews, the mean growth rate was 2.3 mm/year and the reported rupture rates varied between 0 and 1.6 ruptures per 100 person-years. Growth rates increased markedly with aneurysm diameter, but insufficient detail was available to guide surveillance intervals. Based on individual surveillance data, for each 0.5-cm increase in AAA diameter, growth rates increased by about 0.5 mm/year and rupture rates doubled. To control the risk of exceeding 5.5 cm to below 10% in men, on average a 7-year surveillance interval is sufficient for a 3.0-cm aneurysm, whereas an 8-month interval is necessary for a 5.0-cm aneurysm. To control the risk of rupture to below 1%, the corresponding estimated surveillance intervals are 9 years and 17 months. Average growth rates were higher in smokers (by 0.35 mm/year) and lower in patients with diabetes (by 0.51 mm/year). Rupture rates were almost fourfold higher in women than men, doubled in current smokers and increased with higher blood pressure. Increasing the surveillance interval from 1 to 2 years for the smallest aneurysms (3.0-4.4 cm) decreased costs and led to a positive net benefit. For the larger aneurysms (4.5-5.4 cm), increasing surveillance intervals from 3 to 6 months led to equivalent cost-effectiveness. LIMITATIONS: There were no clear reasons why the growth rates varied substantially between studies. Uniform diagnostic criteria for rupture were not available. The long-term cost-effectiveness results may be susceptible to the modelling assumptions made. CONCLUSIONS: Surveillance intervals of several years are clinically acceptable for men with AAAs in the range 3.0-4.0 cm. Intervals of around 1 year are suitable for 4.0-4.9-cm AAAs, whereas intervals of 6 months would be acceptable for 5.0-5.4-cm AAAs. These intervals are longer than those currently employed in the UK AAA screening programmes. Lengthening surveillance intervals for the smallest aneurysms was also shown to be cost-effective. Future work should focus on optimising surveillance intervals for women, studying whether or not the threshold for surgery should depend on patient characteristics, evaluating the usefulness of surveillance for those with aortic diameters of 2.5-2.9 cm, and developing interventions that may reduce the growth or rupture rates of small AAAs. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Reparations for "Comfort Women": Feminist Geopolitics and Changing Gender Ideologies in South Korea

This paper studies feminist geopolitical practices in South Korea in the context of “comfort women” forced into sexual slavery by the Imperial Japanese military around the Second World War. Although there has been a considerable amount of literature penned on the comfort women issue, existing discussions focus largely on the conflict between nationalist and feminist paradigms, while largely minimizing feminist activism and changing gender narratives within Korean society. Therefore, this research aims to expand the field by considering the struggles that comfort women have endured through the lens of feminist geopolitical scholarship. I argue that comfort women activism constitutes a form of feminist geopolitical practice in a way that challenges masculine gender narratives. It has opened up new spaces where comfort women survivors can produce a sense of “survivorhood” and move beyond passivity throughout their lives. The rise of their active voices signals the overturning of traditional patriarchal structures; consequently, along with other forms of activism, these narratives have eventually led to a shift in public attitudes. Unlike how nationalist accounts were dominant in the early 1990s, the increased public attention towards the feminist accounts in the mid-2010s has subsequently increased media coverage of survivors and feminist practices

Links of cytoskeletal integrity with disease and aging

Aging is a complex feature and involves loss of multiple functions and nonreversible phenotypes. However, several studies suggest it is possible to protect against aging and promote rejuvenation. Aging is associated with many factors, such as telomere shortening, DNA damage, mitochondrial dysfunction, and loss of homeostasis. The integrity of the cytoskeleton is associated with several cellular functions, such as migration, proliferation, degeneration, and mitochondrial bioenergy production, and chronic disorders, including neuronal degeneration and premature aging. Cytoskeletal integrity is closely related with several functional activities of cells, such as aging, proliferation, degeneration, and mitochondrial bioenergy production. Therefore, regulation of cytoskeletal integrity may be useful to elicit antiaging effects and to treat degenerative diseases, such as dementia. The actin cytoskeleton is dynamic because its assembly and disassembly change depending on the cellular status. Aged cells exhibit loss of cytoskeletal stability and decline in functional activities linked to longevity. Several studies reported that improvement of cytoskeletal stability can recover functional activities. In particular, microtubule stabilizers can be used to treat dementia. Furthermore, studies of the quality of aged oocytes and embryos revealed a relationship between cytoskeletal integrity and mitochondrial activity. This review summarizes the links of cytoskeletal properties with aging and degenerative diseases and how cytoskeletal integrity can be modulated to elicit antiaging and therapeutic effects

Multi-point monitoring of nitrous oxide emissions and aeration efficiency in a full-scale conventional activated sludge tank

In this work the biological tank of a WRRF in Italy was monitored placing five floating hoods on a plug-flow-like biological aerated tank surface in order to capture emission dynamics in both time and space domains. The five hoods report which location is more responsible for N2O production at a certain moment of the day. Moreover, with this experimental investigation, a spatial shift in N2O production towards the end of the biological tank could be detected. This provides important insights in the changes in biological dynamics especially with varying incoming load

UBR2 of the N-end rule pathway is required for chromosome stability via histone ubiquitylation in spermatocytes and somatic cells

The N-end rule pathway is a proteolytic system in which its recognition components (N-recognins) recognize destabilizing N-terminal residues of short-lived proteins as an essential element of specific degrons, called N-degrons. The RING E3 ligases UBR2 and UBR1 are major N-recognins that share size (200 kDa), conserved domains and substrate specificities to N-degrons. Despite the known function of the N-end rule pathway in degradation of cytosolic proteins, the major phenotype of UBR2-deficient male mice is infertility caused by arrest of spermatocytes at meiotic prophase I. UBR2-deficient spermatocytes are impaired in transcriptional silencing of sex chromosome-linked genes and ubiquitylation of histone H2A. In this study we show that the recruitment of UBR2 to meiotic chromosomes spatiotemporally correlates to the induction of chromatin-associated ubiquitylation, which is significantly impaired in UBR2-deficient spermatocytes. UBR2 functions as a scaffold E3 that promotes HR6B/UbcH2-dependent ubiquitylation of H2A and H2B but not H3 and H4, through a mechanism distinct from typical polyubiquitylation. The E3 activity of UBR2 in histone ubiquitylation is allosterically activated by dipeptides bearing destabilizing N-terminal residues. Insufficient monoubiquitylation and polyubiquitylation on UBR2-deficient meiotic chromosomes correlate to defects in double strand break (DSB) repair and other meiotic processes, resulting in pachytene arrest at stage IV and apoptosis. Some of these functions of UBR2 are observed in somatic cells, in which UBR2 is a chromatin-binding protein involved in chromatin-associated ubiquitylation upon DNA damage. UBR2-deficient somatic cells show an array of chromosomal abnormalities, including hyperproliferation, chromosome instability, and hypersensitivity to DNA damage-inducing reagents. UBR2-deficient mice enriched in C57 background die upon birth with defects in lung expansion and neural development. Thus, UBR2, known as the recognition component of a major cellular proteolytic system, is associated with chromatin and controls chromatin dynamics and gene expression in both germ cells and somatic cells. © 2012 Kwon et al

Complete nucleotide sequence and organization of the mitogenome of endangered Eumenis autonoe (Lepidoptera: Nymphalidae)

Eumenis autonoe, a member of the lepidopteran family, Nymphalidae (superfamily Papilionoidea) is an endangered species and is found only on one isolated remote island Jeju in South Korea, on Halla Mt, at altitudes higher than 1,400 m. In this study, the complete mitochondrial genome (mitogenome) of E. autonoe was reported. The 15,489-bp long E. autonoe genome evidenced the typical gene content found in animal mitogenomes, and harbors the gene arrangement identical to all other sequencedlepidopteran insects, which differs from the most common type found in insects, due to the movement of tRNAMet to a position 5’-upstream of tRNAIle. As has been observed in many other lepidopteran insects, no typical ATN codon for the COI gene is available. Thus, we also designated the CGA (arginine) found at the beginning of the COI gene as a lepidopteran COI starter, in accordance with previous suggestions. The 678 bp long A + T-rich region, which is second longest in sequencedlepidopteran insects, harbored 10 identical 27 bp long tandem repeats plus one 13 - bp long incomplete final repeat. Such a repeat sequence has been, thus far, only rarely detected in lepidopteran mitogenomes. The E. autonoe A + T-rich region harbored a poly-T stretch of 19 bp and a conserved ATAGA motif located at the end of the region, which have been suggested to function as structural signals for minor-strand mtDNA replication. Phylogenetic reconstruction using the concatenated 13amino acid and nucleotide sequences of the protein-coding genes (PCGs) consistently supported a close relationship between Bombycoidea and Geometroidea among six available lepidopteran superfamilies (Tortricoidea, Pyraloidea, Papilionoidea, Bombycoidea, Geometroidea and Noctuoidea). Among the true butterflies (Pieridae, Nymphalidae, Lycaenidae and Papilionidae), a closer relationship between Lycaenidae and Pieridae, excluding Nymphalidae was consistently concluded to exist,although this result deviated from the traditional view

Dimerization-Induced Fermi-Surface Reconstruction in IrTe2

We report a de Haas-van Alphen (dHvA) oscillation study on IrTe2 single crystals showing complex dimer formations. By comparing the angle dependence of dHvA oscillations with band structure calculations, we show distinct Fermi surface reconstruction induced by a 1/5-type and a 1/8-type dimerizations. This verifies that an intriguing quasi-two-dimensional conducting plane across the layers is induced by dimerization in both cases. A phase transition to the 1/8 phase with higher dimer density reveals that local instabilities associated with intra-and interdimer couplings are the main driving force for complex dimer formations in IrTe2.X11149sciescopu

Recent advances in osmotic energy generation via pressure-retarded osmosis (PRO): A review

© 2015 by the authors. Global energy consumption has been highly dependent on fossil fuels which cause severe climate change and, therefore, the exploration of new technologies to produce effective renewable energy plays an important role in the world. Pressure-retarded osmosis (PRO) is one of the promising candidates to reduce the reliance on fossil fuels by harnessing energy from the salinity gradient between seawater and fresh water. In PRO, water is transported though a semi-permeable membrane from a low-concentrated feed solution to a high-concentrated draw solution. The increased volumetric water flow then runs a hydro-turbine to generate power. PRO technology has rapidly improved in recent years; however, the commercial-scale PRO plant is yet to be developed. In this context, recent developments on the PRO process are reviewed in terms of mathematical models, membrane modules, process designs, numerical works, and fouling and cleaning. In addition, the research requirements to accelerate PRO commercialization are discussed. It is expected that this article can help comprehensively understand the PRO process and thereby provide essential information to activate further research and development

Age differences in social comparison tendency and personal relative deprivation

We examined age-related differences in social comparison orientation and personal relative deprivation (PRD). In Study 1, participants (N = 1,290) reported their tendencies to engage in social comparisons and PRD. Older adults reported lower levels of social comparison tendency and PRD, and social comparison tendency mediated the relation between age and PRD. The findings reported in Study 1 were replicated in Study 2 using a sample of participants between the ages of 18 to 30 (n = 180) and 60+ years old (n = 176). Our findings provide evidence that older adults report lower levels of social comparison tendency that, in turn, relate to lower levels of PRD.This research was funded by a grant from the Leverhulme Trust (RPG-2013-148).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.paid.2015.08.00

One-volt-driven superfast polymer actuators based on single-ion conductor

The key challenges in the advancement of actuator technologies related to artificial muscles include fast-response time, low operation voltages and durability. Although several researchers have tackled these challenges over the last few decades, no breakthrough has been made. Here we describe a platform for the development of soft actuators that moves a few millimetres under 1V in air, with a superfast response time of tens of milliseconds. An essential component of this actuator is the single-ion-conducting polymers that contain well-defined ionic domains through the introduction of zwitterions; this achieved an exceptionally high dielectric constant of 76 and a 300-fold enhancement in ionic conductivity. Moreover, the actuator demonstrated long-term durability, with negligible changes in the actuator stroke over 20,000 cycles in air. Owing to its low-power consumption (only 4 mW), we believe that this actuator could pave the way for cutting-edge biomimetic technologies in the future.11135Ysciescopu