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Schulman-Marcus, Joshua,Lin, Fay Y.,Gransar, Heidi,Berman, Daniel,Callister, Tracy,DeLago, Augustin,Hadamitzky, Martin,Hausleiter, Joerg,Al-Mallah, Mouaz,Budoff, Matthew,Kaufmann, Philipp,Achenbach, S Oxford University Press 2017 European heart journal cardiovascular Imaging Vol.18 No.8
<P><B>Abstract</B></P><P><B>Aims</B></P><P>To identify the effect of early revascularization on 5-year survival in patients with CAD diagnosed by coronary-computed tomographic angiography (CCTA).</P><P><B>Methods and results</B></P><P>We examined 5544 stable patients with suspected CAD undergoing CCTA who were followed a median of 5.5 years in a large international registry. Patients were categorized as having low-, intermediate-, or high-risk CAD based on CCTA findings. Two treatment groups were defined: early revascularization within 90 days of CCTA (<I>n</I> = 1171) and medical therapy (<I>n</I> = 4373). To account for the non-randomized referral to revascularization, we developed a propensity score by logistic regression. This score was incorporated into Cox proportional hazard models to calculate the effect of revascularization on all-cause mortality. Death occurred in 363 (6.6%) patients and was more frequent in medical therapy. In multivariable models, when compared with medical therapy, the mortality benefit of revascularization varied significantly over time and by CAD risk (<I>P</I> for interaction 0.04). In high-risk CAD, revascularization was significantly associated with lower mortality at 1 year (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.11–0.47) and 5 years (HR 0.31, 95% CI 0.18–0.54). For intermediate-risk CAD, revascularization was associated with reduced mortality at 1 year (HR 0.45, 95% CI 0.22–0.93) but not 5 years (HR 0.63, 95% CI 0.33–1.20). For low-risk CAD, there was no survival benefit at either time point.</P><P><B>Conclusions</B></P><P>Early revascularization was associated with reduced 1-year mortality in intermediate- and high-risk CAD detected by CCTA, but this association only persisted for 5-year mortality in high-risk CAD.</P>
Translating Beowulf: Translators Crouched and Dangers Rampant
Jana K. Schulman 한국중세근세영문학회 2004 중세르네상스 영문학 Vol.12 No.1
Beowulf is an ambiguous text. One area of ambiguity not obvious to the reader of the poem in Modern English is the occurrence of ambiguous pronoun referents in the Old English. In this essay, I look at six examples of ambiguity: intentional ambiguity (an analysis of the word ellengœst); blurred boundaries and monsters (the use of aglœca in l. 1269a); grammatical ambiguities and dragons (the pronoun "he" and its referent in l. 2568b); ambiguous connections and betrayal (the pronoun "he" in l. 1167); pronominal ambiguities (ll. 2490b and 2692b); and, finally, the substantivized adjective rica in l. 310b. When editors and translators make decisions about referents for pronouns and substantivized adjectives, they deny the poem's ambiguities and violate the symbolic logic of the text. The ambiguity in Beowulf creates a richer and more nuanced poem; translators need to devise a means of acknowledging these ambiguities. In this essay, I conclude that translators should consider alternating words as in the case of guest and demon, by noting the use of aglœca for both Grendel and Beowulf, by footnoting the pronouns to explain their significance, and finally by choosing neutral terms when possible (such as "the mighty one" for se rica).
Allison R. Schulman,Ming V. Lin,Anna Rutherford,Walter W. Chan,Marvin Ryou 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.2
Background/Aims: Liver biopsy has traditionally been used for determining the degree of fibrosis, however there are several limitations. Endoscopic ultrasound (EUS) real-time elastography (RTE) is a novel technology that uses image enhancement to display differences in tissue compressibility. We sought to assess whether liver fibrosis index (LFI) can distinguish normal, fatty, and cirrhotic liver tissue. Methods: A total of 50 patients undergoing EUS were prospectively enrolled. RTE of the liver was performed to synthesize the LFI in each patient. Univariate and multivariable analyses were performed. Chi-square and t-tests were performed for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant. Results: Abdominal imaging prior to endoscopic evaluation suggested normal tissue, fatty liver, and cirrhosis in 26, 16, and 8 patients, respectively. Patients with cirrhosis had significantly increased mean LFI compared to the fatty liver (3.2 vs. 1.7, p<0.001) and normal (3.2 vs. 0.8, p<0.001) groups. The fatty liver group showed significantly increased LFI compared to the normal group (3.8 vs. 1.4, p<0.001). Multivariable regression analysis suggested that LFI was an independent predictor of group features (p<0.001). Conclusions: LFI computed from RTE images significantly correlates with abdominal imaging and can distinguish normal, fatty, and cirrhotic-appearing livers; therefore, LFI may play an important role in patients with chronic liver disease.
Respiratory Review of 2013: Pulmonary Thromboembolism
Hwang, Hun Gyu,Schulman, Sam The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.3
Pulmonary embolism (PE), which can originate as a consequence of deep vein thrombosis (DVT), is the most frequent and potentially fatal venous thromboembolic event. Despite the fact that the incidence of venous thromboembolism (VTE) in Asians is lower than that in the Western populations, a recent epidemiologic study demonstrates an increasing incidence of VTE in the Korean population. Anticoagulants, including low molecular weight heparin (LMWH) and vitamin K antagonist (VKAs), have been the main treatments for PE, however, recently new oral anticoagulants (NOACs) were introduced. We will review how well patients with PE can be managed with the existing anticoagulants and NOACs along with the time span of treatment, which still pose some challenges for clinicians.
Ó,Hartaigh, Brí,ain,Gransar, Heidi,Callister, Tracy,Shaw, Leslee J.,Schulman-Marcus, Joshua,Stuijfzand, Wijnand J.,Valenti, Valentina,Cho, Iksung,Szymonifka, Jackie,Lin, Fay Y.,Berman, Dan Elsevier 2018 JACC CARDIOVASCULAR IMAGING Vol.11 No.3
<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>The purpose of this study was to develop and validate a simple-to-use nomogram for prediction of 5-, 10-, and 15-year survival among asymptomatic adults.</P> <P><B>Background</B></P> <P>Simple-to-use prognostication tools that incorporate robust methods such as coronary artery calcium scoring (CACS) for predicting near-, intermediate- and long-term mortality are warranted.</P> <P><B>Methods</B></P> <P>In a consecutive series of 9,715 persons (mean age: 53.4 ± 10.5 years; 59.3% male) undergoing CACS, we developed a nomogram using Cox proportional hazards regression modeling that included: age, sex, smoking, hypertension, dyslipidemia, diabetes, family history of coronary artery disease, and CACS. We developed a prognostic index (PI) summing the number of risk points corresponding to weighted covariates, which was used to configure the nomogram. Validation of the nomogram was assessed by discrimination and calibration applied to a separate cohort of 7,824 adults who also underwent CACS.</P> <P><B>Results</B></P> <P>A total of 936 and 294 deaths occurred in the derivation and validation sets at a median follow-up of 14.6 years (interquartile range: 13.7 to 15.5 years) and 9.4 years (interquartile range: 6.8 to 11.5 years), respectively. The developed model effectively predicted 5-, 10-, and 15-year probability of survival. The PI displayed high discrimination in the derivation and validation sets (C-index 0.74 and 0.76, respectively), indicating suitable external performance of our nomogram model. The predicted and actual estimates of survival in each dataset according to PI quartiles were similar (though not identical), demonstrating improved model calibration.</P> <P><B>Conclusions</B></P> <P>A simple-to-use nomogram effectively predicts 5-, 10- and 15-year survival for asymptomatic adults undergoing screening for cardiac risk factors. This nomogram may be considered for use in clinical care.</P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>
Han, Donghee,Hartaigh, Brí,ain Ó,Gransar, Heidi,Lee, Ji Hyun,Rizvi, Asim,Baskaran, Lohendran,Schulman-Marcus, Joshua,Dunning, Allison,Achenbach, Stephan,Al-Mallah, Mouaz H,Berman, Daniel S Oxford University Press 2018 European heart journal cardiovascular Imaging Vol.19 No.6
<P><B>Abstract</B></P><P><B>Aims</B></P><P>Coronary computed tomography angiography (CCTA) and coronary artery calcium score (CACS) have prognostic value for coronary artery disease (CAD) events beyond traditional risk assessment. Age is a risk factor with very high weight and little is known regarding the incremental value of CCTA over CAC for predicting cardiac events in older adults.</P><P><B>Methods and results</B></P><P>Of 27 125 individuals undergoing CCTA, a total of 3145 asymptomatic adults were identified. This study sample was categorized according to tertiles of age (cut-off points: 52 and 62 years). CAD severity was classified as 0, 1–49, and ≥50% maximal stenosis in CCTA, and further categorized according to number of vessels ≥50% stenosis. The Framingham 10-year risk score (FRS) and CACS were employed as major covariates. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death or non-fatal MI. During a median follow-up of 26 months (interquartile range: 18–41 months), 59 (1.9%) MACE occurred. For patients in the top age tertile, CCTA improved discrimination beyond a model included FRS and CACS (C-statistic: 0.75 vs. 0.70, <I>P</I>-value = 0.015). Likewise, the addition of CCTA improved category-free net reclassification (cNRI) of MACE in patients within the highest age tertile (e.g. cNRI = 0.75; proportion of events/non-events reclassified were 50 and 25%, respectively; <I>P</I>-value <0.05, all). CCTA displayed no incremental benefit beyond FRS and CACS for prediction of MACE in the lower age tertiles.</P><P><B>Conclusion</B></P><P>CCTA provides added prognostic value beyond cardiac risk factors and CACS for the prediction of MACE in asymptomatic older adults.</P>
Genome Constitution and Classification Using Retrotransposon-Based Markers in the Orphan Crop Banana
( Chee How Teo ),( Siang Hee Tan ),( Chai Ling Ho ),( Qamaruz Zaman Faridah ),( Yasmin Rofina Othman ),( John Seymour Heslop Harrison ),( Ruslan Kalendar ),( Alan Howard Schulman ) 한국식물학회 2005 Journal of Plant Biology Vol.48 No.1
We have exploited the repetitive and dispersed nature of many long terminal repeat (LTR)-retrotransposon families for characterizing genome constitutions and classifying cultivars of the genus Musa. Insertional polymorphisms of the elements were studied using seven published and two newly designed primers facing outwards from the LTRs and reverse transcriptase (RT) domain of the retrotransposon. The primers generated specific amplification patterns showing the universal applicability of this marker type. The Inter-Retrotransposon Amplified Polymorphism (IRAP) markers distinguished the A and B genomes of the banana species (Musa acuminata Colla and Musa balbisiana Colla) and between banana cultivars. The IRAP markers enabled phylogenetic analysis of 16 Malaysian banana cultivars and determination of the genome constitution of hybrid banana (AAB, ABB, AABB, and AAAB), and gave information about ancestral genotypes of the hybrids. In addition, the TRAP detected new retrotransposon insertions into the genome of tissue culture regenerants. This PCR-based IRAP assay is amenable to large-scale throughput demands in screening breeding populations and is applicable for any crop.