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"Lee, Alex"
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An efficient approach to estimate the risk of coronary artery disease for people living with HIV using machine-learning-based retinal image analysis
People living with HIV (PLWH) have increased risks of non-communicable diseases, especially cardiovascular diseases. Current HIV clinical management guidelines recommend regular cardiovascular risk screening, but the risk equation models are not specific for PLWH. Better tools are needed to assess cardiovascular risk among PLWH accurately.
We performed a prospective study to determine the performance of automatic retinal image analysis in assessing coronary artery disease (CAD) in PLWH. We enrolled PLWH with ≥1 cardiovascular risk factor. All participants had computerized tomography (CT) coronary angiogram and digital fundus photographs. The primary outcome was coronary atherosclerosis; secondary outcomes included obstructive CAD. In addition, we compared the performances of three models (traditional cardiovascular risk factors alone; retinal characteristics alone; and both traditional and retinal characteristics) by comparing the area under the curve (AUC) of receiver operating characteristic curves.
Among the 115 participants included in the analyses, with a mean age of 54 years, 89% were male, 95% had undetectable HIV RNA, 45% had hypertension, 40% had diabetes, 45% had dyslipidemia, and 55% had obesity, 71 (61.7%) had coronary atherosclerosis, and 23 (20.0%) had obstructive CAD. The machine-learning models, including retinal characteristics with and without traditional cardiovascular risk factors, had AUC of 0.987 and 0.979, respectively and had significantly better performance than the model including traditional cardiovascular risk factors alone (AUC 0.746) in assessing coronary artery disease atherosclerosis. The sensitivity and specificity for risk of coronary atherosclerosis in the combined model were 93.0% and 93.2%, respectively. For the assessment of obstructive CAD, models using retinal characteristics alone (AUC 0.986) or in combination with traditional risk factors (AUC 0.991) performed significantly better than traditional risk factors alone (AUC 0.777). The sensitivity and specificity for risk of obstructive CAD in the combined model were 95.7% and 97.8%, respectively.
In this cohort of Asian PLWH at risk of cardiovascular diseases, retinal characteristics, either alone or combined with traditional risk factors, had superior performance in assessing coronary atherosclerosis and obstructive CAD.
People living with HIV in an Asian cohort with risk factors for cardiovascular disease had a high prevalence of coronary artery disease (CAD). A machine-learning-based retinal image analysis could increase the accuracy in assessing the risk of coronary atherosclerosis and obstructive CAD.
Journal Article
A History of modernist poetry
\"A History of Modernist Poetry examines innovative Anglophone poetries from Decadence to the post-war period. The first of its three parts considers formal and contextual issues, including myth, politics, gender, and race, while the second and third parts discuss a wide range of individual poets, including Ezra Pound, T.S. Eliot, W.B. Yeats, Mina Loy, Gertrude Stein, Wallace Stevens, William Carlos Williams, and Marianne Moore, as well as key movements such as Imagism, Objectivism, and the Harlem Renaissance. This book also addresses the impact of both World Wars on experimental poetries and the crucial role of magazines in disseminating and proselytizing on behalf of poetic modernism. The collection concludes with a wide-ranging discussion of the inheritance of modernism in recent writing on both sides of the Atlantic\" -- Provided by publisher.
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Dispersible Exfoliated Zeolite Nanosheets and Their Application as a Selective Membrane
Thin zeolite films are attractive for a wide range of applications, including molecular sieve membranes, catalytic membrane reactors, permeation barriers, and low-dielectric-constant materials. Synthesis of thin zeolite films using high-aspect-ratio zeolite nanosheets is desirable because of the packing and processing advantages of the nanosheets over isotropic zeolite nanoparticles. Attempts to obtain a dispersed suspension of zeolite nanosheets via exfoliation of their lamellar precursors have been hampered because of their structure deterioration and morphological damage (fragmentation, curling, and aggregation). We demonstrated the synthesis and structure determination of highly crystalline nanosheets of zeolite frameworks MWW and MFI. The purity and morphological integrity of these nanosheets allow them to pack well on porous supports, facilitating the fabrication of molecular sieve membranes.
Journal Article
Action Comics : 80 years of Superman
Classic Superman stories spanning 1938 to 2012 and including the first appearances of Supergirl, Brainiac, the Fortress of Solitude, and others.
Book
Cell of origin affects tumour development and phenotype in pancreatic ductal adenocarcinoma
ObjectivePancreatic ductal adenocarcinoma (PDAC) is a highly aggressive tumour thought to arise from ductal cells via pancreatic intraepithelial neoplasia (PanIN) precursor lesions. Modelling of different genetic events in mice suggests both ductal and acinar cells can give rise to PDAC. However, the impact of cellular context alone on tumour development and phenotype is unknown.DesignWe examined the contribution of cellular origin to PDAC development by inducing PDAC-associated mutations, KrasG12D expression and Trp53 loss, specifically in ductal cells (Sox9CreER;KrasLSL-G12D;Trp53flox/flox (‘Duct:KPcKO ’)) or acinar cells (Ptf1aCreER;KrasLSL-G12D;Trp53flox/flox (‘Acinar:KPcKO ’)) in mice. We then performed a thorough analysis of the resulting histopathological changes.ResultsBoth mouse models developed PDAC, but Duct:KPcKO mice developed PDAC earlier than Acinar:KPcKO mice. Tumour development was more rapid and associated with high-grade murine PanIN (mPanIN) lesions in Duct:KPcKO mice. In contrast, Acinar:KPcKO mice exhibited widespread metaplasia and low-grade as well as high-grade mPanINs with delayed progression to PDAC. Acinar-cell-derived tumours also had a higher prevalence of mucinous glandular features reminiscent of early mPanIN lesions.ConclusionThese findings indicate that ductal cells are primed to form carcinoma in situ that become invasive PDAC in the presence of oncogenic Kras and Trp53 deletion, while acinar cells with the same mutations appear to require a prolonged period of transition or reprogramming to initiate PDAC. Our findings illustrate that PDAC can develop in multiple ways and the cellular context in which mutations are acquired has significant impact on precursor lesion initiation, disease progression and tumour phenotype.
Journal Article
Aircraft-based measurements of High Arctic springtime aerosol show evidence for vertically varying sources, transport and composition
The sources, chemical transformations and removal mechanisms of aerosol transported to the Arctic are key factors that control Arctic aerosol–climate interactions. Our understanding of sources and processes is limited by a lack of vertically resolved observations in remote Arctic regions. We present vertically resolved observations of trace gases and aerosol composition in High Arctic springtime, made largely north of 80∘ N, during the NETCARE campaign. Trace gas gradients observed on these flights defined the polar dome as north of 66–68∘ 30′ N and below potential temperatures of 283.5–287.5 K. In the polar dome, we observe evidence for vertically varying source regions and chemical processing. These vertical changes in sources and chemistry lead to systematic variation in aerosol composition as a function of potential temperature. We show evidence for sources of aerosol with higher organic aerosol (OA), ammonium and refractory black carbon (rBC) content in the upper polar dome. Based on FLEXPART-ECMWF calculations, air masses sampled at all levels inside the polar dome (i.e., potential temperature <280.5 K, altitude <∼3.5 km) subsided during transport over transport times of at least 10 days. Air masses at the lowest potential temperatures, in the lower polar dome, had spent long periods (>10 days) in the Arctic, while air masses in the upper polar dome had entered the Arctic more recently. Variations in aerosol composition were closely related to transport history. In the lower polar dome, the measured sub-micron aerosol mass was dominated by sulfate (mean 74 %), with lower contributions from rBC (1 %), ammonium (4 %) and OA (20 %). At higher altitudes and higher potential temperatures, OA, ammonium and rBC contributed 42 %, 8 % and 2 % of aerosol mass, respectively. A qualitative indication for the presence of sea salt showed that sodium chloride contributed to sub-micron aerosol in the lower polar dome, but was not detectable in the upper polar dome. Our observations highlight the differences in Arctic aerosol chemistry observed at surface-based sites and the aerosol transported throughout the depth of the Arctic troposphere in spring.
Journal Article
Batman hush : the 15th anniversary deluxe edition
\"The best-selling and critically acclaimed HUSH storyline is here: re-experience the entire thrilling adventure in one complete deluxe hardcover volume! This special 15th anniversary deluxe edition also includes sketches, character designs, altered art and annotations by artist and DC publisher Jim Lee! Gotham City is infected by a crime epidemic and all of Batman's enemies have emerged to throw his life into utter chaos. But little do they know that they're all pawns of the villainous Hush in an elaborate game of revenge against Bruce Wayne. Pushed past his breaking point, Batman will need to use more than the world's greatest detective skills to uncover the true identity of this mysterious mastermind before it's too late.\"-- Provided by publisher.
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