We present a proof of the Riemannian Penrose inequality with charge in the context of asymptotically flat initial data sets for the Einstein–Maxwell equations, having possibly multiple black holes with no charged matter outside the horizon, and satisfying the relevant dominant energy condition. The proof is based on a generalization of Hubert Bray's conformal flow of metrics adapted to this setting.
Given a surface of higher genus, we will look at the Weil-Petersson completion of the Teichmüller space of the surface, and will study the geometry induced by the Weil-Petersson distance functional.Although the completion is no longer a Riemannian manifold, it has characteristics similar to those of Cartan-Hadamard manifolds.
Objective: We investigated the effect of immersion of feet in CO2 -enriched water for preventing expansion and formation of ischemic ulcer in critical limb ischemia of diabetic patients after surgical revascularization. Materials and methods: Eligible patients were allocated CO2 group (CO2 immersion plus standard care) or control group (standard care alone) and were followed up for 3 months after surgical revascularization. The end point is defined as an expansion of a target ulcer (more than 101% of original size) or the formation of new ulcers during the follow-up period. Results: Fifty-nine patients out of originally enrolled 66 patients with type II diabetes were included in intention-to-treat population. The cumulative prevention rate for ischemic ulcer after 3 months was 97.1% in the CO2 group, while, in the control group, it was 77.8%, i.e., significantly lower than the CO2 group (P = 0.012, log-rank test). The transcutaneous oxygen pressure increased significantly only in the CO2 group, from 56 ± 14 to 63 ± 15 mmHg (P < 0.01, Wilcoxon signed rank test), in 3 months. Conclusion: These results suggest that addition of CO2 immersion to standard care of critical limb ischemia in diabetic patients improves early postoperative outcome after vascular surgery.
Composite polyolefin membranes with graded chlorination gradient were obtained by photochlorination of polyethylene, polypropylene, and polystyrene films using ultraviolet and visible light. The maximum chlorine contents of these membranes were 12%, 8.5%, and 6.5%, respectively. As for polyethylene, the surface photochlorination reduced gas permeation of carbon dioxide and oxygen down to 1/30 and 1/21 of the original polyethylene; it also improved the wettability without changing substantially other favorable physical properties such as tensile strength, elongation, and water vapor permeation. The water contact angle of chlorinated polyethylene was comparable to that of poly(vinyl chloride). The infrared spectra suggest the presence of the chlorine of the CHClCHCl type rather than of the CCl2 type in the photochlorination of polyethylene. In an effort to obtain useful membranes with a photocrosslinking functional group as a side chain, surface-photochlorinated polyethylene was allowed to react with sodium N,N-dimethyldithiocarbamate or sodium N-methyl-N-carboxymethyldithiocarbamate in dimethylformamide at 50°C for 48 hr according to the procedure by which poly(vinyl chloride) was previously reacted. The polymer thus obtained has 4.1 mole-% SCSNMe2 and 3.4 mole-% SCSN(CH3)CH2COONa groups.
We study the problem of asymptotically flat bi-axially symmetric stationary solutions of the vacuum Einstein equations in 5-dimensional spacetime. In this setting, the cross section of any connected component of the event horizon is a prime 3-manifold of positive Yamabe type, namely the 3-sphere S3, the ring S1×S2, or the lens space L(p, q). The Einstein vacuum equations reduce to an axially symmetric harmonic map with prescribed singularities from R3 into the symmetric space SL(3,R)/SO(3). In this paper, we solve the problem for all possible topologies, and in particular the first candidates for smooth vacuum non-degenerate black lenses are produced. In addition, a generalization of this result is given in which the spacetime is allowed to have orbifold singularities. We also formulate conditions for the absence of conical singularities which guarantee a physically relevant solution.
Abstract Background Severity of functional limitations (FLs) has been considered as a prognostic factor in patients with heart failure (HF). However, trajectory patterns of FLs after discharge and their associated factors have remained unclear. Purpose This study aimed to explore trajectories of FLs after discharge and to examine clinical characteristics based on the identified trajectories. Methods This study was performed as a part of a multicenter cohort study. The cohort study enrolled hospitalized patients due to acute HF or exacerbation of chronic HF and who were able to walk at discharge. Patients with severe cognitive or psychological disorders or less than 6-month life expectancy were excluded. FLs were assessed using Performance Measure for Activities of Daily Living-8 (PMADL-8; higher scores indicate worse FLs) at discharge and 1-, 6-, 10- and 14-month after discharge. To identify FLs trajectories getting worse after discharge, we excluded patients already having severe FLs at discharge (PMADL-8 ≥21, a cut off value for predicting poor prognosis). Group-based trajectory modeling (GBTM) was conducted to identify distinct PMADL-8 trajectories. Then, associated factors of trajectory group that showed increasing FLs after discharge were examined using logistic regression analysis adjusted for potential confounders. Results A total of 953 patients were included in the analysis (age: 70.6±11.8 years, men: 70.9%, left ventricular ejection fraction <40%: 41.3%). GBTM identified four PMADL-8 trajectories: two separate trajectories where PMADL-8 remained low (T1: 14.1%, T2: 31.3%), mildly increasing PMADL-8 trajectory (T3: 41.0%) and rapidly increasing PMADL-8 trajectory (T4: 13.6%) (Figure). Logistic regression analysis showed that age (odds ratio 1.05, per 1 year; 95% confidence interval 1.02–1.07), women (2.12; 1.31–3.45), brain natriuretic peptide ≥200 pg/mL (1.88; 1.10–3.21), estimated glomerular filtration rate <30 mL/min/1.73m2 (2.50; 1.41–4.41), depression (2.34; 1.44–3.80), and re-hospitalization due to HF during 1-year follow-up (2.85; 1.56–5.21) were independent associated factors of T4 group. Figure 1. Trajectories of PMADL-8 Conclusions The high-risk population for increasing FLs after discharge was identified by GBTM. The findings of this study suggest the importance of long-term HF management for preventing FLs after discharge especially among those with older age, female gender and depression. Acknowledgement/Funding This work was supported by a Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science [16H01862].
To clarify the pathogenic role of enteropathogenic Escherichia coli (EPEC) or enteroaggregative E. coli (EAggEC), the possession of eaeA gene of EPEC or aggR gene of EAggEC in the strains isolatedfrom 525 patients in sporadic diarrhea cases during 3 years (1998-2000) in Tama, Tokyo was investigatedby a PCR method. The eaeA -positive E.coli strains were confirmed from 23 cases including5 cases detected verotoxin-producing E.coli (VTEC), and those except VTEC strains (18 cases, 3.4%) were the 5th predominant enteropathogen following rotavirus, Campylobacter, adenovirus, and Salmonella. By age, 17 eaeA-positive cases were from children <10 years of age, and noticeably, ofwhich 9 were from infants <24months of age. On the other hand, although aggR -positive E.colistrains were detected from 11 cases (2.1%), of which 6 also were from infants<24 months of age.Clinical symptoms of patients whom eaeA or aggR gene-positive E.coli was isolated as the only potentialenteric pathogen were similar, showing a mild gastroenteritic features.Only one strain of eaeA-positive E.coli and 4 of aggR -strains were typed with the commercial Oantisera, which were O55, and O86, O111 or O126. In antibiotic sensitivity tests for 9 agents, 22% of eaeA-strains and 91% of aggR-strains showed resistant, especially 10 aggR-strains had resistant toABPC. These findings suggest that these organisms are a significant causative agents of infantile diarrheaand the PCR method is a useful procedure for the diagnosis of EPEC or EAggEC infectiousdisease.
Abstract Background Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear. Purpose We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis. Methods This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories. Results The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p<0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p<0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p<0.001). Conclusion Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome. Funding Acknowledgement Type of funding source: None
