Purpose: Transthyretin cardiac amyloidosis (ATTR-CA) has been linked to many extra-cardiac manifestations including bilateral carpal tunnel syndrome (CTS). The aim of this study is to analyze patients with bilate...Purpose: Transthyretin cardiac amyloidosis (ATTR-CA) has been linked to many extra-cardiac manifestations including bilateral carpal tunnel syndrome (CTS). The aim of this study is to analyze patients with bilateral CTS to identify patients with high-risk features or “red flags” for ATTR-CA, identify if systematic screening was done for ATTR-CA and define opportunities for improved detection. Methods: Out of >5000 patients with bilateral CTS evaluated in a single tertiary care center in Southeast Michigan (2010-2016), we retrospectively studied a focused population of patients: men > 50 years and women > 60 years old with bilateral CTS and atrial fibrillation (n = 295). Baseline demographic, comorbidities, and electrocardiographic and echocardiographic findings were analyzed. A high-risk group suspicious for ATTR-CA was identified as patients with bilateral CTS, atrial fibrillation, and concomitant “red flags” including heart failure and left ventricular hypertrophy. Results: Out of 295 patients, 51.2% were female, 75.6% were White, and 22.4% were African American. Upon comparing the high-risk group (n = 67) with the remaining study population (n = 228), both diagnosis of ATTR-CA and mortality were higher among the high-risk group (7.5% vs 0.4% and 43.3% vs 24.6%, respectively, P = 0.003). Conclusions: A substantial number of bilateral CTS patients had additional “red flags” warranting formal evaluation for ATTR-CA;however, systematic evaluation for cardiac amyloidosis was not performed in many patients. This emphasizes that Multidisciplinary collaboration is needed to create a systematic workflow and to raise awareness amongst cardiologists and other physicians for suspecting ATTR-CA in bilateral CTS patients who have additional “red flags”.展开更多
Saussure regarded nautical flag signalling codes as a prime example of semiological systems.They have something in common with language(e.g.,the principle of arbitrariness)but also some distinctive features(for instan...Saussure regarded nautical flag signalling codes as a prime example of semiological systems.They have something in common with language(e.g.,the principle of arbitrariness)but also some distinctive features(for instance,visual signifiers are unlike auditory ones in being able to deploy different features at the same time,such as shape and colour).The best-known example is the International Code of Signals(ICS).The system as it was during Saussure’s lifetime is explained with reference to his scattered observations,such as that a signal flag is merely“un morceau d’étoffe”until it is brought into use according to the prescriptions of the code shared by its users.Some commentators at the time envisaged this form of visual communication as a“universal language”.However,it is based on a restricted code,lacking the semantic universality of natural language.Each flag represents a letter,and combinations of flags represent predefined wordings in a“code book”.Such visual codes therefore depend on the prior existence of natural languages into and out of which they can be translated.展开更多
People wave flags during an event organized by the Hong Kong Chinese Enterprises Association to unite families in their call for order and harmony in the Ocean Park, south China’s Hong Kong Special Administrative Reg...People wave flags during an event organized by the Hong Kong Chinese Enterprises Association to unite families in their call for order and harmony in the Ocean Park, south China’s Hong Kong Special Administrative Region, on August 24.展开更多
Twenty years ago, in 1992, the International Maritime Organization set the objective of extending the regional Port State Control agreements to the world scale. This would be achieved, it was hoped, by ＂exporting＂ t...Twenty years ago, in 1992, the International Maritime Organization set the objective of extending the regional Port State Control agreements to the world scale. This would be achieved, it was hoped, by ＂exporting＂ the model of the Paris MoU （Memorandum of Understanding） agreement of 1982 to other regional areas. Now would seem to be a good time to consider the prospects for a future scenario where all the countries involved form a truly global network with uniform procedures. The authors of this article put forward an earlier objective that could be the beginning of that global policy, fi＇om a detailed look at the three most important regional agreements （Paris, Tokyo and Vifia del Mar） that encompass geographically the following areas, respectively： Europe plus Canada, the Asia-Pacific, and South America. To this end, we first make a theoretical comparison based on the legal standards of application, and then present a study made of all the vessels detained under the three agreements, with a view to determining whether or not there are different kinds of behaviours, with regard to the flags and ＂recognised organizations＂ used by the vessels to certify their levels of safety. The numerical variables we have taken as basic with respect to compliance with the international standards are： the date that the vessel＇s keel was laid （age of the vessel） and as significant categorical variables, the type of vessel, the flag, the typology of that flag, the corresponding classification society, and whether or not that society is a member of the IACS （International Association of Classification Societies）. The results show a similar trend between the Paris and Tokyo agreements, but in the case of Vifia del Mar, the level of efficacy in the control appears to be insufficient in comparison with the standard of the other two.展开更多
文摘Purpose: Transthyretin cardiac amyloidosis (ATTR-CA) has been linked to many extra-cardiac manifestations including bilateral carpal tunnel syndrome (CTS). The aim of this study is to analyze patients with bilateral CTS to identify patients with high-risk features or “red flags” for ATTR-CA, identify if systematic screening was done for ATTR-CA and define opportunities for improved detection. Methods: Out of >5000 patients with bilateral CTS evaluated in a single tertiary care center in Southeast Michigan (2010-2016), we retrospectively studied a focused population of patients: men > 50 years and women > 60 years old with bilateral CTS and atrial fibrillation (n = 295). Baseline demographic, comorbidities, and electrocardiographic and echocardiographic findings were analyzed. A high-risk group suspicious for ATTR-CA was identified as patients with bilateral CTS, atrial fibrillation, and concomitant “red flags” including heart failure and left ventricular hypertrophy. Results: Out of 295 patients, 51.2% were female, 75.6% were White, and 22.4% were African American. Upon comparing the high-risk group (n = 67) with the remaining study population (n = 228), both diagnosis of ATTR-CA and mortality were higher among the high-risk group (7.5% vs 0.4% and 43.3% vs 24.6%, respectively, P = 0.003). Conclusions: A substantial number of bilateral CTS patients had additional “red flags” warranting formal evaluation for ATTR-CA;however, systematic evaluation for cardiac amyloidosis was not performed in many patients. This emphasizes that Multidisciplinary collaboration is needed to create a systematic workflow and to raise awareness amongst cardiologists and other physicians for suspecting ATTR-CA in bilateral CTS patients who have additional “red flags”.
文摘Saussure regarded nautical flag signalling codes as a prime example of semiological systems.They have something in common with language(e.g.,the principle of arbitrariness)but also some distinctive features(for instance,visual signifiers are unlike auditory ones in being able to deploy different features at the same time,such as shape and colour).The best-known example is the International Code of Signals(ICS).The system as it was during Saussure’s lifetime is explained with reference to his scattered observations,such as that a signal flag is merely“un morceau d’étoffe”until it is brought into use according to the prescriptions of the code shared by its users.Some commentators at the time envisaged this form of visual communication as a“universal language”.However,it is based on a restricted code,lacking the semantic universality of natural language.Each flag represents a letter,and combinations of flags represent predefined wordings in a“code book”.Such visual codes therefore depend on the prior existence of natural languages into and out of which they can be translated.
文摘People wave flags during an event organized by the Hong Kong Chinese Enterprises Association to unite families in their call for order and harmony in the Ocean Park, south China’s Hong Kong Special Administrative Region, on August 24.
文摘Twenty years ago, in 1992, the International Maritime Organization set the objective of extending the regional Port State Control agreements to the world scale. This would be achieved, it was hoped, by ＂exporting＂ the model of the Paris MoU （Memorandum of Understanding） agreement of 1982 to other regional areas. Now would seem to be a good time to consider the prospects for a future scenario where all the countries involved form a truly global network with uniform procedures. The authors of this article put forward an earlier objective that could be the beginning of that global policy, fi＇om a detailed look at the three most important regional agreements （Paris, Tokyo and Vifia del Mar） that encompass geographically the following areas, respectively： Europe plus Canada, the Asia-Pacific, and South America. To this end, we first make a theoretical comparison based on the legal standards of application, and then present a study made of all the vessels detained under the three agreements, with a view to determining whether or not there are different kinds of behaviours, with regard to the flags and ＂recognised organizations＂ used by the vessels to certify their levels of safety. The numerical variables we have taken as basic with respect to compliance with the international standards are： the date that the vessel＇s keel was laid （age of the vessel） and as significant categorical variables, the type of vessel, the flag, the typology of that flag, the corresponding classification society, and whether or not that society is a member of the IACS （International Association of Classification Societies）. The results show a similar trend between the Paris and Tokyo agreements, but in the case of Vifia del Mar, the level of efficacy in the control appears to be insufficient in comparison with the standard of the other two.
