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The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site–related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site–related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (P interaction = 0.049). Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA. [Display omitted] [ABSTRACT FROM AUTHOR]

Perineural invasion (PNI) hinders the ability to establish local control of oral squamous cell carcinoma (OSCC). To date, PNI can be evaluated only in surgical specimens and not in preoperative biopsy material, rendering timely therapeutic planning impossible. Insulin-like growth factor-II mRNA binding protein-3 (IMP3) expression appears to be of diagnostic and prognostic utility for many solid tumours, and laminin-5 expression in surgical specimens has been identified as a valid predictor of neural spread of head-and-neck neoplasms. The ability to use preoperative biopsy material to identify patients exhibiting PNI is fundamental for good management of OSCC. We examined a series of 64 consecutive patients treated (primarily via surgery) for OSCC between 2009 and 2014 at the Maxillofacial Surgery Unit, University of Bologna. We evaluated IMP3 and laminin-5 expression in preoperative biopsy material using immunohistochemistry and quantitative reverse transcription polymerase chain reaction. We sought to correlate expression of IMP3 and laminin-5 with PNI evident in surgical specimens. Expression of IMP3 and laminin-5 in preoperative biopsy material appeared to be predictive of PNI in patients with OSCC (P < 0.001). Additionally, the results of multivariate analyses showed that IMP3 status was an independent predictor of death of patients with OSCC (P = 0.001). The present study demonstrates that IMP3 and laminin-5 expression in preoperative biopsy material correlate well with PNI status and may allow accurate preoperative risk stratification of patients with OSCC. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we draw on a 16-month study funded by the Learning and Teaching Support Network in the UK and entitled Mathematicians as Educational Co-Researchers. The study''s aims were two-fold. Primarily we intended to explore mathematicians’ reflections on issues identified in the literature as highly topical in the area of teaching and learning of undergraduate mathematics. We also wished to explore the conditions under which mutually effective collaboration between mathematicians and researchers in mathematics education might be achieved. Participants were 20 mathematicians from 6 mathematics departments and the study involved a series of Focus Group Interviews where pre-distributed samples of mathematical problems, typical written student responses, observation protocols, interview transcripts and outlines of relevant bibliography were used to trigger an exploration of pedagogical issues. Here we elaborate the theme ‘On the Pedagogical Insights of Mathematicians’ as it emerged from the data analysis. We do so in two parts: in the first part we present the participants’ reflections on issues of interaction and communication within the context of teaching and learning in higher education. The data suggest that the lecturers believe that mathematical learning is achieved more effectively as an interactive process and recognise that lecturing is not a method generally conducive to interaction. However, they discuss ways in which interaction can be achieved and refer to seminars, tutorials and feedback to students’ writing as other opportunities for interaction that must not be missed. In the second part, we focus on the lecturers’ pedagogical reflections regarding the abstract nature of university mathematics and, in particular, the ways in which teaching can facilitate the transition from the concrete to the abstract. We conclude with a brief evaluation of the project by the mathematicians themselves. [Copyright &y& Elsevier]

• Mathematical modelling tasks trigger student navigation across disciplines. • Students' graphing activity excessively privileges time as independent variable. • Students' graphing activity privileges data illustration rather than interpretation. • Commognitive analysis traces meta-level learning in students' modelling activity. • Lecturer awareness of student meta-level learning needs improves task design. Through a commognitive lens, we examine twelve first-semester biology students'. engagement with graphing routines as they work in groups, during four sessions of Mathematical Modelling (MM). We trace the students' meta-level learning, particularly as they fluctuate between deploying graphs for mere illustration of data and as sense-making tools. We account for student activity in relation to precedent events in their experiences of graphing and as fluid, if not always productive, interplay between ritualised and exploratory engagement with graph construction and interpretation routines. The students' construal of the task situations is marked by efforts to keep up with lecturer expectations which allow for changing degrees of student agency but do not factor in the influence of precedent events. Our analysis has pedagogical implications for the way MM problems are formulated and also foregrounds the capacity of the commognitive framework to trace de-ritualization and meta-level learning in students' MM activity. [ABSTRACT FROM AUTHOR]

Coronary artery ectasia (CAE) is associated with ascending aortic (AA) ectasia. The purpose of this study is to evaluate the diagnostic performance of different echocardiographic parameters (EP) in predicting the presence of CAE. Four hundred-eighteen patients with AA ectasia candidate to coronary angiography were identified and divided in two groups in respect of the presence of CAE. Receiver-operating characteristic curves areas (AUC) were used to assess the discrimination power of the following EP: aortic annulus diameter, sinuses of Valsalva (SV) diameter, sino-tubular junction (STJ) diameter, AA diameter, STJ to SV ratio (STJ-to-SV) and STJ to AA ratio (STJ-to-AA). All these parameters were indexed by body surface area. The relationship between the best EP and the presence of CAE was investigated by means of multivariable logistic regression. The rate of CAE in the study population was 32%. On univariable logistic regression, aortic annulus, STJ, STJ-to-SV and STJ-to-AA were associated with the presence of CAE after Bonferroni correction. STJ-to-SV emerged as the parameter with the best discrimination power (AUC = 0.81) compared to STJ (AUC = 0.69), STJ-to-AA (AUC = 0.68), aortic annulus (AUC = 0.59), AA (AUC = 0.56) and SV (AUC = 0.55); (p for comparison <0.01). An 89.6% value for STJ-to-SV ratio emerged as the best cut-off to diagnose CAE with a sensitivity = 75%, specificity = 82%, positive predictive value = 66% and negative predictive value = 88%. On multivariable analysis, STJ-to-SV was still associated with the presence of CAE (OR = 1.15;95%CI:1.11–1.19; p < 0.01). In patients with dilated aorta, STJ-to-SV sampled by transthoracic echocardiography shows a good diagnostic performance in predicting the presence of CAE. Non invasive predictor of coronary artery ectasia: sino-tubular junction diameter to sinus of Valsava diameter ratio at transthoracic echocardiography is a good tool to prognosticate the presence of coronary artery ectasia at coronary angiography in patients with ascending aorta dilatation. [Display omitted] • Coronary ectasia (CAE) is linked to ascending aortic aneurysms, but not all of them are affected by CAE. • Coronary angiography is the gold standard for CAE diagnosis. • Echo assessment was done in all patients candidate to coronary angiography with ascending aorta ≥4 mm. • Angiography presence of CAE let us to compare the two groups. • The sino-tubular junction to sinus of Valsalva ratio is the best echo predictor of CAE. [ABSTRACT FROM AUTHOR]

Background: Although a 1-year duration of dual antiplatelet therapy (DAPT) is used in many patients after drug-eluting stent (DES) implantation, the evidence supporting this duration is uncertain.Objectives: The authors investigated the risk-benefit profile of 1-year vs ≤6-month DAPT after DES using 2 novel scores to risk stratify bleeding and ischemic events.Methods: Ischemic and bleeding risk scores were generated from ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), a multicenter, international, "all-comers" registry that enrolled 8,665 patients treated with DES. The risk-benefit profile of 1-year vs ≤6-month DAPT was then investigated across risk strata from an individual patient data pooled dataset of 7 randomized trials that enrolled 15,083 patients treated with DES.Results: In the derivation cohort, the ischemic score and the bleeding score had c-indexes of 0.76 and 0.66, respectively, and both were well calibrated. In the pooled dataset, no significant difference was apparent in any ischemic endpoint between 1-year and ≤6-month DAPT, regardless of the risk strata. In the overall dataset, there was no significant difference in the risk of clinically relevant bleeding between 1-year and ≤6-month DAPT; however, among 2,508 patients at increased risk of bleeding, 1-year compared with ≤6-month DAPT was associated with greater bleeding (HR: 2.80; 95% CI: 1.12-7.13) without a reduced risk of ischemic events in any risk strata, including those with acute coronary syndromes. These results were consistent in a network meta-analysis.Conclusions: In the present large-scale study, compared with ≤6-month DAPT, a 1-year duration of DAPT was not associated with reduced adverse ischemic events in any risk strata (including acute coronary syndromes) but was associated with greater bleeding in patients at increased risk of bleeding. [ABSTRACT FROM AUTHOR]

• History-focused tasks and mathtasks prompt problematizing of mathematics and teaching. • Problematizing activities reshape teacher narratives about unknowns and variables. • Engaging teachers with primary sources generates narratives on mathematics as mutable. • Problematizing activities promote listening to students and innovative assessment. • Commognitive analyses can provide robust evaluation of longitudinal interventions. We explore the conjecture that engaging teachers with activities which feature mathematical practices from the past (history-focused tasks) and in today's mathematics classrooms (mathtasks) can promote teachers' problematizing of mathematics and its pedagogy. Here, we sample evidence of discursive shifts observed as twelve mathematics teachers engage with a set of problematizing activities (PA) – three rounds of history-focused and mathtask combinations – during a four–month postgraduate course. We trace how the commognitive conflicts orchestrated in the PA triggered changes in the teachers' narratives about: mathematical objects (such as what a function is); how mathematical objects come to be (such as what led to the emergence of the function object); and, pedagogy (such as what value may lie in listening to students or in trialing innovative assessment practices). Our study explores a hitherto under-researched capacity of the commognitive framework to steer the design, evidence identification and impact evaluation of pedagogical interventions. [ABSTRACT FROM AUTHOR]