Sample records for achieved stable disease

  1. Benefit from autologous stem cell transplantation in primary refractory myeloma? Different outcomes in progressive versus stable disease

    PubMed Central

    Rosiñol, Laura; García-Sanz, Ramón; Lahuerta, Juan José; Hernández-García, Miguel; Granell, Miquel; de la Rubia, Javier; Oriol, Albert; Hernández-Ruiz, Belén; Rayón, Consuelo; Navarro, Isabel; García-Ruiz, Juan Carlos; Besalduch, Joan; Gardella, Santiago; Jiménez, Javier López; Díaz-Mediavilla, Joaquín; Alegre, Adrián; Miguel, Jesús San; Bladé, Joan

    2012-01-01

    Background Several studies of autologous stem cell transplantation in primary refractory myeloma have produced encouraging results. However, the outcome of primary refractory patients with stable disease has not been analyzed separately from the outcome of patients with progressive disease. Design and Methods In the Spanish Myeloma Group 2000 trial, 80 patients with primary refractory myeloma (49 with stable disease and 31 with progressive disease), i.e. who were refractory to initial chemotherapy, were scheduled for tandem transplants (double autologous transplant or a single autologous transplant followed by an allogeneic transplant). Patients with primary refractory disease included those who never achieved a minimal response (≥25% M-protein decrease) or better. Responses were assessed using the European Bone Marrow Transplant criteria. Results There were no significant differences in the rates of partial response or better between patients with stable or progressive disease. However, 38% of the patients with stable disease at the time of transplantation remained in a stable condition or achieved a minimal response after transplantation versus 7% in the group with progressive disease (P=0.0017) and the rate of early progression after transplantation was significantly higher among the group with progressive disease at the time of transplantation (22% versus 2%; P=0.0043). After a median follow-up of 6.6 years, the median survival after first transplant of the whole series was 2.3 years. Progression-free and overall survival from the first transplant were shorter in patients with progressive disease (0.6 versus 2.3 years, P=0.00004 and 1.1 versus 6 years, P=0.00002, respectively). Conclusions Our results show that patients with progressive refractory myeloma do not benefit from autologous transplantation, while patients with stable disease have an outcome comparable to those with chemosensitive disease. (ClinicalTrials.gov:NCT00560053) PMID:22058223

  2. Randomized, Multicenter Study of Gefitinib Dose-escalation in Advanced Non-small-cell Lung Cancer Patients Achieved Stable Disease after One-month Gefitinib Treatment

    PubMed Central

    Xue, Cong; Hong, Shaodong; Li, Ning; Feng, Weineng; Jia, Jun; Peng, Jiewen; Lin, Daren; Cao, Xiaolong; Wang, Siyang; Zhang, Weimin; Zhang, Hongyu; Dong, Wei; Zhang, Li

    2015-01-01

    There is no consensus on the optimal treatment for patients with advanced non-small-cell lung cancer (NSCLC) and stable disease (SD) after gefitinib therapy. This randomized, open-label, multicenter study aimed to explore whether dose-escalation of gefitinib would improve response and survival in NSCLC patients who achieved SD after one-month of standard gefitinib dosage. Between May 2009 and January 2012, 466 patients were enrolled and 100 eligible patients were randomized (1:1) to receive either a higher dose (500 mg/d; H group) or to continue standard dose (250 mg/d; S group) of gefitinib. Objective response rate (ORR) was similar between the two groups (12.5% vs 12.5%, p = 1.000). There were no significant differences regarding progression-free survival (PFS) and overall survival (OS) between both arms (H group vs S group: median PFS, 5.30 months vs 6.23 months, p = 0.167; median OS, 13.70 months vs 18.87 months, p = 0.156). Therefore, dose-escalation of gefitinib does not confer a response or survival advantage in patients who achieve SD with one month of standard-dose gefitinib treatment. PMID:26216071

  3. Ivabradine in stable coronary artery disease without clinical heart failure.

    PubMed

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel; Tardif, Jean-Claude; Tendera, Michal; Ferrari, Roberto

    2014-09-18

    An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate-reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per minute or more. We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12,049 patients with activity-limiting angina [class ≥II on the Canadian Cardiovascular Society scale, which ranges from I to IV, with higher classes indicating greater limitations on physical activity owing to angina]). We randomly assigned patients to placebo or ivabradine, at a dose of up to 10 mg twice daily, with the dose adjusted to achieve a target heart rate of 55 to 60 beats per minute. The primary end point was a composite of death from cardiovascular causes or nonfatal myocardial infarction. At 3 months, the mean (±SD) heart rate of the patients was 60.7±9.0 beats per minute in the ivabradine group versus 70.6±10.1 beats per minute in the placebo group. After a median follow-up of 27.8 months, there was no significant difference between the ivabradine group and the placebo group in the incidence of the primary end point (6.8% and 6.4%, respectively; hazard ratio, 1.08; 95% confidence interval, 0.96 to 1.20; P=0.20), nor were there significant differences in the incidences of death from cardiovascular causes and nonfatal myocardial infarction. Ivabradine was associated with an increase in the incidence of the primary end point among patients with activity-limiting angina but not among those without activity-limiting angina (P=0.02 for interaction). The incidence of bradycardia was higher with ivabradine than with placebo (18.0% vs. 2.3%, P<0.001). Among patients who had stable coronary

  4. Clinical presentation and management of stable coronary artery disease in Austria.

    PubMed

    Pichlhöfer, Otto; Maier, Manfred; Badr-Eslam, Roza; Ristl, Robin; Zebrowska, Magdalena; Lang, Irene M

    2017-01-01

    Cardiovascular disease is the main cause of death in Austria. However, no systematic information exists regarding characteristics and treatments of contemporary patients with stable coronary artery disease (CAD) in Austria. We assembled two retrospective physicians' databases to describe demographics, clinical profiles, and therapeutic strategies in patients with stable CAD. In addition, we compared patient profiles of secondary care internists and hospital-based cardiologists with those of general practitioners in a primary care setting outside of hospital. The study population was identified from retrospective chart review of 1020 patients from 106 primary care physicians in Austria (ProCor II registry), and was merged with a previous similar database of 1280 patients under secondary care (ProCor I registry) to yield a total patient number of 2300. Female patients with stable CAD were older, had more angina and/or heart failure symptoms, and more depression than males. Female gender, type 2 diabetes mellitus, higher CCS class and asthma/COPD were predictors of elevated heart rate, while previous coronary events/revascularization predicted a lower heart rate in multivariate analysis. There were no significant differences with regard to characteristics and management of patients of general practitioners in the primary care setting versus internists in secondary care. Characteristics and treatments of unselected patients with stable ischemic heart disease in Austria resemble the pattern of large international registries of stable ischemic heart disease, with the exception that diabetes and systemic hypertension were more prevalent.

  5. Effects of Trimetazidine on T Wave Alternans in Stable Coronary Artery Disease

    PubMed Central

    Yaman, Mehmet; Gümrükçüoğlu, Hasan Ali; Şahin, Musa; Şimşek, Hakkı; Akdağ, Serkan

    2016-01-01

    Background and Objectives Studies reveal that the microvolt T wave alternans (MTWA) test has a high negative predictive value for arrhythmic mortality among patients with ischemic or non-ischemic cardiomyopathy. In this study, we investigate the effects of trimetazidine treatment on MTWA and several echocardiographic parameters in patients with stable coronary artery disease. Subjects and Methods One hundred patients (23 females, mean age 55.6±9.2 years) with stable ischemic heart disease were included in the study group. Twenty-five age- and sex-matched patients with stable coronary artery disease formed the control group. All patients were stable with medical treatment, and had no active complaints. Trimetazidine, 60 mg/day, was added to their current treatment for a minimum three months in the study group and the control group received no additional treatment. Pre- and post-treatment MTWA values were measured by 24 hour Holter testing. Left ventricular systolic and diastolic functions were assessed by echocardiography. Results After trimetazidine treatment, several echocardiographic parameters related with diastolic dysfunction significantly improved. MTWA has been found to be significantly improved after trimethazidine treatment (63±8 μV vs. 53±7 μV, p<0.001). Abnormal MTWA was present in 29 and 11 patients pre- and post-treatment, respectively (p< 0.001). Conclusion Trimetazidine improves MTWA, a non-invasive determinant of electrical instability. Moreover, several echocardiographic parameters related with left ventricular functions also improved. Thus, we can conclude that trimetazidine may be an effective agent to prevent arrhythmic complications and improve myocardial functions in patients with stable coronary artery disease. PMID:27275171

  6. Warfarin compared with aspirin for older Chinese patients with stable coronary heart diseases and atrial fibrillation complications.

    PubMed

    Liu, Xinbing; Huang, Hongman; Yu, Jianhua; Cao, Guoliang; Feng, Liuliu; Xu, Qitan; Zhang, Shufu; Zhou, Mingcheng; Li, Yigang

    2014-06-01

    To compare the therapeutic warfarin and aspirin efficacies for treatments of atrial fibrillation (AF) complicated with stable coronary heart disease particularly in older Chinese patients. In our prospective study 101 patients with AF and stable coronary heart disease older than 80 years were randomized into two groups. One group (n = 51) basically received 1.25 mg/day warfarin per os, followed by addition of 0.5 - 1.0 mg/day from day 3 - 5 if the international normalized ratio (INR) was initially < 1.5 and in order to achieve a maintained INR between 1.6 and 2.5 (warfarin group). The second group (n = 50) received 100 mg aspirin per day (control group). All patients were medicated and monitored for a period of 2 years. The primary endpoint was the occurrence of ischemic stroke or systemic embolism, and the composite secondary endpoint was non-fatal myocardial infarction and all causes of death. For safety evaluation, the hemorrhage rates were recorded. The warfarin medication was superior regarding the overall occurrence of ischemic stroke or systemic embolism as well as non-fatal myocardial infarction and all causes of death outcomes compared to aspirin administration during the 2 years of medication (17.6% vs. 36.0%, p = 0.03), while there was no significant difference of mild (5 vs. 4), severe (2 vs. 1), and fatal (1 vs. 1) hemorrhage incidences between the warfarin and aspirin groups (p > 0.05). Warfarin was found to be more efficacious than aspirin for an anticoagulation therapy of older Chinese patients with AF and stable coronary heart disease.

  7. Fractional flow reserve-guided management in stable coronary disease and acute myocardial infarction: recent developments

    PubMed Central

    Berry, Colin; Corcoran, David; Hennigan, Barry; Watkins, Stuart; Layland, Jamie; Oldroyd, Keith G.

    2015-01-01

    Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, and improvements in the diagnosis and treatment of CAD can reduce the health and economic burden of this condition. Fractional flow reserve (FFR) is an evidence-based diagnostic test of the physiological significance of a coronary artery stenosis. Fractional flow reserve is a pressure-derived index of the maximal achievable myocardial blood flow in the presence of an epicardial coronary stenosis as a ratio to maximum achievable flow if that artery were normal. When compared with standard angiography-guided management, FFR disclosure is impactful on the decision for revascularization and clinical outcomes. In this article, we review recent developments with FFR in patients with stable CAD and recent myocardial infarction. Specifically, we review novel developments in our understanding of CAD pathophysiology, diagnostic applications, prognostic studies, clinical trials, and clinical guidelines. PMID:26038588

  8. Stable ischemic heart disease in women: current perspectives.

    PubMed

    Samad, Fatima; Agarwal, Anushree; Samad, Zainab

    2017-01-01

    Cardiovascular disease is the leading cause of death in women accounting for 1 in every 4 female deaths. Pathophysiology of ischemic heart disease in women includes epicardial coronary artery, endothelial dysfunction, coronary vasospasm, plaque erosion and spontaneous coronary artery dissection. Angina is the most common presentation of stable ischemic heart disease (SIHD) in women. Risk factors for SIHD include traditional risks such as older age, obesity (body mass index [BMI] >25 kg/m 2 ), smoking, hypertension, dyslipidemia, cerebrovascular and peripheral vascular disease, sedentary lifestyle, family history of premature coronary artery disease, metabolic syndrome and diabetes mellitus, and nontraditional risk factors, such as gestational diabetes, insulin resistance/polycystic ovarian disease, pregnancy-induced hypertension, pre-eclampsia, eclampsia, menopause, mental stress and autoimmune diseases. Diagnostic testing can be used effectively to risk stratify women. Guidelines-directed medical therapy including aspirin, statins, beta-blocker therapy, calcium channel blockers and ranolazine should be instituted for symptom and ischemia management. Despite robust evidence regarding the adverse outcomes seen in women with ischemic heart disease, knowledge gaps exist in several areas. Future research needs to be directed toward a greater understanding of the role of nontraditional risk factors for SIHD in women, gaining deeper insights into the sex differences in therapeutic effects and formulating a sex-specific algorithm for the management of SIHD in women.

  9. Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients.

    PubMed

    Planas, Mercé; Alvarez, J; García-Peris, P A; de la Cuerda, C; de Lucas, P; Castellà, M; Canseco, F; Reyes, L

    2005-06-01

    Nutritional depletion is a common problem in chronic obstructive pulmonary disease (COPD) patients. It is caused, to a large extent, by an imbalance between low-energy intake and high-energy requirements. This problem adversely affects morbidity and mortality. However, the use of nutritional supplements to reach their energy necessities requires optimisation between positive and adverse effects on outcome before being used systematically as part of their comprehensive care. The aim of our study was to investigate the effects of oral nutritional repletion on quality of life in stable COPD patients. Prospective, randomised and multi-centre study. Stable COPD patients with a body mass index 22, a fat-free mass index 16, and/or a recent involuntary weight loss (5% during last month, or 10% during the last 3 months) were studied. Exclusion criteria were to present signs of an airway infection, to have a cardiovascular, neurological, or endocrine disease, to be treated with oral steroids, immunosuppressors or oxygen therapy at home, and to receive nutritional supplements. During 12 weeks, patients were encouraged to ingest a total daily defined energy intake. Randomly, in patients from group A the total daily energy load was Resting Energy Expenditure (REE)x1.7, and those from group B, REE x1.3. Total daily energy intake was achieved with regular food plus, if necessary, oral nutritional supplement rich in proteins (with 50% of whey protein), with predominance of carbohydrates over fat, and enriched in antioxidants. Primary end-point variable was quality of life. Secondary end-point outcomes included body weight, body composition, lung function, handgrip strength, and compliance with the energy intake previously planned. Data were treated with a SAS System. Student's test, Wilcoxon's rank sum test, and Mann-Whitney's test were used. At baseline both groups of patients were comparable. All patients needed oral nutritional supplements to achieve total daily defined energy

  10. Anammox-zeolite system acting as buffer to achieve stable effluent nitrogen values.

    PubMed

    Yapsakli, Kozet; Aktan, Cigdem Kalkan; Mertoglu, Bulent

    2017-02-01

    For a successful nitrogen removal, Anammox process needs to be established in line with a stable partial nitritation pretreatment unit since wastewater influent is mostly unsuitable for direct treatment by Anammox. Partial nitritation is, however, a critical bottleneck for the nitrogen removal since it is often difficult to maintain the right proportions of NO 2 -N and NH 4 -N during long periods of time for Anammox process. This study investigated the potential of Anammox-zeolite biofilter to buffer inequalities in nitrite and ammonium nitrogen in the influent feed. Anammox-zeolite biofilter combines the ion-exchange property of zeolite with the biological removal by Anammox process. Continuous-flow biofilter was operated for 570 days to test the response of Anammox-zeolite system for irregular ammonium and nitrite nitrogen entries. The reactor demonstrated stable and high nitrogen removal efficiencies (approximately 95 %) even when the influent NO 2 -N to NH 4 -N ratios were far from the stoichiometric ratio for Anammox reaction (i.e. NO 2 -N to NH 4 -N ranging from 0 to infinity). This is achieved by the sorption of surplus NH 4 -N by zeolite particles in case ammonium rich influent came in excess with respect to Anammox stoichiometry. Similarly, when ammonium-poor influent is fed to the reactor, ammonium desorption took place due to shifts in ion-exchange equilibrium and deficient amount were supplied by previously sorbed NH 4 -N. Here, zeolite acted as a preserving reservoir of ammonium where both sorption and desorption took place when needed and this caused the Anammox-zeolite system to act as a buffer system to generate a stable effluent.

  11. Reexamining the Efficacy and Value of Percutaneous Coronary Intervention for Patients With Stable Ischemic Heart Disease

    PubMed Central

    Weintraub, William S.; Boden, William E.

    2017-01-01

    Percutaneous coronary intervention (PCI) continues to be performed frequently for patients with stable ischemic heart disease, despite uncertain efficacy. Individual randomized trial data and meta-analyses have not demonstrated that PCI in addition to optimal medical therapy reduces the incidence of death or myocardial infarction in patients with stable disease. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial did not show benefit for cardiovascular outcomes or mortality but did find a modest improvement in quality of life that did not persist at 3 years. Long-term follow-up from COURAGE (up to 15 years) found no differences in mortality, consistent with other published literature. How PCI could reduce long-term mortality or prevent myocardial infarction is not clear because sites of future plaque rupture leading to myocardial infarction are unpredictable and PCI can only treat localized anatomic segments of obstructive atherosclerosis. In addition, PCI is expensive, and the value to society of PCI for stable disease has not been demonstrated. The ISCHEMIA trial will assess the role of PCI for stable ischemic heart disease using newer technology and in patients with greater ischemic burden than in COURAGE. After nearly a decade, the COURAGE trial and other studies have given us pause to critically reexamine the role of PCI for patients with stable ischemic heart disease. Until further research can show that PCI can reduce cardiovascular events in these patients, a first-line strategy of optimal medical therapy is known to be safe, effective, and noninferior to PCI, and our practice should more closely follow this strategy. PMID:27380178

  12. [Role of serum leptin in the severity of coronary artery disease in patients with stable angina].

    PubMed

    Jerez-Valero, Miguel; Meliveo-García, Ana; Jordán-Martínez, Laura; Carrasco-Chinchilla, Fernando; Moreno-Santos, Inmaculada; Ordóñez, Antonio; Sánchez-Fernández, Pedro L; Vázquez, Rafael; Hernández-García, José M; Gómez-Doblas, Juan J; Pérez-Belmonte, Luis M; de Teresa-Galván, Eduardo; Jiménez-Navarro, Manuel

    2016-07-01

    Leptin is a plasmatic peptide hormone that has been related to cardiovascular homeostasis and atherosclerosis but much is still unknown about its relationship with coronary artery disease. The aim of this study was to evaluate the value of serum leptin in patients with stable angina and its relationship with the severity of coronary disease. 204 patients, 152 with stable angina (coronary artery disease group) and 52 without coronary disease excluded by cardiac computerized tomography (control group) were included. The coronary artery disease group was divided into 2 subgroups according to severity of coronary disease (single or multivessel disease, 46 and 106 patients, respectively). Serum leptin levels were determined by Enzyme-Linked InmunoSorbent Assay. Leptin levels were significantly higher in patients with multivessel disease and were independently associated with a greater severity of coronary artery disease when compared with controls (OR 1.14; 95%CI: 1.03-1.27; p=0.014) and with patients with single vessel disease (OR 1.12; 95%CI: 1.01-1.25; p=0.036). Serum leptin was tested as a diagnostic marker of multivessel disease with an area under the curve obtained from Receiver Operating Characteristics of 0.6764 (95%CI 0.5765-0.7657). Serum leptin levels were associated in patients with stable angina with the severity of coronary artery disease, suggesting its value in the development of coronary disease and as a future therapeutic target. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  13. Management of outpatients in France with stable coronary artery disease. Findings from the prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) registry.

    PubMed

    Danchin, Nicolas; Ferrieres, Jean; Guenoun, Maxime; Cattan, Simon; Rushton-Smith, Sophie K; Greenlaw, Nicola; Ferrari, Roberto; Steg, Philippe Gabriel

    2014-01-01

    Improvements in the treatment of coronary artery disease mean that an increasing number of patients survive acute cardiovascular events and live as outpatients with or without anginal symptoms. To determine the characteristics and management of contemporary outpatients with stable coronary artery disease in Western Europe, and to compare France with the other Western European countries. CLARIFY (prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an international, prospective, observational, longitudinal study. Between November 2009 and July 2010, 32,954 adult outpatients with stable coronary artery disease (defined as a history of documented myocardial infarction [of >3 months], prior coronary revascularization, chest pain with myocardial ischaemia, or coronary stenosis of>50% proven by angiography) were enrolled in 45 countries. The demographics and management of CLARIFY patients enrolled in France were compared with those enrolled in other Western European countries (Austria, Belgium, Denmark, Germany, Greece, Ireland, Italy, Netherlands, Portugal, Spain, Switzerland and the UK). Of the 14,726 patients enrolled in Western Europe (mean age 66.2 [10.2] years; 79.6% male), 2432 (16.5%) were from France. The use of aspirin was lower in France than in other Western European countries (74.5% vs. 86.9%, respectively), whereas use of thienopyridines (48.5% vs. 21.7%), oral anticoagulants (12.3% vs. 9.0%) and lipid-lowering drugs (95.8% vs. 92.5%) was higher. Beta-blockers were used in 73% of both groups. Angina was less prevalent in France (6.3% vs. 15.5%) and French patients showed higher levels of physical activity than their counterparts in Western Europe. The management of patients with stable CAD in France appears favourable, with good adherence to guideline-based therapies, but there remains room for improvement in terms of symptom and risk factor control. Copyright © 2014. Published by Elsevier Masson SAS.

  14. Atrial fibrillation management, outcomes and predictors of stable disease in daily practice: prospective non-interventional study.

    PubMed

    Bosch, Ralph F; Kirch, Wilhelm; Theuer, Juergen-Detlef; Pittrow, David; Kohlhaußen, Annette; Willich, Stefan N; Bonnemeier, Hendrik

    2013-08-10

    We aimed to describe the current management of patients with atrial fibrillation (AF) by cardiologists, and to identify predicting factors for a stable disease course. 2753 consecutive patients with ECG-confirmed AF in the previous 12 months were documented in a 1-year observational (non-interventional) study from 616 centers. Stable disease was defined as having neither AF related intervention nor change in antiarrhythmic therapy in the previous 12 months. Stepwise selection of parameters for multivariate regression was used to identify factors for stable AF. At baseline, paroxysmal AF was reported in 33.5%, persistent in 26.7%, and permanent in 39.7%; rate control alone was the prevailing antiarrhythmic strategy (64.2%). Drugs for thromboembolic prevention were administered in 93.8%, with a clear predominance of oral anticoagulants (OAC), alone or in combination with antiplatelet drugs. Electrical or pharmacological conversions were reported in 23.6%. A total of 96 (3.5%) patients in the total cohort experienced stroke, 72 patients (2.6%) TIA, and 24 (0.9%) arterial embolism. 26% were hospitalized during follow-up (0.4 events per patient), and 9.4% developed incident heart failure (42% prevalence at follow-up). The rate of stable patients was 43.4%. In the multivariate model male gender, history of stroke, and permanent (vs. persistent) AF were associated with stable disease. Conversely, the factors chronic heart failure, impaired left ventricular function, rhythm-control (vs. other), OAC and antiplatelet therapy were significantly correlated with unstable disease. The relatively low proportion of stable patients and in particular, the high hospitalization and stroke rate indicate difficulties in everyday management of patients with AF. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II.

    PubMed

    Gitt, Anselm K; Lautsch, Dominik; Ferrières, Jean; De Ferrari, Gaetano M; Vyas, Ami; Baxter, Carl A; Bash, Lori D; Ashton, Veronica; Horack, Martin; Almahmeed, Wael; Chiang, Fu-Tien; Poh, Kian Keong; Brudi, Philippe; Ambegaonkar, Baishali

    2017-11-01

    Low-density lipoprotein cholesterol (LDL-C) is a major contributor to cardiovascular disease. In the Dyslipidemia International Study II (DYSIS II), we determined LDL-C target value attainment, use of lipid-lowering therapy (LLT), and cardiovascular outcomes in patients with stable coronary heart disease (CHD) and those suffering from an acute coronary syndrome (ACS). DYSIS II included patients from 18 countries. Patients with either stable CHD or an ACS were enrolled if they were ≥18 years old and had a full lipid profile available. Data were collected at a physician visit (CHD cohort) or at hospital admission and 120 days later (ACS cohort). A total of 10,661 patients were enrolled, 6794 with stable CHD and 3867 with an ACS. Mean LDL-C levels were low at 88 mg/dl and 108 mg/dl for the CHD and ACS cohorts respectively, with only 29.4% and 18.9% displaying a level below 70 mg/dl. LLT was utilized by 93.8% of the CHD cohort, with a mean daily statin dosage of 25 ± 18 mg. The proportion of the ACS cohort treated with LLT rose from 65.2% at admission to 95.6% at follow-up. LLT-treated patients, who were female, obese, or current smokers, were less likely to achieve an LDL-C level of <70 mg/dl, while those with type 2 diabetes, chronic kidney disease, or those taking a higher statin dosage were more likely. Few of these very high-risk patients achieved the LDL-C target, indicating huge potential for improving cardiovascular outcome by use of more intensive LLT. Copyright © 2017. Published by Elsevier B.V.

  16. Management standards for stable coronary artery disease in India.

    PubMed

    Mishra, Sundeep; Ray, Saumitra; Dalal, Jamshed J; Sawhney, J P S; Ramakrishnan, S; Nair, Tiny; Iyengar, S S; Bahl, V K

    2016-12-01

    Coronary artery disease (CAD) is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD) is characterised by episodes of transient central chest pain (angina pectoris), often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS) is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella. Copyright © 2016. Published by Elsevier B.V.

  17. Effects of Arnica comp.-Heel® on reducing cardiovascular events in patients with stable coronary disease.

    PubMed

    Fioranelli, Massimo; Bianchi, Maria; Roccia, Maria G; Di Nardo, Veronica

    2016-02-01

    The purpose of the study was to evaluate the effectiveness of the treatment with one tablet a day of a low dose multicomponent medication (Arnica comp.-Heel® tablets) with anti-inflammatory properties in order to reduce the risk of cardiovascular events in patients with clinically stable coronary disease. The presence of inflammatory cells in atherosclerotic plaques of patients with stable coronary disease indicates the possibility to act by inhibiting the inflammatory phenomenon with Arnica comp.-Heel® tablets reducing the risk of instability of the plaque and, consequently, improving the clinical outcome in patients with stable coronary disease. Within this retrospective observational spontaneous clinical study 44 patients (31 males and 13 females) all presenting stable coronary artery disease were evaluated; 25 subjects were treated with only acetylsalicylic acid and/or clopidogrel in association with statins (standard therapeutic protocol) while for the other 18 subjects the standard therapeutic protocol was integrated with Arnica comp.-Heel® (one sublingual tablet/day). The primary outcome was to evaluate the incidence of acute coronary syndrome, out-of-hospital cardiac arrest, or non-cardioembolic ischemic stroke. The evaluation of the primary outcome showed that in the group of patients (18) who received the standard therapeutic protocol plus Arnica comp.-Heel® only one cardiovascular event was registered (5.6%) while in the group treated only with standard therapy 4 events were recorded in 25 patients (16%). The treatment with Arnica comp.-Heel® (one tablet/day) in combination with standard therapies for secondary prevention is effective in reducing the incidence of cardiovascular events in patients with stable coronary artery disease.

  18. Physical Activity and Mortality in Patients With Stable Coronary Heart Disease.

    PubMed

    Stewart, Ralph A H; Held, Claes; Hadziosmanovic, Nermin; Armstrong, Paul W; Cannon, Christopher P; Granger, Christopher B; Hagström, Emil; Hochman, Judith S; Koenig, Wolfgang; Lonn, Eva; Nicolau, José C; Steg, Philippe Gabriel; Vedin, Ola; Wallentin, Lars; White, Harvey D

    2017-10-03

    Recommendations for physical activity in patients with stable coronary heart disease (CHD) are based on modest evidence. The authors analyzed the association between self-reported exercise and mortality in patients with stable CHD. A total of 15,486 patients from 39 countries with stable CHD who participated in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) study completed questions at baseline on hours spent each week taking mild, moderate, and vigorous exercise. Associations between the volume of habitual exercise in metabolic equivalents of task hours/week and adverse outcomes during a median follow-up of 3.7 years were evaluated. A graded decrease in mortality occurred with increased habitual exercise that was steeper at lower compared with higher exercise levels. Doubling exercise volume was associated with lower all-cause mortality (unadjusted hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.79 to 0.85; adjusting for covariates, HR: 0.90; 95% CI: 0.87 to 0.93). These associations were similar for cardiovascular mortality (unadjusted HR: 0.83; 95% CI: 0.80 to 0.87; adjusted HR: 0.92; 95% CI: 0.88 to 0.96), but myocardial infarction and stroke were not associated with exercise volume after adjusting for covariates. The association between decrease in mortality and greater physical activity was stronger in the subgroup of patients at higher risk estimated by the ABC-CHD (Age, Biomarkers, Clinical-Coronary Heart Disease) risk score (p for interaction = 0.0007). In patients with stable CHD, more physical activity was associated with lower mortality. The largest benefits occurred between sedentary patient groups and between those with the highest mortality risk. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Darapladib for preventing ischemic events in stable coronary heart disease.

    PubMed

    White, Harvey D; Held, Claes; Stewart, Ralph; Tarka, Elizabeth; Brown, Rebekkah; Davies, Richard Y; Budaj, Andrzej; Harrington, Robert A; Steg, P Gabriel; Ardissino, Diego; Armstrong, Paul W; Avezum, Alvaro; Aylward, Philip E; Bryce, Alfonso; Chen, Hong; Chen, Ming-Fong; Corbalan, Ramon; Dalby, Anthony J; Danchin, Nicolas; De Winter, Robbert J; Denchev, Stefan; Diaz, Rafael; Elisaf, Moses; Flather, Marcus D; Goudev, Assen R; Granger, Christopher B; Grinfeld, Liliana; Hochman, Judith S; Husted, Steen; Kim, Hyo-Soo; Koenig, Wolfgang; Linhart, Ales; Lonn, Eva; López-Sendón, José; Manolis, Athanasios J; Mohler, Emile R; Nicolau, José C; Pais, Prem; Parkhomenko, Alexander; Pedersen, Terje R; Pella, Daniel; Ramos-Corrales, Marco A; Ruda, Mikhail; Sereg, Mátyás; Siddique, Saulat; Sinnaeve, Peter; Smith, Peter; Sritara, Piyamitr; Swart, Henk P; Sy, Rody G; Teramoto, Tamio; Tse, Hung-Fat; Watson, David; Weaver, W Douglas; Weiss, Robert; Viigimaa, Margus; Vinereanu, Dragos; Zhu, Junren; Cannon, Christopher P; Wallentin, Lars

    2014-05-01

    Elevated lipoprotein-associated phospholipase A2 activity promotes the development of vulnerable atherosclerotic plaques, and elevated plasma levels of this enzyme are associated with an increased risk of coronary events. Darapladib is a selective oral inhibitor of lipoprotein-associated phospholipase A2. In a double-blind trial, we randomly assigned 15,828 patients with stable coronary heart disease to receive either once-daily darapladib (at a dose of 160 mg) or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the components of the primary end point as well as major coronary events (death from coronary heart disease, myocardial infarction, or urgent coronary revascularization for myocardial ischemia) and total coronary events (death from coronary heart disease, myocardial infarction, hospitalization for unstable angina, or any coronary revascularization). During a median follow-up period of 3.7 years, the primary end point occurred in 769 of 7924 patients (9.7%) in the darapladib group and 819 of 7904 patients (10.4%) in the placebo group (hazard ratio in the darapladib group, 0.94; 95% confidence interval [CI], 0.85 to 1.03; P=0.20). There were also no significant between-group differences in the rates of the individual components of the primary end point or in all-cause mortality. Darapladib, as compared with placebo, reduced the rate of major coronary events (9.3% vs. 10.3%; hazard ratio, 0.90; 95% CI, 0.82 to 1.00; P=0.045) and total coronary events (14.6% vs. 16.1%; hazard ratio, 0.91; 95% CI, 0.84 to 0.98; P=0.02). In patients with stable coronary heart disease, darapladib did not significantly reduce the risk of the primary composite end point of cardiovascular death, myocardial infarction, or stroke. (Funded by GlaxoSmithKline; STABILITY ClinicalTrials.gov number, NCT00799903.).

  20. Change in blood antioxidant status of horses moved from a stable following diagnosis of equine motor neuron disease

    PubMed Central

    Delguste, Catherine; de Moffarts, Brieuc; Kirschvink, Nathalie; Art, Tatiana; Pincemail, Joël; Defraigne, Jean-Olivier; Amory, Hélène; Lekeux, Pierre

    2007-01-01

    The antioxidant status of 10 horses living in stable 1 where 2 cases of equine motor neuron disease had previously been diagnosed was assessed before and 9 weeks after moving to another stable. Duration of residence in stable 1, subsequent moving, or both, significantly affected several parameters of the antioxidant status. PMID:18050798

  1. Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease.

    PubMed

    Rothberg, Michael B; Sivalingam, Senthil K; Kleppel, Reva; Schweiger, Marc; Hu, Bo; Sepucha, Karen R

    2015-07-01

    Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI. To assess the quality of informed decision making and its association with patient decisions. We performed a cross-sectional analysis of recorded conversations between August 1, 2008, and August 31, 2012, among adults with known or suspected stable coronary disease at outpatient cardiology practices. Presence of 7 elements of informed decision making and the decision to undergo angiography and possible PCI. Of 59 conversations conducted by 23 cardiologists, 2 (3%) included all 7 elements of informed decision making; 8 (14%) met a more limited definition of procedure, alternatives, and risks. Specific elements significantly associated with not choosing angiography and possible PCI included discussion of uncertainty (odds ratio [OR], 20.5; 95% CI, 2.3-204.9), patient's role (OR, 5.3; 95% CI, 1.3-21.3), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5), and exploration of patient preference (OR, 4.8; 95% CI, 1.2-19.4). Neither the presence of angina nor severity of symptoms was associated with choosing angiography and possible PCI. In a multivariable analysis using the total number of elements as a predictor, better informed patients were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005). In conversations between cardiologists and patients with stable angina, informed decision making is often incomplete. More complete discussions are associated with patients choosing not to undergo angiography and possible PCI.

  2. Evolving biomarkers improve prediction of long-term mortality in patients with stable coronary artery disease: the BIO-VILCAD score.

    PubMed

    Kleber, M E; Goliasch, G; Grammer, T B; Pilz, S; Tomaschitz, A; Silbernagel, G; Maurer, G; März, W; Niessner, A

    2014-08-01

    Algorithms to predict the future long-term risk of patients with stable coronary artery disease (CAD) are rare. The VIenna and Ludwigshafen CAD (VILCAD) risk score was one of the first scores specifically tailored for this clinically important patient population. The aim of this study was to refine risk prediction in stable CAD creating a new prediction model encompassing various pathophysiological pathways. Therefore, we assessed the predictive power of 135 novel biomarkers for long-term mortality in patients with stable CAD. We included 1275 patients with stable CAD from the LUdwigshafen RIsk and Cardiovascular health study with a median follow-up of 9.8 years to investigate whether the predictive power of the VILCAD score could be improved by the addition of novel biomarkers. Additional biomarkers were selected in a bootstrapping procedure based on Cox regression to determine the most informative predictors of mortality. The final multivariable model encompassed nine clinical and biochemical markers: age, sex, left ventricular ejection fraction (LVEF), heart rate, N-terminal pro-brain natriuretic peptide, cystatin C, renin, 25OH-vitamin D3 and haemoglobin A1c. The extended VILCAD biomarker score achieved a significantly improved C-statistic (0.78 vs. 0.73; P = 0.035) and net reclassification index (14.9%; P < 0.001) compared to the original VILCAD score. Omitting LVEF, which might not be readily measureable in clinical practice, slightly reduced the accuracy of the new BIO-VILCAD score but still significantly improved risk classification (net reclassification improvement 12.5%; P < 0.001). The VILCAD biomarker score based on routine parameters complemented by novel biomarkers outperforms previous risk algorithms and allows more accurate classification of patients with stable CAD, enabling physicians to choose more personalized treatment regimens for their patients.

  3. Updates in the management of stable chronic obstructive pulmonary disease.

    PubMed

    Narsingam, Saiprasad; Bozarth, Andrew L; Abdeljalil, Asem

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory process. It is increasingly recognized as a major public health problem, affecting more than 20 million adults in the US. It is also recognized as a leading cause of hospitalizations and is the fourth leading cause of death in the US. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) operates to promote evidence-based management of COPD, increase awareness and encourage research. In 2011, GOLD published a consensus report detailing evidence-based management strategies for COPD, which were last updated in 2015. In recent years, newer strategies and a growing number of new pharmacologic agents to treat symptoms of COPD have also been introduced and show promise in improving the management of COPD. We aim to provide an evidence-based review of the available and upcoming pharmacologic and non-pharmacologic treatment options for stable COPD, with continued emphasis on evidence-based management.

  4. Predictors of Academic Achievement for School Age Children with Sickle Cell Disease.

    PubMed

    Smith, Kelsey E; Patterson, Chavis A; Szabo, Margo M; Tarazi, Reem A; Barakat, Lamia P

    2013-01-01

    Children with sickle cell disease (SCD) are at risk for neurocognitive impairment and poor academic achievement, although there is limited research on factors predicting academic achievement in this population. This study explores the relative contribution to academic achievement of a comprehensive set of factors, such as environmental (socioeconomic status), disease-related (stroke, transfusion therapy, adherence), and psychosocial variables (child behavior, child quality of life (QoL)), controlling for intellectual functioning (IQ). Eighty-two children with SCD completed measures assessing IQ and academic achievement, while parents completed questionnaires assessing adherence, child behavior, and child quality of life. Medical chart reviews were conducted to determine disease-related factors. Hierarchical regression analyses indicated that 55% of the variance in academic skills was accounted for by IQ, parent education, chronic transfusion status, and QoL [ R 2 = .55, F (5, 77) = 18.34, p < .01]. Follow-up analyses for broad reading [ R 2 = .52, F (5, 77) = 16.37, p < .01], and math calculation [ R 2 = .44, F (5, 77) = 12.14, p < .01] were also significant. The findings suggest a significant contribution of factors beyond IQ to academic achievement. Findings allow for identification of children with SCD at risk for academic difficulties for whom psychoeducational interventions may enhance academic achievement.

  5. ACHIEVEMENTS IN THE STRUGGLE AGAINST INFECTIOUS DISEASES IN THE AZERBAIDZHAN SSR,

    DTIC Science & Technology

    Great achievements have been made in controlling such diseases as malaria, exanthemous, and recurrent typhus, dysentery, typhoid fever, whooping ... cough , and many childhood diseases such as diphtheria, scarlet fever, and measles. The success is attributed to a system of sanitary-epidemiological

  6. Predictors of Academic Achievement for School-Age Children with Sickle Cell Disease

    ERIC Educational Resources Information Center

    Smith, Kelsey E.; Patterson, Chavis A.; Szabo, Margo M.; Tarazi, Reem A.; Barakat, Lamia P.

    2013-01-01

    Children with sickle cell disease (SCD) are at risk for neurocognitive impairment and poor academic achievement, although there is limited research on factors predicting academic achievement in this population. This study explores the relative contribution to academic achievement of a comprehensive set of factors, such as environmental…

  7. Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients.

    PubMed

    Kalra, Paul R; García-Moll, Xavier; Zamorano, José; Kalra, Philip A; Fox, Kim M; Ford, Ian; Ferrari, Roberto; Tardif, Jean-Claude; Tendera, Michal; Greenlaw, Nicola; Steg, Ph Gabriel

    2014-01-01

    To assess the frequency of chronic kidney disease (CKD), define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease. 22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY) were included. Baseline estimated glomerular filtration rate (eGFR) was calculated (CKD-Epidemiology Collaboration formula) and patients categorised according to CKD stage: >89, 60-89, 45-59 and <45 mL/min/1.73 m2. Mean (SD) age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2) was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2); lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers). The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall) and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR. Chronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently in

  8. Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes.

    PubMed

    Mohandas, Padma; Bewley, Anthony; Taylor, Ruth

    2018-03-01

    In recent years, there has been a reported increase in affliction of the skin with small fibres or other particles. The condition has been referred to as Morgellons disease. Patients present with stinging, burning or crawling sensations of the skin, with perceived extrusion of inanimate material alongside fatigue and other systemic symptoms. Sufferers often experience significant morbidity and reduction in quality of life. We aimed to explore the various clinical presentations, management strategies and outcomes employed to treat this condition in our patients. We conducted a retrospective case notes review of 35 patients referred to our multidisciplinary psycho-dermatology clinic at the Royal London Hospital between January 2004 and January 2017. The majority of patients were women (25) 71.4%, with a mean age of 54.6 years (26-80 years). Most (26) 74.2% were living alone. The average duration of illness prior to presentation was 3.8 years (4 months-20 years). Many patients had perceived precipitating factors (54.2%) and often self-diagnosed (28.5%). Psychiatric co-morbidities included 42.8% with depressive symptoms and 25.7% with anxiety. Substance misuse was elicited in five patients (14%). Management of patients included both the treatment of skin disease and psychosocial co-morbidities. Out of the 35 patients who attended (14) 40% cleared or showed significant improvement. Sixteen (45.7%) patients were stable and under review. One patient declined treatment and three did not attend review. One patient died from disease unrelated to her skin condition. Morgellons disease is a condition, which is widely discussed on the internet and patients often self-diagnose. The course of the disease can be chronic and debilitating. For a positive outcome, it is important that a strong physican-patient relationship is cultivated. As demonstrated in this case series, managing patients holistically in an integrated multidisciplinary dermatology setting helps achieve

  9. Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes.

    PubMed

    Everett, Brendan M; Brooks, Maria Mori; Vlachos, Helen E A; Chaitman, Bernard R; Frye, Robert L; Bhatt, Deepak L

    2015-08-13

    Cardiac troponin concentrations are used to identify patients who would benefit from urgent revascularization for acute coronary syndromes. We hypothesized that they might be used in patients with stable ischemic heart disease to identify those at high risk for cardiovascular events who might also benefit from prompt coronary revascularization. We measured the cardiac troponin T concentration at baseline with a high-sensitivity assay in 2285 patients who had both type 2 diabetes and stable ischemic heart disease and were enrolled in the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes trial. We tested for an association between the troponin T concentration and a composite end point of death from cardiovascular causes, myocardial infarction, or stroke; we then evaluated whether random assignment to prompt revascularization reduced the rate of the composite end point in patients with an abnormal troponin T concentration (≥14 ng per liter) as compared with those with a normal troponin T concentration (<14 ng per liter). Of the 2285 patients, 2277 (99.6%) had detectable (≥3 ng per liter) troponin T concentrations and 897 (39.3%) had abnormal troponin T concentrations at baseline. The 5-year rate of the composite end point was 27.1% among the patients who had had abnormal troponin T concentrations at baseline, as compared with 12.9% among those who had had normal baseline troponin T concentrations. In models that were adjusted for cardiovascular risk factors, severity of diabetes, electrocardiographic abnormalities, and coronary anatomy, the hazard ratio for the composite end point among patients with abnormal troponin T concentrations was 1.85 (95% confidence interval [CI], 1.48 to 2.32; P<0.001). Among patients with abnormal troponin T concentrations, random assignment to prompt revascularization, as compared with medical therapy alone, did not result in a significant reduction in the rate of the composite end point (hazard ratio, 0.96; 95% CI

  10. Achieving Stable Radiation Pressure Acceleration of Heavy Ions via Successive Electron Replenishment from Ionization of a High-Z Material Coating

    NASA Astrophysics Data System (ADS)

    Qiao, Bin; Shen, X. F.; Zhang, H.; Kar, S.; Zhou, C. T.; Chang, H. X.; Borghesi, M.; He, X. T.

    2017-10-01

    Among various laser-driven acceleration schemes, radiation pressure acceleration (RPA) is regarded as one of the most promising schemes to obtain high-quality ion beams. Although RPA is very attractive in principle, it is difficult to be achieved experimentally. One of the most important reasons is the dramatic growth of the multi-dimensional Rayleigh-Taylor-like (RT) instabilities. In this talk, we report a novel method to achieve stable RPA of ions from laser-irradiated ultrathin foils, where a high-Z material coating in front is used. The coated high-Z material, acting as a moving electron repository, continuously replenishes the accelerating ion foil with comoving electrons in the light-sail acceleration stage due to its successive ionization under laser fields with Gaussian temporal profile. As a result, the detrimental effects such as electron loss induced by the RT and other instabilities are significantly offset and suppressed so that stable acceleration of ions are maintained. Supported by the NSAF, Grant No. U1630246; the NNSF China Grants No. 11575298; and the National Key Program of S&T Research and Development, Grant No. 2016YFA0401100.

  11. Prognostic value of B-Type natriuretic peptides in patients with stable coronary artery disease: the PEACE Trial.

    PubMed

    Omland, Torbjørn; Sabatine, Marc S; Jablonski, Kathleen A; Rice, Madeline Murguia; Hsia, Judith; Wergeland, Ragnhild; Landaas, Sverre; Rouleau, Jean L; Domanski, Michael J; Hall, Christian; Pfeffer, Marc A; Braunwald, Eugene

    2007-07-17

    The purpose of this study was to assess the association between B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the incidence of specific cardiovascular events in low-risk patients with stable coronary disease, the incremental prognostic information obtained from these two biomarkers compared with traditional risk factors, and their ability to identify patients who may benefit from angiotensin-converting enzyme (ACE) inhibition. The prognostic value of BNPs in low-risk patients with stable coronary artery disease remains unclear. Baseline plasma BNP and NT-proBNP concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibition) study, a placebo-controlled trial of trandolapril. Multivariable Cox regression was used to assess the association between natriuretic peptide concentrations and the incidence of cardiovascular mortality, fatal or nonfatal myocardial infarction, heart failure, and stroke. The BNP and NT-proBNP levels were strongly related to the incidence of cardiovascular mortality, heart failure, and stroke but not to myocardial infarction. In multivariable models, BNP remained associated with increased risk of heart failure, whereas NT-proBNP remained associated with increased risk of cardiovascular mortality, heart failure, and stroke. By C-statistic calculations, BNP and NT-proBNP significantly improved the predictive accuracy of the best available model for incident heart failure, and NT-proBNP also improved the model for cardiovascular death. The magnitude of effect of ACE inhibition on the likelihood of experiencing cardiovascular end points was similar, regardless of either BNP or NT-proBNP baseline concentrations. In low-risk patients with stable coronary artery disease and preserved ventricular function, BNPs provide strong and incremental prognostic

  12. Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management.

    PubMed

    Schulman-Marcus, Joshua; Weintraub, William S; Boden, William E

    2017-10-15

    Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease.

    PubMed

    Eikelboom, John W; Connolly, Stuart J; Bosch, Jackie; Dagenais, Gilles R; Hart, Robert G; Shestakovska, Olga; Diaz, Rafael; Alings, Marco; Lonn, Eva M; Anand, Sonia S; Widimsky, Petr; Hori, Masatsugu; Avezum, Alvaro; Piegas, Leopoldo S; Branch, Kelley R H; Probstfield, Jeffrey; Bhatt, Deepak L; Zhu, Jun; Liang, Yan; Maggioni, Aldo P; Lopez-Jaramillo, Patricio; O'Donnell, Martin; Kakkar, Ajay K; Fox, Keith A A; Parkhomenko, Alexander N; Ertl, Georg; Störk, Stefan; Keltai, Matyas; Ryden, Lars; Pogosova, Nana; Dans, Antonio L; Lanas, Fernando; Commerford, Patrick J; Torp-Pedersen, Christian; Guzik, Tomek J; Verhamme, Peter B; Vinereanu, Dragos; Kim, Jae-Hyung; Tonkin, Andrew M; Lewis, Basil S; Felix, Camilo; Yusoff, Khalid; Steg, P Gabriel; Metsarinne, Kaj P; Cook Bruns, Nancy; Misselwitz, Frank; Chen, Edmond; Leong, Darryl; Yusuf, Salim

    2017-10-05

    We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=-4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events. (Funded by Bayer; COMPASS Clinical

  14. Depression in patients with stable chronic obstructive pulmonary disease: a cross-sectional study in the national center for respiratory diseases in Indonesia.

    PubMed

    Rosrita, Nur Nina; Yunus, Faisal; Ginting, Tribowo Tuahta; Nurwidya, Fariz

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world, including Indonesia. It can cause comorbidities such as osteoporosis, heart failure, diabetes, and depression. Depression is a common. The purpose of this study is to reveal the prevalence of depression in stable COPD patients in Persahabatan Hospital Jakarta and its associated factors. This is a cross-sectional study in which stable COPD patients who visited COPD Outpatient Clinic in Persahabatan Hospital Jakarta and met the inclusion and exclusion criteria were asked for a history of disease, physical examination, lung function test and underwent Mini International Neuropsychiatric Interview Version (MINI) ICD 10. One hundred and forty-one patients were enrolled in this study. Prevalence of depression was 19.1%. Subjects with moderate-high COPD assessment test (CAT) score ≥ 10 have 14 times higher risk of having depression (p<0.001) compared to subjects with mild CAT score (< 10). There was a statistically significant association between symptoms-based COPD group (p<0.001), smoking status (p<0.007) and Brinkmann index (p<0.026) with depression. We found no statistically significant association between risk-based COPD group (p=0.799) and airflow limitation (p>1.000) with depression. The prevalence of depression in stable COPD patients in Persahabatan Hospital Jakarta was 19.1%. There was a statistically significant association between symptoms-based COPD group, smoking status, and Brinkmann index with depression in stable COPD patients.

  15. Clinical and MRI outcomes after stopping or switching disease-modifying therapy in stable MS patients: a case series report.

    PubMed

    Berkovich, Regina

    2017-10-01

    To evaluate clinical and MRI outcomes after stopping or switching disease-modifying therapy in patients with stable MS. A retrospective chart review was conducted of stable MS patients who discontinued or switched their DMT from 2011 to 2015. Clinical and MRI outcomes were obtained at baseline and 1-year follow-up. For the DMT discontinuation group, 15 patients were included, with 67% female, 53% Caucasian, mean age of 45.3 ± 12.2 years, disease duration of 9.1 ± 4.3 years, MS type (80% RRMS, 20% SPMS), and EDSS of 3.7 ± 1.6. The average duration of stable MS course was 5.5 ± 3.7 years. Within a mean of 6.4 ± 2.2 months after DMT discontinuation, all 15 patients experienced worsening of MS disease. After re-evaluation of MS treatment options, all 15 patients were restarted on DMT, of which, 6 (40%) restarted on their prior DMT, 4 (26.7%) switched to another DMT due to adverse events on prior DMT, and 5 (33.3%) switched to a more potent DMT due to worsening of MS activity. One year follow-up showed 2 patients (13.3%) who were restarted on their prior DMT experienced a relapse and the remaining 13 patients (86.7%) had no clinical or MRI activities. For the DMT switch group, 23 patients were included, with 65% female, 61% Caucasian, a mean age of 46.9 ± 11.6 years, disease duration of 11.7 ± 5.1 years, MS Type (83% RRMS, 17% SPMS), and EDSS of 3.5 ± 0.9. After switching DMT, 9 (39.1%) patients experienced worsening of clinical or MRI outcomes at the 1-year follow-up. Of the 9 switch failures, the majority (N = 6) were due to switching to dimethyl fumarate. DMT discontinuation in stable MS patients resulted in worsening of MS disease course for all patients, which improved upon DMT restart or switch. In contrast, 39% of MS stable patients experienced worsening of MS disease course when switched to another DMT, with DMT selection potentially impacting switch outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Achieving Stable Radiation Pressure Acceleration of Heavy Ions via Successive Electron Replenishment from Ionization of a High-Z Material Coating

    NASA Astrophysics Data System (ADS)

    Shen, X. F.; Qiao, B.; Zhang, H.; Kar, S.; Zhou, C. T.; Chang, H. X.; Borghesi, M.; He, X. T.

    2017-05-01

    A method to achieve stable radiation pressure acceleration (RPA) of heavy ions from laser-irradiated ultrathin foils is proposed, where a high-Z material coating in front is used. The coated high-Z material, acting as a moving electron repository, continuously replenishes the accelerating heavy ion foil with comoving electrons in the light-sail acceleration stage due to its successive ionization under laser fields with Gaussian temporal profile. As a result, the detrimental effects such as foil deformation and electron loss induced by the Rayleigh-Taylor-like and other instabilities in RPA are significantly offset and suppressed so that stable acceleration of heavy ions are maintained. Particle-in-cell simulations show that a monoenergetic Al13 + beam with peak energy 3.8 GeV and particle number 1 010 (charge >20 nC ) can be obtained at intensity 1 022 W /cm2 .

  17. Characterisation of clot microstructure properties in stable coronary artery disease.

    PubMed

    Sabra, Ahmed; Lawrence, Matthew James; Aubrey, Robert; Obaid, Daniel; Chase, Alexander; Smith, Dave; Thomas, Phillip; Storton, Sharon; Davies, Gareth R; Hawkins, Karl; Williams, Phylip Rhodri; Morris, Keith; Evans, Phillip Adrian

    2017-01-01

    Coronary artery disease (CAD) is associated with an increased prothrombotic tendency and is also linked to unfavourably altered clot microstructure. We have previously described a biomarker of clot microstructure (d f ) that is unfavourably altered in acute myocardial infarction. The d f biomarker assesses whether the blood will form denser or looser microstructures when it clots. In this study we assessed in patients with stable chest pain whether d f can differentiate between obstructed and unobstructed CAD. A blood sample prior to angiography was obtained from 251 consecutive patients undergoing diagnostic coronary angiography. Patients were categorised based on angiographic findings as presence or absence of obstructive CAD (stenosis ≥50%). The blood sample was assessed using the d f biomarker, standard laboratory markers and platelet aggregometry (Multiplate). A significant difference (p=0.028) in d f was observed between obstructive CAD (1.748±0.057, n=83) and unobstructive CAD (1.732±0.052, n=168), where patients with significant CAD produce denser, more tightly packed clots. d f was also raised in men with obstructive CAD compared with women (1.745±0.055 vs 1.723±0.052, p=0.007). Additionally d f significantly correlated with the platelets response to arachidonic acid as measured by the ASPItest area under the curve readings from platelet aggregometry (correlation coefficient=0.166, p=0.008), a low value of the ASPItest indicating effective aspirin use was associated with looser, less dense clots. For the first time, we characterise clot microstructure, as measured by d f , in patients with stable CAD. d f can potentially be used to risk-stratify patients with stable CAD and assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.

  18. Self-Reported Health and Outcomes in Patients With Stable Coronary Heart Disease.

    PubMed

    Stewart, Ralph A H; Hagström, Emil; Held, Claes; Wang, Tom Kai Ming; Armstrong, Paul W; Aylward, Philip E; Cannon, Christopher P; Koenig, Wolfgang; López-Sendón, José Luis; Mohler, Emile R; Hadziosmanovic, Nermin; Krug-Gourley, Susan; Ramos Corrales, Marco Antonio; Siddique, Saulat; Steg, Philippe Gabriel; White, Harvey D; Wallentin, Lars

    2017-08-22

    The major determinants and prognostic importance of self-reported health in patients with stable coronary heart disease are uncertain. The STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial randomized 15 828 patients with stable coronary heart disease to treatment with darapladib or placebo. At baseline, 98% of participants completed a questionnaire that included the question, "Overall, how do you feel your general health is now?" Possible responses were excellent, very good, good, average , and poor . Adjudicated major adverse cardiac events, which included cardiovascular death, myocardial infarction, and stroke, were evaluated by Cox regression during 3.7 years of follow-up for participants who reported excellent or very good health (n=2304), good health (n=6863), and average or poor health (n=6361), before and after adjusting for 38 covariates. Self-reported health was most strongly associated with geographic region, depressive symptoms, and low physical activity ( P <0.0001 for all). Poor/average compared with very good/excellent self-reported health was independently associated with major adverse cardiac events (hazard ratio [HR]: 2.30 [95% confidence interval (CI), 1.92-2.76]; adjusted HR: 1.83 [95% CI, 1.51-2.22]), cardiovascular mortality (HR: 4.36 [95% CI, 3.09-6.16]; adjusted HR: 2.15 [95% CI, 1.45-3.19]), and myocardial infarction (HR: 1.87 [95% CI, 1.46-2.39]; adjusted HR: 1.68 [95% CI, 1.25-2.27]; P <0.0002 for all). Self-reported health is strongly associated with geographical region, mood, and physical activity. In a global coronary heart disease population, self-reported health was independently associated with major cardiovascular events and mortality beyond what is measurable by established risk indicators. URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00799903. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  19. Determinants of variations in initial treatment strategies for stable ischemic heart disease

    PubMed Central

    Bennell, Maria C.; Qiu, Feng; Kingsbury, Kori J.; Austin, Peter C.; Wijeysundera, Harindra C.

    2015-01-01

    Background: The ratio of revascularization to medical therapy (referred to herein as the revascularization ratio) for the initial treatment of stable ischemic heart disease varies considerably across hospitals. We conducted a comprehensive study to identify patient, physician and hospital factors associated with variations in the revascularization ratio across 18 cardiac centres in the province of Ontario. We also explored whether clinical outcomes differed between hospitals with high, medium and low ratios. Methods: We identified all patients in Ontario who had stable ischemic heart disease documented by index angiography performed between Oct. 1, 2008, and Sept. 30, 2011, at any of the 18 cardiac centres in the province. We classified patients by initial treatment strategy (medical therapy or revascularization). Hospitals were classified into equal tertiles based on their revascularization ratio. The primary outcome was all-cause mortality. Patient follow-up was until Dec. 31, 2012. Hierarchical logistic regression models identified predictors of revascularization. Multivariable Cox proportional hazards models, with a time-varying covariate for actual treatment received, were used to evaluate the impact of the revascularization ratio on clinical outcomes. Results: Variation in revascularization ratios was twofold across the hospitals. Patient factors accounted for 67.4% of the variation in revascularization ratios. Physician and hospital factors were not significantly associated with the variation. Significant patient-level predictors of revascularization were history of smoking, multivessel disease, high-risk findings on noninvasive stress testing and more severe symptoms of angina (v. no symptoms). Treatment at hospitals with a high revascularization ratio was associated with increased mortality compared with treatment at hospitals with a low ratio (hazard ratio 1.12, 95% confidence interval 1.03–1.21). Interpretation: Most of the variation in

  20. Practical management problems of stable chronic obstructive pulmonary disease in the elderly.

    PubMed

    Pistelli, Riccardo; Ferrara, Letizia; Misuraca, Clementina; Bustacchini, Silvia

    2011-12-01

    Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease. In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic - such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation - and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations. The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be

  1. Chagas disease: an impediment in achieving the Millennium Development Goals in Latin America

    PubMed Central

    Franco-Paredes, Carlos; Von, Anna; Hidron, Alicia; Rodríguez-Morales, Alfonso J; Tellez, Ildefonso; Barragán, Maribel; Jones, Danielle; Náquira, Cesar G; Mendez, Jorge

    2007-01-01

    Background Achieving sustainable economic and social growth through advances in health is crucial in Latin America within the framework of the United Nations Millennium Development Goals. Discussion Health-related Millennium Development Goals need to incorporate a multidimensional approach addressing the specific epidemiologic profile for each region of the globe. In this regard, addressing the cycle of destitution and suffering associated with infection with Trypanosoma cruzi, the causal agent of Chagas disease of American trypanosomiasis, will play a key role to enable the most impoverished populations in Latin America the opportunity to achieve their full potential. Most cases of Chagas disease occur among forgotten populations because these diseases persist exclusively in the poorest and the most marginalized communities in Latin America. Summary Addressing the cycle of destitution and suffering associated with T. cruzi infection will contribute to improve the health of the most impoverished populations in Latin America and will ultimately grant them with the opportunity to achieve their full economic potential. PMID:17725836

  2. Advances in primate stable isotope ecology-Achievements and future prospects.

    PubMed

    Crowley, Brooke E; Reitsema, Laurie J; Oelze, Vicky M; Sponheimer, Matt

    2016-10-01

    Stable isotope biogeochemistry has been used to investigate foraging ecology in non-human primates for nearly 30 years. Whereas early studies focused on diet, more recently, isotopic analysis has been used to address a diversity of ecological questions ranging from niche partitioning to nutritional status to variability in life history traits. With this increasing array of applications, stable isotope analysis stands to make major contributions to our understanding of primate behavior and biology. Most notably, isotopic data provide novel insights into primate feeding behaviors that may not otherwise be detectable. This special issue brings together some of the recent advances in this relatively new field. In this introduction to the special issue, we review the state of isotopic applications in primatology and its origins and describe some developing methodological issues, including techniques for analyzing different tissue types, statistical approaches, and isotopic baselines. We then discuss the future directions we envision for the field of primate isotope ecology. Am. J. Primatol. 78:995-1003, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  3. Predictors of heart failure in patients with stable coronary artery disease: a PEACE study.

    PubMed

    Lewis, Eldrin F; Solomon, Scott D; Jablonski, Kathleen A; Rice, Madeline Murguia; Clemenza, Francesco; Hsia, Judith; Maggioni, Aldo P; Zabalgoitia, Miguel; Huynh, Thao; Cuddy, Thomas E; Gersh, Bernard J; Rouleau, Jean; Braunwald, Eugene; Pfeffer, Marc A

    2009-05-01

    Heart failure (HF) is a disease commonly associated with coronary artery disease. Most risk models for HF development have focused on patients with acute myocardial infarction. The Prevention of Events with Angiotensin-Converting Enzyme Inhibition population enabled the development of a risk model to predict HF in patients with stable coronary artery disease and preserved ejection fraction. In the 8290, Prevention of Events with Angiotensin-Converting Enzyme Inhibition patients without preexisting HF, new-onset HF hospitalizations, and fatal HF were assessed over a median follow-up of 4.8 years. Covariates were evaluated and maintained in the Cox regression multivariable model using backward selection if P<0.05. A risk score was developed and converted to an integer-based scoring system. Among the Prevention of Events with Angiotensin-Converting Enzyme Inhibition population (age, 64+/-8; female, 18%; prior myocardial infarction, 55%), there were 268 cases of fatal and nonfatal HF. Twelve characteristics were associated with increased risk of HF along with several baseline medications, including older age, history of hypertension, and diabetes. Randomization to trandolapril independently reduced the risk of HF. There was no interaction between trandolapril treatment and other risk factors for HF. The risk score (range, 0 to 21) demonstrated excellent discriminatory power (c-statistic 0.80). Risk of HF ranged from 1.75% in patients with a risk score of 0% to 33% in patients with risk score >or=16. Among patients with stable coronary artery disease and preserved ejection fraction, traditional and newer factors were independently associated with increased risk of HF. Trandolopril decreased the risk of HF in these patients with preserved ejection fraction.

  4. Understanding and benchmarking health service achievement of policy goals for chronic disease

    PubMed Central

    2012-01-01

    Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be

  5. Achieving Stable Radiation Pressure Acceleration of Heavy Ions via Successive Electron Replenishment from Ionization of a High-Z Material Coating.

    PubMed

    Shen, X F; Qiao, B; Zhang, H; Kar, S; Zhou, C T; Chang, H X; Borghesi, M; He, X T

    2017-05-19

    A method to achieve stable radiation pressure acceleration (RPA) of heavy ions from laser-irradiated ultrathin foils is proposed, where a high-Z material coating in front is used. The coated high-Z material, acting as a moving electron repository, continuously replenishes the accelerating heavy ion foil with comoving electrons in the light-sail acceleration stage due to its successive ionization under laser fields with Gaussian temporal profile. As a result, the detrimental effects such as foil deformation and electron loss induced by the Rayleigh-Taylor-like and other instabilities in RPA are significantly offset and suppressed so that stable acceleration of heavy ions are maintained. Particle-in-cell simulations show that a monoenergetic Al^{13+} beam with peak energy 3.8 GeV and particle number 10^{10} (charge >20  nC) can be obtained at intensity 10^{22}  W/cm^{2}.

  6. Diabetes mellitus and cardiovascular clinical characteristics of Spanish women with stable ischaemic heart disease: Data from the SIRENA study.

    PubMed

    Gámez, José M; Masmiquel, Luis; Ripoll, Tomás; Barrios, Vivencio; Anguita, Manuel

    2017-01-01

    The relationship between diabetes and the cardiovascular clinical characteristics of Spanish women with stable ischaemic heart disease was studied in a nationwide cross-sectional study. Diabetes was related to a higher burden of risk factors, comorbidity, multivessel disease and coronary surgery. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis.

    PubMed

    Lupoli, Roberta; Pizzicato, Paolo; Scalera, Antonella; Ambrosino, Pasquale; Amato, Manuela; Peluso, Rosario; Di Minno, Matteo Nicola Dario

    2016-12-13

    In this study, we evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment. Obesity can be considered a low-grade, chronic systemic inflammatory disease and some studies suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with anti-rheumatic drugs. A systematic search was performed in major electronic databases (PubMed, Web of Science, Scopus, Embase) to identify studies reporting MDA achievement in obese and/or overweight patients with RA or PsA and in normal-weight RA or PsA control subjects. Results were expressed as Odds Ratios (ORs) with pertinent 95% Confidence Intervals (95%CIs). We included 17 studies (10 on RA and 7 on PsA) comprising a total of 6693 patients (1562 with PsA and 5131 with RA) in the analysis. The MDA achievement rate was significantly lower in obese patients than in normal-weight subjects (OR 0.447, 95% CI 0.346-0.577, p < 0.001, I 2  = 62.6%, p < 0.001). Similarly, overweight patients showed a significantly lower prevalence of MDA achievement than normal-weight subjects (OR 0.867, 95% CI 0.757-0.994, p = 0.041, I 2  = 64%, p = 0.007). Interestingly, the effect of obesity on MDA was confirmed when we separately analyzed data on patients with RA and patients with PsA. In contrast, when we evaluated the effect of overweight, our results were confirmed for PsA but not for RA. A meta-regression analysis showed that follow-up duration, age, male sex, and treatment duration are covariates significantly affecting the effect of obesity/overweight on MDA achievement. The results of our meta-analysis suggest that obesity and overweight reduce the chances to achieve MDA in patients with rheumatic diseases receiving treatment with traditional or biologic disease-modifying antirheumatic

  8. Sequence analysis of Jembrana disease virus strains reveals a genetically stable lentivirus.

    PubMed

    Desport, Moira; Stewart, Meredith E; Mikosza, Andrew S; Sheridan, Carol A; Peterson, Shane E; Chavand, Olivier; Hartaningsih, Nining; Wilcox, Graham E

    2007-06-01

    Jembrana disease virus (JDV) is a lentivirus associated with an acute disease syndrome with a 20% case fatality rate in Bos javanicus (Bali cattle) in Indonesia, occurring after a short incubation period and with no recurrence of the disease after recovery. Partial regions of gag and pol and the entire env were examined for sequence variation in DNA samples from cases of Jembrana disease obtained from Bali, Sumatra and South Kalimantan in Indonesian Borneo. A high level of nucleotide conservation (97-100%) was observed in gag sequences from samples taken in Bali and Sumatra, indicating that the source of JDV in Sumatra was most likely to have originated from Bali. The pol sequences and, unexpectedly, the env sequences from Bali samples were also well conserved with low nucleotide (96-99%) and amino acid substitutions (95-99%). However, the sample from South Kalimantan (JDV(KAL/01)) contained more divergent sequences, particularly in env (88% identity). Phylogenetic analysis revealed that the JDV(KAL/01)env sequences clustered with the sequence from the Pulukan sample (Bali) from 2001. JDV appears to be remarkably stable genetically and has undergone minor genetic changes over a period of nearly 20 years in Bali despite becoming endemic in the cattle population of the island.

  9. Bioelectrical impedance phase angle relates to function, disease severity and prognosis in stable chronic obstructive pulmonary disease.

    PubMed

    Maddocks, Matthew; Kon, Samantha S C; Jones, Sarah E; Canavan, Jane L; Nolan, Claire M; Higginson, Irene J; Gao, Wei; Polkey, Michael I; Man, William D-C

    2015-12-01

    Bioelectrical impedance analysis (BIA) provides a simple method to assess changes in body composition. Raw BIA variables such as phase angle provide direct information on cellular mass and integrity, without the assumptions inherent in estimating body compartments, e.g. fat-free mass (FFM). Phase angle is a strong functional and prognostic marker in many disease states, but data in COPD are lacking. Our aims were to describe the measurement of phase angle in patients with stable COPD and determine the construct and discriminate validity of phase angle by assessing its relationship with established markers of function, disease severity and prognosis. 502 outpatients with stable COPD were studied. Phase angle and FFM by BIA, quadriceps strength (QMVC), 4-m gait speed (4MGS), 5 sit-to-stand time (5STS), incremental shuttle walk (ISW), and composite prognostic indices (ADO, iBODE) were measured. Patients were stratified into normal and low phase angle and FFM index. Phase angle correlated positively with FFM and functional outcomes (r = 0.35-0.66, p < 0.001) and negatively with prognostic indices (r = -0.35 to -0.48, p < 0.001). In regression models, phase angle was independently associated with ISW, ADO and iBODE whereas FFM was removed. One hundred and seventy patients (33.9% [95% CI, 29.9-38.1]) had a low phase angle. Phenotypic characteristics included lower QMVC, ISW, and 4MGS, higher 5STS, ADO and iBODE scores, and more exacerbations and hospital days in past year. The proportion of patients to have died was significantly higher in patients with low phase angle compared to those with normal phase angle (8.2% versus 3.6%, p = 0.02). Phase angle relates to markers of function, disease severity and prognosis in patients with COPD. As a directly measured variable, phase angle offers more useful information than fat-free mass indices. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond.

    PubMed

    Ortu, Giuseppina; Williams, Oliver

    2017-09-27

    Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered. The authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process. Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps. Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process. The authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.

  11. Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease.

    PubMed

    Larsen, Sanne Bøjet; Grove, Erik Lerkevang; Neergaard-Petersen, Søs; Würtz, Morten; Hvas, Anne-Mette; Kristensen, Steen Dalby

    2017-08-05

    Increased platelet aggregation during antiplatelet therapy may predict cardiovascular events in patients with coronary artery disease. The majority of these patients receive aspirin monotherapy. We aimed to investigate whether high platelet-aggregation levels predict cardiovascular events in stable coronary artery disease patients treated with aspirin. We included 900 stable coronary artery disease patients with either previous myocardial infarction, type 2 diabetes mellitus, or both. All patients received single antithrombotic therapy with 75 mg aspirin daily. Platelet aggregation was evaluated 1 hour after aspirin intake using the VerifyNow Aspirin Assay (Accriva Diagnostics) and Multiplate Analyzer (Roche; agonists: arachidonic acid and collagen). Adherence to aspirin was confirmed by serum thromboxane B 2 . The primary end point was the composite of nonfatal myocardial infarction, ischemic stroke, and cardiovascular death. At 3-year follow-up, 78 primary end points were registered. The primary end point did not occur more frequently in patients with high platelet-aggregation levels (first versus fourth quartile) assessed by VerifyNow (hazard ratio: 0.5 [95% CI, 0.3-1.1], P =0.08) or Multiplate using arachidonic acid (hazard ratio: 1.0 [95% CI, 0.5-2.1], P =0.92) or collagen (hazard ratio: 1.4 [95% CI, 0.7-2.8], P =0.38). Similar results were found for the composite secondary end point (nonfatal myocardial infarction, ischemic stroke, stent thrombosis, and all-cause death) and the single end points. Thromboxane B 2 levels did not predict any end points. Renal insufficiency was the only clinical risk factor predicting the primary and secondary end points. This study is the largest to investigate platelet aggregation in stable coronary artery disease patients receiving aspirin as single antithrombotic therapy. We found that high platelet-aggregation levels did not predict cardiovascular events. © 2017 The Authors. Published on behalf of the American Heart

  12. Platelet inhibition with ticagrelor versus clopidogrel in Hispanic patients with stable coronary artery disease with or without diabetes mellitus.

    PubMed

    Clavijo, Leonardo C; Maya, Juan; Carlson, Glenn; Angiolillo, Dominick J; Teng, Renli; Caplan, Richard; Price, Matthew J

    2015-12-01

    Diabetes mellitus (DM) disproportionately affects Hispanic patients. DM patients have enhanced platelet reactivity and reduced sensitivity to clopidogrel. Ticagrelor demonstrated a more rapid onset and greater magnitude of platelet inhibition than clopidogrel in Hispanic patients with stable coronary artery disease (CAD). This subgroup analysis examined the onset and level of platelet inhibition of ticagrelor and clopidogrel in Hispanic patients with DM. This was a subgroup analysis of a randomized, open-label, crossover study in which 40 Hispanic patients with stable CAD received ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose (MD) then clopidogrel 600 mg LD/75 mg once-daily MD, or vice versa. The primary end point was on-treatment platelet reactivity at 2 hours post-LD using the VerifyNow™ P2Y12 test. 21 patients had DM and 19 were non-diabetic. At 2 hours post-LD, mean platelet reactivity in the diabetic group was 34.5 PRU with ticagrelor versus 219.3 PRU with clopidogrel (P<0.001), and in the non-diabetic group was 33.7 PRU with ticagrelor versus 181.0 PRU with clopidogrel (P<0.001). In both diabetic and non-diabetic subgroups, mean platelet reactivity declined to a significantly greater extent with ticagrelor than clopidogrel at all time points evaluated (0.5, 2, and 8 hours post LD and after 7-9 days of MD). Patients were significantly more likely to have high on-treatment platelet reactivity (≥208 PRU) during treatment with clopidogrel compared with ticagrelor, regardless of diabetic status. Among Hispanic patients with stable CAD, ticagrelor achieves a faster onset and greater magnitude of platelet inhibition compared with clopidogrel, irrespective of diabetic status. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease.

    PubMed

    Sedlis, Steven P; Hartigan, Pamela M; Teo, Koon K; Maron, David J; Spertus, John A; Mancini, G B John; Kostuk, William; Chaitman, Bernard R; Berman, Daniel; Lorin, Jeffrey D; Dada, Marcin; Weintraub, William S; Boden, William E

    2015-11-12

    Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years. We obtained permission from the patients at the Department of Veterans Affairs (VA) sites and some non-VA sites in the United States to use their Social Security numbers to track their survival after the original trial period ended. We searched the VA national Corporate Data Warehouse and the National Death Index for survival information and the dates of death from any cause. We calculated survival according to the Kaplan-Meier method and used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics. Extended survival information was available for 1211 patients (53% of the original population). The median duration of follow-up for all patients was 6.2 years (range, 0 to 15); the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years (range, 0 to 15). A total of 561 deaths (180 during the follow-up period in the original trial and 381 during the extended follow-up period) occurred: 284 deaths (25%) in the PCI group and 277 (24%) in the medical-therapy group (adjusted hazard ratio, 1.03; 95% confidence interval, 0.83 to 1.21; P=0.76). During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA

  14. Stable or improved neurological manifestations during miglustat therapy in patients from the international disease registry for Niemann-Pick disease type C: an observational cohort study.

    PubMed

    Patterson, Marc C; Mengel, Eugen; Vanier, Marie T; Schwierin, Barbara; Muller, Audrey; Cornelisse, Peter; Pineda, Mercè

    2015-05-28

    Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological degeneration, where the rate of neurological disease progression varies depending on age at neurological onset. We report longitudinal data on functional disease progression and safety observations in patients in the international NPC Registry who received continuous treatment with miglustat. The NPC Registry is a prospective observational cohort of NP-C patients. Enrolled patients who received ≥1 year of continuous miglustat therapy (for ≥90 % of the observation period, with no single treatment interruption >28 days) were included in this analysis. Disability was measured using a scale rating the four domains, ambulation, manipulation, language and swallowing from 0 (normal) to 1 (worst). Neurological disease progression was analysed in all patients based on: 1) annual progression rates between enrolment and last follow up, and; 2) categorical analysis with patients categorised as 'improved/stable' if ≥3/4 domain scores were lower/unchanged, and as 'progressed' if <3 scores were lower/unchanged between enrolment and last follow-up visit. In total, 283 patients were enrolled from 28 centers in 13 European countries, Canada and Australia between September 2009 and October 2013; 92 patients received continuous miglustat therapy. The mean (SD) miglustat exposure during the observation period (enrolment to last follow-up) was 2.0 (0.7) years. Among 84 evaluable patients, 9 (11 %) had early-infantile (<2 years), 27 (32 %) had late-infantile (2 to <6 years), 30 (36 %) had juvenile (6 to <15 years) and 18 (21 %) had adolescent/adult (≥15 years) onset of neurological manifestations. The mean (95%CI) composite disability score among all patients was 0.37 (0.32,0.42) at enrolment and 0.44 (0.38,0.50) at last follow-up visit, and the mean annual progression rate was 0.038 (0.018,0.059). Progression of composite disability scores appeared highest

  15. Profiles of chronic obstructive lung disease: characteristics of stable chronic obstructive lung disease in different parts of Asia.

    PubMed

    Bhome, Arvind B; Brashier, Bill

    2014-03-01

    This review discusses the recent Asian chronic obstructive lung disease (COPD) studies that characterize stable COPD, to understand its peculiarities. Asian research has improved our understanding of COPD. Household air pollution (HAP) is as important as smoking. Smoking in Asia is varied, and noncigarette smoking exposure remains under-investigated. Prevalence studies are often questionnaire based. Spirometry-based prevalence needs study. Burden of obstructive lung disease studies are getting published. Female COPD in Asia is predominantly HAP induced. The patients are underweight, milder 'Global Initiative for Obstructive Lung Disease- class' and have compromised health-related quality of life often with depression and anxiety, but other comorbidities do occur and are getting defined.Nonsmokers' COPD is often associated with small airway thickening, less emphysema, but considerable morbidity. Asian COPD may have an eosinophilic component, but its significance is unknown. There is genetic predisposition among some Asians to COPD, and among some patients to lung cancer. The emerging pandemic of lifestyle diseases demands that metabolic and cardiovascular comorbidities in COPD need investigation. COPD in Asia is increasing and burdensome. It is affecting both sexes; is caused by HAP as much as smoking; causes poor quality of life and intense psychological burden; and is associated with unique patho-physiology, which will require research and action.

  16. State of the Art: Blood Biomarkers for Risk Stratification in Patients with Stable Ischemic Heart Disease.

    PubMed

    Omland, Torbjørn; White, Harvey D

    2017-01-01

    Multiple circulating biomarkers have been associated with the incidence of cardiovascular events and proposed as potential tools for risk stratification in stable ischemic heart disease (IHD), yet current guidelines do not make any firm recommendations concerning the use of biomarkers for risk stratification in this setting. This state-of-the-art review provides an overview of biomarkers for risk stratification in stable IHD. Circulating biomarkers associated with the risk of cardiovascular events in patients with stable IHD reflect different pathophysiological processes, including myocardial injury, myocardial stress and remodeling, metabolic status, vascular inflammation, and oxidative stress. Compared to the primary prevention setting, biomarkers reflecting end-organ damage and future risk of heart failure development and cardiovascular death may play more important roles in the stable IHD setting. Accordingly, biomarkers that reflect chronic, low-grade myocardial injury, and stress, i.e., high-sensitivity cardiac troponins and natriuretic peptides, provide graded and incremental prognostic information to conventional risk markers. In contrast, in stable IHD patients the prognostic value of traditional metabolic biomarkers, including serum lipids, is limited. Among several novel biomarkers, growth-differentiation factor-15 may provide the most robust prognostic information, whereas most inflammatory markers provide limited incremental prognostic information to risk factor models that include conventional risk factors, natriuretic peptides, and high-sensitivity troponins. Circulating biomarkers hold promise as useful tools for risk stratification in stable IHD, but their future incorporation into clinically useful risk scores will depend on prospective, rigorously performed clinical trials that document enhanced risk prediction. © 2016 American Association for Clinical Chemistry.

  17. Neonatal Respiratory Diseases in the Newborn Infant: Novel Insights from Stable Isotope Tracer Studies.

    PubMed

    Carnielli, Virgilio P; Giorgetti, Chiara; Simonato, Manuela; Vedovelli, Luca; Cogo, Paola

    2016-01-01

    Respiratory distress syndrome is a common problem in preterm infants and the etiology is multifactorial. Lung underdevelopment, lung hypoplasia, abnormal lung water metabolism, inflammation, and pulmonary surfactant deficiency or disfunction play a variable role in the pathogenesis of respiratory distress syndrome. High-quality exogenous surfactant replacement studies and studies on surfactant metabolism are available; however, the contribution of surfactant deficiency, alteration or dysfunction in selected neonatal lung conditions is not fully understood. In this article, we describe a series of studies made by applying stable isotope tracers to the study of surfactant metabolism and lung water. In a first set of studies, which we call 'endogenous studies', using stable isotope-labelled intravenous surfactant precursors, we showed the feasibility of measuring surfactant synthesis and kinetics in infants using several metabolic precursors including plasma glucose, plasma fatty acids and body water. In a second set of studies, named 'exogenous studies', using stable isotope-labelled phosphatidylcholine tracer given endotracheally, we could estimate surfactant disaturated phosphatidylcholine pool size and half-life. Very recent studies are focusing on lung water and on the endogenous biosynthesis of the surfactant-specific proteins. Information obtained from these studies in infants will help to better tailor exogenous surfactant treatment in neonatal lung diseases. © 2016 S. Karger AG, Basel.

  18. The clinical profile of women with stable ischaemic heart disease in Spain. More effort is needed in secondary prevention. SIRENA study.

    PubMed

    Gámez, J M; Ripoll, T; Barrios, V; Anguita, M; Pedreira, M; Madariaga, I

    2016-01-01

    Cardiovascular diseases are the leading cause of death for women, especially ischaemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischaemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischaemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. A multicentre observational study was conducted with a sample of 631 women with stable ischaemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. Women with stable ischaemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischaemic heart disease. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Mind the bubbles: achieving stable measurements of maximum hydraulic conductivity through woody plant samples

    PubMed Central

    Espino, Susana; Schenk, H. Jochen

    2011-01-01

    The maximum specific hydraulic conductivity (kmax) of a plant sample is a measure of the ability of a plants’ vascular system to transport water and dissolved nutrients under optimum conditions. Precise measurements of kmax are needed in comparative studies of hydraulic conductivity, as well as for measuring the formation and repair of xylem embolisms. Unstable measurements of kmax are a common problem when measuring woody plant samples and it is commonly observed that kmax declines from initially high values, especially when positive water pressure is used to flush out embolisms. This study was designed to test five hypotheses that could potentially explain declines in kmax under positive pressure: (i) non-steady-state flow; (ii) swelling of pectin hydrogels in inter-vessel pit membranes; (iii) nucleation and coalescence of bubbles at constrictions in the xylem; (iv) physiological wounding responses; and (v) passive wounding responses, such as clogging of the xylem by debris. Prehydrated woody stems from Laurus nobilis (Lauraceae) and Encelia farinosa (Asteraceae) collected from plants grown in the Fullerton Arboretum in Southern California, were used to test these hypotheses using a xylem embolism meter (XYL'EM). Treatments included simultaneous measurements of stem inflow and outflow, enzyme inhibitors, stem-debarking, low water temperatures, different water degassing techniques, and varied concentrations of calcium, potassium, magnesium, and copper salts in aqueous measurement solutions. Stable measurements of kmax were observed at concentrations of calcium, potassium, and magnesium salts high enough to suppress bubble coalescence, as well as with deionized water that was degassed using a membrane contactor under strong vacuum. Bubble formation and coalescence under positive pressure in the xylem therefore appear to be the main cause for declining kmax values. Our findings suggest that degassing of water is essential for achieving stable and precise

  20. Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry.

    PubMed

    Fauchier, Laurent; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Fox, Kim M; Tardif, Jean-Claude; Tendera, Michal; Steg, Ph Gabriel

    2015-01-01

    Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease. CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score (p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention (p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively) were associated with reduced oral anticoagulant use. In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients. ISRCTN registry of clinical trials: ISRCTN43070564.

  1. Use of Anticoagulants and Antiplatelet Agents in Stable Outpatients with Coronary Artery Disease and Atrial Fibrillation. International CLARIFY Registry

    PubMed Central

    Fauchier, Laurent; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Fox, Kim M.; Tardif, Jean-Claude; Tendera, Michal; Steg, Ph. Gabriel

    2015-01-01

    Background Few data are available regarding the use of antithrombotic strategies in coronary artery disease patients with atrial fibrillation (AF) in everyday practice. We sought to describe the prevalence of AF and its antithrombotic management in a contemporary population of patients with stable coronary artery disease. Methods and Findings CLARIFY is an international, prospective, longitudinal registry of outpatients with stable coronary artery disease, defined as prior (≥12 months) myocardial infarction, revascularization procedure, coronary stenosis >50%, or chest pain associated with evidence of myocardial ischemia. Overall, 33,428 patients were screened, of whom 32,954 had data available for analysis at baseline; of these 2,229 (6.7%) had a history of AF. Median (interquartile range) CHA2DS2-VASc score was 4 (3, 5). Oral anticoagulation alone was used in 25.7%, antiplatelet therapy alone in 52.8% (single 41.8%, dual 11.0%), and both in 21.5%. OAC use was independently associated with permanent AF (p<0.001), CHA2DS2-VASc score (p=0.006), pacemaker (p<0.001), stroke (p=0.04), absence of angina (p=0.004), decreased left ventricular ejection fraction (p<0.001), increased waist circumference (p=0.005), and longer history of coronary artery disease (p=0.008). History of percutaneous coronary intervention (p=0.004) and no/partial reimbursement for cardiovascular medication (p=0.01, p<0.001, respectively) were associated with reduced oral anticoagulant use. Conclusions In this contemporary cohort of patients with stable coronary artery disease and AF, most of whom are theoretical candidates for anticoagulation, oral anticoagulants were used in only 47.2%. Half of the patients received antiplatelet therapy alone and one-fifth received both antiplatelets and oral anticoagulants. Efforts are needed to improve adherence to guidelines in these patients. Trial Registration ISRCTN registry of clinical trials: ISRCTN43070564. PMID:25915904

  2. The Impact of motivational interviewing on illness perception in patients with stable coronary artery disease. A randomised controlled study

    PubMed

    Mülhauser, Sara; Bonhôte Börner, Martine; Saner, Hugo; Zumstein-Shaha, Maya

    2018-04-01

    Background: Coronary heart disease (CHD) constitutes one of the most frequent causes of death for individuals > 60 years. Lifestyle dependent risk factors are key. Hence, cardiac rehabilitation is essential for optimal CHD treatment. However, individuals rarely comprehend their illness. Motivational interviewing promotes illness perception. Aim/Methods: A randomised-controlled study was conducted to determine the effect of motivational interviewing on illness perception. Patients with stable coronary heart disease were consecutively recruited after elective percutaneous transluminal coronary angioplasty (PTCA). The intervention group received a short motivational interview (MI) about the disease and related risk factors as an intervention. The control group had usual treatment. Illness perception was assessed (Illness Perception Questionnaire-Revised) prior to the intervention and six months afterwards. Results: A total of 312 patients (intervention group: n = 148, control group: n = 164) were recruited into the study (mean age: 66.2 years). After the intervention, a significant change was observed in the domain of emotional reactions regarding the disease. Conclusion: To improve illness perception in patients with stable CHD, one short intervention with MI may have an effect. Whether intensifying the MI-intervention is more effective, requires further research.

  3. Follow-Up Consultation Through a Healthcare Kiosk for Patients with Stable Chronic Disease in a Primary Care Setting: A Prospective Study.

    PubMed

    Bahadin, Juliana; Shum, Eugene; Ng, Grace; Tan, Nicolette; Sellayah, Pushpavalli; Tan, Sze Wee

    2017-05-01

    The global healthcare kiosk market is growing, and kiosks are projected to be a larger part of healthcare delivery in the coming decades. We developed an unmanned healthcare kiosk that automates the management of stable patients with chronic conditions to complement face-to-face primary care physician (PCP) visits. The aim of our study was to show that the kiosk could be a feasible means of delivering care for stable patients with chronic conditions and could generate cost savings for the management of patients with stable chronic disease. We conducted a prospective single-arm study of 95 participants with well-controlled chronic cardiovascular diseases who visited our clinic in Singapore every 3 months for review and medication refill. During their subsequent appointments for chronic disease management at 3 and 6 months, participants used the kiosk instead of consulting a physician. All participants who used the kiosk were also evaluated by a nurse clinician (NC). The kiosk assessment of whether the patient was well controlled was then compared to the NC's assessment to determine rates of agreement. Patient satisfaction was evaluated through a questionnaire, and any adverse outcomes were documented. Cohen's κ for agreement between the kiosk and the NC assessment of patients' chronic care control was 0.575 (95% CI, 0.437-0.713). The modest agreement was due to differences in systolic blood pressure measurements between the kiosk and the NC. The 96% of participants who completed two kiosk visits were all satisfied with the kiosk as a care delivery alternative. None of the participants managed through the kiosk suffered any adverse outcomes. Use of the kiosk resulted in a reduction of 128 face-to-face PCP visits. Healthcare kiosks can potentially be used to complement primary care clinician visits for managing patients with stable chronic diseases and can generate cost savings.

  4. Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research.

    PubMed

    Hand, Carri L; Wilkins, Seanne; Letts, Lori J; Law, Mary C

    2013-10-01

    Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult. This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease. Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes. For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments. Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.

  5. Silent myocardial ischemia in patients with stable coronary artery disease receiving conventional antianginal drug therapy.

    PubMed

    Ferreira, João Fernando Monteiro; César, Luiz Antonio Machado; Gruppi, César J; Giorgi, Dante M A; Hueb, Whady A; Mansur, Antonio P; Ramires, José A F

    2007-11-01

    Few data are available on the behavior of myocardial ischemia during daily activities in patients with coronary artery disease receiving antianginal drug therapy. To study the mechanism generating myocardial ischemia by evaluating blood pressure and heart rate changes in patients with stable atherosclerotic disease receiving drug therapy and with evidence of myocardial ischemia. Fifty non-hospitalized patients (40 males) underwent 24-hour electrocardiographic monitoring synchronized with blood pressured monitoring. Thirty five episodes of myocardial ischemia were detected in 17 patients, with a total duration of 146.3 minutes; angina was reported in five cases. Twenty nine episodes (100.3 minutes) occurred during wakefulness, with 11 episodes (35.3 + 3.7 min) in the period from 11 a.m. to 3 p.m. Blood pressure and heart rate evaluation in the three ten-minute intervals following the ischemic episodes showed a statistically significant difference (p< 0.05), unlike that shown for the three intervals preceding the episodes. However, during the ischemic episode, a higher than 10-mmHg elevation in blood pressure and 5 beats per minute in heart rate were observed when compared with the time interval between 20 and 10 minutes before the episode. The mean heart rate at the onset of ischemia during the exercise test performed before the study was 118.2 + 14.0, and 81.1 + 20.8 beats per minute on the 24-hour electrocardiogram (p < 0.001). The incidence of silent myocardial ischemia is high in stable coronary artery disease and is related to alterations in blood pressure and heart rate, with different thresholds for ischemia for the same patient.

  6. Dynamically stable magnetic suspension/bearing system

    DOEpatents

    Post, R.F.

    1996-02-27

    A magnetic bearing system contains magnetic subsystems which act together to support a rotating element in a state of dynamic equilibrium. However, owing to the limitations imposed by Earnshaw`s Theorem, the magnetic bearing systems to be described do not possess a stable equilibrium at zero rotational speed. Therefore, mechanical stabilizers are provided, in each case, to hold the suspended system in equilibrium until its speed has exceeded a low critical speed where dynamic effects take over, permitting the achievement of a stable equilibrium for the rotating object. A state of stable equilibrium is achieved above a critical speed by use of a collection of passive elements using permanent magnets to provide their magnetomotive excitation. The magnetic forces exerted by these elements, when taken together, levitate the rotating object in equilibrium against external forces, such as the force of gravity or forces arising from accelerations. At the same time, this equilibrium is made stable against displacements of the rotating object from its equilibrium position by using combinations of elements that possess force derivatives of such magnitudes and signs that they can satisfy the conditions required for a rotating body to be stably supported by a magnetic bearing system over a finite range of those displacements. 32 figs.

  7. Dynamically stable magnetic suspension/bearing system

    DOEpatents

    Post, Richard F.

    1996-01-01

    A magnetic bearing system contains magnetic subsystems which act together to support a rotating element in a state of dynamic equilibrium. However, owing to the limitations imposed by Earnshaw's Theorem, the magnetic bearing systems to be described do not possess a stable equilibrium at zero rotational speed. Therefore, mechanical stabilizers are provided, in each case, to hold the suspended system in equilibrium until its speed has exceeded a low critical speed where dynamic effects take over, permitting the achievement of a stable equilibrium for the rotating object. A state of stable equilibrium is achieved above a critical speed by use of a collection of passive elements using permanent magnets to provide their magnetomotive excitation. The magnetic forces exerted by these elements, when taken together, levitate the rotating object in equilibrium against external forces, such as the force of gravity or forces arising from accelerations. At the same time, this equilibrium is made stable against displacements of the rotating object from its equilibrium position by using combinations of elements that possess force derivatives of such magnitudes and signs that they can satisfy the conditions required for a rotating body to be stably supported by a magnetic bearing system over a finite range of those displacements.

  8. Quantifying the benefits of achieving or maintaining long-term low risk profile for cardiovascular disease: The Doetinchem Cohort Study.

    PubMed

    Hulsegge, Gerben; Smit, Henriëtte A; van der Schouw, Yvonne T; Daviglus, Martha L; Verschuren, W M Monique

    2015-10-01

    Studies investigating the relation between risk profiles and cardiovascular disease have measured risk at baseline only. We investigated maintenance and changes of risk profiles over time and their potential impact on incident cardiovascular disease. Population-based cohort study. Risk factors were measured at baseline (1987-1991) among 5574 cardiovascular disease-free adults aged 20-59 years. They were classified into four risk categories according to smoking status, presence of diabetes and widely accepted cut-off values for blood pressure, total cholesterol/HDL-ratio and body mass index. Categories were subdivided (maintenance, deterioration, improvement) based on risk factor levels at six and 11 years of follow-up. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cardiovascular disease incidence 5-10 years following the risk-change period were fitted using Cox proportional hazards models. Only 12% of participants were low risk at baseline, and only 7% maintained it. Participants who maintained a low risk profile over 11 years had seven times lower risk of cardiovascular disease (HR: 0.14, 95% CI: 0.05-0.41) than participants with long-term high risk profile, whereas those low risk at baseline whose profile deteriorated had three times lower risk (HR: 0.36, 95% CI: 0.18-0.71). Our results suggest that, within each baseline risk profile group, compared with a stable profile, improving profiles may be associated with up to two-fold lower HRs, and deteriorating profiles with about two-fold higher HRs. Our study, using long-term risk profiles, demonstrates the full benefits of low risk profile. These findings underscore the importance of achieving and maintaining low risk from young adulthood onwards. © The European Society of Cardiology 2014.

  9. Stable same-sex friendships with higher achieving partners promote mathematical reasoning in lower achieving primary school children.

    PubMed

    DeLay, Dawn; Laursen, Brett; Kiuru, Noona; Poikkeus, Anna-Maija; Aunola, Kaisa; Nurmi, Jari-Erik

    2015-11-01

    This study was designed to investigate friend influence over mathematical reasoning in a sample of 374 children in 187 same-sex friend dyads (184 girls in 92 friendships; 190 boys in 95 friendships). Participants completed surveys that measured mathematical reasoning in the 3rd grade (approximately 9 years old) and 1 year later in the 4th grade (approximately 10 years old). Analyses designed for dyadic data (i.e., longitudinal actor-partner interdependence model) indicated that higher achieving friends influenced the mathematical reasoning of lower achieving friends, but not the reverse. Specifically, greater initial levels of mathematical reasoning among higher achieving partners in the 3rd grade predicted greater increases in mathematical reasoning from 3rd grade to 4th grade among lower achieving partners. These effects held after controlling for peer acceptance and rejection, task avoidance, interest in mathematics, maternal support for homework, parental education, length of the friendship, and friendship group norms on mathematical reasoning. © 2015 The British Psychological Society.

  10. Stable Same-Sex Friendships with Higher Achieving Partners Promote Mathematical Reasoning in Lower Achieving Primary School Children

    PubMed Central

    DeLay, Dawn; Laursen, Brett; Kiuru, Noona; Poikkeus, Anna-Maija; Aunola, Kaisa; Nurmi, Jari-Erik

    2015-01-01

    This study is designed to investigate friend influence over mathematical reasoning in a sample of 374 children in 187 same-sex friend dyads (184 girls in 92 friendships; 190 boys in 95 friendships). Participants completed surveys that measured mathematical reasoning in the 3rd grade (approximately 9 years old) and one year later in the 4th grade (approximately 10 years old). Analyses designed for dyadic data (i.e., longitudinal Actor-Partner Interdependence Models) indicated that higher achieving friends influenced the mathematical reasoning of lower achieving friends, but not the reverse. Specifically, greater initial levels of mathematical reasoning among higher achieving partners in the 3rd grade predicted greater increases in mathematical reasoning from 3rd grade to 4th grade among lower achieving partners. These effects held after controlling for peer acceptance and rejection, task avoidance, interest in mathematics, maternal support for homework, parental education, length of the friendship, and friendship group norms on mathematical reasoning. PMID:26402901

  11. Cryptic disease-induced mortality may cause host extinction in an apparently stable host-parasite system.

    PubMed

    Valenzuela-Sánchez, Andrés; Schmidt, Benedikt R; Uribe-Rivera, David E; Costas, Francisco; Cunningham, Andrew A; Soto-Azat, Claudio

    2017-09-27

    The decline of wildlife populations due to emerging infectious disease often shows a common pattern: the parasite invades a naive host population, producing epidemic disease and a population decline, sometimes with extirpation. Some susceptible host populations can survive the epidemic phase and persist with endemic parasitic infection. Understanding host-parasite dynamics leading to persistence of the system is imperative to adequately inform conservation practice. Here we combine field data, statistical and mathematical modelling to explore the dynamics of the apparently stable Rhinoderma darwinii - Batrachochytrium dendrobatidis (Bd) system. Our results indicate that Bd-induced population extirpation may occur even in the absence of epidemics and where parasite prevalence is relatively low. These empirical findings are consistent with previous theoretical predictions showing that highly pathogenic parasites are able to regulate host populations even at extremely low prevalence, highlighting that disease threats should be investigated as a cause of population declines even in the absence of an overt increase in mortality. © 2017 The Author(s).

  12. Relation of coronary collateral circulation with epicardial fat volume in patients with stable coronary artery disease

    PubMed Central

    Enhos, Asım; Sahin, Irfan; Can, Mehmet Mustafa; Biter, Ibrahim; Dinckal, Mustafa Hakan; Serebruany, Victor

    2013-01-01

    Objective To investigated the relationship between epicardial fat volume (EFV) and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). Methods The study population consisted of 152 consecutive patients with CAD who underwent coronary angiography and were found to have at least 95% significiant lesion in at least one major coronary artery. EFV was assessed utilizing 64-multislice computed tomography. The patients were classifield into impaired CCC group (Group 1, Rentrop grades 0−1, n = 58), or adequate CCC (Group 2, Rentrop grades 2−3, n = 94). Results The EFV values were significantly higher in paitients with adequate CCC than in those with impaired CCC. In multivariate logistic regression analysis, EFV (OR = 1.059; 95% CI: 1.035−1.085; P = 0.001); and presence of angina were independent predictors of adequate CCC. In receiver-operating characteristic curve analysis, the EFV value > 106.5 mL yielded an area under the curve value of 0.84, with the test sensitivity of 49.3%, and with 98.3% specifity. Conclusions High EFV, and the presence of angina independently predict adequate CCC in patients with stable coronary artery disease. This association offers new diagnostic opportinities to assess collateral flow by conventional ultrasound techniques. PMID:24454327

  13. Medical therapy v. PCI in stable coronary artery disease: a cost-effectiveness analysis.

    PubMed

    Wijeysundera, Harindra C; Tomlinson, George; Ko, Dennis T; Dzavik, Vladimir; Krahn, Murray D

    2013-10-01

    Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS) reduces angina and repeat procedures compared with optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset their increased costs and small increase in adverse events. Cost utility analysis of initial medical therapy v. PCI with either BMS or DES. . Markov cohort decision model. Data Sources. Propensity-matched observational data from Ontario, Canada, for baseline event rates. Effectiveness and utility data obtained from the published literature, with costs from the Ontario Case Costing Initiative. Patients with stable coronary artery disease, confirmed after angiography, stratified by risk of restenosis based on diabetic status, lesion size, and lesion length. Time Horizon. Lifetime. Perspective. Ontario Ministry of Health and Long Term Care. Interventions. Optimal medical therapy, PCI with BMS or DES. Lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). of Base Case Analysis. In the overall population, medical therapy had the lowest lifetime costs at $22,952 v. $25,081 and $25,536 for BMS and DES, respectively. Medical therapy had a quality-adjusted life expectancy of 10.1 v. 10.26 QALYs for BMS, producing an ICER of $13,271/QALY. The DES strategy had a quality-adjusted life expectancy of only 10.20 QALYs and was dominated by the BMS strategy. This ranking was consistent in all groups stratified by restenosis risk, except diabetic patients with long lesions in small arteries, in whom DES was cost-effective compared with medical therapy (ICER of $18,826/QALY). Limitations. There is the possibility of residual unobserved confounding. In patients with stable coronary artery disease, an initial BMS strategy is cost-effective.

  14. Serum Uric Acid Levels and Uric Acid/Creatinine Ratios in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients: Are These Parameters Efficient Predictors of Patients at Risk for Exacerbation and/or Severity of Disease?

    PubMed

    Durmus Kocak, Nagihan; Sasak, Gulsah; Aka Akturk, Ulku; Akgun, Metin; Boga, Sibel; Sengul, Aysun; Gungor, Sinem; Arinc, Sibel

    2016-11-03

    BACKGROUND Serum uric acid (sUA) levels were previously found to be correlated with hypoxic states. We aimed to determine the levels of sUA and sUA/creatinine ratios in stable COPD patients and to evaluate whether sUA level and sUA/creatinine ratio can be used as predictors of exacerbation risk and disease severity. MATERIAL AND METHODS This cross-sectional study included stable COPD patients and healthy controls. The sUA levels and sUA/creatinine ratios in each group were evaluated and their correlations with the study parameters were investigated. ROC analyses for exacerbation risk and disease severity were reported. RESULTS The study included 110 stable COPD patients and 52 healthy controls. The mean sUA levels and sUA/creatinine ratios were significantly higher in patients with COPD compared to healthy controls. The most common comorbidities in COPD patients were hypertension, diabetes, and coronary artery disease. While sUA levels were significantly higher in patients with hypertension (p=0.002) and malignancy (p=0.033), sUA/creatinine ratios was higher in patients with malignancy (p=0.004). The ROC analyses indicated that sUA/creatinine ratios can be more useful than sUA levels in predicting exacerbation risk (AUC, 0.586 vs. 0.426) and disease severity (AUC, 0.560 vs. 0.475) especially at higher cut-off values, but with low specificity. CONCLUSIONS Our study suggested that sUA levels and sUA/creatinine ratios increased in patients with stable COPD, especially among patients with certain comorbidities compared to healthy controls. At higher cut-off values, sUA levels and especially sUA/creatinine ratios, might be useful in predicting COPD exacerbation risk and disease severity. Also, their association with comorbidities, especially with malignancy and hypertension, may benefit from further investigation.

  15. Adaptive evolution influences the infectious dose of MERS-CoV necessary to achieve severe respiratory disease.

    PubMed

    Douglas, Madeline G; Kocher, Jacob F; Scobey, Trevor; Baric, Ralph S; Cockrell, Adam S

    2018-04-01

    We recently established a mouse model (288-330 +/+ ) that developed acute respiratory disease resembling human pathology following infection with a high dose (5 × 10 6 PFU) of mouse-adapted MERS-CoV (icMERSma1). Although this high dose conferred fatal respiratory disease in mice, achieving similar pathology at lower viral doses may more closely reflect naturally acquired infections. Through continued adaptive evolution of icMERSma1 we generated a novel mouse-adapted MERS-CoV (maM35c4) capable of achieving severe respiratory disease at doses between 10 3 and 10 5 PFU. Novel mutations were identified in the maM35c4 genome that may be responsible for eliciting etiologies of acute respiratory distress syndrome at 10-1000 fold lower viral doses. Importantly, comparative genetics of the two mouse-adapted MERS strains allowed us to identify specific mutations that remained fixed through an additional 20 cycles of adaptive evolution. Our data indicate that the extent of MERS-CoV adaptation determines the minimal infectious dose required to achieve severe respiratory disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Evaluation of Inhaled Procaterol for Potential Assist Use in Patients with Stable Chronic Obstructive Pulmonary Disease.

    PubMed

    Kodaka, Norio; Yamagishi, Toru; Watanabe, Kayo; Kishimoto, Kumiko; Nakano, Chihiro; Oshio, Takeshi; Niitsuma, Kumiko; Shimada, Nagashige; Matsuse, Hiroto

    2018-05-17

    International guidelines recommend the use of long-acting bronchodilators for the treatment of chronic obstructive pulmonary disease (COPD), but the usefulness of short-acting bronchodilator assist use for stable COPD remains uncertain. The purpose of the present study was to objectively demonstrate the effects of assist use of procaterol, a short-acting -agonist, on the respiratory mechanics of stable COPD patients treated with a long-acting bronchodilator using forced oscillation technique (FOT) and conventional spirometry. We also confirmed the length of time for which procaterol assist could significantly improve pulmonary function. We enrolled 28 outpatients with mild to severe COPD (GOLD stages I-III), who had used the same long-acting bronchodilator for longer than 3 months and who were in stable condition. All measures were performed using both FOT and spirometry sequentially from 15 min to 2 h after inhalation. Compared to baseline, inhaled procaterol assist use modestly but significantly improved spirometric and FOT measurements within 2 h after inhalation. These significant effects continued for at least 2 h. Significant correlations were found between parameters measured by spirometry and those measured by FOT. Procaterol assist use modestly but significantly improved pulmonary function determined by spirometry and respiratory mechanics in patients with stable COPD treated with long-acting bronchodilators. Thus, inhaled procaterol has potential for assist use for COPD. ©2018The Author(s). Published by S. Karger AG, Basel.

  17. C.E.R.A. administered once monthly corrects and maintains stable hemoglobin levels in chronic kidney disease patients not on dialysis: the observational study MICENAS II.

    PubMed

    Martínez-Castelao, Alberto; Cases, Aleix; Coll, Elisabeth; Bonal, Jordi; Galceran, Josep M; Fort, Joan; Moreso, Francesc; Torregrosa, Vicente; Guirado, Lluís; Ruiz, Pilar

    2015-01-01

    C.E.R.A. (continuous erythropoietin receptor activator, pegilated-rHuEPO ß) corrects and maintains stable hemoglobin levels in once-monthly administration in chronic kidney disease (CKD) patients. The aim of this study was to evaluate the management of anemia with C.E.R.A. in CKD patients not on dialysis in the clinical setting. Two hundred seventy two anemic CKD patients not on dialysis treated with C.E.R.A. were included in this retrospective, observational, multicentric study during 2010. Demographical characteristics, analytical parameters concerning anemia, treatment data and iron status were recorded. C.E.R.A. achieved a good control of anemia in both naïve patients (mean Hemoglobin 11.6g/dL) and patients converted from a previous ESA (mean Hemoglobin 11.7g/dL). Most naïve patients received C.E.R.A. once monthly during the correction phase and required a low monthly dose (median dose 75 µg/month). The same median dose was required in patients converted from a previous ESA, and it was lower than recommended in the Summary of Product Characteristics (SPC). Iron status was adequate in 75% of anemic CKD patients, but only 50% of anemic patients with iron deficiency received iron supplementation. C.E.R.A. corrects and maintains stable hemoglobin levels in anemic CKD patients not on dialysis, requiring conversion doses lower than those recommended by the SPC, and achieving target hemoglobin levels with once-monthly dosing frequency both in naïve and converted patients.

  18. Predictive Model for Anxiety and Depression in Spanish Patients with Stable Chronic Obstructive Pulmonary Disease.

    PubMed

    González-Gutiérrez, María Victoria; Guerrero Velázquez, José; Morales García, Concepción; Casas Maldonado, Francisco; Gómez Jiménez, Francisco Javier; González Vargas, Francisco

    2016-03-01

    The association between chronic obstructive pulmonary disease (COPD) and anxiety and depression is not yet completely characterized, and differences between countries may exist. We used a predictive model to assess this association in a Spanish population. Prospective transversal descriptive study of 204 patients with stable COPD. Concomitant anxiety or depression were diagnosed by psychiatric assessment, using the diagnostic criteria of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Sociodemographic, clinical and lung function parameters were analyzed. In total, 36% of stable COPD patients had psychiatric comorbidities, but 76% were unaware of their diagnosis. Nineteen percent had a pure anxiety disorder, 9.8% had isolated depression, and 7.3% had a mixed anxiety-depression disorder. Predictive variables in the multivariate analysis were younger age, higher educational level, lack of home support, higher BODE index, and greater number of exacerbations. The ROC curve of the model had an AUC of 0.765 (P<0.001). In COPD, concomitant psychiatric disorders are significantly associated with sociodemographic factors. Anxiety disorders are more common than depression. Patients with more severe COPD, according to BODE, younger patients and those with a higher educational level have a greater risk of being diagnosed with anxiety or depression in a structured psychiatric interview. In our population, most patients with psychiatric comorbidities remain unidentified. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  19. Plasma big endothelin-1 level and the severity of new-onset stable coronary artery disease.

    PubMed

    Chen, Juan; Chen, Man-Hua; Guo, Yuan-Lin; Zhu, Cheng-Gang; Xu, Rui-Xia; Dong, Qian; Li, Jian-Jun

    2015-01-01

    To investigate the usefulness of the plasma big endothelin-1 (big ET-1) level in predicting the severity of new-onset stable angiography-proven coronary artery disease (CAD). A total of 963 consecutive stable CAD patients with more than 50% stenosis in at least one main vessel were enrolled. The patients were classified into the three groups according to the tertile of the Gensini score (GS, low GS <20, n=300; intermediate GS 20-40, n=356 and high GS >40, n=307), and the relationship between the big ET-1 level and GS was evaluated. The plasma levels of big ET-1 increased significantly in association with increases in the GS tertile (p=0.007). A multivariate analysis suggested that the plasma big ET-1 level was an independent predictor for a high GS (OR=2.26, 95%CI: 1.23-4.15, p=0.009), and there was a positive correlation between the big ET-1 level and the GS (r=0.20, p=0.000). The area under the receiver operating characteristic curve (AUC) for the big ET-1 level in predicting a high GS was 0.64 (95% CI 0.60-0.68, p=0.000), and the optimal cutoff value for the plasma big ET-1 level for predicting a high GS was 0.34 fmol/mL, with a sensitivity of 62.6% and specificity of 60.3%. In the high-big ET-1 level group (≥0.34 fmol/mL), there were significantly increased rates of three-vessel disease (43.6% vs. 35.4%, p=0.017) and a high GS [31 (17-54) vs. 24 (16-44), p=0.001] compared with that observed in the low-big ET-1 level group. The present findings indicate that the plasma big ET-1 level is a useful predictor of the severity of new-onset stable CAD associated with significant stenosis.

  20. Perindopril and β-blocker for the prevention of cardiac events and mortality in stable coronary artery disease patients: A EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) subanalysis.

    PubMed

    Bertrand, Michel E; Ferrari, Roberto; Remme, Willem J; Simoons, Maarten L; Fox, Kim M

    2015-12-01

    β-Blockers relieve angina/ischemia in stable coronary artery disease (CAD), and angiotensin-converting enzyme inhibitors prevent CAD outcomes. In EUROPA, the angiotensin-converting enzyme inhibitor perindopril reduced cardiovascular outcomes in low-risk stable CAD patients over 4.2 years. This post hoc analysis examined whether the addition of perindopril to β-blocker in EUROPA had additional benefits on outcomes compared with standard therapy including β-blocker. EUROPA was a multicenter, double-blind, placebo-controlled, randomized trial in patients with documented stable CAD. Randomized EUROPA patients who received β-blocker at baseline were identified, and the effect on cardiovascular outcomes of adding perindopril or placebo was analyzed. Endpoints were the same as those in EUROPA. At baseline, 62% (n = 7534 [3789 on perindopril and 3745 on placebo]) received β-blocker. Treatment with perindopril/β-blocker reduced the relative risk of the primary end point (cardiovascular death, nonfatal myocardial infarction, and resuscitated cardiac arrest) by 24% compared with placebo/β-blocker (HR, 0.76; 95% CI, 0.64-0.91; P = .002). Addition of perindopril also reduced fatal or nonfatal myocardial infarction by 28% (HR, 0.72; 95% CI, 0.59-0.88; P = .001) and hospitalization for heart failure by 45% (HR, 0.55; 95% CI, 0.33-0.93; P = .025). Serious adverse drug reactions were rare in both groups, and cardiovascular death and hospitalizations occurred less often with perindopril/β-blocker. The addition of perindopril to β-blocker in stable CAD patients was safe and resulted in reductions in cardiovascular outcomes and mortality compared with standard therapy including β-blocker. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease.

    PubMed

    Toyota, Toshiaki; Morimoto, Takeshi; Shiomi, Hiroki; Ando, Kenji; Ono, Koh; Shizuta, Satoshi; Kato, Takao; Saito, Naritatsu; Furukawa, Yutaka; Nakagawa, Yoshihisa; Horie, Minoru; Kimura, Takeshi

    2017-03-24

    Few studies have evaluated the prevalence and clinical outcomes of ad hoc percutaneous coronary intervention (PCI), performing diagnostic coronary angiography and PCI in the same session, in stable coronary artery disease (CAD) patients.Methods and Results:From the CREDO-Kyoto PCI/CABG registry cohort-2, 6,943 patients were analyzed as having stable CAD and undergoing first PCI. Ad hoc PCI and non-ad hoc PCI were performed in 1,722 (24.8%) and 5,221 (75.1%) patients, respectively. The cumulative 5-year incidence and adjusted risk for all-cause death were not significantly different between the 2 groups (15% vs. 15%, P=0.53; hazard ratio: 1.15, 95% confidence interval: 0.98-1.35, P=0.08). Ad hoc PCI relative to non-ad hoc PCI was associated with neutral risk for myocardial infarction, any coronary revascularization, and bleeding, but was associated with a trend towards lower risk for stroke (hazard ratio: 0.78, 95% confidence interval: 0.60-1.02, P=0.06). Ad hoc PCI in stable CAD patients was associated with at least comparable 5-year clinical outcomes as with non-ad hoc PCI. Considering patients' preference and the cost-saving, the ad hoc PCI strategy might be a safe and attractive option for patients with stable CAD, although the prevalence of ad hoc PCI was low in the current study population.

  2. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial.

    PubMed

    Connolly, Stuart J; Eikelboom, John W; Bosch, Jackie; Dagenais, Gilles; Dyal, Leanne; Lanas, Fernando; Metsarinne, Kaj; O'Donnell, Martin; Dans, Anthony L; Ha, Jong-Won; Parkhomenko, Alexandr N; Avezum, Alvaro A; Lonn, Eva; Lisheng, Liu; Torp-Pedersen, Christian; Widimsky, Petr; Maggioni, Aldo P; Felix, Camilo; Keltai, Katalin; Hori, Masatsugu; Yusoff, Khalid; Guzik, Tomasz J; Bhatt, Deepak L; Branch, Kelley R H; Cook Bruns, Nancy; Berkowitz, Scott D; Anand, Sonia S; Varigos, John D; Fox, Keith A A; Yusuf, Salim

    2017-11-10

    Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic events but have not yet been tested in combination or against each other in patients with stable coronary artery disease. In this multicentre, double-blind, randomised, placebo-controlled, outpatient trial, patients with stable coronary artery disease or peripheral artery disease were recruited at 602 hospitals, clinics, or community centres in 33 countries. This paper reports on patients with coronary artery disease. Eligible patients with coronary artery disease had to have had a myocardial infarction in the past 20 years, multi-vessel coronary artery disease, history of stable or unstable angina, previous multi-vessel percutaneous coronary intervention, or previous multi-vessel coronary artery bypass graft surgery. After a 30-day run in period, patients were randomly assigned (1:1:1) to receive rivaroxaban (2·5 mg orally twice a day) plus aspirin (100 mg once a day), rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg orally once a day). Randomisation was computer generated. Each treatment group was double dummy, and the patients, investigators, and central study staff were masked to treatment allocation. The primary outcome of the COMPASS trial was the occurrence of myocardial infarction, stroke, or cardiovascular death. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. Between March 12, 2013, and May 10, 2016, 27 395 patients were enrolled to the COMPASS trial, of whom 24 824 patients had stable coronary artery disease from 558 centres. The combination of rivaroxaban plus aspirin reduced the primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of 8261; hazard ratio [HR] 0·74, 95% CI 0·65-0·86, p<0·0001). By comparison

  3. Detection of adenovirus and respiratory syncytial virus in patients with chronic obstructive pulmonary disease: Exacerbation versus stable condition.

    PubMed

    Kokturk, Nurdan; Bozdayi, Gulendam; Yilmaz, Senay; Doğan, Bora; Gulbahar, Ozlem; Rota, Seyyal; Tatlicioglu, Turkan

    2015-08-01

    Latent infection with adenovirus and respiratory syncytial virus (RSV) is associated with chronic obstructive pulmonary disease (COPD). The role of respiratory viral infections are emerging in COPD exacerbations. The present study aimed to investigate the prevalence of adenovirus and RSV serotypes A and B in individuals with acute exacerbations of COPD (COPD-AE) and stable COPD. Twenty seven patients with COPD-AE were evaluated using a prospective longitudinal study design. Induced sputum, sera and nasal smears were sampled from patients experiencing COPD-AE and those in a stable condition. Adenoplex® multiplex polymerase chain reaction (PCR) kits and Invitek RTP® DNA/RNA Virus Mini kits were used for PCR assays of adenovirus and RSV, respectively. Eighteen patients who experienced a COPD-AE were also evaluated while in a stable condition. The results showed that three sputum samples were positive for adenovirus in patients experiencing an exacerbation, while one was positive among the patients in a stable condition. RSV serotype A was detected in 17/27 (63%) patients with COPD-AE and 10/18 (55.6%) patients in a stable condition. RSV serotype B was not detected. Patients with COPD-AE, who were positive for RSV serotype A exhibited higher serum fibrinogen levels than those who were negative (438.60 ± 126.08 mg/dl compared with 287.60 ± 85.91 mg/dl; P=0.004). Eight/ten patients who were positive for RSV serotype A while in a stable condition, were also positive during COPD-AE. The results of the present study suggested that RSV infection may be prevalent in patients with COPD-AE and in those in a stable condition. Therefore, chronic RSV infection may occur in COPD. The detection and prevention of RSV may be useful in the management of COPD.

  4. Periodontal status affects C-reactive protein and lipids in patients with stable heart disease from a tertiary care cardiovascular clinic.

    PubMed

    Flores, Manuela F; Montenegro, Marlon M; Furtado, Mariana V; Polanczyk, Carisi A; Rösing, Cassiano K; Haas, Alex N

    2014-04-01

    There are scarce data on the impact of the periodontal condition in the control of biomarkers in patients with cardiovascular disease (CVD). The aim of this study is to assess whether periodontal inflammation and tissue breakdown are associated with C-reactive protein (CRP) and lipids in patients with stable heart disease. This cross-sectional study included 93 patients with stable coronary artery disease (57 males; mean age: 63.5 ± 9.8 years) who were in outpatient care for at least 6 months. After applying a structured questionnaire, periodontal examinations were performed by two calibrated periodontists in six sites per tooth at all teeth. Blood samples were collected from patients on the day of periodontal examination to determine levels of CRP, lipids, and glycated hemoglobin. Multiple linear regression models were fitted to evaluate the association among different periodontal and blood parameters controlling for sex, body mass index, glycated hemoglobin, use of oral hypoglycemic drugs, and smoking. Overall, the sample presented high levels of periodontal inflammation and tissue breakdown. Unadjusted mean concentrations of triglycerides (TGs), very-low-density lipoprotein cholesterol, and glucose were significantly higher in individuals with severe periodontitis. When multiple linear regression models were applied, number of teeth with clinical attachment loss ≥6 mm and presence of severe periodontitis were significantly associated with higher CRP concentrations. Bleeding on probing was significantly associated with TGs, total cholesterol, and non-high-density lipoprotein cholesterol. In this sample of patients with stable CVD, current periodontal inflammation and tissue breakdown are associated with cardiovascular inflammatory markers, such as CRP and lipid profile.

  5. Chronic Kidney Disease and Risk of Presenting with Acute Myocardial Infarction versus Stable Exertional Angina in Adults with Coronary Heart Disease

    PubMed Central

    Go, Alan S.; Bansal, Nisha; Chandra, Malini; Lathon, Phenius V.; Fortmann, Stephen P.; Iribarren, Carlos; Hsu, Chi-yuan; Hlatky, Mark A.

    2011-01-01

    Objective To examine whether kidney dysfunction is associated with the type of clinical presentation of coronary heart disease (CHD). Background Reduced kidney function increases risk of developing CHD, but it is not known whether it also influences the acuity of clinical presentation, which has important prognostic implications. Methods We conducted a case-control study of subjects whose first clinical presentation of CHD was either acute myocardial infarction or stable exertional angina between October 2001-December 2003. Glomerular filtration rate (eGFR) before the incident event was estimated using calibrated serum creatinine and the abbreviated MDRD equation. Patient characteristics and use of medications were ascertained from self-report and health plan databases. We used multivariable logistic regression to examine the association of reduced eGFR and CHD presentation. Results We studied 803 adults with incident acute myocardial infarction and 419 adults with incident stable exertional angina who had a baseline eGFR ≤130 ml/min/1.73 m2. Mean eGFR was lower among subjects with acute myocardial infarction compared with stable angina. Compared with eGFR 90–130 ml/min/1.73 m2, we found a strong, graded independent association between reduced eGFR and presenting with acute myocardial infarction: adjusted odds ratio (OR) 1.36 (95% CI: 0.99 to 1.86) for eGFR 60–89 ml/min/1.73 m2, OR 1.55 (0.92 to 2.62) for eGFR 45–59 ml/min/1.73 m2 and OR 3.82 (1.55 to 9.46) for eGFR <45 ml/min/1.73 m2 (P<0.001 for trend). Conclusion eGFR less than 45 ml/min/1.73 m2 is a strong, independent predictor of presenting with acute myocardial infarction versus stable angina as the initial manifestation of CHD. PMID:21958887

  6. Stable isotopic labeling-based quantitative targeted glycomics (i-QTaG).

    PubMed

    Kim, Kyoung-Jin; Kim, Yoon-Woo; Kim, Yun-Gon; Park, Hae-Min; Jin, Jang Mi; Hwan Kim, Young; Yang, Yung-Hun; Kyu Lee, Jun; Chung, Junho; Lee, Sun-Gu; Saghatelian, Alan

    2015-01-01

    Mass spectrometry (MS) analysis combined with stable isotopic labeling is a promising method for the relative quantification of aberrant glycosylation in diseases and disorders. We developed a stable isotopic labeling-based quantitative targeted glycomics (i-QTaG) technique for the comparative and quantitative analysis of total N-glycans using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We established the analytical procedure with the chemical derivatizations (i.e., sialic acid neutralization and stable isotopic labeling) of N-glycans using a model glycoprotein (bovine fetuin). Moreover, the i-QTaG using MALDI-TOF MS was evaluated with various molar ratios (1:1, 1:2, 1:5) of (13) C6 /(12) C6 -2-aminobenzoic acid-labeled glycans from normal human serum. Finally, this method was applied to direct comparison of the total N-glycan profiles between normal human sera (n = 8) and prostate cancer patient sera (n = 17). The intensities of the N-glycan peaks from i-QTaG method showed a good linearity (R(2) > 0.99) with the amount of the bovine fetuin glycoproteins. The ratios of relative intensity between the isotopically 2-AA labeled N-glycans were close to the theoretical molar ratios (1:1, 1:2, 1:5). We also demonstrated that the up-regulation of the Lewis antigen (~82%) in sera from prostate cancer patients. In this proof-of-concept study, we demonstrated that the i-QTaG method, which enables to achieve a reliable comparative quantitation of total N-glycans via MALDI-TOF MS analysis, has the potential to diagnose and monitor alterations in glycosylation associated with disease states or biotherapeutics. © 2015 American Institute of Chemical Engineers.

  7. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis

    PubMed Central

    Stortecky, Stefan; Stefanini, Giulio G; daCosta, Bruno R; Rutjes, Anne Wilhelmina; Di Nisio, Marcello; Siletta, Maria G; Maione, Ausilia; Alfonso, Fernando; Clemmensen, Peter M; Collet, Jean-Philippe; Cremer, Jochen; Falk, Volkmar; Filippatos, Gerasimos; Hamm, Christian; Head, Stuart; Kappetein, Arie Pieter; Kastrati, Adnan; Knuuti, Juhani; Landmesser, Ulf; Laufer, Günther; Neumann, Franz-Joseph; Richter, Dimitri; Schauerte, Patrick; Sousa Uva, Miguel; Taggart, David P; Torracca, Lucia; Valgimigli, Marco; Wijns, William; Witkowski, Adam; Kolh, Philippe; Juni, Peter

    2014-01-01

    Objective To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. Design Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. Eligibility criteria for selecting studies A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. Data sources Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation. Main outcome measure All cause mortality. Results 100 trials in 93 553 patients with 262 090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably

  8. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.

    PubMed

    Seemungal, T; Harper-Owen, R; Bhowmik, A; Moric, I; Sanderson, G; Message, S; Maccallum, P; Meade, T W; Jeffries, D J; Johnston, S L; Wedzicha, J A

    2001-11-01

    The effects of respiratory viral infection on the time course of chronic obstructive pulmonary disease (COPD) exacerbation were examined by monitoring changes in systemic inflammatory markers in stable COPD and at exacerbation. Eighty-three patients with COPD (mean [SD] age, 66.6 [7.1] yr, FEV(1), 1.06 [0.61] L) recorded daily peak expiratory flow rate and any increases in respiratory symptoms. Nasal samples and blood were taken for respiratory virus detection by culture, polymerase chain reaction, and serology, and plasma fibrinogen and serum interleukin-6 (IL-6) were determined at stable baseline and exacerbation. Sixty-four percent of exacerbations were associated with a cold occurring up to 18 d before exacerbation. Seventy-seven viruses (39 [58.2%] rhinoviruses) were detected in 66 (39.2%) of 168 COPD exacerbations in 53 (64%) patients. Viral exacerbations were associated with frequent exacerbators, colds with increased dyspnea, a higher total symptom count at presentation, a longer median symptom recovery period of 13 d, and a tendency toward higher plasma fibrinogen and serum IL-6 levels. Non-respiratory syncytial virus (RSV) respiratory viruses were detected in 11 (16%), and RSV in 16 (23.5%), of 68 stable COPD patients, with RSV detection associated with higher inflammatory marker levels. Respiratory virus infections are associated with more severe and frequent exacerbations, and may cause chronic infection in COPD. Prevention and early treatment of viral infections may lead to a decreased exacerbation frequency and morbidity associated with COPD.

  9. Heart rate and use of β-blockers in Mexican stable outpatients with coronary artery disease.

    PubMed

    Alcocer-Gamba, Marco Antonio; Martínez-Sánchez, Carlos; Verdejo-Paris, Juan; Ferrari, Roberto; Fox, Kim; Greenlaw, Nicola; Steg Philippe, Gabriel

    2015-01-01

    To evaluate the use of β-blockers and to monitor heart rate in Mexican patients with coronary artery disease. CLARIFY is an outpatients registry with stable CAD. A total of 33,283 patients from 45 countries were enrolled between November 2009 and July 2010 from which 1342 were Mexican patients. The mean HR pulse was 70 bpm (beats per minute). Patients in Mexico were compared with the remaining global CLARIFY population. Patients in Mexico had a higher incidence of acute myocardial infarction and percutaneous coronary intervention, and lower incidence of revascularization surgery compared with the remaining CLARIFY population. More often, Mexican patients presented with diabetes, but less often hypertension and stroke. These patients were split into three mutually exclusive groups of HR ≤ 60 (N=263), HR 61-69 (N=356) and HR ≥ 70 (N=722). Patients with elevated HR had a higher incidence of diabetes and higher diastolic blood pressure on average than those with controlled HR. Regarding the use of β-blockers, they were used in 63.3% of patients, 2.7% showed intolerance or contraindication to treatment to monitor heart rate, and ivabradine was used in 2.3%. Out of approximately 849 patients receiving treatment of β-blockers, 52.1% had ≥ 70 bpm HR. In a large proportion of Mexican patients with stable coronary disease the HR remain elevated, > 70 bpm, even with the use of β-blockers; this requires further attention. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  10. Transradial percutaneous coronary intervention without on-site cardiac surgery for stable coronary disease and myocardial infarction: preliminary report and initial experience in 174 patients.

    PubMed

    Escárcega, Ricardo O; Pérez-Alva, Juan C; Jiménez-Hernández, Mario; Mendoza-Pinto, Claudia; Pérez, Ruben S; Porras, Renán S; García-Carrasco, Mario

    2010-10-01

    On-site cardiac surgery is not widely available in developing countries despite a high prevalence of coronary artery disease. To analyze the safety, feasibility and cost-effectiveness of transradial percutaneous coronary intervention without on-site cardiac surgery in a community hospital in a developing country. Of the 174 patients who underwent PCI for the first time in our center, we analyzed two groups: stable coronary disease and acute myocardial infarction. The primary endpoint was the rate of complications during the first 24 hours after PCI. We also analyzed the length of hospital stay and the rate of hospital readmission in the first week after PCI, and compared costs between the radial and femoral approaches. The study group comprised 131 patients with stable coronary disease and 43 with acute MI. Among the patients with stable coronary disease 8 (6.1%) had pulse loss, 12 (9.16%) had on-site hematoma, and 3 (2.29%) had bleeding at the site of the puncture. Among the patients with acute MI, 3 (6.98) had pulse loss and 5 (11.63%) had bleeding at the site of the puncture. There were no cases of atriovenous fistula or nerve damage. In the stable coronary disease group, 130 patients (99%) were discharged on the same day (2.4 +/- 2 hours). In the acute MI group, the length of stay was 6.6 +/- 2.5 days with at least 24 hours in the intensive care unit. There were no hospital readmissions in the first week after the procedure. The total cost, which includes equipment related to the specific approach and recovery room stay, was significantly lower with the radial approach compared to the femoral approach (US$ 500 saving per intervention). The transradial approach was safe and feasible in a community hospital in a developing country without on-site cardiac surgery backup. The radial artery approach is clearly more cost-effective than the femoral approach.

  11. [Geographical differences in clinical characteristics and management of stable outpatients with coronary artery disease: comparison between the Italian and international population included in the Worldwide CLARIFY registry].

    PubMed

    Pozzoli, Massimo; Tavazzi, Luigi

    2014-04-01

    Limited data are available regarding specific differences among countries in demographic and clinical characteristics and treatment of patients with stable coronary artery disease. CLARIFY is an international, prospective and longitudinal registry including more than 33 000 patients with stable coronary artery disease enrolled in 45 countries worldwide. Data were used to compare the characteristics of patients enrolled in Italy with those enrolled in Europe and in the rest of the world. Baseline data were available for 33 283 patients, 2112 of whom from Italy and 12 614 from the remaining western European countries. Italian patients were found to be older, more frequently smoker, hypertensive and with sedentary habits. In addition, they presented more frequently a history of myocardial infarction, carotid arterial disease and chronic obstructive pulmonary disease. In addition, when compared with patients of both European and international cohorts, more Italian patients had undergone coronary angiography and angioplasty. As far as treatment was concerned, a greater number of Italian patients were taking ivabradine, angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, nitrates, thienopyridines, while those taking beta-blockers, calcium antagonists and other antianginal medications were fewer. Among ambulatory patients with stable coronary artery disease, there are important geographic differences in terms of risk factors, clinical characteristics, surgical and pharmacological treatment.

  12. Approximated Stable Inversion for Nonlinear Systems with Nonhyperbolic Internal Dynamics. Revised

    NASA Technical Reports Server (NTRS)

    Devasia, Santosh

    1999-01-01

    A technique to achieve output tracking for nonminimum phase nonlinear systems with non- hyperbolic internal dynamics is presented. The present paper integrates stable inversion techniques (that achieve exact-tracking) with approximation techniques (that modify the internal dynamics) to circumvent the nonhyperbolicity of the internal dynamics - this nonhyperbolicity is an obstruction to applying presently available stable inversion techniques. The theory is developed for nonlinear systems and the method is applied to a two-cart with inverted-pendulum example.

  13. Formestane, a steroidal aromatase inhibitor after failure of non-steroidal aromatase inhibitors (anastrozole and letrozole): is a clinical benefit still achievable?

    PubMed

    Carlini, P; Frassoldati, A; De Marco, S; Casali, A; Ruggeri, E M; Nardi, M; Papaldo, P; Fabi, A; Paoloni, F; Cognetti, F

    2001-11-01

    There are few clinical data on the sequential use of aromatase inhibitors (AI). This paper focuses on the relevance of clinical benefit CB (CR + PR + SD > or = 6 months) in postmenopausal metastatic breast cancer (MBC) patients treated with the steroidal aromatase inhibitor (SAI) formestane (FOR). who had already received non-steroidal aromatase inhibitor (nSAI): letrozole (LTZ) or anastrozole (ANZ). Twenty postmenopausal women with MBC were analysed in this retrospective two-centre study with the sequence nSAI-FOR. When receiving ANZ, 1 of 11 achieved a complete response and 9 of 11 a stable disease > or = 6 months, and receiving LTZ 1 of 9 achieved a partial response and 4 of 9 a stable disease > or = 6 months. The analysis of the entire population treated with FOR showed an overall CB of 55% (11 of 20) with a median duration of 15 months and median time to progression (TTP) of 6 months. Formestane 250 mg once bi-weekly seems to be an attractive alternative third-line hormonal therapy for the treatment of patients with MBC, previously treated with nSAI.

  14. Rumen-stable delivery systems.

    PubMed

    Papas; Wu

    1997-12-08

    Ruminants have a distinct digestive system which serves a unique symbiotic relationship between the host animal and predominantly anaerobic rumen bacteria and protozoa. Rumen fermentation can be both beneficial by enabling utilization of cellulose and non-protein nitrogen and detrimental by reducing the nutritive value of some carbohydrates, high biological value proteins and by hydrogenating unsaturated lipids. In addition it can also result in the modification and inactivation of many pharmacologically active ingredients administered to the host animal via the oral route. The advances in ruminant nutrition and health demand a rumen-stable delivery system which can deliver the active ingredient post-ruminally while simultaneously meet efficacy, safety and cost criteria. In contrast to drug delivery systems for humans, the demand for low-cost has hindered the development of effective rumen-stable delivery systems. Historically, heat and chemical treatment of feed components, low solubility analogues or lipid-based formulations have been used to achieve some degree of rumen-stability, and products have been developed accordingly. Recently, a polymeric pH-dependent rumen-stable delivery system has been developed and commercialized. The rationale of this delivery system is based on the pH difference between ruminal and abomasal fluids. The delivery system is composed of a basic polymer, a hydrophobic substance and a pigment material. It can be applied as a coating to solid particles via a common encapsulation method such as air-suspension coating. In the future, the delivery system could be used to deliver micronutrients and pharmaceuticals post-ruminally to ruminant animals. A further possible application of the delivery system is that it could also be combined with other controlled delivery devices/systems in order to enhance slow release or to achieve targeted delivery needs for ruminants. This paper discusses the rumen protection and the abomasal release mechanism

  15. Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  16. Determinants of heart rate turbulence in individuals without apparent heart disease and in patients with stable coronary artery disease.

    PubMed

    Pinnacchio, Gaetano; Lanza, Gaetano Antonio; Stazi, Alessandra; Careri, Giulia; Coviello, Ilaria; Mollo, Roberto; Crea, Filippo

    2015-12-01

    To assess the characteristics and determinants of heart rate turbulence (HRT) in individuals without any apparent heart disease and in patients with coronary artery disease (CAD). Heart rate turbulence parameters, turbulence onset (TO), and turbulence slope (TS) were calculated on 24 h electrocardiogram recordings in 209 individuals without any heart disease (group 1) and in 157 CAD patients (group 2). In group 1, only age independently predicted abnormal TO (≥0%) [odds ratio (OR), 1.05; P<0.001], while predictors of abnormal TS (≤2.5 ms/RR) were age (OR, 0.85; P < 0.001) and hypertension (OR, 0.19; P = 0.028). In group 2 patients, only age independently predicted TO (OR, 1.03; P = 0.038), while age (OR, 0.90; P = 0.001) and left ventricular ejection fraction (LVEF; OR, 1.07; P = 0.008) predicted TS. Heart rate turbulence values were different in groups 1 and 2. Turbulence onset was (mean, standard deviation) -1.80 ± 2.24 vs. -0.73 ± 1.61%, respectively (P < 0.001), whereas TS was (median, interquartile interval) 5.83 (3.25-10.55) vs. 2.93 (1.73-5.81) ms/RR, respectively (P < 0.001). Coronary artery disease group, however, did not predict abnormal HRT parameters in multivariable analyses, both in the whole population and when comparing two subgroups matched for age and gender. Age and (for TS) LVEF, indeed, were the only independent predictors of abnormal HRT. Age is a major HRT determinant both in subjects without any apparent heart disease and in stable CAD patients. Hypertension and LVEF contribute independently to HRT in these two groups, respectively. Coronary artery disease group was not by itself associated with abnormal HRT parameters in multivariable analyses. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  17. Small airway dysfunction in smokers with stable ischemic heart disease.

    PubMed

    Llontop, Claudia; Garcia-Quero, Cristina; Castro, Almudena; Dalmau, Regina; Casitas, Raquel; Galera, Raúl; Iglesias, Alberto; Martinez-Ceron, Elisabet; Soriano, Joan B; García-Río, Francisco

    2017-01-01

    A higher prevalence of airflow limitation (AL) has been described in patients with ischemic heart disease (IHD). Although small airway dysfunction (SAD) is an early feature of AL, there is little information about its occurrence in IHD patients. Our objective was to describe the prevalence of SAD in IHD patients, while comparing patient-related outcomes and future health risk among IHD patients with AL, SAD and normal lung function. In 118 consecutive smoking patients with stable IHD, comorbidities, utilization of healthcare resources, current treatment, blood biochemistry and health status were recorded. SAD was evaluated by impulse oscillometry, and pre- and post-bronchodilator spirometry was performed. The prevalence of AL and SAD were 20.3 (95% CI, 13.1-27.6%) and 26.3% (95% CI, 18.3-34.2%), respectively. Compared to the normal lung function group, patients with SAD and without AL had lower spirometric values, poorer quality of life and higher levels of C-reactive protein (CRP), as well as increased cardiovascular risk and more vascular age. In patients with normal spirometry, the presence of SAD was independently associated with pack-years, HDL-cholesterol and CRP levels. In patients with IHD, the presence of SAD is common and that it is associated with reduced health status and increased future cardiac risk.

  18. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease.

    PubMed

    Steg, Ph Gabriel; Ferrari, Roberto; Ford, Ian; Greenlaw, Nicola; Tardif, Jean-Claude; Tendera, Michal; Abergel, Hélène; Fox, Kim M

    2012-01-01

    Heart rate (HR) is an emerging risk factor in coronary artery disease (CAD). However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR. CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%). Mean (SD) age was 64.2 (10.5) years, HR by pulse was 68.3 (10.6) bpm, and by electrocardiogram was 67.2 (11.4) bpm. Overall, 44.0% had HR ≥ 70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR ≥ 70 bpm. HR ≥ 70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents. Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR ≥ 70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.

  19. Cognitive function in patients with stable coronary heart disease: Related cerebrovascular and cardiovascular responses.

    PubMed

    Gayda, Mathieu; Gremeaux, Vincent; Bherer, Louis; Juneau, Martin; Drigny, Joffrey; Dupuy, Olivier; Lapierre, Gabriel; Labelle, Véronique; Fortier, Annik; Nigam, Anil

    2017-01-01

    Chronic exercise has been shown to prevent or slow age-related decline in cognitive functions in otherwise healthy, asymptomatic individuals. We sought to assess cognitive function in a stable coronary heart disease (CHD) sample and its relationship to cerebral oxygenation-perfusion, cardiac hemodynamic responses, and [Formula: see text] peak compared to age-matched and young healthy control subjects. Twenty-two young healthy controls (YHC), 20 age-matched old healthy controls (OHC) and 25 patients with stable CHD were recruited. Cognitive function assessment included short term-working memory, perceptual abilities, processing speed, cognitive inhibition and flexibility and long-term verbal memory. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamic (impedance cardiography) and left frontal cerebral oxygenation-perfusion (near-infra red spectroscopy) were measured during and after a maximal incremental ergocycle test. Compared to OHC and CHD, YHC had higher [Formula: see text] peak, maximal cardiac index (CI max), cerebral oxygenation-perfusion (ΔO2 Hb, ΔtHb: exercise and recovery) and cognitive function (for all items) (P<0.05). Compared to OHC, CHD patients had lower [Formula: see text] peak, CI max, cerebral oxygenation-perfusion (during recovery) and short term-working memory, processing speed, cognitive inhibition and flexibility and long-term verbal memory (P<0.05). [Formula: see text] peak and CI max were related to exercise cerebral oxygenation-perfusion and cognitive function (P<0.005). Cerebral oxygenation-perfusion (exercise) was related to cognitive function (P<0.005). Stable CHD patients have a worse cognitive function, a similar cerebral oxygenation/perfusion during exercise but reduced one during recovery vs. their aged-matched healthy counterparts. In the all sample, cognitive functions correlated with [Formula: see text] peak, CI max and cerebral oxygenation-perfusion.

  20. Oxidative Phospholipidomics in health and disease: Achievements, challenges and hopes.

    PubMed

    Reis, Ana

    2017-10-01

    Phospholipid peroxidation products are recognized as important bioactive lipid mediators playing an active role as modulators in signalling events in inflammation, immunity and infection. The biochemical responses are determined by the oxidation structural features present in oxPL modulating biophysical and biological properties in model membranes and lipoproteins. In spite of the extensive work conducted with model systems over the last 20 years, the study of oxPL in biological systems has virtually stagnated. In fact, very little is known concerning the predominant oxPL in fluids and tissues, their basal levels, and any variations introduced with age, gender and ethnicity in health and disease. In consequence, knowledge on oxPL has not yet translated into clinical diagnostic, in the early and timely diagnosis of "silent" diseases such as atherosclerosis and cardiovascular diseases, or as prognosis tools in disease stratification and particularly useful in the context of multimorbidities. Their use as therapeutic solutions or the development of innovative functional biomaterials remains to be explored. This review summarizes the achievements made in the identification of oxPL revealing an enormous structural diversity. A brief overview of the challenges associated with the analysis of such diverse array of products is given and a critical evaluation on key aspects in the analysis pipeline that need to be addressed. Once these issues are addressed, Oxidative Phospholipidomics will hopefully lead to major breakthrough discoveries in biochemistry, pharmaceutical, and clinical areas for the upcoming 20 years. This article is part of Special Issue entitled 4-Hydroxynonenal and Related Lipid Oxidation Products. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Treatments for Parkinson disease--past achievements and current clinical needs.

    PubMed

    Poewe, Werner

    2009-02-17

    Although idiopathic Parkinson disease (PD) remains the only neurodegenerative disorder for which there are highly effective symptomatic therapies, there are still major unmet needs regarding its long-term management. Although levodopa continues as the gold standard for efficacy, its chronic use is associated with potentially disabling motor complications. Current evidence suggests that these are related to mode of administration, whereby multiple oral doses of levodopa generate pulsatile stimulation of striatal dopamine receptors. Current dopamine agonists, while producing more constant plasma levels, fail to match levodopa's efficacy. Strategies to treat levodopa-related motor complications are only partially effective, rarely abolishing motor fluctuations or dyskinesias. Best results are currently achieved with invasive strategies via subcutaneous (s.c.) or intraduodenal delivery of apomorphine or levodopa, or deep brain stimulation of the subthalamic nucleus. Another area of major unmet medical need is related to nondopaminergic and nonmotor symptoms of PD. Targeting transmitter systems beyond the dopamine system is an interesting approach, both for the motor and nonmotor problems of PD. So far, clinical trial evidence regarding 5-HT agonists, glutamate antagonists, adenosine A(2) antagonists and alpha-adrenergic receptor antagonists, has been inconsistent, but trials with cholinesterase inhibitors and atypical antipsychotics to treat dementia and psychosis, have been successful. However, the ultimate goal of PD medical management is modifying disease progression, thereby delaying the evolution of motor and nonmotor complications of advanced disease. As understanding of preclinical markers for PD develops, there is new hope for neuropreventive strategies to target "at risk" populations before clinical onset of disease.

  2. An Update on the Global Initiative for Chronic Obstructive Lung Disease 2017 Guidelines With a Focus on Classification and Management of Stable COPD.

    PubMed

    Burkes, Robert M; Donohue, James F

    2018-06-01

    The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines offer important changes to the assessment and management of stable COPD of importance to practitioners, respiratory therapists, pharmacists, and nurses who care for patients with COPD. Therapies are now chosen based on the burden of symptoms and the history of COPD exacerbations, and inhaler regimens are modifiable based on continual clinical reassessment. Although identifying the degree of airway obstruction remains important for informing the clinical status of the patient with COPD, FEV 1 is no longer used to direct the therapeutic approach. Therapies and modes of inhaled medication delivery for each GOLD grouping have been modified and reflect the need for reevaluation of patient symptoms and COPD exacerbation history as an indicator to add or withdraw therapies. As the knowledge of this important disease continues to expand, exacerbation and symptom prevention in patients with stable COPD will remain as an important target of COPD therapies and research. Novel drug combinations and delivery devices are sure to positively affect the practitioner's approach to patients with stable COPD. The new 2017 GOLD guidelines represent a step toward personalized care of the patient with COPD. Copyright © 2018 by Daedalus Enterprises.

  3. Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease.

    PubMed

    Lindholm, Daniel; Lindbäck, Johan; Armstrong, Paul W; Budaj, Andrzej; Cannon, Christopher P; Granger, Christopher B; Hagström, Emil; Held, Claes; Koenig, Wolfgang; Östlund, Ollie; Stewart, Ralph A H; Soffer, Joseph; White, Harvey D; de Winter, Robbert J; Steg, Philippe Gabriel; Siegbahn, Agneta; Kleber, Marcus E; Dressel, Alexander; Grammer, Tanja B; März, Winfried; Wallentin, Lars

    2017-08-15

    Currently, there is no generally accepted model to predict outcomes in stable coronary heart disease (CHD). This study evaluated and compared the prognostic value of biomarkers and clinical variables to develop a biomarker-based prediction model in patients with stable CHD. In a prospective, randomized trial cohort of 13,164 patients with stable CHD, we analyzed several candidate biomarkers and clinical variables and used multivariable Cox regression to develop a clinical prediction model based on the most important markers. The primary outcome was cardiovascular (CV) death, but model performance was also explored for other key outcomes. It was internally bootstrap validated, and externally validated in 1,547 patients in another study. During a median follow-up of 3.7 years, there were 591 cases of CV death. The 3 most important biomarkers were N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and low-density lipoprotein cholesterol, where NT-proBNP and hs-cTnT had greater prognostic value than any other biomarker or clinical variable. The final prediction model included age (A), biomarkers (B) (NT-proBNP, hs-cTnT, and low-density lipoprotein cholesterol), and clinical variables (C) (smoking, diabetes mellitus, and peripheral arterial disease). This "ABC-CHD" model had high discriminatory ability for CV death (c-index 0.81 in derivation cohort, 0.78 in validation cohort), with adequate calibration in both cohorts. This model provided a robust tool for the prediction of CV death in patients with stable CHD. As it is based on a small number of readily available biomarkers and clinical factors, it can be widely employed to complement clinical assessment and guide management based on CV risk. (The Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy Trial [STABILITY]; NCT00799903). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights

  4. Relationship between hematologic parameters and left ventricular systolic dysfunction in stable patients with multi-vessel coronary artery disease.

    PubMed

    Doğdu, Orhan; Akpek, Mahmut; Yarlıoğlueş, Mikail; Kalay, Nihat; Ardıç, Idris; Elçik, Deniz; Senarslan, Omer; Kaya, Mehmet Güngör

    2012-12-01

    Multi-vessel coronary artery disease (MVCAD) has long been recognized as an important predictor of adverse outcomes in patients with chronic stable angina. The aim of this study is to investigate the relationship between hematologic parameters and impairment of left ventricular systolic functions in patients with stable MVCAD. Patients (n=202) with stable angina and MVCAD were included in this study. According to the left ventricle ejection fraction (LVEF) determined by echocardiography, patients were divided into two groups as the preserved group (LVEF >50%) and the impaired group (LVEF <50%). The preserved group consisted of 106 patients and the impaired group consisted of 96 patients. The frequency of diabetes mellitus was significantly higher in the impaired group compared to the preserved group (respectively, 50% vs. 33%, p=0.01). High sensitivity C-reactive protein (hs-CRP) levels and, neutrophil/lymphocyte ratio (N/L ratio) were significantly higher in the impaired group than in the preserved group (3.9±2.4 vs. 7.9±3.8, p<0.001; 2.7±0.7 vs. 3.9±1.2, p<0.001, respectively). There was a significant correlation between LVEF, N/L ratio and hs-CRP; hs-CRP and N/L ratio were positively correlated (r=0.584; p<0.001), and LVEF was negatively correlated with both hs-CRP and N/L ratio (r=-0.48, p<0.001 and r=-0.43, p<0.001, respectively). A N/L ratio >3.0 had 77% sensitivity and 68% specificity in predicting left ventricular dysfunction in patients with stable MVCAD. In multivariate analysis, N/L ratio (OR: 2.456, <95% Cl 2.056-4.166; p<0.001) was an independent predictor of left ventricular dysfunction in stable patients with MVCAD. N/L ratio and hs-CRP, which is inexpensive and easily measurable in the laboratory, is independently associated with impaired LV systolic functions in patients with stable MVCAD.

  5. Combating the "other diseases" of MDG 6: changing the paradigm to achieve equity and poverty reduction?

    PubMed

    Molyneux, David H

    2008-06-01

    This paper suggests that the 'other diseases' of Millennium Development Goal 6 (MDG 6) are ignored by policy-makers and politicians who overfocus on unachievable objectives and targets around the 'big three' diseases of HIV, tuberculosis (TB) and malaria, which if the planet was viewed by aliens would be seen as the only diseases that existed on the planet. The diseases of the majority of the poor represent 'low hanging fruit' for control and elimination and opportunities are ignored despite the availability of cheap or donated drugs and ample evidence that such interventions are effective and reduce incidence, as well as mortality and morbidity. The time frame available to achieve the MDGs of some 7-8 years requires a re-evaluation of what can be done with the tools available now and which can address the problems faced by the majority of poor people afflicted by disabling conditions which together represent a global burden greater than malaria or TB. The author considers also the volume of research relevant to the MDGs and their achievement is distorted by the focus on high tech end research which cannot be delivered by 2015 and that in terms of the 90:10 gap in research relevant to the problems of the poorest the real gap is 99:1. The concepts of distortion of donor funding for diseases of MDG 6 for implementation of largely curative interventions which do not reduce incidence as well as research which addresses problems that cannot reach poor people in the time frame to 2015 is emphasised. New paradigms are required if any impact on MDG 6 is to be achieved recognising the needs of the majority via an equitable distribution of funding.

  6. Focus on ulcerative colitis: stable gastric pentadecapeptide BPC 157.

    PubMed

    Sikiric, P; Seiwerth, S; Rucman, R; Turkovic, B; Rokotov, D S; Brcic, L; Sever, M; Klicek, R; Radic, B; Drmic, D; Ilic, S; Kolenc, D; Stambolija, V; Zoricic, Z; Vrcic, H; Sebecic, B

    2012-01-01

    Stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419) may be the new drug stable in human gastric juice, effective both in the upper and lower GI tract, and free of side effects. BPC 157, in addition to an antiulcer effect efficient in therapy of inflammatory bowel disease (IBD) (PL 14736) so far only tested in clinical phase II, has a very safe profile, and exhibited a particular wound healing effect. It also has shown to interact with the NO-system, providing endothelium protection and angiogenic effect, even in severely impaired conditions (i.e., it stimulated expression of early growth response 1 gene responsible for cytokine and growth factor generation and early extracellular matrix (collagen) formation (but also its repressor nerve growth factor 1-A binding protein-2)), important to counteract severe complications of advanced and poorly controlled IBD. Hopefully, the lessons from animal studies, particularly advanced intestinal anastomosis healing, reversed short bowel syndrome and fistula healing indicate BPC 157's high significance in further IBD therapy. Also, this supportive evidence (i.e., no toxic effect, limit test negative, LD1 not achieved, no side effect in trials) may counteract the problems commonly exercised in the use of peptidergic agents, particularly those used on a long-term basis.

  7. The significance of major and stable molecular responses in chronic myeloid leukemia in the tyrosine kinase inhibitor era

    PubMed Central

    Renault, Ilana Zalcberg; Scholl, Vanesa; Hassan, Rocio; Capelleti, Paola; de Lima, Marcos; Cortes, Jorge

    2011-01-01

    Tyrosine kinase inhibitors have changed the management and outcomes of chronic myeloid leukemia patients. Quantitative polymerase chain reaction is used to monitor molecular responses to tyrosine kinase inhibitors. Molecular monitoring represents the most sensitive tool to judge chronic myeloid leukemia disease course and allows early detection of relapse. Evidence of achieving molecular response is important for several reasons: 1. early molecular response is associated with major molecular response rates at 18-24 months; 2. patients achieving major molecular response are less likely to lose their complete cytogenetic response; 3. a durable, stable major molecular response is associated with increased progression-free survival. However, standardization of molecular techniques is still challenging. PMID:23049363

  8. Estimating exercise capacity from walking tests in elderly individuals with stable coronary artery disease.

    PubMed

    Mandic, Sandra; Walker, Robert; Stevens, Emily; Nye, Edwin R; Body, Dianne; Barclay, Leanne; Williams, Michael J A

    2013-01-01

    Compared with symptom-limited cardiopulmonary exercise test (CPET), timed walking tests are cheaper, well-tolerated and simpler alternative for assessing exercise capacity in coronary artery disease (CAD) patients. We developed multivariate models for predicting peak oxygen consumption (VO2peak) from 6-minute walk test (6MWT) distance and peak shuttle walk speed for elderly stable CAD patients. Fifty-eight CAD patients (72 SD 6 years, 66% men) completed: (1) CPET with expired gas analysis on a cycle ergometer, (2) incremental 10-meter shuttle walk test, (3) two 6MWTs, (4) anthropometric assessment and (5) 30-second chair stands. Linear regression models were developed for estimating VO2peak from 6MWT distance and peak shuttle walk speed as well as demographic, anthropometric and functional variables. Measured VO2peak was significantly related to 6MWT distance (r = 0.719, p < 0.001) and peak shuttle walk speed (r = 0.717, p < 0.001). The addition of demographic (age, gender), anthropometric (height, weight, body mass index, body composition) and functional characteristics (30-second chair stands) increased the accuracy of predicting VO2peak from both 6MWT distance and peak shuttle walk speed (from 51% to 73% of VO2peak variance explained). Addition of demographic, anthropometric and functional characteristics improves the accuracy of VO2peak estimate based on walking tests in elderly individuals with stable CAD. Implications for Rehabilitation Timed walking tests are cheaper, well-tolerated and simpler alternative for assessing exercise capacity in cardiac patients. Walking tests could be used to assess individual's functional capacity and response to therapeutic interventions when symptom-limited cardiopulmonary exercise testing is not practical or not necessary for clinical reasons. Addition of demographic, anthropometric and functional characteristics improves the accuracy of peak oxygen consumption estimate based on 6-minute walk test distance

  9. The influence of contrast media on kidney function in patients with stable coronary artery disease.

    PubMed

    Reuter, Simon Bertram; Harutyunyan, Marina; Mygind, Naja Dam; Jørgensen, Erik; Kastrup, Jens

    2014-08-01

    To investigate the incidence of contrast media-induced nephropathy (CIN) in patients with stable coronary artery disease (CAD) referred for elective coronary intervention following hydration routines. The reversibility of CIN was followed in a 6 month-period. A total of 447 patients referred for elective coronary intervention due to suspected CAD were included. Blood samples were collected before and 24 h after intervention and medical records were obtained. Patients had no drinking fluid restrictions and were routinely treated with a 1000 ml saline infusion. All patients were invited to a 6-month examination and collection of blood samples. A total of 19 patients (4.3%) developed CIN. CIN patients had a pre-investigation higher estimated glomerular filtration rate (eGRF), lower level of kidney failure and lower creatinine level than non-CIN patients. Kidney function was not normalized in CIN patients 6 months after the intervention. Two patients still met the definition of CIN. With no restriction in fluid intake and supplementary infusion of saline, only a few patients with stable CAD developed early indications of CIN during elective coronary interventions. Kidney function and the amount of contrast media used was not a predictor of CIN development. The induced CIN was not completely normalized in a 6-month follow-up period.

  10. Asymmetric Dimethylarginine versus Proton Pump Inhibitors Usage in Patients with Stable Coronary Artery Disease: A Cross-Sectional Study.

    PubMed

    Kruszelnicka, Olga; Świerszcz, Jolanta; Bednarek, Jacek; Chyrchel, Bernadeta; Surdacki, Andrzej; Nessler, Jadwiga

    2016-04-15

    A recent experimental study suggested that proton pump inhibitors (PPI), widely used to prevent gastroduodenal complications of dual antiplatelet therapy, may increase the accumulation of the endogenous nitric oxide synthesis antagonist asymmetric dimethylarginine (ADMA), an adverse outcome predictor. Our aim was to assess the effect of PPI usage on circulating ADMA in coronary artery disease (CAD). Plasma ADMA levels were compared according to PPI use for ≥1 month prior to admission in 128 previously described non-diabetic men with stable CAD who were free of heart failure or other coexistent diseases. Patients on PPI tended to be older and with insignificantly lower estimated glomerular filtration rate (GFR). PPI use was not associated with any effect on plasma ADMA (0.51 ± 0.11 (SD) vs. 0.50 ± 0.10 µmol/L for those with PPI (n = 53) and without PPI (n = 75), respectively; p = 0.7). Additionally, plasma ADMA did not differ between PPI users and non-users stratified by a history of current smoking, CAD severity or extent. The adjustment for patients' age and GFR did not substantially change the results. Thus, PPI usage does not appear to affect circulating ADMA in non-diabetic men with stable CAD. Whether novel mechanisms of adverse PPI effects on the vasculature can be translated into clinical conditions, requires further studies.

  11. Small airway dysfunction in smokers with stable ischemic heart disease

    PubMed Central

    Llontop, Claudia; Garcia-Quero, Cristina; Castro, Almudena; Dalmau, Regina; Casitas, Raquel; Galera, Raúl; Iglesias, Alberto; Martinez-Ceron, Elisabet; Soriano, Joan B.; García-Río, Francisco

    2017-01-01

    Background A higher prevalence of airflow limitation (AL) has been described in patients with ischemic heart disease (IHD). Although small airway dysfunction (SAD) is an early feature of AL, there is little information about its occurrence in IHD patients. Our objective was to describe the prevalence of SAD in IHD patients, while comparing patient-related outcomes and future health risk among IHD patients with AL, SAD and normal lung function. Methods In 118 consecutive smoking patients with stable IHD, comorbidities, utilization of healthcare resources, current treatment, blood biochemistry and health status were recorded. SAD was evaluated by impulse oscillometry, and pre- and post-bronchodilator spirometry was performed. Results The prevalence of AL and SAD were 20.3 (95% CI, 13.1–27.6%) and 26.3% (95% CI, 18.3–34.2%), respectively. Compared to the normal lung function group, patients with SAD and without AL had lower spirometric values, poorer quality of life and higher levels of C-reactive protein (CRP), as well as increased cardiovascular risk and more vascular age. In patients with normal spirometry, the presence of SAD was independently associated with pack-years, HDL-cholesterol and CRP levels. Conclusion In patients with IHD, the presence of SAD is common and that it is associated with reduced health status and increased future cardiac risk. PMID:28846677

  12. The Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases.

    PubMed

    Redekop, William K; Lenk, Edeltraud J; Luyendijk, Marianne; Fitzpatrick, Christopher; Niessen, Louis; Stolk, Wilma A; Tediosi, Fabrizio; Rijnsburger, Adriana J; Bakker, Roel; Hontelez, Jan A C; Richardus, Jan H; Jacobson, Julie; de Vlas, Sake J; Severens, Johan L

    2017-01-01

    Lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH) and trachoma represent the five most prevalent neglected tropical diseases (NTDs). They can be controlled or eliminated by means of safe and cost-effective interventions delivered through programs of Mass Drug Administration (MDA)-also named Preventive Chemotherapy (PCT). The WHO defined targets for NTD control/elimination by 2020, reinforced by the 2012 London Declaration, which, if achieved, would result in dramatic health gains. We estimated the potential economic benefit of achieving these targets, focusing specifically on productivity and out-of-pocket payments. Productivity loss was calculated by combining disease frequency with productivity loss from the disease, from the perspective of affected individuals. Productivity gain was calculated by deducting the total loss expected in the target achievement scenario from the loss in a counterfactual scenario where it was assumed the pre-intervention situation in 1990 regarding NTDs would continue unabated until 2030. Economic benefits from out-of-pocket payments (OPPs) were calculated similarly. Benefits are reported in 2005 US$ (purchasing power parity-adjusted and discounted at 3% per annum from 2010). Sensitivity analyses were used to assess the influence of changes in input parameters. The economic benefit from productivity gain was estimated to be I$251 billion in 2011-2020 and I$313 billion in 2021-2030, considerably greater than the total OPPs averted of I$0.72 billion and I$0.96 billion in the same periods. The net benefit is expected to be US$ 27.4 and US$ 42.8 for every dollar invested during the same periods. Impact varies between NTDs and regions, since it is determined by disease prevalence and extent of disease-related productivity loss. Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large uncertainty, these benefits far exceed the investment

  13. Elevated plasma lipoprotein(a) levels were associated with increased risk of cardiovascular events in Chinese patients with stable coronary artery disease.

    PubMed

    Dai, Wen; Long, Junke; Cheng, Ying; Chen, Yaqin; Zhao, Shuiping

    2018-05-16

    Recent studies have suggested that lipoprotein(a) [Lp(a)] is associated with cardiovascular disease (CVD). However, the contribution of Lp(a) to residual risk of CVD has not been determined in Chinese populations. We conducted a prospective study to evaluate the association between Lp(a) and the risk of major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease (CAD) who received optimal medication treatment (OMT). The study enrolled 1602 patients with stable CAD from 5 hospitals in China. The baseline clinical characteristics and follow-up MACE data for the patients were recorded. Coronary lesion severity was assessed by the Gensini scoring system. All-cause death, non-fatal myocardial infarction, non-fatal stroke and unplanned coronary revascularization were considered MACEs. We found that plasma Lp(a) levels were positively associated with coronary lesion severity at baseline (p < 0.001). During a mean follow-up period of 39.6 months, 166 (10.4%) patients suffered MACEs. There were significant differences in the adjusted event-free survival rates among the Lp(a) quartile subgroups (p = 0.034). The hazard ratio for MACEs was 1.291 (95% confidence interval: 1.091-1.527, p = 0.003) per standardized deviation in the log-transformed Lp(a) level after adjustment for traditional cardiovascular risk factors. Therefore, Lp(a) was an independent predictor of MACEs in Chinese patients with stable CAD who received OMT.

  14. Longitudinal Effects of Perceived Control on Academic Achievement

    ERIC Educational Resources Information Center

    You, Sukkyung; Hong, Sehee; Ho, Hsiu-Zu

    2011-01-01

    It is well established that perceived control plays an important role in student academic achievement, but little is known about its longitudinal stability, ethnic variation, and developmental effects on subsequent achievement during adolescence. Findings from this study indicated (a) perceived control remains stable during adolescence for each of…

  15. Positive affect and survival in patients with stable coronary heart disease: findings from the Heart and Soul Study.

    PubMed

    Hoen, Petra W; Denollet, Johan; de Jonge, Peter; Whooley, Mary A

    2013-07-01

    Positive affect can improve survival, but the mechanisms responsible for this association are unknown. We sought to evaluate the association between positive affect and mortality in patients with stable coronary heart disease and to determine biological and behavioral factors that might explain this association. The Heart and Soul Study is a prospective cohort study of 1,018 outpatients with stable coronary heart disease. Participants were recruited between September 11, 2000, and December 20, 2002, and were followed up to June 2011. Baseline positive affect was assessed by using the 10-item positive affect subscale of the Positive and Negative Affect Schedule. Cox proportional hazards regression was used to estimate the risk of mortality (primary outcome measure) and cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack) associated with positive affect, adjusting for baseline cardiac disease severity and depression. We also evaluated the extent to which these associations were explained by potential biological and behavioral mediators. A total of 369 patients (36%) died during a mean ± SD follow-up period of 7.1 ± 2.5 years. Positive affect was not significantly associated with cardiovascular events (hazard ratio [HR]: 0.89; 95% CI, 0.79-1.00; P = .06). However, each standard deviation (8.8-point) increase in positive affect score was associated with a 16% decreased risk of all-cause mortality (HR: 0.84; 95% CI, 0.76-0.92; P = .001). After adjustment for cardiac disease severity and depressive symptoms, positive affect remained significantly associated with improved survival (HR: 0.87; 95% CI, 0.78-0.97; P = .01). The association was no longer significant after adjustment for behavioral factors, and particularly physical activity (HR: 0.92; 95% CI, 0.82-1.03; P = .16). Further adjustment for C-reactive protein and omega-3 fatty acids did not result in any meaningful changes (HR: 0.94; 95% CI, 0.84-1.06; P = .31). In this

  16. Extremely Stable Polypyrrole Achieved via Molecular Ordering for Highly Flexible Supercapacitors.

    PubMed

    Huang, Yan; Zhu, Minshen; Pei, Zengxia; Huang, Yang; Geng, Huiyuan; Zhi, Chunyi

    2016-01-27

    The cycling stability of flexible supercapacitors with conducting polymers as electrodes is limited by the structural breakdown arising from repetitive counterion flow during charging/discharging. Supercapacitors made of facilely electropolymerized polypyrrole (e-PPy) have ultrahigh capacitance retentions of more than 97, 91, and 86% after 15000, 50000, and 100000 charging/discharging cycles, respectively, and can sustain more than 230000 charging/discharging cycles with still approximately half of the initial capacitance retained. To the best of our knowledge, such excellent long-term cycling stability was never reported. The fully controllable electropolymerization shows superiority in molecular ordering, favoring uniform stress distribution and charge transfer. Being left at ambient conditions for even 8 months, e-PPy supercapacitors completely retain the good electrochemical performance. The extremely stable supercapacitors with excellent flexibility and scalability hold considerable promise for the commerical application of flexible and wearable electronics.

  17. Comprehensive disease control (CDC): what does achieving CDC mean for patients with rheumatoid arthritis?

    PubMed

    Emery, Paul; Kavanaugh, Arthur; Bao, Yanjun; Ganguli, Arijit; Mulani, Parvez

    2015-12-01

    This study assessed the impact of simultaneous achievement of clinical, functional and structural efficacy, herein referred to as comprehensive disease control (CDC), on short-term and long-term work-related outcomes, health-related quality of life (HRQoL), pain and fatigue. Data were pooled from three randomised trials of adalimumab plus methotrexate for treatment of early-stage or late-stage rheumatoid arthritis (RA). CDC was defined as 28-joint Disease Activity Score using C reactive protein <2.6, Health Assessment Questionnaire <0.5 and change from baseline in modified Total Sharp Score ≤0.5. Changes in scores at weeks 26 and 52 for work-related outcomes, Short Form 36 (SF-36) physical (PCS) and mental component scores (MCS), a Visual Analogue Scale measuring pain (VAS-Pain) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) were compared between patient groups defined by achievement of CDC at week 26 using linear regression with adjustment for baseline scores. Patients with RA who achieved CDC at week 26 (n=200) had significantly greater improvements in VAS-Pain (46.9 vs 26.9; p<0.0001), FACIT-F (13.3 vs 7.5; p<0.0001), SF-36 PCS (19.7 vs 8.9; p<0.0001) and SF-36 MCS (8.1 vs 5.0; p=0.0004) than those who did not (n=1267). Results were consistent at week 52 and among methotrexate-naive patients with early RA, methotrexate-experienced patients with late-stage RA and patients with inadequate response to methotrexate. Patients with RA who achieved CDC at week 26 had improved short-term and long-term HRQoL, pain, fatigue and work-related outcomes compared with patients who do not. These results demonstrate that the joint achievement of all CDC components provides meaningful benefits to patients. DE019: NCT00195702, PREMIER: NCT00195702, OPTIMA: NCT00195702. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial.

    PubMed

    Taguchi, Isao; Iimuro, Satoshi; Iwata, Hiroshi; Takashima, Hiroaki; Abe, Mitsuru; Amiya, Eisuke; Ogawa, Takanori; Ozaki, Yukio; Sakuma, Ichiro; Nakagawa, Yoshihisa; Hibi, Kiyoshi; Hiro, Takafumi; Fukumoto, Yoshihiro; Hokimoto, Seiji; Miyauchi, Katsumi; Yamazaki, Tsutomu; Ito, Hiroshi; Otsuji, Yutaka; Kimura, Kazuo; Takahashi, Jun; Hirayama, Atsushi; Yokoi, Hiroyoshi; Kitagawa, Kazuo; Urabe, Takao; Okada, Yasushi; Terayama, Yasuo; Toyoda, Kazunori; Nagao, Takehiko; Matsumoto, Masayasu; Ohashi, Yasuo; Kaneko, Tetsuji; Fujita, Retsu; Ohtsu, Hiroshi; Ogawa, Hisao; Daida, Hiroyuki; Shimokawa, Hiroaki; Saito, Yasushi; Kimura, Takeshi; Inoue, Teruo; Matsuzaki, Masunori; Nagai, Ryozo

    2018-05-08

    Current guidelines call for high-intensity statin therapy in patients with cardiovascular disease on the basis of several previous "more versus less statins" trials. However, no clear evidence for more versus less statins has been established in an Asian population. In this prospective, multicenter, randomized, open-label, blinded end point study, 13 054 Japanese patients with stable coronary artery disease who achieved low-density lipoprotein cholesterol (LDL-C) <120 mg/dL during a run-in period (pitavastatin 1 mg/d) were randomized in a 1-to-1 fashion to high-dose (pitavastatin 4 mg/d; n=6526) or low-dose (pitavastatin 1 mg/d; n=6528) statin therapy. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. The secondary composite end point was a composite of the primary end point and clinically indicated coronary revascularization excluding target-lesion revascularization at sites of prior percutaneous coronary intervention. The mean age of the study population was 68 years, and 83% were male. The mean LDL-C level before enrollment was 93 mg/dL with 91% of patients taking statins. The baseline LDL-C level after the run-in period on pitavastatin 1 mg/d was 87.7 and 88.1 mg/dL in the high-dose and low-dose groups, respectively. During the entire course of follow-up, LDL-C in the high-dose group was lower by 14.7 mg/dL than in the low-dose group ( P <0.001). With a median follow-up of 3.9 years, high-dose as compared with low-dose pitavastatin significantly reduced the risk of the primary end point (266 patients [4.3%] and 334 patients [5.4%]; hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; P =0.01) and the risk of the secondary composite end point (489 patients [7.9%] and 600 patients [9.7%]; hazard ratio, 0.83; 95% confidence interval, 0.73-0.93; P =0.002). High-dose pitavastatin also significantly reduced the risks of several other

  19. Quantitative analyses and modelling to support achievement of the 2020 goals for nine neglected tropical diseases.

    PubMed

    Hollingsworth, T Déirdre; Adams, Emily R; Anderson, Roy M; Atkins, Katherine; Bartsch, Sarah; Basáñez, María-Gloria; Behrend, Matthew; Blok, David J; Chapman, Lloyd A C; Coffeng, Luc; Courtenay, Orin; Crump, Ron E; de Vlas, Sake J; Dobson, Andy; Dyson, Louise; Farkas, Hajnal; Galvani, Alison P; Gambhir, Manoj; Gurarie, David; Irvine, Michael A; Jervis, Sarah; Keeling, Matt J; Kelly-Hope, Louise; King, Charles; Lee, Bruce Y; Le Rutte, Epke A; Lietman, Thomas M; Ndeffo-Mbah, Martial; Medley, Graham F; Michael, Edwin; Pandey, Abhishek; Peterson, Jennifer K; Pinsent, Amy; Porco, Travis C; Richardus, Jan Hendrik; Reimer, Lisa; Rock, Kat S; Singh, Brajendra K; Stolk, Wilma; Swaminathan, Subramanian; Torr, Steve J; Townsend, Jeffrey; Truscott, James; Walker, Martin; Zoueva, Alexandra

    2015-12-09

    Quantitative analysis and mathematical models are useful tools in informing strategies to control or eliminate disease. Currently, there is an urgent need to develop these tools to inform policy to achieve the 2020 goals for neglected tropical diseases (NTDs). In this paper we give an overview of a collection of novel model-based analyses which aim to address key questions on the dynamics of transmission and control of nine NTDs: Chagas disease, visceral leishmaniasis, human African trypanosomiasis, leprosy, soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. Several common themes resonate throughout these analyses, including: the importance of epidemiological setting on the success of interventions; targeting groups who are at highest risk of infection or re-infection; and reaching populations who are not accessing interventions and may act as a reservoir for infection,. The results also highlight the challenge of maintaining elimination 'as a public health problem' when true elimination is not reached. The models elucidate the factors that may be contributing most to persistence of disease and discuss the requirements for eventually achieving true elimination, if that is possible. Overall this collection presents new analyses to inform current control initiatives. These papers form a base from which further development of the models and more rigorous validation against a variety of datasets can help to give more detailed advice. At the moment, the models' predictions are being considered as the world prepares for a final push towards control or elimination of neglected tropical diseases by 2020.

  20. Amyloid-β Plaques in Clinical Alzheimer's Disease Brain Incorporate Stable Isotope Tracer In Vivo and Exhibit Nanoscale Heterogeneity.

    PubMed

    Wildburger, Norelle C; Gyngard, Frank; Guillermier, Christelle; Patterson, Bruce W; Elbert, Donald; Mawuenyega, Kwasi G; Schneider, Theresa; Green, Karen; Roth, Robyn; Schmidt, Robert E; Cairns, Nigel J; Benzinger, Tammie L S; Steinhauser, Matthew L; Bateman, Randall J

    2018-01-01

    Alzheimer's disease (AD) is a neurodegenerative disorder with clinical manifestations of progressive memory decline and loss of executive function and language. AD affects an estimated 5.3 million Americans alone and is the most common form of age-related dementia with a rapidly growing prevalence among the aging population-those 65 years of age or older. AD is characterized by accumulation of aggregated amyloid-beta (Aβ) in the brain, which leads to one of the pathological hallmarks of AD-Aβ plaques. As a result, Aβ plaques have been extensively studied after being first described over a century ago. Advances in brain imaging and quantitative measures of Aβ in biological fluids have yielded insight into the time course of plaque development decades before and after AD symptom onset. However, despite the fundamental role of Aβ plaques in AD, in vivo measures of individual plaque growth, growth distribution, and dynamics are still lacking. To address this question, we combined stable isotope labeling kinetics (SILK) and nanoscale secondary ion mass spectrometry (NanoSIMS) imaging in an approach termed SILK-SIMS to resolve plaque dynamics in three human AD brains. In human AD brain, plaques exhibit incorporation of a stable isotope tracer. Tracer enrichment was highly variable between plaques and the spatial distribution asymmetric with both quiescent and active nanometer sub-regions of tracer incorporation. These data reveal that Aβ plaques are dynamic structures with deposition rates over days indicating a highly active process. Here, we report the first, direct quantitative measures of in vivo deposition into plaques in human AD brain. Our SILK-SIMS studies will provide invaluable information on plaque dynamics in the normal and diseased brain and offer many new avenues for investigation into pathological mechanisms of the disease, with implications for therapeutic development.

  1. Challenges with Evidence-Based Management of Stable Ischemic Heart Disease.

    PubMed

    Patel, Amit V; Bangalore, Sripal

    2017-02-01

    Stable ischemic heart disease (SIHD) is a highly prevalent condition associated with increased costs, morbidity, and mortality. Management goals of SIHD can broadly be thought of in terms of improving prognosis and/or improving symptoms. Treatment options include medical therapy as well as revascularization, either with percutaneous coronary intervention or coronary artery bypass grafting. Herein, we will review the current evidence base for treatment of SIHD as well as its challenges and discuss ongoing studies to help address some of these knowledge gaps. There has been no consistent reduction in death or myocardial infarction (MI) with revascularization vs. medical therapy in patients with SIHD in contemporary trials. Angina and quality of life have been shown to be relieved more rapidly with revascularization vs. optimal medical therapy; however, the durability of these results is uncertain. There have been challenges and limitations in several of the trials addressing the optimal treatment strategy for SIHD due to potential selection bias (due to knowledge of coronary anatomy prior to randomization), patient crossover, and advances in medical therapy and revascularization strategies since trial completion. The challenges inherent to prior trials addressing the optimal management strategy for SIHD have impacted the generalizability of results to real-world cohorts. Until the results of additional ongoing trials are available, the decision for revascularization or medical therapy should be based on patients' symptoms, weighing the risks and benefits of each approach, and patient preference.

  2. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease.

    PubMed

    Vale, Margarite J; Jelinek, Michael V; Best, James D; Dart, Anthony M; Grigg, Leeanne E; Hare, David L; Ho, Betty P; Newman, Robert W; McNeil, John J

    Disease management programs in which drugs are prescribed by dietitians or nurses have been shown to improve the coronary risk factor profile in patients with coronary heart disease. However, those disease management programs in which drugs are not prescribed by allied health professionals have not improved coronary risk factor status. The objective of the Coaching patients On Achieving Cardiovascular Health (COACH) study was to determine whether dietitians or nurses who did not prescribe medications could coach patients with coronary heart disease to work with their physicians to achieve the target levels for their total cholesterol (TC) and other risk factors. Multicenter randomized controlled trial in which 792 patients from 6 university teaching hospitals underwent a stratified randomization by cardiac diagnosis within each hospital: 398 were assigned to usual care plus The COACH Program and 394 to usual care alone. Patients in The COACH Program group received regular personal coaching via telephone and mailings to achieve the target levels for their particular coronary risk factors. There was one coach per hospital. The primary outcome was the change in TC (DeltaTC) from baseline (in hospital) to 6 months after randomization. Secondary outcomes included measurement of a wide range of physical, nutritional, and psychological factors. The analysis was performed by intention to treat. The COACH Program achieved a significantly greater DeltaTC than usual care alone: the mean DeltaTC was 21 mg/dL (0.54 mmol/L) (95% confidence interval [CI], 16-25 mg/dL [0.42-0.65 mmol/L]) in The COACH Program vs 7 mg/dL (0.18 mmol/L) (95% CI, 3-11 mg/dL [0.07-0.29 mmol/L]) in the usual care group (P<.0001). Thus, the reduction in TC from baseline to 6 months after randomization was 14 mg/dL (0.36 mmol/L) (95% CI, 8-20 mg/dL [0.20-0.52 mmol/L]) greater in The COACH Program group than in the usual care group. Coaching produced substantial improvements in most of the other coronary

  3. Treatment for Stable Coronary Artery Disease: A Network Meta-Analysis of Cost-Effectiveness Studies

    PubMed Central

    Caruba, Thibaut; Katsahian, Sandrine; Schramm, Catherine; Charles Nelson, Anaïs; Durieux, Pierre; Bégué, Dominique; Juillière, Yves; Dubourg, Olivier

    2014-01-01

    Introduction and Objectives Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina. PMID:24896266

  4. Tofacitinib in Rheumatoid Arthritis: Lack of Early Change in Disease Activity Predicts a Low Probability of Achieving Low Disease Activity at Month 6.

    PubMed

    Van Vollenhoven, Ronald F; Lee, Eun Bong; Fallon, Lara; Zwillich, Samuel H; Wilkinson, Bethanie; Chapman, Douglass; Demasi, Ryan; Keystone, Edward

    2018-04-26

    Optimal targeted treatment in rheumatoid arthritis requires early identification of failure to respond. This post-hoc analysis explored the relationship between early disease activity changes and achievement of low disease activity (LDA) and remission targets with tofacitinib. Data were from two randomized, double-blind, Phase 3 studies. In ORAL Start (NCT01039688), methotrexate (MTX)-naïve patients received tofacitinib 5 or 10 mg BID, or MTX, for 24 months. In placebo-controlled ORAL Standard (NCT00853385), MTX-inadequate responder (MTX-IR) patients received tofacitinib 5 or 10 mg BID or adalimumab 40 mg Q2W, with MTX, for 12 months. Probabilities of achieving LDA (CDAI ≤10; DAS28-4[ESR] ≤3.2) at months 6 and 12 were calculated, given failure to achieve threshold improvement from baseline (change in CDAI ≥6; DAS28-4[ESR] ≥1.2) at month 1 or 3. In ORAL Start, 7.2% and 5.4% of patients receiving tofacitinib 5 and 10 mg BID, respectively, failed to improve CDAI ≥6 at month 3; of those who failed, 3.8% and 28.6%, respectively, achieved month 6 CDAI-defined LDA. In ORAL Standard, 18.8% and 17.5% of patients receiving tofacitinib 5 and 10 mg BID, respectively, failed to improve CDAI ≥6 at month 3; of those who failed, 0% and 2.9%, respectively, achieved month 6 CDAI-defined LDA. Findings were similar when considering month 1 improvements or DAS28-4(ESR) thresholds. In MTX-IR patients, lack of response to tofacitinib after 1 or 3 months predicted low probability of achieving LDA at month 6. Lack of early response may be considered when deciding whether to continue treatment with tofacitinib. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. The Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases

    PubMed Central

    Luyendijk, Marianne; Fitzpatrick, Christopher; Niessen, Louis; Stolk, Wilma A.; Tediosi, Fabrizio; Rijnsburger, Adriana J.; Bakker, Roel; Hontelez, Jan A. C.; Richardus, Jan H.; Jacobson, Julie; de Vlas, Sake J.; Severens, Johan L.

    2017-01-01

    Background Lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH) and trachoma represent the five most prevalent neglected tropical diseases (NTDs). They can be controlled or eliminated by means of safe and cost-effective interventions delivered through programs of Mass Drug Administration (MDA)—also named Preventive Chemotherapy (PCT). The WHO defined targets for NTD control/elimination by 2020, reinforced by the 2012 London Declaration, which, if achieved, would result in dramatic health gains. We estimated the potential economic benefit of achieving these targets, focusing specifically on productivity and out-of-pocket payments. Methods Productivity loss was calculated by combining disease frequency with productivity loss from the disease, from the perspective of affected individuals. Productivity gain was calculated by deducting the total loss expected in the target achievement scenario from the loss in a counterfactual scenario where it was assumed the pre-intervention situation in 1990 regarding NTDs would continue unabated until 2030. Economic benefits from out-of-pocket payments (OPPs) were calculated similarly. Benefits are reported in 2005 US$ (purchasing power parity-adjusted and discounted at 3% per annum from 2010). Sensitivity analyses were used to assess the influence of changes in input parameters. Results The economic benefit from productivity gain was estimated to be I$251 billion in 2011–2020 and I$313 billion in 2021–2030, considerably greater than the total OPPs averted of I$0.72 billion and I$0.96 billion in the same periods. The net benefit is expected to be US$ 27.4 and US$ 42.8 for every dollar invested during the same periods. Impact varies between NTDs and regions, since it is determined by disease prevalence and extent of disease-related productivity loss. Conclusion Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large

  6. Risk prediction with triglycerides in patients with stable coronary disease on statin treatment.

    PubMed

    Werner, Christian; Filmer, Anja; Fritsch, Marco; Groenewold, Stephanie; Gräber, Stefan; Böhm, Michael; Laufs, Ulrich

    2014-12-01

    The aim of the prospective Homburg Cream and Sugar study was to analyze the role of fasting and postprandial serum triglycerides (TG) as risk modifiers in patients with coronary artery disease (CAD). A sequential oral triglyceride and glucose tolerance test was developed to obtain standardized measurements of postprandial TG kinetics and glucose in 514 consecutive patients with stable CAD confirmed by angiography (95% were treated with a statin). Fasting and postprandial TG predicted the primary outcome measure of cardiovascular death and hospitalizations after 48 months follow-up (fasting TG >150 vs. <106 mg/dl: Hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.31-2.45, p = 0.0001; area under the curve >1120 vs. <750 mg/dl/5 hr: HR 1.78, 95% CI 1.29-2.45, p = 0.0003). Parameters of the postprandial TG increase did not improve risk prediction compared to fasting TG. The number of cardiovascular deaths and myocardial infarctions was higher in the upper tertile of fasting TG (HR 1.79, 95%-CI 1.04-3.09, p = 0.03). Risk prediction by TG was independent of traditional risk factors, medication, glucose metabolism, LDL- and HDL-cholesterol. Total cholesterol, LDL- and HDL-cholesterol concentrations were not associated with the primary outcome. Fasting serum triglycerides >150 mg/dl independently predict cardiovascular events in patients with coronary artery disease on guideline-recommended medication. Assessment of postprandial TG does not improve risk prediction compared to fasting TG in these patients.

  7. [Status of β-blocker use and heart rate control in Chinese patients with stable coronary artery disease].

    PubMed

    Sun, Yihong; Yu, Jinming; Hu, Dayi

    2016-01-01

    To observe the current status of β-blocker (BB) use and heart rate control in Chinese patients with stable coronary artery disease (SCAD) based on subgroup data of the prospective observational longitudinal registry of patients with stable coronary artery disease (CLARIFY). The CLARIFY study is an international prospective observational registry of outpatients with SCAD. From November 2009 to July 2010, patients with SCAD were enrolled, and demographic information, clinical indicators, medication and blood flow reconstruction were collected. Patients were divided in three mutually exclusive categories by baseline pulse palpation heart rate(HR)≤60 beats per minute (bpm)(n=397), 61-69 bpm(n=782), and ≥70 bpm(n=1 443). The patients were also divided into taking BB or not taking BB groups. The aim of present study is to describe and analyze the current status and factors related to the HR control and BB use in the Chinese subgroup of CLARIFY. A total of 2 622 patients were enrolled from 56 centers across China. The mean age was (63.6±10.3) years old with 75.6% (1 983) male patients, 55.0% (1 443) patients had HR≥70 bpm. Mean HR measure by electrocardiogram(ECG) was (69.4±10.2)bpm, 50.9% (1 334 cases) patients had myocardial infarction(MI) history. A total of 21.9%(575 cases) patients had anginal symptoms; coronary angiography was performed in 88.8%(2 327 cases) of the patients. 76.2%(1 997 cases) patients were treated with BB (any molecule and any dose), 2.7% (70 cases) with digoxin or derivatives, 3.9% (103 cases) with verapamil or diltiazem, and 1.8% (47 cases) with amiodarone or dronedarone and 0.1%(2 cases) received ivabradine. BB use was similar among 3 HR groups(P>0.05). The independent risk factors associated with HR≥70 bpm were diabetes(OR=1.31), current smoker(OR=1.57), chronic heart failure(CHF) with NYHA Ⅲ (OR=2.13) and increased diastolic blood pressure (OR=1.30). Conversely, high physical activity (OR=0.61), former smoker (OR=0.76) and history

  8. Achieving neuroprotection with LRRK2 kinase inhibitors in Parkinson disease.

    PubMed

    West, Andrew B

    2017-12-01

    In the translation of discoveries from the laboratory to the clinic, the track record in developing disease-modifying therapies in neurodegenerative disease is poor. A carefully designed development pipeline built from discoveries in both pre-clinical models and patient populations is necessary to optimize the chances for success. Genetic variation in the leucine-rich repeat kinase two gene (LRRK2) is linked to Parkinson disease (PD) susceptibility. Pathogenic mutations, particularly those in the LRRK2 GTPase (Roc) and COR domains, increase LRRK2 kinase activities in cells and tissues. In some PD models, small molecule LRRK2 kinase inhibitors that block these activities also provide neuroprotection. Herein, the genetic and biochemical evidence that supports the involvement of LRRK2 kinase activity in PD susceptibility is reviewed. Issues related to the definition of a therapeutic window for LRRK2 inhibition and the safety of chronic dosing are discussed. Finally, recommendations are given for a biomarker-guided initial entry of LRRK2 kinase inhibitors in PD patients. Four key areas must be considered for achieving neuroprotection with LRRK2 kinase inhibitors in PD: 1) identification of patient populations most likely to benefit from LRRK2 kinase inhibitors, 2) prioritization of superior LRRK2 small molecule inhibitors based on open disclosures of drug performance, 3) incorporation of biomarkers and empirical measures of LRRK2 kinase inhibition in clinical trials, and 4) utilization of appropriate efficacy measures guided in part by rigorous pre-clinical modeling. Meticulous and rational development decisions can potentially prevent incredibly costly errors and provide the best chances for LRRK2 inhibitors to slow the progression of PD. Copyright © 2017 The Author. Published by Elsevier Inc. All rights reserved.

  9. Gender- and age-related differences in clinical presentation and management of outpatients with stable coronary artery disease.

    PubMed

    Ferrari, Roberto; Abergel, Hélène; Ford, Ian; Fox, Kim M; Greenlaw, Nicola; Steg, Ph Gabriel; Hu, Dayi; Tendera, Michal; Tardif, Jean-Claude

    2013-09-10

    Contemporary generalizable data on the demographics and management of outpatients with stable coronary artery disease (CAD) in routine clinical practice are sparse. Using the data from the CLARIFY registry we describe gender- and age-related differences in baseline characteristics and management of these patients across broad geographic regions. This international, prospective, observational, longitudinal registry enrolled stable CAD outpatients from 45 countries in Africa, Asia, Australia, Europe, the Middle East, and North, Central, and South America. Baseline data were available for 33280 patients. Mean (SD) age was 64 (10.5) years and 22.5% of patients were female. The prevalence of CAD risk factors was generally higher in women than in men. Women were older (66.6 vs 63.4 years), more frequently diagnosed with diabetes (33% vs 28%), hypertension (79% vs 69%), and higher resting heart rate (69 vs 67 bpm), and were less physically active. Smoking and a history of myocardial infarction were more common in men. Women were more likely to have angina (28% vs 20%), but less likely to have undergone revascularization procedures. CAD was more likely to be asymptomatic in older patients perhaps because of reduced levels of physical activity. Prescription of evidence-based medication for secondary prevention varied with age, with patients ≥ 75 years treated less often with beta blockers, aspirin and angiotensin-converting enzyme inhibitors than patients <65 years. Important gender-related differences in clinical characteristics and management continue to exist in all age groups of outpatients with stable CAD. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. [The Relationship of Serum Leptin Level and Metabolism in Elderly People with Stable Chronic Obstructive Pulmonary Disease].

    PubMed

    Yang, Lu; Zhang, Xue-mei; Hu, Xiu-ying; Zhang, Yan-ling

    2016-01-01

    To investigate the correlation of serum leptin and to energy consumption and metabolization in the patients with chronic obstructive pulmonary disease (COPD). We included 92 outpatients with stable COPD in West China Hospital of Sichuan University as trail group (COPD group) and 80 healthy elderly people in community as control group. All patients and healthy control received the measurements of body mass index (BMI), fat mass, resting energy expenditure (REE), lung function, serum leptin and tumor necrosis factor-α (TNF-α). The concentrations of serum leptin, BMI and lung function were lower in COPD group than those in control group (P < 0.01). The concentrations of serum leptin between two groups were not difference after the adjusted results of BMI and fat mass.. There was no difference of REE and TNF-α concentrations in these two groups. The serum leptin had positive correlation with BMI and fat mass, but there were no correlation between of TNF-α and serum leptin. In elderly people with stable COPD, the decline on the serum leptin is related to the decrease of BMI and fat mass, but barely related to the level of TNF-α.

  11. How Stable Is Stable?

    ERIC Educational Resources Information Center

    Baehr, Marie

    1994-01-01

    Provides a problem where students are asked to find the point at which a soda can floating in some liquid changes its equilibrium between stable and unstable as the soda is removed from the can. Requires use of Newton's first law, center of mass, Archimedes' principle, stable and unstable equilibrium, and buoyant force position. (MVL)

  12. Towards stable and commercially available perovskite solar cells

    DOE PAGES

    Park, Nam-Gyu; Grätzel, Michael; Miyasaka, Tsutomu; ...

    2016-10-17

    Solar cells employing a halide perovskite with an organic cation now show power conversion efficiency of up to 22%. But, these cells are facing issues towards commercialization, such as the need to achieve long-term stability and the development of a manufacturing method for the reproducible fabrication of high-performance devices. We propose a strategy to obtain stable and commercially viable perovskite solar cells. A reproducible manufacturing method is suggested, as well as routes to manage grain boundaries and interfacial charge transport. Electroluminescence is regarded as a metric to gauge theoretical efficiency. We highlight how optimizing the design of device architectures ismore » important not only for achieving high efficiency but also for hysteresis-free and stable performance. Here, we argue that reliable device characterization is needed to ensure the advance of this technology towards practical applications. We believe that perovskite-based devices can be competitive with silicon solar modules, and discuss issues related to the safe management of toxic material.« less

  13. Antianginal Therapy for Stable Ischemic Heart Disease: A Contemporary Review.

    PubMed

    Padala, Santosh K; Lavelle, Michael P; Sidhu, Mandeep S; Cabral, Katherine P; Morrone, Doralisa; Boden, William E; Toth, Peter P

    2017-11-01

    Chronic angina pectoris is associated with considerable morbidity and mortality, especially if treated suboptimally. For many patients, aggressive pharmacologic intervention is necessary in order to alleviate anginal symptoms. The optimal treatment of stable ischemic heart disease (SIHD) should be the prevention of angina and ischemia, with the goal of maximizing both quality and quantity of life. In addition to effective risk factor modification with lifestyle changes, intensive pharmacologic secondary prevention is the therapeutic cornerstone in managing patients with SIHD. Current guidelines recommend a multifaceted therapeutic approach with β-blockers as first-line treatment. Another important pharmacologic intervention for managing SIHD is nitrates. Nitrates can provide both relief of acute angina and can be used prophylactically before exposure to known triggers of myocardial ischemia to prevent angina. Additional therapeutic options include calcium channel blockers and ranolazine, an inhibitor of the late inward sodium current, that can be used alone or in addition to nitrates or β-blockers when these agents fail to alleviate symptoms. Ranolazine appears to be particularly effective for patients with microvascular angina and endothelial dysfunction. In addition, certain antianginal therapies are approved in Europe and have been shown to improve symptoms, including ivabradine, nicorandil, and trimetazidine; however, these have yet to be approved in the United States. Ultimately, there are several different medications available to the physician for managing the patient with SIHD having chronic angina, when either used alone or in combination. The purpose of this review is to highlight the most important therapeutic approaches to optimizing contemporary treatment in response to individual patient needs.

  14. Amyloid-β Plaques in Clinical Alzheimer’s Disease Brain Incorporate Stable Isotope Tracer In Vivo and Exhibit Nanoscale Heterogeneity

    PubMed Central

    Wildburger, Norelle C.; Gyngard, Frank; Guillermier, Christelle; Patterson, Bruce W.; Elbert, Donald; Mawuenyega, Kwasi G.; Schneider, Theresa; Green, Karen; Roth, Robyn; Schmidt, Robert E.; Cairns, Nigel J.; Benzinger, Tammie L. S.; Steinhauser, Matthew L.; Bateman, Randall J.

    2018-01-01

    Alzheimer’s disease (AD) is a neurodegenerative disorder with clinical manifestations of progressive memory decline and loss of executive function and language. AD affects an estimated 5.3 million Americans alone and is the most common form of age-related dementia with a rapidly growing prevalence among the aging population—those 65 years of age or older. AD is characterized by accumulation of aggregated amyloid-beta (Aβ) in the brain, which leads to one of the pathological hallmarks of AD—Aβ plaques. As a result, Aβ plaques have been extensively studied after being first described over a century ago. Advances in brain imaging and quantitative measures of Aβ in biological fluids have yielded insight into the time course of plaque development decades before and after AD symptom onset. However, despite the fundamental role of Aβ plaques in AD, in vivo measures of individual plaque growth, growth distribution, and dynamics are still lacking. To address this question, we combined stable isotope labeling kinetics (SILK) and nanoscale secondary ion mass spectrometry (NanoSIMS) imaging in an approach termed SILK–SIMS to resolve plaque dynamics in three human AD brains. In human AD brain, plaques exhibit incorporation of a stable isotope tracer. Tracer enrichment was highly variable between plaques and the spatial distribution asymmetric with both quiescent and active nanometer sub-regions of tracer incorporation. These data reveal that Aβ plaques are dynamic structures with deposition rates over days indicating a highly active process. Here, we report the first, direct quantitative measures of in vivo deposition into plaques in human AD brain. Our SILK–SIMS studies will provide invaluable information on plaque dynamics in the normal and diseased brain and offer many new avenues for investigation into pathological mechanisms of the disease, with implications for therapeutic development. PMID:29623063

  15. Limitations of analyses based on achieved blood pressure: lessons from the African American study of kidney disease and hypertension trial.

    PubMed

    Davis, Esa M; Appel, Lawrence J; Wang, Xuelei; Greene, Tom; Astor, Brad C; Rahman, Mahboob; Toto, Robert; Lipkowitz, Michael S; Pogue, Velvie A; Wright, Jackson T

    2011-06-01

    Blood pressure (BP) guidelines that set target BP levels often rely on analyses of achieved BP from hypertension treatment trials. The objective of this article was to compare the results of analyses of achieved BP to intention-to-treat analyses on renal disease progression. Participants (n=1094) in the African-American Study of Kidney Disease and Hypertension Trial were randomly assigned to either usual BP goal defined by a mean arterial pressure goal of 102 to 107 mm Hg or lower BP goal defined by a mean arterial pressure goal of ≤92 mm Hg. Median follow-up was 3.7 years. Primary outcomes were rate of decline in measured glomerular filtration rate and a composite of a decrease in glomerular filtration rate by >50% or >25 mL/min per 1.73 m(2), requirement for dialysis, transplantation, or death. Intention-to-treat analyses showed no evidence of a BP effect on either the rate of decline in glomerular filtration rate or the clinical composite outcome. In contrast, the achieved BP analyses showed that each 10-mm Hg increment in mean follow-up achieved mean arterial pressure was associated with a 0.35 mL/min per 1.73 m(2) (95% CI: 0.08 to 0.62 mL/min per 1.73 m(2); P=0.01) faster mean glomerular filtration rate decline and a 17% (95% CI: 5% to 32%; P=0.006) increased risk of the clinical composite outcome. Analyses based on achieved BP lead to markedly different inferences than traditional intention-to-treat analyses, attributed in part to confounding of achieved BP with comorbidities, disease severity, and adherence. Clinicians and policy makers should exercise caution when making treatment recommendations based on analyses relating outcomes to achieved BP.

  16. [Effects of aerobic exercise combined with resistance training on the cardiorespiratory fitness and exercise capacity of patients with stable coronary artery disease].

    PubMed

    Liu, S X; Chen, Y Y; Xie, K L; Zhang, W L

    2017-12-24

    Objective: To observe the effects of aerobic exercise combined with resistance training on the cardiorespiratory fitness and exercise capacity of patients with stable coronary artery disease (CAD) . Methods: From June 2014 to December 2015, 73 patients with stable CAD in our department were recruited and randomly assigned to two groups: the control group ( n= 38) and the exercise group ( n= 35) . Patients in both groups received conventional medical treatment for CAD and related cardiac health education. While for patients in exercise group, a twelve-week aerobic exercise combined with resistance training program were applied on top of conventional treatment and health education. Cardiorespiratory fitness and exercise capacity were evaluated by cardiopulmonary exercise testing. Results: (1) The exercise capacity was significantly increased in the exercise group after 12 weeks training as compared to baseline level: peak oxygen uptake per kilogram ( (26.25±5.14) ml·kg(-1)·min(-1) vs. (20.88±4.59) ml·kg(-1)·min(-1)) , anaerobic threshold ( (15.24±2.75) ml·kg(-1)·min(-1) vs. (13.52±2.92) ml·kg(-1)·min(-1)], peak oxygen pulse ( (11.91±2.89) ml/beat vs. (9.77±2.49) ml/beat) , peak Watts ( (113.2±34.0) W vs. (103.7±27.9) W) , peak metabolic equivalent ( (7.57±1.46) METs vs. (6.00±1.32) METs) (all P< 0.05 vs. baseline) . (2) The degree of improvement of peak oxygen uptake per kilogram ( (26.25±5.14) ml·kg(-1)·min(-1) vs. (22.32±4.00) ml·kg(-1)·min(-1)) , anaerobic threshold ( (15.24±2.75) ml·kg(-1)·min(-1) vs. (13.76±2.51) ml·kg(-1)·min(-1)) , peak oxygen pulse ( (11.91±2.89) ml/beat vs. (9.99±2.15) ml/beat) and peak metabolic equivalent ( (7.57±1.46) METs vs. (6.47±1.17) METs) were significantly higher in exercise group than in control group (all P< 0.05) . Conclusion: Aerobic training at an aerobic threshold level combined with Thera-band resistance training is safe for patients with stable coronary artery disease. This combined

  17. Influence of horse stable environment on human airways.

    PubMed

    Elfman, Lena; Riihimäki, Miia; Pringle, John; Wålinder, Robert

    2009-05-25

    Many people spend considerable amount of time each day in equine stable environments either as employees in the care and training of horses or in leisure activity. However, there are few studies available on how the stable environment affects human airways. This study examined in one horse stable qualitative differences in indoor air during winter and late summer conditions and assessed whether air quality was associated with clinically detectable respiratory signs or alterations to selected biomarkers of inflammation and lung function in stable personnel. The horse stable environment and stable-workers (n = 13) in one stable were investigated three times; first in the winter, second in the interjacent late summer and the third time in the following winter stabling period. The stable measurements included levels of ammonia, hydrogen sulphide, total and respirable dust, airborne horse allergen, microorganisms, endotoxin and glucan. The stable-workers completed a questionnaire on respiratory symptoms, underwent nasal lavage with subsequent analysis of inflammation markers, and performed repeated measurements of pulmonary function. Measurements in the horse stable showed low organic dust levels and high horse allergen levels. Increased viable level of fungi in the air indicated a growing source in the stable. Air particle load as well as 1,3-beta-glucan was higher at the two winter time-points, whereas endotoxin levels were higher at the summer time-point. Two stable-workers showed signs of bronchial obstruction with increased PEF-variability, increased inflammation biomarkers relating to reported allergy, cold or smoking and reported partly work-related symptoms. Furthermore, two other stable-workers reported work-related airway symptoms, of which one had doctor's diagnosed asthma which was well treated. Biomarkers involved in the development of airway diseases have been studied in relation to environmental exposure levels in equine stables. Respirable dust and 1

  18. Stable azodye photo-alignment layer for liquid crystal devices achieved by "turning off" dye photosensitivity

    NASA Astrophysics Data System (ADS)

    McGinty, C.; Finnemeyer, V.; Reich, R.; Clark, H.; Berry, S.; Bos, P.

    2017-11-01

    We have previously proposed a low cost, versatile process for stabilizing azodye photo-alignment layers for liquid crystal devices by utilizing a surface localized reactive mesogen (RM) layer. The RM is applied by dissolving the monomer in a liquid crystal material prior to filling the cell. In this paper, we show the significant effect of azodye layer thickness on the long term stability of these alignment layers when exposed to polarized light. We demonstrate, surprisingly, that thin azodye layers (˜3 nm) provide improved stability over thicker (˜40 nm) layers. Using this process, we show cells which have been stable to exposure with polarized light through one month. Additionally, we demonstrate the use of a photo-alignment layer to align the liquid crystals that afterwards can be rendered insensitive to polarized light. This was accomplished by using the process described above with the additional step of eliminating the photosensitivity of the azodye layer through photo-bleaching; the result is an RM alignment layer that will be stable when exposed to polarized light in the dye absorption band.

  19. Long-term healthcare use and costs in patients with stable coronary artery disease: a population-based cohort using linked health records (CALIBER)

    PubMed Central

    Walker, Simon; Asaria, Miqdad; Manca, Andrea; Palmer, Stephen; Gale, Chris P.; Shah, Anoop Dinesh; Abrams, Keith R.; Crowther, Michael; Timmis, Adam; Hemingway, Harry; Sculpher, Mark

    2016-01-01

    Abstract Aims To examine long-term healthcare utilization and costs of patients with stable coronary artery disease (SCAD). Methods and results Linked cohort study of 94 966 patients with SCAD in England, 1 January 2001 to 31 March 2010, identified from primary care, secondary care, disease, and death registries. Resource use and costs, and cost predictors by time and 5-year cardiovascular disease (CVD) risk profile were estimated using generalized linear models. Coronary heart disease hospitalizations were 20.5% in the first year and 66% in the year following a non-fatal (myocardial infarction, ischaemic or haemorrhagic stroke) event. Mean healthcare costs were £3133 per patient in the first year and £10 377 in the year following a non-fatal event. First-year predictors of cost included sex (mean cost £549 lower in females), SCAD diagnosis (non-ST-elevation myocardial infarction cost £656 more than stable angina), and co-morbidities (heart failure cost £657 more per patient). Compared with lower risk patients (5-year CVD risk 3.5%), those of higher risk (5-year CVD risk 44.2%) had higher 5-year costs (£23 393 vs. £9335) and lower lifetime costs (£43 020 vs. £116 888). Conclusion Patients with SCAD incur substantial healthcare utilization and costs, which varies and may be predicted by 5-year CVD risk profile. Higher risk patients have higher initial but lower lifetime costs than lower risk patients as a result of shorter life expectancy. Improved cardiovascular survivorship among an ageing CVD population is likely to require stratified care in anticipation of the burgeoning demand. PMID:27042338

  20. Expert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary Disease.

    PubMed

    Riesco Miranda, Juan Antonio; Alcázar, Bernardino; Alfageme, Inmaculada; Casanova, Ciro; Celli, Bartolomé; de-Torres, Juan P; Jiménez Ruiz, Carlos A

    2017-10-01

    To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from1 (total disagreement) to10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels. A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Stable radio frequency dissemination by simple hybrid frequency modulation scheme.

    PubMed

    Yu, Longqiang; Wang, Rong; Lu, Lin; Zhu, Yong; Wu, Chuanxin; Zhang, Baofu; Wang, Peizhang

    2014-09-15

    In this Letter, we propose a fiber-based stable radio frequency transfer system by a hybrid frequency modulation scheme. Creatively, two radio frequency signals are combined and simultaneously transferred by only one laser diode. One frequency component is used to detect the phase fluctuation, and the other one is the derivative compensated signal providing a stable frequency for the remote end. A proper ratio of the frequencies of the components is well maintained by parameter m to avoid interference between them. Experimentally, a stable 200 MHz signal is transferred over 100 km optical fiber with the help of a 1 GHz detecting signal, and fractional instability of 2×10(-17) at 10(5) s is achieved.

  2. Translational phases of evidence in a prognostic biomarker: a systematic review and meta-analysis of natriuretic peptides and the prognosis of stable coronary disease.

    PubMed

    Sutaria, Shailen; Philipson, Peter; Fitzpatrick, Natalie K; Abrams, Keith; Moreno, Santiago G; Timmis, Adam; Hingorani, Aroon D; Hemingway, Harry

    2012-04-01

    Translational phases of study are important in evaluating whether a prognostic biomarker is likely to have impact on clinical practice but systematic evaluations of such evidence are lacking. To systematically evaluate the clinical usefulness of the published literature on the association of natriuretic peptides (NP) and prognosis in stable coronary disease. MEDLINE and EMBASE until the end of July 2009, without restrictions. Prospective studies measuring NP in people with stable coronary disease who were followed-up for all cause mortality, coronary or cardiovascular events. Two independent reviewers categorised studies according to the American Heart Association phase of study, and extracted data according to the study reporting guidelines from the American Heart Association and REMARK. Systematic review of 19 studies found 17 which were phase 2, reporting an association between NP and events, two phase 3 studies, statistically examining the incremental prognostic value of NP, but no studies assessing whether NP predicted risk sufficiently to change management (phase 4), improve clinical outcomes (phase 5) or cost effectiveness (phase 6). No study referred to a statistical analytic protocol. Meta-analysis of 14 studies, reporting 18,841 patients and 1655 outcome events, found an RR for events of 3.28 (95% CI 2.45 to 4.38) comparing top versus bottom third of NP. This effect was 26% lower among the five studies which adjusted for a priori confounders (age, sex, renal function and left ventricular function) and 38% lower when adjusting for publication bias (Egger's p=0.001). The unbiased strength of association of NP with prognosis in stable coronary disease is unclear, and there is a lack of reports of clinically useful measures of prediction and discrimination or studies relating NP levels to clinical decision making. The available literature is confined to early phases and is of limited clinical usefulness.

  3. Prognostic models for stable coronary artery disease based on electronic health record cohort of 102 023 patients.

    PubMed

    Rapsomaniki, Eleni; Shah, Anoop; Perel, Pablo; Denaxas, Spiros; George, Julie; Nicholas, Owen; Udumyan, Ruzan; Feder, Gene Solomon; Hingorani, Aroon D; Timmis, Adam; Smeeth, Liam; Hemingway, Harry

    2014-04-01

    The population with stable coronary artery disease (SCAD) is growing but validated models to guide their clinical management are lacking. We developed and validated prognostic models for all-cause mortality and non-fatal myocardial infarction (MI) or coronary death in SCAD. Models were developed in a linked electronic health records cohort of 102 023 SCAD patients from the CALIBER programme, with mean follow-up of 4.4 (SD 2.8) years during which 20 817 deaths and 8856 coronary outcomes were observed. The Kaplan-Meier 5-year risk was 20.6% (95% CI, 20.3, 20.9) for mortality and 9.7% (95% CI, 9.4, 9.9) for non-fatal MI or coronary death. The predictors in the models were age, sex, CAD diagnosis, deprivation, smoking, hypertension, diabetes, lipids, heart failure, peripheral arterial disease, atrial fibrillation, stroke, chronic kidney disease, chronic pulmonary disease, liver disease, cancer, depression, anxiety, heart rate, creatinine, white cell count, and haemoglobin. The models had good calibration and discrimination in internal (external) validation with C-index 0.811 (0.735) for all-cause mortality and 0.778 (0.718) for non-fatal MI or coronary death. Using these models to identify patients at high risk (defined by guidelines as 3% annual mortality) and support a management decision associated with hazard ratio 0.8 could save an additional 13-16 life years or 15-18 coronary event-free years per 1000 patients screened, compared with models with just age, sex, and deprivation. These validated prognostic models could be used in clinical practice to support risk stratification as recommended in clinical guidelines.

  4. Stable isotope-resolved metabolomics and applications for drug development

    PubMed Central

    Fan, Teresa W-M.; Lorkiewicz, Pawel; Sellers, Katherine; Moseley, Hunter N.B.; Higashi, Richard M.; Lane, Andrew N.

    2012-01-01

    Advances in analytical methodologies, principally nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS), during the last decade have made large-scale analysis of the human metabolome a reality. This is leading to the reawakening of the importance of metabolism in human diseases, particularly cancer. The metabolome is the functional readout of the genome, functional genome, and proteome; it is also an integral partner in molecular regulations for homeostasis. The interrogation of the metabolome, or metabolomics, is now being applied to numerous diseases, largely by metabolite profiling for biomarker discovery, but also in pharmacology and therapeutics. Recent advances in stable isotope tracer-based metabolomic approaches enable unambiguous tracking of individual atoms through compartmentalized metabolic networks directly in human subjects, which promises to decipher the complexity of the human metabolome at an unprecedented pace. This knowledge will revolutionize our understanding of complex human diseases, clinical diagnostics, as well as individualized therapeutics and drug response. In this review, we focus on the use of stable isotope tracers with metabolomics technologies for understanding metabolic network dynamics in both model systems and in clinical applications. Atom-resolved isotope tracing via the two major analytical platforms, NMR and MS, has the power to determine novel metabolic reprogramming in diseases, discover new drug targets, and facilitates ADME studies. We also illustrate new metabolic tracer-based imaging technologies, which enable direct visualization of metabolic processes in vivo. We further outline current practices and future requirements for biochemoinformatics development, which is an integral part of translating stable isotope-resolved metabolomics into clinical reality. PMID:22212615

  5. Palpation simulator with stable haptic feedback.

    PubMed

    Kim, Sang-Youn; Ryu, Jee-Hwan; Lee, WooJeong

    2015-01-01

    The main difficulty in constructing palpation simulators is to compute and to generate stable and realistic haptic feedback without vibration. When a user haptically interacts with highly non-homogeneous soft tissues through a palpation simulator, a sudden change of stiffness in target tissues causes unstable interaction with the object. We propose a model consisting of a virtual adjustable damper and an energy measuring element. The energy measuring element gauges energy which is stored in a palpation simulator and the virtual adjustable damper dissipates the energy to achieve stable haptic interaction. To investigate the haptic behavior of the proposed method, impulse and continuous inputs are provided to target tissues. If a haptic interface point meets with the hardest portion in the target tissues modeled with a conventional method, we observe unstable motion and feedback force. However, when the target tissues are modeled with the proposed method, a palpation simulator provides stable interaction without vibration. The proposed method overcomes a problem in conventional haptic palpation simulators where unstable force or vibration can be generated if there is a big discrepancy in material property between an element and its neighboring elements in target tissues.

  6. Better lipid target achievement for secondary prevention through disease management programs for diabetes mellitus and coronary heart disease in clinical practice in Germany.

    PubMed

    Gitt, Anselm K; Sonntag, Frank; Jannowitz, Christina; Weizel, Achim; Karmann, Barbara; Schaefer, Juergen R; Pittrow, David; Hildemann, Steven K

    2016-01-01

    Disease management programs (DMP) for diabetes mellitus (DM) or coronary heart disease (CHD) address the treatment of lipid disorders. The current registry aimed to compare drug utilization, lipid lowering effects and further outcomes of outpatients at high cardiovascular risk in DMP for DM or CHD compared to patients in routine care (no-DMP). This was a prospective non-interventional registry with a 1 year follow-up which enrolled consecutive patients with known DM and/or any vascular disease on simvastatin 40 mg monotherapy, to document lipid target achievement in clinical practice in Germany according to existing guidelines. Drug use (maintenance, add-on, switch, discontinuation) and other components of care were upon the discretion of the treating physician. Of a total of 12,154 patients (mean age 65.8 years, 61.2% males), 3273 were in DMP CHD, 3265 in DMP DM and 1760 in DMP CHD + DM. In DMP patients compared to no-DMP patients, comorbidities/risk factors were more frequent. More patients in the DMP groups attained the target level of low density lipoprotein (LDL-C) <70 mg/dl (1.8 mmol/l) at baseline (8.5% DMP vs. 5.7% no-DMP), at 6 month (10.3% vs. 7.4%) and 12 month follow-up (10.1% vs. 7.1%). Cholesterol absorption inhibitors were added in 16% of the patients at the end of the baseline or at the follow-up visits, while statin treatment (including mean dose) remained largely unchanged. Target achievement rates were highest for all time points in the DMP CHD + DM group. With respect to limitations, this study was restricted to lipid disorders as qualifying diagnosis and simvastatin as qualifying treatment, which is a potential cause of selection bias. Information on non-pharmacological measures was not collected, and the 12-month follow-up period was relatively short. Patients in DMP compared to those not in DMP achieved better LDL-C lowering and higher control rates, but overall lipid target achievement rates need to be improved. Longer

  7. Highly Reflective Multi-stable Electrofluidic Display Pixels

    NASA Astrophysics Data System (ADS)

    Yang, Shu

    Electronic papers (E-papers) refer to the displays that mimic the appearance of printed papers, but still owning the features of conventional electronic displays, such as the abilities of browsing websites and playing videos. The motivation of creating paper-like displays is inspired by the truths that reading on a paper caused least eye fatigue due to the paper's reflective and light diffusive nature, and, unlike the existing commercial displays, there is no cost of any form of energy for sustaining the displayed image. To achieve the equivalent visual effect of a paper print, an ideal E-paper has to be a highly reflective with good contrast ratio and full-color capability. To sustain the image with zero power consumption, the display pixels need to be bistable, which means the "on" and "off" states are both lowest energy states. Pixel can change its state only when sufficient external energy is given. There are many emerging technologies competing to demonstrate the first ideal E-paper device. However, none is able to achieve satisfactory visual effect, bistability and video speed at the same time. Challenges come from either the inherent physical/chemical properties or the fabrication process. Electrofluidic display is one of the most promising E-paper technologies. It has successfully demonstrated high reflectivity, brilliant color and video speed operation by moving colored pigment dispersion between visible and invisible places with electrowetting force. However, the pixel design did not allow the image bistability. Presented in this dissertation are the multi-stable electrofluidic display pixels that are able to sustain grayscale levels without any power consumption, while keeping the favorable features of the previous generation electrofluidic display. The pixel design, fabrication method using multiple layer dry film photoresist lamination, and physical/optical characterizations are discussed in details. Based on the pixel structure, the preliminary

  8. Documenting Reading Achievement and Growth for Students Taking Alternate Assessments

    ERIC Educational Resources Information Center

    Tindal, Gerald; Nese, Joseph F. T.; Farley, Dan; Saven, Jessica L.; Elliott, Stephen N.

    2016-01-01

    Students with disabilities have been included in state accountability systems for more than a decade; however, only in the past few years have alternate assessments of alternate achievement standards (AA-AAS) become stable enough to allow examination of these students' achievement growth. Using data from Oregon's AA-AAS in Reading during the…

  9. Harnessing collaborative technology to accelerate achievement of chronic disease management objectives for Canada.

    PubMed

    Thompson, Leslee J; Healey, Lindsay; Falk, Will

    2007-01-01

    Morgan and colleagues put forth a call to action for the transformation of the Canadian healthcare system through the adoption of a national chronic disease prevention and management (CDPM) strategy. They offer examples of best practices and national solutions including investment in clinical information technologies to help support improved care and outcomes. Although we acknowledge that the authors propose CDPM solutions that are headed in the right direction, more rapid deployment of solutions that harness the potential of advanced collaborative technologies is required. We provide examples of how technologies that exist today can help to accelerate the achievement of some key CDPM objectives.

  10. Achieving sustainable plant disease management through evolutionary principles.

    PubMed

    Zhan, Jiasui; Thrall, Peter H; Burdon, Jeremy J

    2014-09-01

    Plants and their pathogens are engaged in continuous evolutionary battles and sustainable disease management requires novel systems to create environments conducive for short-term and long-term disease control. In this opinion article, we argue that knowledge of the fundamental factors that drive host-pathogen coevolution in wild systems can provide new insights into disease development in agriculture. Such evolutionary principles can be used to guide the formulation of sustainable disease management strategies which can minimize disease epidemics while simultaneously reducing pressure on pathogens to evolve increased infectivity and aggressiveness. To ensure agricultural sustainability, disease management programs that reflect the dynamism of pathogen population structure are essential and evolutionary biologists should play an increasing role in their design. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Achieving Stable Radiation Pressure Acceleration of Heavy Ions via Successive Electron Replenishment from Ionization of a High-Z Material Coating

    NASA Astrophysics Data System (ADS)

    Shen, X. F.; Qiao, B.; Chang, H. X.; Kar, S.; Zhou, C. T.; Borghesi, M.; He, X. T.

    2016-10-01

    Generation of monoenergetic heavy ion beams aroused more scientific interest in recent years. Radiation pressure acceleration (RPA) is an ideal mechanism for obtaining high-quality heavy ion beams, in principle. However, to achieve the same energy per nucleon (velocity) as protons, heavy ions undergo much more serious Rayleigh-Taylor-like (RT) instability and afterwards much worse Coulomb explosion due to loss of co-moving electrons. This leads to premature acceleration termination of heavy ions and very low energy attained in experiment. The utilization of a high-Z coating in front of the target may suppress the RT instability and Coulomb explosion by continuously replenishing the accelerating heavy ion foil with co-moving electrons due to its successive ionization under laser fields with Gaussian temporal and spatial profiles. Thus stable RPA can be realized. Two-dimensional and three-dimensional particles-in-cell simulations with dynamic ionization show that a monoenergetic Al13+ beam with peak energy 4.0GeV and particle number 1010 (charge > 20nC) can be obtained at intensity 1022 W/cm2. Supported by the NSF, Nos. 11575298 and 1000-Talents Program of China.

  12. Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial.

    PubMed

    Vidal-Petiot, Emmanuelle; Stebbins, Amanda; Chiswell, Karen; Ardissino, Diego; Aylward, Philip E; Cannon, Christopher P; Ramos Corrales, Marco A; Held, Claes; López-Sendón, José Luis; Stewart, Ralph A H; Wallentin, Lars; White, Harvey D; Steg, Philippe Gabriel

    2017-10-01

    To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  13. Molecular Phenotypes Distinguish Patients with Relatively Stable from Progressive Idiopathic Pulmonary Fibrosis (IPF)

    PubMed Central

    Boon, Kathy; Bailey, Nathaniel W.; Yang, Jun; Steel, Mark P.; Groshong, Steve; Kervitsky, Dolly; Brown, Kevin K.; Schwarz, Marvin I.; Schwartz, David A.

    2009-01-01

    Background Idiopathic pulmonary fibrosis (IPF) is a progressive, chronic interstitial lung disease that is unresponsive to current therapy and often leads to death. However, the rate of disease progression differs among patients. We hypothesized that comparing the gene expression profiles between patients with stable disease and those in which the disease progressed rapidly will lead to biomarker discovery and contribute to the understanding of disease pathogenesis. Methodology and Principal Findings To begin to address this hypothesis, we applied Serial Analysis of Gene Expression (SAGE) to generate lung expression profiles from diagnostic surgical lung biopsies in 6 individuals with relatively stable (or slowly progressive) IPF and 6 individuals with progressive IPF (based on changes in DLCO and FVC over 12 months). Our results indicate that this comprehensive lung IPF SAGE transcriptome is distinct from normal lung tissue and other chronic lung diseases. To identify candidate markers of disease progression, we compared the IPF SAGE profiles in stable and progressive disease, and identified a set of 102 transcripts that were at least 5-fold up regulated and a set of 89 transcripts that were at least 5-fold down regulated in the progressive group (P-value≤0.05). The over expressed genes included surfactant protein A1, two members of the MAPK-EGR-1-HSP70 pathway that regulate cigarette-smoke induced inflammation, and Plunc (palate, lung and nasal epithelium associated), a gene not previously implicated in IPF. Interestingly, 26 of the up regulated genes are also increased in lung adenocarcinomas and have low or no expression in normal lung tissue. More importantly, we defined a SAGE molecular expression signature of 134 transcripts that sufficiently distinguished relatively stable from progressive IPF. Conclusions These findings indicate that molecular signatures from lung parenchyma at the time of diagnosis could prove helpful in predicting the likelihood of

  14. Achieving and maintaining asthma control in an urban pediatric disease management program: the Breathmobile Program.

    PubMed

    Jones, Craig A; Clement, Loran T; Morphew, Tricia; Kwong, Kenny Yat Choi; Hanley-Lopez, Jean; Lifson, Francene; Opas, Lawrence; Guterman, Jeffrey J

    2007-06-01

    National guidelines suggest that, with appropriate care, most patients can control their asthma. The probabilities of children achieving and maintaining control with ongoing care are unknown. We sought to evaluate the degree to which children in a lower socioeconomic urban setting achieve and maintain control of asthma with regular participation in a disease management program that provides guideline-based care. Interdisciplinary teams of asthma specialists use mobile clinics to offer ongoing care at schools and county clinics. A guideline-derived construct of asthma control is recorded at each visit. Two thousand one hundred eighty-five enrollees were eligible to evaluate the time to first achieve control, and 1591 patients were eligible to evaluate subsequent control maintenance. Depending on severity, 70% to 87% of patients with persistent asthma achieved control by visit 3, and 89% to 98% achieved control by visit 6. Subsequent control maintenance was highly variable. Thirty-nine percent of patients displayed well-controlled asthma (control at >90% of subsequent visits), whereas 13% displayed difficult-to-control asthma (<50% of subsequent visits). Patients from each baseline severity category were found in each group. Maintenance of control was influenced by physician-estimated compliance with the treatment plan, baseline severity, and the interval between clinic visits. Many children can achieve asthma control with regular visit intervals and guideline-based care; however, long-term control can be highly variable among patients in all severity categories. These findings highlight the need and feasibility for systematically tracking each patient's clinical response to individualize therapy and guide the use of population management strategies.

  15. Thrombolysis in myocardial infarction frame count in coronary arteries without visible atherosclerosis in coronary angiography of patients with stable coronary artery disease.

    PubMed

    Tacoy, Gulten A; Yazici, Guliz E; Kocaman, Sinan A; Ozdemir, Murat H

    2009-06-01

    To investigate the thrombolysis in myocardial infarction (TIMI) frame count (TFC) in the coronary arteries without visible atherosclerosis in coronary angiography of patients with stable coronary artery disease (CAD). Eighty-three patients (mean age 58+/-10, 31 [37%] males), who underwent coronary angiographic evaluation for stable angina in Gazi University, Ankara, Turkey, Cardiology clinic between 2006-2007 were enrolled. Forty patients with normal coronary arteries were defined as group I. Group II consisted of 43 patients, who have one normal coronary artery in the setting of stable CAD defined as stenoses 50% or greater in at least one major coronary artery. Coronary blood flow and microvascular perfusion was evaluated by TFC. In group II, the TFC of left anterior descending artery (LAD) in 15 patients, TFC of circumflex artery (CX) in 18 patient, and TFC of right coronary artery (RCA) in 10 patients were evaluated. In group II, the TFC of LAD (37+/-12 versus 29+/-12, p=0.015) and CX (22+/-8 versus 18+/-9, p=0.035) were significantly higher than those in group I. The TFC of RCA was similar between groups (17+/-9 versus 17+/-8, p=0.990). After the adjustment of the risk factors by multivariate regression analyses, the association between TFC and clinical characteristic was statistically non-significant. The TFC decreased in angiographically normal LAD and CX arteries in the setting of stable angina pectoris. The important predictor was CAD alone, irrespective of the clinical parameters.

  16. The effect of heart rate reduction by ivabradine on collateral function in patients with chronic stable coronary artery disease.

    PubMed

    Gloekler, Steffen; Traupe, Tobias; Stoller, Michael; Schild, Deborah; Steck, Hélène; Khattab, Ahmed; Vogel, Rolf; Seiler, Christian

    2014-01-01

    To evaluate the effect of heart rate reduction by ivabradine on coronary collateral function in patients with chronic stable coronary artery disease (CAD). This was a prospective randomised placebo-controlled monocentre trial in a university hospital setting. 46 patients with chronic stable CAD received placebo (n=23) or ivabradine (n=23) for the duration of 6 months. The main outcome measure was collateral flow index (CFI) as obtained during a 1 min coronary artery balloon occlusion at study inclusion (baseline) and at the 6-month follow-up examination. CFI is the ratio between simultaneously recorded mean coronary occlusive pressure divided by mean aortic pressure both subtracted by mean central venous pressure. During follow-up, heart rate changed by +0.2±7.8 beats/min in the placebo group, and by -8.1±11.6 beats/min in the ivabradine group (p=0.0089). In the placebo group, CFI decreased from 0.140±0.097 at baseline to 0.109±0.067 at follow-up (p=0.12); it increased from 0.107±0.077 at baseline to 0.152±0.090 at follow-up in the ivabradine group (p=0.0461). The difference in CFI between the 6-month follow-up and baseline examination amounted to -0.031±0.090 in the placebo group and to +0.040±0.094 in the ivabradine group (p=0.0113). Heart rate reduction by ivabradine appears to have a positive effect on coronary collateral function in patients with chronic stable CAD. NCT01039389.

  17. Metabolic alkalosis in adults with stable cystic fibrosis.

    PubMed

    Al-Ghimlas, Fahad; Faughnan, Marie E; Tullis, Elizabeth

    2012-01-01

    The frequency of metabolic alkalosis among adults with stable severe CF-lung disease is unknown. Retrospective chart review. Fourteen CF and 6 COPD (controls) patients were included. FEV1 was similar between the two groups. PaO2 was significantly higher in the COPD (mean ± 2 SD is 72.0 ± 6.8 mmHg,) than in the CF group (56.1 ± 4.1 mmHg). The frequency of metabolic alkalosis in CF patients (12/14, 86%) was significantly greater (p=0.04) than in the COPD group (2/6, 33%). Mixed respiratory acidosis and metabolic alkalosis was evident in 4 CF and 1 COPD patients. Primary metabolic alkalosis was observed in 8 CF and none of the COPD patients. One COPD patient had respiratory and metabolic alkalosis. Metabolic alkalosis is more frequent in stable patients with CF lung disease than in COPD patients. This might be due to defective CFTR function with abnormal electrolyte transport within the kidney and/ or gastrointestinal tract.

  18. [The effect of sodium chloride baths on the physical work capacity and extrasystole of patients with ischemic heart disease and stable stenocardia].

    PubMed

    Klemenkov, S V; Davydova, O B; Levitskiĭ, E F; Chashchin, N F; Sharova, O Ia; Kubushko, I V

    1999-01-01

    73 patients with ischemic heart disease (IHD) and stable angina pectoris of NYHA class I and II underwent balneotherapy. 43 of them took a course of sodium chloride baths, 30 control patients took common water baths. As shown by spiroveloergometry and Holter monitoring, sodium chloride baths are a good training modality in IHD patients. They enhance muscular performance and coronary heart reserve, reduce the mean 24-h number of ventricular extrasystoles by 49.9%, supraventricular extrasystoles by 57.5%.

  19. Demonstration of a stable ultrafast laser based on a nonlinear microcavity

    PubMed Central

    Peccianti, M.; Pasquazi, A.; Park, Y.; Little, B.E.; Chu, S.T.; Moss, D.J.; Morandotti, R.

    2012-01-01

    Ultrashort pulsed lasers, operating through the phenomenon of mode-locking, have had a significant role in many facets of our society for 50 years, for example, in the way we exchange information, measure and diagnose diseases, process materials, and in many other applications. Recently, high-quality resonators have been exploited to demonstrate optical combs. The ability to phase-lock their modes would allow mode-locked lasers to benefit from their high optical spectral quality, helping to realize novel sources such as precision optical clocks for applications in metrology, telecommunication, microchip-computing, and many other areas. Here we demonstrate the first mode-locked laser based on a microcavity resonator. It operates via a new mode-locking method, which we term filter-driven four-wave mixing, and is based on a CMOS-compatible high quality factor microring resonator. It achieves stable self-starting oscillation with negligible amplitude noise at ultrahigh repetition rates, and spectral linewidths well below 130 kHz. PMID:22473009

  20. Conjugated polymer dots for ultra-stable full-color fluorescence patterning.

    PubMed

    Chang, Kaiwen; Liu, Zhihe; Chen, Haobin; Sheng, Lan; Zhang, Sean Xiao-An; Chiu, Daniel T; Yin, Shengyan; Wu, Changfeng; Qin, Weiping

    2014-11-12

    Stable full-color fluorescence patterning are achieved by multicolor polymer-dot inks. The fluorescent patterns show extraordinary stability upon various treatments, offering a superior combination of bright fluorescence, excellent photostability, chemical resistance, and eco-friendship. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. Sex Differences in Cardiac Medication Use Post-Catheterization in Patients Undergoing Coronary Angiography for Stable Angina with Nonobstructive Coronary Artery Disease.

    PubMed

    Galway, Shannon; Adatia, Falisha; Grubisic, Maja; Lee, May; Daniele, Patrick; Humphries, Karin H; Sedlak, Tara L

    2017-09-01

    Treatment of patients with stable angina and nonobstructive coronary artery disease (CAD) has not been well characterized. We comparatively evaluated medication use in males and females with stable angina with no CAD, nonobstructive CAD, and obstructive CAD. We studied all patients ≥20 years old with stable angina undergoing coronary angiography in British Columbia (BC), Canada, from January 2008 to March 2010 (n = 7,535). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1%-49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through BC PharmaNet for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, antiplatelet agents, and prescriptions for all three ACE-I/ARBs, beta-blockers, and statins (combination therapy). Following angiography, patients with no and nonobstructive CAD had significantly lower rates of prescription use of all medications, including combination therapy, than patients with obstructive CAD (p < 0.001). Use of ACE-I/ARBs, beta-blockers, statins, and combination therapy did not differ by sex, but females had higher use of CCB in all CAD groups, and clopidogrel in nonobstructive and obstructive CAD groups, compared to males. In patients with stable angina, medication use following angiography is low in nonobstructive CAD with only 58.9% prescribed a statin and 19.4% on combination therapy at 3 months. There are no important sex differences in medication use in any CAD category post-angiography. Future studies should explore methods of improving quality of care in patients with nonobstructive CAD.

  2. Risk prediction in stable cardiovascular disease using a high-sensitivity cardiac troponin T single biomarker strategy compared to the ESC-SCORE.

    PubMed

    Biener, Moritz; Giannitsis, Evangelos; Kuhner, Manuel; Zelniker, Thomas; Mueller-Hennessen, Matthias; Vafaie, Mehrshad; Stoyanov, Kiril M; Neumann, Franz-Josef; Katus, Hugo A; Hochholzer, Willibald; Valina, Christian Marc

    2018-01-01

    To evaluate the prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) compared with the ESC-SCORE. We included low-risk outpatients with stable cardiovascular (CV) disease categorised into need for non-secondary and secondary prevention. The prognostication of hs-cTnT at index visit was compared with the European Society of Cardiology-Systematic COronary Risk Evaluation (ESC-SCORE) with respect to all-cause mortality (ACM) and two composite endpoints (ACM, acute myocardial infarction (AMI) and stroke and ACM, AMI, stroke and rehospitalisation for acute coronary syndrome (ACS) and decompensated heart failure (DHF)). Within a median follow-up of 796 days, a total of 16 deaths, 32 composite endpoints of ACM, AMI and stroke and 83 composite endpoints of ACM, AMI, stroke, rehospitalisation for ACS and DHF were observed among 693 stable low-risk outpatients. Using C-statistics, measurement of hs-cTnT alone outperformed the ESC-SCORE for the prediction of ACM in the entire study population (Δarea under the curve (AUC) 0.221, p=0.0039) and both prevention groups (non-secondary: ΔAUC 0.164, p=0.0208; secondary: ΔAUC 0.264, p=0.0134). For the prediction of all other secondary endpoints, hs-cTnT was at least as effective as the ESC-SCORE, both in secondary and non-secondary prevention. Using continuous and categorical net reclassification improvement and integrated discrimination improvement, hs-cTnT significantly improved reclassification regarding all endpoints in the entire population and in the secondary prevention cohort. In non-secondary prevention, hs-cTnT improved reclassification only for ACM. The results were confirmed in an independent external cohort on 2046 patients. Hs-cTnT is superior to the multivariable ESC-SCORE for the prediction of ACM and a composite endpoint in stable outpatients with and without relevant CV disease. NCT01954303; Pre-results.

  3. Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease.

    PubMed

    Madsen, Debbie M; Diederichsen, Axel C P; Hosbond, Susanne E; Gerke, Oke; Mickley, Hans

    2017-03-01

    Typical angina pectoris (AP) and high-sensitive troponin I (hs-TnI) are independently associated with coronary artery disease (CAD) and future cardiovascular events (CVE). This study aimed to assess the individual and combined diagnostic and prognostic impact of symptoms and hs-TnI in stable chest pain patients without prior cardiovascular disease. During a one-year period, 487 patients with suspected stable AP underwent invasive or CT-coronary angiography (significant stenosis ≥50%). At study inclusion, a careful symptom evaluation was obtained, and patients were classified as having typical AP, atypical AP, or non-cardiac chest pain. Hs-TnI was measured in all patients and divided into tertiles for analysis. Follow-up was a median of 4.9 years with cardiovascular death, non-fatal myocardial infarction, unstable AP, ischemic stroke, coronary-artery-bypass-grafting, percutaneous coronary intervention, and peripheral vascular surgery as combined endpoint. Hs-TnI was detected in 486 patients (99.8%). By multivariate regression analysis, typical AP and hs-TnI elevation were associated with increased risk of having significant CAD (typical AP, OR: 3.46; 95% CI: 2.07-5.79; p < 0.0001, hs-TnI, OR: 1.50; 95% CI: 1.12-2.01; p = 0.007) and experiencing future CVE (typical AP, HR: 2.64; 95% CI: 1.74-3.99; p = 0.001, hs-TnI, HR: 1.26; 95% CI: 1.06-1.49; p = 0.008). Patients in the lowest hs-TnI tertile, without typical AP (n = 107) had a 1.9% absolute risk of significant CAD and a 3.7% absolute risk of long-term CVE. In clinical stable patients without known cardiovascular disease, a thorough chest-pain history in combination with hs-TnI testing can identify a significant low-risk group. The prognostic need for coronary angiography in these patients seems limited. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Thermal design and test results for SUNLITE ultra-stable reference cavity

    NASA Technical Reports Server (NTRS)

    Amundsen, Ruth M.

    1991-01-01

    SUNLITE (Stanford University-NASA Laser In-Space Technology Experiment) is a space-based experiment which uses a reference cavity to provide a stable frequency reference for a terahertz laser oscillator. Thermal stability of the cavity is a key factor in attaining a stable narrow-linewidth laser beam. The mount which is used to support and align the cavity will provide thermal isolation from the environment. The baseline requirement for thermal stability of the cavity is 0.025 C/min, but the design is directed toward achieving stability well beyond this requirement to improve the science data gained. A prototype of the cavity mount was fabricated and tested to characterize the thermal performance. The thermal vacuum test involved stable high-resolution temperature measurements and stable baseplate temperature control over long durations. Based on test data, the cavity mount design satisfies the severe requirement for the cavity thermal stability.

  5. Mining Stable Roles in RBAC

    NASA Astrophysics Data System (ADS)

    Colantonio, Alessandro; di Pietro, Roberto; Ocello, Alberto; Verde, Nino Vincenzo

    In this paper we address the problem of generating a candidate role-set for an RBAC configuration that enjoys the following two key features: it minimizes the administration cost; and, it is a stable candidate role-set. To achieve these goals, we implement a three steps methodology: first, we associate a weight to roles; second, we identify and remove the user-permission assignments that cannot belong to a role that have a weight exceeding a given threshold; third, we restrict the problem of finding a candidate role-set for the given system configuration using only the user-permission assignments that have not been removed in the second step—that is, user-permission assignments that belong to roles with a weight exceeding the given threshold. We formally show—proof of our results are rooted in graph theory—that this methodology achieves the intended goals. Finally, we discuss practical applications of our approach to the role mining problem.

  6. Friend Influence on Achievement during Middle Childhood

    ERIC Educational Resources Information Center

    DeLay, Dawn

    2013-01-01

    This study was designed to investigate friend influence on academic achievement and task avoidance during middle childhood in a sample of 794 participants in 397 stable same-sex friendship dyads (205 girl dyads and 192 boy dyads) from four municipalities in Finland: two in Central Finland, one in Western Finland, and one in Eastern Finland.…

  7. The number and function of circulating CD34+CD133+ progenitor cells decreased in stable coronary artery disease but not in acute myocardial infarction

    PubMed Central

    Kondo, Takahisa; Shintani, Satoshi; Maeda, Kengo; Hayashi, Mutsuharu; Inden, Yasuya; Numaguchi, Yasushi; Sugiura, Kaichiro; Morita, Yasuhiro; Kitamura, Tomoya; Kamiya, Haruo; Sone, Takahito; Ohno, Miyoshi; Murohara, Toyoaki

    2010-01-01

    Objective Circulating CD34+CD133+ cells are one of the main sources of circulating endothelial progenitor cells (EPCs). Age is inversely related to the number and function of CD34+CD133+ progenitor cells in stable coronary artery disease (CAD), but the relationship remains unclear in acute myocardial infarction (AMI). The authors aimed to clarify how ageing affects the number and function of mobilised CD34+CD133+ progenitor cells in AMI. Design and results Circulating CD34+CD133+ progenitor cells were measured by flow cytometry. Measurements were made at admission for CAD, or on day 7 after the onset of AMI. In stable CAD (n=131), circulating CD34+CD133+ cells decreased with age (r=−0.344, p<0.0001). In AMI, circulating CD34+CD133+ cells did not correlate with age (n=50), and multivariate analysis revealed that the decreased number of circulating CD34+CD133+ cells was associated with male sex and higher peak creatinine kinase. The ability to give rise to functional EPCs, which show good migratory and tube-forming capabilities, deteriorated among stable CAD subjects (n=10) compared with AMI subjects (N=6). Conclusions In stable CAD, the number and function of circulating CD34+CD133+ progenitor cells decreased with age, whereas those mobilised and circulating in AMI did not. PMID:27325937

  8. Circadian Activity Rhythms, Time Urgency, and Achievement Concerns.

    ERIC Educational Resources Information Center

    Watts, Barbara L.

    Many physiological and psychological processes fluctuate throughout the day in fairly stable, rhythmic patterns. The relationship between individual differences in circadian activity rhythms and a sense of time urgency were explored as well as a number of achievement-related variables. Undergraduates (N=308), whose circadian activity rhythms were…

  9. Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease.

    PubMed

    Kataoka, Yu; Puri, Rishi; Hammadah, Muhammad; Duggal, Bhanu; Uno, Kiyoko; Kapadia, Samir R; Tuzcu, E Murat; Nissen, Steven E; King, Peta; Nicholls, Stephen J

    2016-08-01

    Numerous reports suggest sex-related differences in atherosclerosis. Frequency-domain optical coherence tomography has enabled visualization of plaque microstructures associated with disease instability. The prevalence of plaque microstructures between sexes has not been characterized. We investigated sex differences in plaque features in patients with coronary artery disease. Nonculprit plaques on frequency-domain optical coherence tomography imaging were compared between men and women with either stable coronary artery disease (n=320) or acute coronary syndromes (n=115). A greater prevalence of cardiovascular risk factors was observed in women. Nonculprit plaques in women with stable coronary artery disease were more likely to exhibit plaque erosion (8.6% versus 0.3%; P=0.03) and a smaller lipid arc (163.1±71.4° versus 211.2±71.2°; P=0.03), and less likely to harbor cholesterol crystals (17.2% versus 27.5%; P=0.01) and calcification (15.4% versus 34.4%; P=0.008), whereas fibrous cap thickness (105.2±62.1 versus 96.1±40.4 µm; P=0.57), the prevalence of thin-cap fibroatheroma (26.5% versus 25.2%; P=0.85), and microchannels (19.2% versus 20.5%; P=0.95) were comparable. In women with acute coronary syndrome, a smaller lipid arc (171.6±53.2° versus 235.8±86.4°; P=0.03), a higher frequency of plaque erosion (11.4% versus 0.6%; P=0.04), and a lower prevalence of cholesterol crystal (28.6% versus 38.2%; P=0.03) and calcification (10.0% versus 23.7%; P=0.01) were observed. These differences persisted after adjusting clinical demographics. Although thin-cap fibroatheromas in men clustered within proximal arterial segments, thin-cap fibroatheromas were evenly distributed in women. Despite more comorbid risk factors in women, their nonculprit plaques exhibited more plaque erosion, and less cholesterol and calcium content. This distinct phenotype suggests sex-related differences in the pathophysiology of atherosclerosis. © 2016 American Heart Association, Inc.

  10. Treatment-naïve Gaucher disease patients achieve therapeutic goals and normalization with velaglucerase alfa by 4years in phase 3 trials.

    PubMed

    Zimran, Ari; Elstein, Deborah; Gonzalez, Derlis E; Lukina, Elena A; Qin, Yulin; Dinh, Quinn; Turkia, Hadhami Ben

    2018-02-01

    Gaucher disease is an inherited metabolic disease characterized by β-glucocerebrosidase deficiency and commonly treated with enzyme replacement therapy (ERT). The efficacy of ERT with velaglucerase alfa was assessed based on the achievement of published therapeutic goals and the normalization of disease parameters in 39 treatment-naïve patients with type 1 Gaucher disease, 6 to 62years of age, enrolled in phase 3 clinical trials. After 4years of ERT, therapeutic goals for thrombocytopenia and splenomegaly had been achieved in 100% of patients; goals for anemia and hepatomegaly had been achieved in 95% and 94% of patients, respectively. Consistent with the goal for bone mineral density, lumbar spine bone density improved in 87% of patients ≥18years of age. At year 4, compared with clinical ranges for healthy individuals, 86% of patients with a low baseline hemoglobin concentration had normalized, 60% with a low baseline platelet count had normalized, 67% with baseline splenomegaly had normalized, 58% with hepatomegaly had normalized, and lumbar spine bone density had normalized in 53% of adults. The decade-old therapeutic goals do not reflect the potential for normalization of clinical parameters in ERT-treated patients. Goals consistent with normalization or near-normalization should be considered. ClinicalTrials.gov identifiers: NCT00430625, NCT00553631, NCT00635427. Copyright © 2016 Shire Human Genetic Therapies, Inc. Published by Elsevier Inc. All rights reserved.

  11. Type of dyslipidemia and achievement of the LDL-cholesterol goal in chronic kidney disease patients at the University Hospital.

    PubMed

    Sangsawang, Tamon; Sriwijitkamol, Apiradee

    2015-01-01

    Chronic kidney disease (CKD) has been defined as a coronary artery disease risk equivalent. Therefore, the current guideline has been recommended for CKD patients to reach and maintain a low-density lipoprotein-cholesterol (LDL-C) goal of less than 100 mg/dL. However, the data regarding the achievement of LDL-C goal in these patients is lacking. This study was conducted to evaluate the types of dyslipidemia affecting patients with CKD stages 3 and 4 and to determine whether these patients achieved LDL-C goal. We performed a retrospective chart review of patients with CKD stage 3 or 4 and dyslipidemia who were followed-up at Siriraj Hospital between October 2011 and September 2012. In total, 150 patients with CKD stage 3 or 4 and dyslipidemia were recruited. The mean age was 72±10 years, and the body mass index was 25.6±4 kg/m(2); 60% had CKD stage 3 with an estimated glomerular filtration rate of 34±12 mL/min/1.73 m(2), and 54% had type 2 diabetes. The percentage of patients with hypercholesterolemia was 78%, hypertriglyceridemia 54%, and low high-density lipoprotein-C 36%. Of these, 52% had mixed hyperlipidemia. Statin treatment was prescribed to 87% of the patients, of which only 31.3% achieved the LDL-C goal according to the National Cholesterol Education Program and the European Society of Cardiology/European Atherosclerosis Society recommendations. Patients who did not achieve the LDL-C goal had a higher cholesterol level at diagnosis and higher prevalence of type 2 diabetes and stroke than those who achieved it. Two-thirds of CKD patients with hyperlipidemia had mixed hyperlipidemia. Despite the high frequency of statin treatment, only one-third of patients with CKD achieved the LDL-C goal. Thus, a developmental plan for the management of dyslipidemia in patients with CKD should be implemented to increase their achievement of the LDL-C goal.

  12. The Ratio of Eicosapentaenoic Acid (EPA) to Arachidonic Acid may be a Residual Risk Marker in Stable Coronary Artery Disease Patients Receiving Treatment with Statin Following EPA Therapy.

    PubMed

    Tani, Shigemasa; Nagao, Ken; Kawauchi, Kenji; Yagi, Tsukasa; Atsumi, Wataru; Matsuo, Rei; Hirayama, Atsushi

    2017-10-01

    We investigated the relationship between the eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio and non-high-density lipoprotein cholesterol (non-HDL-C) level, a major residual risk of coronary artery disease (CAD), in statin-treated CAD patients following EPA therapy. We conducted a 6-month, prospective, randomized clinical trial to investigate the effect of the additional administration of EPA on the EPA/AA ratio and the serum non-HDL-C level in stable CAD patients receiving statin treatment. We assigned CAD patients already receiving statin therapy to an EPA group (1800 mg/day; n = 50) or a control group (n = 50). A significant reduction in the serum non-HDL-C level was observed in the EPA group, compared with the control group (-9.7 vs. -1.2%, p = 0.01). A multiple-regression analysis with adjustments for coronary risk factors revealed that achieved EPA/AA ratio was more reliable as an independent and significant predictor of a reduction in the non-HDL-C level at a 6-month follow-up examination (β = -0.324, p = 0.033) than the absolute change in the EPA/AA ratio. Interestingly, significant negative correlations were found between the baseline levels and the absolute change values of both non-HDL-C and triglyceride-rich lipoproteins, both markers of residual risk of CAD, indicating that patients with a higher baseline residual risk achieved a greater reduction. The present results suggest that the achieved EPA/AA ratio, but not the absolute change in EPA/AA ratio, following EPA therapy might be a useful marker for the risk stratification of CAD among statin-treated patients with a high non-HDL-C level. UMIN ( http://www.umin.ac.jp/ ) Study ID: UMIN000010452.

  13. Treatment of resistant glomerular diseases with adrenocorticotropic hormone gel: a prospective trial.

    PubMed

    Bomback, Andrew S; Canetta, Pietro A; Beck, Laurence H; Ayalon, Rivka; Radhakrishnan, Jai; Appel, Gerald B

    2012-01-01

    Adrenocorticotropic hormone (ACTH) has shown promising results in glomerular diseases resistant to conventional therapies, but the reported data have solely been from retrospective, observational studies. In this prospective, open-label study (NCT01129284), 15 subjects with resistant glomerular diseases were treated with ACTH gel (80 units subcutaneously twice weekly) for 6 months. Resistant membranous nephropathy (MN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS) were defined as failure to achieve sustained remission of proteinuria off immunosuppressive therapy with at least 2 treatment regimens; resistant IgA nephropathy was defined as >1 g/g urine protein:creatinine ratio despite maximally tolerated RAAS blockade. Remission was defined as stable or improved renal function with ≥50% reduction in proteinuria to <0.5 g/g (complete remission) or 0.5-3.5 g/g (partial remission). The study included 5 subjects with resistant idiopathic MN, 5 subjects with resistant MCD (n = 2)/FSGS (n = 3), and 5 subjects with resistant IgA nephropathy. Two resistant MN subjects achieved partial remission on ACTH therapy, although 3 achieved immunologic remission of disease (PLA(2)R antibody disappeared by 4 months of therapy). One subject with resistant FSGS achieved complete remission on ACTH; one subject with resistant MCD achieved partial remission but relapsed within 4 weeks of stopping ACTH. Two subjects with resistant IgA nephropathy demonstrated >50% reductions in proteinuria while on ACTH, with proteinuria consistently <1 g/g by 6 months. Three of 15 subjects reported significant steroid-like adverse effects with ACTH, including weight gain and hyperglycemia, prompting early termination of therapy without any clinical response. ACTH gel is a promising treatment for resistant glomerular diseases and should be studied further in controlled trials against currently available therapies for resistant disease. Copyright © 2012 S. Karger AG, Basel.

  14. Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease.

    PubMed

    Kato, Shingo; Saito, Naka; Kirigaya, Hidekuni; Gyotoku, Daiki; Iinuma, Naoki; Kusakawa, Yuka; Iguchi, Kohei; Nakachi, Tatsuya; Fukui, Kazuki; Futaki, Masaaki; Iwasawa, Tae; Taguri, Masataka; Kimura, Kazuo; Umemura, Satoshi

    2016-06-01

    The prognostic significance of the SYNTAX (Synergy between PCI with Taxus and cardiac surgery) score has recently been demonstrated in patients with stable multivessel or left main coronary artery disease (CAD). The present study determines whether adding the SYNTAX score to Framingham risk score (FRS), left ventricular ejection fraction (LVEF) and presence of myocardial infarction (MI) by late gadolinium enhancement (LGE) magnetic resonance imaging can improve the risk stratification in patients with stable CAD. We calculated the SYNTAX score in 161 patients with stable CAD (mean age: 66 ± 10 years old). During a mean follow-up of 2.3 years, 56 (35 %) of 161 patients developed cardiovascular events defined as cardiovascular death, non-fatal MI, cerebral infarction, unstable angina pectoris, hospitalization due to heart failure and revascularization. Multivariate Cox regression analysis selected triglycerides [hazard ratio (HR): 1.005 (95 % confidence interval (CI): 1.001-1.008), p < 0.008], presence of LGE [HR: 6.329 (95 % CI: 2.662-15.05), p < 0.001] and the SYNTAX score [HR: 1.085 (95 % CI: 1.044-1.127), p < 0.001] as risk factors for future cardiovascular events. Adding the SYNTAX score to FRS, EF and LGE significantly improved the net reclassification index (NRI) [40.4 % (95 % CI: 18.1-54.8 %), p < 0.05] with an increase in C-statistics of 0.089 (from 0.707 to 0.796). An increase in C-statistics and significant improvement of NRI showed that adding the SYNTAX score to the FRS, LVEF and LGE incrementally improved risk stratification in patient with stable CAD.

  15. A gender perspective on sleeplessness behavior, effects of sleep loss, and coping resources in patients with stable coronary artery disease.

    PubMed

    Edéll-Gustafsson, Ulla; Svanborg, Eva; Swahn, Eva

    2006-01-01

    The primary aim of this study was to systematically compare perceived sleep quality, sleeplessness behavior, sense of mastery, self-esteem, depression, subjective health, and effects of sleep loss in men and women with stable coronary artery disease (CAD). Further aims were to determine possible predictors of poor sleep quality and sense of mastery, as well as the consequences of too little sleep. Comparative-correlation and predictive design were used. Patients with a history of stable angina pectoris scheduled to undergo coronary angiography at Linköping University Hospital in Sweden were included. There were 47 women and 88 men (mean age 62.4 years) with CAD. Structured interviews using validated questionnaires covered sleep quality and sleep habits, effects of sleep loss, psychologic resources, and depression. Multiple stepwise regression analysis showed that sleeplessness behavior, depressed mood, female gender, and pharmacologic treatments with inflammation inhibitors significantly (P<.0001) accounted for the variance of poorer sleep quality. The analysis also showed that the following factors in descending order significantly accounted (P<.0001) for the outcome of sleep quality: inability to feel refreshed by sleep, difficulty in maintaining sleep, gastrointestinal problems, too little sleep, final morning awakening time, sleep onset latency, lying down because of daytime tiredness, and daytime physical tiredness. Compared with men, women with stable CAD may be especially at risk of experiencing poor sleep quality, even when sleeplessness behavior and pharmacologic treatments with inflammation inhibitors are controlled. It is also possible that they may be more at risk of depressed mood.

  16. Stable, semi-stable populations and growth potential.

    PubMed

    Bourgeois-Pichat, J

    1971-07-01

    Abstract Starting from the definition of a Malthusian population given by Alfred J. Lotka, the author recalls how the concept of stable population is introduced in demography, first as a particular case of stable populations, and secondly as a limit of a demographic evolutionary process in which female age-specific fertility rates and age-specific mortality rates remain constant. Then he defines a new concept: the semi-stable population which is a population with a constant age distribution. He shows that such a population coincides at any point of time with the stable population corresponding to the mortality and the fertility at this point of time. In the remaining part of the paper it is shown how the concept of a stable population can be used for defining a coefficient of inertia which measures the resistance of a population to modification of its course as a consequence of changing fertility and mortality. Some formulae are established to calculate this coefficient first for an arbitrary population, and secondly for a semistable population. In this second case the formula is particularly simple. It appears as a product of three terms: the expectation of life at birth in years, the crude birth rate, and a coefficient depending on the rate of growth and for which a numerical table is easy to establish.

  17. Achieving nitritation in a continuous moving bed biofilm reactor at different temperatures through ratio control.

    PubMed

    Bian, Wei; Zhang, Shuyan; Zhang, Yanzhuo; Li, Wenjing; Kan, Ruizhe; Wang, Wenxiao; Zheng, Zhaoming; Li, Jun

    2017-02-01

    A ratio control strategy was implemented in a continuous moving bed biofilm reactor (MBBR) to investigate the response to different temperatures. The control strategy was designed to maintain a constant ratio between dissolved oxygen (DO) and total ammonia nitrogen (TAN) concentrations. The results revealed that a stable nitritation in a biofilm reactor could be achieved via ratio control, which compensated the negative influence of low temperatures by stronger oxygen-limiting conditions. Even with a temperature as low as 6°C, stable nitritation could be achieved when the controlling ratio did not exceed 0.17. Oxygen-limiting conditions in the biofilm reactor were determined by the DO/TAN concentrations ratio, instead of the mere DO concentration. This ratio control strategy allowed the achievement of stable nitritation without complete wash-out of NOB from the reactor. Through the ratio control strategy full nitritation of sidestream wastewater was allowed; however, for mainstream wastewater, only partial nitritation was recommended. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Metabolic Alkalosis in Adults with Stable Cystic Fibrosis

    PubMed Central

    Al-Ghimlas, Fahad; Faughnan, Marie E; Tullis, Elizabeth

    2012-01-01

    Background: The frequency of metabolic alkalosis among adults with stable severe CF-lung disease is unknown. Methods: Retrospective chart review. Results: Fourteen CF and 6 COPD (controls) patients were included. FEV1 was similar between the two groups. PaO2 was significantly higher in the COPD (mean ± 2 SD is 72.0 ± 6.8 mmHg,) than in the CF group (56.1 ± 4.1 mmHg). The frequency of metabolic alkalosis in CF patients (12/14, 86%) was significantly greater (p=0.04) than in the COPD group (2/6, 33%). Mixed respiratory acidosis and metabolic alkalosis was evident in 4 CF and 1 COPD patients. Primary metabolic alkalosis was observed in 8 CF and none of the COPD patients. One COPD patient had respiratory and metabolic alkalosis. Conclusions: Metabolic alkalosis is more frequent in stable patients with CF lung disease than in COPD patients. This might be due to defective CFTR function with abnormal electrolyte transport within the kidney and/ or gastrointestinal tract. PMID:22905070

  19. Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    Sikich, N

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  20. Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study

    PubMed Central

    Escobedo, Jorge; Rana, Jamal S.; Lombardero, Manuel S.; Albert, Stewart G.; Davis, Andrew M.; Kennedy, Frank P.; Mooradian, Arshag D.; Robertson, David G.; Srinivas, V. S.; Gebhart, Suzanne S. P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of prior duration of diabetes, glycated hemoglobin level at study entry, and microalbuminuria or macroalbuminuria on the extent and severity of coronary artery disease (CAD) and peripheral arterial disease. PATIENTS AND METHODS: We studied baseline characteristics of the 2368 participants of the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) study, a randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes and angiographically documented stable CAD. Patients were enrolled from January 1, 2001, through March 31, 2005. Peripheral arterial disease was ascertained by an ankle-brachial index (ABI) of 0.9 or less, and extent of CAD was measured by presence of multivessel disease, a left ventricular ejection fraction (LVEF) of less than 50%, and myocardial jeopardy index. RESULTS: Duration of diabetes of 20 or more years was associated with increased risk of ABI of 0.9 or less (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.04-2.26), intermittent claudication (OR, 1.61; 95% CI, 1.10-2.35), and LVEF of less than 50% (OR, 2.03; 95% CI, 1.37-3.02). Microalbuminuria was associated with intermittent claudication (OR, 1.53; 95% CI, 1.16-2.02) and ABI of 0.9 or less (OR, 1.31; 95% CI, 0.98-1.75), whereas macroalbuminuria was associated with abnormal ABI, claudication, and LVEF of less than 50%. There was a significant association between diabetes duration and extent of CAD as manifested by number of coronary lesions, but no other significant associations were observed between duration of disease, glycated hemoglobin levels, or albumin-to-creatinine ratio and other manifestations of CAD. CONCLUSION: Duration of diabetes and microalbuminuria or macroalbuminuria are important predictors of severity of peripheral arterial disease and left ventricular dysfunction in a cohort of patients selected for the presence of CAD. PMID:20042560

  1. Diagnosis of stable ischemic heart disease: summary of a clinical practice guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons.

    PubMed

    Qaseem, Amir; Fihn, Stephan D; Williams, Sankey; Dallas, Paul; Owens, Douglas K; Shekelle, Paul

    2012-11-20

    The American College of Physicians (ACP) developed this guideline in collaboration with the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons to help clinicians diagnose known or suspected stable ischemic heart disease. Literature on this topic published before November 2011 was identified by using MEDLINE, Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were limited to human studies published in English. This guideline grades the evidence and recommendations according to a translation of the ACCF/AHA grading system into ACP's clinical practice guidelines grading system. This guideline includes 28 recommendations that address the following issues: the initial diagnosis of the patient who might have stable ischemic heart disease, cardiac stress testing to assess the risk for death or myocardial infarction in patients diagnosed with stable ischemic heart disease, and coronary angiography for risk assessment.

  2. Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study.

    PubMed

    Kubo, Satoshi; Yamaoka, Kunihiro; Amano, Koichi; Nagano, Shuji; Tohma, Shigeto; Suematsu, Eiichi; Nagasawa, Hayato; Iwata, Kanako; Tanaka, Yoshiya

    2017-08-01

    To determine whether tofacitinib can be discontinued in patients with RA who achieve low disease activity (LDA). RA patients with LDA after tofacitinib treatment in a phase III and long-term extension study were enrolled in this multicentre, non-randomized, open, prospective, observational study. The decision of discontinuation or continuation of tofacitinib was determined based on patient-physician decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib-free at post-treatment week 52. Clinical outcome was compared between those who continued and those who discontinued tofacitinib. The last observation carried forward method was used for patients who could not discontinue tofacitinib before week 52. Of 64 patients, 54 discontinued and 10 continued tofacitinib therapy. At post-treatment week 52, 20 of the 54 patients (37%) of the discontinuation group remained tofacitinib-free without disease flare. Disease activity at post-treatment week 52 was higher in the discontinuation group than the continuation group. Among the discontinuation group, the RF titre at baseline was significantly lower in patients who remained tofacitinib-free than those who did not (40 vs 113 U/ml). In fact, a higher proportion of patients with lower RF remained tofacitinib-free at week 52 compared with those with higher RF at baseline. In patients who could not achieve tofacitinib-free status, re-initiation of tofacitinib or other biologics improved disease activity. It is possible to discontinue tofacitinib without flare in about a third of patients with RA. A low RF predicts maintenance of LDA after discontinuation of tofacitinib. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  3. Are we there yet? Assessing achievement of vaccine-preventable disease goals in WHO's Western Pacific Region.

    PubMed

    Hennessey, Karen; Schluter, W William; Wang, Xiaojun; Boualam, Liliane; Jee, Youngmee; Mendoza-Aldana, Jorge; Roesel, Sigrun; Diorditsa, Sergey; Ehrenberg, John

    2014-07-23

    Accelerated disease control goals have long been appreciated for their role in galvanizing commitment and bringing a sense of urgency for disease prevention. WHO's Western Pacific Region has 14 on-going communicable disease reduction goals including 1 targeting eradication, 10 targeting elimination, and 3 control initiatives. These goals cover mother-to-child transmission of HIV, congenital syphilis, tuberculosis, leprosy, five parasitic diseases and four vaccine-preventable diseases (VPD). The initiatives have distinct objectives, approaches, and means in which to measure achievement of the goals. Given the long history and experience with VPD initiatives in the Western Pacific Region, this manuscript focuses on the Region's following initiatives: (1) smallpox eradication, (2) polio eradication, (3) measles elimination, (4) maternal and neonatal tetanus elimination (MNTE), and (5) hepatitis B control. There is good consistency across the Region's VPD initiatives yet a pattern of more robust and representative data requirements, stricter evaluation criteria, and more formal evaluation bodies are linked to the intensity of the goal - with eradication being the peak. On the other end of this spectrum, the Regional hepatitis B control initiative has established efficient and low-cost approaches for measuring impact and evaluating if the goals have been met. Even within the confines of VPD initiatives there are some deviations in use of terminology and comparisons across other disease control initiatives in the Region are provided. Copyright © 2014 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

  4. Preview-Based Stable-Inversion for Output Tracking

    NASA Technical Reports Server (NTRS)

    Zou, Qing-Ze; Devasia, Santosh

    1999-01-01

    Stable Inversion techniques can be used to achieve high-accuracy output tracking. However, for nonminimum phase systems, the inverse is non-causal - hence the inverse has to be pre-computed using a pre-specified desired-output trajectory. This requirement for pre-specification of the desired output restricts the use of inversion-based approaches to trajectory planning problems (for nonminimum phase systems). In the present article, it is shown that preview information of the desired output can be used to achieve online inversion-based output tracking of linear systems. The amount of preview-time needed is quantified in terms of the tracking error and the internal dynamics of the system (zeros of the system). The methodology is applied to the online output tracking of a flexible structure and experimental results are presented.

  5. Difference in serum magnesium level among patients with stable chronic obstructive pulmonary disease (COPD) and exacerbated COPD

    NASA Astrophysics Data System (ADS)

    Sanowara, R.; Keliat, E. N.; Abidin, A.

    2018-03-01

    Stable COPD is marked with various degrees of inflammation throughout large and small airways also in the alveoli which cause mucus hypersecretion, narrowing of the airway, and alveoli damage. Exacerbation is an episode of elevated inflammation. The relation between inflammation response and magnesium has been observed with the increase of proinflammation cytokines in magnesium deficiency. A cross-sectional study of 34 patients who came to RSUP H. Adam Malik (17 stable COPD patients and 17 acute exacerbated COPD patients) was conducted to examine serum magnesium level and spirometry in stable condition. Mean serum magnesium level for stable COPD patients group was 2.09 ± 0.11 mEq/L. It was higher than in the exacerbated COPD patients group 1.69 ± 0.27 mEq/L. Mann–Whitney statistical analysis showed a significant difference in magnesium level between stable COPD and exacerbated COPD groups (p<0.05).

  6. A Randomized Controlled Trial of Acupuncture in Stable Ischemic Heart Disease Patients

    PubMed Central

    Mehta, Puja K.; Polk, Donna M.; Zhang, Xiao; Li, Ning; Painovich, Jeannette; Kothawade, Kamlesh; Kirschner, Joan; Qiao, Yi; Ma, Xiuling; Chen, Yii-Der Ida; Brantman, Anna; Shufelt, Chrisandra; Minissian, Margo; Bairey Merz, C. Noel

    2014-01-01

    Background Heart rate variability (HRV) is reduced in stable ischemic heart disease (SIHD) patients and is associated with sudden cardiac death (SCD). We evaluated the impact of traditional acupuncture (TA) on cardiac autonomic function measured by HRV in SIHD patients. Methods We conducted a randomized controlled study of TA, sham acupuncture (SA), and waiting control (WC) in 151 SIHD subjects. TA group received needle insertion at acupuncture sites, SA group received a sham at non-acupuncture sites, while WC received nothing. TA and SA received 3 treatments/week for 12 wks. 24-hour, mental arithmetic stress, and cold pressor (COP) HRV was collected at entry and exit, along with BP, lipids, insulin resistance, hs-CRP, salivary cortisol, peripheral endothelial function by tonometry(PAT), and psychosocial variables. Results Mean age was 63±10; 50% had prior myocardial infarction. Comparison of WC and SA groups demonstrated differences consistent with the unblinded WC status; therefore by design, the control groups were not merged. Exit mental stress HRV was higher in TA vs. SA for markers of parasympathetic tone (p≤0.025), including a 17% higher vagal activity (p=0.008). There were no differences in exit 24-hour or COP HRV, BP, lipids, insulin resistance, hs-CRP, salivary cortisol, PAT, or psychosocial variables. Conclusions TA results in intermediate effects on autonomic function in SIHD patients. TA effect on HRV may be clinically relevant and should be explored further. These data document feasibility and provide sample size estimation for a clinical trial of TA in SIHD patients for prevention of SCD. PMID:25103909

  7. Environmentally stable all-PM all-fiber giant chirp oscillator.

    PubMed

    Erkintalo, Miro; Aguergaray, Claude; Runge, Antoine; Broderick, Neil G R

    2012-09-24

    We report on an environmentally stable giant chirp oscillator operating at 1030 nm. Thanks to the use of a nonlinear amplifying loop mirror as the mode-locker, we are able to extract pulse energies in excess of 10 nJ from a robust all-PM cavity with no free-space elements. Extensive numerical simulations reveal that the output oscillator energy and duration can simply be up-scaled through the lengthening of the cavity with suitably positioned single-mode fiber. Experimentally, using different cavity lengths we have achieved environmentally stable mode-locking at 10, 3.7 and 1.7 MHz with corresponding pulse energies of 2.3, 10 and 16 nJ. In all cases external grating-pair compression below 400 fs has been demonstrated.

  8. Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease: results from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial.

    PubMed

    Berger, Peter B; Bhatt, Deepak L; Fuster, Valentin; Steg, P Gabriel; Fox, Keith A A; Shao, Mingyuan; Brennan, Danielle M; Hacke, Werner; Montalescot, Gilles; Steinhubl, Steven R; Topol, Eric J

    2010-06-15

    Uncertainty exists about the frequency, correlates, and clinical significance of bleeding with dual antiplatelet therapy (DAPT), particularly over an extended period in a stable population. We sought to determine the frequency and time course of bleeding with DAPT in patients with established vascular disease or risk factors only; identify correlates of bleeding; and determine whether bleeding is associated with mortality. We analyzed 15 603 patients enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, a double-blind, placebo-controlled, randomized trial comparing long-term clopidogrel 75 mg/d versus placebo; all patients received aspirin (75 to 162 mg) daily. Patients had either established stable vascular disease or multiple risk factors for vascular disease without established disease. Median follow-up was 28 months. Bleeding was assessed with the use of the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) criteria. Severe bleeding occurred in 1.7% of the clopidogrel group versus 1.3% on placebo (P=0.087); moderate bleeding occurred in 2.1% versus 1.3%, respectively (P<0.001). The risk of bleeding was greatest the first year. Patients without moderate or severe bleeding during the first year were no more likely than placebo-treated patients to have bleeding thereafter. The frequency of bleeding was similar in patients with established disease and risk factors only. In multivariable analysis, the relationship between moderate bleeding and all-cause mortality was strong (hazard ratio, 2.55; 95% confidence interval, 1.71 to 3.80; P<0.0001), along with myocardial infarction (hazard ratio, 2.92; 95% confidence interval, 2.04 to 4.18; P<0.0001) and stroke (hazard ratio, 4.20; 95% confidence interval, 3.05 to 5.77; P<0.0001). In CHARISMA, there was an increased risk of bleeding with long-term clopidogrel. The incremental risk of bleeding was greatest in the

  9. Intravenous administration of brain-targeted stable nucleic acid lipid particles alleviates Machado-Joseph disease neurological phenotype.

    PubMed

    Conceição, Mariana; Mendonça, Liliana; Nóbrega, Clévio; Gomes, Célia; Costa, Pedro; Hirai, Hirokazu; Moreira, João Nuno; Lima, Maria C; Manjunath, N; Pereira de Almeida, Luís

    2016-03-01

    Others and we showed that RNA interference holds great promise for the treatment of dominantly inherited neurodegenerative disorders such as Machado-Joseph disease (MJD), for which there is no available treatment. However, successful experiments involved intracranial administration of viral vectors and there is a need for a safer and less invasive procedure. In this work, we successfully generated stable nucleic acid lipid particles (SNALPs), incorporating a short peptide derived from rabies virus glycoprotein (RVG-9r) and encapsulating small interfering RNAs (siRNAs), which can target mutant ataxin-3. The developed formulation exhibited important features that make it adequate for systemic administration: high encapsulation efficiency of siRNAs, ability to protect the encapsulated siRNAs, appropriate and homogeneous particle size distribution. Following optimization of the formulation and in vitro validation of its efficacy to silence the MJD-causing protein - mutant ataxin-3 - in neuronal cells, in vivo experiments showed that intravenous administration of RVG-9r-targeted SNALPs efficiently silenced mutant ataxin-3 reducing neuropathology and motor behavior deficits in two mouse models of MJD. To our knowledge, this is the first report showing beneficial impact of a non-viral gene silencing strategy in MJD and the first time that a non-invasive systemic administration proved to be beneficial on a polyglutamine disorder. Our study opens new avenues towards MJD therapy that can also be applied to other neurodegenerative diseases linked to the production of pathogenic proteins. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Diagnosis and Pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease: The Finnish Guidelines

    PubMed Central

    Kankaanranta, Hannu; Harju, Terttu; Kilpeläinen, Maritta; Mazur, Witold; Lehto, Juho T; Katajisto, Milla; Peisa, Timo; Meinander, Tuula; Lehtimäki, Lauri

    2015-01-01

    The Finnish Medical Society Duodecim initiated and managed the update of the Finnish national guideline for chronic obstructive pulmonary disease (COPD). The Finnish COPD guideline was revised to acknowledge the progress in diagnosis and management of COPD. This Finnish COPD guideline in English language is a part of the original guideline and focuses on the diagnosis, assessment and pharmacotherapy of stable COPD. It is intended to be used mainly in primary health care but not forgetting respiratory specialists and other healthcare workers. The new recommendations and statements are based on the best evidence available from the medical literature, other published national guidelines and the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. This guideline introduces the diagnostic approach, differential diagnostics towards asthma, assessment and treatment strategy to control symptoms and to prevent exacerbations. The pharmacotherapy is based on the symptoms and a clinical phenotype of the individual patient. The guideline defines three clinically relevant phenotypes including the low and high exacerbation risk phenotypes and the neglected asthma–COPD overlap syndrome (ACOS). These clinical phenotypes can help clinicians to identify patients that respond to specific pharmacological interventions. For the low exacerbation risk phenotype, pharmacotherapy with short-acting β2-agonists (salbutamol, terbutaline) or anticholinergics (ipratropium) or their combination (fenoterol–ipratropium) is recommended in patients with less symptoms. If short-acting bronchodilators are not enough to control symptoms, a long-acting β2-agonist (formoterol, indacaterol, olodaterol or salmeterol) or a long-acting anticholinergic (muscarinic receptor antagonists; aclidinium, glycopyrronium, tiotropium, umeclidinium) or their combination is recommended. For the high exacerbation risk phenotype, pharmacotherapy with a long-acting anticholinergic or a fixed

  11. PCI Choice: Cardiovascular clinicians' perceptions of shared decision making in stable coronary artery disease.

    PubMed

    Coylewright, Megan; O'Neill, Elizabeth S; Dick, Sara; Grande, Stuart W

    2017-06-01

    Describe cardiovascular clinicians' perceptions of Shared Decision Making following use of a decision aid (DA) for stable coronary artery disease (CAD) "PCI Choice", in a randomized controlled trial. We conducted a semi-structured qualitative interview study with cardiologists and physician extenders (n=13) after using PCI Choice in practice. Interviews were transcribed then coded. Codes were organized into salient themes. Final themes were determined by consensus with all authors. Most clinicians (70%) had no prior knowledge of SDM or DAs. Mixed views about the role of the DA in the visit were related to misconceptions of how patient education differed from SDM. Qualitative assessment of clinician perceptions generated three themes: 1) Gaps exist in clinician knowledge around SDM; 2) Clinicians are often uncomfortable with modifying baseline practice; and 3) Clinicians express interest in using DAs after initial exposure within a research setting. Use of DAs by clinicians during clinic visits may improve understanding of SDM. Initial use is marked by a reluctance to modify established practice patterns. As clinicians explore new approaches to benefit their patients, there is an opportunity for DAs that provide clinician instruction on core elements of SDM to lead to enhanced SDM in clinical practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Design and rationale of the MR-INFORM study: stress perfusion cardiovascular magnetic resonance imaging to guide the management of patients with stable coronary artery disease.

    PubMed

    Hussain, Shazia T; Paul, Matthias; Plein, Sven; McCann, Gerry P; Shah, Ajay M; Marber, Michael S; Chiribiri, Amedeo; Morton, Geraint; Redwood, Simon; MacCarthy, Philip; Schuster, Andreas; Ishida, Masaki; Westwood, Mark A; Perera, Divaka; Nagel, Eike

    2012-09-19

    In patients with stable coronary artery disease (CAD), decisions regarding revascularisation are primarily driven by the severity and extent of coronary luminal stenoses as determined by invasive coronary angiography. More recently, revascularisation decisions based on invasive fractional flow reserve (FFR) have shown improved event free survival. Cardiovascular magnetic resonance (CMR) perfusion imaging has been shown to be non-inferior to nuclear perfusion imaging in a multi-centre setting and superior in a single centre trial. In addition, it is similar to invasively determined FFR and therefore has the potential to become the non-invasive test of choice to determine need for revascularisation. The MR-INFORM study is a prospective, multi-centre, randomised controlled non-inferiority, outcome trial. The objective is to compare the efficacy of two investigative strategies for the management of patients with suspected CAD. Patients presenting with stable angina are randomised into two groups: 1) The FFR-INFORMED group has subsequent management decisions guided by coronary angiography and fractional flow reserve measurements. 2) The MR-INFORMED group has decisions guided by stress perfusion CMR. The primary end-point will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation) at one year. Clinical trials.gov identifier NCT01236807. MR INFORM will assess whether an initial strategy of CMR perfusion is non-inferior to invasive angiography supplemented by FFR measurements to guide the management of patients with stable coronary artery disease. Non-inferiority of CMR perfusion imaging to the current invasive reference standard (FFR) would establish CMR perfusion imaging as an attractive non-invasive alternative to current diagnostic pathways.

  13. Multi-Dimensional Asymptotically Stable 4th Order Accurate Schemes for the Diffusion Equation

    NASA Technical Reports Server (NTRS)

    Abarbanel, Saul; Ditkowski, Adi

    1996-01-01

    An algorithm is presented which solves the multi-dimensional diffusion equation on co mplex shapes to 4th-order accuracy and is asymptotically stable in time. This bounded-error result is achieved by constructing, on a rectangular grid, a differentiation matrix whose symmetric part is negative definite. The differentiation matrix accounts for the Dirichlet boundary condition by imposing penalty like terms. Numerical examples in 2-D show that the method is effective even where standard schemes, stable by traditional definitions fail.

  14. Advances in natural stable isotope ratio analysis of human hair to determine nutritional and metabolic status.

    PubMed

    Petzke, Klaus J; Fuller, Benjamin T; Metges, Cornelia C

    2010-09-01

    We review the literature on the use of stable isotope ratios at natural abundance to reveal information about dietary habits and specific nutrient intakes in human hair protein (keratin) and amino acids. In particular, we examine whether hair isotopic compositions can be used as unbiased biomarkers to provide information about nutritional status, metabolism, and diseases. Although the majority of research on the stable isotope ratio analysis of hair has focused on bulk protein, methods have been recently employed to examine amino acid-specific isotope ratios using gas chromatography or liquid chromatography coupled to an isotope ratio mass spectrometer. The isotopic measurement of amino acids has the potential to answer research questions on amino acid nutrition, metabolism, and disease processes and can contribute to a better understanding of the variations in bulk protein isotope ratio values. First results suggest that stable isotope ratios are promising as unbiased nutritional biomarkers in epidemiological research. However, variations in stable isotope ratios of human hair are also influenced by nutrition-dependent nitrogen balance, and more controlled clinical research is needed to examine these effects in human hair. Stable isotope ratio analysis at natural abundance in human hair protein offers a noninvasive method to reveal information about long-term nutritional exposure to specific nutrients, nutritional habits, and in the diagnostics of diseases leading to nutritional stress and impaired nitrogen balance.

  15. Percutaneous treatment with drug-eluting stent vs bypass surgery in patients suffering from chronic stable angina with multivessel disease involving significant proximal stenosis in left anterior descending artery.

    PubMed

    Yan, Qiao; Changsheng, Ma; Shaoping, Nie; Xiaohui, Liu; Junping, Kang; Qiang, Lv; Xin, Du; Rong, Hu; Yin, Zhang; Changqi, Jia; Jiahui, Wu; Xinmin, Liu; Jianzeng, Dong; Fang, Chen; Yujie, Zhou; Shuzheng, Lv; Fangjiong, Huang; Chengxiong, Gu; Xuesi, Wu

    2009-10-01

    The aim of the present study was to compare the effects of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in patients suffering from chronic stable angina with multivessel disease, involving significant proximal stenosis in the left anterior descending artery (LAD). All consecutive patients suffering from chronic stable angina with multivessel disease involving significant proximal LAD stenosis underwent DES implantation (n=600) or CABG (n=709) at our institution. At 2 years, the unadjusted mortality was significantly lower in the DES group than in the CABG group (2.2% vs 5.2%, P=0.004), but the adjusted risk of death was similar (odds ratio (OR) 0.74, 95%CI 0.28-1.97, P=0.555). Furthermore, both the adjusted rate of nonfatal myocardial infarction and cerebrovascular events was also comparable. However, the unadjusted and adjusted risk of major adverse cardiac cerebrovascular events in the DES was significantly higher than in the CABG (13.3% vs 9.6%, OR 2.71, 95%CI 1.56-4.74, P<0.001), which is probably attributed to the higher subsequent revascularization rate after DES implantation. DES showed comparable long-term mortality for the treatment of multivessel disease involving significant proximal stenosis in LAD in comparison with CABG.

  16. Endocrinology Meets Metabolomics: Achievements, Pitfalls, and Challenges.

    PubMed

    Tokarz, Janina; Haid, Mark; Cecil, Alexander; Prehn, Cornelia; Artati, Anna; Möller, Gabriele; Adamski, Jerzy

    2017-10-01

    The metabolome, although very dynamic, is sufficiently stable to provide specific quantitative traits related to health and disease. Metabolomics requires balanced use of state-of-the-art study design, chemical analytics, biostatistics, and bioinformatics to deliver meaningful answers to contemporary questions in human disease research. The technology is now frequently employed for biomarker discovery and for elucidating the mechanisms underlying endocrine-related diseases. Metabolomics has also enriched genome-wide association studies (GWAS) in this area by providing functional data. The contributions of rare genetic variants to metabolome variance and to the human phenotype have been underestimated until now. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Vocational interests of intellectually gifted and highly achieving young adults.

    PubMed

    Vock, Miriam; Köller, Olaf; Nagy, Gabriel

    2013-06-01

    Vocational interests play a central role in the vocational decision-making process and are decisive for the later job satisfaction and vocational success. Based on Ackerman's (1996) notion of trait complexes, specific interest profiles of gifted high-school graduates can be expected. Vocational interests of gifted and highly achieving adolescents were compared to those of their less intelligent/achieving peers according to Holland's (1997) RIASEC model. Further, the impact of intelligence and achievement on interests were analysed while statistically controlling for potentially influencing variables. Changes in interests over time were investigated. N= 4,694 German students (age: M= 19.5, SD= .80; 54.6% females) participated in the study (TOSCA; Köller, Watermann, Trautwein, & Lüdtke, 2004). Interests were assessed in participants' final year at school and again 2 years later (N= 2,318). Gifted participants reported stronger investigative and realistic interests, but lower social interests than less intelligent participants. Highly achieving participants reported higher investigative and (in wave 2) higher artistic interests. Considerable gender differences were found: gifted girls had a flat interest profile, while gifted boys had pronounced realistic and investigative and low social interests. Multilevel multiple regression analyses predicting interests by intelligence and school achievement revealed stable interest profiles. Beyond a strong gender effect, intelligence and school achievement each contributed substantially to the prediction of vocational interests. At the time around graduation from high school, gifted young adults show stable interest profiles, which strongly differ between gender and intelligence groups. These differences are relevant for programmes for the gifted and for vocational counselling. ©2012 The British Psychological Society.

  18. Non-haemodynamic anti-anginal agents in the management of patients with stable coronary artery disease and diabetes: A review of the evidence.

    PubMed

    Ambrosio, Giuseppe; Tamargo, Juan; Grant, Peter J

    2016-03-01

    Patients with coronary artery disease and concomitant diabetes mellitus tend to have more extensive vessel disease than non-diabetes mellitus coronary artery disease patients, are at high risk of adverse cardiovascular events and suffer from a great anginal burden. Very few trials have specifically addressed the issue of optimal anti-anginal therapy in coronary artery disease patients who also have diabetes mellitus. Among 'classical' anti-anginal agents, recent guidelines do not specifically recommend any molecule over others; however, European Society of Cardiology guidelines acknowledge that favourable data in patients with concomitant diabetes mellitus and coronary artery disease are available for trimetazidine and ranolazine, two anti-anginal agents with a non-haemodynamic mechanism of action. The aim of this article is to review available evidence supporting the anti-anginal efficacy of these two drugs in the difficult-to-treat population of diabetes mellitus patients, including their effects on glycated haemoglobin (HbA1c), a measure of medium-term glycaemic control. Although direct head-to-head comparisons have not been performed, available evidence favours ranolazine as an effective anti-anginal agent over trimetazidine in this population. In addition, ranolazine lowers HbA1c, indicating that it may improve glycaemic control in patients with diabetes mellitus. Conversely, scanty data are available on the metabolic effects of trimetazidine in this cohort of patients. Thus, ranolazine may represent a valuable therapeutic option in stable coronary artery disease patients with diabetes mellitus. © The Author(s) 2015.

  19. Experimental study of a flexible and environmentally stable electroadhesive device

    NASA Astrophysics Data System (ADS)

    Guo, J.; Bamber, T.; Singh, J.; Manby, D.; Bingham, P. A.; Justham, L.; Petzing, J.; Penders, J.; Jackson, M.

    2017-12-01

    Electroadhesion is a promising adhesion mechanism for robotics and material handling applications due to several distinctive advantages it has over existing technologies. These advantages include enhanced adaptability, gentle/flexible handling, reduced complexity, and ultra-low energy consumption. Unstable electroadhesive forces, however, can arise in ambient environments. Electroadhesive devices that can produce stable forces in changing environments are thus desirable. In this study, a flexible and environmentally stable electroadhesive device was designed and manufactured by conformally coating a layer of barium titanate dielectric on a chemically etched thin copper laminate. The results, obtained from an advanced electroadhesive "normal force" testing platform, show that only a relative difference of 5.94% in the normal force direction was observed. This was achieved when the relative humidity changed from 25% to 53%, temperature from 13.7 °C to 32.8 °C, and atmospheric pressure from 999 hPa to 1016.9 hPa. This environmentally stable electroadhesive device may promote the application of the electroadhesion technology.

  20. Plasma big endothelin-1 levels at admission and future cardiovascular outcomes: A cohort study in patients with stable coronary artery disease.

    PubMed

    Zhou, Bing-Yang; Guo, Yuan-Lin; Wu, Na-Qiong; Zhu, Cheng-Gang; Gao, Ying; Qing, Ping; Li, Xiao-Lin; Wang, Yao; Dong, Qian; Liu, Geng; Xu, Rui Xia; Cui, Chuan-Jue; Sun, Jing; Li, Jian-Jun

    2017-03-01

    Big endothelin-1 (ET-1) has been proposed as a novel prognostic indicator of acute coronary syndrome, while its predicting role of cardiovascular outcomes in patients with stable coronary artery disease (CAD) is unclear. A total of 3154 consecutive patients with stable CAD were enrolled and followed up for 24months. The outcomes included all-cause death, non-fatal myocardial infarction, stroke and unplanned revascularization (percutaneous coronary intervention and coronary artery bypass grafting). Baseline big ET-1 was measured using sandwich enzyme immunoassay method. Cox proportional hazard regression analysis and Kaplan-Meier analysis were used to evaluate the prognostic value of big ET-1 on cardiovascular outcomes. One hundred and eighty-nine (5.99%) events occurred during follow-up. Patients were divided into two groups: events group (n=189) and non-events group (n=2965). The results indicated that the events group had higher levels of big ET-1 compared to non-events group. Multivariable Cox proportional hazard regression analysis showed that big ET-1 was positively and statistically correlated with clinical outcomes (Hazard Ratio: 1.656, 95% confidence interval: 1.099-2.496, p=0.016). Additionally, the Kaplan-Meier analysis revealed that patients with higher big ET-1 presented lower event-free survival (p=0.016). The present study firstly suggests that big ET-1 is an independent risk marker of cardiovascular outcomes in patients with stable CAD. And more studies are needed to confirm our findings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Highly scalable multichannel mesh electronics for stable chronic brain electrophysiology

    PubMed Central

    Fu, Tian-Ming; Hong, Guosong; Viveros, Robert D.; Zhou, Tao

    2017-01-01

    Implantable electrical probes have led to advances in neuroscience, brain−machine interfaces, and treatment of neurological diseases, yet they remain limited in several key aspects. Ideally, an electrical probe should be capable of recording from large numbers of neurons across multiple local circuits and, importantly, allow stable tracking of the evolution of these neurons over the entire course of study. Silicon probes based on microfabrication can yield large-scale, high-density recording but face challenges of chronic gliosis and instability due to mechanical and structural mismatch with the brain. Ultraflexible mesh electronics, on the other hand, have demonstrated negligible chronic immune response and stable long-term brain monitoring at single-neuron level, although, to date, it has been limited to 16 channels. Here, we present a scalable scheme for highly multiplexed mesh electronics probes to bridge the gap between scalability and flexibility, where 32 to 128 channels per probe were implemented while the crucial brain-like structure and mechanics were maintained. Combining this mesh design with multisite injection, we demonstrate stable 128-channel local field potential and single-unit recordings from multiple brain regions in awake restrained mice over 4 mo. In addition, the newly integrated mesh is used to validate stable chronic recordings in freely behaving mice. This scalable scheme for mesh electronics together with demonstrated long-term stability represent important progress toward the realization of ideal implantable electrical probes allowing for mapping and tracking single-neuron level circuit changes associated with learning, aging, and neurodegenerative diseases. PMID:29109247

  2. Highly scalable multichannel mesh electronics for stable chronic brain electrophysiology.

    PubMed

    Fu, Tian-Ming; Hong, Guosong; Viveros, Robert D; Zhou, Tao; Lieber, Charles M

    2017-11-21

    Implantable electrical probes have led to advances in neuroscience, brain-machine interfaces, and treatment of neurological diseases, yet they remain limited in several key aspects. Ideally, an electrical probe should be capable of recording from large numbers of neurons across multiple local circuits and, importantly, allow stable tracking of the evolution of these neurons over the entire course of study. Silicon probes based on microfabrication can yield large-scale, high-density recording but face challenges of chronic gliosis and instability due to mechanical and structural mismatch with the brain. Ultraflexible mesh electronics, on the other hand, have demonstrated negligible chronic immune response and stable long-term brain monitoring at single-neuron level, although, to date, it has been limited to 16 channels. Here, we present a scalable scheme for highly multiplexed mesh electronics probes to bridge the gap between scalability and flexibility, where 32 to 128 channels per probe were implemented while the crucial brain-like structure and mechanics were maintained. Combining this mesh design with multisite injection, we demonstrate stable 128-channel local field potential and single-unit recordings from multiple brain regions in awake restrained mice over 4 mo. In addition, the newly integrated mesh is used to validate stable chronic recordings in freely behaving mice. This scalable scheme for mesh electronics together with demonstrated long-term stability represent important progress toward the realization of ideal implantable electrical probes allowing for mapping and tracking single-neuron level circuit changes associated with learning, aging, and neurodegenerative diseases. Copyright © 2017 the Author(s). Published by PNAS.

  3. Recent achievements in restorative neurology: Progressive neuromuscular diseases

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Dimitrijevic, M.R.; Kakulas, B.A.; Vrbova, G.

    1986-01-01

    This book contains 27 chapters. Some of the chapter titles are: Computed Tomography of Muscles in Neuromuscular Disease; Mapping the Genes for Muscular Dystrophy; Trophic Factors and Motor Neuron Development; Size of Motor Units and Firing Rate in Muscular Dystrophy; Restorative Possibilities in Relation to the Pathology of Progressive Neuromuscular Disease; and An Approach to the Pathogenesis of some Congenital Myopathies.

  4. Rural Transient Children and School Achievement: An Australian Perspective.

    ERIC Educational Resources Information Center

    Birch, Ian; Lally, Mike

    1994-01-01

    Among 336 students aged 4-8 in 4 rural Australian schools, transient students scored marginally lower on ability tests than their residentially stable peers. However, teachers gave more weight to family background and support, as opposed to disruption of schooling, as influencing children's adjustment to change and school achievement. (LP)

  5. The correlation between lymphocyte/monocyte ratio and coronary collateral circulation in stable coronary artery disease patients.

    PubMed

    Kurtul, Alparslan; Duran, Mustafa

    2017-01-01

    Coronary collateral circulation (CCC) has an important impact on cardiovascular prognosis and well-developed CCC is associated with better clinical outcomes. We investigated whether lymphocyte/monocyte ratio (LMR) has an association with CCC in patients with stable coronary artery disease (SCAD). The study population consisted of 245 patients with SCAD. Patients were classified into a poor CCC group (Rentrop grades 0/1, n = 87), or good CCC group (Rentrop grades 2/3, n = 158). LMR values were significantly higher in patients with good CCC than in those with poor CCC (4.41 ± 1.58 vs 2.76 ± 1.10; p < 0.001). In receiver operating characteristic analysis, optimal cutoff of LMR for predicting well-developed CCC was 3.38. In multivariate analysis, LMR >3.38 (OR 4.637; p = 0.004), high sensitivity C-reactive protein (OR 0.810, p < 0.001), dyslipidemia (OR 2.485; p = 0.039), and presence of chronic total occlusion (OR 16.836; p < 0.001) were independent predictors of well-developed CCC. Increased LMR predicts well-developed CCC in SCAD patients.

  6. Relationships Between Components of Blood Pressure and Cardiovascular Events in Patients with Stable Coronary Artery Disease and Hypertension.

    PubMed

    Vidal-Petiot, Emmanuelle; Greenlaw, Nicola; Ford, Ian; Ferrari, Roberto; Fox, Kim M; Tardif, Jean-Claude; Tendera, Michal; Parkhomenko, Alexander; Bhatt, Deepak L; Steg, P Gabriel

    2018-01-01

    Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40-1.87), 1.00 (ref), 1.07 (95% CI, 0.94-1.21), 1.54 (95% CI, 1.32-1.79), and 2.34 (95% CI, 1.95-2.81) for PP<45, 45 to 54 (reference), 55 to 64, 65 to 74, and ≥75 mm Hg, respectively, and 1.50 (95% CI, 1.31-1.72), 1.00 (reference), and 1.58 (95% CI, 1.42-1.77) for diastolic BPs of <70, 70 to 79 (ref), and ≥80 mm Hg, respectively. In a cross-classification analysis between diastolic BP and PP, the relationship between diastolic BP and the primary outcome remained J-shaped when the analysis was restricted to patients with the lowest-risk PP (45-64 mm Hg), with adjusted hazard ratios of 1.53 (95% CI, 1.27-1.83), 1.00 (ref), and 1.54 (95% CI, 1.34-1.75) in the <70, 70 to 79 (reference), and ≥80 mm Hg subgroups, respectively. The J-shaped relationship between diastolic BP and cardiovascular events in hypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease. URL: http://www.clarify-registry.com. Unique identifier: ISRCTN43070564. © 2017 American Heart

  7. Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients.

    PubMed

    Teo, Boon Wee; Chua, Horng Ruey; Wong, Weng Kin; Haroon, Sabrina; Subramanian, Srinivas; Loh, Ping Tyug; Sethi, Sunil; Lau, Titus

    2016-05-01

    Clinical practice guidelines recommend different blood pressure (BP) goals for chronic kidney disease (CKD) patients. Usage of antihypertensive medication and attainment of BP targets in Asian CKD patients remain unclear. This study describes the profile of antihypertensive agents used and BP components in a multiethnic Asian population with stable CKD. Stable CKD outpatients with variability of serum creatinine levels < 20%, taken > 3 months apart, were recruited. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated manometers, according to practice guidelines. Serum creatinine was assayed and the estimated glomerular filtration rate (GFR) calculated using the CKD Epidemiology Collaboration equation. BP and antihypertensive medication profile was examined using univariate analyses. 613 patients (55.1% male; 74.7% Chinese, 6.4% Indian, 11.4% Malay; 35.7% diabetes mellitus) with a mean age of 57.8 ± 14.5 years were recruited. Mean SBP was 139 ± 20 mmHg, DBP was 74 ± 11 mmHg, serum creatinine was 166 ± 115 µmol/L and GFR was 53 ± 32 mL/min/1.73 m(2). At a lower GFR, SBP increased (p < 0.001), whereas DBP decreased (p = 0.0052). Mean SBP increased in tandem with the number of antihypertensive agents used (p < 0.001), while mean DBP decreased when ≥ 3 antihypertensive agents were used (p = 0.0020). Different targets are recommended for each BP component in CKD patients. A majority of patients cannot attain SBP targets and/or exceed DBP targets. Research into monitoring and treatment methods is required to better define BP targets in CKD patients. Copyright: © Singapore Medical Association.

  8. Unresolved issues in the management of chronic stable angina.

    PubMed

    Camm, A John; Manolis, Athanasios; Ambrosio, Giuseppe; Daly, Caroline; Komajda, Michel; Lopez de Sa, Esteban; Lopez-Sendon, Jose Luis; Mugelli, Alessandro; Muggli, Franco; Tamargo, Juan

    2015-12-15

    Chronic stable angina is a common and progressive disease which has a major impact on patient quality of life and imposes a high financial and medical burden on society. Given the range of agents now available, optimal medical therapy - which according to guidelines is the preferred option in the majority of patients with low-risk disease - offers the opportunity for effective control. However, recent studies suggest that management remains suboptimal in up to a third of patients and that physicians often underestimate the extent to which angina continues to limit patients' lives. A higher frequency of angina also relates directly to increased healthcare costs. These factors suggest the need for the development and implementation of appropriate guidelines, for tools to encourage the regular, systematic assessment of the management of chronic stable angina patients, and for improved means of communication between doctors and patients. Neither physicians nor their patients need to accept that a certain level of angina symptoms is unavoidable. Copyright © 2015. Published by Elsevier Ireland Ltd.

  9. Stable gastric pentadecapeptide BPC 157: novel therapy in gastrointestinal tract.

    PubMed

    Sikiric, Predrag; Seiwerth, Sven; Rucman, Rudolf; Turkovic, Branko; Rokotov, Dinko Stancic; Brcic, Luka; Sever, Marko; Klicek, Robert; Radic, Bozo; Drmic, Domagoj; Ilic, Spomenko; Kolenc, Danijela; Vrcic, Hrvoje; Sebecic, Bozidar

    2011-01-01

    Stable gastric pentadecapeptide BPC 157 is an anti-ulcer peptidergic agent, safe in inflammatory bowel disease clinical trials (GEPPPGKPADDAGLV, M.W. 1419, PL 14736) and wound healing, stable in human gastric juice and has no reported toxicity. We focused on BPC 157 as a therapy in peridontitis, esophagus, stomach, duodenum, intestine, liver and pancreas lesions. Particularly, it has a prominent effect on alcohol-lesions (i.e., acute, chronic) and NSAIDs-lesions (interestingly, BPC 157 both prevents and reverses adjuvant arthritis). In rat esophagitis and failed function of both lower esophageal sphincter (LES) and pyloric sphincters (PS), BPC 157 increased pressure in both sphincters till normal and reduced esophagitis. However, in healthy rats, it may decrease (PS) or increase (LES) the pressure in sphincters. It has strong angiogenic potential, it acts protectively on endothelium, prevents and reverses thrombus formation after abdominal aorta anastomosis, affects many central disturbances (i.e., dopamine and 5-HT system), the NO-system (either L-arginine and L-NAME effects), endothelin, acts as a free radical scavenger (counteracting CCl4-, paracetamol-, diclofenac-injuries) and exhibits neuroprotective properties. BPC 157 successfully heals the intestinal anastomosis, gastrocutaneous, duodenocutaneous and colocutaneous fistulas in rats, as well as interacting with the NO-system. Interestingly, the fistula closure was achieved even when the BPC 157 therapy was postponed for one month. In short-bowel syndrome escalating throughout 4 weeks, the constant weight gain above preoperative values started immediately with peroral and parental BPC 157 therapy and the villus height, crypth depth and muscle thickness (inner (circular) muscular layer) additionally increased. Thus, BPC 157 may improve gastrointestinal tract therapy.

  10. Toxicity by NSAIDs. Counteraction by stable gastric pentadecapeptide BPC 157.

    PubMed

    Sikiric, Predrag; Seiwerth, Sven; Rucman, Rudolf; Turkovic, Branko; Rokotov, Dinko Stancic; Brcic, Luka; Sever, Marko; Klicek, Robert; Radic, Bozo; Drmic, Domagoj; Ilic, Spomenko; Kolenc, Danijela; Aralica, Gorana; Safic, Hana; Suran, Jelena; Rak, Davor; Dzidic, Senka; Vrcic, Hrvoje; Sebecic, Bozidar

    2013-01-01

    Stable gastric pentadecapeptide BPC 157 is an anti-ulcer peptidergic agent, proven in clinical trials to be both safe in inflammatory bowel disease (PL-10, PLD-116, PL 14736) and wound healing, stable in human gastric juice, with no toxicity being reported. Recently, we claim that BPC 157 may be used as an antidote against NSAIDs. We focused on BPC 157 beneficial effects on stomach, duodenum, intestine, liver and brain injuries, adjuvant arthritis, pain, hyper/hypothermia, obstructive thrombus formation and thrombolysis, blood vessel function, counteraction of prolonged bleeding and thrombocytopenia after application of various anticoagulants and antiplatelet agents and wound healing improvement. The arguments for BPC 157 antidote activity (i.e., the role of BPC 157 in cytoprotection, being a novel mediator of Robert's cytoprotection and BPC 157 beneficial effects on NSAIDs mediated lesions in the gastrointestinal tract, liver and brain and finally, counteraction of aspirin-induced prolonged bleeding and thrombocytopenia) obviously have a counteracting effect on several established side-effects of NSAIDs use. The mentioned variety of the beneficial effects portrayed by BPC 157 may well be a foundation for establishing BPC 157 as a NSAIDs antidote since no other single agent has portrayed a similar array of effects. Unlike NSAIDs, a very high safety (no reported toxicity (LD1 could be not achieved)) profile is reported for BPC 157. Also, unlike the different dosage levels of aspirin, as a NSAIDs prototype, which differ by a factor of about ten, all these beneficial and counteracting effects of BPC 157 were obtained using the equipotent dosage (μg, ng/kg) in parenteral or peroral regimens.

  11. The effect of periodontal therapy on C-reactive protein, endothelial function, lipids and proinflammatory biomarkers in patients with stable coronary artery disease: study protocol for a randomized controlled trial.

    PubMed

    Saffi, Marco Aurélio Lumertz; Furtado, Mariana Vargas; Montenegro, Márlon Munhoz; Ribeiro, Ingrid Webb Josephson; Kampits, Cassio; Rabelo-Silva, Eneida Rejane; Polanczyk, Carisi Anne; Rösing, Cassiano Kuchenbecker; Haas, Alex Nogueira

    2013-09-06

    Scarce information exists regarding the preventive effect of periodontal treatment in the recurrence of cardiovascular events. Prevention may be achieved by targeting risk factors for recurrent coronary artery disease (CAD) in patients with previous history of cardiovascular events. The aim of this trial is to compare the effect of two periodontal treatment approaches on levels of C-reactive protein, lipids, flow-mediated dilation and serum concentrations of proinflammatory and endothelial markers in stable CAD patients with periodontitis over a period of 12 months. This is a randomized, parallel design, examiner blinded, controlled clinical trial. Individuals from both genders, 35 years of age and older, with concomitant diagnosis of CAD and periodontitis will be included. CAD will be defined as the occurrence of at least one of the following events 6 months prior to entering the trial: documented history of myocardial infarction; surgical or percutaneous myocardial revascularization and lesion >50% in at least one coronary artery assessed by angiography; presence of angina and positive noninvasive testing of ischemia. Diagnosis of periodontitis will be defined using the CDC-AAP case definition (≥2 interproximal sites with clinical attachment loss ≥6 mm and ≥1 interproximal site with probing depth ≥5 mm). Individuals will have to present at least ten teeth present to be included. One hundred individuals will be allocated to test (intensive periodontal treatment comprised by scaling and root planing) or control (community periodontal treatment consisting of one session of supragingival plaque removal only) treatment groups. Full-mouth six sites per tooth periodontal examinations and subgingival biofilm samples will be conducted at baseline, 3, 6 and 12 months after treatment. The primary outcome of this study will be C-reactive protein changes over time. Secondary outcomes include levels of total cholesterol, LDL-C, HDL-C, triglycerides, IL-1β, IL-6, TNF

  12. Stable fiber-optic time transfer by active radio frequency phase locking.

    PubMed

    Yin, Feifei; Wu, Zhongle; Dai, Yitang; Ren, Tianpeng; Xu, Kun; Lin, Jintong; Tang, Geshi

    2014-05-15

    In this Letter we demonstrate a fiber link capable of stable time signal transfer utilizing our active long-distance radio frequency (RF) stabilization technology. Taking advantage of the chromatic dispersion in optical fiber, our scheme compensates dynamically the link delay variation by tuning the optical carrier wavelength to phase lock a round-trip RF reference. Since the time signal and the RF reference are carried by the same optical carrier, a highly stable time transfer is achieved at the same time. Experimentally, we demonstrate a stability of the time signal transfer over 50-km fiber with a time deviation of 40 ps at 1-s average and 2.3 ps at 1000-s average. The performance of the RF reference delivery is also tested, with an Allan deviation of 2×10(-15) at 1000-s average. According to our proposal, a simultaneous stable time and frequency transfer is expected.

  13. Dietary vitamin K guidance: an effective strategy for stable control of oral anticoagulation?

    USDA-ARS?s Scientific Manuscript database

    Numerous factors have been identified as risk factors for instability of oral anticoagulation, including variability in vitamin K intake. However few studies have directly tested the feasibility of manipulating dietary vitamin K to achieve stable oral anticoagulation. Recent findings from a rando...

  14. Usefulness of Beta blockade in contemporary management of patients with stable coronary heart disease.

    PubMed

    Winchester, David E; Pepine, Carl J

    2014-11-15

    Considerable progress has been made over the last few decades in the management of clinically stable coronary heart disease (SCHD), including improvements in interventions (e.g., percutaneous revascularization), pharmacological management, and risk factor control (e.g., smoking, diet, activity level, hypercholesterolemia, hypertension). Although β blockers have long been used for the treatment of SCHD, their efficacy was established in the era before widespread use of reperfusion interventions, modern medical therapy (e.g., angiotensin-converting enzyme inhibitors, angiotensin receptor blockers), or preventive treatments (e.g., aspirin, statins). On the basis of these older data, β blockers are assumed beneficial, and their use has been extrapolated beyond patients with heart failure and previous myocardial infarction, which provided the best evidence for efficacy. However, there are no randomized clinical trials demonstrating that β blockers decrease clinical events in patients with SCHD in the modern era. Furthermore, these agents are associated with weight gain, problems with glycemic control, fatigue, and bronchospasm, underscoring the fact that their use is not without risk. In conclusion, data are currently lacking to support the widespread use of β blockers for all SCHD patients, but contemporary data suggest that they be reserved for a well-defined high-risk group of patients with evidence of ongoing ischemia, left ventricular dysfunction, heart failure, and perhaps some arrhythmias. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Change in Leukocyte Telomere Length Predicts Mortality in Patients with Stable Coronary Heart Disease from the Heart and Soul Study.

    PubMed

    Goglin, Sarah E; Farzaneh-Far, Ramin; Epel, Elissa S; Lin, Jue; Blackburn, Elizabeth H; Whooley, Mary A

    2016-01-01

    Short telomere length independently predicts mortality in patients with coronary heart disease. Whether 5-year change in telomere length predicts subsequent mortality in patients with coronary heart disease has not been evaluated. In a prospective cohort study of 608 individuals with stable coronary artery disease, we measured leukocyte telomere length at baseline and after five years of follow-up. We divided the sample into tertiles of telomere change: shortened, maintained or lengthened. We used Cox survival models to evaluate 5-year change in telomere length as a predictor of mortality. During an average of 4.2 years follow-up, there were 149 deaths. Change in telomere length was inversely predictive of all-cause mortality. Using the continuous variable of telomere length change, each standard deviation (325 base pair) greater increase in telomere length was associated with a 24% reduction in mortality (HR 0.76, 95% CI 0.61-0.94; p = 0.01), adjusted for age, sex, waist to hip ratio, exercise capacity, LV ejection fraction, serum creatinine, and year 5 telomere length. Mortality occurred in 39% (79/203) of patients who experienced telomere shortening, 22% (45/203) of patients whose telomere length was maintained, and 12% (25/202) of patients who experienced telomere lengthening (p<0.001). As compared with patients whose telomere length was maintained, those who experienced telomere lengthening were 56% less likely to die (HR 0.44, 95% CI, 0.23-0.87). In patients with coronary heart disease, an increase in leukocyte telomere length over 5 years is associated with decreased mortality.

  16. Effect of rosuvastatin on coronary atheroma in stable coronary artery disease: multicenter coronary atherosclerosis study measuring effects of rosuvastatin using intravascular ultrasound in Japanese subjects (COSMOS).

    PubMed

    Takayama, Tadateru; Hiro, Takafumi; Yamagishi, Masakazu; Daida, Hiroyuki; Hirayama, Atsushi; Saito, Satoshi; Yamaguchi, Tetsu; Matsuzaki, Masunori

    2009-11-01

    It has been suggested that intensive lipid-lowering therapy using statins significantly decreases atheromatous plaque volume. The effect of rosuvastatin on plaque volume in patients with stable coronary artery disease (CAD), including those receiving prior lipid-lowering therapy, was examined in the present study. A 76-week open-label trial was performed at 37 centers in Japan. Eligible patients began treatment with rosuvastatin 2.5 mg/day, which could be increased at 4-week intervals to stable CAD, including those who had previously used other lipid-lowering drugs. Rosuvastatin might be useful in the setting of secondary prevention in patients with stable CAD.

  17. Lithography-free large-area metamaterials for stable thermophotovoltaic energy conversion

    DOE PAGES

    Coppens, Zachary J.; Kravchenko, Ivan I.; Valentine, Jason G.

    2016-02-08

    A large-area metamaterial thermal emitter is fabricated using facile, lithography-free techniques. The device is composed of conductive oxides, refractory ceramics, and noble metals and shows stable, selective emission after exposure to 1173 K for 22 h in oxidizing and inert atmospheres. Lastly, the results indicate that the metamaterial can be used to achieve high-performance thermophotovoltaic devices for applications such as portable power generation.

  18. Percutaneous coronary intervention for poor coronary microcirculation reperfusion of patients with stable angina pectoris.

    PubMed

    Li, J S; Zhao, X J; Ma, B X; Wang, Z

    2016-01-01

    Percutaneous coronary intervention (PCI) has been extensively applied to repair the forward flow of diseased coronary artery and can achieve significant curative results. However, some patients with acute myocardial infarction (AMI) develop non-perfusion or poor perfusion of cardiac muscle tissue after PCI, which increases the incidence of cardiovascular events and the death rate. PCI can dredge narrowed or infarct-related artery (IRA) and thus induce full reperfusion of ischemic myocardium. It is found in practice that some cases of AMI still have no perfusion or poor perfusion in myocardial tissue even though coronary angiography suggests opened coronary artery after PCI, which increases the incidence of vascular events and mortality. Therefore, to explore the detailed mechanism of PCI in treating coronary microcirculation of patients with stable angina pectoris, we selected 140 patients with stable angina pectoris for PCI, observing the index of microcirculatory resistance (IMR) of descending branch and changes of myocardial injury markers and left ventricular systolic function, and made a subgroup analysis based on the correlation between clinical indexes, IMR and other variables of diabetic and non-diabetic patients, PCI-related and non-PCI-related myocardial infarction patients. The results suggest that IMR of anterior descending branch after PCI was higher compared to that before PCI, and the difference was significant (P less than 0.05); creatine kinase-MB (CK-MB), myohemoglobin and high sensitive troponin T were all increased after PCI, and the difference was also significant (P less than 0.05); brain natriuretic peptide (BNP) level became higher after PCI, with significant difference (P less than 0.05); left ventricular ejection fraction (LVEF) declined after PCI, and the difference before and after PCI was statistically significant (P less than 0.05). Moreover, subgroup analysis results of the three groups all demonstrated statistically significant

  19. Explaining the Substantial Inter-Domain and Over-Time Correlations in Student Achievement: The Importance of Stable Student Attributes

    ERIC Educational Resources Information Center

    Marks, Gary N.

    2016-01-01

    Multi-domain and longitudinal studies of student achievement routinely find moderate to strong correlations across achievement domains and even stronger within-domain correlations over time. The purpose of this study is to examine the sources of these patterns analysing student achievement in 5 domains across Years 3, 5 and 7. The analysis is of…

  20. Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need

    PubMed Central

    Corcoran, David

    2018-01-01

    The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease—INOCA). We review new insights into the pathophysiology of angina whereby myocardial ischaemia results from a deficient supply of oxygenated blood to the myocardium, due to various combinations of focal or diffuse epicardial disease (macrovascular), microvascular dysfunction or both. Macrovascular disease may be due to the presence of obstructive CAD secondary to atherosclerosis, or may be dynamic due to a functional disorder (eg, coronary artery spasm, myocardial bridging). Pathophysiology of coronary microvascular disease may involve anatomical abnormalities resulting in increased coronary resistance, or functional abnormalities resulting in abnormal vasomotor tone. We consider novel clinical diagnostic techniques enabling new insights into the causes of angina and appraise the need for improved therapeutic options for patients with INOCA. We conclude that the taxonomy of stable CAD could improve to better reflect the heterogeneous pathophysiology of the coronary circulation. We propose the term ‘stable coronary syndromes’ (SCS), which aligns with the well-established terminology for ‘acute coronary syndromes’. SCS subtends a clinically relevant classification that more fully encompasses the different diseases of the epicardial and microvascular coronary circulation. PMID:29030424

  1. Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: time to achievement, total duration, and predictors.

    PubMed

    Wallace, Carol A; Giannini, Edward H; Spalding, Steven J; Hashkes, Philip J; O'Neil, Kathleen M; Zeft, Andrew S; Szer, Ilona S; Ringold, Sarah; Brunner, Hermine I; Schanberg, Laura E; Sundel, Robert P; Milojevic, Diana S; Punaro, Marilynn G; Chira, Peter; Gottlieb, Beth S; Higgins, Gloria C; Ilowite, Norman T; Kimura, Yukiko; Johnson, Anne; Huang, Bin; Lovell, Daniel J

    2014-06-01

    To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA). Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment. Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare. Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.

  2. Impact of active and stable psoriasis on health-related quality of life: the PSO-LIFE study.

    PubMed

    Daudén, E; Herrera, E; Puig, L; Sánchez-Carazo, J L; Toribio, J; Perulero, N

    2013-10-01

    The aim of this study was to assess the impact of psoriasis on health-related quality of life (HRQOL) using different questionnaires. Prospective observational study of patients with plaque psoriasis of at least 6 months' duration stratified by active and stable disease. The patients were evaluated at baseline, 7 days, and 12 weeks. At the 3 visits, the investigators recorded sociodemographic and clinical data and the patients completed the following HRQOL questionnaires: the Dermatology Life Quality Index (DLQI), the Psoriasis Disability Index (PDI), and psoriasis quality of life questionnaire (PSO-LIFE). In total, 304 patients (182 with active psoriasis and 122 with stable psoriasis) were evaluated. The mean (SD) age was 45.3 (14.5) years, and 56.3% of the group were men. At baseline, the mean (SD) psoriasis and area severity index (PASI) score was 17.0 (7.4) in patients with active disease and 5.6 (5.3) in those with stable disease; a reduction was seen in PASI scores during the evaluation period (P<.01). The mean (SD) score on the PSO-LIFE questionnaire increased significantly from 57.4 (20.4) to 72.2 (19.6) in patients with active psoriasis and from 76.4 (20.6) to 82.3 (18.3) in those with stable disease (P<0.01 in both groups). The difference in standardized mean scores between the 2 groups was 0.79 for the DLQI, 0.62 for the PDI, and 0.85 for the PSO-LIFE questionnaire. The impact of psoriasis on HRQOL as assessed by the PSO-LIFE questionnaire was greater in patients with lesions in visible areas than in those with less visible lesions (P<.01). Changes in PSO-LIFE and PASI scores were moderately and significantly correlated (r=-0.4). The impact of psoriasis on HRQOL is higher in patients with active disease. The PSO-LIFE questionnaire showed a greater tendency to discriminate between active and stable psoriasis than either the DLQI or the PDI. PSO-LIFE scores correlated significantly with lesion site and disease severity as measured by PASI. Copyright

  3. Achieving stable remission with maintenance electroconvulsive therapy in a patient with treatment-resistant schizophrenia

    PubMed Central

    Moeller, Sebastian; Kalkwarf, Neele; Lücke, Caroline; Ortiz, Diana; Jahn, Sonja; Först, Christiane; Braun, Niclas; Philipsen, Alexandra; Müller, Helge H.O.

    2017-01-01

    Abstract Rationale: Up to one third of all schizophrenic patients are classified as having treatment-resistant schizophrenia (TRS). This subgroup faces remarkable medical and psychosocial damages, and pharmacotherapy is often limited due to nonresponse and/or side effects. Maintenance electroconvulsive therapy (M-ECT) might be effective in TRS. Patient concerns: We present a case of a 26-year-old male patient with a TRS. Diagnoses: He received a treatment series of ECT sessions and a course of 24 M-ECTs. Interventions: The entire treatment was tolerated without significant side effects. Outcomes: Moreover, the Psychotic Symptom Rating Scale (PSYRATS) scores for both positive and negative symptoms decreased and remained stable over the course of M-ECT. Lessons: Because of the remarkable improvement in the negative and positive symptom clusters, we propose systematic examinations in the field of M-ECT in TRS patients. These studies should integrate long-term outcome and tolerance measurements, gaining insight into the optimal duration of treatment for this indication. PMID:29310360

  4. Stable isotopes suggest low site fidelity in Bar-Headed Geese (Anser indicus) in Mongolia: Implications for disease transmission

    USGS Publications Warehouse

    Bridge, Eli S.; Kelly, Jeffrey F.; Xiangming Xiao,; Batbayar, Nyambayar; Natsagdorj, Tseveenmyadag; Hill, Nichola J.; Takekawa, John Y.; Hawkes, Lucy A.; Bishop, Charles M.; Butler, Patrick J.; Newman, Scott H.

    2015-01-01

    Population connectivity is an important consideration in studies of disease transmission and biological conservation, especially with regard to migratory species. Determining how and when different subpopulations intermingle during different phases of the annual cycle can help identify important geographical regions or features as targets for conservation efforts and can help inform our understanding of continental-scale disease transmission. In this study, stable isotopes of hydrogen and carbon in contour feathers were used to assess the degree of molt-site fidelity among Bar-headed Geese (Anser indicus) captured in north-central Mongolia. Samples were collected from actively molting Bar-headed Geese (n = 61), and some individual samples included both a newly grown feather (still in sheath) and an old, worn feather from the bird's previous molt (n = 21). Although there was no difference in mean hydrogen isotope ratios for the old and new feathers, the isotopic variance in old feathers was approximately three times higher than that of the new feathers, which suggests that these birds use different and geographically distant molting locations from year to year. To further test this conclusion, online data and modeling tools from the isoMAP website were used to generate probability landscapes for the origin of each feather. Likely molting locations were much more widespread for old feathers than for new feathers, which supports the prospect of low molt-site fidelity. This finding indicates that population connectivity would be greater than expected based on data from a single annual cycle, and that disease spread can be rapid even in areas like Mongolia where Bar-headed Geese generally breed in small isolated groups.

  5. Stable Eutectoid Transformation in Nodular Cast Iron: Modeling and Validation

    NASA Astrophysics Data System (ADS)

    Carazo, Fernando D.; Dardati, Patricia M.; Celentano, Diego J.; Godoy, Luis A.

    2017-01-01

    This paper presents a new microstructural model of the stable eutectoid transformation in a spheroidal cast iron. The model takes into account the nucleation and growth of ferrite grains and the growth of graphite spheroids. Different laws are assumed for the growth of both phases during and below the intercritical stable eutectoid. At a microstructural level, the initial conditions for the phase transformations are obtained from the microstructural simulation of solidification of the material, which considers the divorced eutectic and the subsequent growth of graphite spheroids up to the initiation of the stable eutectoid transformation. The temperature field is obtained by solving the energy equation by means of finite elements. The microstructural (phase change) and macrostructural (energy balance) models are coupled by a sequential multiscale procedure. Experimental validation of the model is achieved by comparison with measured values of fractions and radius of 2D view of ferrite grains. Agreement with such experiments indicates that the present model is capable of predicting ferrite phase fraction and grain size with reasonable accuracy.

  6. Chip Scale Ultra-Stable Clocks: Miniaturized Phonon Trap Timing Units for PNT of CubeSats

    NASA Technical Reports Server (NTRS)

    Rais-Zadeh, Mina; Altunc, Serhat; Hunter, Roger C.; Petro, Andrew

    2016-01-01

    The Chip Scale Ultra-Stable Clocks (CSUSC) project aims to provide a superior alternative to current solutions for low size, weight, and power timing devices. Currently available quartz-based clocks have problems adjusting to the high temperature and extreme acceleration found in space applications, especially when scaled down to match small spacecraft size, weight, and power requirements. The CSUSC project aims to utilize dual-mode resonators on an ovenized platform to achieve the exceptional temperature stability required for these systems. The dual-mode architecture utilizes a temperature sensitive and temperature stable mode simultaneously driven on the same device volume to eliminate ovenization error while maintaining extremely high performance. Using this technology it is possible to achieve parts-per-billion (ppb) levels of temperature stability with multiple orders of magnitude smaller size, weight, and power.

  7. The denaturation and degradation of stable enzymes at high temperatures.

    PubMed Central

    Daniel, R M; Dines, M; Petach, H H

    1996-01-01

    Now that enzymes are available that are stable above 100 degrees C it is possible to investigate conformational stability at this temperature, and also the effect of high-temperature degradative reactions in functioning enzymes and the inter-relationship between degradation and denaturation. The conformational stability of proteins depends upon stabilizing forces arising from a large number of weak interactions, which are opposed by an almost equally large destabilizing force due mostly to conformational entropy. The difference between these, the net free energy of stabilization, is relatively small, equivalent to a few interactions. The enhanced stability of very stable proteins can be achieved by an additional stabilizing force which is again equivalent to only a few stabilizing interactions. There is currently no strong evidence that any particular interaction (e.g. hydrogen bonds, hydrophobic interactions) plays a more important role in proteins that are stable at 100 degrees C than in those stable at 50 degrees C, or that the structures of very stable proteins are systematically different from those of less stable proteins. The major degradative mechanisms are deamidation of asparagine and glutamine, and succinamide formation at aspartate and glutamate leading to peptide bond hydrolysis. In addition to being temperature-dependent, these reactions are strongly dependent upon the conformational freedom of the susceptible amino acid residues. Evidence is accumulating which suggests that even at 100 degrees C deamidation and succinamide formation proceed slowly or not at all in conformationally intact (native) enzymes. Whether this is the case at higher temperatures is not yet clear, so it is not known whether denaturation of degradation will set the upper limit of stability for enzymes. PMID:8694749

  8. Drug Therapy for Stable Angina Pectoris.

    PubMed

    Rousan, Talla A; Mathew, Sunil T; Thadani, Udho

    2017-03-01

    Chronic stable angina pectoris refers to the predictable, reproducible occurrence of pressure or a choking sensation in the chest or adjacent areas caused by myocardial ischemia in association with physical or emotional stress, and cessation of exertion and or sublingual nitroglycerin invariably relieves the discomfort. It is a common presenting symptom of severe narrowing of one or more coronary arteries, non-obstructive coronary arteries, or even when the coronary arteries are angiographically normal. Patients often avoid activities which precipitate symptoms and have impaired quality of life. Most patients with angina pectoris can be managed with lifestyle changes, especially abstinence from smoking and regular exercise, and anti-anginal drugs. However, the choice of initial or combination antianginals as recommended in the guidelines is not evidence based. In addition, patients with stable angina due to coronary artery disease should also receive aspirin and a statin. Treatment of patients with angina and normal coronary arteries remains to be established. The aim of this article is to provide the readers not only with a guideline-based approach, which varies from one country to another, but also an individual-based approach, which takes into consideration circulatory status and the presence or absence of comorbidities in the treatment decision-making process. This manuscript primarily deals with drug therapy of stable angina pectoris and not coronary artery revascularization, which also provides angina relief but is usually reserved for patients who fail to respond to adequate drug therapy.

  9. Student Mobility and Demographics: Relationships to Aptitude and Achievement in a Three-Year Middle School.

    ERIC Educational Resources Information Center

    Bolinger, Kevin; Gilman, David

    This study examined differences between stable (n=107) and mobile (n=39) students attending a three-year middle school in Terre Haute (Indiana). Demographic variables of gender, ethnicity, and family income were considered, in addition to mobility, to assess possible relationships with aptitude and achievement. Achievement was measured by the…

  10. Identification of new biosignatures for clinical outcomes in stable coronary artery disease - The study protocol and initial observations of a prospective follow-up study in Taiwan.

    PubMed

    Leu, Hsin-Bang; Yin, Wei-Hsian; Tseng, Wei-Kung; Wu, Yen-Wen; Lin, Tsung-Hsien; Yeh, Hung-I; Chang, Kuan-Cheng; Wang, Ji-Hung; Wu, Chau-Chung; Chen, Jaw-Wen

    2017-01-28

    Either classic or novel biomarkers have not been well investigated for clinical outcomes of coronary artery disease (CAD) in Asian people especially ethnic Chinese. We reported here a prospective national-based follow-up study that aims to elucidate the clinical profiles and to identify the new biosignatures (especially the non-lipid profile and inflammatory biomakers) for future clinical outcomes in a sizable cohort of stable CAD patients in Taiwan. A total of 2500 CAD patients under stable condition after successful percutaneous coronary intervention will be enrolled for clinical data collection and blood/urine sampling in northern, southern, western, or eastern part of Taiwan between 2012 and 2017. They will be regularly followed up at least annually for 5 years to assess all cause deaths, hard clinical events (including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke), and total cardiovascular events (including hard events, unplanned revascularization procedures, unplanned hospitalization for refractory or unstable angina, and for other causes such as stroke, transient ischemic attack, heart failure, or peripheral arterial occlusive disease). The classic and newly defined biosignatures will be compared in patients with and without clinical events during follow-up. The novel biomarkers will be identified via metabolomics analyses. Additionally, psychological personality and lifestyle data will be incorporated to explore the new dimensional views of the complex mechanisms of the disease. Till December 2014, the initial 1663 patients have been successfully enrolled. Among them, 85.93% are male; 36.22% have type 2 diabetes; 64.82% have hypertension; 56.04% are smokers and 20.44% have a family history of CAD. Their lipid profiles are under contemporary medical control with a mean plasma total cholesterol level of 163.51 ± 36.99 mg/dL and a mean low-density lipoprotein cholesterol level of 95.21 ± 29.98 mg/dL. This nationwide study

  11. Stable Isotope Ratios as Biomarkers of Diet for Health Research

    PubMed Central

    O’Brien, Diane M.

    2016-01-01

    Diet is a leading modifiable risk factor for chronic disease, but it remains difficult to measure accurately due to the error and bias inherent in self-reported methods of diet assessment. Consequently there is a pressing need for more objective biomarkers of diet for use in health research. The stable isotope ratios of light elements are a promising set of candidate biomarkers because they vary naturally and reproducibly among foods, and those variations are captured in molecules and tissues with high fidelity. Recent studies have identified valid isotopic measures of short and long-term sugar intake, meat intake, and fish intake in specific populations. These studies provide a strong foundation for validating stable isotopic biomarkers in the general United States population. Approaches to improve specificity for specific foods are needed, for example, by modeling intake using multiple stable isotope ratios, or by isolating and measuring specific molecules linked to foods of interest. PMID:26048703

  12. Quasi-stable injection channels in a wakefield accelerator

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wiltshire-Turkay, Mara; Farmer, John P.; Pukhov, Alexander

    2016-05-15

    The influence of initial position on the acceleration of externally injected electrons in a plasma wakefield is investigated. Test-particle simulations show previously unobserved complex structure in the parameter space, with quasi-stable injection channels forming for particles injected in narrow regions away from the wake centre. Particles injected into these channels remain in the wake for a considerable time after dephasing and as a result achieve significantly higher energy than their neighbours. The result is relevant to both the planning and optimisation of experiments making use of external injection.

  13. Nutritional Approaches to Achieve Weight Loss in Nonalcoholic Fatty Liver Disease.

    PubMed

    Hsu, Christine C; Ness, Erik; Kowdley, Kris V

    2017-03-01

    Nonalcoholic fatty liver disease (NAFLD) can range in spectrum from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH), which is characterized by lipotoxicity, hepatocellular ballooning, and inflammation and can progress to cirrhosis. Weight loss is the cornerstone treatment for NAFLD and NASH. Various randomized controlled trials have shown that weight loss of ≥5-10% leads to significant improvements in hepatic steatosis. Diets high in sodium and fructose have been implicated in the pathogenesis of NAFLD. Although some clinical studies suggest that an isocaloric high-fructose diet does not worsen NAFLD, these clinical studies are often short in duration. More recently, the Dietary Approaches to Stop Hypertension diet, a sodium-restricted diet, has been associated with less prevalence of NAFLD and has been shown to improve NAFLD. In addition, the Mediterranean diet has been promising in improving hepatic steatosis, and a larger randomized controlled trial is currently enrolling subjects. For those who are unable to pursue weight loss through dietary approaches, bariatric surgery has been shown to improve hepatic steatosis and steatohepatitis. This method has been variable in improving hepatic fibrosis. In conclusion, weight loss is crucial to the improvement of NAFLD and NASH, and patients should attempt various diets in an attempt to achieve weight loss. © 2017 American Society for Nutrition.

  14. Heparin monotherapy or bivalirudin during percutaneous coronary intervention in patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease: results from the Evaluation of Drug-Eluting Stents and Ischemic Events registry.

    PubMed

    Bangalore, Sripal; Pencina, Michael J; Kleiman, Neal S; Cohen, David J

    2014-06-01

    The use of bivalirudin versus unfractionated heparin monotherapy in patients without ST-segment-elevation myocardial infarction is not well defined. The study population consisted of patients enrolled in the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry with either non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease, who underwent percutaneous coronary intervention with either unfractionated heparin or bivalirudin monotherapy. Propensity score matching was used to adjust for baseline characteristics. The primary bleeding (in-hospital composite bleeding-access site bleeding, thrombolysis in myocardial infarction major/minor bleeding, or transfusion) and primary (in-hospital death/myocardial infarction) and secondary ischemic outcomes (death/myocardial infarction/unplanned repeat revascularization at 12 months) were evaluated. Propensity score matching yielded 1036 patients with non-ST-segment-elevation acute coronary syndromes and 2062 patients with stable ischemic heart disease. For the non-ST-segment-elevation acute coronary syndrome cohort, bivalirudin use was associated with lower bleeding (difference, -3.3% [-0.8% to -5.8%]; P=0.01; number need to treat=30) without increase in either primary (difference, 1.2% [4.1% to -1.8%]; P=0.45) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [1.3% to -1.3%]; P=1.00). Similarly, in the stable ischemic heart disease cohort, bivalirudin use was associated with lower bleeding (difference, -1.8% [-0.4% to -3.3%]; P=0.01; number need to treat=53) without increase in either primary (difference, 0.4% [2.3% to -1.5%]; P=0.70) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [0.7% to -0.7%]; P=1.00) when compared with unfractionated heparin monotherapy. Among patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease undergoing percutaneous coronary intervention, bivalirudin use

  15. Heart disease and intimacy

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000540.htm Heart disease and intimacy To use the sharing features on ... 22267844 . Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Zipes DP, Libby P, Bonow RO, Mann ...

  16. Stable electron beams from laser wakefield acceleration with few-terawatt driver using a supersonic air jet

    NASA Astrophysics Data System (ADS)

    Boháček, K.; Kozlová, M.; Nejdl, J.; Chaulagain, U.; Horný, V.; Krůs, M.; Ta Phuoc, K.

    2018-03-01

    The generation of stable electron beams produced by the laser wakefield acceleration mechanism with a few-terawatt laser system (600 mJ, 50 fs) in a supersonic synthetic air jet is reported and the requirements necessary to build such a stable electron source are experimentally investigated in conditions near the bubble regime threshold. The resulting electron beams have stable energies of (17.4 ± 1.1) MeV and an energy spread of (13.5 ± 1.5) MeV (FWHM), which has been achieved by optimizing the properties of the supersonic gas jet target for the given laser system. Due to the availability of few-terawatt laser systems in many laboratories around the world these stable electron beams open possibilities for applications of this type of particle source.

  17. Direct quantitative evaluation of disease symptoms on living plant leaves growing under natural light.

    PubMed

    Matsunaga, Tomoko M; Ogawa, Daisuke; Taguchi-Shiobara, Fumio; Ishimoto, Masao; Matsunaga, Sachihiro; Habu, Yoshiki

    2017-06-01

    Leaf color is an important indicator when evaluating plant growth and responses to biotic/abiotic stress. Acquisition of images by digital cameras allows analysis and long-term storage of the acquired images. However, under field conditions, where light intensity can fluctuate and other factors (shade, reflection, and background, etc.) vary, stable and reproducible measurement and quantification of leaf color are hard to achieve. Digital scanners provide fixed conditions for obtaining image data, allowing stable and reliable comparison among samples, but require detached plant materials to capture images, and the destructive processes involved often induce deformation of plant materials (curled leaves and faded colors, etc.). In this study, by using a lightweight digital scanner connected to a mobile computer, we obtained digital image data from intact plant leaves grown in natural-light greenhouses without detaching the targets. We took images of soybean leaves infected by Xanthomonas campestris pv. glycines , and distinctively quantified two disease symptoms (brown lesions and yellow halos) using freely available image processing software. The image data were amenable to quantitative and statistical analyses, allowing precise and objective evaluation of disease resistance.

  18. A Gain-Programmable Transit-Time-Stable and Temperature-Stable PMT Voltage Divider

    NASA Astrophysics Data System (ADS)

    Liu, Yaqiang; Li, Hongdi; Wang, Yu; Xing, Tao; Xie, Shuping; Uribe, J.; Baghaei, H.; Ramirez, R.; Kim, Soonseok; Wong, Wai-Hoi

    2004-10-01

    A gain-programmable, transit-time-stable, temperature-stable photomultiplier (PMT) voltage divider design is described in this paper. The signal-to-noise ratio can be increased by changing a PMT gain directly instead of adjusting the gain of the preamplifier. PMT gain can be changed only by adjusting the voltages for the dynodes instead of changing the total high voltage between the anode and the photocathode, which can cause a significant signal transit-time variation that cannot be accepted by an application with a critical timing requirement, such as positron emission tomography (PET) or time-of-flight (TOF) detection/PET. The dynode voltage can be controlled by a digital analog converter isolated with a linear optocoupler. The optocoupler consists of an infrared light emission diode (LED) optically coupled with two phototransistors, and one is used in a servo feedback circuit to control the LED drive current for compensating temperature characteristics. The results showed that a six times gain range could be achieved; the gain drift was <0.5% over a 20/spl deg/C temperature range; 250 ps transit-time variation was measured over the entire gain range. A compact print circuit board (PCB) for the voltage divider integrated with a fixed-gain preamplifier has been designed and constructed. It can save about $30 per PMT channel compared with a commercial PMT voltage divider along with a variable gain amplifier. The preamplifier can be totally disabled, therefore in a system with a large amount of PMTs, only one channel can be enabled for calibrating the PMT gain. This new PMT voltage divider design is being applied to our animal PET camera and TOF/PET research.

  19. Feeling safe and motivated to achieve better health: Experiences with a partnership-based nursing practice programme for in-home patients with chronic obstructive pulmonary disease.

    PubMed

    Leine, Marit; Wahl, Astrid Klopstad; Borge, Christine Råheim; Hustavenes, Magne; Bondevik, Hilde

    2017-09-01

    To explore chronic obstructive pulmonary disease patients' experiences with a partnership-based nursing practice programme in the home setting. Patients with chronic obstructive pulmonary disease suffer from psychological and physiological problems, especially when they return home after hospitalisation from exacerbation. Many express a need for information and knowledge about chronic obstructive pulmonary disease. Partnership as practice is a patient-centred framework providing an individualised practice for each patient. This study intends to achieve a nuanced and improved understanding of chronic obstructive pulmonary disease patients' experiences with a partnership-based nursing practice programme comprising home visits from a respiratory nurse after hospital discharge, alongside interdisciplinary collaboration. This study has a qualitative design with interviews. Six individual semi-structured interviews collected in 2012-2013 constitute the material. Interviews were recorded, transcribed to written text and analysed using systematic text condensation. Three key themes were identified: to be seen, talked with and understood; healthcare support at home-continuity, practical support and facilitation; and exchange of knowledge. However, there were two generic themes that permeated the material: feeling safe and comforted, and motivation to achieve better health. Patients with chronic obstructive pulmonary disease can experience feeling safe and comforted, and be motivated to make changes in order to achieve better health after participating in a partnership-based nursing practice programme that includes home visits from a respiratory nurse and interdisciplinary cooperation after hospital discharge. To feel safe is of great importance, and how this relates to the patient's ability to cope with illness should be explored in further research. The results suggest that the partnership-based nursing practice programme that includes home visits and interdisciplinary

  20. Conservative versus invasive stable ischemic heart disease management strategies: what do we plan to learn from the ISCHEMIA trial?

    PubMed

    Cheng-Torres, Kathleen A; Desai, Karan P; Sidhu, Mandeep S; Maron, David J; Boden, William E

    2016-01-01

    Over the past decade, landmark randomized clinical trials comparing initial management strategies in stable ischemic heart disease (SIHD) have demonstrated no significant reduction in 'hard' end points (all-cause mortality, cardiac death or myocardial infarction) with one strategy versus another. The main advantage derived from early revascularization is improved short-term quality of life. Nonetheless, questions remain regarding how best to manage SIHD patients, such as whether a high-risk subgroup can be identified that may experience a survival or myocardial infarction benefit from early revascularization, and if not, when should diagnostic catheterization and revascularization be performed. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial is designed to address these questions by randomizing SIHD patients with at least moderate ischemia to an initial conservative strategy of optimal medical therapy or an initial invasive strategy of optimal medical therapy plus cardiac catheterization and revascularization.

  1. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study.

    PubMed

    Gurbel, Paul A; Bliden, Kevin P; Butler, Kathleen; Tantry, Udaya S; Gesheff, Tania; Wei, Cheryl; Teng, Renli; Antonino, Mark J; Patil, Shankar B; Karunakaran, Arun; Kereiakes, Dean J; Parris, Cordel; Purdy, Drew; Wilson, Vance; Ledley, Gary S; Storey, Robert F

    2009-12-22

    Ticagrelor is the first reversibly binding oral P2Y(12) receptor antagonist. This is the first study to compare the onset and offset of platelet inhibition (IPA) with ticagrelor using the PLATO (PLATelet inhibition and patient Outcomes) trial loading dose (180 mg) with a high loading dose (600 mg) of clopidogrel. In a multicenter, randomized, double-blind study, 123 patients with stable coronary artery disease who were taking aspirin therapy (75 to 100 mg/d) received ticagrelor (180-mg load, 90-mg BID maintenance dose [n=57]), clopidogrel (600-mg load, 75-mg/d maintenance dose [n=54]), or placebo (n=12) for 6 weeks. Greater IPA (20 micromol/L ADP, final extent) occurred with ticagrelor than with clopidogrel at 0.5, 1, 2, 4, 8, and 24 hours after loading and at 6 weeks (P<0.0001 for all); by 2 hours after loading, a greater proportion of patients achieved >50% IPA (98% versus 31%, P<0.0001) and >70% IPA (90% versus 16%, P<0.0001) in the ticagrelor group than in the clopidogrel group, respectively. A faster offset occurred with ticagrelor than with clopidogrel (4-to-72-hour slope [% IPA/h] -1.04 versus -0.48, P<0.0001). At 24 hours after the last dose, mean IPA was 58% for ticagrelor versus 52% for clopidogrel (P=NS). IPA for ticagrelor on day 3 after the last dose was comparable to clopidogrel at day 5; IPA on day 5 for ticagrelor was similar to clopidogrel on day 7 and did not differ from placebo (P=NS). Ticagrelor achieved more rapid and greater platelet inhibition than high-loading-dose clopidogrel; this was sustained during the maintenance phase and was faster in offset after drug discontinuation.

  2. Carbon Nanomaterial Based Biosensors for Non-Invasive Detection of Cancer and Disease Biomarkers for Clinical Diagnosis

    PubMed Central

    Tung, Thanh Tran

    2017-01-01

    The early diagnosis of diseases, e.g., Parkinson’s and Alzheimer’s disease, diabetes, and various types of cancer, and monitoring the response of patients to the therapy plays a critical role in clinical treatment; therefore, there is an intensive research for the determination of many clinical analytes. In order to achieve point-of-care sensing in clinical practice, sensitive, selective, cost-effective, simple, reliable, and rapid analytical methods are required. Biosensors have become essential tools in biomarker sensing, in which electrode material and architecture play critical roles in achieving sensitive and stable detection. Carbon nanomaterials in the form of particle/dots, tube/wires, and sheets have recently become indispensable elements of biosensor platforms due to their excellent mechanical, electronic, and optical properties. This review summarizes developments in this lucrative field by presenting major biosensor types and variability of sensor platforms in biomedical applications. PMID:28825646

  3. Respiratory Muscle Strength in Patients With Chronic Obstructive Pulmonary Disease.

    PubMed

    Kim, Nam-Sik; Seo, Jeong-Hwan; Ko, Myoung-Hwan; Park, Sung-Hee; Kang, Seong-Woong; Won, Yu Hui

    2017-08-01

    To compare the respiratory muscle strength between patients with stable and acutely exacerbated (AE) chronic obstructive pulmonary disease (COPD) at various stages. A retrospective medical record review was conducted on patients with COPD from March 2014 to May 2016. Patients were subdivided into COPD stages 1-4 according to the Global Initiative for Chronic Obstructive Lung Disease guidelines: mild, moderate, severe, and very severe. A rehabilitation physician reviewed their medical records and initial assessment, including spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), COPD Assessment Test, and modified Medical Research Council scale. We then compared the initial parameters in patients with a stable condition and those at AE status. The AE group (n=94) had significantly lower MIP (AE, 55.93±20.57; stable, 67.88±24.96; p=0.006) and MIP% (AE, 82.82±27.92; stable, 96.64±30.46; p=0.015) than the stable patient group (n=36). MIP, but not MEP, was proportional to disease severity in patients with AE and stable COPD. The strength of the inspiratory muscles may better reflect severity of disease when compared to that of expiratory muscles.

  4. Changes of Respiratory Mechanics in COPD Patients from Stable State to Acute Exacerbations with Respiratory Failure.

    PubMed

    Ceriana, Piero; Vitacca, Michele; Carlucci, Annalisa; Paneroni, Mara; Pisani, Lara; Nava, Stefano

    2017-04-01

    Symptoms, clinical course, functional and biological data during an exacerbation of chronic obstructive pulmonary disease (EXCOPD) have been investigated, but data on physiological changes of respiratory mechanics during a severe exacerbation with respiratory acidosis requiring noninvasive mechanical ventilation (NIMV) are scant. The aim of this study was to evaluate changes of respiratory mechanics in COPD patients comparing data observed during EXCOPD with those observed during stable state in the recovery phase. In 18 COPD patients having severe EXCOPD requiring NIMV for global respiratory failure, we measured respiratory mechanics during both EXCOPD (T0) and once the patients achieved a stable state (T1). The diaphragm and inspiratory muscles effort was significantly increased under relapse, as well as the pressure-time product of the diaphragm and the inspiratory muscle (PTPdi and PTPes). The resistive loads to breathe (i.e., PEEPi,dyn, compliance and inspiratory resistances) were also markedly increased, while the maximal pressures generated by the diaphragm and the inspiratory muscles, together with forced expired volumes were decreased. All these indices statistically improved but with a great intrasubject variability in stable condition. Moreover, tension-time index (TTdi) significantly improved from the EXCOPD state to the condition of clinical stability (0.156 ± 0.04 at T0 vs. 0.082 ± 0.02 at T1 p < 0.001). During an EXCOPD, the load/capacity of the respiratory pump is impaired, and although the patients exhibit a rapid shallow breathing pattern, this does not necessarily correlate with a TTdi ≥ 0.15. These changes are reverted once they recover from the EXCOPD, despite a large variability between patients.

  5. Bi-stable optical actuator

    DOEpatents

    Holdener, Fred R.; Boyd, Robert D.

    2000-01-01

    The present invention is a bi-stable optical actuator device that is depowered in both stable positions. A bearing is used to transfer motion and smoothly transition from one state to another. The optical actuator device may be maintained in a stable position either by gravity or a restraining device.

  6. Management of stable angina: A commentary on the European Society of Cardiology guidelines.

    PubMed

    Ambrosio, Giuseppe; Mugelli, Alessandro; Lopez-Sendón, José; Tamargo, Juan; Camm, John

    2016-09-01

    In 2013 the European Society of Cardiology (ESC) released new guidelines on the management of stable coronary artery disease. These guidelines update and replace the previous ESC guidelines on the management of stable angina pectoris, issued in 2006. There are several new aspects in the 2013 ESC guidelines compared with the 2006 version. This opinion paper provides an in-depth interpretation of the ESC guidelines with regard to these issues, to help physicians in making evidence-based therapeutic choices in their routine clinical practice. The first new element is the definition of stable coronary artery disease itself, which has now broadened from a 'simple' symptom, angina pectoris, to a more complex disease that can even be asymptomatic. In the first-line setting, the major changes in the new guidelines are the upgrading of calcium channel blockers, the distinction between dihydropyridines and non-dihydropyridine calcium channel blockers, and the presence of important statements regarding the combination of calcium channel blockers with beta-blockers. In the second-line setting, the 2013 ESC guidelines recommend the addition of long-acting nitrates, ivabradine, nicorandil or ranolazine to first-line agents. Trimetazidine may also be considered. However, no clear distinction is made among different second-line drugs, despite different quality of evidence in favour of these agents. For example, the use of ranolazine is supported by strong and recent evidence, while data supporting the use of the traditional agents appear relatively scanty. © The European Society of Cardiology 2016.

  7. [Effect of treatment with selenium electrophoresis on biochemical indices in patients suffering from ischaemic cardiac disease with a stable stenocardia of tension].

    PubMed

    Kurtsikidze, I

    2006-08-01

    Disturbances in lipid metabolism, intensification of lipid peroxidize oxidation and functions of sympatho-adrenal system play an important role in the development and progressing of ischaemic cardiac disease. As a result of investigations it has been established that microelement--selenium has an antiatherogenic action and suppresses peroxidize oxidation of lipids. The effect of treatment with selenium electrophoresis in patients suffering from ischaemic cardiac disease with a stable stenocardia of tension has been studied. Total of 76 patients with ICS:SST of I-II functional classes (FC) have been investigated. It has been established that treatment with selenium electrophoresis provokes a reduction of overall cholesterol, triglycerides and beta-lipoproteins content in blood serum, as well as a decrease of cholesterol amount in beta-lipoproteins, lipoproteins of low and very low density and diene conjugates in blood serum and adrenaline and norepinephrine excretion with urine; increase of lipoprotein amount of high density in blood serum, activity of catalase and selenium excretion with urine. Above-said positive changes in biochemical data were more pronounced for the ICS:SST of the first FC.

  8. Recombinant protein production from stable mammalian cell lines and pools.

    PubMed

    Hacker, David L; Balasubramanian, Sowmya

    2016-06-01

    We highlight recent developments for the production of recombinant proteins from suspension-adapted mammalian cell lines. We discuss the generation of stable cell lines using transposons and lentivirus vectors (non-targeted transgene integration) and site-specific recombinases (targeted transgene integration). Each of these methods results in the generation of cell lines with protein yields that are generally superior to those achievable through classical plasmid transfection that depends on the integration of the transfected DNA by non-homologous DNA end-joining. This is the main reason why these techniques can also be used for the generation of stable cell pools, heterogenous populations of recombinant cells generated by gene delivery and genetic selection without resorting to single cell cloning. This allows the time line from gene transfer to protein production to be reduced. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Force production during squats performed with a rotational resistance device under stable versus unstable conditions.

    PubMed

    Moras, Gerard; Vázquez-Guerrero, Jairo

    2015-11-01

    [Purpose] Force production during a squat action on a rotational resistance device (RRD) under stable and unstable conditions. [Subjects and Methods] Twenty-one healthy males were asked to perform six sets of six repetitions of squats on an RRD on either stable or unstable surfaces. The stable and unstable sets were performed on different days. Muscular outputs were obtained from a linear encoder and a strain gauge fixed to a vest. [Results] Overall, the results showed no significant differences for any of the dependent variables across exercise modes. Forcemean outputs were higher in the concentric phase than in the eccentric phase for each condition, but there were no differences in velocity, time or displacement. The forcepeak was similar in the eccentric and concentric phases of movement under both stable and unstable conditions. There were no significant differences in forcemean between sets per condition or between conditions. [Conclusion] These results suggest that performing squats with a RRD achieves similar forcemean and forcepeak under stable and unstable conditions. The forcepeak produced is also similar in concentric and eccentric phases.

  10. Force production during squats performed with a rotational resistance device under stable versus unstable conditions

    PubMed Central

    Moras, Gerard; Vázquez-Guerrero, Jairo

    2015-01-01

    [Purpose] Force production during a squat action on a rotational resistance device (RRD) under stable and unstable conditions. [Subjects and Methods] Twenty-one healthy males were asked to perform six sets of six repetitions of squats on an RRD on either stable or unstable surfaces. The stable and unstable sets were performed on different days. Muscular outputs were obtained from a linear encoder and a strain gauge fixed to a vest. [Results] Overall, the results showed no significant differences for any of the dependent variables across exercise modes. Forcemean outputs were higher in the concentric phase than in the eccentric phase for each condition, but there were no differences in velocity, time or displacement. The forcepeak was similar in the eccentric and concentric phases of movement under both stable and unstable conditions. There were no significant differences in forcemean between sets per condition or between conditions. [Conclusion] These results suggest that performing squats with a RRD achieves similar forcemean and forcepeak under stable and unstable conditions. The forcepeak produced is also similar in concentric and eccentric phases. PMID:26696707

  11. Stress cardiac magnetic resonance imaging provides effective cardiac risk reclassification in patients with known or suspected stable coronary artery disease.

    PubMed

    Shah, Ravi; Heydari, Bobak; Coelho-Filho, Otavio; Murthy, Venkatesh L; Abbasi, Siddique; Feng, Jiazhuo H; Pencina, Michael; Neilan, Tomas G; Meadows, Judith L; Francis, Sanjeev; Blankstein, Ron; Steigner, Michael; di Carli, Marcelo; Jerosch-Herold, Michael; Kwong, Raymond Y

    2013-08-06

    A recent large-scale clinical trial found that an initial invasive strategy does not improve cardiac outcomes beyond optimized medical therapy in patients with stable coronary artery disease. Novel methods to stratify at-risk patients may refine therapeutic decisions to improve outcomes. In a cohort of 815 consecutive patients referred for evaluation of myocardial ischemia, we determined the net reclassification improvement of the risk of cardiac death or nonfatal myocardial infarction (major adverse cardiac events) incremental to clinical risk models, using guideline-based low (<1%), moderate (1% to 3%), and high (>3%) annual risk categories. In the whole cohort, inducible ischemia demonstrated a strong association with major adverse cardiac events (hazard ratio=14.66; P<0.0001) with low negative event rates of major adverse cardiac events and cardiac death (0.6% and 0.4%, respectively). This prognostic robustness was maintained in patients with previous coronary artery disease (hazard ratio=8.17; P<0.0001; 1.3% and 0.6%, respectively). Adding inducible ischemia to the multivariable clinical risk model (adjusted for age and previous coronary artery disease) improved discrimination of major adverse cardiac events (C statistic, 0.81-0.86; P=0.04; adjusted hazard ratio=7.37; P<0.0001) and reclassified 91.5% of patients at moderate pretest risk (65.7% to low risk; 25.8% to high risk) with corresponding changes in the observed event rates (0.3%/y and 4.9%/y for low and high risk posttest, respectively). Categorical net reclassification index was 0.229 (95% confidence interval, 0.063-0.391). Continuous net reclassification improvement was 1.11 (95% confidence interval, 0.81-1.39). Stress cardiac magnetic resonance imaging effectively reclassifies patient risk beyond standard clinical variables, specifically in patients at moderate to high pretest clinical risk and in patients with previous coronary artery disease. http://www.clinicaltrials.gov. Unique identifier: NCT

  12. Evaluating the Quality of Research into a Single Prognostic Biomarker: A Systematic Review and Meta-analysis of 83 Studies of C-Reactive Protein in Stable Coronary Artery Disease

    PubMed Central

    Hemingway, Harry; Philipson, Peter; Chen, Ruoling; Fitzpatrick, Natalie K.; Damant, Jacqueline; Shipley, Martin; Abrams, Keith R.; Moreno, Santiago; McAllister, Kate S. L.; Palmer, Stephen; Kaski, Juan Carlos; Timmis, Adam D.; Hingorani, Aroon D.

    2010-01-01

    Background Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP) with fatal and nonfatal events among patients with stable coronary disease. Methods and Findings We searched MEDLINE (1966 to 2009) and EMBASE (1980 to 2009) and selected prospective studies of patients with stable coronary disease, reporting a relative risk for the association of CRP with death and nonfatal cardiovascular events. We included 83 studies, reporting 61,684 patients and 6,485 outcome events. No study reported a prespecified statistical analysis protocol; only two studies reported the time elapsed (in months or years) between initial presentation of symptomatic coronary disease and inclusion in the study. Studies reported a median of seven items (of 17) from the REMARK reporting guidelines, with no evidence of change over time. The pooled relative risk for the top versus bottom third of CRP distribution was 1.97 (95% confidence interval [CI] 1.78–2.17), with substantial heterogeneity (I2 = 79.5). Only 13 studies adjusted for conventional risk factors (age, sex, smoking, obesity, diabetes, and low-density lipoprotein [LDL] cholesterol) and these had a relative risk of 1.65 (95% CI 1.39–1.96), I2 = 33.7. Studies reported ten different ways of comparing CRP values, with weaker relative risks for those based on continuous measures. Adjusting for publication bias (for which there was strong evidence, Egger's p<0.001) using a validated method reduced the relative risk to 1.19 (95% CI 1.13–1.25). Only two studies reported a measure of discrimination (c-statistic). In 20 studies the detection rate for subsequent events could be calculated and was 31% for a 10% false positive rate, and the calculated pooled c-statistic was 0.61 (0.57–0.66). Conclusion Multiple types of reporting bias, and publication bias, make the magnitude of any

  13. Stable doping of carbon nanotubes via molecular self assembly

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lee, B.; Chen, Y.; Podzorov, V., E-mail: podzorov@physics.rutgers.edu

    2014-10-14

    We report a novel method for stable doping of carbon nanotubes (CNT) based on methods of molecular self assembly. A conformal growth of a self-assembled monolayer of fluoroalkyl trichloro-silane (FTS) at CNT surfaces results in a strong increase of the sheet conductivity of CNT electrodes by 60–300%, depending on the CNT chirality and composition. The charge carrier mobility of undoped partially aligned CNT films was independently estimated in a field-effect transistor geometry (~100 cm²V⁻¹s⁻¹). The hole density induced by the FTS monolayer in CNT sheets is estimated to be ~1.8 ×10¹⁴cm⁻². We also show that FTS doping of CNT anodesmore » greatly improves the performance of organic solar cells. This large and stable doping effect, easily achieved in large-area samples, makes this approach very attractive for applications of CNTs in transparent and flexible electronics.« less

  14. Stable Cyclic Carbenes and Related Species beyond Diaminocarbenes

    PubMed Central

    Melaimi, Mohand; Soleilhavoup, Michèle

    2011-01-01

    The success of homogeneous catalysis can be attributed largely to the development of a diverse range of ligand frameworks that have been used to tune the behavior of various systems. Spectacular results in this area have been achieved using cyclic diaminocarbenes (NHCs) as a result of their strong σ-donor properties. Although it is possible to cursorily tune the structure of NHCs, any diversity is still far from matching their phosphorus-based counterparts, which is one of the great strengths of the latter. A variety of stable acyclic carbenes are known, but they are either reluctant to bind metals or they give rise to fragile metal complexes. During the last five years, new types of stable cyclic carbenes, as well as related carbon-based ligands (which are not NHCs), and which feature even stronger σ-donor properties have been developed. Their synthesis and characterization as well as the stability, electronic properties, coordination behavior, and catalytic activity of the ensuing complexes are discussed, and comparisons with their NHC cousins are made. PMID:20836099

  15. Cardiac Troponin I and Amino-Terminal Pro B-Type Natriuretic Peptide in Dogs With Stable Chronic Kidney Disease.

    PubMed

    Pelander, L; Häggström, J; Ley, C J; Ljungvall, I

    2017-05-01

    Increased concentrations of N-terminal pro B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in dogs with azotemia have been documented. Knowledge of mechanisms behind increased concentrations of cardiac biomarkers in dogs with azotemia is warranted for correct interpretation of test results. The aim of the article was to investigate possible associations between plasma concentrations of cTnI and NT-proBNP, respectively, and patient characteristics, glomerular filtration rate (GFR), a plasma volume factor (PVF) derived from scintigraphic examination (PVf), systolic blood pressure (SBP), selected hematologic and biochemical variables, and echocardiographic measurements in dogs with stable chronic kidney disease (CKD) and in healthy dogs. Fifty student-, staff-, and client-owned dogs were included. Twenty-three of the dogs were healthy and 27 were diagnosed with CKD. In this cross-sectional observational study, dogs with a previous diagnosis of CKD and healthy control dogs were included. At inclusion, all dogs were characterized by physical examination, repeated blood pressure measurements, complete urinalysis, hematology and biochemistry panel, echocardiography, abdominal ultrasound examination of the entire urinary tract, and scintigraphic examination for measurement of GFR. Plasma volume factor and PCV were independently associated with NT-proBNP (Radj2 = 0.42; P < .0001). Age, body weight (BW), and SBP were independently associated with cTnI (Radj2 = 0.50; P < .0001). Neither NT-proBNP nor cTnI concentrations were independently associated with measured GFR. Thus, findings were not suggestive of passive accumulation of either marker, suggesting that increased circulating concentrations of cTnI and NT-proBNP can be interpreted similarly in dogs with stable CKD as in dogs without CKD. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary

  16. The synthesis of a tritium, carbon-14, and stable isotope-labeled cathepsin C inhibitors.

    PubMed

    Allen, Paul; Bragg, Ryan A; Caffrey, Moya; Ericsson, Cecilia; Hickey, Michael J; Kingston, Lee P; Elmore, Charles S

    2017-02-01

    As part of a medicinal chemistry program aimed at developing a highly potent and selective cathepsin C inhibitor, tritium, carbon-14, and stable isotope-labeled materials were required. The synthesis of tritium-labeled methanesulfonate 5 was achieved via catalytic tritiolysis of a chloro precursor, albeit at a low radiochemical purity of 67%. Tritium-labeled AZD5248 was prepared via a 3-stage synthesis, utilizing amide-directed hydrogen isotope exchange. Carbon-14 and stable isotope-labeled AZD5248 were successfully prepared through modifications of the medicinal chemistry synthetic route, enabling the use of available labeled intermediates. Copyright © 2016 John Wiley & Sons, Ltd.

  17. Stable Direct Adaptive Control of Linear Infinite-dimensional Systems Using a Command Generator Tracker Approach

    NASA Technical Reports Server (NTRS)

    Balas, M. J.; Kaufman, H.; Wen, J.

    1985-01-01

    A command generator tracker approach to model following contol of linear distributed parameter systems (DPS) whose dynamics are described on infinite dimensional Hilbert spaces is presented. This method generates finite dimensional controllers capable of exponentially stable tracking of the reference trajectories when certain ideal trajectories are known to exist for the open loop DPS; we present conditions for the existence of these ideal trajectories. An adaptive version of this type of controller is also presented and shown to achieve (in some cases, asymptotically) stable finite dimensional control of the infinite dimensional DPS.

  18. [Effects of exercise therapy at the intensity of anaerobic threshold for exercise tolerance in patients with chronic stable coronary artery disease].

    PubMed

    Che, Lin; Gong, Zhu; Jiang, Jin-fa; Xu, Wen-jun; Deng, Bing; Xu, Jia-hong; Yan, Wen-wen; Zhang, Qi-ping; Wang, Le-min

    2011-06-28

    To investigate the effects of exercise therapy at the intensity of anaerobic threshold (AT) for exercise tolerance in patients with chronic stable coronary artery disease. Forty-three patients with chronic stable coronary artery disease (3 patients after coronary arterial bypass graft (CABG) surgery, 22 patients with old myocardial infarction and 18 unstable angina pectoris undergoing successful percutaneous coronary intervention (PCI) finished twice cardiopulmonary exercise test (CPET) and followed their rehabilitation program for 3 months. Thirty-two patients finished their aerobic exercise therapy based on their individual anaerobic thresholds while 11 patients had no exercise therapy. The heart rate at AT intensity (97 ± 9/min) was lower than their traditional minimal target heart rate (112 ± 7/min) and lower than heart rate (115 ± 11/min) at ischemic threshold post-CPET. The O(2) consumption (10.7 ± 2.4 to 12.6 ± 2.9 ml×min(-1)×kg(-1)) (P = 0.04) and workload (37 ± 18 to 47 ± 13 J/s) (P = 0.04) at AT level and the O(2) consumption (15.3 ± 3.1 to 20.6 ± 4.2 ml×min(-1)×kg(-1), P = 0.02) and workload(68 ± 12 and 87 ± 14 J/s, P = 0.01) at peak level markedly increased after 3 months in the exercise group. And the O(2) consumption (15.3 ± 2.9 to 16.2 ± 3.1 ml×min(-1)×kg(-1)) and workload (65 ± 13 to 73 ± 16 J/s) at peak level mild increased after 3 months in the non-exercise group, but their O(2) consumption (11.0 ± 2.7 to 11.3 ± 2.8 ml×min(-1)×kg(-1)) and workload (38 ± 11 to 37 ± 9 J/s) at AT level had no obvious change. AT exercise intensity was lower than ischemic threshold post-CPET. Exercise therapy at the intensity of anaerobic threshold can improve oxygen capacity and exercise tolerance.

  19. Stable isotope tracers and exercise physiology: past, present and future.

    PubMed

    Wilkinson, Daniel J; Brook, Matthew S; Smith, Kenneth; Atherton, Philip J

    2017-05-01

    Stable isotope tracers have been invaluable assets in physiological research for over 80 years. The application of substrate-specific stable isotope tracers has permitted exquisite insight into amino acid, fatty-acid and carbohydrate metabolic regulation (i.e. incorporation, flux, and oxidation, in a tissue-specific and whole-body fashion) in health, disease and response to acute and chronic exercise. Yet, despite many breakthroughs, there are limitations to 'substrate-specific' stable isotope tracers, which limit physiological insight, e.g. the need for intravenous infusions and restriction to short-term studies (hours) in controlled laboratory settings. In recent years significant interest has developed in alternative stable isotope tracer techniques that overcome these limitations, in particular deuterium oxide (D 2 O or heavy water). The unique properties of this tracer mean that through oral administration, the turnover and flux through a number of different substrates (muscle proteins, lipids, glucose, DNA (satellite cells)) can be monitored simultaneously and flexibly (hours/weeks/months) without the need for restrictive experimental control. This makes it uniquely suited for the study of 'real world' human exercise physiology (amongst many other applications). Moreover, using D 2 O permits evaluation of turnover of plasma and muscle proteins (e.g. dynamic proteomics) in addition to metabolomics (e.g. fluxomics) to seek molecular underpinnings, e.g. of exercise adaptation. Here, we provide insight into the role of stable isotope tracers, from substrate-specific to novel D 2 O approaches, in facilitating our understanding of metabolism. Further novel potential applications of stable isotope tracers are also discussed in the context of integration with the snowballing field of 'omic' technologies. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

  20. Stable integrated hyper-parametric oscillator based on coupled optical microcavities.

    PubMed

    Armaroli, Andrea; Feron, Patrice; Dumeige, Yannick

    2015-12-01

    We propose a flexible scheme based on three coupled optical microcavities that permits us to achieve stable oscillations in the microwave range, the frequency of which depends only on the cavity coupling rates. We find that the different dynamical regimes (soft and hard excitation) affect the oscillation intensity, but not their periods. This configuration may permit us to implement compact hyper-parametric sources on an integrated optical circuit with interesting applications in communications, sensing, and metrology.

  1. Stable Water Oxidation in Acid Using Manganese-Modified TiO2 Protective Coatings.

    PubMed

    Siddiqi, Georges; Luo, Zhenya; Xie, Yujun; Pan, Zhenhua; Zhu, Qianhong; Röhr, Jason A; Cha, Judy J; Hu, Shu

    2018-06-06

    Accomplishing acid-stable water oxidation is a critical matter for achieving both long-lasting water-splitting devices and other fuel-forming electro- and photocatalytic processes. Because water oxidation releases protons into the local electrolytic environment, it becomes increasingly acidic during device operation, which leads to corrosion of the photoactive component and hence loss in device performance and lifetime. In this work, we show that thin films of manganese-modified titania, (Ti,Mn)O x , topped with an iridium catalyst, can be used in a coating stabilization scheme for acid-stable water oxidation. We achieved a device lifetime of more than 100 h in pH = 0 acid. We successfully grew (Ti,Mn)O x coatings with uniform elemental distributions over a wide range of manganese compositions using atomic layer deposition (ALD), and using X-ray photoelectron spectroscopy, we show that (Ti,Mn)O x films grown in this manner give rise to closer-to-valence-band Fermi levels, which can be further tuned with annealing. In contrast to the normally n-type or intrinsic TiO 2 coatings, annealed (Ti,Mn)O x films can make direct charge transfer to a Fe(CN) 6 3-/4- redox couple dissolved in aqueous electrolytes. Using the Fe(CN) 6 3-/4- redox, we further demonstrated anodic charge transfer through the (Ti,Mn)O x films to high work function metals, such as iridium and gold, which is not previously possible with ALD-grown TiO 2 . We correlated changes in the crystallinity (amorphous to rutile TiO 2 ) and oxidation state (2+ to 3+) of the annealed (Ti,Mn)O x films to their hole conductivity and electrochemical stability in acid. Finally, by combining (Ti,Mn)O x coatings with iridium, an acid-stable water-oxidation anode, using acid-sensitive conductive fluorine-doped tin oxides, was achieved.

  2. Aspirin in stroke prevention in nonvalvular atrial fibrillation and stable vascular disease: an era of new anticoagulants.

    PubMed

    Turagam, Mohit K; Velagapudi, Poonam; Leal, Miguel A; Kocheril, Abraham G

    2012-04-01

    Atrial fibrillation (AF) is a major cause of ischemic stroke, especially in the elderly. There are currently enough data to support the notion that anticoagulation with warfarin or dabigatran is far superior to aspirin in the prevention of stroke or systemic embolism in AF. Aspirin is the preferred modality in patients who are either not candidates for anticoagulation, such as patients with increased risk for bleeding, low-risk patients based on the CHADS2 score or patients who have difficulty in maintaining a therapeutic international normalized ratio. There is no dispute on the recommendations regarding stroke prevention in high-risk patients (CHADS2 risk score of 2 and beyond) with AF. However, there is some controversy regarding the appropriate strategy (anticoagulation vs aspirin) for stroke prevention in low-risk patients (CHA2DS2-VASc score of 0-1). Novel oral anticoagulant drugs (direct thrombin inhibitors and Factor Xa inhibitors) might further diminish the role of aspirin for stroke prevention in AF due to their superior efficacy, lack of need for monitoring of therapeutic effects and lower bleeding risk when compared with warfarin, especially in patients with stable vascular disease.

  3. Refining a brief decision aid in stable CAD: cognitive interviews.

    PubMed

    Kelly-Blake, Karen; Clark, Stacie; Dontje, Katherine; Olomu, Adesuwa; Henry, Rebecca C; Rovner, David R; Rothert, Marilyn L; Holmes-Rovner, Margaret

    2014-02-13

    We describe the results of cognitive interviews to refine the "Making Choices©" Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the "think aloud" interview technique to assess the clarity, usefulness, and design of each page of the DA. Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three. Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.

  4. Stable long-term chronic brain mapping at the single-neuron level.

    PubMed

    Fu, Tian-Ming; Hong, Guosong; Zhou, Tao; Schuhmann, Thomas G; Viveros, Robert D; Lieber, Charles M

    2016-10-01

    Stable in vivo mapping and modulation of the same neurons and brain circuits over extended periods is critical to both neuroscience and medicine. Current electrical implants offer single-neuron spatiotemporal resolution but are limited by such factors as relative shear motion and chronic immune responses during long-term recording. To overcome these limitations, we developed a chronic in vivo recording and stimulation platform based on flexible mesh electronics, and we demonstrated stable multiplexed local field potentials and single-unit recordings in mouse brains for at least 8 months without probe repositioning. Properties of acquired signals suggest robust tracking of the same neurons over this period. This recording and stimulation platform allowed us to evoke stable single-neuron responses to chronic electrical stimulation and to carry out longitudinal studies of brain aging in freely behaving mice. Such advantages could open up future studies in mapping and modulating changes associated with learning, aging and neurodegenerative diseases.

  5. Statistics of stable marriages

    NASA Astrophysics Data System (ADS)

    Dzierzawa, Michael; Oméro, Marie-José

    2000-11-01

    In the stable marriage problem N men and N women have to be matched by pairs under the constraint that the resulting matching is stable. We study the statistical properties of stable matchings in the large N limit using both numerical and analytical methods. Generalizations of the model including singles and unequal numbers of men and women are also investigated.

  6. 5-Hydroxymethylcytosine is a predominantly stable DNA modification

    NASA Astrophysics Data System (ADS)

    Bachman, Martin; Uribe-Lewis, Santiago; Yang, Xiaoping; Williams, Michael; Murrell, Adele; Balasubramanian, Shankar

    2014-12-01

    5-Hydroxymethylcytosine (hmC) is an oxidation product of 5-methylcytosine which is present in the deoxyribonucleic acid (DNA) of most mammalian cells. Reduction of hmC levels in DNA is a hallmark of cancers. Elucidating the dynamics of this oxidation reaction and the lifetime of hmC in DNA is fundamental to understanding hmC function. Using stable isotope labelling of cytosine derivatives in the DNA of mammalian cells and ultrasensitive tandem liquid-chromatography mass spectrometry, we show that the majority of hmC is a stable modification, as opposed to a transient intermediate. In contrast with DNA methylation, which occurs immediately during replication, hmC forms slowly during the first 30 hours following DNA synthesis. Isotopic labelling of DNA in mouse tissues confirmed the stability of hmC in vivo and demonstrated a relationship between global levels of hmC and cell proliferation. These insights have important implications for understanding the states of chemically modified DNA bases in health and disease.

  7. Stable carbon and sulfur isotopes as records of the early biosphere

    NASA Technical Reports Server (NTRS)

    Desmarais, David J.

    1989-01-01

    The abundance ratios of the stable isotopes of light elements such as carbon and sulfur can differ between various naturally-occurring chemical compounds. If coexisting compounds have achieved mutual chemical and isotopic equilibrium, then the relative isotopic composition can record the conditions at which equilibrium was last maintained. If coexisting chemical compounds indeed formed simultaneously but had not achieved mutual equilibrium, then their relative isotopic compositions often reflect the conditions and mechanisms associated with the kinetically controlled reactions responsible for their production. In the context of Mars, the stable isotopic compositions of various minerals might record not only the earlier environmental conditions of the planet, but also whether or not the chemistry of life ever occurred there. Two major geochemical reservoirs occur in Earth's crust, both for carbon and sulfur. In rocks formed in low temperature sedimentary environments, the oxidized forms of these elements tend to be enriched in the isotope having the larger mass, relative to the reduced forms. In sediments where the organics and sulfides were formed by biological processes, these isotopic contrasts were caused by the processes of biological CO2 fixation and dissimilatory sulfate reduction. Such isotopic contrasts between oxidized and reduced forms of carbon and sulfur are permitted by thermodynamics at ambient temperatures. However, nonbiological chemical reactions associated with the production of organic matter and the reduction of organics and sulfides are extremely slow at ambient temperatures. Thus the synthesis of organics and sulfides under ambient conditions illustrates life's profound role as a chemical catalyst that has altered the chemistry of Earth's crust. Because the stable isotopes of carbon and sulfur can reflect their chemistry, they are useful probes of the Martian surface.

  8. Angle-stable and compressed angle-stable locking for tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. Biomechanical evaluation.

    PubMed

    Mückley, Thomas; Hoffmeier, Konrad; Klos, Kajetan; Petrovitch, Alexander; von Oldenburg, Geert; Hofmann, Gunther O

    2008-03-01

    Retrograde intramedullary nailing is an established procedure for tibiotalocalcaneal arthrodesis. The goal of this study was to evaluate the effects of angle-stable locking or compressed angle-stable locking on the initial stability of the nails and on the behavior of the constructs under cyclic loading conditions. Tibiotalocalcaneal arthrodesis was performed in fifteen third-generation synthetic bones and twenty-four fresh-frozen cadaver legs with use of retrograde intramedullary nailing with three different locking modes: a Stryker nail with compressed angle-stable locking, a Stryker nail with angle-stable locking, and a statically locked Biomet nail. Analyses were performed of the initial stability of the specimens (range of motion) and the laxity of the constructs (neutral zone) in dorsiflexion/plantar flexion, varus/valgus, and external rotation/internal rotation. Cyclic testing up to 100,000 cycles was also performed. The range of motion and the neutral zone in dorsiflexion/plantar flexion at specific cycle increments were determined. In both bone models, the intramedullary nails with compressed angle-stable locking and those with angle-stable locking were significantly superior, in terms of a smaller range of motion and neutral zone, to the statically locked nails. The compressed angle-stable nails were superior to the angle-stable nails only in the synthetic bone model, in external/internal rotation. Cyclic testing showed the nails with angle-stable locking and those with compressed angle-stable locking to have greater stability in both models. In the synthetic bone model, compressed angle-stable locking was significantly better than angle-stable locking; in the cadaver bone model, there was no significant difference between these two locking modes. During cyclic testing, five statically locked nails in the cadaver bone model failed, whereas one nail with angle-stable locking and one with compressed angle-stable locking failed. Regardless of the bone model

  9. In Vivo Stable Transduction of Humanized Liver Tissue in Chimeric Mice via High-Capacity Adenovirus–Lentivirus Hybrid Vector

    PubMed Central

    Kataoka, Miho; Tateno, Chise; Yoshizato, Katsutoshi; Kawasaki, Yoshiko; Kimura, Takahiro; Faure-Kumar, Emmanuelle; Palmer, Donna J.; Ng, Philip; Okamura, Haruki; Kasahara, Noriyuki

    2010-01-01

    Abstract We developed hybrid vectors employing high-capacity adenovirus as a first-stage carrier encoding all the components required for in situ production of a second-stage lentivirus, thereby achieving stable transgene expression in secondary target cells. Such vectors have never previously been tested in normal tissues, because of the scarcity of suitable in vivo systems permissive for second-stage lentivirus assembly. Here we employed a novel murine model in which endogenous liver tissue is extensively reconstituted with engrafted human hepatocytes, and successfully achieved stable transduction by the second-stage lentivirus produced in situ from first-stage adenovirus. This represents the first demonstration of the functionality of adenoviral-lentiviral hybrid vectors in a normal parenchymal organ in vivo. PMID:19725756

  10. Ultrashort polarization-tailored bichromatic fields from a CEP-stable white light supercontinuum.

    PubMed

    Kerbstadt, Stefanie; Timmer, Daniel; Englert, Lars; Bayer, Tim; Wollenhaupt, Matthias

    2017-05-29

    We apply ultrafast polarization shaping to an ultrabroadband carrier envelope phase (CEP) stable white light supercontinuum to generate polarization-tailored bichromatic laser fields of low-order frequency ratio. The generation of orthogonal linearly and counter-rotating circularly polarized bichromatic fields is achieved by introducing a composite polarizer in the Fourier plane of a 4 f polarization shaper. The resulting Lissajous- and propeller-type polarization profiles are characterized experimentally by cross-correlation trajectories. The scheme provides full control over all bichromatic parameters and allows for individual spectral phase modulation of both colors. Shaper-based CEP control and the generation of tailored bichromatic fields is demonstrated. These bichromatic CEP-stable polarization-shaped ultrashort laser pulses provide a versatile class of waveforms for coherent control experiments.

  11. The Effectiveness of Trimetazidine Treatment in Patients with Stable Angina Pectoris of Various Durations: Results from the CHOICE-2 Study.

    PubMed

    Glezer, Maria

    2018-05-15

    Trimetazidine (TMZ) has been shown to reduce angina symptoms and to increase exercise capacity in randomized clinical trials, but more extensive data would be useful to assess its effects in real-world clinical practice and in patients with different durations of disease. CHOICE-2 was a Russian, multicenter, 6-month, open-label, prospective observational study that assessed the effect of adding TMZ modified release 35 mg bid to antianginal treatment in a real-world setting. The present analysis of CHOICE-2 results explored the effects of adding TMZ to background antianginal therapies with regard to the duration of stable angina. A total of 741 patients with known durations of disease were divided into four groups according to stable angina pectoris (AP) duration, ranging from less than 1 year to more than 9 years. Addition of TMZ led to a significant decrease in the frequency of angina attacks and in the use of short-acting nitrates in all groups. In patients with recently diagnosed angina (AP duration < 1 year), the average number of angina attacks per week decreased significantly from 3.75 ± 4.63 to 0.67 ± 1.51 and in those with advanced disease (AP duration > 9 years) from 5.63 ± 5.24 to 1.32 ± 2.07. Angina-free walking distance also improved significantly. Addition of TMZ also improved patient well-being. Results were achieved rapidly (within 2 weeks), were maintained over 6 months, and were obtained in all patient groups regardless of angina duration. TMZ added to other antianginal therapies proved to be effective for reducing angina attacks and short-acting nitrate use, increasing angina-free walking distance, and improving patient well-being in a real-life setting, irrespective of angina duration, including patients with recently diagnosed angina. This provides an opportunity for intensification of treatment early on in the disease process, with the aim of decreasing angina burden and improving patient quality of life. Servier. ISRCTN

  12. Changes in multifractal properties for stable angina pectoris

    NASA Astrophysics Data System (ADS)

    Knežević, Andrea; Martinis, Mladen; Krstačić, Goran; Vargović, Emil

    2005-12-01

    The multifractal approach has been applied to temporal fluctuations of heartbeat (RR) intervals, measured in various regimes of physical activity (ergometric data), taken from healthy subjects and those having stable angina pectoris (SAP). The problem we address here is whether SAP changes multifractality observed in healthy subjects. The G-moment method is used to analyse the multifractal spectrum. It is observed that both sets of data characterize multifractality, but a different trend in multifractal behaviour is found for SAP disease, under pronounced physical activity.

  13. Unexpected inverse relationship between impaired glucose metabolism and lipoprotein-associated phospholipase A2 activity in patients with stable vascular disease.

    PubMed

    Mayer, Otto; Seidlerová, Jitka; Filipovský, Jan; Timoracká, Katarina; Bruthans, Jan; Vaněk, Jiří; Cerná, Lenka; Wohlfahrt, Peter; Renata, Cífková; Trefil, Ladislav

    2014-07-01

    Elevated lipoprotein-associated phospholipase A2 activity (aLp-PLA2) is associated with increased risk of cardiovascular events. In patients with stable atherovascular disease, we aimed to investigate whether impaired glucose metabolism might be associated with higher risk of elevated aLp-PLA2. We conducted a cross-sectional study in 825 stable patients after acute coronary syndrome, coronary revascularization or after first ischemic stroke (Czech part of EUROASPIRE III surveys). We measured aLp-PLA2 using diaDexus commercial kit. In multiple step-wise regression analysis, the aLp-PLA2 was significantly positively associated with male gender, current smoking, LDL cholesterol and metabolic syndrome and negatively with statin treatment, body mass index and LDL/apoB ratio. After adjustment for these confounders, we observed an inverse relationship between aLp-PLA2 and fasting glycemia [β coefficient -2.18 (p<0.0001)] or glycated hemoglobin A1c (HbA1c) [β coefficient -5.89 (p<0.0001)]. Moreover, we found a positive association between aLp-PLA2 and pancreatic β cell function [β coefficient +0.10 (p<0.0001)], but not with an insulin sensitivity. In present study, we cannot confirm any additive risk of impaired glucose metabolism in terms of increased activity of Lp-PLA2. On the contrary, presence of inadequately controlled diabetes mellitus was independently associated with lower risk of elevated aLp-PLA2 . Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  14. Nocturnal oxygen saturation in children with stable cystic fibrosis.

    PubMed

    van der Giessen, Lianne; Bakker, Marije; Joosten, Koen; Hop, Wim; Tiddens, Harm

    2012-11-01

    Hypoxemia during sleep is a common finding in Cystic Fibrosis (CF) patients with more advanced lung disease. Nocturnal hypoxemia is associated with frequent awakenings and poor sleep quality. For children with CF, data of nocturnal oxygen saturation are sparse. To assess the oxygen saturation profile during sleep in 25 clinically stable children with CF lung disease and to correlate these data with spirometry, cough frequency, sleep quality, and CT-scan scores. During two nights cough was recorded with a digital audio recorder in 25 clinically stable CF patients. In addition oxygen saturation was measured. The day following the recording spirometry was carried out. CT scores were obtained from the most recent routine CT scan. Twenty-two patients were included in the study. Mean age (range) was 13 (6-18) years. Spirometry was FVC% 84 (range 52-114), FEV(1) % 77 (range 43-115), and FEF(75) % 50 (range 12-112). The mean SO(2) was 95.6% for the first and 96.2% for the second night. Mean SO(2) between the two nights correlated strongly (r(s) = 0.84, P < 0.001). Positive correlation was observed between mean SO(2) of the two nights (mean × SO(2)) and FVC, FEV(1) and FEF(75). Correlations were found between mean × SO(2) and the total CT score (r(s) = -0.45, P = 0.05) and the bronchiectasis subscore (r(s) = -0.48, P = 0.03). Nocturnal oxygen saturation in children with stable CF is lower than that in healthy children, and is correlated with lung function parameters and CT scores. Monitoring oxygen saturation during one night is sufficient to get a representative recording. Copyright © 2012 Wiley Periodicals, Inc.

  15. Perceptually stable regions for arbitrary polygons.

    PubMed

    Rocha, J

    2003-01-01

    Zou and Yan have recently developed a skeletonization algorithm of digital shapes based on a regularity/singularity analysis; they use the polygon whose vertices are the boundary pixels of the image to compute a constrained Delaunay triangulation (CDT) in order to find local symmetries and stable regions. Their method has produced good results but it is slow since its complexity depends on the number of contour pixels. This paper presents an extension of their technique to handle arbitrary polygons, not only polygons of short edges. Consequently, not only can we achieve results as good as theirs for digital images, but we can also compute skeletons of polygons of any number of edges. Since we can handle polygonal approximations of figures, the skeletons are more resilient to noise and faster to process.

  16. Long-term effects of cardiac rehabilitation in elderly individuals with stable coronary artery disease.

    PubMed

    Mandic, Sandra; Stevens, Emily; Hodge, Claire; Brown, Casey; Walker, Robert; Body, Dianne; Barclay, Leanne; Nye, Edwin R; Williams, Michael J A

    2016-01-01

    To compare exercise capacity and cardiovascular response to exercise in elderly individuals with coronary artery disease (CAD) who attend ongoing community-based maintenance cardiac rehabilitation (CR) versus age- and gender-matched healthy "very active" (HVA; ≥ 2000 kcal/week) and healthy "less active" (HLA; <2000 kcal/week) individuals. Sixty-three participants (age: 72.3 ± 5.1 years; 62% men; n = 21 per group) completed the following assessments: (1) symptom-limited graded exercise test with expired gas analysis and bioimpedance assessment of cardiovascular function during exercise; (2) walking tests; (3) physical function; (4) anthropometry and (5) 12-month physical activity recall. The CR group achieved 98% (range: 73-154%) of age- and gender-predicted peak oxygen consumption for healthy individuals. Peak oxygen consumption was lower in CR compared to HVA but not HLA group (VO2peak: CR: 19.0 ± 4.5, HVA: 23.7 ± 2.9, HLA: 20.7 ± 4.7 ml ·kg(-1)ċmin(-1), p = 0.001 versus HVA; p = 0.390 versus HLA). Peak heart rate was lower in CR compared to both HVA and HLA. Walking test results and cardiovascular and physical function were not different between the groups. Elderly individuals with CAD participating in maintenance CR have similar exercise capacity and cardiorespiratory response to exercise compared to their age- and gender-matched less active healthy peers. The findings support referral of elderly patients to community-based CR. Fitness benefits of long-term maintenance cardiac rehabilitation (CR) programs remain unknown. Elderly individuals with coronary artery disease participating in maintenance CR have exercise capacity and cardiorespiratory response to exercise similar to their less active healthy peers. Maintenance CR may play an important role prolonging independent living in elderly individuals.

  17. Multi-region analysis of longitudinal FDG-PET for the classification of Alzheimer’s disease

    PubMed Central

    Gray, Katherine R.; Wolz, Robin; Heckemann, Rolf A.; Aljabar, Paul; Hammers, Alexander; Rueckert, Daniel

    2012-01-01

    Imaging biomarkers for Alzheimer’s disease are desirable for improved diagnosis and monitoring, as well as drug discovery. Automated image-based classification of individual patients could provide valuable diagnostic support for clinicians, when considered alongside cognitive assessment scores. We investigate the value of combining cross-sectional and longitudinal multi-region FDG-PET information for classification, using clinical and imaging data from the Alzheimer’s Disease Neuroimaging Initiative. Whole-brain segmentations into 83 anatomically defined regions were automatically generated for baseline and 12-month FDG-PET images. Regional signal intensities were extracted at each timepoint, as well as changes in signal intensity over the follow-up period. Features were provided to a support vector machine classifier. By combining 12-month signal intensities and changes over 12 months, we achieve significantly increased classification performance compared with using any of the three feature sets independently. Based on this combined feature set, we report classification accuracies of 88% between patients with Alzheimer’s disease and elderly healthy controls, and 65% between patients with stable mild cognitive impairment and those who subsequently progressed to Alzheimer’s disease. We demonstrate that information extracted from serial FDG-PET through regional analysis can be used to achieve state-of-the-art classification of diagnostic groups in a realistic multi-centre setting. This finding may be usefully applied in the diagnosis of Alzheimer’s disease, predicting disease course in individuals with mild cognitive impairment, and in the selection of participants for clinical trials. PMID:22236449

  18. Nutritional Approaches to Achieve Weight Loss in Nonalcoholic Fatty Liver Disease123

    PubMed Central

    Hsu, Christine C; Ness, Erik; Kowdley, Kris V

    2017-01-01

    Nonalcoholic fatty liver disease (NAFLD) can range in spectrum from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH), which is characterized by lipotoxicity, hepatocellular ballooning, and inflammation and can progress to cirrhosis. Weight loss is the cornerstone treatment for NAFLD and NASH. Various randomized controlled trials have shown that weight loss of ≥5–10% leads to significant improvements in hepatic steatosis. Diets high in sodium and fructose have been implicated in the pathogenesis of NAFLD. Although some clinical studies suggest that an isocaloric high-fructose diet does not worsen NAFLD, these clinical studies are often short in duration. More recently, the Dietary Approaches to Stop Hypertension diet, a sodium-restricted diet, has been associated with less prevalence of NAFLD and has been shown to improve NAFLD. In addition, the Mediterranean diet has been promising in improving hepatic steatosis, and a larger randomized controlled trial is currently enrolling subjects. For those who are unable to pursue weight loss through dietary approaches, bariatric surgery has been shown to improve hepatic steatosis and steatohepatitis. This method has been variable in improving hepatic fibrosis. In conclusion, weight loss is crucial to the improvement of NAFLD and NASH, and patients should attempt various diets in an attempt to achieve weight loss. PMID:28298270

  19. Foraging and farming as niche construction: stable and unstable adaptations

    PubMed Central

    Rowley-Conwy, Peter; Layton, Robert

    2011-01-01

    All forager (or hunter–gatherer) societies construct niches, many of them actively by the concentration of wild plants into useful stands, small-scale cultivation, burning of natural vegetation to encourage useful species, and various forms of hunting, collectively termed ‘low-level food production’. Many such niches are stable and can continue indefinitely, because forager populations are usually stable. Some are unstable, but these usually transform into other foraging niches, not geographically expansive farming niches. The Epipalaeolithic (final hunter–gatherer) niche in the Near East was complex but stable, with a relatively high population density, until destabilized by an abrupt climatic change. The niche was unintentionally transformed into an agricultural one, due to chance genetic and behavioural attributes of some wild plant and animal species. The agricultural niche could be exported with modifications over much of the Old World. This was driven by massive population increase and had huge impacts on local people, animals and plants wherever the farming niche was carried. Farming niches in some areas may temporarily come close to stability, but the history of the last 11 000 years does not suggest that agriculture is an effective strategy for achieving demographic and political stability in the world's farming populations. PMID:21320899

  20. Tree-ring stable isotopes record the impact of a foliar fungal pathogen on CO(2) assimilation and growth in Douglas-fir.

    PubMed

    Saffell, Brandy J; Meinzer, Frederick C; Voelker, Steven L; Shaw, David C; Brooks, J Renée; Lachenbruch, Barbara; McKay, Jennifer

    2014-07-01

    Swiss needle cast (SNC) is a fungal disease of Douglas-fir (Pseudotsuga menziesii) that has recently become prevalent in coastal areas of the Pacific Northwest. We used growth measurements and stable isotopes of carbon and oxygen in tree-rings of Douglas-fir and a non-susceptible reference species (western hemlock, Tsuga heterophylla) to evaluate their use as proxies for variation in past SNC infection, particularly in relation to potential explanatory climate factors. We sampled trees from an Oregon site where a fungicide trial took place from 1996 to 2000, which enabled the comparison of stable isotope values between trees with and without disease. Carbon stable isotope discrimination (Δ(13)C) of treated Douglas-fir tree-rings was greater than that of untreated Douglas-fir tree-rings during the fungicide treatment period. Both annual growth and tree-ring Δ(13)C increased with treatment such that treated Douglas-fir had values similar to co-occurring western hemlock during the treatment period. There was no difference in the tree-ring oxygen stable isotope ratio between treated and untreated Douglas-fir. Tree-ring Δ(13)C of diseased Douglas-fir was negatively correlated with relative humidity during the two previous summers, consistent with increased leaf colonization by SNC under high humidity conditions that leads to greater disease severity in following years. © 2013 John Wiley & Sons Ltd.

  1. Validation of ICD-9 Codes for Stable Miscarriage in the Emergency Department.

    PubMed

    Quinley, Kelly E; Falck, Ailsa; Kallan, Michael J; Datner, Elizabeth M; Carr, Brendan G; Schreiber, Courtney A

    2015-07-01

    International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes have not been validated for identifying cases of missed abortion where a pregnancy is no longer viable but the cervical os remains closed. Our goal was to assess whether ICD-9 code "632" for missed abortion has high sensitivity and positive predictive value (PPV) in identifying patients in the emergency department (ED) with cases of stable early pregnancy failure (EPF). We studied females ages 13-50 years presenting to the ED of an urban academic medical center. We approached our analysis from two perspectives, evaluating both the sensitivity and PPV of ICD-9 code "632" in identifying patients with stable EPF. All patients with chief complaints "pregnant and bleeding" or "pregnant and cramping" over a 12-month period were identified. We randomly reviewed two months of patient visits and calculated the sensitivity of ICD-9 code "632" for true cases of stable miscarriage. To establish the PPV of ICD-9 code "632" for capturing missed abortions, we identified patients whose visits from the same time period were assigned ICD-9 code "632," and identified those with actual cases of stable EPF. We reviewed 310 patient records (17.6% of 1,762 sampled). Thirteen of 31 patient records assigned ICD-9 code for missed abortion correctly identified cases of stable EPF (sensitivity=41.9%), and 140 of the 142 patients without EPF were not assigned the ICD-9 code "632"(specificity=98.6%). Of the 52 eligible patients identified by ICD-9 code "632," 39 cases met the criteria for stable EPF (PPV=75.0%). ICD-9 code "632" has low sensitivity for identifying stable EPF, but its high specificity and moderately high PPV are valuable for studying cases of stable EPF in epidemiologic studies using administrative data.

  2. Stable scalable control of soliton propagation in broadband nonlinear optical waveguides

    NASA Astrophysics Data System (ADS)

    Peleg, Avner; Nguyen, Quan M.; Huynh, Toan T.

    2017-02-01

    We develop a method for achieving scalable transmission stabilization and switching of N colliding soliton sequences in optical waveguides with broadband delayed Raman response and narrowband nonlinear gain-loss. We show that dynamics of soliton amplitudes in N-sequence transmission is described by a generalized N-dimensional predator-prey model. Stability and bifurcation analysis for the predator-prey model are used to obtain simple conditions on the physical parameters for robust transmission stabilization as well as on-off and off-on switching of M out of N soliton sequences. Numerical simulations for single-waveguide transmission with a system of N coupled nonlinear Schrödinger equations with 2 ≤ N ≤ 4 show excellent agreement with the predator-prey model's predictions and stable propagation over significantly larger distances compared with other broadband nonlinear single-waveguide systems. Moreover, stable on-off and off-on switching of multiple soliton sequences and stable multiple transmission switching events are demonstrated by the simulations. We discuss the reasons for the robustness and scalability of transmission stabilization and switching in waveguides with broadband delayed Raman response and narrowband nonlinear gain-loss, and explain their advantages compared with other broadband nonlinear waveguides.

  3. Wall-crossing between stable and co-stable ADHM data

    NASA Astrophysics Data System (ADS)

    Ohkawa, Ryo

    2018-06-01

    We prove formula between Nekrasov partition functions defined from stable and co-stable ADHM data for the plane following method by Nakajima and Yoshioka (Kyoto J Math 51(2):263-335, 2011) based on the theory of wall-crossing formula developed by Mochizuki (Donaldson type invariants for algebraic surfaces: transition of moduli stacks, Lecture notes in mathematics, vol 1972, Springer, Berlin, 2009). This formula is similar to conjectures by Ito et al. [J High Energy Phys 2013(5):045, 2013, (4.1), (4.2)] for A1 singularity.

  4. Biosensors for Non-Invasive Detection of Celiac Disease Biomarkers in Body Fluids.

    PubMed

    Pasinszki, Tibor; Krebsz, Melinda

    2018-06-16

    Celiac disease is a chronic gluten-initiated autoimmune disorder that predominantly damages the mucosa of the small intestine in genetically-susceptible individuals. It affects a large and increasing number of the world’s population. The diagnosis of this disease and monitoring the response of patients to the therapy, which is currently a life-long gluten-free diet, require the application of reliable, rapid, sensitive, selective, simple, and cost-effective analytical tools. Celiac disease biomarker detection in full blood, serum, or plasma offers a non-invasive way to do this and is well-suited to being the first step of diagnosis. Biosensors provide a novel and alternative way to perform conventional techniques in biomarker sensing, in which electrode material and architecture play important roles in achieving sensitive, selective, and stable detection. There are many opportunities to build and modify biosensor platforms using various materials and detection methods, and the aim of the present review is to summarize developments in this field.

  5. Development of a New Generation of Stable, Tunable, and Catalytically Active Nanoparticles Produced by the Helium Nanodroplet Deposition Method

    DOE PAGES

    Wu, Qiyuan; Ridge, Claron J.; Zhao, Shen; ...

    2016-07-13

    Nanoparticles (NPs) are revolutionizing many areas of science and technology, often delivering unprecedented improvements to properties of the conventional materials. However, despite important advances in NPs synthesis and applications, numerous challenges still remain. Development of alternative synthetic method capable of producing very uniform, extremely clean and very stable NPs is urgently needed. If successful, such method can potentially transform several areas of nanoscience, including environmental and energy related catalysis. Here we present the first experimental demonstration of catalytically active NPs synthesis achieved by the helium nanodroplet isolation method. This alternative method of NPs fabrication and deposition produces narrowly distributed, clean,more » and remarkably stable NPs. The fabrication is achieved inside ultra-low temperature, superfluid helium nanodroplets, which can be subsequently deposited onto any substrate. Lastly, this technique is universal enough to be applied to nearly any element, while achieving high deposition rates for single element as well as composite core-shell NPs.« less

  6. Epicardial fat thickness in stable coronary artery disease: its relationship with high-sensitive cardiac troponin T and N-terminal pro-brain natriuretic peptide.

    PubMed

    Börekçi, Abdurrezzak; Gür, Mustafa; Özaltun, Betül; Baykan, Ahmet Oytun; Harbalioğlu, Hazar; Seker, Taner; Sen, Ömer; Acele, Armağan; Gözükara, Mehmet Yavuz; Kuloğlu, Osman; Koç, Mevlüt; Çayli, Murat

    2014-12-01

    Epicardial adipose tissue is related to coronary atherosclerosis, left ventricle hypertrophy, myocardial dysfunction, cardiomyopathy, and inflammation, which produces a variety of cytokines that influence key pathogenic mechanisms of atherogenesis. The main goal of this study is to examine the relationship between epicardial fat thickness (EFT) and cardiovascular risk markers as well as the complexity of coronary artery disease (CAD) in patients with stable CAD. We prospectively included 439 stable CAD patients undergoing coronary angiography in the present study (mean age: 62.2±10.7 years). Patients were divided into two groups (EFTlow and EFThigh groups) according to their median EFT values. EFT was evaluated by two-dimensional echocardiography before angiography. The SYNTAX score was calculated in all patients. N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), high-sensitive cardiac troponin T (hs-cTnT), uric acid, and other biochemical markers were also measured. Age, SYNTAX score, frequencies of diabetes, hyperlipidemia, and hypertension, NT-proBNP, hs-CRP, hs-cTnT, and uric acid levels were higher in EFThigh group compared with the EFTlow group (P<0.05 for all). EFT was associated independently with age (β=-0.102, P=0.001), diabetes (β=-0.083, P=0.011), SYNTAX score (β=0.352, P<0.001), hs-CRP level (β=0.217, P<0.001), hs-cTnT level (β=0.197, P<0.001), and NT-proBNP level (β=0.300, P<0.001) in multivariate analysis. EFT obtained by echocardiograpy may not only be an easy tool but also an important tool for early detection of increased cardiac risk as well as the extent and complexity of CAD in patients with stable CAD.

  7. Simple test of intestinal calcium absorption measured by stable strontium.

    PubMed Central

    Milsom, S; Ibbertson, K; Hannan, S; Shaw, D; Pybus, J

    1987-01-01

    A clinical test of intestinal calcium absorption has been developed using non-radioactive stable strontium as a calcium tracer. In nine elderly subjects there was a close correlation between the fractional absorption of strontium and radioactive calcium (45Ca) during a five hour period after the simultaneous oral administration of the two tracers. Comparable precision was achieved with each tracer in six subjects in whom the test was repeated after two weeks. The effect of food on strontium absorption was examined in a further 33 normal subjects (age 21-60 years), and the administration of the strontium with a standard breakfast was shown to reduce the variance at individual time points. A simplified test in which serum strontium concentration was measured four hours after the oral dose given with a standard breakfast was adopted as the routine procedure. The normal range (mean (2 SD], established over 97 tests in 53 patients, was 7.0-18.0% of the dose in the extracellular fluid. A further 30 patients with possible disorders of calcium absorption (10 with primary hyperparathyroidism and 20 with coeliac disease) were studied by this standard test. In both groups of patients the mean four hour strontium values were significantly different from normal. This standard strontium absorption test allows assessment of calcium absorption with sufficient sensitivity and precision to have a wide application in clinical practice. PMID:3115389

  8. Low-cost electrodes for stable perovskite solar cells

    NASA Astrophysics Data System (ADS)

    Bastos, João P.; Manghooli, Sara; Jaysankar, Manoj; Tait, Jeffrey G.; Qiu, Weiming; Gehlhaar, Robert; De Volder, Michael; Uytterhoeven, Griet; Poortmans, Jef; Paetzold, Ulrich W.

    2017-06-01

    Cost-effective production of perovskite solar cells on an industrial scale requires the utilization of exclusively inexpensive materials. However, to date, highly efficient and stable perovskite solar cells rely on expensive gold electrodes since other metal electrodes are known to cause degradation of the devices. Finding a low-cost electrode that can replace gold and ensure both efficiency and long-term stability is essential for the success of the perovskite-based solar cell technology. In this work, we systematically compare three types of electrode materials: multi-walled carbon nanotubes (MWCNTs), alternative metals (silver, aluminum, and copper), and transparent oxides [indium tin oxide (ITO)] in terms of efficiency, stability, and cost. We show that multi-walled carbon nanotubes are the only electrode that is both more cost-effective and stable than gold. Devices with multi-walled carbon nanotube electrodes present remarkable shelf-life stability, with no decrease in the efficiency even after 180 h of storage in 77% relative humidity (RH). Furthermore, we demonstrate the potential of devices with multi-walled carbon nanotube electrodes to achieve high efficiencies. These developments are an important step forward to mass produce perovskite photovoltaics in a commercially viable way.

  9. Creation of stable molecular junctions with a custom-designed scanning tunneling microscope.

    PubMed

    Lee, Woochul; Reddy, Pramod

    2011-12-02

    The scanning tunneling microscope break junction (STMBJ) technique is a powerful approach for creating single-molecule junctions and studying electrical transport in them. However, junctions created using the STMBJ technique are usually mechanically stable for relatively short times (<1 s), impeding detailed studies of their charge transport characteristics. Here, we report a custom-designed scanning tunneling microscope that enables the creation of metal-single molecule-metal junctions that are mechanically stable for more than 1 minute at room temperature. This stability is achieved by a design that minimizes thermal drift as well as the effect of environmental perturbations. The utility of this instrument is demonstrated by performing transition voltage spectroscopy-at the single-molecule level-on Au-hexanedithiol-Au, Au-octanedithiol-Au and Au-decanedithiol-Au junctions.

  10. Bridging disulfides for stable and defined antibody drug conjugates.

    PubMed

    Badescu, George; Bryant, Penny; Bird, Matthew; Henseleit, Korinna; Swierkosz, Julia; Parekh, Vimal; Tommasi, Rita; Pawlisz, Estera; Jurlewicz, Kosma; Farys, Monika; Camper, Nicolas; Sheng, XiaoBo; Fisher, Martin; Grygorash, Ruslan; Kyle, Andrew; Abhilash, Amrita; Frigerio, Mark; Edwards, Jeff; Godwin, Antony

    2014-06-18

    To improve both the homogeneity and the stability of ADCs, we have developed site-specific drug-conjugating reagents that covalently rebridge reduced disulfide bonds. The new reagents comprise a drug, a linker, and a bis-reactive conjugating moiety that is capable of undergoing reaction with both sulfur atoms derived from a reduced disulfide bond in antibodies and antibody fragments. A disulfide rebridging reagent comprising monomethyl auristatin E (MMAE) was prepared and conjugated to trastuzumab (TRA). A 78% conversion of antibody to ADC with a drug to antibody ratio (DAR) of 4 was achieved with no unconjugated antibody remaining. The MMAE rebridging reagent was also conjugated to the interchain disulfide of a Fab derived from proteolytic digestion of TRA, to give a homogeneous single drug conjugated product. The resulting conjugates retained antigen-binding, were stable in serum, and demonstrated potent and antigen-selective cell killing in in vitro and in vivo cancer models. Disulfide rebridging conjugation is a general approach to prepare stable ADCs, which does not require the antibody to be recombinantly re-engineered for site-specific conjugation.

  11. Mechanisms of stable lipid loss in a social insect

    PubMed Central

    Ament, Seth A.; Chan, Queenie W.; Wheeler, Marsha M.; Nixon, Scott E.; Johnson, S. Peir; Rodriguez-Zas, Sandra L.; Foster, Leonard J.; Robinson, Gene E.

    2011-01-01

    SUMMARY Worker honey bees undergo a socially regulated, highly stable lipid loss as part of their behavioral maturation. We used large-scale transcriptomic and proteomic experiments, physiological experiments and RNA interference to explore the mechanistic basis for this lipid loss. Lipid loss was associated with thousands of gene expression changes in abdominal fat bodies. Many of these genes were also regulated in young bees by nutrition during an initial period of lipid gain. Surprisingly, in older bees, which is when maximum lipid loss occurs, diet played less of a role in regulating fat body gene expression for components of evolutionarily conserved nutrition-related endocrine systems involving insulin and juvenile hormone signaling. By contrast, fat body gene expression in older bees was regulated more strongly by evolutionarily novel regulatory factors, queen mandibular pheromone (a honey bee-specific social signal) and vitellogenin (a conserved yolk protein that has evolved novel, maturation-related functions in the bee), independent of nutrition. These results demonstrate that conserved molecular pathways can be manipulated to achieve stable lipid loss through evolutionarily novel regulatory processes. PMID:22031746

  12. Mechanisms of stable lipid loss in a social insect.

    PubMed

    Ament, Seth A; Chan, Queenie W; Wheeler, Marsha M; Nixon, Scott E; Johnson, S Peir; Rodriguez-Zas, Sandra L; Foster, Leonard J; Robinson, Gene E

    2011-11-15

    Worker honey bees undergo a socially regulated, highly stable lipid loss as part of their behavioral maturation. We used large-scale transcriptomic and proteomic experiments, physiological experiments and RNA interference to explore the mechanistic basis for this lipid loss. Lipid loss was associated with thousands of gene expression changes in abdominal fat bodies. Many of these genes were also regulated in young bees by nutrition during an initial period of lipid gain. Surprisingly, in older bees, which is when maximum lipid loss occurs, diet played less of a role in regulating fat body gene expression for components of evolutionarily conserved nutrition-related endocrine systems involving insulin and juvenile hormone signaling. By contrast, fat body gene expression in older bees was regulated more strongly by evolutionarily novel regulatory factors, queen mandibular pheromone (a honey bee-specific social signal) and vitellogenin (a conserved yolk protein that has evolved novel, maturation-related functions in the bee), independent of nutrition. These results demonstrate that conserved molecular pathways can be manipulated to achieve stable lipid loss through evolutionarily novel regulatory processes.

  13. Unencapsulated Air-stable Organic Field Effect Transistor by All Solution Processes for Low Power Vapor Sensing

    NASA Astrophysics Data System (ADS)

    Feng, Linrun; Tang, Wei; Zhao, Jiaqing; Yang, Ruozhang; Hu, Wei; Li, Qiaofeng; Wang, Ruolin; Guo, Xiaojun

    2016-02-01

    With its excellent mechanical flexibility, low-cost and low-temperature processing, the solution processed organic field-effect transistor (OFET) is a promising platform technology for developing ubiquitous sensor applications in digital health, environment monitoring and Internet of Things. However, a contradiction between achieving low voltage operation and having stable performance severely hinder the technology to become commercially viable. This work shows that, by reducing the sub-gap density of states (DOS) at the channel for low operation voltage and using a proper low-k non-polar polymer dielectric layer, such an issue can be addressed. Stable electrical properties after either being placed for weeks or continuously prolonged bias stressing for hours in ambient air are achieved for all solution processed unencapsulated OFETs with the channel being exposed to the ambient air for analyte detection. The fabricated device presents a steep subthreshold swing less than 100 mV/decade, and an ON/OFF ratio of 106 at a voltage swing of 3 V. The low voltage and stable operation allows the sensor made of the OFET to be incorporated into a battery-powered electronic system for continuously reliable sensing of ammonia vapor in ambient air with very small power consumption of about 50 nW.

  14. Unencapsulated Air-stable Organic Field Effect Transistor by All Solution Processes for Low Power Vapor Sensing

    PubMed Central

    Feng, Linrun; Tang, Wei; Zhao, Jiaqing; Yang, Ruozhang; Hu, Wei; Li, Qiaofeng; Wang, Ruolin; Guo, Xiaojun

    2016-01-01

    With its excellent mechanical flexibility, low-cost and low-temperature processing, the solution processed organic field-effect transistor (OFET) is a promising platform technology for developing ubiquitous sensor applications in digital health, environment monitoring and Internet of Things. However, a contradiction between achieving low voltage operation and having stable performance severely hinder the technology to become commercially viable. This work shows that, by reducing the sub-gap density of states (DOS) at the channel for low operation voltage and using a proper low-k non-polar polymer dielectric layer, such an issue can be addressed. Stable electrical properties after either being placed for weeks or continuously prolonged bias stressing for hours in ambient air are achieved for all solution processed unencapsulated OFETs with the channel being exposed to the ambient air for analyte detection. The fabricated device presents a steep subthreshold swing less than 100 mV/decade, and an ON/OFF ratio of 106 at a voltage swing of 3 V. The low voltage and stable operation allows the sensor made of the OFET to be incorporated into a battery-powered electronic system for continuously reliable sensing of ammonia vapor in ambient air with very small power consumption of about 50 nW. PMID:26861412

  15. Angiotensin II receptor blockers versus angiotensin-converting enzyme inhibitors in patients with stable coronary artery disease: Prevalence, correlates, and prognostic impact (from the CORONOR study).

    PubMed

    Lemesle, Gilles; Lamblin, Nicolas; Meurice, Thibaud; Tricot, Olivier; Bauters, Christophe

    2017-03-01

    In international guidelines for patients with stable coronary artery disease (CAD), angiotensin-converting enzyme inhibitors (ACE-I) are recommended while angiotensin II receptor blockers (ARB) are proposed as an alternative in case of intolerance. There are no real-life data on the frequency and correlates of ARB use in this setting. We studied 3363 outpatients included in a prospective registry on stable CAD (the CORONOR study) and receiving an ARB or an ACE-I at inclusion. Altogether, 944 patients received an ARB (28.1%). Factors positively and independently associated with ARB use versus ACE-I use were a history of hypertension, the absence of prior myocardial infarction, age, female gender, estimated glomerular filtration rate <60ml/min/m 2 , and left ventricular ejection fraction ≥40%. In the whole study population, the hazard ratio (HR) for the combined endpoint (cardiovascular death, myocardial infarction, stroke) of patients with ARB use was 0.95 (0.69-1.31) (p=0.765) (patients with ACE-I use as reference). Similar results were observed when the analysis was restricted to a propensity-matched cohort: HR=0.91 (0.62-1.34) (p=0.632). Our study shows that a significant proportion of stable CAD patients are treated with ARB rather than with ACE-I in modern practice. Several correlates of ARB prescription were identified. Our results suggest that patients receiving ARB have similar outcome than patients receiving ACE-I. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  16. Altered Gray Matter Volume in Stable Chronic Obstructive Pulmonary Disease with Subclinical Cognitive Impairment: an Exploratory Study.

    PubMed

    Wang, Chunrong; Ding, Yanhui; Shen, Bixian; Gao, Dehong; An, Jie; Peng, Kewen; Hou, Gangqiang; Zou, Liqiu; Jiang, Mei; Qiu, Shijun

    2017-05-01

    Gray matter volume deficits have been identified in cognitively impaired patients with chronic obstructive pulmonary disease (COPD). However, it remains unknown whether the gray matter volume is altered in COPD patients with subclinical cognitive impairment. To determine whether any gray matter abnormalities are present in these patients, neuropsychological tests and structural MRI data were analyzed from 60 patients with COPD and 60 age-, gender-, education-, and handedness-matched normal controls (NCs). The COPD patients had similar Mini-Mental State Examination (MMSE) scores compared with the NCs. However, they had reduced Montreal Cognitive Assessment (MoCA) scores for visuospatial and executive and naming and memory functions (P < 0.001). Voxel-based morphometry (VBM) analysis revealed that the COPD patients had significantly lowered gray matter volumes in several brain regions, including the left precuneus (PrCU), bilateral calcarine (CAL), right superior temporal gyrus/middle temporal gyrus (STG/MTG), bilateral fusiform gyrus (FG), and right inferior parietal lobule (IPL) (P < 0.01, corrected). Importantly, the forced vital capacity (FVC) was found to be associated with the gray matter volume in the calcarine. The present study confirmed that brain structural changes were present in stable COPD patients with subclinical cognitive impairment. These findings may provide new insights into the pathogenesis of COPD.

  17. Development of a stable cation modified graphene oxide membrane for water treatment

    NASA Astrophysics Data System (ADS)

    Yu, Wenzheng; (Yet Yu, Tong; Graham, Nigel

    2017-12-01

    Membranes prepared from layers of graphene oxide (GO) offer substantial advantages over conventional materials for water treatment (e.g. greater flux), but the stability of GO membranes in water has not been achieved until now. In this study the behavior of GO membranes prepared with different quantities and species of cations has been investigated to establish the feasibility of their application in water treatment. A range of cation-modified GO membranes were prepared and exposed to aqueous solutions containing specific chemical constituents. In pure water, unmodified and Na-modified GO membranes were highly unstable, while GO membranes modified with multivalent cations were stable provided there were sufficient quantities of cations present; their relative capability to achieve GO stability was as follows: Al3+  >  Ca2+  >  Mg2+  >  Na+. It is believed that the mechanism of cross-linking, and membrane stability, is via metal-carboxylate chelates and cation-graphite surface interactions (cation-π interaction), and that the latter appears to increase with increasing cation valency. The instability of cation (Ca or Al)-modified GO membranes by NaCl solutions during permeation occurred as Na+ exchanged with the incorporated multivalent cations, but a high content of Al3+ in the GO membrane impeded Al3+/Na+ exchange and thus retained membrane stability. In solutions containing biopolymers representative of surface waters or seawater (protein and polysaccharide solutions), Ca-GO membranes (even with high Ca2+ content) were not stable, while Al-GO membranes were stable if the Al3+ content was sufficiently high; Al-formed membranes also had a greater flux than Ca-GO membranes.

  18. Stable Size Distribution of Amyloid Plaques Over the Course of Alzheimer Disease

    PubMed Central

    Serrano-Pozo, Alberto; Mielke, Matthew L.; Muzitansky, Alona; Gómez-Isla, Teresa; Growdon, John H.; Bacskai, Brian J.; Betensky, Rebecca A.; Frosch, Matthew P.; Hyman, Bradley T.

    2012-01-01

    Amyloid-β plaques are a key pathological feature of Alzheimer disease (AD), but whether plaque sizes increase or stabilize over the course of AD is unknown. We measured the size distribution of total immunoreactive (10D5-positive) and dense-core (Thioflavine-S-positive) plaques in the temporal neocortex of a large group of AD and plaque-bearing age-matched non-demented subjects to test the hypothesis that amyloid plaques continue to grow along with the progression of the disease. The size of amyloid-β (10D5)-positive plaques did not differ between groups whereas dense-core plaques from the AD group were slightly larger than those in the non-demented group (~25%–30%, p = 0.01). Within the AD group, dense-core plaque size did not independently correlate with duration of clinical disease (from 4 to 21 years, p = 0.68), whereas 10D5-positive plaque size correlated negatively with disease duration (p = 0.01). By contrast, an earlier age of symptom onset strongly predicted a larger postmortem plaque size; this effect was independent of disease duration and the presence of the APOEε4 allele (p = 0.0001). We conclude that plaques vary in size among patients, with larger size distributions correlating with an earlier age of onset, but plaques do not substantially increase in size over the clinical course of the disease. PMID:22805771

  19. Force Outputs during Squats Performed Using a Rotational Inertia Device under Stable versus Unstable Conditions with Different Loads.

    PubMed

    Vázquez-Guerrero, Jairo; Moras, Gerard; Baeza, Jennifer; Rodríguez-Jiménez, Sergio

    2016-01-01

    The purpose of the study was to compare the force outputs achieved during a squat exercise using a rotational inertia device in stable versus unstable conditions with different loads and in concentric and eccentric phases. Thirteen male athletes (mean ± SD: age 23.7 ± 3.0 years, height 1.80 ± 0.08 m, body mass 77.4 ± 7.9 kg) were assessed while squatting, performing one set of three repetitions with four different loads under stable and unstable conditions at maximum concentric effort. Overall, there were no significant differences between the stable and unstable conditions at each of the loads for any of the dependent variables. Mean force showed significant differences between some of the loads in stable and unstable conditions (P < 0.010) and peak force output differed between all loads for each condition (P < 0.045). Mean force outputs were greater in the concentric than in the eccentric phase under both conditions and with all loads (P < 0.001). There were no significant differences in peak force between concentric and eccentric phases at any load in either stable or unstable conditions. In conclusion, squatting with a rotational inertia device allowed the generation of similar force outputs under stable and unstable conditions at each of the four loads. The study also provides empirical evidence of the different force outputs achieved by adjusting load conditions on the rotational inertia device when performing squats, especially in the case of peak force. Concentric force outputs were significantly higher than eccentric outputs, except for peak force under both conditions. These findings support the use of the rotational inertia device to train the squatting exercise under unstable conditions for strength and conditioning trainers. The device could also be included in injury prevention programs for muscle lesions and ankle and knee joint injuries.

  20. Force Outputs during Squats Performed Using a Rotational Inertia Device under Stable versus Unstable Conditions with Different Loads

    PubMed Central

    Vázquez-Guerrero, Jairo; Moras, Gerard

    2016-01-01

    The purpose of the study was to compare the force outputs achieved during a squat exercise using a rotational inertia device in stable versus unstable conditions with different loads and in concentric and eccentric phases. Thirteen male athletes (mean ± SD: age 23.7 ± 3.0 years, height 1.80 ± 0.08 m, body mass 77.4 ± 7.9 kg) were assessed while squatting, performing one set of three repetitions with four different loads under stable and unstable conditions at maximum concentric effort. Overall, there were no significant differences between the stable and unstable conditions at each of the loads for any of the dependent variables. Mean force showed significant differences between some of the loads in stable and unstable conditions (P < 0.010) and peak force output differed between all loads for each condition (P < 0.045). Mean force outputs were greater in the concentric than in the eccentric phase under both conditions and with all loads (P < 0.001). There were no significant differences in peak force between concentric and eccentric phases at any load in either stable or unstable conditions. In conclusion, squatting with a rotational inertia device allowed the generation of similar force outputs under stable and unstable conditions at each of the four loads. The study also provides empirical evidence of the different force outputs achieved by adjusting load conditions on the rotational inertia device when performing squats, especially in the case of peak force. Concentric force outputs were significantly higher than eccentric outputs, except for peak force under both conditions. These findings support the use of the rotational inertia device to train the squatting exercise under unstable conditions for strength and conditioning trainers. The device could also be included in injury prevention programs for muscle lesions and ankle and knee joint injuries. PMID:27111766

  1. Generation of stable subfemtosecond hard x-ray pulses with optimized nonlinear bunch compression

    DOE PAGES

    Huang, Senlin; Ding, Yuantao; Huang, Zhirong; ...

    2014-12-15

    In this paper, we propose a simple scheme that leverages existing x-ray free-electron laser hardware to produce stable single-spike, subfemtosecond x-ray pulses. By optimizing a high-harmonic radio-frequency linearizer to achieve nonlinear compression of a low-charge (20 pC) electron beam, we obtain a sharp current profile possessing a few-femtosecond full width at half maximum temporal duration. A reverse undulator taper is applied to enable lasing only within the current spike, where longitudinal space charge forces induce an electron beam time-energy chirp. Simulations based on the Linac Coherent Light Source parameters show that stable single-spike x-ray pulses with a duration less thanmore » 200 attoseconds can be obtained.« less

  2. High pressure versus high intensity noninvasive ventilation in stable hypercapnic chronic obstructive pulmonary disease: a randomized crossover trial.

    PubMed

    Murphy, Patrick B; Brignall, Kate; Moxham, John; Polkey, Michael I; Davidson, A Craig; Hart, Nicholas

    2012-01-01

    High-intensity (high-pressure and high backup rate) noninvasive ventilation has recently been advocated for the management of stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the relative contributions of high inspiratory pressure and high backup rate to ventilator adherence and physiological outcome have not been investigated. Patients with stable hypercapnic COPD (daytime PaCO(2) > 6 kPa) and nocturnal hypoventilation were enrolled. Patients were randomly allocated to high-pressure and high backup rate (high-intensity) and high-pressure and low backup rate (high-pressure) for a 6-week period. At the end of the first treatment period, patients were switched to the alternative treatment. The primary outcome measure was mean nightly ventilator usage. Twelve patients were recruited, with seven completing the 12-week trial protocol. The mean patient age was 71 ± 8 years, with a forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) of 50% ± 13% and FEV(1) of 32% ± 12%. The baseline PaCO(2) and PaO(2) were 8.6 ± 1.7 kPa and 7.3 ± 1.4 kPa, respectively. There was no significant difference demonstrated in mean nightly ventilator usage between the high-intensity and high-pressure groups (difference of 4 minutes; 95% confidence interval -45 to 53; P = 0.9). Furthermore, there were no differences in any of the secondary endpoints, with the exception of the respiratory domain of the Severe Respiratory Insufficiency questionnaire, which was lower in the high-intensity arm than in the high-pressure arm (57 ± 11 versus 69 ± 16; P < 0.05). There was no additional benefit, in terms of night-time ventilator adherence or any of the other measured parameters, demonstrated by addition of a high backup rate to high-pressure noninvasive ventilation. These data suggest that it is the high-pressure component of the high-intensity noninvasive ventilation approach that plays the important therapeutic role in the management of hypercapnic

  3. Realization of Multi-Stable Ground States in a Nematic Liquid Crystal by Surface and Electric Field Modification

    NASA Astrophysics Data System (ADS)

    Gwag, Jin Seog; Kim, Young-Ki; Lee, Chang Hoon; Kim, Jae-Hoon

    2015-06-01

    Owing to the significant price drop of liquid crystal displays (LCDs) and the efforts to save natural resources, LCDs are even replacing paper to display static images such as price tags and advertising boards. Because of a growing market demand on such devices, the LCD that can be of numerous surface alignments of directors as its ground state, the so-called multi-stable LCD, comes into the limelight due to the great potential for low power consumption. However, the multi-stable LCD with industrial feasibility has not yet been successfully performed. In this paper, we propose a simple and novel configuration for the multi-stable LCD. We demonstrate experimentally and theoretically that a battery of stable surface alignments can be achieved by the field-induced surface dragging effect on an aligning layer with a weak surface anchoring. The simplicity and stability of the proposed system suggest that it is suitable for the multi-stable LCDs to display static images with low power consumption and thus opens applications in various fields.

  4. Atomically precise metal nanoclusters: stable sizes and optical properties

    NASA Astrophysics Data System (ADS)

    Jin, Rongchao

    2015-01-01

    Controlling nanoparticles with atomic precision has long been a major dream of nanochemists. Breakthroughs have been made in the case of gold nanoparticles, at least for nanoparticles smaller than ~3 nm in diameter. Such ultrasmall gold nanoparticles indeed exhibit fundamentally different properties from those of the plasmonic counterparts owing to the quantum size effects as well as the extremely high surface-to-volume ratio. These unique nanoparticles are often called nanoclusters to distinguish them from conventional plasmonic nanoparticles. Intense work carried out in the last few years has generated a library of stable sizes (or stable stoichiometries) of atomically precise gold nanoclusters, which are opening up new exciting opportunities for both fundamental research and technological applications. In this review, we have summarized the recent progress in the research of thiolate (SR)-protected gold nanoclusters with a focus on the reported stable sizes and their optical absorption spectra. The crystallization of nanoclusters still remains challenging; nevertheless, a few more structures have been achieved since the earlier successes in Au102(SR)44, Au25(SR)18 and Au38(SR)24 nanoclusters, and the newly reported structures include Au20(SR)16, Au24(SR)20, Au28(SR)20, Au30S(SR)18, and Au36(SR)24. Phosphine-protected gold and thiolate-protected silver nanoclusters are also briefly discussed in this review. The reported gold nanocluster sizes serve as the basis for investigating their size dependent properties as well as the development of applications in catalysis, sensing, biological labelling, optics, etc. Future efforts will continue to address what stable sizes are existent, and more importantly, what factors determine their stability. Structural determination and theoretical simulations will help to gain deep insight into the structure-property relationships.

  5. Entropy Stable Wall Boundary Conditions for the Compressible Navier-Stokes Equations

    NASA Technical Reports Server (NTRS)

    Parsani, Matteo; Carpenter, Mark H.; Nielsen, Eric J.

    2014-01-01

    Non-linear entropy stability and a summation-by-parts framework are used to derive entropy stable wall boundary conditions for the compressible Navier-Stokes equations. A semi-discrete entropy estimate for the entire domain is achieved when the new boundary conditions are coupled with an entropy stable discrete interior operator. The data at the boundary are weakly imposed using a penalty flux approach and a simultaneous-approximation-term penalty technique. Although discontinuous spectral collocation operators are used herein for the purpose of demonstrating their robustness and efficacy, the new boundary conditions are compatible with any diagonal norm summation-by-parts spatial operator, including finite element, finite volume, finite difference, discontinuous Galerkin, and flux reconstruction schemes. The proposed boundary treatment is tested for three-dimensional subsonic and supersonic flows. The numerical computations corroborate the non-linear stability (entropy stability) and accuracy of the boundary conditions.

  6. A Mid-scala Cochlear Implant Electrode Design Achieves a Stable Post-surgical Position in the Cochlea of Patients Over Time-A Prospective Observational Study.

    PubMed

    Dees, Guido; Smits, Jeroen Jules; Janssen, A Miranda L; Hof, Janny R; Gazibegovic, Dzemal; Hoof, Marc van; Stokroos, Robert J

    2018-04-01

    Cochlear implant (CI) electrode design impacts the clinical performance of patients. Stability and the occurrence of electrode array migration, which is the postoperative movement of the electrode array, were investigated using a mid-scalar electrode array and postoperative image analysis. A prospective observational study was conducted. A mid-scalar electrode was surgically placed using a mastoidectomy, followed by a posterior tympanotomy and an extended round-window or cochleostomy insertion. A few days after surgery and 3 months later Cone Beam Computed Tomography (CBCT) was performed. The two different CBCT's were fused, and the differences between the electrode positions in three dimensions were calculated (the migration). A migration greater than 0.5 mm was deemed clinically relevant. Fourteen subjects participated. The mid-scalar electrode migrated in one patient (7%). This did not lead to the extrusion of an electrode contact. The mean migration of every individual electrode contact in all patients was 0.36 mm (95% confidence interval 0.22-0.50 mm), which approximates to the estimated measurement error of the CBCT technique. A mid-scalar electrode array achieves a stable position in the cochlea in a small but representative group of patients. The methods applied in this work can be used for providing postoperative feedback for surgeons and for benchmarking electrode designs.

  7. Clinical presentation and management of stable coronary artery disease: insights from the international prospective CLARIFY registry - results from the Greek national cohort.

    PubMed

    Sbarouni, Eftihia; Voudris, Vassilis; Georgiadou, Panagiota; Hamilos, Michalis; Steg, P Gabriel; Fox, Kim M; Greenlaw, Nicola; Ferrari, Roberto; Vardas, Panos E

    2014-01-01

    Coronary artery disease (CAD) is highly prevalent worldwide, yet there is a paucity of data regarding the clinical characteristics and management of outpatients with stable CAD. In this paper, we report the baseline data of the Greek cohort and we compare our national data with the global results of the entire registry, as well as the results from the western European countries. CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis >50%, or chest pain associated with proven myocardial ischemia. A total of 33,283 patients from 45 countries in 4 continents were enrolled between November 2009 and July 2010; of these, 14,726 were from western European countries (Austria, Belgium, Denmark, France, Germany, Greece, Ireland, Italy, Netherlands, Portugal, Spain, Switzerland and the United Kingdom) and 559 patients were enrolled in Greece. Compared to their counterparts in western Europe and the entire cohort, Greeks were younger (p<0.0001, p<0.0001, respectively), more predominantly male (p<0.0039, p<0.0001), with a higher body mass index (p<0.0002, p<0.0001) and a larger waist circumference (p<0.0001, p<0.0001), as well as a higher prevalence of family history of CAD (p<0.0008, 0.0005), hyperlipidemia (p<0.0001, p<0.0001) and smoking (p<0.0001, p<0.0001). Noninvasive testing (p<0.0001, p<0.0001, respectively) and coronary angiography (p<0.0001, 0.0013) along with surgical revascularization (CABG) (p<0.0001, 0.0088) were performed more often in Greece. Antiplatelets, b-blockers and lipid lowering medications were used to an equal extent in Greece as in the other two cohorts. There are substantial differences in demographics, clinical profiles and treatment in patients with stable CAD within the data set, which are also observed for Greek data. Interestingly, these differences are consistent in relation to the global

  8. Water Prescription in Autosomal Dominant Polycystic Kidney Disease: A Pilot Study

    PubMed Central

    Creed, Catherine; Winklhofer, Franz T.; Grantham, Jared J.

    2011-01-01

    Summary Background and objectives In animal models of polycystic kidney disease, the ingestion of large amounts of water promotes diuresis by suppressing plasma levels of arginine vasopressin (AVP) and renal levels of cAMP, slowing cyst progression. Whether simple water ingestion is a potential therapeutic strategy for individuals with autosomal dominant polycystic kidney disease (ADPKD) is unknown. In this study, a simple method to quantify the amount of water to achieve a specific mean urine osmolality target in patients with ADPKD was developed and tested. Design, setting, participants, & measurements In eight ADPKD patients eating typical diets, osmolality and volume were measured in 24-hour urine collections. The amount of additional ingested water required daily to achieve a mean urine osmolality of 285 ± 45 mosm/kg was determined. Participants were instructed to distribute the prescribed water over waking hours for each of 5 days. Blood chemistries, 24-hour urine collections, BP, and weight were measured before and after the period of supplemental water intake. Results Five patients achieved the 285 mosm/kg urine target without difficulty. Mean urine osmolality decreased and mean urine volume increased; serum sodium, weight, and BP were unchanged. Daily osmolar excretion remained constant, indicating a stable ad lib dietary intake of solutes and protein over the 2-week study period. Conclusions The amount of additional water needed to achieve a urine osmolality target can be approximated from the urine osmolar excretion in ADPKD patients eating typical diets, providing a quantitative method to prescribe supplemental water for such individuals. PMID:20876670

  9. Clopidogrel Use as Single Antiplatelet Therapy in Outpatients with Stable Coronary Artery Disease: Prevalence, Correlates and Association with Prognosis (from the CORONOR Study).

    PubMed

    Lemesle, Gilles; Schurtz, Guillaume; Meurice, Thibaud; Tricot, Olivier; Lemaire, Nestor; Caudmont, Sébastien; Philias, André; Ketelers, Régis; Lamblin, Nicolas; Bauters, Christophe

    2016-01-01

    Clopidogrel use as single antiplatelet therapy (SAPT) has never been evaluated in stable coronary artery disease (CAD) outpatients either as compared to placebo or aspirin. We therefore studied 2,823 outpatients included in a prospective registry. The patients were divided into 2 groups according to their antiplatelet therapy regimen: patients treated with clopidogrel were compared with those treated with aspirin alone. The mean time since CAD diagnosis was 7.9 years. Altogether, 776 (27.5%) patients received clopidogrel as SAPT. Factors independently associated with clopidogrel use were prior aortic or peripheral intervention, drug-eluting stent implantation, stroke, carotid endarterectomy and time since CAD diagnosis. Clopidogrel tended to be used in higher-risk patients: composite of cardiovascular death, myocardial infarction or stroke at 5.8 versus 4.2% (p = 0.056). However, after propensity score matching, similar event rates were observed between the groups: 5.9% when treated with clopidogrel versus 4.4% with aspirin (p = 0.207). The rate of bleeding was also similar between the groups. Our study shows that a significant proportion of stable CAD patients are treated with clopidogrel as SAPT in modern practice. Several correlates of such an attitude were identified. Our results suggest that this strategy is not beneficial as compared to aspirin alone in terms of ischaemic or bleeding events. © 2016 S. Karger AG, Basel.

  10. Hadamard Factorization of Stable Polynomials

    NASA Astrophysics Data System (ADS)

    Loredo-Villalobos, Carlos Arturo; Aguirre-Hernández, Baltazar

    2011-11-01

    The stable (Hurwitz) polynomials are important in the study of differential equations systems and control theory (see [7] and [19]). A property of these polynomials is related to Hadamard product. Consider two polynomials p,q ∈ R[x]:p(x) = anxn+an-1xn-1+...+a1x+a0q(x) = bmx m+bm-1xm-1+...+b1x+b0the Hadamard product (p × q) is defined as (p×q)(x) = akbkxk+ak-1bk-1xk-1+...+a1b1x+a0b0where k = min(m,n). Some results (see [16]) shows that if p,q ∈R[x] are stable polynomials then (p×q) is stable, also, i.e. the Hadamard product is closed; however, the reciprocal is not always true, that is, not all stable polynomial has a factorization into two stable polynomials the same degree n, if n> 4 (see [15]).In this work we will give some conditions to Hadamard factorization existence for stable polynomials.

  11. Stable hovering of a jellyfish-like flying machine

    PubMed Central

    Ristroph, Leif; Childress, Stephen

    2014-01-01

    Ornithopters, or flapping-wing aircraft, offer an alternative to helicopters in achieving manoeuvrability at small scales, although stabilizing such aerial vehicles remains a key challenge. Here, we present a hovering machine that achieves self-righting flight using flapping wings alone, without relying on additional aerodynamic surfaces and without feedback control. We design, construct and test-fly a prototype that opens and closes four wings, resembling the motions of swimming jellyfish more so than any insect or bird. Measurements of lift show the benefits of wing flexing and the importance of selecting a wing size appropriate to the motor. Furthermore, we use high-speed video and motion tracking to show that the body orientation is stable during ascending, forward and hovering flight modes. Our experimental measurements are used to inform an aerodynamic model of stability that reveals the importance of centre-of-mass location and the coupling of body translation and rotation. These results show the promise of flapping-flight strategies beyond those that directly mimic the wing motions of flying animals. PMID:24430122

  12. Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease.

    PubMed

    Wu, Weiliang; Zhang, Xianming; Lin, Lin; Ou, Yonger; Li, Xiaoying; Guan, Lili; Guo, Bingpeng; Zhou, Luqian; Chen, Rongchang

    2017-01-01

    Inspiratory muscle training (IMT) is a rehabilitation therapy for stable patients with COPD. However, its therapeutic effect remains undefined due to the unclear nature of diaphragmatic mobilization during IMT. Diaphragmatic mobilization, represented by transdiaphragmatic pressure (Pdi), and neural respiratory drive, expressed as the corrected root mean square (RMS) of the diaphragmatic electromyogram (EMGdi), both provide vital information to select the proper IMT device and loads in COPD, therefore contributing to the curative effect of IMT. Pdi and RMS of EMGdi (RMSdi%) were measured and compared during inspiratory resistive training and threshold load training in stable patients with COPD. Pdi and neural respiratory drive were measured continuously during inspiratory resistive training and threshold load training in 12 stable patients with COPD (forced expiratory volume in 1 s ± SD was 26.1%±10.2% predicted). Pdi was significantly higher during high-intensity threshold load training (91.46±17.24 cmH 2 O) than during inspiratory resistive training (27.24±6.13 cmH 2 O) in stable patients with COPD, with P <0.01 for each. Significant difference was also found in RMSdi% between high-intensity threshold load training and inspiratory resistive training (69.98%±16.78% vs 17.26%±14.65%, P <0.01). We concluded that threshold load training shows greater mobilization of Pdi and neural respiratory drive than inspiratory resistive training in stable patients with COPD.

  13. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study.

    PubMed

    Carmona-Bayonas, Alberto; Jiménez-Fonseca, Paula; Virizuela Echaburu, Juan; Antonio, Maite; Font, Carme; Biosca, Mercè; Ramchandani, Avinash; Martínez, Jerónimo; Hernando Cubero, Jorge; Espinosa, Javier; Martínez de Castro, Eva; Ghanem, Ismael; Beato, Carmen; Blasco, Ana; Garrido, Marcelo; Bonilla, Yaiza; Mondéjar, Rebeca; Arcusa Lanza, María Ángeles; Aragón Manrique, Isabel; Manzano, Aránzazu; Sevillano, Elena; Castañón, Eduardo; Cardona, Mercé; Gallardo Martín, Elena; Pérez Armillas, Quionia; Sánchez Lasheras, Fernando; Ayala de la Peña, Francisco

    2015-02-10

    To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections. We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status ≥ 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade ≥ 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per μL (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk (≥ 3 points). We present a multicenter validation of CISNE. We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC). CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes. © 2015 by American Society of Clinical Oncology.

  14. Modeling stable isotope transport in metamorphic and hydrothermal systems

    NASA Astrophysics Data System (ADS)

    Baumgartner, L. P.; Mueller, T.; Skora, S.; Begue, F.

    2007-12-01

    Stable isotopes are powerful tools for deciphering the fluid flow histories of metamorphic terrains. The nature of fluid flow, fluid sources, and fluid fluxes can be delineated in well constrained studies. Continuum mechanics models for stable isotope fluid-rock exchange were developed and used over the last three decades in an attempt to accurately interpret the signatures left behind by fluid flow in the earths crust. The efforts have been hampered by the realization that the exchange of many stable isotopes, e.g. oxygen and carbon, by intracrystalline diffusion, hence without re-organization of the crystal lattice, appears to be too slow to achieve significant exchange. This should lead to relatively flat isotopic exchange profiles on hand-, outcrop, or aureole scale. Nevertheless, isotopic fronts are typically sharp (sub mm to cm scale), when measured in the field. This has lead to the suggestion that these sharp fronts correspond to the sides of infiltration fronts, implying the data to have been collected at a high angle to the infiltration direction. Nevertheless, the fact that the oxygen and carbon fronts are located at the same place is not explained by this. A review of published carbon and oxygen data reveals that many contact aureoles show linear trends in oxygen-carbon isotope ratio diagrams for carbonate sample suits. This implies that the fluid composition infiltrating the aureoles had essentially an X(CO2) of 0.5. This is in contrast to skarn mineralogy developed, which requires a water-rich fluid, in agreement with the general notion that igneous fluids are water-rich. These and other observations indicate that the mass transport equation used for stable isotope exchange needs to be improved to model appropriately the actual isotope kinetics during fluid-rock exchange. Detailed isotope studies on systems where net transport reactions are driven by mass transport have led us to identify different exchange mechanisms, including: a) the stable isotope

  15. Stable nuclear transformation of Eudorina elegans

    PubMed Central

    2013-01-01

    Background A fundamental step in evolution was the transition from unicellular to differentiated, multicellular organisms. Volvocine algae have been used for several decades as a model lineage to investigate the evolutionary aspects of multicellularity and cellular differentiation. There are two well-studied volvocine species, a unicellular alga (Chlamydomonas reinhardtii) and a multicellular alga with differentiated cell types (Volvox carteri). Species with intermediate characteristics also exist, which blur the boundaries between unicellularity and differentiated multicellularity. These species include the globular alga Eudorina elegans, which is composed of 16–32 cells. However, detailed molecular analyses of E. elegans require genetic manipulation. Unfortunately, genetic engineering has not yet been established for Eudorina, and only limited DNA and/or protein sequence information is available. Results Here, we describe the stable nuclear transformation of E. elegans by particle bombardment using both a chimeric selectable marker and reporter genes from different heterologous sources. Transgenic algae resistant to paromomycin were achieved using the aminoglycoside 3′-phosphotransferase VIII (aphVIII) gene of Streptomyces rimosus, an actinobacterium, under the control of an artificial promoter consisting of two V. carteri promoters in tandem. Transformants exhibited an increase in resistance to paromomycin by up to 333-fold. Co-transformation with non-selectable plasmids was achieved with a rate of 50 - 100%. The luciferase (gluc) gene from the marine copepod Gaussia princeps, which previously was engineered to match the codon usage of C. reinhardtii, was used as a reporter gene. The expression of gluc was mediated by promoters from C. reinhardtii and V. carteri. Heterologous heat shock promoters induced an increase in luciferase activity (up to 600-fold) at elevated temperatures. Long-term stability and both constitutive and inducible expression of the co

  16. Mechanical unfolding reveals stable 3-helix intermediates in talin and α-catenin

    PubMed Central

    2018-01-01

    Mechanical stability is a key feature in the regulation of structural scaffolding proteins and their functions. Despite the abundance of α-helical structures among the human proteome and their undisputed importance in health and disease, the fundamental principles of their behavior under mechanical load are poorly understood. Talin and α-catenin are two key molecules in focal adhesions and adherens junctions, respectively. In this study, we used a combination of atomistic steered molecular dynamics (SMD) simulations, polyprotein engineering, and single-molecule atomic force microscopy (smAFM) to investigate unfolding of these proteins. SMD simulations revealed that talin rod α-helix bundles as well as α-catenin α-helix domains unfold through stable 3-helix intermediates. While the 5-helix bundles were found to be mechanically stable, a second stable conformation corresponding to the 3-helix state was revealed. Mechanically weaker 4-helix bundles easily unfolded into a stable 3-helix conformation. The results of smAFM experiments were in agreement with the findings of the computational simulations. The disulfide clamp mutants, designed to protect the stable state, support the 3-helix intermediate model in both experimental and computational setups. As a result, multiple discrete unfolding intermediate states in the talin and α-catenin unfolding pathway were discovered. Better understanding of the mechanical unfolding mechanism of α-helix proteins is a key step towards comprehensive models describing the mechanoregulation of proteins. PMID:29698481

  17. Does Context, Practice or Competition affect Female Athletes’ Achievement Goal Dominance, Goal Pursuit, Burnout and Motivation?

    PubMed Central

    Fernández-Rio, Javier; Cecchini, Jose A.; Méndez-Giménez, Antonio

    2017-01-01

    Abstract The goal of this study was to assess the effects of two different achievement sport contexts, practice and competition, on the motivational profile of professional/semi-professional athletes. Forty-eight Spanish national/international-level female athletes (basketball = 18; handball = 12; soccer = 11; volleyball = 7), mean age 25.14 ± 3.43 years, agreed to participate in the study. They completed a questionnaire, prior and after training and competition, to assess achievement goals, achievement goal dominance, goal pursuit, motivational climate, motivation, burnout and perceived recovery-exertion. Data analyses revealed that, both in practice and competition, these team-sport athletes overwhelmingly showed a strong mastery-approach achievement goal in dominance as well as in pursuit. A significant finding was that this group of national/international-level, professional/semi-professional athletes not only adopted a mastery-approach achievement goal, but they also actively pursued it. It is also remarkable that this profile remained stable at post-tests, even after a painful defeat in competition, which produced a significant negative effect on the athletes’ burnout (emotional and physical exhaustion and devaluation of sport participation) and self-determined motivation. As expected, the difference between total recovery and perceived exertion significantly increased after practice and competition. National/international-level team-sport professional/semi-professional female athletes held and pursue stable mastery-approach goal dominance. PMID:29134051

  18. Measuring Transcutaneous Oxygenation to Validate the Duration Required to Achieve Electrode Equilibration.

    PubMed

    Chiang, Nathaniel; Jain, Jitendra K; Sleigh, Jamie; Vasudevan, Thodur

    2018-06-01

    The transcutaneous oxygenation measurement (TCOM) system is useful in assessing tissue viability. There are no clear recommendations regarding the duration required for the electrode to equilibrate and reliably evaluate tissue oxygenation values. The objective of this study was to validate the duration required to achieve electrode equilibration in a clinical setting. Minute-by-minute recordings using TCOM (TCOM3; Radiometer Medical ApS, Brønshøj, Copenhagen) were obtained for 82 limbs in 50 participants. Twenty-five limbs were in patients with peripheral vascular disease; 30 were in patients with no known peripheral vascular disease; and 27 were in healthy volunteers. Transcutaneous partial pressure of oxygen and carbon dioxide (TcPO2 and TcPCO2) were recorded over a 15-minute period. Participants' TcPO2 decreased and TcPCO2 increased over time. Both changed in a nonlinear fashion, eventually settling at an "equilibrium" where the measurements became stable. The difference in proportional change of TcPO2 between minutes 14 and 15 was 0.8%, and for TcPCO2was 2.9%. Changes in TCOM measurements over time were similar among the 3 groups. This is the first study to target minute-by-minute variation in TcPO2 and TcPCO2 measurements. Recording for a minimum of 15 minutes allows a reliable period for the TCOM electrode to equilibrate to record absolute values and determine wound healing potential.

  19. Stable, low cost SAW microwave transmitter

    NASA Astrophysics Data System (ADS)

    Lau, K. F.; Yen, K. H.

    1986-06-01

    The design flexibility and application possibilities of surface acoustic wave (SAW) technology is discussed. When a highly stable, AM-modulated transmitter is required, a SAW resonator can provide an oscillator Q of up to 20,000 at 1 GHz. When FM modulation is required, the SAW delay line can provide a lower oscillator Q, which represents the optimum tradeoff between frequency stability and FM modulability. The capabilities of SAW oscillators are reviewed, and two example transmitters are presented. One transmitter operates at 1680 MHz and provides an AM-modulated signal. The second operates at the 400 to 406 MHz range and provides an FM-modulated output at one of six frequencies. SAW transmitters are suitable for applications where moderately high stability and low cost are key factors. With direct generation of signals at microwave frequencies and the flexibility of SAW oscillator design, a wide range of performance characteristics can be achieved.

  20. The role of vaspin as a predictor of coronary angiography result in SCAD (stable coronary artery disease) patients.

    PubMed

    Stančík, Matej; Ságová, Ivana; Kantorová, Ema; Mokáň, Marián

    2017-05-08

    The role of vaspin in the pathogenesis of stable coronary artery disease (SCAD) have been repeatedly addressed in clinical studies. However, from the point of view of clinical practice, the results of earlier studies are still inconclusive. The data of 106 SCAD patients who received coronary angiography and 85 coronary artery disease-free controls were collected and analysed. The patients were divided into subgroups according to their pre-test probability (PTP) and according to the result of coronary angiography. Fasting vaspin concentrations were compared between subgroups of SCAD patients and between target group and controls. The effect of age and smoking on the result of coronary angiography was compared to the effect of vaspin using the binomial regression. We did not find significant difference in vaspin level between target group and controls. Unless the pre-test probability was taken into account, we did not find vaspin difference in the target group, when dividing patients on the basis of presence/absence of significant coronary stenosis. In the subgroup of SCAD patients with PTP between 15% - 65%, those with significant coronary stenoses had higher mean vaspin concentration (0,579 ± 0,898 ng/ml) than patients without significant stenoses. (0,379 ± 0,732 ng/ml) (t = -2595; p = 0,012; d = 0,658; 1-β = 0,850). Age, smoking status and vaspin significantly contributed to the HSCS prediction in binomial regression model in patients with low PTP (OR: 1.1, 4.9, 8.7, respectively). According to our results, vaspin cannot be used as an independent marker for the presence of CAD in general population. However, our results indicate that measuring vaspin in SCAD patients might be clinically useful in patients with PTP below 66%.

  1. Stable, Long-Term, Spatial Memory in Young and Aged Rats Achieved with a One Day Morris Water Maze Training Protocol

    ERIC Educational Resources Information Center

    Barrientos, Ruth M.; Kitt, Meagan M.; D'Angelo, Heather M.; Watkins, Linda R.; Rudy, Jerry W.; Maier, Steven F.

    2016-01-01

    Here, we present data demonstrating that a 1 d Morris water maze training protocol is effective at producing stable, long-term spatial memory in both young (3 mo old) and aged (24 mo old) F344xBN rats. Four trials in each of four sessions separated by a 2.5 h ISI produced robust selective search for the platform 1 and 4 d after training, in both…

  2. HbA1c monitoring interval in patients on treatment for stable type 2 diabetes. A ten-year retrospective, open cohort study.

    PubMed

    Ohde, Sachiko; Deshpande, Gautam A; Yokomichi, Hiroshi; Takahashi, Osamu; Fukui, Tsuguya; Yamagata, Zentaro

    2018-01-01

    [Aims] This study aims to suggest an informative interval for HbA1c in DM patients with stable glycemic control, based on test characteristics of the HbA1C assay using the signal-to-noise ratio method. [Methods] This was a retrospective, open cohort study. Data were collected between January 2005 to December 2014 at a tertiary-level community hospital in Japan. All adult patients aged under 75 years, with stable glycemic control on a first pharmaceutical regimen for Type II diabetes, and at least two HbA1c measurements after they achieved glycemic stability, were included in the analysis. We defined stable glycemic control as HbA1c <7.0% (52 mmol/mol) and requiring no change in the medication regimen after three consecutive measurements. We adapted a signal-to-noise method for distinguishing true change from measurement error by constructing a linear random effects model to calculate signal and noise for HbA1c. The screening interval for HbA1c was defined as informative when the signal-to-noise ratio exceeded 1. [Results] Among 1066 adults with diabetes, 639 patients (18.5%) were identified as achieving stable glycemic control (511 male (67.3%)), with a mean HbA1c (SD) of 6.4 (0.4)% (46 mmol/mol). Patients with stable glycemic control increase their HbA1c 0.27% (3 mmol/mol) every year while HbA1c has 0.32% (3.5 mmol/mol) noise, as testing characteristics. Signal exceeds noise after 1.2 years (95%CI: 0.9-1.6). [Conclusion] Once patients achieve stable glycemic control at their HbA1c goal, an informative interval for HbA1c monitoring is once every year. Current guidelines, which suggest testing every six months, may contribute to substantial over-testing. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Caffeine Citrate Dosing Adjustments to Assure Stable Caffeine Concentrations in Preterm Neonates.

    PubMed

    Koch, Gilbert; Datta, Alexandre N; Jost, Kerstin; Schulzke, Sven M; van den Anker, John; Pfister, Marc

    2017-12-01

    To identify dosing strategies that will assure stable caffeine concentrations in preterm neonates despite changing caffeine clearance during the first 8 weeks of life. A 3-step simulation approach was used to compute caffeine doses that would achieve stable caffeine concentrations in the first 8 weeks after birth: (1) a mathematical weight change model was developed based on published weight distribution data; (2) a pharmacokinetic model was developed based on published models that accounts for individual body weight, postnatal, and gestational age on caffeine clearance and volume of distribution; and (3) caffeine concentrations were simulated for different dosing regimens. A standard dosing regimen of caffeine citrate (using a 20 mg/kg loading dose and 5 mg/kg/day maintenance dose) is associated with a maximal trough caffeine concentration of 15 mg/L after 1 week of treatment. However, trough concentrations subsequently exhibit a clinically relevant decrease because of increasing clearance. Model-based simulations indicate that an adjusted maintenance dose of 6 mg/kg/day in the second week, 7 mg/kg/day in the third to fourth week and 8 mg/kg/day in the fifth to eighth week assures stable caffeine concentrations with a target trough concentration of 15 mg/L. To assure stable caffeine concentrations during the first 8 weeks of life, the caffeine citrate maintenance dose needs to be increased by 1 mg/kg every 1-2 weeks. These simple adjustments are expected to maintain exposure to stable caffeine concentrations throughout this important developmental period and might enhance both the short- and long-term beneficial effects of caffeine treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Structure of the thermally stable Zika virus.

    PubMed

    Kostyuchenko, Victor A; Lim, Elisa X Y; Zhang, Shuijun; Fibriansah, Guntur; Ng, Thiam-Seng; Ooi, Justin S G; Shi, Jian; Lok, Shee-Mei

    2016-05-19

    Zika virus (ZIKV), formerly a neglected pathogen, has recently been associated with microcephaly in fetuses, and with Guillian-Barré syndrome in adults. Here we present the 3.7 Å resolution cryo-electron microscopy structure of ZIKV, and show that the overall architecture of the virus is similar to that of other flaviviruses. Sequence and structural comparisons of the ZIKV envelope (E) protein with other flaviviruses show that parts of the E protein closely resemble the neurovirulent West Nile and Japanese encephalitis viruses, while others are similar to dengue virus (DENV). However, the contribution of the E protein to flavivirus pathobiology is currently not understood. The virus particle was observed to be structurally stable even when incubated at 40 °C, in sharp contrast to the less thermally stable DENV. This is also reflected in the infectivity of ZIKV compared to DENV serotypes 2 and 4 (DENV2 and DENV4) at different temperatures. The cryo-electron microscopy structure shows a virus with a more compact surface. This structural stability of the virus may help it to survive in the harsh conditions of semen, saliva and urine. Antibodies or drugs that destabilize the structure may help to reduce the disease outcome or limit the spread of the virus.

  5. New South Wales annual vaccine-preventable disease report, 2013.

    PubMed

    Rosewell, Alexander; Spokes, Paula; Gilmour, Robin

    2015-01-01

    To describe the epidemiology of selected vaccine-preventable diseases in New South Wales, Australia for 2013. Data from the New South Wales Notifiable Conditions Information Management System were analysed by local health district of residence, age, Aboriginality, vaccination status and organism. Risk factor and vaccination status data were collected by public health units. Pertussis notification rates in infants were low, and no infant pertussis deaths were reported. Despite a high number of imported measles cases, there was limited secondary transmission. The invasive meningococcal disease notification rate declined, and disease due to serogroup C remained low and stable. Vaccine-preventable diseases were relatively well controlled in New South Wales in 2013, with declining or stable notification rates in most diseases compared with the previous year.

  6. Air-stable and freestanding lithium alloy/graphene foil as an alternative to lithium metal anodes

    NASA Astrophysics Data System (ADS)

    Zhao, Jie; Zhou, Guangmin; Yan, Kai; Xie, Jin; Li, Yuzhang; Liao, Lei; Jin, Yang; Liu, Kai; Hsu, Po-Chun; Wang, Jiangyan; Cheng, Hui-Ming; Cui, Yi

    2017-10-01

    Developing high-capacity anodes is a must to improve the energy density of lithium batteries for electric vehicle applications. Alloy anodes are one promising option, but without pre-stored lithium, the overall energy density is limited by the low-capacity lithium metal oxide cathodes. Recently, lithium metal has been revived as a high-capacity anode, but faces several challenges owing to its high reactivity and uncontrolled dendrite growth. Here, we show a series of Li-containing foils inheriting the desirable properties of alloy anodes and pure metal anodes. They consist of densely packed LixM (M = Si, Sn, or Al) nanoparticles encapsulated by large graphene sheets. With the protection of graphene sheets, the large and freestanding LixM/graphene foils are stable in different air conditions. With fully expanded LixSi confined in the highly conductive and chemically stable graphene matrix, this LixSi/graphene foil maintains a stable structure and cyclability in half cells (400 cycles with 98% capacity retention). This foil is also paired with high-capacity Li-free V2O5 and sulfur cathodes to achieve stable full-cell cycling.

  7. Mechanical aspects of a multidirectional, angular stable osteosynthesis system and comparison with four conventional systems.

    PubMed

    Gbara, Ali; Heiland, Max; Schmelzle, Rainer; Blake, Felix

    2008-04-01

    Following open reduction, internal fixation of fractures of the mandible is predominantly achieved using plates and screws. Today, a multitude of osteosynthesis systems are available on the market. One therapy modality, primarily developed for orthopaedic surgery, is using angular stable osteosynthesis plate systems. The dominating principle of these is the bond between screw and plate following insertion. This principle of an "internal fixateur" results in a more stable fixation of the fragments associated with less compression of the bone surfaces. A new multidirectional osteosynthesis system (TiFix=Smartlock, Hamburg - Germany) was modified to fit the maxillofacial region and compared with four other well established osteosynthesis systems developed by Mondial, Medicon, Synthes, Leibinger-Stryker, one of these (Unilock by Synthes) being also angular stable. The resistance to deformation in varying directions was investigated following fixation in four different materials. The TiFix system proved more resistant to deformation even when mounted with fewer screws than the non-angular stable systems. This system results in greater stability even when fewer screws are used. For the clinician this means smaller access incisions, less soft tissue trauma, better aesthetic results, decreased duration of operation and a reduction of costs.

  8. Air-stable and freestanding lithium alloy/graphene foil as an alternative to lithium metal anodes

    DOE PAGES

    Zhao, Jie; Zhou, Guangmin; Yan, Kai; ...

    2017-07-10

    Developing high-capacity anodes is a must to improve the energy density of lithium batteries for electric vehicle applications. Alloy anodes are one promising option, but without pre-stored lithium, the overall energy density is limited by the low-capacity lithium metal oxide cathodes. Recently, lithium metal has been revived as a high-capacity anode, but faces several challenges owing to its high reactivity and uncontrolled dendrite growth. Here, we show a series of Li-containing foils inheriting the desirable properties of alloy anodes and pure metal anodes. They consist of densely packed Li xM (M = Si, Sn, or Al) nanoparticles encapsulated by largemore » graphene sheets. With the protection of graphene sheets, the large and freestanding Li xM/graphene foils are stable in different air conditions. With fully expanded Li xSi confined in the highly conductive and chemically stable graphene matrix, this LixSi/graphene foil maintains a stable structure and cyclability in half cells (400 cycles with 98% capacity retention). As a result, this foil is also paired with high-capacity Li-free V 2O 5 and sulfur cathodes to achieve stable full-cell cycling.« less

  9. Air-stable and freestanding lithium alloy/graphene foil as an alternative to lithium metal anodes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zhao, Jie; Zhou, Guangmin; Yan, Kai

    Developing high-capacity anodes is a must to improve the energy density of lithium batteries for electric vehicle applications. Alloy anodes are one promising option, but without pre-stored lithium, the overall energy density is limited by the low-capacity lithium metal oxide cathodes. Recently, lithium metal has been revived as a high-capacity anode, but faces several challenges owing to its high reactivity and uncontrolled dendrite growth. Here, we show a series of Li-containing foils inheriting the desirable properties of alloy anodes and pure metal anodes. They consist of densely packed Li xM (M = Si, Sn, or Al) nanoparticles encapsulated by largemore » graphene sheets. With the protection of graphene sheets, the large and freestanding Li xM/graphene foils are stable in different air conditions. With fully expanded Li xSi confined in the highly conductive and chemically stable graphene matrix, this LixSi/graphene foil maintains a stable structure and cyclability in half cells (400 cycles with 98% capacity retention). As a result, this foil is also paired with high-capacity Li-free V 2O 5 and sulfur cathodes to achieve stable full-cell cycling.« less

  10. Highly stable, extremely high-temperature, nonvolatile memory based on resistance switching in polycrystalline Pt nanogaps

    PubMed Central

    Suga, Hiroshi; Suzuki, Hiroya; Shinomura, Yuma; Kashiwabara, Shota; Tsukagoshi, Kazuhito; Shimizu, Tetsuo; Naitoh, Yasuhisa

    2016-01-01

    Highly stable, nonvolatile, high-temperature memory based on resistance switching was realized using a polycrystalline platinum (Pt) nanogap. The operating temperature of the memory can be drastically increased by the presence of a sharp-edged Pt crystal facet in the nanogap. A short distance between the facet edges maintains the nanogap shape at high temperature, and the sharp shape of the nanogap densifies the electric field to maintain a stable current flow due to field migration. Even at 873 K, which is a significantly higher temperature than feasible for conventional semiconductor memory, the nonvolatility of the proposed memory allows stable ON and OFF currents, with fluctuations of less than or equal to 10%, to be maintained for longer than eight hours. An advantage of this nanogap scheme for high-temperature memory is its secure operation achieved through the assembly and disassembly of a Pt needle in a high electric field. PMID:27725705

  11. Stable gastric pentadecapeptide BPC 157 in trials for inflammatory bowel disease (PL-10, PLD-116, PL14736, Pliva, Croatia) heals ileoileal anastomosis in the rat.

    PubMed

    Vuksic, Tihomir; Zoricic, Ivan; Brcic, Luka; Sever, Marko; Klicek, Robert; Radic, Bozo; Cesarec, Vedran; Berkopic, Lidija; Keller, Neike; Blagaic, Alenka Boban; Kokic, Neven; Jelic, Ivan; Geber, Juraj; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

    2007-01-01

    Gastric pentadecapeptide BPC 157 (BPC 157), which has been shown to be safe in clinical trials for inflammatory bowel disease (PL-10, PLD-116, PL14736, Pliva, Croatia), may be able to cure intestinal anastomosis dehiscence. This antiulcer peptide shows no toxicity, is limit test negative, and a lethal dose is not achieved. It is stable in human gastric juice. In comparison with other standard treatments it is more effective for ulcers and various wounds, and can be used without a carrier needed for other peptides, both locally and systemically (i.e., perorally, parenterally). We studied the effectiveness of BPC 157 for ileoileal anastomosis healing in rats. We assessed ileoileal anastomosis dehiscence macroscopically, histologically, and biomechanically (volume [ml] infused through a syringe-perfusion pump system (1 ml/10 s), and pressure [mmHg] to leak induction [catheter connected to a chamber and a monitor, at 10 cm proximal to anastomosis]), at 1, 2, 3, 4, 5, 6, 7, and 14 days. BPC 157 (10 microg, 10 ng, 10 pg/kg i.p. (or saline [5 ml/kg]) was first administered after surgery, while it was last given 24 h before either assessment or sacrifice. Throughout the experiment, both higher doses of BPC 157 were shown to improve all parameters of anastomotic wound healing. The formation of adhesions remained slight, the blood vessels were filled with blood, and a mild intestinal passage obstruction was only temporarily observed. Anastomosis without leakage induces markedly higher volume and pressure values, with a continuous increase toward healthy values. From day 1, edema was markedly attenuated and the number of granulocytes decreased, while from days 4 or 5 necrosis decreased and granulation tissue, reticulin, and collagen formation substantially increased, thus resulting in increased epithelization. This study showed BPC 157 to have a beneficial effect on ileoileal anastomosis healing in the rat.

  12. Scallop-Inspired Shell Engineering of Microparticles for Stable and High Volumetric Capacity Battery Anodes.

    PubMed

    Zhang, Xinghao; Guo, Ruiying; Li, Xianglong; Zhi, Linjie

    2018-06-01

    Building stable and efficient electron and ion transport pathways are critically important for energy storage electrode materials and systems. Herein, a scallop-inspired shell engineering strategy is proposed and demonstrated to confine high volume change silicon microparticles toward the construction of stable and high volumetric capacity binder-free lithium battery anodes. As for each silicon microparticle, the methodology involves an inner sealed but adaptable overlapped graphene shell, and an outer open hollow shell consisting of interconnected reduced graphene oxide, mimicking the scallop structure. The inner closed shell enables simultaneous stabilization of the interfaces of silicon with both carbon and electrolyte, substantially facilitates efficient and rapid transport of both electrons and lithium ions from/to silicon, the outer open hollow shell creates stable and robust transport paths of both electrons and lithium ions throughout the electrode without any sophisticated additives. The resultant self-supported electrode has achieved stable cycling with rapidly increased coulombic efficiency in the early stage, superior rate capability, and remarkably high volumetric capacity upon a facile pressing process. The rational design and engineering of graphene shells of the silicon microparticles developed can provide guidance for the development of a wide range of other high capacity but large volume change electrochemically active materials. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Achievements and challenges in legume breeding for pest and disease resistance

    USDA-ARS?s Scientific Manuscript database

    Yield stability of legume crops is constrained by a number of pest and diseases. Major diseases are rusts, powdery and downy mildews, ascochyta blight, botrytis gray molds, anthracnoses, damping-off, root rots, collar rot, vascular wilts and white mold. Parasitic weeds, viruses, bacteria, nematodes ...

  14. Stability of Self-Esteem Ratings and Their Relation to Academic Achievement: A Longitudinal Study

    ERIC Educational Resources Information Center

    Rubin, Rosalyn A.

    1978-01-01

    In a sample of 380 children, self-esteem as measured by the Coopersmith Self-Esteem Inventory became more stable and more highly correlated with school achievement as the children grew older. Children's self-perceptions appear less firmly established, and therefore may be more responsive to intervention, at earlier ages. (Author)

  15. Carboxylate-based molecular magnet: One path toward achieving stable quantum correlations at room temperature

    DOE PAGES

    Cruz, C.; Soares-Pinto, D. O.; Brandão, P.; ...

    2016-03-07

    The control of quantum correlations in solid-state systems by means of material engineering is a broad avenue to be explored, since it makes possible steps toward the limits of quantum mechanics and the design of novel materials with applications on emerging quantum technologies. This letter explores the potential of molecular magnets to be prototypes of materials for quantum information technology in this context. More precisely, we engineered a material and from its geometric quantum discord we found significant quantum correlations up to 9540 K (even without entanglement); and, a pure singlet state occupied up to around 80 K (above liquidmore » nitrogen temperature), additionally. Our results could only be achieved due to the carboxylate group promoting a metal-to-metal huge magnetic interaction.« less

  16. Organic solution-processible electroluminescent molecular glasses for non-doped standard red OLEDs with electrically stable chromaticity

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bi, Xiaoman; Zuo, Weiwei; Liu, Yingliang, E-mail: liuylxn@sohu.com

    Highlights: • The D–A–D electroluminescent molecular glasses are synthesized. • Non-doped red electroluminescent film is fabricated by spin-coating. • Red OLED shows stable wavelength, luminous efficiency and chromaticity. • CIE1931 coordinate is in accord with standard red light in PAL system. - Abstract: Organic light-emitting molecular glasses (OEMGs) are synthesized through the introduction of nonplanar donor and branched aliphatic chain into electroluminescent emitters. The target OEMGs are characterized by {sup 1}H NMR, {sup 13}C NMR, IR, UV–vis and fluorescent spectra as well as elemental analysis, TG and DSC. The results indicated that the optical, electrochemical and electroluminescent properties of OEMGsmore » are adjusted successfully by the replacement of electron-donating group. The non-doped OLED device with a standard red electroluminescent emission is achieved by spin-coating the THF solution of OEMG with a triphenylamine moiety. This non-doped red OLED device takes on an electrically stable electroluminescent performance, including the stable maximum electroluminescent wavelength of 640 nm, the stable luminous efficiency of 2.4 cd/A and the stable CIE1931 coordinate of (x, y) = (0.64, 0.35), which is basically in accord with the CIE1931 coordinate (x, y) = (0.64, 0.33) of standard red light in PAL system.« less

  17. Magneto-hydrodynamically stable axisymmetric mirrorsa)

    NASA Astrophysics Data System (ADS)

    Ryutov, D. D.; Berk, H. L.; Cohen, B. I.; Molvik, A. W.; Simonen, T. C.

    2011-09-01

    Making axisymmetric mirrors magnetohydrodynamically (MHD) stable opens up exciting opportunities for using mirror devices as neutron sources, fusion-fission hybrids, and pure-fusion reactors. This is also of interest from a general physics standpoint (as it seemingly contradicts well-established criteria of curvature-driven instabilities). The axial symmetry allows for much simpler and more reliable designs of mirror-based fusion facilities than the well-known quadrupole mirror configurations. In this tutorial, after a summary of classical results, several techniques for achieving MHD stabilization of the axisymmetric mirrors are considered, in particular: (1) employing the favorable field-line curvature in the end tanks; (2) using the line-tying effect; (3) controlling the radial potential distribution; (4) imposing a divertor configuration on the solenoidal magnetic field; and (5) affecting the plasma dynamics by the ponderomotive force. Some illuminative theoretical approaches for understanding axisymmetric mirror stability are described. The applicability of the various stabilization techniques to axisymmetric mirrors as neutron sources, hybrids, and pure-fusion reactors are discussed; and the constraints on the plasma parameters are formulated.

  18. Photonic Shape Memory Polymer with Stable Multiple Colors

    PubMed Central

    2017-01-01

    A photonic shape memory polymer film that shows large color response (∼155 nm) in a wide temperature range has been fabricated from a semi-interpenetrating network of a cholesteric polymer and poly(benzyl acrylate). The large color response is achieved by mechanical embossing of the photonic film above its broad glass transition temperature. The embossed film, as it recovers to its original shape on heating through the broad thermal transition, exhibits multiple structural colors ranging from blue to orange. The relaxation behavior of the embossed film can be fully described using a Kelvin–Voigt model, which reveals that the influence of temperature on the generation of colors is much stronger than that of time, thereby producing stable multiple colors. PMID:28840717

  19. Stable isotope labeling tandem mass spectrometry (SILT) to quantify protein production and clearance rates

    PubMed Central

    Bateman, Randall J.; Munsell, Ling Y.; Chen, Xianghong; Holtzman, David M.; Yarasheski, Kevin E.

    2007-01-01

    In all biological systems, protein amount is a function of the rate of production and clearance. The speed of a response to a disturbance in protein homeostasis is determined by turnover rate. Quantifying alterations in protein synthesis and clearance rates is vital to understanding disease pathogenesis (e.g., aging, inflammation). No methods exist for quantifying production and clearance rates of low abundance (femtomole) proteins in vivo. We describe a novel, mass spectrometry-based method for quantitating low abundance protein synthesis and clearance rates in vitro and in vivo in animals and humans. The utility of this method is demonstrated with amyloid-beta (Aß), an important low abundance protein involved in Alzheimer's disease pathogenesis. We used in vivo stable isotope labeling, immunoprecipitation of Aß from cerebrospinal fluid, and quantitative liquid chromatography electrospray-ionization tandem mass spectrometry (LC-ESI-tandem MS) to quantify human Aß protein production and clearance rates. The method is sensitive and specific for stable isotope labeled amino acid incorporation into CNS (± 1% accuracy). This in vivo method can be used to identify pathophysiologic changes in protein metabolism; and may serve as a biomarker for monitoring disease risk, progression, or response to novel therapeutic agents. The technique is adaptable to other macromolecules, such as carbohydrates or lipids. PMID:17383190

  20. Ultra Stable Microwave Radiometers for Future Sea Surface Salinity Missions

    NASA Technical Reports Server (NTRS)

    Wilson, William J.; Tanner, Alan B.; Pellerano, Fernando A.; Horgan, Kevin A.

    2005-01-01

    The NASA Earth Science System Pathfinder (ESSP) mission Aquarius will measure global sea surface salinity with 100-km spatial resolution every 8 days with an average monthly salinity accuracy of 0.2 psu (parts per thousand). This requires an L-band low-noise radiometer with the long-term calibration stability of less than 0.1 K over 8 days. This three-year research program on ultra stable radiometers has addressed the radiometer requirements and configuration necessary to achieve this objective for Aquarius and future ocean salinity missions. The system configuration and component performance have been evaluated with radiometer testbeds at both JPL and GSFC. The research has addressed several areas including component characterization as a function of temperature, a procedure for the measurement and correction for radiometer system non-linearity, noise diode calibration versus temperature, low noise amplifier performance over voltage, and temperature control requirements to achieve the required stability. A breadboard radiometer, utilizing microstrip-based technologies, has been built to demonstrate this long-term stability. This report also presents the results of the radiometer test program, a detailed radiometer noise model, and details of the operational switching sequence optimization that can be used to achieve the low noise and stability requirements. Many of the results of this research have been incorporated into the Aquarius radiometer design and will allow this instrument to achieve its goals.

  1. Increased calcium absorption from synthetic stable amorphous calcium carbonate: Double-blind randomized crossover clinical trial in post-menopausal women

    USDA-ARS?s Scientific Manuscript database

    Calcium supplementation is a widely recognized strategy for achieving adequate calcium intake. We designed this blinded, randomized, crossover interventional trial to compare the bioavailability of a new stable synthetic amorphous calcium carbonate (ACC) with that of crystalline calcium carbonate (C...

  2. Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges.

    PubMed

    Muhsen, Khitam; Green, Manfred S; Soskolne, Varda; Neumark, Yehuda

    2017-06-24

    Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries. Nevertheless, life expectancy has remained lower among Israeli Arabs than Israeli Jews, and this gap has recently widened. Age-adjusted mortality as a result of heart disease, stroke, or diabetes remains higher in Arabs, whereas age-adjusted incidence and mortality of cancer were higher among Jews. The prevalence of obesity and low physical activity in Israel is considerably higher among Arabs than Jews. Smoking prevalence is highest for Arab men and lowest for Arab women. Health inequalities are also evident by the indicators of socioeconomic position and in subpopulations, such as immigrants from the former Soviet Union, ultra-Orthodox Jews, and Bedouin Arabs. Despite universal health coverage and substantial improvements in the overall health of the Israeli population, substantial inequalities in NCDs persist. These differences might be explained, at least in part, by gaps in social determinants of health. The Ministry of Health has developed comprehensive programmes to reduce these inequalities between the major population groups. Sustained coordinated multisectoral efforts are needed to achieve a greater impact and to address other social inequalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. A crawling robot driven by multi-stable origami

    NASA Astrophysics Data System (ADS)

    Pagano, Alexander; Yan, Tongxi; Chien, Brian; Wissa, A.; Tawfick, S.

    2017-09-01

    Using origami folding to construct and actuate mechanisms and machines offers attractive opportunities from small, scalable, and cheap robots to deployable adaptive structures. This paper presents the design of a bio-inspired origami crawling robot constructed by folding sheets of paper. The origami building block structure is based on the Kresling crease pattern (CP), a chiral tower with a polygonal base, which expands and contracts through coupled longitudinal and rotational motion similar to a screw. We design the origami to have multi-stable structural equilibria which can be tuned by changing the folding CP. Kinematic analysis of these structures based on rigid-plates and hinges at fold lines precludes the shape transformation associated with the bistability of the physical models. To capture the kinematics of the bi-stable origami, the panels’ deformation behavior is modeled utilizing principles of virtual folds. Virtual folds approximate material bending by hinged, rigid panels, which facilitates the development of a kinematic solution via rigid-plate rotation analysis. As such, the kinetics and stability of folded structures are investigated by assigning suitable torsional spring constants to the fold lines. The results presented demonstrate the effect of fold-pattern geometries on the snapping behavior of the bi-stable origami structure based on the Kresling pattern. The crawling robot is presented as a case study for the use of this origami structure to mimic crawling locomotion. The robot is comprised of two origami towers nested inside a paper bellow, and connected by 3D printed end plates. DC motors are used to actuate the expansion and contraction of the internal origami structures to achieve forward locomotion and steering. Beyond locomotion, this simple design can find applications in manipulators, booms, and active structures.

  4. Entropy stable discontinuous interfaces coupling for the three-dimensional compressible Navier-Stokes equations

    NASA Astrophysics Data System (ADS)

    Parsani, Matteo; Carpenter, Mark H.; Nielsen, Eric J.

    2015-06-01

    Non-linear entropy stability and a summation-by-parts (SBP) framework are used to derive entropy stable interior interface coupling for the semi-discretized three-dimensional (3D) compressible Navier-Stokes equations. A complete semi-discrete entropy estimate for the interior domain is achieved combining a discontinuous entropy conservative operator of any order [1,2] with an entropy stable coupling condition for the inviscid terms, and a local discontinuous Galerkin (LDG) approach with an interior penalty (IP) procedure for the viscous terms. The viscous penalty contributions scale with the inverse of the Reynolds number (Re) so that for Re → ∞ their contributions vanish and only the entropy stable inviscid interface penalty term is recovered. This paper extends the interface couplings presented [1,2] and provides a simple and automatic way to compute the magnitude of the viscous IP term. The approach presented herein is compatible with any diagonal norm summation-by-parts (SBP) spatial operator, including finite element, finite volume, finite difference schemes and the class of high-order accurate methods which include the large family of discontinuous Galerkin discretizations and flux reconstruction schemes.

  5. Achieving Guideline-Driven High-Intensity Statin Dose in Cardiac Rehabilitation Patients With Coronary Artery Disease.

    PubMed

    Lin, Jonathan; Banathy, Alexandra; Winters, Carla; Andersen, Lars; Hudson, Cindy; Testa, Heidi; Reardon, Joy; Alagona, Peter

    2018-05-12

    The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends high-intensity statin therapy in patients aged ≤75 y with clinical coronary artery disease (CAD). The effectiveness of cardiac rehabilitation (CR) in lipid management and guideline adherence is unknown. The purpose of this study is to determine whether CR participation affects guideline-driven achievement for statin use. This multicenter retrospective study evaluated statin utilization in patients pre- and post-CR between January 1, 2014, and August 31, 2015. Records for patients with known CAD who completed 18 or more CR sessions were reviewed for statin-drug use and dose before and after CR and documented statin intolerance. Of the total 468 patients, 76% were male with mean age ± SD = 66.0 ± 10.8 y and range of 32 to 89 y. Patients aged ≤75 y (n = 375) showed a modest but statistically significant increase (P = .0006) in high-intensity statin use post-CR (56.3%-61.1%). Males demonstrated a significant increase in high-intensity statin use (P = .0005). Of the 146 patients aged ≤75 y not on high-intensity statins post-CR, only 21 had history of statin intolerance. Of the subjects aged >75 y (n = 93), 91% were already on high- or moderate-intensity statins with no significant change during CR. Patients aged ≤75 y following CR completion increased high-intensity statin use but only by 4.8% and 33% of subjects were inadequately treated. The updated 2013 treatment recommendations simplified statin use, yet substantial data continue to reveal that guideline achievement even post-CR remains limited.

  6. New South Wales annual vaccine-preventable disease report, 2013

    PubMed Central

    Rosewell, Alexander; Spokes, Paula

    2015-01-01

    Aim To describe the epidemiology of selected vaccine-preventable diseases in New South Wales, Australia for 2013. Methods Data from the New South Wales Notifiable Conditions Information Management System were analysed by local health district of residence, age, Aboriginality, vaccination status and organism. Risk factor and vaccination status data were collected by public health units. Results Pertussis notification rates in infants were low, and no infant pertussis deaths were reported. Despite a high number of imported measles cases, there was limited secondary transmission. The invasive meningococcal disease notification rate declined, and disease due to serogroup C remained low and stable. Conclusion Vaccine-preventable diseases were relatively well controlled in New South Wales in 2013, with declining or stable notification rates in most diseases compared with the previous year. PMID:26306215

  7. Indirect Effects of Child Reports of Teacher-Student Relationship on Achievement

    PubMed Central

    Hughes, Jan N.; Wu, Jiun-Yu; Kwok, Oi-man; Villarreal, Victor; Johnson, Audrea Y.

    2012-01-01

    The effect of student-reported teacher-student relationship quality (TSRQ) on academic motivation and achievement was investigated among a sample of 690 academically at risk elementary students (52.8% male). Measures of TSRQ, achievement, and motivation were collected annually for 3 consecutive years, beginning when participants were in grade 2 (24.8%) or grade 3 (74.6%). Child-reported conflict was stable across the 3 years, whereas warmth declined. Boys and African American students reported greater conflict than did girls and Caucasian and Hispanic students. Girls and African American students reported higher warmth than boys and non-African American students. Using path analysis, the authors tested the hypothesis that measures of student motivation in Year 2 mediated the effects of conflict and warmth in Year 1 on reading and math achievement in Year 3. Child-perceived conflict predicted cross-year changes in teacher-rated behavioral engagement, which, in turn, predicted cross-year changes in reading and math achievement. Math competence beliefs also mediated the effect of child- perceived warmth on math achievement. Effects controlled for stability of measures across time, the within-wave association between measures, and baseline measures of IQ and economic adversity. Implications of findings for improving the academic achievement of students at-risk for school failure are discussed. PMID:23226873

  8. Indirect Effects of Child Reports of Teacher-Student Relationship on Achievement.

    PubMed

    Hughes, Jan N; Wu, Jiun-Yu; Kwok, Oi-Man; Villarreal, Victor; Johnson, Audrea Y

    2012-01-01

    The effect of student-reported teacher-student relationship quality (TSRQ) on academic motivation and achievement was investigated among a sample of 690 academically at risk elementary students (52.8% male). Measures of TSRQ, achievement, and motivation were collected annually for 3 consecutive years, beginning when participants were in grade 2 (24.8%) or grade 3 (74.6%). Child-reported conflict was stable across the 3 years, whereas warmth declined. Boys and African American students reported greater conflict than did girls and Caucasian and Hispanic students. Girls and African American students reported higher warmth than boys and non-African American students. Using path analysis, the authors tested the hypothesis that measures of student motivation in Year 2 mediated the effects of conflict and warmth in Year 1 on reading and math achievement in Year 3. Child-perceived conflict predicted cross-year changes in teacher-rated behavioral engagement, which, in turn, predicted cross-year changes in reading and math achievement. Math competence beliefs also mediated the effect of child- perceived warmth on math achievement. Effects controlled for stability of measures across time, the within-wave association between measures, and baseline measures of IQ and economic adversity. Implications of findings for improving the academic achievement of students at-risk for school failure are discussed.

  9. L-Band Transmit/Receive Module for Phase-Stable Array Antennas

    NASA Technical Reports Server (NTRS)

    Andricos, Constantine; Edelstein, Wendy; Krimskiy, Vladimir

    2008-01-01

    Interferometric synthetic aperture radar (InSAR) has been shown to provide very sensitive measurements of surface deformation and displacement on the order of 1 cm. Future systematic measurements of surface deformation will require this capability over very large areas (300 km) from space. To achieve these required accuracies, these spaceborne sensors must exhibit low temporal decorrelation and be temporally stable systems. An L-band (24-cmwavelength) InSAR instrument using an electronically steerable radar antenna is suited to meet these needs. In order to achieve the 1-cm displacement accuracy, the phased array antenna requires phase-stable transmit/receive (T/R) modules. The T/R module operates at L-band (1.24 GHz) and has less than 1- deg absolute phase stability and less than 0.1-dB absolute amplitude stability over temperature. The T/R module is also high power (30 W) and power efficient (60-percent overall efficiency). The design is currently implemented using discrete components and surface mount technology. The basic T/R module architecture is augmented with a calibration loop to compensate for temperature variations, component variations, and path loss variations as a function of beam settings. The calibration circuit consists of an amplitude and phase detector, and other control circuitry, to compare the measured gain and phase to a reference signal and uses this signal to control a precision analog phase shifter and analog attenuator. An architecture was developed to allow for the module to be bidirectional, to operate in both transmit and receive mode. The architecture also includes a power detector used to maintain a transmitter power output constant within 0.1 dB. The use of a simple, stable, low-cost, and high-accuracy gain and phase detector made by Analog Devices (AD8302), combined with a very-high efficiency T/R module, is novel. While a self-calibrating T/R module capability has been sought for years, a practical and cost-effective solution has

  10. Data Acquisition Based on Stable Matching of Bipartite Graph in Cooperative Vehicle–Infrastructure Systems †

    PubMed Central

    Tang, Xiaolan; Hong, Donghui; Chen, Wenlong

    2017-01-01

    Existing studies on data acquisition in vehicular networks often take the mobile vehicular nodes as data carriers. However, their autonomous movements, limited resources and security risks impact the quality of services. In this article, we propose a data acquisition model using stable matching of bipartite graph in cooperative vehicle-infrastructure systems, namely, DAS. Contents are distributed to roadside units, while vehicular nodes support supplementary storage. The original distribution problem is formulated as a stable matching problem of bipartite graph, where the data and the storage cells compose two sides of vertices. Regarding the factors relevant with the access ratio and delay, the preference rankings for contents and roadside units are calculated, respectively. With a multi-replica preprocessing algorithm to handle the potential one-to-many mapping, the matching problem is addressed in polynomial time. In addition, vehicular nodes carry and forward assistant contents to deliver the failed packets because of bandwidth competition. Furthermore, an incentive strategy is put forward to boost the vehicle cooperation and to achieve a fair bandwidth allocation at roadside units. Experiments show that DAS achieves a high access ratio and a small storage cost with an acceptable delay. PMID:28594359

  11. Safety of stable isotope use.

    PubMed

    Koletzko, B; Sauerwald, T; Demmelmair, H

    1997-08-01

    The increased employment of stable isotope tracers for diagnostic and research purposes frequently raises questions on potential risks associated with their use, which is of particular importance in the paediatric age group. Biological effects and the potential of adverse events has been evaluated in a large number of animal and, in part, also human studies. Possible differences in physical, chemical and biochemical behaviour resulting in kinetic and thermodynamic isotope effects between stable isotopes of the same element are related to the relative differences in atomic weight. Deuterium (2H), which differs markedly in mass from the predominant hydrogen isotope 1H, may induce serious side-effects at high concentrations in body fluids. The threshold dose for the occurrence of side-effects lies well above the usual tracer dosages for clinical use. In contrast to deuterium, heavier stable isotopes such as 13C, 15N or 18O that differ relatively little in mass from the predominant isotopes such as 12C, does not show any adverse biological effects even at highest enrichments. The doses of stable isotope tracer substances that are used for clinical diagnostic and research purposes appear safe and without any adverse effects. Stable isotope tracers should only be used in children if the trace is safe at the doses applied, and tracer is chemically pure and stable. In the case of intravenous application, the tracer preparation must also be sterile and pyrogen free.

  12. [Circular RNA in human disease and their potential clinic significance].

    PubMed

    Chen, Yonghua; Li, Cheng; Tan, Chunlu; Mai, Gang; Liu, Xubao

    2017-02-10

    Circular RNAs (circ RNAs) are a novel type of RNA that, unlike linear RNAs, form a covalently closed continuous loop and are highly represented in the eukaryotic transcriptome. They share a stable structure, high expression and often exhibit tissue/developmental-stage-specific expression. Emerging evidence indicates that circRNAs might play important roles in human disease, such as cancer, neurological disorders and atherosclerotic vascular disease risk. The huge potentials of circRNAs are recently being discovered from the laboratory to the clinic. CircRNAs might be developed as a potential novel and stable biomarker and potential drugs used in disease diagnosis and treatment. Here, we review the current understanding of the roles of circRNAs in human disease and their potential clinic significance in disease.

  13. Stable configurations in social networks

    NASA Astrophysics Data System (ADS)

    Bronski, Jared C.; DeVille, Lee; Ferguson, Timothy; Livesay, Michael

    2018-06-01

    We present and analyze a model of opinion formation on an arbitrary network whose dynamics comes from a global energy function. We study the global and local minimizers of this energy, which we call stable opinion configurations, and describe the global minimizers under certain assumptions on the friendship graph. We show a surprising result that the number of stable configurations is not necessarily monotone in the strength of connection in the social network, i.e. the model sometimes supports more stable configurations when the interpersonal connections are made stronger.

  14. Stable Spheromaks with Profile Control

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Fowler, T K; Jayakumar, R

    A spheromak equilibrium with zero edge current is shown to be stable to both ideal MHD and tearing modes that normally produce Taylor relaxation in gun-injected spheromaks. This stable equilibrium differs from the stable Taylor state in that the current density j falls to zero at the wall. Estimates indicate that this current profile could be sustained by non-inductive current drive at acceptable power levels. Stability is determined using the NIMROD code for linear stability analysis. Non-linear NIMROD calculations with non-inductive current drive could point the way to improved fusion reactors.

  15. Role of Neurotrophic Factors in Parkinson's Disease.

    PubMed

    Tome, Diogo; Fonseca, Carla Pais; Campos, Filipa Lopes; Baltazar, Graca

    2017-01-01

    Parkinson's disease is an age-associated progressive neurodegenerative disorder that has gained crescent social and economic impact due to the aging of the western society. All current therapies are symptomatic and fail to reverse or halt the progression of dopaminergic neurons loss. The discovery of the capability of neurotrophic factors to protect these neurons lead numerous research groups to focus their efforts in developing therapies aiming at promoting the control of Parkinson´s disease through the delivery of neurotrophic factors to the brain or by boosting their endogenous levels. Both strategies were successful in inducing protection of dopaminergic neurons and motor recovery in preclinical models of the disease. Contrariwise, very limited success was obtained in clinical studies, where glial cell line-derived neurotrophic factor and neurturin were the neurotrophic factors of choice for Parkinson's disease therapy. These drawbacks motivate the development of novel forms of delivery or the modification of the injected molecules aiming at providing a more stable and effective administration with improved diffusion in the target tissue, and without the immune responses observed in the earliest clinical studies. Although promising results were obtained with some of these new approaches performed in experimental models of the disease, they were not yet tested in human studies. In this review, we present the current knowledge on neurotrophic factors and their role in Parkinson's disease, focusing on the strategies that have been developed to increase their levels in target areas of the brain to achieve protection of dopaminergic neurons and motor behaviour recovery. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  16. A Practical Cryogen-Free CO2 Purification and Freezing Technique for Stable Isotope Analysis.

    PubMed

    Sakai, Saburo; Matsuda, Shinichi

    2017-04-18

    Since isotopic analysis by mass spectrometry began in the early 1900s, sample gas for light-element isotopic measurements has been purified by the use of cryogens and vacuum-line systems. However, this conventional purification technique can achieve only certain temperatures that depend on the cryogens and can be sustained only as long as there is a continuous cryogen supply. Here, we demonstrate a practical cryogen-free CO 2 purification technique using an electrical operated cryocooler for stable isotope analysis. This approach is based on portable free-piston Stirling cooling technology and controls the temperature to an accuracy of 0.1 °C in a range from room temperature to -196 °C (liquid-nitrogen temperature). The lowest temperature can be achieved in as little as 10 min. We successfully purified CO 2 gas generated by carbonates and phosphoric acid reaction and found its sublimation point to be -155.6 °C at 0.1 Torr in the vacuum line. This means that the temperature required for CO 2 trapping is much higher than the liquid-nitrogen temperature. Our portable cooling system offers the ability to be free from the inconvenience of cryogen use for stable isotope analysis. It also offers a new cooling method applicable to a number of fields that use gas measurements.

  17. Achieving stable remission with maintenance electroconvulsive therapy in a patient with treatment-resistant schizophrenia: A case report.

    PubMed

    Moeller, Sebastian; Kalkwarf, Neele; Lücke, Caroline; Ortiz, Diana; Jahn, Sonja; Först, Christiane; Braun, Niclas; Philipsen, Alexandra; Müller, Helge H O

    2017-12-01

    Up to one third of all schizophrenic patients are classified as having treatment-resistant schizophrenia (TRS). This subgroup faces remarkable medical and psychosocial damages, and pharmacotherapy is often limited due to nonresponse and/or side effects. Maintenance electroconvulsive therapy (M-ECT) might be effective in TRS. We present a case of a 26-year-old male patient with a TRS. He received a treatment series of ECT sessions and a course of 24 M-ECTs. The entire treatment was tolerated without significant side effects. Moreover, the Psychotic Symptom Rating Scale (PSYRATS) scores for both positive and negative symptoms decreased and remained stable over the course of M-ECT. Because of the remarkable improvement in the negative and positive symptom clusters, we propose systematic examinations in the field of M-ECT in TRS patients. These studies should integrate long-term outcome and tolerance measurements, gaining insight into the optimal duration of treatment for this indication.

  18. Nocturnal cough in children with stable cystic fibrosis.

    PubMed

    van der Giessen, Lianne; Loeve, Martine; de Jongste, Johan; Hop, Wim; Tiddens, Harm

    2009-09-01

    To date no studies have been published on nocturnal cough frequency in children with stable CF. Aim of the study was to assess nocturnal cough frequency in children with CF. In addition nocturnal cough frequency was correlated with parameters of disease severity. During two nights cough was recorded with a digital audio recorder in 25 patients (mean age 13 years; range 6-19) with clinically stable CF. In addition oxygen saturation was measured. The day following the recording spirometry was carried out. CT scores were obtained from the most recent routine CT scan. Cough was expressed in cough seconds (csec) and in cough seconds per hour (csec/hr). Data shown are median values and interquartile range (IQR). First night: 8 csec (IQR 3-52); 0.9 csec/hr (IQR 0.3-6.1) Second night: 6 csec (IQR 2-32); 0.6 csec/hr (IQR 0.1-3.4). Csec in the 1st night did not correlate significantly with csec in the 2nd night. Only for the 2nd night a strong correlation was found between csec/hr and the FEV1%pred (r(s) = -0.75, P < 0.001) and FEF(75) %pred (r(s) = -0.71, P < 0.001). Bronchiectasis score correlated borderline with the mean csec/hr of both nights (r(s) = 0.39, P = 0.08). During both nights cough was significantly higher in the first hour of sleep (P < or = 0.04). Frequency of nocturnal coughing in children with CF was higher than that described for normal children. Nocturnal cough tended to be more severe in children with more advanced CF lung disease. Nocturnal cough was more severe in the first hour of sleep and varied from night-to-night. Copyright 2009 Wiley-Liss, Inc.

  19. A randomised trial of the pharmacodynamic and pharmacokinetic effects of ticagrelor compared with clopidogrel in Hispanic patients with stable coronary artery disease.

    PubMed

    Price, Matthew J; Clavijo, Leonardo; Angiolillo, Dominick J; Carlson, Glenn; Caplan, Richard; Teng, Renli; Maya, Juan

    2015-01-01

    The objective was to compare the pharmacodynamic (PD) and pharmacokinetic (PK) effects of ticagrelor with clopidogrel among subjects of Hispanic ethnicity, as the PD and PK effects of antiplatelet agents among Hispanics are not specifically known. This was a randomised, open-label, crossover PD/PK study of 40 Hispanic subjects with stable coronary artery disease (CAD). Subjects were allocated to either ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose (MD) followed by clopidogrel 600 mg LD/75 mg once-daily MD with an intervening washout period, or vice versa. The primary endpoint was on-treatment reactivity (OTR) at 2 h post-LD according to the VerifyNow P2Y12 test. OTR was significantly lower at 2 h post-LD with ticagrelor compared with clopidogrel (34 PRU vs. 201 PRU, least square means difference = -167 PRU [95 % CI, -197, -137], P < 0.001). OTR was also lower with ticagrelor at 30 min and 8 h post-LD (P < 0.001). The greater magnitude of antiplatelet effect with ticagrelor persisted after 7 days of MD (52 PRU [95 % CI, 30, 73] vs. 182 PRU [95 % CI, 160, 205], P < 0.001). Mean plasma concentration of ticagrelor and its active metabolite were greatest at 2 h post-LD, with similar levels at 2 h post-MD after 7 days of MD. Among Hispanic subjects with stable CAD, ticagrelor provides a more rapid onset of platelet inhibition and a significantly greater antiplatelet effect compared with clopidogrel during both the loading and maintenance phases of treatment.

  20. A maximally stable extremal region based scene text localization method

    NASA Astrophysics Data System (ADS)

    Xiao, Chengqiu; Ji, Lixin; Gao, Chao; Li, Shaomei

    2015-07-01

    Text localization in natural scene images is an important prerequisite for many content-based image analysis tasks. This paper proposes a novel text localization algorithm. Firstly, a fast pruning algorithm is designed to extract Maximally Stable Extremal Regions (MSER) as basic character candidates. Secondly, these candidates are filtered by using the properties of fitting ellipse and the distribution properties of characters to exclude most non-characters. Finally, a new extremal regions projection merging algorithm is designed to group character candidates into words. Experimental results show that the proposed method has an advantage in speed and achieve relatively high precision and recall rates than the latest published algorithms.

  1. Producing High-Performance, Stable, Sheared-Flow Z-Pinches in the FuZE project

    NASA Astrophysics Data System (ADS)

    Golingo, R. P.; Shumlak, U.,; Nelson, B. A.; Claveau, E. L.; Forbes, E. G.; Stepanov, A. D.; Weber, T. R.; Zhang, Y.; McLean, H. S.; Tummel, K. K.; Higginson, D. P.; Schmidt, A. E.; University of Washington (UW) Collaboration; Lawrence Livermore National Laboratory (LLNL) Collaboration

    2017-10-01

    The Fusion Z-Pinch Experiment (FuZE) has made significant strides towards generating high-performance, stable Z-pinch plasmas with goals of ne = 1018 cm-3 and T =1 keV. The Z-pinch plasmas are stabilized with a sheared axial flow that is driven by a coaxial accelerator. The new FuZE device has been constructed and reproduces the major scientific achievements the ZaP project at the University of Washington; ne = 1016 cm-3,T = 100 eV, r<1 cm, and tstable >20 μs. These parameters are measured with an array of magnetic field probes, spectroscopy, and fast framing cameras. The plasma parameters are achieved using a small fraction of the maximum energy storage and gas injection capability of the FuZE device. Higher density, ne = 5×1017 cm-3, and temperature, T = 500 eV, Z-pinch plasmas are formed by increasing the pinch current. At the higher voltages and currents, the ionization rates in the accelerator increase. By modifying the neutral gas profile in the accelerator, the plasma flow from the accelerator is maintained, driving the flow shear. Formation and sustainment of the sheared-flow Z-pinch plasma will be discussed. Experimental data demonstrating high performance plasmas in a stable Z-pinches will be shown. This work is supported by an award from US ARPA-E.

  2. Critical advancements in achieving high power and stable nonprecious metal catalyst–based MEAs for real-world proton exchange membrane fuel cell applications

    PubMed Central

    Zhou, Yingjie; Bai, Kyoung

    2018-01-01

    Despite great progress in the development of nonprecious metal catalysts (NPMCs) over the past several decades, the performance and stability of these promising catalysts have not yet achieved commercial readiness for proton exchange membrane fuel cells (PEMFCs). Through rational design of the cathode catalyst layer (CCL), we demonstrate the highest reported performance for an NPMC-based membrane electrode assembly (MEA), achieving a peak power of 570 mW/cm2 under air. This record performance is achieved using a precommercial catalyst for which nearly all pores are <3 nm in diameter, challenging previous beliefs regarding the need for larger catalyst pores to achieve high current densities. This advance is achieved at industrially relevant scales (50 cm2 MEA) using a precommercial NPMC. In situ electrochemical analysis of the CCLs is also used to help gain insight into the degradation mechanism observed during galvanostatic testing. Overall, the performance of this NPMC-based MEA has achieved commercial readiness and will be introduced into an NPMC-based product for portable power applications. PMID:29582018

  3. Validation of α-Synuclein as a CSF Biomarker for Sporadic Creutzfeldt-Jakob Disease.

    PubMed

    Llorens, Franc; Kruse, Niels; Karch, André; Schmitz, Matthias; Zafar, Saima; Gotzmann, Nadine; Sun, Ting; Köchy, Silja; Knipper, Tobias; Cramm, Maria; Golanska, Ewa; Sikorska, Beata; Liberski, Pawel P; Sánchez-Valle, Raquel; Fischer, Andre; Mollenhauer, Brit; Zerr, Inga

    2018-03-01

    The analysis of cerebrospinal fluid (CSF) biomarkers gains importance in the differential diagnosis of prion diseases. However, no single diagnostic tool or combination of them can unequivocally confirm prion disease diagnosis. Electrochemiluminescence (ECL)-based immunoassays have demonstrated to achieve high diagnostic accuracy in a variety of sample types due to their high sensitivity and dynamic range. Quantification of CSF α-synuclein (a-syn) by an in-house ECL-based ELISA assay has been recently reported as an excellent approach for the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD), the most prevalent form of human prion disease. In the present study, we validated a commercially available ECL-based a-syn ELISA platform as a diagnostic test for correct classification of sCJD cases. CSF a-syn was analysed in 203 sCJD cases with definite diagnosis and in 445 non-CJD cases. We investigated reproducibility and stability of CSF a-syn and made recommendations for its analysis in the sCJD diagnostic workup. A sensitivity of 98% and a specificity of 97% were achieved when using an optimal cut-off of 820 pg/mL a-syn. Moreover, we were able to show a negative correlation between a-syn levels and disease duration suggesting that CSF a-syn may be a good prognostic marker for sCJD patients. The present study validates the use of a-syn as a CSF biomarker of sCJD and establishes the clinical and pre-analytical parameters for its use in differential diagnosis in clinical routine. Additionally, the current test presents some advantages compared to other diagnostic approaches: it is fast, economic, requires minimal amount of CSF and a-syn levels are stable along disease progression.

  4. [Replacement of plaque by buccal mucosa in the treatment of Peyronieś disease: a report of 27 cases].

    PubMed

    Liu, Ben; Zhu, Xuan-Wen; Zhong, Da-Chuan; Shen, Bo-Hua; Jiang, Hai; Xie, Li-Ping

    2009-01-01

    To evaluate the clinical results of the replacement of plaque by buccal mucosa in the treatment of Peyronie's disease. We performed surgical replacement of the plaque by free autograft of buccal mucosa on 27 patients with Peyronie's disease, ranging in age from 24 to 72 years (mean 53), varying in disease course between 1 and 13 years, with a penile curvature angle of 30 degrees - 80 degrees in erection. Of the total number, 15 patients had the plaque located in the dorsal root, 6 in the dorsal shaft, 3 in the subcoronal shaft and 3 in the ventral shaft of the penis; 24 had 1 plaque, 2 had 2 and 1 had 3, ranging in size from 0.7 cm x 0.7 cm to 1.6 cm x 1.0 cm. Satisfactory results were achieved in all the cases, with no such complications as hematoma, infection, oral numbness, and tightness of the mouth. Of the 24 cases that were followed up for 0.5 to 7 years, complete straightening of the penis was achieved in 21, slight residual curvature (< 15 degrees) was noted in 3, a little shortening of the penis (< 1 cm) in 2, and erectile pain in 3. Buccal mucosa, with a stable elasticity and no shrinkage, can be recommended for wide use in the surgical treatment of Peyronie's disease.

  5. Advances in stable isotope assisted labeling strategies with information science.

    PubMed

    Kigawa, Takanori

    2017-08-15

    Stable-isotope (SI) labeling of proteins is an essential technique to investigate their structures, interactions or dynamics by nuclear magnetic resonance (NMR) spectroscopy. The assignment of the main-chain signals, which is the fundamental first step in these analyses, is usually achieved by a sequential assignment method based on triple resonance experiments. Independently of the triple resonance experiment-based sequential assignment, amino acid-selective SI labeling is beneficial for discriminating the amino acid type of each signal; therefore, it is especially useful for the signal assignment of difficult targets. Various combinatorial selective labeling schemes have been developed as more sophisticated labeling strategies. In these strategies, amino acids are represented by combinations of SI labeled samples, rather than simply assigning one amino acid to one SI labeled sample as in the case of conventional amino acid-selective labeling. These strategies have proven to be useful for NMR analyses of difficult proteins, such as those in large complex systems, in living cells, attached or integrated into membranes, or with poor solubility. In this review, recent advances in stable isotope assisted labeling strategies will be discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Li 2OHCl crystalline electrolyte for stable metallic lithium anodes

    DOE PAGES

    Hood, Zachary D.; Wang, Hui; Samuthira Pandian, Amaresh; ...

    2016-01-22

    In a classic example of stability from instability, we show that Li 2OHCl solid electrolyte forms a stable solid electrolyte interface (SEI) with metallic lithium anode. The Li 2OHCl solid electrolyte can be readily achieved through simple mixing of air-stable LiOH and LiCl precursors with a mild processing temperature under 400 °C. Additionally, we show that continuous, dense Li 2OHCl membranes can be fabricated at temperatures less than 400 °C, standing in great contrast to current processing temperatures of over 1600 °C for most oxide-based solid electrolytes. The ionic conductivity and Arrhenius activation energy were explored for the LiOH-LiCl systemmore » of crystalline solid electrolytes where Li 2OHCl with increased crystal defects was found to have the highest ionic conductivity and reasonable Arrhenius activation energy. The Li 2OHCl solid electrolyte displays stability against metallic lithium, even in extreme conditions past the melting point of lithium metal. Furthermore, to understand this excellent stability, we show that SEI formation is critical in stabilizing the interface between metallic lithium and the Li 2OHCl solid electrolyte.« less

  7. Achieving a stable time response in polymeric radiation sensors under charge injection by X-rays.

    PubMed

    Intaniwet, Akarin; Mills, Christopher A; Sellin, Paul J; Shkunov, Maxim; Keddie, Joseph L

    2010-06-01

    Existing inorganic materials for radiation sensors suffer from several drawbacks, including their inability to cover large curved areas, lack of tissue-equivalence, toxicity, and mechanical inflexibility. As an alternative to inorganics, poly(triarylamine) (PTAA) diodes have been evaluated for their suitability for detecting radiation via the direct creation of X-ray induced photocurrents. A single layer of PTAA is deposited on indium tin oxide (ITO) substrates, with top electrodes selected from Al, Au, Ni, and Pd. The choice of metal electrode has a pronounced effect on the performance of the device; there is a direct correlation between the diode rectification factor and the metal-PTAA barrier height. A diode with an Al contact shows the highest quality of rectifying junction, and it produces a high X-ray photocurrent (several nA) that is stable during continuous exposure to 50 kV Mo Kalpha X-radiation over long time scales, combined with a high signal-to-noise ratio with fast response times of less than 0.25 s. Diodes with a low band gap, 'Ohmic' contact, such as ITO/PTAA/Au, show a slow transient response. This result can be explained by the build-up of space charge at the metal-PTAA interface, caused by a high level of charge injection due to X-ray-induced carriers. These data provide new insights into the optimum selection of metals for Schottky contacts on organic materials, with wider applications in light sensors and photovoltaic devices.

  8. Stable and selective self-assembly of α-lipoic acid on Ge(001) for biomolecule immobilization

    NASA Astrophysics Data System (ADS)

    Kazmierczak, M.; Flesch, J.; Mitzloff, J.; Capellini, G.; Klesse, W. M.; Skibitzki, O.; You, C.; Bettenhausen, M.; Witzigmann, B.; Piehler, J.; Schroeder, T.; Guha, S.

    2018-05-01

    We demonstrate a novel method for the stable and selective surface functionalization of germanium (Ge) embedded in silicon dioxide. The Ge(001) surface is functionalized using α-lipoic acid (ALA), which can potentially be utilized for the immobilization of a wide range of biomolecules. We present a detailed pH-dependence study to establish the effect of the incubation pH value on the adsorption layer of the ALA molecules. A threshold pH value for functionalization is identified, dividing the examined pH range into two regions. Below a pH value of 7, the formation of a disordered ALA multilayer is observed, whereas a stable well-ordered ALA mono- to bi-layer on Ge(001) is achieved at higher pH values. Furthermore, we analyze the stability of the ALA layer under ambient conditions, revealing the most stable functionalized Ge(001) surface to effectively resist oxidation for up to one week. Our established functionalization method paves the way towards the successful immobilization of biomolecules in future Ge-based biosensors.

  9. Development of molecular markers for breeding for disease resistant crops

    USDA-ARS?s Scientific Manuscript database

    Rice blast disease caused by the filamentous ascomycetes fungus Magnaporthe oryzae and sheath blight disease caused by the soil borne fungus Rhizocotonia solani are the two major rice diseases that threaten stable rice production in the USA and worldwide. These two diseases have been managed with a ...

  10. Coronary artery disease (image)

    MedlinePlus

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the ... blood to the heart can slow or stop, causing chest pain (stable ...

  11. Ethnicity and Onset of Cardiovascular Disease: A CALIBER Study

    ClinicalTrials.gov

    2017-06-07

    Abdominal Aortic Aneurysm; Coronary Heart Disease; Sudden Cardiac Death; Intracerebral Haemorrhage; Heart Failure; Ischemic Stroke; Myocardial Infarction; Stroke; Peripheral Arterial Disease; Stable Angina Pectoris; Subarachnoid Haemorrhage; Transient Ischemic Attack; Unstable Angina; Cardiac Arrest

  12. Tellurium Stable Isotope Fractionation in Chondritic Meteorites

    NASA Astrophysics Data System (ADS)

    Fehr, M. A.; Hammond, S. J.; Parkinson, I. J.

    2014-09-01

    New Te double spike procedures were set up to obtain high-precision accurate Te stable isotope data. Tellurium stable isotope data for 16 chondrite falls are presented, providing evidence for significant Te stable isotope fractionation.

  13. Non-Invasive Ventilation (NIV) and Homeostatic Model Assessment (HOMA) Index in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients with Chronic Hypercapnic Respiratory Failure: A Pilot Study.

    PubMed

    Dimoulis, Andreas; Pastaka, Chaido; Tsolaki, Vasiliki; Tsilioni, Irini; Pournaras, Spyridon; Liakos, Nikolaos; Georgoulias, Panagiotis; Gourgoulianis, Konstantinos

    2015-08-01

    The effects of Non-invasive Ventilation (NIV) on Insulin Resistance (IR) in stable Chronic Obstructive Pulmonary Disease (COPD) patients have not been fully explored. The aim of this study was to assess the effects of NIV on IR and adiponectin levels during one year application of NIV in stable COPD patients with Chronic Hypercapnic Respiratory Failure. Twenty-five (25) stable COPD patients with Chronic Hypercapnic Respiratory Failure and with no self-reported comorbidities completed the study. NIV was administered in the spontaneous/timed mode via a full face mask using a bi-level positive airway pressure system. Spirometry, blood pressure, arterial blood gases, dyspnea, daytime sleepiness, serum fasting glucose and insulin levels were assessed. IR was assessed with the calculation of the Homeostatic Model Assessment (HOMA) index. Adiponectin was measured with radioimmunoassay. Study participants were re-evaluated on the first, third, sixth, ninth and twelfth month after the initial evaluation. There was a significant improvement in FEV1 values from the first month (34.1 ± 11.6% vs 37 ± 12.3%, p = 0.05). There was a significant decrease in IR by the ninth month of NIV use (3.4 ± 2.3 vs 2.2 ± 1.4, p < 0.0001), while adiponectin levels significantly improved from the first month of NIV use. Stepwise regression analysis revealed that baseline HOMA index was associated with paCO2 (β = 0.07 ± 0.02, p = 0.001), while baseline adiponectin levels were associated with FVC (β = 0.05 ± 0.02, p = 0.035) and the concentration of serum bicarbonate (HCO3-) (-β = 0.18 ± 0.06, p = 0.002). Insulin sensitivity and glucose metabolism as well as adiponectin levels improved along with the improvements in respiratory failure.

  14. Sex Differences in Platelet Reactivity and Cardiovascular and Psychological Response to Mental Stress in Patients With Stable Ischemic Heart Disease

    PubMed Central

    Samad, Zainab; Boyle, Stephen; Ersboll, Mads; Vora, Amit N.; Zhang, Ye; Becker, Richard C.; Williams, Redford; Kuhn, Cynthia; Ortel, Thomas L.; Rogers, Joseph G.; O’Connor, Christopher; Velazquez, Eric J.; Jiang, Wei

    2016-01-01

    BACKGROUND Although emotional stress is associated with ischemic heart disease (IHD) and related clinical events, sex-specific differences in the psychobiological response to mental stress have not been clearly identified. OBJECTIVES We aimed to study the differential psychological and cardiovascular responses to mental stress between male and female patients with stable IHD. METHODS Patients with stable IHD enrolled in the REMIT (Responses of Mental Stress–Induced Myocardial Ischemia to Escitalopram) study underwent psychometric assessments, transthoracic echocardiography, and platelet aggregation studies at baseline and after 3 mental stress tasks. Mental stress–induced myocardial ischemia (MSIMI) was defined as the development or worsening of regional wall motion abnormality, reduction of left ventricular ejection fraction (LVEF) ≥8% by transthoracic echocardiography, and/or ischemic ST-segment change on electrocardiogram during 1 or more of the 3 mental stress tasks. RESULTS In the 310 participants with known IHD (18% women, 82% men), most baseline characteristics were similar between women and men (including heart rate, blood pressure, and LVEF), although women were more likely to be nonwhite, living alone (p < 0.001), and unmarried (p < 0.001); they also had higher baseline depression and anxiety (p < 0.05). At rest, women had heightened platelet aggregation responses to serotonin (p = 0.007) and epinephrine (p = 0.004) compared with men. Following mental stress, women had more MSIMI (57% vs. 41%, p < 0.04), expressed more negative (p = 0.02) and less positive emotion (p < 0.001), and demonstrated higher collagen-stimulated platelet aggregation responses (p = 0.04) than men. Men were more likely than women to show changes in traditional physiological measures, such as blood pressure (p < 0.05) and double product. CONCLUSIONS In this exploratory analysis, we identified clear, measurable, and differential responses to mental stress in women and men

  15. Oral Huangqi Formulae for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Wu, Lei; Chen, Yuanbin; Xu, Yinji; Guo, Xinfeng; Li, Xiaoyan; Zhang, Anthony Lin; May, Brian H.; Xue, Charlie Changli; Wen, Zehuai; Lin, Lin

    2013-01-01

    Objective. To evaluate the efficacy and safety of oral Huangqi formulae for the treatment of stable COPD. Methods. The major databases were searched until September 2010 and supplemented with a manual search. Randomized controlled trials (RCTs) of oral Huangqi formulae that reported on lung function, St. George's Respiratory Questionnaire, symptom improvement and/or frequency of exacerbations were extracted by two reviewers. The Cochrane tool was used for the assessment of risk of bias in the included trials. Data were analyzed with RevMan 5.1.2 software. Results. 25 RCTs (1,661 participants) were included. Compared with conventional therapy (CT) alone, oral Huangqi formulae plus CT increased FEV1, and a similar result was found comparing Huangqi formulae with no treatment. Improvements in SGRQ total score, COPD-related symptoms and reduction of frequency of exacerbations were found in patients receiving Huangqi formulae plus CT compared to those receiving CT alone or CT plus placebo. No serious adverse events were reported. However, there were some methodological inadequacies in the included studies. Conclusions. The benefits of Huangqi formulae for stable COPD were promising, but its efficacy and safety have not been established due to methodological weakness and possible bias in the reported results. Further rigorously designed studies are warranted. PMID:23606889

  16. Serum levels of C-reactive protein in patients with stable coronary artery disease: JUPITER in perspective.

    PubMed

    Saely, Christoph H; Rein, Philipp; Vonbank, Alexander; Drexel, Heinz

    2010-10-29

    The JUPITER trial has recently demonstrated an outstanding reduction of cardiovascular events by 20 mg rosuvastatin/day in subjects with high CRP who were apparently healthy at baseline. However, absence of atherosclerosis in JUPITER was based on the subjects' history and not proven objectively. To put the results of JUPITER in perspective, we evaluated serum CRP in a consecutive series of 703 statin-naïve Caucasian patients with angiographically proven stable CAD. From these stable CAD patients, only 69.2% met the ≥2.0 mg/l serum CRP inclusion criterion of the JUPITER trial. Median CRP [interquartile range] in our CAD patients was 3.3 [1.6-6.6] mg/l, which was significantly (p<0.001) lower than the median CRP in JUPITER (4.2 mg/l). Our results point to considerable subclinical atherosclerosis in the patients studied in JUPITER. The impressive results of that trial may not be generalizable to healthy populations all over the world. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  17. The nonlinear model for emergence of stable conditions in gas mixture in force field

    NASA Astrophysics Data System (ADS)

    Kalutskov, Oleg; Uvarova, Liudmila

    2016-06-01

    The case of M-component liquid evaporation from the straight cylindrical capillary into N - component gas mixture in presence of external forces was reviewed. It is assumed that the gas mixture is not ideal. The stable states in gas phase can be formed during the evaporation process for the certain model parameter valuesbecause of the mass transfer initial equationsnonlinearity. The critical concentrations of the resulting gas mixture components (the critical component concentrations at which the stable states occur in mixture) were determined mathematically for the case of single-component fluid evaporation into two-component atmosphere. It was concluded that this equilibrium concentration ratio of the mixture components can be achieved by external force influence on the mass transfer processes. It is one of the ways to create sustainable gas clusters that can be used effectively in modern nanotechnology.

  18. Longitudinal study of low and high achievers in early mathematics.

    PubMed

    Navarro, Jose I; Aguilar, Manuel; Marchena, Esperanza; Ruiz, Gonzalo; Menacho, Inmaculada; Van Luit, Johannes E H

    2012-03-01

    Longitudinal studies allow us to identify, which specific maths skills are weak in young children, and whether there is a continuing weakness in these areas throughout their school years. This 2-year study investigated whether certain socio-demographic variables affect early mathematical competency in children aged 5-7 years. A randomly selected sample of 127 students (64 female; 63 male) participated. At the start of the study, the students were approximately 5 years old (M= 5.2; SD= 0.28; range = 4.5-5.8). The students were assessed using the Early Numeracy Test and then allocated to a high (n= 26), middle (n= 76), or low (n= 25) achievers group. The same children were assessed again with the Early Numeracy Test at 6 and 7 years old, respectively. Eight socio-demographic characteristics were also evaluated: family model, education of the parent(s), job of the parent(s), number of family members, birth order, number of computers at home, frequency of teacher visits, and hours watching television. Early Numeracy Test scores were more consistent for the high-achievers group than for the low-achievers group. Approximately 5.5% of low achievers obtained low scores throughout the study. A link between specific socio-demographic characteristics and early achievement in mathematics was only found for number of computers at home. The level of mathematical ability among students aged 5-7 years remains relatively stable regardless of the initial level of achievement. However, early screening for mathematics learning disabilities could be useful in helping low-achieving students overcome learning obstacles. ©2011 The British Psychological Society.

  19. Establishment of Stable, Cell-Mediated Immunity that Makes "Susceptible" Mice Resistant to Leishmania major

    NASA Astrophysics Data System (ADS)

    Bretscher, Peter A.; Wei, Guojian; Menon, Juthika N.; Bielefeldt-Ohmann, Helle

    1992-07-01

    Cell-mediated, but not antibody-mediated, immune responses protect humans against certain pathogens that produce chronic diseases such as leishmaniasis. Effective vaccination against such pathogens must therefore produce an immunological "imprint" so that stable, cell-mediated immunity is induced in all individuals after natural infection. BALB/c mice "innately susceptible" to Leishmania major produce antibodies after substantial infection. In the present study, "susceptible" mice injected with a small number of parasites mounted a cell-mediated response and acquired resistance to a larger, normally pathogenic, challenge. This vaccination strategy may be applicable in diseases in which protection is dependent on cell-mediated immunity.

  20. Eculizumab for dense deposit disease and C3 glomerulonephritis.

    PubMed

    Bomback, Andrew S; Smith, Richard J; Barile, Gaetano R; Zhang, Yuzhou; Heher, Eliot C; Herlitz, Leal; Stokes, M Barry; Markowitz, Glen S; D'Agati, Vivette D; Canetta, Pietro A; Radhakrishnan, Jai; Appel, Gerald B

    2012-05-01

    The principle defect in dense deposit disease and C3 glomerulonephritis is hyperactivity of the alternative complement pathway. Eculizumab, a monoclonal antibody that binds to C5 to prevent formation of the membrane attack complex, may prove beneficial. In this open-label, proof of concept efficacy and safety study, six subjects with dense deposit disease or C3 glomerulonephritis were treated with eculizumab every other week for 1 year. All had proteinuria >1 g/d and/or AKI at enrollment. Subjects underwent biopsy before enrollment and repeat biopsy at the 1-year mark. The subjects included three patients with dense deposit disease (including one patient with recurrent dense deposit disease in allograft) and three patients with C3 glomerulonephritis (including two patients with recurrent C3 glomerulonephritis in allograft). Genetic and complement function testing revealed a mutation in CFH and MCP in one subject each, C3 nephritic factor in three subjects, and elevated levels of serum membrane attack complex in three subjects. After 12 months, two subjects showed significantly reduced serum creatinine, one subject achieved marked reduction in proteinuria, and one subject had stable laboratory parameters but histopathologic improvements. Elevated serum membrane attack complex levels normalized on therapy and paralleled improvements in creatinine and proteinuria. Clinical and histopathologic data suggest a response to eculizumab in some but not all subjects with dense deposit disease and C3 glomerulonephritis. Elevation of serum membrane attack complex before treatment may predict response. Additional research is needed to define the subgroup of dense deposit disease/C3 glomerulonephritis patients in whom eculizumab therapy can be considered.

  1. Uses of stable isotopes in fish ecology

    EPA Science Inventory

    Analyses of fish tissues (other than otoliths) for stable isotope ratios can provide substantial information on fish ecology, including physiological ecology. Stable isotopes of nitrogen and carbon frequently are used to determine the mix of diet sources for consumers. Stable i...

  2. Biochemical and Spectroscopic Characterization of Highly Stable Photosystem II Supercomplexes from Arabidopsis*

    PubMed Central

    Crepin, Aurelie; Santabarbara, Stefano; Caffarri, Stefano

    2016-01-01

    Photosystem II (PSII) is a large membrane supercomplex involved in the first step of oxygenic photosynthesis. It is organized as a dimer, with each monomer consisting of more than 20 subunits as well as several cofactors, including chlorophyll and carotenoid pigments, lipids, and ions. The isolation of stable and homogeneous PSII supercomplexes from plants has been a hindrance for their deep structural and functional characterization. In recent years, purification of complexes with different antenna sizes was achieved with mild detergent solubilization of photosynthetic membranes and fractionation on a sucrose gradient, but these preparations were only stable in the cold for a few hours. In this work, we present an improved protocol to obtain plant PSII supercomplexes that are stable for several hours/days at a wide range of temperatures and can be concentrated without degradation. Biochemical and spectroscopic properties of the purified PSII are presented, as well as a study of the complex solubility in the presence of salts. We also tested the impact of a large panel of detergents on PSII stability and found that very few are able to maintain the integrity of PSII. Such new PSII preparation opens the possibility of performing experiments that require room temperature conditions and/or high protein concentrations, and thus it will allow more detailed investigations into the structure and molecular mechanisms that underlie plant PSII function. PMID:27432883

  3. Prediction of Severe Disease in Children with Diarrhea in a Resource-Limited Setting

    PubMed Central

    Levine, Adam C.; Munyaneza, Richard M.; Glavis-Bloom, Justin; Redditt, Vanessa; Cockrell, Hannah C.; Kalimba, Bantu; Kabemba, Valentin; Musavuli, Juvenal; Gakwerere, Mathias; Umurungi, Jean Paul de Charles; Shah, Sachita P.; Drobac, Peter C.

    2013-01-01

    Objective To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting. Methods Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death. Results The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93). Conclusions While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings. PMID:24349271

  4. Generation of stable PDX derived cell lines using conditional reprogramming.

    PubMed

    Borodovsky, Alexandra; McQuiston, Travis J; Stetson, Daniel; Ahmed, Ambar; Whitston, David; Zhang, Jingwen; Grondine, Michael; Lawson, Deborah; Challberg, Sharon S; Zinda, Michael; Pollok, Brian A; Dougherty, Brian A; D'Cruz, Celina M

    2017-12-06

    Efforts to develop effective cancer therapeutics have been hindered by a lack of clinically predictive preclinical models which recapitulate this complex disease. Patient derived xenograft (PDX) models have emerged as valuable tools for translational research but have several practical limitations including lack of sustained growth in vitro. In this study, we utilized Conditional Reprogramming (CR) cell technology- a novel cell culture system facilitating the generation of stable cultures from patient biopsies- to establish PDX-derived cell lines which maintain the characteristics of the parental PDX tumor. Human lung and ovarian PDX tumors were successfully propagated using CR technology to create stable explant cell lines (CR-PDX). These CR-PDX cell lines maintained parental driver mutations and allele frequency without clonal drift. Purified CR-PDX cell lines were amenable to high throughput chemosensitivity screening and in vitro genetic knockdown studies. Additionally, re-implanted CR-PDX cells proliferated to form tumors that retained the growth kinetics, histology, and drug responses of the parental PDX tumor. CR technology can be used to generate and expand stable cell lines from PDX tumors without compromising fundamental biological properties of the model. It offers the ability to expand PDX cells in vitro for subsequent 2D screening assays as well as for use in vivo to reduce variability, animal usage and study costs. The methods and data detailed here provide a platform to generate physiologically relevant and predictive preclinical models to enhance drug discovery efforts.

  5. A stable high-order perturbation of surfaces method for numerical simulation of diffraction problems in triply layered media

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hong, Youngjoon, E-mail: hongy@uic.edu; Nicholls, David P., E-mail: davidn@uic.edu

    The accurate numerical simulation of linear waves interacting with periodic layered media is a crucial capability in engineering applications. In this contribution we study the stable and high-order accurate numerical simulation of the interaction of linear, time-harmonic waves with a periodic, triply layered medium with irregular interfaces. In contrast with volumetric approaches, High-Order Perturbation of Surfaces (HOPS) algorithms are inexpensive interfacial methods which rapidly and recursively estimate scattering returns by perturbation of the interface shape. In comparison with Boundary Integral/Element Methods, the stable HOPS algorithm we describe here does not require specialized quadrature rules, periodization strategies, or the solution ofmore » dense non-symmetric positive definite linear systems. In addition, the algorithm is provably stable as opposed to other classical HOPS approaches. With numerical experiments we show the remarkable efficiency, fidelity, and accuracy one can achieve with an implementation of this algorithm.« less

  6. Pathogenic mycobacteria achieve cellular persistence by inhibiting the Niemann-Pick Type C disease cellular pathway.

    PubMed

    Fineran, Paul; Lloyd-Evans, Emyr; Lack, Nathan A; Platt, Nick; Davis, Lianne C; Morgan, Anthony J; Höglinger, Doris; Tatituri, Raju Venkata V; Clark, Simon; Williams, Ian M; Tynan, Patricia; Al Eisa, Nada; Nazarova, Evgeniya; Williams, Ann; Galione, Antony; Ory, Daniel S; Besra, Gurdyal S; Russell, David G; Brenner, Michael B; Sim, Edith; Platt, Frances M

    2016-11-18

    Tuberculosis remains a major global health concern. The ability to prevent phagosome-lysosome fusion is a key mechanism by which intracellular mycobacteria, including Mycobacterium tuberculosis , achieve long-term persistence within host cells. The mechanisms underpinning this key intracellular pro-survival strategy remain incompletely understood. Host macrophages infected with persistent mycobacteria share phenotypic similarities with cells taken from patients suffering from Niemann-Pick Disease Type C (NPC), a rare lysosomal storage disease in which endocytic trafficking defects and lipid accumulation within the lysosome lead to cell dysfunction and cell death. We investigated whether these shared phenotypes reflected an underlying mechanistic connection between mycobacterial intracellular persistence and the host cell pathway dysfunctional in NPC. The induction of NPC phenotypes in macrophages from wild-type mice or obtained from healthy human donors was assessed via infection with mycobacteria and subsequent measurement of lipid levels and intracellular calcium homeostasis. The effect of NPC therapeutics on intracellular mycobacterial load was also assessed. Macrophages infected with persistent intracellular mycobacteria phenocopied NPC cells, exhibiting accumulation of multiple lipid types, reduced lysosomal Ca 2+ levels, and defects in intracellular trafficking. These NPC phenotypes could also be induced using only lipids/glycomycolates from the mycobacterial cell wall. These data suggest that persistent intracellular mycobacteria inhibit the NPC pathway, likely via inhibition of the NPC1 protein, and subsequently induce altered acidic store Ca 2+ homeostasis. Reduced lysosomal calcium levels may provide a mechanistic explanation for the reduced levels of phagosome-lysosome fusion in mycobacterial infection. Treatments capable of correcting defects in NPC mutant cells via modulation of host cell calcium were of benefit in promoting clearance of mycobacteria

  7. Cognitive Performance Is Highly Stable over a 2-Year-Follow-Up in Chronic Kidney Disease Patients in a Dedicated Medical Environment.

    PubMed

    Gronewold, Janine; Todica, Olga; Seidel, Ulla K; Volsek, Michaela; Kribben, Andreas; Bruck, Heike; Hermann, Dirk M

    2016-01-01

    As kidney and brain functions decline with aging, chronic kidney disease (CKD) and dementia are becoming increasing health burdens worldwide. Among the risk factors for cognitive impairment, CKD is increasingly recognized. The precise impact of CKD on the development of cognitive impairment is poorly understood. In the New Tools for the Prevention of Cardiovascular Disease in Chronic Kidney Disease (NTCVD) cohort, which was recruited in a dedicated nephrology department, we examined the 2-year course of cognitive performance in 120 patients (73 patients with CKD stages 3-5D, 47 control patients without CKD with similar vascular risk profile) using a comprehensive battery of 10 neuropsychological tests. Kidney function, vascular risk factors and cognitive performance were highly stable both in CKD and control patients. The summary score of cognitive performance in CKD patients was very similar at baseline (z = -0.63±0.76) and follow-up (z = -0.54±0.79, p = 0.113), as was cognitive performance in control patients (z = -0.01±0.59 and 0.01±0.70, p = 0.862, at baseline and follow-up, respectively). Total serum cholesterol (199.6±36.0 and 186.0±32.9, p = 0.005 in controls; 194.4±46.1 and 181.2±41.2, p = 0.008 in CKD) and common carotid intima-media thickness (0.87±0.18 and 0.84±0.17, p = 0.351 in controls; 0.88±0.21 and 0.82±0.16, p = 0.002 in CKD) moderately but significantly decreased during the follow-up. In multivariable regression analyses, high age (β = -0.28, 95%CI = -0.48 to 0.08, p = 0.007) predicted decrease in cognitive performance. In this well-defined cohort receiving state-of-the-art therapy, cognitive performance did not decrease over 2 years. Our data emphasize the aspect of risk factor control, suggesting that dedicated medical care might prevent cognitive decline in CKD patients.

  8. Optimizing management of chronic obstructive pulmonary disease in the upcoming decade.

    PubMed

    Russell, Richard; Anzueto, Antonio; Weisman, Idelle

    2011-01-10

    Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and mortality. Caring for patients with COPD, particularly those with advanced disease who experience frequent exacerbations, places a significant burden on health care budgets, and there is a global need to reduce the financial and personal burden of COPD. Evolving scientific evidence on the natural history and clinical course of COPD has fuelled a fundamental shift in our approach to the disease. The emergence of data highlighting the heterogeneity in rate of lung function decline has altered our perception of disease progression in COPD and our understanding of appropriate strategies for the management of stable disease. These data have demonstrated that early, effective, and prolonged bronchodilation has the potential to slow the rate of decline in lung function and to reduce the frequency of exacerbations that contribute to functional decline. The goals of therapy for COPD are no longer confined to controlling symptoms, reducing exacerbations, and maintaining quality of life, and slowing disease progression is now becoming an achievable aim. A challenge for the future will be to capitalize on these observations by improving the identification and diagnosis of patients with COPD early in the course of their disease, so that effective interventions can be introduced before the more advanced, disabling, and costly stages of the disease. Here we critically review emerging data that underpin the advances in our understanding of the clinical course and management of COPD, and evaluate both current and emerging pharmacologic options for effective maintenance treatment.

  9. HDAC4 as a potential therapeutic target in neurodegenerative diseases: a summary of recent achievements

    PubMed Central

    Mielcarek, Michal; Zielonka, Daniel; Carnemolla, Alisia; Marcinkowski, Jerzy T.; Guidez, Fabien

    2015-01-01

    For the past decade protein acetylation has been shown to be a crucial post-transcriptional modification involved in the regulation of protein functions. Histone acetyltransferases (HATs) mediate acetylation of histones which results in the nucleosomal relaxation associated with gene expression. The reverse reaction, histone deacetylation, is mediated by histone deacetylases (HDACs) leading to chromatin condensation followed by transcriptional repression. HDACs are divided into distinct classes: I, IIa, IIb, III, and IV, on the basis of size and sequence homology, as well as formation of distinct repressor complexes. Implications of HDACs in many diseases, such as cancer, heart failure, and neurodegeneration, have identified these molecules as unique and attractive therapeutic targets. The emergence of HDAC4 among the members of class IIa family as a major player in synaptic plasticity raises important questions about its functions in the brain. The characterization of HDAC4 specific substrates and molecular partners in the brain will not only provide a better understanding of HDAC4 biological functions but also might help to develop new therapeutic strategies to target numerous malignancies. In this review we highlight and summarize recent achievements in understanding the biological role of HDAC4 in neurodegenerative processes. PMID:25759639

  10. Entropy Stable Wall Boundary Conditions for the Three-Dimensional Compressible Navier-Stokes Equations

    NASA Technical Reports Server (NTRS)

    Parsani, Matteo; Carpenter, Mark H.; Nielsen, Eric J.

    2015-01-01

    Non-linear entropy stability and a summation-by-parts framework are used to derive entropy stable wall boundary conditions for the three-dimensional compressible Navier-Stokes equations. A semi-discrete entropy estimate for the entire domain is achieved when the new boundary conditions are coupled with an entropy stable discrete interior operator. The data at the boundary are weakly imposed using a penalty flux approach and a simultaneous-approximation-term penalty technique. Although discontinuous spectral collocation operators on unstructured grids are used herein for the purpose of demonstrating their robustness and efficacy, the new boundary conditions are compatible with any diagonal norm summation-by-parts spatial operator, including finite element, finite difference, finite volume, discontinuous Galerkin, and flux reconstruction/correction procedure via reconstruction schemes. The proposed boundary treatment is tested for three-dimensional subsonic and supersonic flows. The numerical computations corroborate the non-linear stability (entropy stability) and accuracy of the boundary conditions.

  11. Evaluation of RNA from human trabecular bone and identification of stable reference genes.

    PubMed

    Cepollaro, Simona; Della Bella, Elena; de Biase, Dario; Visani, Michela; Fini, Milena

    2018-06-01

    The isolation of good quality RNA from tissues is an essential prerequisite for gene expression analysis to study pathophysiological processes. This study evaluated the RNA isolated from human trabecular bone and defined a set of stable reference genes. After pulverization, RNA was extracted with a phenol/chloroform method and then purified using silica columns. The A260/280 ratio, A260/230 ratio, RIN, and ribosomal ratio were measured to evaluate RNA quality and integrity. Moreover, the expression of six candidates was analyzed by qPCR and different algorithms were applied to assess reference gene stability. A good purity and quality of RNA was achieved according to A260/280 and A260/230 ratios, and RIN values. TBP, YWHAZ, and PGK1 were the most stable reference genes that should be used for gene expression analysis. In summary, the method proposed is suitable for gene expression evaluation in human bone and a set of reliable reference genes has been identified. © 2017 Wiley Periodicals, Inc.

  12. Achieving symptomatic remission in out-patients with schizophrenia--a naturalistic study with quetiapine.

    PubMed

    Wobrock, T; Köhler, J; Klein, P; Falkai, P

    2009-08-01

    Symptomatic remission was defined as a score of mild or less on each of eight key schizophrenia symptoms on the Positive and Negative Syndrome Scale (PANSS-8). To evaluate the symptomatic remission criterion in clinical practice and to determine predictors for achieving symptomatic remission, a 12-week non-interventional study (NIS) with quetiapine was conducted in Germany. For the comparison of patients with and without symptomatic remission, sociodemographic and clinical variables of 693 patients were analyzed by logistic regression for their predictive value to achieve remission. Four hundred and four patients (58.3%) achieved symptomatic remission after 12 weeks' treatment with quetiapine. Remission was significantly predicted by a low degree of PANSS-8 total score, PANSS single items blunted affect (N1), social withdrawal (N4), lack of spontaneity (N6), mannerism and posturing (G5), and low disease severity (CGI-S) at baseline. Predictors of non-remission were older age, diagnosis of schizophrenic residuum, multiple previous episodes, longer duration of current episode, presence of concomitant diseases, and alcohol abuse. This study demonstrated that the majority of schizophrenia out-patients achieved symptomatic remission after 12 weeks treatment and confirms the importance of managing negative symptoms in order to achieve disease remission.

  13. Heart Rate and Initial Presentation of Cardiovascular Diseases (Caliber)

    ClinicalTrials.gov

    2013-09-17

    Abdominal Aortic Aneurysm; Coronary Heart Disease NOS; Unheralded Coronary Death; Intracerebral Haemorrhage; Heart Failure; Ischemic Stroke; Myocardial Infarction; Stroke; Peripheral Arterial Disease; Stable Angina Pectoris; Subarachnoid Haemorrhage; Transient Ischemic Attack; Unstable Angina; Cardiac Arrest, Sudden Cardiac Death

  14. Risk Factors in the Initial Presentation of Specific Cardiovascular Disease Syndromes

    ClinicalTrials.gov

    2013-03-03

    Heart Diseases; Cardiovascular Diseases; Acute Myocardial Infarction; Unstable Angina; Chronic Stable Angina; Ischemic Stroke; Cerebrovascular Accident; Subarachnoid Hemorrhage; Transient Ischemic Attack; Abdominal Aortic Aneurysm; Peripheral Arterial Disease; Sudden Coronary Death; Ventricular Arrhythmia; Sudden Death; Cardiac Arrest; Heart Failure

  15. A Hollow-Structured Manganese Oxide Cathode for Stable Zn-MnO₂ Batteries.

    PubMed

    Guo, Xiaotong; Li, Jianming; Jin, Xu; Han, Yehu; Lin, Yue; Lei, Zhanwu; Wang, Shiyang; Qin, Lianjie; Jiao, Shuhong; Cao, Ruiguo

    2018-05-05

    Aqueous rechargeable zinc-manganese dioxide (Zn-MnO₂) batteries are considered as one of the most promising energy storage devices for large scale-energy storage systems due to their low cost, high safety, and environmental friendliness. However, only a few cathode materials have been demonstrated to achieve stable cycling for aqueous rechargeable Zn-MnO₂ batteries. Here, we report a new material consisting of hollow MnO₂ nanospheres, which can be used for aqueous Zn-MnO₂ batteries. The hollow MnO₂ nanospheres can achieve high specific capacity up to ~405 mAh g −1 at 0.5 C. More importantly, the hollow structure of birnessite-type MnO₂ enables long-term cycling stability for the aqueous Zn-MnO₂ batteries. The excellent performance of the hollow MnO₂ nanospheres should be due to their unique structural properties that enable the easy intercalation of zinc ions.

  16. Progress toward achieving the national 1990 objectives for sexually transmitted diseases.

    PubMed

    1987-04-03

    A summary evaluation of the status of 5 sexually transmitted disease (STD) goals is presented by the U.S. Public Health Service. 1st, gonorrhea cases, after a rapid rise in the early 1970s, have been steadily declining on the whole. Female cases, however, have been increasing, and resistant strains have spread dramatically. Thus it seems the goal of 280 cases per 100,000 by 1990 will not be met. 2nd, the pelvic inflammatory disease rate is declining toward the goal, even though Chlamydia infections remain a problem. 3rd, the incidence of syphilis, especially in males, is approaching the target of 7/100,000. Congenital syphilis is rising, due both to emphasis on reporting and to a real increase. 4th, the goal of effective diagnosis and treatment of STD by 95% of clinicians is being approached with postgraduate courses and medical school curricula, but this end is probably too ambitious. 5th, all junior and senior high school students should be receiving accurate education about STD. No information on these efforts is available. After these goals were in place, the STD burden has increased phenomenally because of the appearance of AIDS, the maturation of the baby boom generation, and the realization that over 50 different diseases, 13 million cases and 7000 deaths occur annually, excluding AIDS. The cost of treating pelvic inflammatory disease alone is estimated at $2.6 billion annually. Primary prevention is the only feasible priority.

  17. Role of risk stratification by SPECT, PET, and hybrid imaging in guiding management of stable patients with ischaemic heart disease: expert panel of the EANM cardiovascular committee and EACVI.

    PubMed

    Acampa, Wanda; Gaemperli, Oliver; Gimelli, Alessia; Knaapen, Paul; Schindler, Thomas H; Verberne, Hein J; Zellweger, Michael J

    2015-12-01

    Risk stratification has become increasingly important in the management of patients with suspected or known ischaemic heart disease (IHD). Recent guidelines recommend that these patients have their care driven by risk assessment. The purpose of this position statement is to summarize current evidence on the value of cardiac single-photon emission computed tomography, positron emission tomography, and hybrid imaging in risk stratifying asymptomatic or symptomatic patients with suspected IHD, patients with stable disease, patients after coronary revascularization, heart failure patients, and specific patient population. In addition, this position statement evaluates the impact of imaging results on clinical decision-making and thereby its role in patient management. The document represents the opinion of the European Association of Nuclear Medicine (EANM) Cardiovascular Committee and of the European Association of Cardiovascular Imaging (EACVI) and intends to stimulate future research in this field. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  18. Eradication of Yaws: Historical Efforts and Achieving WHO's 2020 Target

    PubMed Central

    Asiedu, Kingsley; Fitzpatrick, Christopher; Jannin, Jean

    2014-01-01

    Background Yaws, one of the 17 neglected tropical diseases (NTDs), is targeted for eradication by 2020 in resolution WHA66.12 of the World Health Assembly (2013) and the WHO roadmap on NTDs (2012). The disease frequently affects children who live in poor socioeconomic conditions. Between 1952 and 1964, WHO and the United Nations Children's Fund (UNICEF) led a global eradication campaign using injectable benzathine penicillin. Recent developments using a single dose of oral azithromycin have renewed optimism that eradication can be achieved through a comprehensive large-scale treatment strategy. We review historical efforts to eradicate yaws and argue that this goal is now technically feasible using new tools and with the favorable environment for control of NTDs. We also summarize the work of WHO's Department of Control of Neglected Tropical Diseases in leading the renewed eradication initiative and call on the international community to support efforts to achieve the 2020 eradication goal. The critical factor remains access to azithromycin. Excluding medicines, the financial cost of yaws eradication could be as little as US$ 100 million. Conclusions The development of new tools has renewed interest in eradication of yaws; with modest support, the WHO eradication target of 2020 can be achieved. PMID:25254372

  19. The Millennium Development Goals: experiences, achievements and what's next.

    PubMed

    Lomazzi, Marta; Borisch, Bettina; Laaser, Ulrich

    2014-01-01

    The Millennium Development Goals (MDGs) are eight international development goals to be achieved by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender inequality, environmental damage and the global partnership. Most activities worldwide have focused on maternal and child health and communicable diseases, while less attention has been paid to environmental sustainability and the development of a global partnership. Up to now, several targets have been at least partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200 million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015 agenda is now under discussion. The new targets, whatever they will be called, should reflect today's political situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach should be adopted.

  20. The Millennium Development Goals: experiences, achievements and what's next

    PubMed Central

    Lomazzi, Marta; Borisch, Bettina; Laaser, Ulrich

    2014-01-01

    The Millennium Development Goals (MDGs) are eight international development goals to be achieved by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender inequality, environmental damage and the global partnership. Most activities worldwide have focused on maternal and child health and communicable diseases, while less attention has been paid to environmental sustainability and the development of a global partnership. Up to now, several targets have been at least partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200 million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015 agenda is now under discussion. The new targets, whatever they will be called, should reflect today's political situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach should be adopted. PMID:24560268

  1. Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease.

    PubMed

    Vedin, Ola; Hagström, Emil; Östlund, Ollie; Avezum, Alvaro; Budaj, Andrzej; Flather, Marcus D; Harrington, Robert A; Koenig, Wolfgang; Soffer, Joseph; Siegbahn, Agneta; Steg, Philippe Gabriel; Stewart, Ralph A H; Wallentin, Lars; White, Harvey D; Held, Claes

    2017-10-15

    Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss- a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial. Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels and biomarker levels, and the relationship between tooth loss levels and outcomes, respectively. After multivariable adjustment, the relative biomarker increase between the highest and the lowest tooth loss level was: high-sensitivity C-reactive protein 1.21 (95% confidence interval, 1.14-1.29), interleukin 6 1.14 (1.10-1.18), lipoprotein-associated phospholipase A 2 activity 1.05 (1.03-1.06), growth differentiation factor 15 1.11 (1.08-1.14), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1.18 (1.11-1.25). No association was detected for high-sensitivity troponin T 1.02 (0.98-1.05). Some attenuation of the relationship between tooth loss and outcomes resulted from the addition of biomarkers to the multivariable analysis, of which NT-proBNP had the biggest impact. A graded and independent association between tooth loss and several prognostic biomarkers was observed, suggesting that tooth loss and its underlying mechanisms may be involved in multiple pathophysiological pathways also implicated in the development and prognosis of CHD. The association between tooth loss and cardiovascular death and stroke persisted despite comprehensive adjustment including prognostic biomarkers. www.clinicaltrials.gov; NCT00799903. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. On Stable Marriages and Greedy Matchings

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Manne, Fredrik; Naim, Md; Lerring, Hakon

    2016-12-11

    Research on stable marriage problems has a long and mathematically rigorous history, while that of exploiting greedy matchings in combinatorial scientific computing is a younger and less developed research field. In this paper we consider the relationships between these two areas. In particular we show that several problems related to computing greedy matchings can be formulated as stable marriage problems and as a consequence several recently proposed algorithms for computing greedy matchings are in fact special cases of well known algorithms for the stable marriage problem. However, in terms of implementations and practical scalable solutions on modern hardware, the greedymore » matching community has made considerable progress. We show that due to the strong relationship between these two fields many of these results are also applicable for solving stable marriage problems.« less

  3. School Absences and School Achievements in Children with Congenital Coagulation Disorders.

    ERIC Educational Resources Information Center

    Kvist, S. Beatrice M.

    1988-01-01

    Ten Finnish children (aged 7-15 years) suffering from hemophilia or von Willebrand's disease were compared with 20 healthy schoolmates with reference to scholastic achievement and school absences. It appears that despite a greater number of absences, the children affected by the disease were doing relatively well in school. (TJH)

  4. Predicting the Benefits of Percutaneous Coronary Intervention on 1-Year Angina and Quality of Life in Stable Ischemic Heart Disease: Risk Models From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation).

    PubMed

    Zhang, Zugui; Jones, Philip; Weintraub, William S; Mancini, G B John; Sedlis, Steven; Maron, David J; Teo, Koon; Hartigan, Pamela; Kostuk, William; Berman, Daniel; Boden, William E; Spertus, John A

    2018-05-01

    Percutaneous coronary intervention (PCI) is a therapy to reduce angina and improve quality of life in patients with stable ischemic heart disease. However, it is unclear whether the quality of life after PCI is more dependent on the PCI or other patient-related factors. To address this question, we created models to predict angina and quality of life 1 year after PCI and medical therapy. Using data from the 2287 stable ischemic heart disease patients randomized in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) to PCI plus optimal medical therapy (OMT) versus OMT alone, we built prediction models for 1-year Seattle Angina Questionnaire angina frequency, physical limitation, and quality of life scores, both as continuous outcomes and categorized by clinically desirable states, using multivariable techniques. Although most patients improved regardless of treatment, marked variability was observed in Seattle Angina Questionnaire scores 1 year after randomization. Adding PCI conferred a greater mean improvement (about 2 points) in Seattle Angina Questionnaire scores that were not affected by patient characteristics ( P values for all interactions >0.05). The proportion of patients free of angina or having very good/excellent physical limitation (physical function) or quality of life at 1 year was 57%, 58%, 66% with PCI+OMT and 50%, 55%, 59% with OMT alone group, respectively. However, other characteristics, such as baseline symptoms, age, diabetes mellitus, and the magnitude of myocardium subtended by narrowed coronary arteries were as, or more, important than revascularization in predicting symptoms (partial R 2 =0.07 versus 0.29, 0.03 versus 0.22, and 0.05 versus 0.24 in the domain of angina frequency, physical limitation, and quality of life, respectively). There was modest/good discrimination of the models (C statistic=0.72-0.82) and excellent calibration (coefficients of determination for predicted versus observed

  5. Stable cycling in discrete-time genetic models.

    PubMed

    Hastings, A

    1981-11-01

    Examples of stable cycling are discussed for two-locus, two-allele, deterministic, discrete-time models with constant fitnesses. The cases that cycle were found by using numerical techniques to search for stable Hopf bifurcations. One consequence of the results is that apparent cases of directional selection may be due to stable cycling.

  6. Use of allopurinol with low-dose 6-mercaptopurine in inflammatory bowel disease to achieve optimal active metabolite levels: A review of four cases and the literature

    PubMed Central

    Witte, Todd N; Ginsberg, Allen L

    2008-01-01

    BACKGROUND: At least one-third of patients with inflammatory bowel disease do not respond or are intolerant to therapy with 6-mercaptopurine (6-MP). A subgroup fails to attain optimal levels of 6-thioguanine nucleotide (6-TGN) and instead shunts to 6-methylmercaptopurine nucleotide (6-MMPN). PATIENTS AND METHODS: A retrospective chart review was conducted, and four patients are described who had been previously unable to achieve optimal 6-TGN metabolite levels until allopurinol was added to their treatment. RESULTS: All four patients achieved optimal 6-TGN levels and undetectable 6-MMPN with a mean 6-MP dose of 0.49 mg/kg. Three achieved steroid-free clinical remission. Two of those three patients had normalization of liver enzymes; one patient had baseline normal liver enzymes despite an initial 6-MMPN level of 27,369 pmol/8×108 red blood cells. Two patients experienced reversible leukopenia. CONCLUSIONS: Combination allopurinol and low-dose 6-MP is an effective means to achieve optimal metabolite levels and steroid-free clinical remission in previously refractory patients. Caution is advised. PMID:18299738

  7. Bi-stable optical element actuator device

    DOEpatents

    Holdener, Fred R.; Boyd, Robert D.

    2002-01-01

    The present invention is a bistable optical element actuator device utilizing a powered means to move an actuation arm, to which an optical element is attached, between two stable positions. A non-powered means holds the actuation arm in either of the two stable positions. The optical element may be a electromagnetic (EM) radiation or particle source, an instrument, or EM radiation or particle transmissive reflective or absorptive elements. A bearing is used to transfer motion and smoothly transition the actuation arm between the two stable positions.

  8. The alpha(3) Scheme - A Fourth-Order Neutrally Stable CESE Solver

    NASA Technical Reports Server (NTRS)

    Chang, Sin-Chung

    2007-01-01

    The conservation element and solution element (CESE) development is driven by a belief that a solver should (i) enforce conservation laws in both space and time, and (ii) be built from a non-dissipative (i.e., neutrally stable) core scheme so that the numerical dissipation can be controlled effectively. To provide a solid foundation for a systematic CESE development of high order schemes, in this paper we describe a new 4th-order neutrally stable CESE solver of the advection equation Theta u/Theta + alpha Theta u/Theta x = 0. The space-time stencil of this two-level explicit scheme is formed by one point at the upper time level and three points at the lower time level. Because it is associated with three independent mesh variables u(sup n) (sub j), (u(sub x))(sup n) (sub j) , and (uxz)(sup n) (sub j) (the numerical analogues of u, Theta u/Theta x, and Theta(exp 2)u/Theta x(exp 2), respectively) and four equations per mesh point, the new scheme is referred to as the alpha(3) scheme. As in the case of other similar CESE neutrally stable solvers, the alpha(3) scheme enforces conservation laws in space-time locally and globally, and it has the basic, forward marching, and backward marching forms. These forms are equivalent and satisfy a space-time inversion (STI) invariant property which is shared by the advection equation. Based on the concept of STI invariance, a set of algebraic relations is developed and used to prove that the alpha(3) scheme must be neutrally stable when it is stable. Moreover it is proved rigorously that all three amplification factors of the alpha(3) scheme are of unit magnitude for all phase angles if |v| <= 1/2 (v = alpha delta t/delta x). This theoretical result is consistent with the numerical stability condition |v| <= 1/2. Through numerical experiments, it is established that the alpha(3) scheme generally is (i) 4th-order accurate for the mesh variables u(sup n) (sub j) and (ux)(sup n) (sub j); and 2nd-order accurate for (uxx)(sup n) (sub

  9. Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study.

    PubMed

    Kyriakakis, Nikolaos; Lynch, Julie; Gilbey, Stephen G; Webb, Susan M; Murray, Robert D

    2017-06-01

    Patients with acromegaly demonstrate impaired quality of life (QoL), but data on long-term QoL changes in treated acromegaly are limited. This study evaluates and identifies factors that influence QoL in patients with long-term biochemical remission. The study consists of a cross-sectional arm comparing QoL between patients with treated and controlled acromegaly and healthy controls; and a longitudinal arm assessing QoL changes in patients with biochemically stable disease during 5.7±0.6 years of follow-up. A total of 58 patients and 116 matched controls were recruited for the cross-sectional arm; 28 patients completed the longitudinal arm. Three generic questionnaires (Psychological General Well-Being Schedule [PGWBS], 36-item Short-Form [SF-36], EuroQoL [EQ-5D]) and the disease-specific acromegaly QoL questionnaire (AcroQoL) were applied. Quality of life assessment was performed 11.6±8.2 years following diagnosis and treatment of acromegaly. Patients with treated acromegaly had lower QoL scores compared with controls in all questionnaires with the exception of the PGWBS "Anxiety" subscale. The AcroQoL "Appearance" subscale and the "Physical Function" subscales of the remaining questionnaires were the most underscored domains. No difference in the total and subscale scores of all questionnaires was observed between baseline and follow-up, with the exception of the SF-36 "Physical Function," where a decline was found (58.5±24.7% vs 43.1±31.1%; P=.002). However, after adjusting for covariates, no significant change in any of the QoL scores was seen. Duration of IGF-1/GH control was positively correlated with QoL scores in most questionnaires at baseline, whereas use of GH lowering therapy at the time of QoL assessment was a negative predictive factor of QoL. Patients with biochemically controlled acromegaly demonstrate impaired QoL, which persists despite long-term disease control. This primarily consists of impaired physical function and secondly of impaired

  10. Detection of horse allergen around a stable.

    PubMed

    Elfman, Lena; Brannstrom, Johan; Smedje, Greta

    2008-01-01

    Integrating horse stables with built-up areas may lead to conflicts. Dispersion of horse allergen may become a health risk for allergic people. The aim was to measure the dispersion of horse allergen around a stable, considering wind speed and direction and vegetation. The disturbance of staff at a workplace nearby a stable was investigated. Air sampling was performed around a stable (32 horses) at distances of 50-500 m in all directions. Sampling was done with a pump and an IOM sampler. Samples were collected at 50 points during all seasons. Horse allergen levels were determined using ELISA. Disturbance by horses was studied with a questionnaire handed to the employees in an office near the stable. The median horse allergen level at the stable entrance was 316 U/m(3), in the horse fields 40 U/m(3) and in the whole source area 16 U/m(3), which declined to <2 U/m(3) at about 50 m from the source area. Downwind of the prevailing winds low levels of horse allergen (2-4 U/m(3)) could sometimes be detected at up to 500 m. The staff, including those allergic to horses, managed to tolerate horses close to the workplace. At low winds horse allergen spread in ambient air about 50 m from the stable and horse fields. At higher winds low allergen levels were sometimes found in open areas up to 500 m from the source area. These levels were similar to those found in the office after moving away from the stable area. The employees did not report more symptoms of allergy or asthma while working close to the stable compared to after the move. 2007 S. Karger AG, Basel

  11. Electrolyte additive enabled fast charging and stable cycling lithium metal batteries

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zheng, Jianming; Engelhard, Mark H.; Mei, Donghai

    2017-03-01

    Lithium (Li) metal battery is an attractive energy storage system owing to the ultrahigh specific capacity and the lowest redox potential of Li metal anode. However, safety concern associated with dendrite growth and limited cycle life especially at a high charge current density are two critical challenges hindering the practical applications of rechargeable Li metal batteries. Here, we report for the first time that an optimal amount (0.05 M) of LiPF6 as additive in the LiTFSI-LiBOB dual-salt/carbonate-based electrolyte can significantly enhance the charging capability and the long-term cycle life of Li metal batteries with a moderately high cathode loading ofmore » 1.75 mAh cm-2. Unprecedented stable-cycling (97.1% capacity retention after 500 cycles) along with very limited increase in electrode over-potential has been achieved at a high current density of 1.75 mA cm-2. This unparalleled fast charging and stable cycling performance is contributed from both the stabilized Al cathode current collector, and, more importantly, the robust and conductive SEI layer formed on Li metal anode in the presence of the LiPF6 additive.« less

  12. Highly stable cesium lead iodide perovskite quantum dot light-emitting diodes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zou, Chen; Huang, Chun-Ying; Sanehira, Erin M.

    Recently, all-inorganic perovskites such as CsPbBr3 and CsPbI3, have emerged as promising materials for light-emitting applications. While encouraging performance has been demonstrated, the stability issue of the red-emitting CsPbI3 is still a major concern due to its small tolerance factor. Here we report a highly stable CsPbI3 quantum dot LED with red emission fabricated using an improved purification approach. The device achieved decent external quantum efficiency (EQE) of 0.21 % at a bias of 6 V and outstanding operational stability, with a L70 lifetime (EL intensity decreases to 70% of starting value) of 16 h and 1.5 h under amore » constant driving voltage of 5 V and 6 V (maximum EQE operation) respectively. Furthermore, the device can work under a higher voltage of 7 V (maximum luminance operation) and retain 50% of its initial EL intensity after 500 s. These findings demonstrate the promise of CsPbI3 quantum dots for stable red LEDs, and suggest the feasibility for electrically pumped perovskite lasers with further device optimizations.« less

  13. Highly stable cesium lead iodide perovskite quantum dot light-emitting diodes

    DOE PAGES

    Zou, Chen; Huang, Chun-Ying; Sanehira, Erin M.; ...

    2017-09-11

    Recently, all-inorganic perovskites such as CsPbBr3 and CsPbI3, have emerged as promising materials for light-emitting applications. While encouraging performance has been demonstrated, the stability issue of the red-emitting CsPbI3 is still a major concern due to its small tolerance factor. Here we report a highly stable CsPbI3 quantum dot LED with red emission fabricated using an improved purification approach. The device achieved decent external quantum efficiency (EQE) of 0.21 % at a bias of 6 V and outstanding operational stability, with a L70 lifetime (EL intensity decreases to 70% of starting value) of 16 h and 1.5 h under amore » constant driving voltage of 5 V and 6 V (maximum EQE operation) respectively. Furthermore, the device can work under a higher voltage of 7 V (maximum luminance operation) and retain 50% of its initial EL intensity after 500 s. These findings demonstrate the promise of CsPbI3 quantum dots for stable red LEDs, and suggest the feasibility for electrically pumped perovskite lasers with further device optimizations.« less

  14. Evaluation of a train-the-trainer program for stable coronary artery disease management in community settings: A pilot study.

    PubMed

    Shen, Zhiyun; Jiang, Changying; Chen, Liqun

    2018-02-01

    To evaluate the feasibility and effectiveness of conducting a train-the-trainer (TTT) program for stable coronary artery disease (SCAD) management in community settings. The study involved two steps: (1) tutors trained community nurses as trainers and (2) the community nurses trained patients. 51 community nurses attended a 2-day TTT program and completed questionnaires assessing knowledge, self-efficacy, and satisfaction. By a feasibility and non-randomized control study, 120 SCAD patients were assigned either to intervention group (which received interventions from trained nurses) or control group (which received routine management). Pre- and post-intervention, patients' self-management behaviors and satisfaction were assessed to determine the program's overall impact. Community nurses' knowledge and self-efficacy improved (P<0.001), as did intervention group patients' self-management behaviors (P<0.001). The satisfaction of community nurses and patients was all very positive after training. The TTT program for SCAD management in community settings in China was generally feasible and effective, but many obstacles remain including patients' noncompliance, nurses' busy work schedules, and lack of policy supports. Finding ways to enhance the motivation of community nurses and patients with SCAD are important in implementing community-based TTT programs for SCAD management; further multicenter and randomized control trials are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. The BEAUTIFUL study: randomized trial of ivabradine in patients with stable coronary artery disease and left ventricular systolic dysfunction - baseline characteristics of the study population.

    PubMed

    Ferrari, R; Ford, I; Fox, K; Steg, P G; Tendera, M

    2008-01-01

    Ivabradine is a selective heart rate-lowering agent that acts by inhibiting the pacemaker current If in sinoatrial node cells. Patients with coronary artery disease and left ventricular dysfunction are at high risk of death and cardiac events, and the BEAUTIFUL study was designed to evaluate the effects of ivabradine on outcome in such patients receiving optimal medical therapy. This report describes the study population at baseline. BEAUTIFUL is an international, multicentre, randomized, double-blind trial to compare ivabradine with placebo in reducing mortality and cardiovascular events in patients with stable coronary artery disease and left ventricular systolic dysfunction (ejection fraction <40%). A total of 10,917 patients were randomized. At baseline, their mean age was 65 years, 83% were male, 98% Caucasian, 88% had previous myocardial infarction, 37% had diabetes, and 40% had metabolic syndrome. Mean ejection fraction was 32% and resting heart rate was 71.6 bpm. Concomitant medications included beta-blockers (87%), renin-angiotensin system agents (89%), antithrombotic agents (94%), and lipid-lowering agents (76%). Main results from BEAUTIFUL are expected in 2008, and should show whether ivabradine, on top of optimal medical treatment, reduces mortality and cardiovascular events in this population of high-risk patients. (c) 2007 S. Karger AG, Basel

  16. Reconstructing diet in Napoleon's Grand Army using stable carbon and nitrogen isotope analysis.

    PubMed

    Holder, Sammantha; Dupras, Tosha L; Jankauskas, Rimantas; Williams, Lana; Schultz, John

    2017-05-01

    Historical evidence has provided information regarding disease and mortality in Napoleon Bonaparte's Grand Army, but dietary information beyond individual soldier accounts remains scarce. The purpose of this research is to reconstruct the diets of Napoleon's multiethnic army who were associated with the Russian Campaign of 1812. We conducted stable carbon and nitrogen isotope ratio analysis on femoral bone collagen of 78 individuals recovered from a salvage excavation at the mass gravesite of Šiaurės miestelis in Vilnius, Lithuania. These individuals were later discovered to be Napoleonic soldiers and camp followers who participated in the 1812 Russian Campaign. Stable carbon isotope ratios range from -19.2‰ to -11.8‰, with a mean of -17.8‰ ± 1.5‰ (1 σ). Stable nitrogen isotope ratios range from 7.1‰ to 13.6‰, with a mean of 10.5‰ ± 1.4‰ (1 σ). Both δ 13 C and δ 15 N values show a wide range of variation. Stable isotope data indicate considerable dietary variation in this population associated with a multiethnic and socially stratified military population. Diets ranged from predominantly C 3 -based to predominantly C 4 -based, with varying inputs of terrestrial, freshwater, and marine animal protein. Comparison with other European populations further denotes the exceptional range of dietary variation of soldiers and camp followers in Napoleon's army. © 2017 Wiley Periodicals, Inc.

  17. Selection of stable scFv antibodies by phage display.

    PubMed

    Brockmann, Eeva-Christine

    2012-01-01

    ScFv fragments are popular recombinant antibody formats but often suffer from limited stability. Phage display is a powerful tool in antibody engineering and applicable also for stability selection. ScFv variants with improved stability can be selected from large randomly mutated phage displayed libraries with a specific antigen after the unstable variants have been inactivated by heat or GdmCl. Irreversible scFv denaturation, which is a prerequisite for efficient selection, is achieved by combining denaturation with reduction of the intradomain disulfide bonds. Repeated selection cycles of increasing stringency result in enrichment of stabilized scFv fragments. Procedures for constructing a randomly mutated scFv library by error-prone PCR and phage display selection for enrichment of stable scFv antibodies from the library are described here.

  18. Elastomeric Microchip Electrospray Emitter for Stable Cone-Jet Mode Operation in the Nano-Flow Regime

    PubMed Central

    Kelly, Ryan T.; Tang, Keqi; Irimia, Daniel; Toner, Mehmet; Smith, Richard D.

    2009-01-01

    Despite widespread interest in combining lab-on-a-chip technologies with mass spectrometry (MS)-based analyses, the coupling of microfluidics to electrospray ionization (ESI)-MS remains challenging. We report a robust, integrated poly(dimethylsiloxane) microchip interface for ESI-MS using simple and widely accessible microfabrication procedures. The interface uses an auxiliary channel to provide electrical contact for the stable cone-jet electrospray without sample loss or dilution. The electric field at the channel terminus is enhanced by two vertical cuts that cause the interface to taper to a line rather than to a point, and the formation of a small Taylor cone at the channel exit ensures sub-nL post-column dead volumes. Cone-jet mode electrospray was demonstrated for up to 90% aqueous solutions and for extended durations. Comparable ESI-MS sensitivities were achieved using both microchip and conventional fused silica capillary emitters, but stable cone-jet mode electrosprays could be established over a far broader range of flow rates (from 50-1000 nL/min) and applied potentials using the microchip emitters. This attribute of the microchip emitter should simplify electrospray optimization and make the stable electrospray more resistant to external perturbations. PMID:18419138

  19. Synthesis of carbon-14 and stable isotope labeled Avagacestat: a novel gamma secretase inhibitor for the treatment of Alzheimer's disease.

    PubMed

    Burrell, Richard C; Easter, John A; Cassidy, Michael P; Gillman, Kevin W; Olson, Richard E; Bonacorsi, Samuel J

    2014-08-01

    Bristol-Myers Squibb and others are developing drugs that target novel mechanisms to combat Alzheimer's disease. γ-Secretase inhibitors are one class of potential therapies that have received considerable attention. (R)-2-(4-Chloro-N-(2-fluoro-4-(1,2,4-oxadiazol-3-yl)benzyl)phenylsulfonamido)-5,5,5-trifluoropentanamide (Avagacestat) is a γ-secretase-inhibiting drug that has been investigated by Bristol-Myers Squibb in preclinical and clinical studies. An important step in the development process was the synthesis of a carbon-14-labeled analog for use in a human absorption, distribution, metabolism, and excretion study and a stable isotope labeled analog for use as a standard in bioanalytical assays to accurately quantify the concentration of the drug in biological samples. Carbon-14 labeled Avagacestat was synthesized in seven steps in a 33% overall yield from carbon-14 labeled potassium cyanide. A total of 5.95 mCi was prepared with a specific activity of 0.81 μCi/mg and a radiochemical purity of 99.9%. (13) C6 -Labeled Avagacestat was synthesized in three steps in a 15% overall yield from 4-chloro[(13) C6 ]aniline. A total of 585 mg was prepared with a ultraviolet purity of 99.9%. Copyright © 2014 John Wiley & Sons, Ltd.

  20. Systemic inflammation is higher in peripheral artery disease than in stable coronary artery disease.

    PubMed

    Rein, Philipp; Saely, Christoph H; Silbernagel, Günther; Vonbank, Alexander; Mathies, Rainer; Drexel, Heinz; Baumgartner, Iris

    2015-04-01

    The knowledge on the level of systemic inflammation in peripheral artery disease (PAD) is less well established than that in coronary artery disease (CAD). Systemic inflammation frequently coincides with atherosclerosis, but also with various traits of the metabolic syndrome (MetS). The individual contribution of CAD, PAD, and the MetS to inflammation is not known. We enrolled a total of 1396 patients, 460 patients with PAD Fontaine stages IIa-IV verified by duplex ultrasound (PAD group) and 936 patients free of limb claudication undergoing coronary angiography, of whom 507 had significant CAD with coronary stenoses ≥50% (CAD group), and 429 did not have significant CAD at angiography (control group). C-reactive protein (CRP) was significantly higher in the PAD than in the CAD or in the control group (0.86 ± 1.85 mg/dl versus 0.44 ± 0.87 mg/dl and 0.39 ± 0.52 mg/dl, respectively, p < 0.001 for both comparisons). These significant differences were confirmed when patients with and subjects without the MetS were analyzed separately. In particular, within the PAD group, CRP was significantly higher in patients with the MetS than in subjects without the MetS (1.04 ± 2.01 vs. 0.67 ± 1.64 mg/dl; p = 0.001) and both, the presence of PAD and the MetS proved to be independently associated with CRP in analysis of covariance (F = 31.84; p < 0.001 and F = 10.52; p = 0.001, respectively). Inflammatory activity in PAD patients is higher than in CAD patients and is particularly high in PAD patients affected by the MetS. Low grade systemic inflammation is independently associated with both the MetS and PAD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Forensic Stable Isotope Biogeochemistry

    NASA Astrophysics Data System (ADS)

    Cerling, Thure E.; Barnette, Janet E.; Bowen, Gabriel J.; Chesson, Lesley A.; Ehleringer, James R.; Remien, Christopher H.; Shea, Patrick; Tipple, Brett J.; West, Jason B.

    2016-06-01

    Stable isotopes are being used for forensic science studies, with applications to both natural and manufactured products. In this review we discuss how scientific evidence can be used in the legal context and where the scientific progress of hypothesis revisions can be in tension with the legal expectations of widely used methods for measurements. Although this review is written in the context of US law, many of the considerations of scientific reproducibility and acceptance of relevant scientific data span other legal systems that might apply different legal principles and therefore reach different conclusions. Stable isotopes are used in legal situations for comparing samples for authenticity or evidentiary considerations, in understanding trade patterns of illegal materials, and in understanding the origins of unknown decedents. Isotope evidence is particularly useful when considered in the broad framework of physiochemical processes and in recognizing regional to global patterns found in many materials, including foods and food products, drugs, and humans. Stable isotopes considered in the larger spatial context add an important dimension to forensic science.

  2. Ultra-stable high average power femtosecond laser system tunable from 1.33 to 20  μm.

    PubMed

    Steinle, Tobias; Mörz, Florian; Steinmann, Andy; Giessen, Harald

    2016-11-01

    A highly stable 350 fs laser system with a gap-free tunability from 1.33 to 2.0 μm and 2.13 to 20 μm is demonstrated. Nanojoule-level pulse energy is achieved in the mid-infrared at a 43 MHz repetition rate. The system utilizes a post-amplified fiber-feedback optical parametric oscillator followed by difference frequency generation between the signal and idler. No locking or synchronization electronics are required to achieve outstanding free-running output power and spectral stability of the whole system. Ultra-low intensity noise, close to the pump laser's noise figure, enables shot-noise limited measurements.

  3. Stable Breathing in Patients With Obstructive Sleep Apnea Is Associated With Increased Effort but Not Lowered Metabolic Rate.

    PubMed

    de Melo, Camila M; Taranto-Montemurro, Luigi; Butler, James P; White, David P; Loring, Stephen H; Azarbarzin, Ali; Marques, Melania; Berger, Philip J; Wellman, Andrew; Sands, Scott A

    2017-10-01

    In principle, if metabolic rate were to fall during sleep in a patient with obstructive sleep apnea (OSA), ventilatory requirements could be met without increased respiratory effort thereby favoring stable breathing. Indeed, most patients achieve periods of stable flow-limited breathing without respiratory events for periods during the night for reasons that are unclear. Thus, we tested the hypothesis that in patients with OSA, periods of stable breathing occur when metabolic rate (VO2) declines. Twelve OSA patients (apnea-hypopnea index >15 events/h) completed overnight polysomnography including measurements of VO2 (using ventilation and intranasal PO2) and respiratory effort (esophageal pressure). Contrary to our hypothesis, VO2 did not differ between stable and unstable breathing periods in non-REM stage 2 (208 ± 20 vs. 213 ± 18 mL/min), despite elevated respiratory effort during stable breathing (26 ± 2 versus 23 ± 2 cmH2O, p = .03). However, VO2 was lowered during deeper sleep (244 to 179 mL/min from non-REM stages 1 to 3, p = .04) in conjunction with more stable breathing. Further analysis revealed that airflow obstruction curtailed metabolism in both stable and unstable periods, since CPAP increased VO2 by 14% in both cases (p = .02, .03, respectively). Patients whose VO2 fell most during sleep avoided an increase in PCO2 and respiratory effort. OSA patients typically convert from unstable to stable breathing without lowering metabolic rate. During sleep, OSA patients labor with increased respiratory effort but fail to satisfy metabolic demand even in the absence of overt respiratory events. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  4. Association of Low Levels of Vitamin D with Chronic Stable Angina: A Prospective Case-Control Study

    PubMed Central

    Raina, Ab Hameed; Allai, Mohammad Sultan; Shah, Zafar Amin; Changal, Khalid Hamid; Raina, Manzoor Ahmad; Bhat, Fayaz Ahmad

    2016-01-01

    Background: Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Chronic stable angina is the initial manifestation of CAD in approximately 50% of the patients. Recent evidence suggests that vitamin D is crucial for cardiovascular health. The prevalence of vitamin D deficiency in our region is 83%. A low level of vitamin D is associated with chronic stable angina. Aim: This study was aimed at supporting or refuting this hypothesis in our population. Materials and Methods: The study was a prospective case-control study. We studied 100 cases of chronic stable angina and compared them with 100 matched controls. Vitamin D deficiency was defined as <20 ng/mL, vitamin D insufficiency as 20-30 ng/mL and normal vitamin D level as 31-150 ng/mL. Results: The prevalence of vitamin D deficiency among cases and controls was 75% and 10%, respectively. 75% of the cases were vitamin D-deficient (<20 ng/mL); 12% were vitamin D-insufficient (20-30 ng/mL), and 13% had normal vitamin D levels (31-150 ng/mL). None had a toxic level of vitamin D. Among the controls, 10% were vitamin D-deficient, 33% were vitamin D-insufficient, and 57% had normal vitamin D levels. The mean vitamin level among cases and controls was 15.53 ng/mL and 40.95 ng/mL, respectively, with the difference being statistically significant (P ≤ 0.0001). There was no statistically significant relation between the disease severities, i.e., on coronary angiography (CAG) with vitamin D level. Among the cases, we found that an increasing age was inversely related to vitamin D levels (P = 0.027). Conclusion: Our study indicates a correlation between vitamin D deficiency and chronic stable angina. Low levels may be an independent, potentially modifiable cardiovascular risk factor. PMID:27114971

  5. [Implantation of the paclitaxel-eluting stent Apollo in patients with stable angina pectoris: long-term angiographic and clinical results].

    PubMed

    Batyraliev, T A; Fettser, D V; Samko, A N; Sidorenko, B A

    2010-01-01

    to assess the long-term angiographic and clinical results of percutaneous coronary interventions (PCI) with implantation of the drug-eluting stent (DES) Apollo in patients with stable angina pectoris. The study enrolled 48 patients with stable angina who had been implanted with 59 stents. A follow-up of the patients lasted 12 months. The intervention was successful in 100% patients. Following 12 months, 81.3% of the patients underwent angiography that demonstrated that the vascular diameter decreased by 0.32 +/- 0.45 mm and the rate of restenosis was reduced by only 5.3%. The frequency of evident cardiac complications over 12 months was as high as 11.6%. The DES Apollo provides a way of safely performing PCI, by achieving a high of angiographic success rate. The application of this stent yields long-term good angiographic and clinical results in patients with stable angina pectoris.

  6. Fractional CO2 lasers contribute to the treatment of stable non-segmental vitiligo.

    PubMed

    Yuan, Jinping; Chen, Hongqiang; Yan, Ru; Cui, Shaoshan; Li, Yuan-Hong; Wu, Yan; Gao, Xing-Hua; Chen, Hong-Duo

    2016-12-01

    Stable non-segmental vitiligo is often resistant to conventional therapies. The purpose of this study was to investigate the effect of three types of fractional lasers in the treatment of stable non-segmental vitiligo. Twenty patients were enrolled in the study. The vitiligo lesions of each patient were divided into four treatment parts, and all parts were treated with narrowband ultraviolet-B (NB-UVB). Three of the four parts were respectively treated with three types of fractional lasers (two ablative 10,600-nm CO 2 lasers and one non-ablative 1,565-nm laser), followed by topical betamethasone solution application. The treatment period lasted six months. Efficacy and satisfaction were respectively assessed by dermatologists and patients. The ablative CO 2 lasers, in combination with topical betamethasone solution and NB-UVB, achieved marked to excellent improvement on white patches assessed by dermatologists. Patients showed high satisfaction scores for the treatments. The non-ablative 1,565-nm fractional laser did not provide any further benefit in the treatment of vitiligo. No severe adverse events developed for any of the treatments. The treatment protocol with ablative CO 2 lasers, in combination with topical betamethasone solution and NB-UVB, was suitable for stable non-segmental vitiligo. For vitiligo, the ablative fractional CO 2 laser is more effective than the non-ablative fractional laser.

  7. Predictors of dynamic hyperinflation during the 6-minute walk test in stable chronic obstructive pulmonary disease patients

    PubMed Central

    Chen, Rui; Lin, Lin; Tian, Jing-Wei; Zeng, Bin; Zhang, Lei

    2015-01-01

    Background Dynamic hyperinflation (DH) is a major contributor to exercise limitation in chronic obstructive pulmonary disease (COPD). Therefore, we aimed to elucidate the physiological factors responsible for DH development during the 6-minute walk test (6MWT) in COPD patients and compare ventilatory response to the 6MWT in hyperinflators and non-hyperinflators. Methods A total of 105 consecutive subjects with stable COPD underwent a 6MWT, and the Borg dyspnea scale, oxygen saturation (SpO2), breathing pattern, and inspiratory capacity (IC) were recorded before and immediately after walking. The change in IC was measured, and subjects were divided into hyperinflators (ΔIC >0.0 L) and non-hyperinflators (ΔIC ≤0.0 L). Spirometry, the Modified Medical Research Council (MMRC) dyspnea scale and St George’s Respiratory Questionnaire (SGRQ) were also assessed. Results DH was present in 66.67% of subjects. ΔIC/IC was significantly and negatively correlated with the small airway function. On multiple stepwise regression analysis forced expiratory flow after exhaling 50% of the forced vital capacity (FEF50%) was the only predictor of ΔIC/IC. Non-hyperinflators had a higher post-walking VT (t=2.419, P=0.017) and post-walking VE (t=2.599, P=0.011) than the hyperinflators did. Age and resting IC were independent predictors of the 6-minute walk distance (6MWD) in hyperinflators. Conclusions DH was considerably common in subjects with COPD. Small airway function may partly contribute to the DH severity during walking. The ventilator response to the 6MWT differed between hyperinflators and non-hyperinflators. Resting hyperinflation is an important predictor of functional exercise capacity in hyperinflators. PMID:26380729

  8. n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits.

    PubMed

    Gebauer, Sarah K; Psota, Tricia L; Harris, William S; Kris-Etherton, Penny M

    2006-06-01

    Dietary recommendations have been made for n-3 fatty acids, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) to achieve nutrient adequacy and to prevent and treat cardiovascular disease. These recommendations are based on a large body of evidence from epidemiologic and controlled clinical studies. The n-3 fatty acid recommendation to achieve nutritional adequacy, defined as the amount necessary to prevent deficiency symptoms, is 0.6-1.2% of energy for ALA; up to 10% of this can be provided by EPA or DHA. To achieve recommended ALA intakes, food sources including flaxseed and flaxseed oil, walnuts and walnut oil, and canola oil are recommended. The evidence base supports a dietary recommendation of approximately 500 mg/d of EPA and DHA for cardiovascular disease risk reduction. For treatment of existing cardiovascular disease, 1 g/d is recommended. These recommendations have been embraced by many health agencies worldwide. A dietary strategy for achieving the 500-mg/d recommendation is to consume 2 fish meals per week (preferably fatty fish). Foods enriched with EPA and DHA or fish oil supplements are a suitable alternate to achieve recommended intakes and may be necessary to achieve intakes of 1 g/d.

  9. Area wide management of stable flies

    USDA-ARS?s Scientific Manuscript database

    Stable flies are among the most damaging pests of livestock worldwide. Their painful bites cause both physiological and behavioral changes that reduce productivity and wellbeing of domestic animals and humans alike. Immature stable flies develop in decomposing and fermenting vegetative materials, of...

  10. Antianginal Efficacy of Ivabradine/Metoprolol Combination in Patients With Stable Angina.

    PubMed

    Zarifis, John; Kallistratos, Manolis; Katsivas, Apostolos

    2016-12-01

    Medical treatment is the main clinical strategy for controlling patients with chronic stable angina and improving their quality of life (QoL). Ivabradine treatment on top of metoprolol decreases angina symptoms and improves QoL in patients with stable angina and coronary artery disease (CAD). This is a post hoc analysis (636 CAD patients given ivabradine/metoprolol free combination) of a prospective, noninterventional study that included 2403 patients with CAD and stable angina. Data were recorded at baseline at 1 and 4 months after inclusion. Patient QoL was assessed using the EQ-5D questionnaire. From baseline to study completion; ivabradine administration on top of metoprolol decreased heart rate (HR) from 80.8 ± 9.6 to 64.2 ± 6.2 bpm (P < 0.001). Mean number of angina attacks decreased from 2.0 ± 2.0/wk to 0.2 ± 0.6/wk (P < 0.001), whereas nitroglycerin consumption decreased from 1.4 ± 1.9 times/wk to 0.1 ± 0.4 times/wk (P < 0.001). The percentage of patients in Canadian Cardiovascular Society angina class III to IV decreased from 15.4% to 1.9% (P < 0.001). The improvement of symptoms and angina class led to a significant 14.7-point increase in EQ-5D questionnaire score (P < 0.001). Patients with increased HR showed greater improvement (P = 0.001). Adherence to treatment during the entire trial was high (98%). Ivabradine combined with metoprolol significantly decreased angina symptoms and use of nitroglycerin in patients with stable angina and CAD, leading to improved QoL. The benefits observed with this combination explain the high rate of adherence to treatment. © 2016 Wiley Periodicals, Inc.

  11. Science Achievement Gaps by Gender and Race/Ethnicity in Elementary and Middle School: Trends and Predictors

    ERIC Educational Resources Information Center

    Quinn, David M.; Cooc, North

    2015-01-01

    Research on science achievement disparities by gender and race/ethnicity often neglects the beginning of the pipeline in the early grades. We address this limitation using nationally representative data following students from Grades 3 to 8. We find that the Black-White science test score gap (-1.07 SD in Grade 3) remains stable over these years,…

  12. Eculizumab for Dense Deposit Disease and C3 Glomerulonephritis

    PubMed Central

    Smith, Richard J.; Barile, Gaetano R.; Zhang, Yuzhou; Heher, Eliot C.; Herlitz, Leal; Stokes, M. Barry; Markowitz, Glen S.; D’Agati, Vivette D.; Canetta, Pietro A.; Radhakrishnan, Jai; Appel, Gerald B.

    2012-01-01

    Summary Background and objectives The principle defect in dense deposit disease and C3 glomerulonephritis is hyperactivity of the alternative complement pathway. Eculizumab, a monoclonal antibody that binds to C5 to prevent formation of the membrane attack complex, may prove beneficial. Design, setting, participants, & measurements In this open-label, proof of concept efficacy and safety study, six subjects with dense deposit disease or C3 glomerulonephritis were treated with eculizumab every other week for 1 year. All had proteinuria >1 g/d and/or AKI at enrollment. Subjects underwent biopsy before enrollment and repeat biopsy at the 1-year mark. Results The subjects included three patients with dense deposit disease (including one patient with recurrent dense deposit disease in allograft) and three patients with C3 glomerulonephritis (including two patients with recurrent C3 glomerulonephritis in allograft). Genetic and complement function testing revealed a mutation in CFH and MCP in one subject each, C3 nephritic factor in three subjects, and elevated levels of serum membrane attack complex in three subjects. After 12 months, two subjects showed significantly reduced serum creatinine, one subject achieved marked reduction in proteinuria, and one subject had stable laboratory parameters but histopathologic improvements. Elevated serum membrane attack complex levels normalized on therapy and paralleled improvements in creatinine and proteinuria. Conclusions Clinical and histopathologic data suggest a response to eculizumab in some but not all subjects with dense deposit disease and C3 glomerulonephritis. Elevation of serum membrane attack complex before treatment may predict response. Additional research is needed to define the subgroup of dense deposit disease/C3 glomerulonephritis patients in whom eculizumab therapy can be considered. PMID:22403278

  13. Implementation and characterization of a stable optical frequency distribution system.

    PubMed

    Bernhardt, Birgitta; Hänsch, Theodor W; Holzwarth, Ronald

    2009-09-14

    An optical frequency distribution system has been developed that continuously delivers a stable optical frequency of 268 THz (corresponding to a wavelength of 1118 nm) to different experiments in our institute. For that purpose, a continuous wave (cw) fiber laser has been stabilized onto a frequency comb and distributed across the building by the use of a fiber network. While the light propagates through the fiber, acoustic and thermal effects counteract against the stability and accuracy of the system. However, by employing proper stabilization methods a stability of 2 x 10(-13) tau(-1/2) is achieved, limited by the available radio frequency (RF) reference. Furthermore, the issue of counter-dependant results of the Allan deviation was examined during the data evaluation.

  14. Reducing dosing frequency of carbidopa/levodopa: double-blind crossover study comparing twice-daily bilayer formulation of carbidopa/levodopa (IPX054) versus 4 daily doses of standard carbidopa/levodopa in stable Parkinson disease patients.

    PubMed

    Hinson, Vanessa K; Goetz, Christopher G; Leurgans, Sue; Fan, Wenqing; Nguyen, Tiffany; Hsu, Ann

    2009-01-01

    We compared IPX054, a bilayer tablet of immediate- and extended-release carbidopa/levodopa (CD/LD) given twice daily to standard CD/LD given 4 times daily in patients with stable Parkinson disease (PD). Twelve PD patients with no or mild fluctuations on CD/LD 25/100 mg 4 times daily were randomized to a double-blind crossover comparison with IPX054 (50/200 mg) twice daily. At the end of each 2-week treatment, patients were video recorded while performing a modified Unified Parkinson's Disease Rating Scale motor examination and Rush Dyskinesia Rating Scale at 30-minute intervals over 8.5 hours. The primary outcome measure was the number of videotape epochs rated as "ON" without troublesome dyskinesia by a blinded observer (Wilcoxon signed rank tests). The 9 men and 3 women had a mean age of 69 years and mean PD duration of 6 years. IPX054 and CD/LD showed no significant differences in the primary outcome measure (mean number of video epochs rated as ON without troublesome dyskinesia; P = 0.14). The mean time to ON was improved with IPX054 (P = 0.014), and the mean modified Unified Parkinson's Disease Rating Scale scores slightly favored IPX054 (14.4 vs 16.9; P = 0.052). Mean Rush Dyskinesia Rating Scale scores were not significantly different between IPX054 and CD/LD (0.45 vs 0.69; P = 0.25). No patient developed troublesome dyskinesias. In stable PD patients, no difference was detected between twice-daily treatment with IPX054 and CD/LD given 4 times daily. In this group, substitution with IPX054 reduced dosing frequency while maintaining CD/LD efficacy. In clinical practice, this ease of administration may offer improved treatment compliance.

  15. Prospective Analysis of Behavioral Economic Predictors of Stable Moderation Drinking Among Problem Drinkers Attempting Natural Recovery.

    PubMed

    Tucker, Jalie A; Cheong, JeeWon; Chandler, Susan D; Lambert, Brice H; Pietrzak, Brittney; Kwok, Heather; Davies, Susan L

    2016-12-01

    As interventions have expanded beyond clinical treatment to include brief interventions for persons with less severe alcohol problems, predicting who can achieve stable moderation drinking has gained importance. Recent behavioral economic (BE) research on natural recovery has shown that active problem drinkers who allocate their monetary expenditures on alcohol and saving for the future over longer time horizons tend to have better subsequent recovery outcomes, including maintenance of stable moderation drinking. This study compared the predictive utility of this money-based "Alcohol-Savings Discretionary Expenditure" (ASDE) index with multiple BE analogue measures of behavioral impulsivity and self-control, which have seldom been investigated together, to predict outcomes of natural recovery attempts. Community-dwelling problem drinkers, enrolled shortly after stopping abusive drinking without treatment, were followed prospectively for up to a year (N = 175 [75.4% male], M age = 50.65 years). They completed baseline assessments of preresolution drinking practices and problems, analogue behavioral choice tasks (Delay Discounting, Melioration-Maximization, and Alcohol Purchase Tasks), and a Timeline Followback interview including expenditures on alcohol compared to voluntary savings (ASDE index) during the preresolution year. Multinomial logistic regression models showed that, among the BE measures, only the ASDE index predicted stable moderation drinking compared to stable abstinence or unstable resolutions involving relapse. As hypothesized, stable moderation was associated with more balanced preresolution allocations to drinking and savings (odds ratio = 1.77, 95% confidence interval = 1.02 to 3.08, p < 0.05), suggesting it is associated with longer-term behavior regulation processes than abstinence. The ASDE's unique predictive utility may rest on its comprehensive representation of contextual elements to support this patterning of behavioral

  16. Prospective Analysis of Behavioral Economic Predictors of Stable Moderation Drinking Among Problem Drinkers Attempting Natural Recovery

    PubMed Central

    Tucker, Jalie A.; Cheong, JeeWon; Chandler, Susan D.; Lambert, Brice H.; Pietrzak, Brittney; Kwok, Heather; Davies, Susan L.

    2016-01-01

    Background As interventions have expanded beyond clinical treatment to include brief interventions for persons with less severe alcohol problems, predicting who can achieve stable moderation drinking has gained importance. Recent behavioral economic (BE) research on natural recovery has shown that active problem drinkers who allocate their monetary expenditures on alcohol and saving for the future over longer time horizons tend to have better subsequent recovery outcomes, including maintenance of stable moderation drinking. The present study compared the predictive utility of this money-based “Alcohol-Savings Discretionary Expenditure” (ASDE) index with multiple BE analogue measures of behavioral impulsivity and self-control, which have seldom been investigated together, to predict outcomes of natural recovery attempts. Methods Community-dwelling problem drinkers, enrolled shortly after stopping abusive drinking without treatment, were followed prospectively for up to a year (N = 175 [75.4% male], M age = 50.65 years). They completed baseline assessments of pre-resolution drinking practices and problems; analogue behavioral choice tasks (Delay Discounting, Melioration-Maximization, and Alcohol Purchase Tasks); and a Timeline Followback interview including expenditures on alcohol compared to voluntary savings (ASDE index) during the pre-resolution year. Results Multinomial logistic regression models showed that, among the BE measures, only the ASDE index predicted stable moderation drinking compared to stable abstinence or unstable resolutions involving relapse. As hypothesized, stable moderation was associated with more balanced pre-resolution allocations to drinking and savings (OR = 1.77, 95% CI = 1.02 ∼ 3.08, p < .05), suggesting it is associated with longer term behavior regulation processes than abstinence. Conclusions The ASDE's unique predictive utility may rest on its comprehensive representation of contextual elements to support this patterning of

  17. Use of stable sulphur isotopes to monitor directly the behaviour of sulphur in coal during thermal desulphurization

    USGS Publications Warehouse

    Liu, Chao-Li; Hackley, Keith C.; Coleman, D.D.

    1987-01-01

    A method has been developed using stable sulphur isotope analyses to monitor the behaviour of sulphur forms in a coal during thermal desulphurization. In this method, the natural stable isotopic composition of the pyritic and organic sulphur in coal is used as a tracer to follow their mobility during the desulphurization process. This tracer method is based on the fact that the isotopic compositions of pyritic and organic sulphur are significantly different in some coals. Isotopic results of pyrolysis experiments at temperatures ranging from 350 to 750 ??C indicate that the sulphur released with the volatiles is predominantly organic sulphur. The pyritic sulphur is evolved in significant quantities only when pyrolysis temperatures exceed 500 ??C. The presence of pyrite seems to have no effect on the amount of organic sulphur evolved during pyrolysis. The chemical and isotopic mass balances achieved from three different samples of the Herrin (No. 6) coal of the Illinois Basin demonstrate that this stable isotope tracer method is quantitative. The main disadvantage of this tracing technique is that not all coals contain isotopically distinct organic and pyritic sulphur. ?? 1987.

  18. An organic water-gated ambipolar transistor with a bulk heterojunction active layer for stable and tunable photodetection

    NASA Astrophysics Data System (ADS)

    Xu, Haihua; Zhu, Qingqing; Wu, Tongyuan; Chen, Wenwen; Zhou, Guodong; Li, Jun; Zhang, Huisheng; Zhao, Ni

    2016-11-01

    Organic water-gated transistors (OWGTs) have emerged as promising sensing architectures for biomedical applications and environmental monitoring due to their ability of in-situ detection of biological substances with high sensitivity and low operation voltage, as well as compatibility with various read-out circuits. Tremendous progress has been made in the development of p-type OWGTs. However, achieving stable n-type operation in OWGTs due to the presence of solvated oxygen in water is still challenging. Here, we report an ambipolar OWGT based on a bulk heterojunction active layer, which exhibits a stable hole and electron transport when exposed to aqueous environment. The device can be used as a photodetector both in the hole and electron accumulation regions to yield a maximum responsivity of 0.87 A W-1. More importantly, the device exhibited stable static and dynamic photodetection even when operated in the n-type mode. These findings bring possibilities for the device to be adopted for future biosensing platforms, which are fully compatible with low-cost and low-power organic complementary circuits.

  19. Respiratory muscle activity and patient-ventilator asynchrony during different settings of noninvasive ventilation in stable hypercapnic COPD: does high inspiratory pressure lead to respiratory muscle unloading?

    PubMed

    Duiverman, Marieke L; Huberts, Anouk S; van Eykern, Leo A; Bladder, Gerrie; Wijkstra, Peter J

    2017-01-01

    High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient-ventilator asynchrony (PVA). Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA. Compared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings ( P =0.017). High-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA.

  20. Development of an Echocardiographic Risk-Stratification Index to Predict Heart Failure in Patients With Stable Coronary Artery Disease

    PubMed Central

    Stevens, Steven M.; Farzaneh-Far, Ramin; Na, Beeya; Whooley, Mary A.; Schiller, Nelson B.

    2009-01-01

    OBJECTIVES We sought to determine which transthoracic echocardiographic (TTE) measurements most strongly predict heart failure (HF) and to develop an index for risk stratification in outpatients with coronary artery disease (CAD). BACKGROUND Many TTE measurements have been shown to be predictive of HF, and they might be useful if aggregated into a risk-prediction index. METHODS We performed TTE in 1,024 outpatients with stable CAD enrolled in the Heart and Soul study and followed them for 4.4 years. With Cox proportional hazard models, we evaluated the association of 15 TTE measurements with subsequent HF hospital stay. Those measurements that independently predicted HF were combined into an index. Variables were defined as normal or abnormal on the basis of dichotomous cutoffs determined from the American Society of Echocardiography. Abnormal variables in each measurement were assigned points on the basis of strength of association with HF. RESULTS Of the 15 variables, 5 measurements were independent predictors of HF: left ventricular mass index (LVMI), left atrial volume index (LAVI), mitral regurgitation (MR), left ventricular outflow tract velocity-time integral (VTILVOT), and diastolic dysfunction (DD). In multivariate analysis, each of the 5 measurements independently predicted HF: LVMI >90 g/m2 (hazard ratio [HR]: 4.1; 95% confidence interval [CI]: 2.3 to 7.2, p < 0.0001); pseudo-normal or restrictive DD (HR: 2.9; 95% CI: 1.8 to 4.5, p < 0.0001); VTILVOT <22 mm (HR: 2.2; 95% CI: 1.4 to 3.5, p = 0.0004); mild, moderate, or severe MR (HR: 1.8; 95% CI: 1.2 to 2.8, p = 0.009); and LAVI >29 ml/m2 (HR: 1.6; 95% CI: 1.0 to 2.5, p = 0.06). Combining these measurements, the Heart Failure Index ranged from 0 to 8, representing risk as follows: 3 points for LVMI, 2 points for DD, and 1 point for VTILVOT, MR, and LAVI. Among participants with 0 to 2 points: 4% had HF hospital stays (reference); 3 to 4 points: 10% (HR: 2.4; 95% CI: 1.3 to 4.4, p = 0.003); 5 to 6 points

  1. Highly Efficient Spectrally Stable Red Perovskite Light-Emitting Diodes.

    PubMed

    Tian, Yu; Zhou, Chenkun; Worku, Michael; Wang, Xi; Ling, Yichuan; Gao, Hanwei; Zhou, Yan; Miao, Yu; Guan, Jingjiao; Ma, Biwu

    2018-05-01

    Perovskite light-emitting diodes (LEDs) have recently attracted great research interest for their narrow emissions and solution processability. Remarkable progress has been achieved in green perovskite LEDs in recent years, but not blue or red ones. Here, highly efficient and spectrally stable red perovskite LEDs with quasi-2D perovskite/poly(ethylene oxide) (PEO) composite thin films as the light-emitting layer are reported. By controlling the molar ratios of organic salt (benzylammonium iodide) to inorganic salts (cesium iodide and lead iodide), luminescent quasi-2D perovskite thin films are obtained with tunable emission colors from red to deep red. The perovskite/polymer composite approach enables quasi-2D perovskite/PEO composite thin films to possess much higher photoluminescence quantum efficiencies and smoothness than their neat quasi-2D perovskite counterparts. Electrically driven LEDs with emissions peaked at 638, 664, 680, and 690 nm have been fabricated to exhibit high brightness and external quantum efficiencies (EQEs). For instance, the perovskite LED with an emission peaked at 680 nm exhibits a brightness of 1392 cd m -2 and an EQE of 6.23%. Moreover, exceptional electroluminescence spectral stability under continuous device operation has been achieved for these red perovskite LEDs. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. The Potential for Zinc Stable Isotope Techniques and Modelling to Determine Optimal Zinc Supplementation

    PubMed Central

    Tran, Cuong D.; Gopalsamy, Geetha L.; Mortimer, Elissa K.; Young, Graeme P.

    2015-01-01

    It is well recognised that zinc deficiency is a major global public health issue, particularly in young children in low-income countries with diarrhoea and environmental enteropathy. Zinc supplementation is regarded as a powerful tool to correct zinc deficiency as well as to treat a variety of physiologic and pathologic conditions. However, the dose and frequency of its use as well as the choice of zinc salt are not clearly defined regardless of whether it is used to treat a disease or correct a nutritional deficiency. We discuss the application of zinc stable isotope tracer techniques to assess zinc physiology, metabolism and homeostasis and how these can address knowledge gaps in zinc supplementation pharmacokinetics. This may help to resolve optimal dose, frequency, length of administration, timing of delivery to food intake and choice of zinc compound. It appears that long-term preventive supplementation can be administered much less frequently than daily but more research needs to be undertaken to better understand how best to intervene with zinc in children at risk of zinc deficiency. Stable isotope techniques, linked with saturation response and compartmental modelling, also have the potential to assist in the continued search for simple markers of zinc status in health, malnutrition and disease. PMID:26035248

  3. Ground-based cloud classification by learning stable local binary patterns

    NASA Astrophysics Data System (ADS)

    Wang, Yu; Shi, Cunzhao; Wang, Chunheng; Xiao, Baihua

    2018-07-01

    Feature selection and extraction is the first step in implementing pattern classification. The same is true for ground-based cloud classification. Histogram features based on local binary patterns (LBPs) are widely used to classify texture images. However, the conventional uniform LBP approach cannot capture all the dominant patterns in cloud texture images, thereby resulting in low classification performance. In this study, a robust feature extraction method by learning stable LBPs is proposed based on the averaged ranks of the occurrence frequencies of all rotation invariant patterns defined in the LBPs of cloud images. The proposed method is validated with a ground-based cloud classification database comprising five cloud types. Experimental results demonstrate that the proposed method achieves significantly higher classification accuracy than the uniform LBP, local texture patterns (LTP), dominant LBP (DLBP), completed LBP (CLTP) and salient LBP (SaLBP) methods in this cloud image database and under different noise conditions. And the performance of the proposed method is comparable with that of the popular deep convolutional neural network (DCNN) method, but with less computation complexity. Furthermore, the proposed method also achieves superior performance on an independent test data set.

  4. High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects.

    PubMed

    Ettala, Otto O; Syvänen, Kari T; Korhonen, Päivi E; Kaipia, Antti J; Vahlberg, Tero J; Boström, Peter J; Aarnio, Pertti T

    2014-09-01

    Erectile dysfunction (ED) is especially common in men with cardiovascular diseases (CVDs). However, the data are scarce concerning populations without manifested CVD. The aim of this study was to describe factors associated with ED, especially those associated with decreasing risk of ED, in men with cardiovascular risk factors but without CVD, diabetes, or chronic renal disease. In 2004 to 2007, a cross-sectional population-based sample of men 45 to 70 years old in two rural towns in Finland was collected. Men with previously diagnosed CVD, diabetes, or kidney disease were not invited to the study. In total 1,000 eligible men with cardiovascular risk factors, i.e., central obesity, high scores in the Finnish Diabetes Risk Score, high blood pressure, antihypertensive medication, or family history of coronary heart disease, myocardial infarction, or stroke, were included in the analysis. Questionnaires, clinical measurements, and laboratory tests were obtained. The prevalence of ED was studied comparing the means, and risk factors were studied using multivariate logistic regression analysis. The rate of ED was defined by the International Index of Erectile Function short form (IIEF-5) and by two questions (2Q) about the ability to achieve and to maintain an erection. The prevalence of ED was 57% or 68% using IIEF-5 or 2Q, respectively. Age (odds ratio [OR]: up to 9.16; 95% confidence interval [CI], 5.00-16.79; P < 0.001), smoking (OR: 1.41; 95% CI, 1.04-1.91; P = 0.028), depressive symptoms (OR: 4.04 for moderate and severe; 95% CI,1.22-13.45; P = 0.001), high-intensity physical activity (OR: 0.50; 95% CI, 0.29-0.86; P = 0.045), high education (OR: 0.52; 95% CI, 0.33-0.83; P = 0.013), and stable relationship (OR: 0.43; 95% CI, 0.21-0.88; P = 0.046) were associated with ED. In apparently healthy men with cardiovascular risk factors, decreasing risk of ED is associated with high-intensity physical activity, stable relationship, and high

  5. Stable N-CuInSe.sub.2 /iodide-iodine photoelectrochemical cell

    DOEpatents

    Cahen, David; Chen, Yih W.

    1985-01-01

    In a photoelectrochemical solar cell, stable output and solar efficiency in excess of 10% are achieved with a photoanode of n-CuInSe.sub.2 electrode material and an iodine/iodide redox couple used in a liquid electrolyte. The photoanode is prepared by treating the electrode material by chemical etching, for example in Br.sub.2 /MeOH; heating the etched electrode material in air or oxygen; depositing a surface film coating of indium on the electrode material after the initial heating; and thereafter again heating the electrode material in air or oxygen to oxidize the indium. The electrolyte is treated by the addition of Cu.sup.+ or Cu.sup.2+ salts and In.sup.3+ salts.

  6. Stable n-CuInSe/sub 2/iodide-iodine photoelectrochemical cell

    DOEpatents

    Cahen, D.; Chen, Y.W.

    1984-09-20

    In a photoelectrochemical solar cell, stable output and solar efficiency in excess of 10% are achieved with a photoanode of n-CuInSe/sub 2/ electrode material and an iodine/iodide redox couple used in a liquid electrolyte. The photoanode is prepared by treating the electrode material by chemical etching, for example in Br/sub 2//MeOH; heating the etched electrode material in air or oxygen; depositing a surface film coating of indium on the electrode material after the initial heating; and thereafter again heating the electrode material in air or oxygen to oxidize the indium. The electrolyte is treated by the addition of Cu/sup +/ or Cu/sup 2 +/ salts and in In/sup 3 +/ salts.

  7. Serum creatinine is independently associated with angiographic extent of coronary artery disease in patients with stable angina pectoris.

    PubMed

    Korkmaz, Şule; Demirkan, Burcu; Altay, Hakan; Refiker Ege, Meltem; Çaldır, Vedat; Yılmaz, Mehmet Birhan; Güray, Yeşim; Güray, Ümit; Şaşmaz, Hatice

    2011-08-01

    Renal dysfunction has been shown to be linked to high risk for cardiovascular events. Even milder forms of creatinine elevation are associated with poor cardiovascular outcomes. We designed a retrospective study and searched the association of angiographic extent of coronary artery disease and creatinine levels in patients without overt renal dysfunction. We retrospectively reviewed 892 consecutive patients with typical stable angina pectoris (311 female with mean age of 62 ± 10 years, 581 male with mean age of 56 ± 11 years) at Türkiye Yüksek İhtisas Hospital and creatinine level ≤ 3 mg/dl without history of hemodialysis. Patients without overt renal disease were divided into 3 groups according to level of creatinine (Group A: Cr level <1.2 mg/dl, Group B: Cr level ≥ 1.2 and <1.5 mg/dl and Group C: Cr level ≥ 1.5 -≤ 3 mg/dl). Additionally after evaluation of coronary angiograms, patients were also classified according to those with high stenosis (stenosis score ≥ 16) and high extension scores (extension score >50%) versus low stenosis and low extension scores. Logistic regression analysis was performed to establish the clinical predictors of high total stenosis and high extension scores. Each group of patients according to level of creatinine showed marked difference in terms of angiographic extent of coronary artery disease (p<0.001). Those in the highest creatinine group (≥ 1.5 mg/dl, but not above 3 mg/dl) had the highest total stenosis (17 ± 6, p<0.001) and extension (78 ± 25, p<0.001) scores irrespective of age and gender. Creatinine was shown to be significantly correlated with both stenosis and extension scores. Age (OR:1.035, 95% CI:1.016-1.054, p<0.0001), being male (OR:1.746, 95% CI: 1.135-2.685, p=0.011), presence of hypertension (OR:1.507, 95%CI: 1.005-2.25 p=0.047), presence of diabetes mellitus (OR: 1.865, 95%: 1.250-2.783, p=0.002), previous history of myocardial infarction (OR: 1.624, 95%CI: 1.094-2.413, p=0.016), wall motion

  8. Bird migration and avian influenza: a comparison of hydrogen stable isotopes and satellite tracking methods

    USGS Publications Warehouse

    Bridge, Eli S.; Kelly, Jeffrey F.; Xiao, Xiangming; Takekawa, John Y.; Hill, Nichola J.; Yamage, Mat; Haque, Enam Ul; Islam, Mohammad Anwarul; Mundkur, Taej; Yavuz, Kiraz Erciyas; Leader, Paul; Leung, Connie Y.H.; Smith, Bena; Spragens, Kyle A.; Vandegrift, Kurt J.; Hosseini, Parviez R.; Saif, Samia; Mohsanin, Samiul; Mikolon, Andrea; Islam, Ausrafal; George, Acty; Sivananinthaperumal, Balachandran; Daszak, Peter; Newman, Scott H.

    2014-01-01

    Satellite-based tracking of migratory waterfowl is an important tool for understanding the potential role of wild birds in the long-distance transmission of highly pathogenic avian influenza. However, employing this technique on a continental scale is prohibitively expensive. This study explores the utility of stable isotope ratios in feathers in examining both the distances traveled by migratory birds and variation in migration behavior. We compared the satellite-derived movement data of 22 ducks from 8 species captured at wintering areas in Bangladesh, Turkey, and Hong Kong with deuterium ratios (δD) in the feathers of these and other individuals captured at the same locations. We derived likely molting locations from the satellite tracking data and generated expected isotope ratios based on an interpolated map of δD in rainwater. Although δD was correlated with the distance between wintering and molting locations, surprisingly, measured δD values were not correlated with either expected values or latitudes of molting sites. However, population-level parameters derived from the satellite-tracking data, such as mean distance between wintering and molting locations and variation in migration distance, were reflected by means and variation of the stable isotope values. Our findings call into question the relevance of the rainfall isotope map for Asia for linking feather isotopes to molting locations, and underscore the need for extensive ground truthing in the form of feather-based isoscapes. Nevertheless, stable isotopes from feathers could inform disease models by characterizing the degree to which regional breeding populations interact at common wintering locations. Feather isotopes also could aid in surveying wintering locations to determine where high-resolution tracking techniques (e.g. satellite tracking) could most effectively be employed. Moreover, intrinsic markers such as stable isotopes offer the only means of inferring movement information from

  9. Pathogenic mycobacteria achieve cellular persistence by inhibiting the Niemann-Pick Type C disease cellular pathway

    PubMed Central

    Fineran, Paul; Lloyd-Evans, Emyr; Lack, Nathan A.; Platt, Nick; Davis, Lianne C.; Morgan, Anthony J.; Höglinger, Doris; Tatituri, Raju Venkata V.; Clark, Simon; Williams, Ian M.; Tynan, Patricia; Al Eisa, Nada; Nazarova, Evgeniya; Williams, Ann; Galione, Antony; Ory, Daniel S.; Besra, Gurdyal S.; Russell, David G.; Brenner, Michael B.; Sim, Edith; Platt, Frances M.

    2017-01-01

    Background. Tuberculosis remains a major global health concern. The ability to prevent phagosome-lysosome fusion is a key mechanism by which intracellular mycobacteria, including Mycobacterium tuberculosis, achieve long-term persistence within host cells. The mechanisms underpinning this key intracellular pro-survival strategy remain incompletely understood. Host macrophages infected with intracellular mycobacteria share phenotypic similarities with cells taken from patients suffering from Niemann-Pick Disease Type C (NPC), a rare lysosomal storage disease in which endocytic trafficking defects and lipid accumulation within the lysosome lead to cell dysfunction and cell death. We investigated whether these shared phenotypes reflected an underlying mechanistic connection between mycobacterial intracellular persistence and the host cell pathway dysfunctional in NPC.  Methods. The induction of NPC phenotypes in macrophages from wild-type mice or obtained from healthy human donors was assessed via infection with mycobacteria and subsequent measurement of lipid levels and intracellular calcium homeostasis. The effect of NPC therapeutics on intracellular mycobacterial load was also assessed.  Results. Macrophages infected with intracellular mycobacteria phenocopied NPC cells, exhibiting accumulation of multiple lipid types, reduced lysosomal Ca 2+ levels, and defects in intracellular trafficking. These NPC phenotypes could also be induced using only lipids/glycomycolates from the mycobacterial cell wall. These data suggest that intracellular mycobacteria inhibit the NPC pathway, likely via inhibition of the NPC1 protein, and subsequently induce altered acidic store Ca 2+ homeostasis. Reduced lysosomal calcium levels may provide a mechanistic explanation for the reduced levels of phagosome-lysosome fusion in mycobacterial infection. Treatments capable of correcting defects in NPC mutant cells via modulation of host cell calcium were of benefit in promoting clearance

  10. Stable Chimeras and Independently Synchronizable Clusters

    NASA Astrophysics Data System (ADS)

    Cho, Young Sul; Nishikawa, Takashi; Motter, Adilson E.

    2017-08-01

    Cluster synchronization is a phenomenon in which a network self-organizes into a pattern of synchronized sets. It has been shown that diverse patterns of stable cluster synchronization can be captured by symmetries of the network. Here, we establish a theoretical basis to divide an arbitrary pattern of symmetry clusters into independently synchronizable cluster sets, in which the synchronization stability of the individual clusters in each set is decoupled from that in all the other sets. Using this framework, we suggest a new approach to find permanently stable chimera states by capturing two or more symmetry clusters—at least one stable and one unstable—that compose the entire fully symmetric network.

  11. Stable isotopes in Lithuanian bioarcheological material

    NASA Astrophysics Data System (ADS)

    Skipityte, Raminta; Jankauskas, Rimantas; Remeikis, Vidmantas

    2015-04-01

    Investigation of bioarcheological material of ancient human populations allows us to understand the subsistence behavior associated with various adaptations to the environment. Feeding habits are essential to the survival and growth of ancient populations. Stable isotope analysis is accepted tool in paleodiet (Schutkowski et al, 1999) and paleoenvironmental (Zernitskaya et al, 2014) studies. However, stable isotopes can be useful not only in investigating human feeding habits but also in describing social and cultural structure of the past populations (Le Huray and Schutkowski, 2005). Only few stable isotope investigations have been performed before in Lithuanian region suggesting a quite uniform diet between males and females and protein intake from freshwater fish and animal protein. Previously, stable isotope analysis has only been used to study a Stone Age population however, more recently studies have been conducted on Iron Age and Late medieval samples (Jacobs et al, 2009). Anyway, there was a need for more precise examination. Stable isotope analysis were performed on human bone collagen and apatite samples in this study. Data represented various ages (from 5-7th cent. to 18th cent.). Stable carbon and nitrogen isotope analysis on medieval populations indicated that individuals in studied sites in Lithuania were almost exclusively consuming C3 plants, C3 fed terrestrial animals, and some freshwater resources. Current investigation demonstrated social differences between elites and country people and is promising in paleodietary and daily life reconstruction. Acknowledgement I thank prof. dr. G. Grupe, Director of the Anthropological and Palaeoanatomical State Collection in Munich for providing the opportunity to work in her laboratory. The part of this work was funded by DAAD. Antanaitis-Jacobs, Indre, et al. "Diet in early Lithuanian prehistory and the new stable isotope evidence." Archaeologia Baltica 12 (2009): 12-30. Le Huray, Jonathan D., and Holger

  12. Interleaving subthalamic nucleus deep brain stimulation to avoid side effects while achieving satisfactory motor benefits in Parkinson disease

    PubMed Central

    Zhang, Shizhen; Zhou, Peizhi; Jiang, Shu; Wang, Wei; Li, Peng

    2016-01-01

    Abstract Background: Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment for advanced Parkinson disease (PD). However, achieving ideal outcomes by conventional programming can be difficult in some patients, resulting in suboptimal control of PD symptoms and stimulation-induced adverse effects. Interleaving stimulation (ILS) is a newer programming technique that can individually optimize the stimulation area, thereby improving control of PD symptoms while alleviating stimulation-induced side effects after conventional programming fails to achieve the desired results. Methods: We retrospectively reviewed PD patients who received DBS programming during the previous 4 years in our hospital. We collected clinical and demographic data from 12 patients who received ILS because of incomplete alleviation of PD symptoms or stimulation-induced adverse effects after conventional programming had proven ineffective or intolerable. Appropriate lead location was confirmed with postoperative reconstruction images. The rationale and clinical efficacy of ILS was analyzed. Results: We divided our patients into 4 groups based on the following symptoms: stimulation-induced dysarthria and choreoathetoid dyskinesias, gait disturbance, and incomplete control of parkinsonism. After treatment with ILS, patients showed satisfactory improvement in PD symptoms and alleviation of stimulation-induced side effects, with a mean improvement in Unified PD Rating Scale motor scores of 26.9%. Conclusions: ILS is a newer choice and effective programming strategy to maximize symptom control in PD while decreasing stimulation-induced adverse effects when conventional programming fails to achieve satisfactory outcome. However, we should keep in mind that most DBS patients are routinely treated with conventional stimulation and that not all patients benefit from ILS. ILS is not recommended as the first choice of programming, and it is recommended only when patients have

  13. Does achievement motivation mediate the semantic achievement priming effect?

    PubMed

    Engeser, Stefan; Baumann, Nicola

    2014-10-01

    The aim of our research was to understand the processes of the prime-to-behavior effects with semantic achievement primes. We extended existing models with a perspective from achievement motivation theory and additionally used achievement primes embedded in the running text of excerpts of school textbooks to simulate a more natural priming condition. Specifically, we proposed that achievement primes affect implicit achievement motivation and conducted pilot experiments and 3 main experiments to explore this proposition. We found no reliable positive effect of achievement primes on implicit achievement motivation. In light of these findings, we tested whether explicit (instead of implicit) achievement motivation is affected by achievement primes and found this to be the case. In the final experiment, we found support for the assumption that higher explicit achievement motivation implies that achievement priming affects the outcome expectations. The implications of the results are discussed, and we conclude that primes affect achievement behavior by heightening explicit achievement motivation and outcome expectancies.

  14. Socioeconomic benefit to individuals of achieving 2020 targets for four neglected tropical diseases controlled/eliminated by innovative and intensified disease management: Human African trypanosomiasis, leprosy, visceral leishmaniasis, Chagas disease.

    PubMed

    Lenk, Edeltraud J; Redekop, William K; Luyendijk, Marianne; Fitzpatrick, Christopher; Niessen, Louis; Stolk, Wilma A; Tediosi, Fabrizio; Rijnsburger, Adriana J; Bakker, Roel; Hontelez, Jan A C; Richardus, Jan H; Jacobson, Julie; Le Rutte, Epke A; de Vlas, Sake J; Severens, Johan L

    2018-03-01

    The control or elimination of neglected tropical diseases (NTDs) has targets defined by the WHO for 2020, reinforced by the 2012 London Declaration. We estimated the economic impact to individuals of meeting these targets for human African trypanosomiasis, leprosy, visceral leishmaniasis and Chagas disease, NTDs controlled or eliminated by innovative and intensified disease management (IDM). A systematic literature review identified information on productivity loss and out-of-pocket payments (OPPs) related to these NTDs, which were combined with projections of the number of people suffering from each NTD, country and year for 2011-2020 and 2021-2030. The ideal scenario in which the WHO's 2020 targets are met was compared with a counterfactual scenario that assumed the situation of 1990 stayed unaltered. Economic benefit equaled the difference between the two scenarios. Values are reported in 2005 US$, purchasing power parity-adjusted, discounted at 3% per annum from 2010. Probabilistic sensitivity analyses were used to quantify the degree of uncertainty around the base-case impact estimate. The total global productivity gained for the four IDM-NTDs was I$ 23.1 (I$ 15.9 -I$ 34.0) billion in 2011-2020 and I$ 35.9 (I$ 25.0 -I$ 51.9) billion in 2021-2030 (2.5th and 97.5th percentiles in brackets), corresponding to US$ 10.7 billion (US$ 7.4 -US$ 15.7) and US$ 16.6 billion (US$ 11.6 -US$ 24.0). Reduction in OPPs was I$ 14 billion (US$ 6.7 billion) and I$ 18 billion (US$ 10.4 billion) for the same periods. We faced important limitations to our work, such as finding no OPPs for leprosy. We had to combine limited data from various sources, heterogeneous background, and of variable quality. Nevertheless, based on conservative assumptions and subsequent uncertainty analyses, we estimate that the benefits of achieving the targets are considerable. Under plausible scenarios, the economic benefits far exceed the necessary investments by endemic country governments and their

  15. Minute synthesis of extremely stable gold nanoparticles.

    PubMed

    Zhou, Min; Wang, Baoxiang; Rozynek, Zbigniew; Xie, Zhaohui; Fossum, Jon Otto; Yu, Xiaofeng; Raaen, Steinar

    2009-12-16

    We describe a rapid environmentally friendly wet-chemical approach to synthesize extremely stable non-toxic, biocompatible, water-soluble monodispersed gold nanoparticles (AuNPs) in one step at room temperature. The particles have been successfully achieved in just a few minutes by merely adding sodium hydroxide (NaOH) acting as an initiator for the reduction of HAuCl(4) in aqueous solution in the presence of polyvinylpyrrolidone (PVP) without the use of any reducing agent. It is also proved to be highly efficient for the preparation of AuNPs with controllable sizes. The AuNPs show remarkable stability in water media with high concentrations of salt, various buffer solutions and physiological conditions in biotechnology and biomedicine. Moreover, the AuNPs are also non-toxic at high concentration (100 microM). Therefore, it provides great opportunities to use these AuNPs for biotechnology and biomedicine. This new approach also involved several green chemistry concepts, such as the selection of environmentally benign reagents and solvents, without energy consumption, and less reaction time.

  16. TEACH (Train to Enable/Achieve Culturally Sensitive Healthcare)

    NASA Technical Reports Server (NTRS)

    Maulitz, Russell; Santarelli, Thomas; Barnieu, Joanne; Rosenzweig, Larry; Yi, Na Yi; Zachary, Wayne; OConnor, Bonnie

    2010-01-01

    Personnel from diverse ethnic and demographic backgrounds come together in both civilian and military healthcare systems, facing diagnoses that at one level are equalizers: coronary disease is coronary disease, breast cancer is breast cancer. Yet the expression of disease in individuals from different backgrounds, individual patient experience of disease as a particular illness, and interactions between patients and providers occurring in any given disease scenario, all vary enormously depending on the fortuity of the equation of "which patient happens to arrive in whose exam room." Previously, providers' absorption of lessons-learned depended on learning as an apprentice would when exposed over time to multiple populations. As a result, and because providers are often thrown into situations where communications falter through inadequate direct patient experience, diversity in medicine remains a training challenge. The questions then become: Can simulation and virtual training environments (VTEs) be deployed to short-track and standardize this sort of random-walk problem? Can we overcome the unevenness of training caused by some providers obtaining the valuable exposure to diverse populations, whereas others are left to "sink or swim"? This paper summarizes developing a computer-based VTE called TEACH (Training to Enable/Achieve Culturally Sensitive Healthcare). TEACH was developed to enhance healthcare providers' skills in delivering culturally sensitive care to African-American women with breast cancer. With an authoring system under development to ensure extensibility, TEACH allows users to role-play in clinical oncology settings with virtual characters who interact on the basis of different combinations of African American sub-cultural beliefs regarding breast cancer. The paper reports on the roll-out and evaluation of the degree to which these interactions allow providers to acquire, practice, and refine culturally appropriate communication skills and to

  17. Serum Uric Acid Levels and Onset of Cardiovascular Diseases: a CALIBER Study

    ClinicalTrials.gov

    2018-02-06

    Stable Angina; Unstable Angina; Myocardial Infarction; Unheralded Coronary Heart Disease Death; Heart Failure; Cardiac Arrest; Transient Ischaemic Attack; Ischemic Stroke; Subarachnoid Hemorrhage; Intracerebral Hemorrhage; Peripheral Arterial Disease; Abdominal Aortic Aneurysm; Atrial Fibrillation

  18. Serum cytokine profiling and enrichment analysis reveal the involvement of immunological and inflammatory pathways in stable patients with chronic obstructive pulmonary disease.

    PubMed

    Bade, Geetanjali; Khan, Meraj Alam; Srivastava, Akhilesh Kumar; Khare, Parul; Solaiappan, Krishna Kumar; Guleria, Randeep; Palaniyar, Nades; Talwar, Anjana

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a major global health problem. It results from chronic inflammation and causes irreversible airway damage. Levels of different serum cytokines could be surrogate biomarkers for inflammation and lung function in COPD. We aimed to determine the serum levels of different biomarkers in COPD patients, the association between cytokine levels and various prognostic parameters, and the key pathways/networks involved in stable COPD. In this study, serum levels of 48 cytokines were examined by multiplex assays in 30 subjects (control, n=9; COPD, n=21). Relationships between serum biomarkers and forced expiratory volume in 1 second, peak oxygen uptake, body mass index, dyspnea score, and smoking were assessed. Enrichment pathways and network analyses were implemented, using a list of cytokines showing differential expression between healthy controls and patients with COPD by Cytoscape and GeneGo Metacore™ software (Thomson-Reuters Corporation, New York, NY, USA). Concentrations of cutaneous T-cell attracting chemokine, eotaxin, hepatocyte growth factor, interleukin 6 (IL-6), IL-16, and stem cell factor are significantly higher in COPD patients compared with in control patients. Notably, this study identifies stem cell factor as a biomarker for COPD. Multiple regression analysis predicts that cutaneous T-cell-attracting chemokine, eotaxin, IL-6, and stem cell factor are inversely associated with forced expiratory volume in 1 second and peak oxygen uptake change, whereas smoking is related to eotaxin and hepatocyte growth factor changes. Enrichment pathways and network analyses reveal the potential involvement of specific inflammatory and immune process pathways in COPD. Identified network interaction and regulation of different cytokines would pave the way for deeper insight into mechanisms of the disease process.

  19. Ultrathin dendrimer-graphene oxide composite film for stable cycling lithium-sulfur batteries.

    PubMed

    Liu, Wen; Jiang, Jianbing; Yang, Ke R; Mi, Yingying; Kumaravadivel, Piranavan; Zhong, Yiren; Fan, Qi; Weng, Zhe; Wu, Zishan; Cha, Judy J; Zhou, Henghui; Batista, Victor S; Brudvig, Gary W; Wang, Hailiang

    2017-04-04

    Lithium-sulfur batteries (Li-S batteries) have attracted intense interest because of their high specific capacity and low cost, although they are still hindered by severe capacity loss upon cycling caused by the soluble lithium polysulfide intermediates. Although many structure innovations at the material and device levels have been explored for the ultimate goal of realizing long cycle life of Li-S batteries, it remains a major challenge to achieve stable cycling while avoiding energy and power density compromises caused by the introduction of significant dead weight/volume and increased electrochemical resistance. Here we introduce an ultrathin composite film consisting of naphthalimide-functionalized poly(amidoamine) dendrimers and graphene oxide nanosheets as a cycling stabilizer. Combining the dendrimer structure that can confine polysulfide intermediates chemically and physically together with the graphene oxide that renders the film robust and thin (<1% of the thickness of the active sulfur layer), the composite film is designed to enable stable cycling of sulfur cathodes without compromising the energy and power densities. Our sulfur electrodes coated with the composite film exhibit very good cycling stability, together with high sulfur content, large areal capacity, and improved power rate.

  20. Air-stable flexible organic light-emitting diodes enabled by atomic layer deposition.

    PubMed

    Lin, Yuan-Yu; Chang, Yi-Neng; Tseng, Ming-Hung; Wang, Ching-Chiun; Tsai, Feng-Yu

    2015-01-16

    Organic light-emitting diodes (OLED) are an energy-efficient light source with many desirable attributes, besides being an important display of technology, but its practical application has been limited by its low air-stability. This study demonstrates air-stable flexible OLEDs by utilizing two atomic-layer-deposited (ALD) films: (1) a ZnO film as both a stable electron-injection layer (EIL) and as a gas barrier in plastics-based OLED devices, and (2) an Al2O3/ZnO (AZO) nano-laminated film for encapsulating the devices. Through analyses of the morphology and electrical/gas-permeation properties of the films, we determined that a low ALD temperature of 70 °C resulted in optimal EIL performance from the ZnO film and excellent gas-barrier properties [water vapor transmission rate (WVTR) <5 × 10(-4) g m(-2) day(-1)] from both the ZnO EIL and the AZO encapsulating film. The low-temperature ALD processes eliminated thermal damage to the OLED devices, which were severe when a 90 °C encapsulation process was used, while enabling them to achieve an air-storage lifetime of >10,000 h.

  1. Air-Stable flexible organic light-emitting diodes enabled by atomic layer deposition

    NASA Astrophysics Data System (ADS)

    Lin, Yuan-Yu; Chang, Yi-Neng; Tseng, Ming-Hung; Wang, Ching-Chiun; Tsai, Feng-Yu

    2015-01-01

    Organic light-emitting diodes (OLED) are an energy-efficient light source with many desirable attributes, besides being an important display of technology, but its practical application has been limited by its low air-stability. This study demonstrates air-stable flexible OLEDs by utilizing two atomic-layer-deposited (ALD) films: (1) a ZnO film as both a stable electron-injection layer (EIL) and as a gas barrier in plastics-based OLED devices, and (2) an Al2O3/ZnO (AZO) nano-laminated film for encapsulating the devices. Through analyses of the morphology and electrical/gas-permeation properties of the films, we determined that a low ALD temperature of 70 °C resulted in optimal EIL performance from the ZnO film and excellent gas-barrier properties [water vapor transmission rate (WVTR) <5 × 10-4 g m-2 day-1] from both the ZnO EIL and the AZO encapsulating film. The low-temperature ALD processes eliminated thermal damage to the OLED devices, which were severe when a 90 °C encapsulation process was used, while enabling them to achieve an air-storage lifetime of >10 000 h.

  2. Cerebrospinal fluid neurogranin: relation to cognition and neurodegeneration in Alzheimer's disease.

    PubMed

    Portelius, Erik; Zetterberg, Henrik; Skillbäck, Tobias; Törnqvist, Ulrika; Andreasson, Ulf; Trojanowski, John Q; Weiner, Michael W; Shaw, Leslie M; Mattsson, Niklas; Blennow, Kaj

    2015-11-01

    Synaptic dysfunction is linked to cognitive symptoms in Alzheimer's disease. Thus, measurement of synapse proteins in cerebrospinal fluid may be useful biomarkers to monitor synaptic degeneration. Cerebrospinal fluid levels of the postsynaptic protein neurogranin are increased in Alzheimer's disease, including in the predementia stage of the disease. Here, we tested the performance of cerebrospinal fluid neurogranin to predict cognitive decline and brain injury in the Alzheimer's Disease Neuroimaging Initiative study. An in-house immunoassay was used to analyse neurogranin in cerebrospinal fluid samples from a cohort of patients who at recruitment were diagnosed as having Alzheimer's disease with dementia (n = 95) or mild cognitive impairment (n = 173), as well as in cognitively normal subjects (n = 110). Patients with mild cognitive impairment were grouped into those that remained cognitively stable for at least 2 years (stable mild cognitive impairment) and those who progressed to Alzheimer's disease dementia during follow-up (progressive mild cognitive impairment). Correlations were tested between baseline cerebrospinal fluid neurogranin levels and baseline and longitudinal cognitive impairment, brain atrophy and glucose metabolism within each diagnostic group. Cerebrospinal fluid neurogranin was increased in patients with Alzheimer's disease dementia (P < 0.001), progressive mild cognitive impairment (P < 0.001) and stable mild cognitive impairment (P < 0.05) compared with controls, and in Alzheimer's disease dementia (P < 0.01) and progressive mild cognitive impairment (P < 0.05) compared with stable mild cognitive impairment. In the mild cognitive impairment group, high baseline cerebrospinal fluid neurogranin levels predicted cognitive decline as reflected by decreased Mini-Mental State Examination (P < 0.001) and increased Alzheimer's Disease Assessment Scale-cognitive subscale (P < 0.001) scores at clinical follow-up. In addition, high baseline

  3. Exercise training in patients with heart disease: review of beneficial effects and clinical recommendations.

    PubMed

    Gielen, Stephan; Laughlin, M Harold; O'Conner, Christopher; Duncker, Dirk J

    2015-01-01

    Over the last decades exercise training has evolved into an established evidence-based therapeutic strategy with prognostic benefits in many cardiovascular diseases (CVDs): In stable coronary artery disease (CAD) exercise training attenuates disease progression by beneficially influencing CVD risk factors (i.e., hyperlipidemia, hypertension) and coronary endothelial function. In heart failure (HF) with reduced ejection fraction (HFrEF) training prevents the progressive loss of exercise capacity by antagonizing peripheral skeletal muscle wasting and by promoting left ventricular reverse remodeling with reduction in cardiomegaly and improvement of ejection fraction. Novel areas for exercise training interventions include HF with preserved ejection fraction (HFpEF), pulmonary hypertension, and valvular heart disease. In HFpEF, randomized studies indicate a lusitropic effect of training on left ventricular diastolic function associated with symptomatic improvement of exercise capacity. In pulmonary hypertension, reductions in pulmonary artery pressure were observed following endurance exercise training. Recently, innovative training methods such as high-intensity interval training, resistance training and others have been introduced. Although their prognostic value still needs to be determined, these approaches may achieve superior improvements in aerobic exercise capacity and gain in muscle mass, respectively. In this review, we give an overview of the prognostic and symptomatic benefits of exercise training in the most common cardiac disease entities. Additionally, key guideline recommendations for the initiation of training programs are summarized. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. p-Type Transparent Conducting Oxide/n-Type Semiconductor Heterojunctions for Efficient and Stable Solar Water Oxidation.

    PubMed

    Chen, Le; Yang, Jinhui; Klaus, Shannon; Lee, Lyman J; Woods-Robinson, Rachel; Ma, Jie; Lum, Yanwei; Cooper, Jason K; Toma, Francesca M; Wang, Lin-Wang; Sharp, Ian D; Bell, Alexis T; Ager, Joel W

    2015-08-05

    Achieving stable operation of photoanodes used as components of solar water splitting devices is critical to realizing the promise of this renewable energy technology. It is shown that p-type transparent conducting oxides (p-TCOs) can function both as a selective hole contact and corrosion protection layer for photoanodes used in light-driven water oxidation. Using NiCo2O4 as the p-TCO and n-type Si as a prototypical light absorber, a rectifying heterojunction capable of light driven water oxidation was created. By placing the charge separating junction in the Si using a np(+) structure and by incorporating a highly active heterogeneous Ni-Fe oxygen evolution catalyst, efficient light-driven water oxidation can be achieved. In this structure, oxygen evolution under AM1.5G illumination occurs at 0.95 V vs RHE, and the current density at the reversible potential for water oxidation (1.23 V vs RHE) is >25 mA cm(-2). Stable operation was confirmed by observing a constant current density over 72 h and by sensitive measurements of corrosion products in the electrolyte. In situ Raman spectroscopy was employed to investigate structural transformation of NiCo2O4 during electrochemical oxidation. The interface between the light absorber and p-TCO is crucial to produce selective hole conduction to the surface under illumination. For example, annealing to produce more crystalline NiCo2O4 produces only small changes in its hole conductivity, while a thicker SiOx layer is formed at the n-Si/p-NiCo2O4 interface, greatly reducing the PEC performance. The generality of the p-TCO protection approach is demonstrated by multihour, stable, water oxidation with n-InP/p-NiCo2O4 heterojunction photoanodes.

  5. A randomized study of coconut oil versus sunflower oil on cardiovascular risk factors in patients with stable coronary heart disease.

    PubMed

    Vijayakumar, Maniyal; Vasudevan, D M; Sundaram, K R; Krishnan, Sajitha; Vaidyanathan, Kannan; Nandakumar, Sandya; Chandrasekhar, Rajiv; Mathew, Navin

    2016-01-01

    Coronary artery disease (CAD) and its pathological atherosclerotic process are closely related to lipids. Lipids levels are in turn influenced by dietary oils and fats. Saturated fatty acids increase the risk for atherosclerosis by increasing the cholesterol level. This study was conducted to investigate the impact of cooking oil media (coconut oil and sunflower oil) on lipid profile, antioxidant mechanism, and endothelial function in patients with established CAD. In a single center randomized study in India, patients with stable CAD on standard medical care were assigned to receive coconut oil (Group I) or sunflower oil (Group II) as cooking media for 2 years. Anthropometric measurements, serum, lipids, Lipoprotein a, apo B/A-1 ratio, antioxidants, flow-mediated vasodilation, and cardiovascular events were assessed at 3 months, 6 months, 1 year, and 2 years. Hundred patients in each arm completed 2 years with 98% follow-up. There was no statistically significant difference in the anthropometric, biochemical, vascular function, and in cardiovascular events after 2 years. Coconut oil even though rich in saturated fatty acids in comparison to sunflower oil when used as cooking oil media over a period of 2 years did not change the lipid-related cardiovascular risk factors and events in those receiving standard medical care. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  6. 2×2 dominant achievement goal profiles in high-level swimmers.

    PubMed

    Fernandez-Rio, Javier; Cecchini Estrada, Jose A; Mendez-Giménez, Antonio; Fernández-Garcia, Benjamín; Saavedra, Pablo

    2014-01-01

    The goal of this study was to assess achievement goal dominance, self-determined situational motivation and competence in high-level swimmers before and after three training sessions set at different working intensities (medium, sub-maximal and maximal). Nineteen athletes (males, n=9, 18.00±2.32 years; females, n=10, 16.30±2.01 years, range = 14-18) agreed to participate. They completed a questionnaire that included the Dominant Achievement Goal assessment instrument, the 2×2 Achievement Goals Questionnaire for Sport (AGQ-S), The Situational Motivation Scale (SIMS) and the Competence subscale of the Basic Psychological Needs in Exercise questionnaire (BPNES). Results indicated that participants overwhelmingly showed mastery-approach achievement goal dominance, and it remained stable at the conclusion of the different training sessions under all intensity levels. This profile was positively correlated to self-determined situational motivation and competence. However, swimmers' feelings of competence increased only after the medium intensity level training session. After the completion of the maximal intensity training session, swimmers' self-determined motivation was significantly lower compared to the other two training sessions, which could be caused by a temporary period of burnout. Results indicated that high-level swimmers had a distinct mastery-approach dominant achievement goal profile that was not affected by the workload of the different training sessions. They also showed high levels of self-determined situational motivation and competence. However, heavy workloads should be controlled because they can cause transitory burnout.

  7. Perceptual Learning Immediately Yields New Stable Motor Coordination

    ERIC Educational Resources Information Center

    Wilson, Andrew D.; Snapp-Childs, Winona; Bingham, Geoffrey P.

    2010-01-01

    Coordinated rhythmic movement is specifically structured in humans. Movement at 0[degrees] mean relative phase is maximally stable, 180[degrees] is less stable, and other coordinations can, but must, be learned. Variations in perceptual ability play a key role in determining the observed stabilities so we investigated whether stable movements can…

  8. Exact simulation of max-stable processes.

    PubMed

    Dombry, Clément; Engelke, Sebastian; Oesting, Marco

    2016-06-01

    Max-stable processes play an important role as models for spatial extreme events. Their complex structure as the pointwise maximum over an infinite number of random functions makes their simulation difficult. Algorithms based on finite approximations are often inexact and computationally inefficient. We present a new algorithm for exact simulation of a max-stable process at a finite number of locations. It relies on the idea of simulating only the extremal functions, that is, those functions in the construction of a max-stable process that effectively contribute to the pointwise maximum. We further generalize the algorithm by Dieker & Mikosch (2015) for Brown-Resnick processes and use it for exact simulation via the spectral measure. We study the complexity of both algorithms, prove that our new approach via extremal functions is always more efficient, and provide closed-form expressions for their implementation that cover most popular models for max-stable processes and multivariate extreme value distributions. For simulation on dense grids, an adaptive design of the extremal function algorithm is proposed.

  9. Achievement Goals and Achievement Emotions: A Meta-Analysis

    ERIC Educational Resources Information Center

    Huang, Chiungjung

    2011-01-01

    This meta-analysis synthesized 93 independent samples (N = 30,003) in 77 studies that reported in 78 articles examining correlations between achievement goals and achievement emotions. Achievement goals were meaningfully associated with different achievement emotions. The correlations of mastery and mastery approach goals with positive achievement…

  10. [Finnish disease heritage].

    PubMed

    Kestilä, Marjo; Ikonen, Elina; Lehesjoki, Anna-Elina

    2010-01-01

    The Finnish disease heritage refers to rare hereditary diseases that occur in the Finnish population in a relatively larger proportion than in other populations. The genes underlying all of the 36 diseases of the disease heritage have been identified. Together with her group and collaborators, Leena Palotie identified 15 of these, and this review includes the description of some of these achievements. As a result of the so-called founder effect, one predominant mutation underlying these diseases occurs in our population, facilitating the diagnostics of these diseases in our country.

  11. High-Ability Grouping: Benefits for Gifted Students' Achievement Development Without Costs in Academic Self-Concept.

    PubMed

    Preckel, Franzis; Schmidt, Isabelle; Stumpf, Eva; Motschenbacher, Monika; Vogl, Katharina; Scherrer, Vsevolod; Schneider, Wolfgang

    2017-11-23

    Effects of full-time ability grouping on students' academic self-concept (ASC) and mathematics achievement were investigated in the first 3 years of secondary school (four waves of measurement; students' average age at first wave: 10.5 years). Students were primarily from middle and upper class families living in southern Germany. The study sample comprised 148 (60% male) students from 14 gifted classes and 148 (57% male) students from 25 regular classes (matched by propensity score matching). Data analyses involved multilevel and latent growth curve analyses. Findings revealed no evidence for contrast effects of class-average achievement or assimilation effects of class type on students' ASC. ASC remained stable over time. Students in gifted classes showed higher achievement gains than students in regular classes. © 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.

  12. High-Order Energy Stable WENO Schemes

    NASA Technical Reports Server (NTRS)

    Yamaleev, Nail K.; Carpenter, Mark H.

    2009-01-01

    A third-order Energy Stable Weighted Essentially Non-Oscillatory (ESWENO) finite difference scheme developed by Yamaleev and Carpenter was proven to be stable in the energy norm for both continuous and discontinuous solutions of systems of linear hyperbolic equations. Herein, a systematic approach is presented that enables 'energy stable' modifications for existing WENO schemes of any order. The technique is demonstrated by developing a one-parameter family of fifth-order upwind-biased ESWENO schemes; ESWENO schemes up to eighth order are presented in the appendix. New weight functions are also developed that provide (1) formal consistency, (2) much faster convergence for smooth solutions with an arbitrary number of vanishing derivatives, and (3) improved resolution near strong discontinuities.

  13. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial.

    PubMed

    Fox, Kim; Ford, Ian; Steg, P Gabriel; Tendera, Michal; Ferrari, Roberto

    2008-09-06

    endpoints: admission to hospital for fatal and non-fatal myocardial infarction (0.64, 95% CI 0.49-0.84, p=0.001) and coronary revascularisation (0.70, 95% CI 0.52-0.93, p=0.016). Reduction in heart rate with ivabradine does not improve cardiac outcomes in all patients with stable coronary artery disease and left-ventricular systolic dysfunction, but could be used to reduce the incidence of coronary artery disease outcomes in a subgroup of patients who have heart rates of 70 bpm or greater.

  14. Three-dimensional CTOA and constraint effects during stable tearing in a thin-sheet material

    NASA Technical Reports Server (NTRS)

    Dawicke, D. S.; Newman, J. C., Jr.; Bigelow, C. A.

    1995-01-01

    A small strain theory, three-dimensional elastic-plastic finite element analysis was used to simulate fracture in thin sheet 2024-T3 aluminum alloy in the T-L orientation. Both straight and tunneled cracks were modeled. The tunneled crack front shapes as a function of applied stress were obtained from the fracture surface of tested specimens. The stable crack growth behavior was measured at the specimen surface as a function of applied stress. The fracture simulation modeled the crack tunneling and extension as a function of applied stress. The results indicated that the global constraint factor, alpha(sub g), initially dropped during stable crack growth. After peak applied stress was achieved, alpha(sub g) began to increase slightly. The effect of crack front shape on alpha(sub g) was small, but the crack front shape did greatly influence the local constraint and through-thickness crack-tip opening angle (CTOA) behavior. The surface values of CTOA for the tunneled crack front model agreed well with experimental measurements, showing the same initial decrease from high values during the initial 3mm of crack growth at the specimen's surface. At the same time, the interior CTOA values increased from low angles. After the initial stable tearing region, the CTOA was constant through the thickness. The three-dimensional analysis appears to confirm the potential of CTOA as a two-dimensional fracture criterion.

  15. Highly air stable passivation of graphene based field effect devices.

    PubMed

    Sagade, Abhay A; Neumaier, Daniel; Schall, Daniel; Otto, Martin; Pesquera, Amaia; Centeno, Alba; Elorza, Amaia Zurutuza; Kurz, Heinrich

    2015-02-28

    The sensitivity of graphene based devices to surface adsorbates and charge traps at the graphene/dielectric interface requires proper device passivation in order to operate them reproducibly under ambient conditions. Here we report on the use of atomic layer deposited aluminum oxide as passivation layer on graphene field effect devices (GFETs). We show that successful passivation produce hysteresis free DC characteristics, low doping level GFETs stable over weeks though operated and stored in ambient atmosphere. This is achieved by selecting proper seed layer prior to deposition of encapsulation layer. The passivated devices are also demonstrated to be robust towards the exposure to chemicals and heat treatments, typically used during device fabrication. Additionally, the passivation of high stability and reproducible characteristics is also shown for functional devices like integrated graphene based inverters.

  16. Identities of almost Stable Group Representations

    NASA Astrophysics Data System (ADS)

    Vovsi, S. M.; Khung Shon, Nguen

    1988-02-01

    It is proved that almost stable group representations over a field have a finite basis of identities. Moreover, a variety generated by an arbitrary almost stable representation is Specht and all of its subvarieties have a finite uniformly bounded basis rank. In particular, the identities of an arbitrary representation of a finite group are finitely based.Bibliography: 17 titles.

  17. Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities

    PubMed Central

    Oh, Yeon-Mok; Bhome, Arvind B; Boonsawat, Watchara; Gunasekera, Kirthi Dias; Madegedara, Dushantha; Idolor, Luisito; Roa, Camilo; Kim, Woo Jin; Kuo, Han-Pin; Wang, Chun-Hua; Lan, Le Thi Tuyet; Loh, Li-Cher; Ong, Choo-Khoon; Ng, Alan; Nishimura, Masaharu; Makita, Hironi; Silverman, Edwin K; Lee, Jae Seung; Yang, Ting; Lin, Yingxiang; Wang, Chen; Lee, Sang-Do

    2013-01-01

    Background and objectives Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. We evaluated the characteristics of stable COPD patients in the pulmonology clinics of seven Asian cities and also evaluated whether the exposure to biomass fuels and dusty jobs were related to respiratory symptoms, airflow limitation, and quality of life in the COPD patients. Methods This cross-sectional observational study recruited 922 COPD patients from seven cities of Asia. The patients underwent spirometry and were administered questionnaires about their exposure to cigarette smoking, biomass fuels, and dusty jobs in addition to respiratory symptoms and health related quality of life. Results Of the patients, there appeared to be variations from city to city in the history of exposure to biomass fuels and dusty jobs and also in respiratory symptoms of cough, phlegm, wheeze, and dyspnea. These symptoms were more frequent in those COPD patients with a history of exposure to biomass fuels than without and those with a history of exposure to dusty jobs than without (P < 0.01 for all comparisons). Airflow limitation was more severe in those COPD patients with a history of exposure to biomass fuels than without (52.2% predicted versus 55.9% of post-bronchodilator forced expiratory volume in 1 second [FEV1], P = 0.009); quality of life was poorer in those with exposure to biomass fuels than without (40.4 versus 36.2 of the St George’s Respiratory Questionnaire [SGRQ] total score, P = 0.001). Airflow limitation was more severe in those COPD patients with a history of exposure to dusty jobs than without (51.2% predicted versus 57.3% of post-bronchodilator FEV1, P < 0.001); quality of life was poorer in those with dusty jobs than without (41.0 versus 34.6 of SGRQ score, P = 0.006). Conclusion In Asian cities, the characteristics of COPD patients vary and the history of exposure to biomass fuels or dusty jobs was related to frequency

  18. Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities.

    PubMed

    Oh, Yeon-Mok; Bhome, Arvind B; Boonsawat, Watchara; Gunasekera, Kirthi Dias; Madegedara, Dushantha; Idolor, Luisito; Roa, Camilo; Kim, Woo Jin; Kuo, Han-Pin; Wang, Chun-Hua; Lan, Le Thi Tuyet; Loh, Li-Cher; Ong, Choo-Khoon; Ng, Alan; Nishimura, Masaharu; Makita, Hironi; Silverman, Edwin K; Lee, Jae Seung; Yang, Ting; Lin, Yingxiang; Wang, Chen; Lee, Sang-Do

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. We evaluated the characteristics of stable COPD patients in the pulmonology clinics of seven Asian cities and also evaluated whether the exposure to biomass fuels and dusty jobs were related to respiratory symptoms, airflow limitation, and quality of life in the COPD patients. This cross-sectional observational study recruited 922 COPD patients from seven cities of Asia. The patients underwent spirometry and were administered questionnaires about their exposure to cigarette smoking, biomass fuels, and dusty jobs in addition to respiratory symptoms and health related quality of life. Of the patients, there appeared to be variations from city to city in the history of exposure to biomass fuels and dusty jobs and also in respiratory symptoms of cough, phlegm, wheeze, and dyspnea. These symptoms were more frequent in those COPD patients with a history of exposure to biomass fuels than without and those with a history of exposure to dusty jobs than without (P < 0.01 for all comparisons). Airflow limitation was more severe in those COPD patients with a history of exposure to biomass fuels than without (52.2% predicted versus 55.9% of post-bronchodilator forced expiratory volume in 1 second [FEV(1)], P = 0.009); quality of life was poorer in those with exposure to biomass fuels than without (40.4 versus 36.2 of the St George's Respiratory Questionnaire [SGRQ] total score, P = 0.001). Airflow limitation was more severe in those COPD patients with a history of exposure to dusty jobs than without (51.2% predicted versus 57.3% of post-bronchodilator FEV(1), P < 0.001); quality of life was poorer in those with dusty jobs than without (41.0 versus 34.6 of SGRQ score, P = 0.006). In Asian cities, the characteristics of COPD patients vary and the history of exposure to biomass fuels or dusty jobs was related to frequency of symptoms, severe airflow limitation, and poor

  19. Bradycardia and atrial fibrillation in patients with stable coronary artery disease treated with ivabradine: an analysis from the SIGNIFY study.

    PubMed

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel; Tardif, Jean-Claude; Tendera, Michal; Ferrari, Roberto

    2015-12-07

    The aim of this study was to determine the impact of emergent bradycardia and atrial fibrillation (AF) on cardiovascular outcomes in 19 083 patients with stable coronary artery disease (CAD) receiving ivabradine or placebo (SIGNIFY, Study assessInG the morbidity-mortality beNefits of the If inhibitor ivabradine in patients with coronarY artery disease). Emergent bradycardia (resting heart rate <50 b.p.m. on 12-lead electrocardiogram) with ivabradine was reported in 3572 patients (37.4%) overall, and in 2242 (37.2%) patients with Canadian Cardiovascular Society (CCS) class ≥ 2 angina. There was no difference in outcomes over the course of the study in ivabradine-treated patients with and without emergent bradycardia in the whole population (2.5 vs. 2.9% per year, respectively, for primary composite endpoint of cardiovascular death or non-fatal myocardial infarction) or in the angina subgroup (2.5 vs. 3.2% per year). Neither was there an increase in the rate of primary endpoint after emergent bradycardia was recorded compared with those without emergent bradycardia. There were 754 cases of emergent AF on treatment (2.2% per year ivabradine vs. 1.5% per year placebo) and 469 in the patients with angina (2.2 vs. 1.5% per year). While outcomes occurred more frequently in patients in whom emergent AF had been recorded, there was no treatment-placebo difference in outcomes, including stroke, and no difference in treatment effect in patients with limiting angina. Both in the overall population as well as in the angina subset, bradycardia was common in ivabradine-treated patients, but did not appear to impact outcomes. Emergent AF was relatively rare and did not appear to have an impact on outcomes relative to placebo. ISRCTN61576291. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  20. An intermittent control model of flexible human gait using a stable manifold of saddle-type unstable limit cycle dynamics

    PubMed Central

    Fu, Chunjiang; Suzuki, Yasuyuki; Kiyono, Ken; Morasso, Pietro; Nomura, Taishin

    2014-01-01

    Stability of human gait is the ability to maintain upright posture during walking against external perturbations. It is a complex process determined by a number of cross-related factors, including gait trajectory, joint impedance and neural control strategies. Here, we consider a control strategy that can achieve stable steady-state periodic gait while maintaining joint flexibility with the lowest possible joint impedance. To this end, we carried out a simulation study of a heel-toe footed biped model with hip, knee and ankle joints and a heavy head-arms-trunk element, working in the sagittal plane. For simplicity, the model assumes a periodic desired joint angle trajectory and joint torques generated by a set of feed-forward and proportional-derivative feedback controllers, whereby the joint impedance is parametrized by the feedback gains. We could show that a desired steady-state gait accompanied by the desired joint angle trajectory can be established as a stable limit cycle (LC) for the feedback controller with an appropriate set of large feedback gains. Moreover, as the feedback gains are decreased for lowering the joint stiffness, stability of the LC is lost only in a few dimensions, while leaving the remaining large number of dimensions quite stable: this means that the LC becomes saddle-type, with a low-dimensional unstable manifold and a high-dimensional stable manifold. Remarkably, the unstable manifold remains of low dimensionality even when the feedback gains are decreased far below the instability point. We then developed an intermittent neural feedback controller that is activated only for short periods of time at an optimal phase of each gait stride. We characterized the robustness of this design by showing that it can better stabilize the unstable LC with small feedback gains, leading to a flexible gait, and in particular we demonstrated that such an intermittent controller performs better if it drives the state point to the stable manifold, rather

  1. An intermittent control model of flexible human gait using a stable manifold of saddle-type unstable limit cycle dynamics.

    PubMed

    Fu, Chunjiang; Suzuki, Yasuyuki; Kiyono, Ken; Morasso, Pietro; Nomura, Taishin

    2014-12-06

    Stability of human gait is the ability to maintain upright posture during walking against external perturbations. It is a complex process determined by a number of cross-related factors, including gait trajectory, joint impedance and neural control strategies. Here, we consider a control strategy that can achieve stable steady-state periodic gait while maintaining joint flexibility with the lowest possible joint impedance. To this end, we carried out a simulation study of a heel-toe footed biped model with hip, knee and ankle joints and a heavy head-arms-trunk element, working in the sagittal plane. For simplicity, the model assumes a periodic desired joint angle trajectory and joint torques generated by a set of feed-forward and proportional-derivative feedback controllers, whereby the joint impedance is parametrized by the feedback gains. We could show that a desired steady-state gait accompanied by the desired joint angle trajectory can be established as a stable limit cycle (LC) for the feedback controller with an appropriate set of large feedback gains. Moreover, as the feedback gains are decreased for lowering the joint stiffness, stability of the LC is lost only in a few dimensions, while leaving the remaining large number of dimensions quite stable: this means that the LC becomes saddle-type, with a low-dimensional unstable manifold and a high-dimensional stable manifold. Remarkably, the unstable manifold remains of low dimensionality even when the feedback gains are decreased far below the instability point. We then developed an intermittent neural feedback controller that is activated only for short periods of time at an optimal phase of each gait stride. We characterized the robustness of this design by showing that it can better stabilize the unstable LC with small feedback gains, leading to a flexible gait, and in particular we demonstrated that such an intermittent controller performs better if it drives the state point to the stable manifold, rather

  2. Unconditionally stable WLP-FDTD method for the modeling of electromagnetic wave propagation in gyrotropic materials.

    PubMed

    Li, Zheng-Wei; Xi, Xiao-Li; Zhang, Jin-Sheng; Liu, Jiang-fan

    2015-12-14

    The unconditional stable finite-difference time-domain (FDTD) method based on field expansion with weighted Laguerre polynomials (WLPs) is applied to model electromagnetic wave propagation in gyrotropic materials. The conventional Yee cell is modified to have the tightly coupled current density components located at the same spatial position. The perfectly matched layer (PML) is formulated in a stretched-coordinate (SC) system with the complex-frequency-shifted (CFS) factor to achieve good absorption performance. Numerical examples are shown to validate the accuracy and efficiency of the proposed method.

  3. The beta Pictoris circumstellar disk. XXIV. Clues to the origin of the stable gas

    NASA Astrophysics Data System (ADS)

    Lagrange, A.-M.; Beust, H.; Mouillet, D.; Deleuil, M.; Feldman, P. D.; Ferlet, R.; Hobbs, L.; Lecavelier Des Etangs, A.; Lissauer, J. J.; McGrath, M. A.; McPhate, J. B.; Spyromilio, J.; Tobin, W.; Vidal-Madjar, A.

    1998-02-01

    GHRS high resolution spectra of {beta \\:Pictoris} were obtained to study the stable gas around this star. Several elements are detected and their abundances measured. Upper limits to the abundances of others are also measured. The data permit improved chemical analysis of the stable gas around {beta \\:Pictoris}, and yield new and more accurate estimates of the radiation pressure acting on various elements. We first analyze the data in the framework of a closed-box model. The electron density is evaluated (Neion {S}imeq10(6) cm(-3) ), which in turn implies constraints on the ionization stages of the various elements. The refractory elements in the stable gas have then standard abundances. In contrast, in this model, the lighter elements sulfur and carbon, observed in their neutral form, seem to be depleted. However several arguments, especially the strong radiation pressure, argue against a closed-box hypothesis. We therefore develop hydrodynamical simulations, taking into account the radiation pressure, to reproduce the stable features under three different hypotheses for the origin of the stable gas: stellar ejection, comet evaporation and grain evaporation. They show that a permanent production of gas is needed in order to sustain a stable absorption. In order to reproduce the observed zero velocity of the absorption features a mechanism is also needed to slow down the radial flow of matter. We show that this could be achieved by a colliding ring of neutral hydrogen farther than 0.5AU from the star. Applied to the Fe Ii\\ lines, the simulations constrain the temperature (Tion {S}imeq1500-2000K) and the velocity dispersion (ion {S}imeq2kms(-1) ) in the gaseous medium. When applied to Ca Ii\\ and to other UV lines, they test the chemical composition of the parent source of gas, which is found to have standard abundances in refractory elements. The gas production rate is ion {S}imeq 10(-16}M_{sun) yr(-1) . This description is the first consistent explanation for

  4. Delving into α-stable distribution in noise suppression for seizure detection from scalp EEG

    NASA Astrophysics Data System (ADS)

    Wang, Yueming; Qi, Yu; Wang, Yiwen; Lei, Zhen; Zheng, Xiaoxiang; Pan, Gang

    2016-10-01

    Objective. There is serious noise in EEG caused by eye blink and muscle activities. The noise exhibits similar morphologies to epileptic seizure signals, leading to relatively high false alarms in most existing seizure detection methods. The objective in this paper is to develop an effective noise suppression method in seizure detection and explore the reason why it works. Approach. Based on a state-space model containing a non-linear observation function and multiple features as the observations, this paper delves deeply into the effect of the α-stable distribution in the noise suppression for seizure detection from scalp EEG. Compared with the Gaussian distribution, the α-stable distribution is asymmetric and has relatively heavy tails. These properties make it more powerful in modeling impulsive noise in EEG, which usually can not be handled by the Gaussian distribution. Specially, we give a detailed analysis in the state estimation process to show the reason why the α-stable distribution can suppress the impulsive noise. Main results. To justify each component in our model, we compare our method with 4 different models with different settings on a collected 331-hour epileptic EEG data. To show the superiority of our method, we compare it with the existing approaches on both our 331-hour data and 892-hour public data. The results demonstrate that our method is most effective in both the detection rate and the false alarm. Significance. This is the first attempt to incorporate the α-stable distribution to a state-space model for noise suppression in seizure detection and achieves the state-of-the-art performance.

  5. Time to transient and stable reductions in hot flush frequency in postmenopausal women using conjugated estrogens/bazedoxifene.

    PubMed

    Pinkerton, JoAnn V; Bushmakin, Andrew G; Abraham, Lucy; Komm, Barry S; Bobula, Joel

    2017-09-01

    This post hoc analysis estimates time to transient and stable reductions in hot flush frequency in postmenopausal women using conjugated estrogens/bazedoxifene. In the 12-week Selective estrogens, Menopause, And Response to Therapy (SMART)-2 trial of conjugated estrogens/bazedoxifene 0.45 mg/20 mg and 0.625 mg/20 mg, women with at least seven moderate/severe hot flushes per day or 50 per week at screening recorded frequency of moderate/severe hot flushes in diaries. Nonparametric models and SAS Proc Lifetest were used to estimate median times to various degrees of transient reductions (first day with improvement) and stable reductions (first day with improvement maintained through study's end) in hot flush frequency. Treatment produced transient hot flush reductions of 40% to 100% and stable reductions of 30% to 100% significantly faster than placebo. Median time to a transient 50% reduction was 8 days for conjugated estrogens/bazedoxifene 0.45 mg/20 mg, 9.5 for 0.625 mg/20 mg, and 10 for placebo; median time to a stable 50% reduction was 9, 10, and 38 days. Median time to a transient 90% reduction was 32 and 22.5 days for 0.45 mg/20 mg and 0.625 mg/20 mg, and median time to a stable 90% reduction was 83 and 29 days, respectively; median times to transient/stable 90% reductions were not reached during the 12-week study in the placebo group. Although not all women using conjugated estrogens/bazedoxifene achieve permanent elimination of hot flushes, the frequency is likely to be substantially reduced during the first week to month. Women can expect approximately 50% reduction in hot flush frequency after about 8 to 10 days, and sustained improvement with continued treatment.

  6. Computerized respiratory sounds: a comparison between patients with stable and exacerbated COPD.

    PubMed

    Jácome, Cristina; Oliveira, Ana; Marques, Alda

    2017-09-01

    Diagnosis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is often challenging as it relies on patients' clinical presentation. Computerized respiratory sounds (CRS), namely crackles and wheezes, may have the potential to contribute for the objective diagnosis/monitoring of an AECOPD. This study explored if CRS differ during stable and exacerbation periods in patients with COPD. 13 patients with stable COPD and 14 with AECOPD were enrolled. CRS were recorded simultaneously at trachea, anterior, lateral and posterior chest locations using seven stethoscopes. Airflow (0.4-0.6l/s) was recorded with a pneumotachograph. Breathing phases were detected using airflow signals; crackles and wheezes with validated algorithms. At trachea, anterior and lateral chest, no significant differences were found between the two groups in the number of inspiratory/expiratory crackles or inspiratory wheeze occupation rate. At posterior chest, the number of crackles (median 2.97-3.17 vs. 0.83-1.2, P < 0.001) and wheeze occupation rate (median 3.28%-3.8% vs. 1.12%-1.77%, P = 0.014-0.016) during both inspiration and expiration were significantly higher in patients with AECOPD than in stable patients. During expiration, wheeze occupation rate was also significantly higher in patients with AECOPD at trachea (median 3.12% vs. 0.79%, P < 0.001) and anterior chest (median 3.55% vs. 1.28%, P < 0.001). Crackles and wheezes are more frequent in patients with AECOPD than in stable patients, particularly at posterior chest. These findings suggest that these CRS can contribute to the objective diagnosis/monitoring of AECOPD, which is especially valuable considering that they can be obtained by integrating computerized techniques with pulmonary auscultation, a noninvasive method that is a component of patients' physical examination. © 2015 John Wiley & Sons Ltd.

  7. The effects of chronic achievement motivation and achievement primes on the activation of achievement and fun goals.

    PubMed

    Hart, William; Albarracín, Dolores

    2009-12-01

    This research examined the hypothesis that situational achievement cues can elicit achievement or fun goals depending on chronic differences in achievement motivation. In 4 studies, chronic differences in achievement motivation were measured, and achievement-denoting words were used to influence behavior. The effects of these variables were assessed on self-report inventories, task performance, task resumption following an interruption, and the pursuit of means relevant to achieving or having fun. Findings indicated that achievement priming (vs. control priming) activated a goal to achieve and inhibited a goal to have fun in individuals with chronically high-achievement motivation but activated a goal to have fun and inhibited a goal to achieve in individuals with chronically low-achievement motivation.

  8. The Effects of Chronic Achievement Motivation and Achievement Primes on the Activation of Achievement and Fun Goals

    PubMed Central

    Hart, William; Albarracín, Dolores

    2013-01-01

    This research examined the hypothesis that situational achievement cues can elicit achievement or fun goals depending on chronic differences in achievement motivation. In 4 studies, chronic differences in achievement motivation were measured, and achievement-denoting words were used to influence behavior. The effects of these variables were assessed on self-report inventories, task performance, task resumption following an interruption, and the pursuit of means relevant to achieving or having fun. Findings indicated that achievement priming (vs. control priming) activated a goal to achieve and inhibited a goal to have fun in individuals with chronically high-achievement motivation but activated a goal to have fun and inhibited a goal to achieve in individuals with chronically low-achievement motivation. PMID:19968423

  9. Generation by Reverse Genetics of an Effective, Stable, Live-Attenuated Newcastle Disease Virus Vaccine Based on a Currently Circulating, Highly Virulent Indonesian Strain

    PubMed Central

    Xiao, Sa; Nayak, Baibaswata; Samuel, Arthur; Paldurai, Anandan; Kanabagattebasavarajappa, Mallikarjuna; Prajitno, Teguh Y.; Bharoto, Eny E.; Collins, Peter L.; Samal, Siba K.

    2012-01-01

    Newcastle disease virus (NDV) can cause severe disease in chickens. Although NDV vaccines exist, there are frequent reports of outbreaks in vaccinated chickens. During 2009–2010, despite intense vaccination, NDV caused major outbreaks among commercial poultry farms in Indonesia. These outbreaks raised concern regarding the protective immunity of current vaccines against circulating virulent strains in Indonesia. In this study, we investigated whether a recombinant attenuated Indonesian NDV strain could provide better protection against prevalent Indonesian viruses. A reverse genetics system for the highly virulent NDV strain Banjarmasin/010/10 (Ban/010) isolated in Indonesia in 2010 was constructed. The Ban/010 virus is classified in genotype VII of class II NDV, which is genetically distinct from the commercial vaccine strains B1 and LaSota, which belong to genotype II, and shares only 89 and 87% amino acid identity for the protective antigens F and HN, respectively. A mutant virus, named Ban/AF, was developed in which the virulent F protein cleavage site motif “RRQKR↓F” was modified to an avirulent motif “GRQGR↓L” by three amino acid substitutions (underlined). The Ban/AF vaccine virus did not produce syncytia or plaques in cell culture, even in the presence of added protease. Pathogenicity tests showed that Ban/AF was completely avirulent. Ban/AF replicated efficiently during 10 consecutive passages in chickens and remained genetically stable. Serological analysis showed that Ban/AF induced higher neutralization and hemagglutination inhibition antibody titers against the prevalent viruses than the commercial vaccines B1 or LaSota. Both Ban/AF and commercial vaccines provided protection against clinical disease and mortality after challenge with virulent NDV strain Ban/010 (genotype VII) or GB Texas (genotype II). However, Ban/AF significantly reduced challenge virus shedding from the vaccinated birds compared to B1 vaccine. These results suggest

  10. Stable gastric pentadecapeptide BPC 157-NO-system relation.

    PubMed

    Sikiric, Predrag; Seiwerth, Sven; Rucman, Rudolf; Turkovic, Branko; Rokotov, Dinko Stancic; Brcic, Luka; Sever, Marko; Klicek, Robert; Radic, Bozo; Drmic, Domagoj; Ilic, Spomenko; Kolenc, Danijela; Aralica, Gorana; Stupnisek, Mirjana; Suran, Jelena; Barisic, Ivan; Dzidic, Senka; Vrcic, Hrvoje; Sebecic, Bozidar

    2014-01-01

    We reviewed stable gastric pentadecapeptide BPC 157-NO-system-relation, its close participation in Moncada's (maintained vascular integrity, platelets control) homeostatic healing response of NO-system to injury. Namely, BPC 157's particular healing effect also affects all events after vascular integrity loss (dependent on circumstances, it reduces either thrombosis (abdominal aorta anastomosis) or bleeding/thrombocytopenia (amputation, heparin, warfarin, aspirin)) and in a series of different injurious models, acute and chronic, BPC 157 consistently advances healing after severe injuries in various tissues spontaneously unable to heal; stimulates egr-1 and naB2 genes; exhibits high safety (LD1 not achieved)). Hypothesis, that BPC 157 (since formed constitutively in the gastric mucosa, stable in human gastric juice, along with significance of NO-synthase and the basal formation of NO in stomach mucosa, greater than that seen in other tissues) exhibits a general, effective competing both with L-arginine analogues (i. e., L-NAME) and L-arginine, and that this has some physiologic importance (NO-generation), later, practically supports its beneficial effects illustrating BPC 157 and NOsystem mutual (with L-NAME/L-arginine; alone and together) relations in (i) gastric mucosa and mucosal protection, following alcohol lesions, in cytoprotection course, NO-generation, and blood pressure regulation; (ii) alcohol acute/chronic intoxication, and withdrawal; (iii) cardiovascular disturbances, chronic heart failure, pulmonary hypertension, and arrhythmias; (iv) disturbances after hypokalemia and hyperkalemia, and potassium-cell membrane dysfunction; and finally, in (v) complex healing failure, proved by the fistulas healing, colocutaneous and esophagocutaneous. However, how this advantage of modulating NO-system (i. e., particular effect on eNOS gene), may be practically translated into an enhanced clinical performance remains to be determined.

  11. Students’ Achievement Goals, Learning-Related Emotions and Academic Achievement

    PubMed Central

    Lüftenegger, Marko; Klug, Julia; Harrer, Katharina; Langer, Marie; Spiel, Christiane; Schober, Barbara

    2016-01-01

    In the present research, the recently proposed 3 × 2 model of achievement goals is tested and associations with achievement emotions and their joint influence on academic achievement are investigated. The study was conducted with 388 students using the 3 × 2 Achievement Goal Questionnaire including the six proposed goal constructs (task-approach, task-avoidance, self-approach, self-avoidance, other-approach, other-avoidance) and the enjoyment and boredom scales from the Achievement Emotion Questionnaire. Exam grades were used as an indicator of academic achievement. Findings from CFAs provided strong support for the proposed structure of the 3 × 2 achievement goal model. Self-based goals, other-based goals and task-approach goals predicted enjoyment. Task-approach goals negatively predicted boredom. Task-approach and other-approach predicted achievement. The indirect effects of achievement goals through emotion variables on achievement were assessed using bias-corrected bootstrapping. No mediation effects were found. Implications for educational practice are discussed. PMID:27199836

  12. Study of Atomic Quasi-Stable States, Decoherence And Cooling of Mesoscale Particles

    NASA Astrophysics Data System (ADS)

    Zhong, Changchun

    Quantum mechanics, since its very beginning, has totally changed the way we understand nature. The past hundred years have seen great successes in the application of quantum physics, including atomic spectra, laser technology, condensed matter physics and the remarkable possibility for quantum computing, etc. This thesis is dedicated to a small regime of quantum physics. In the first part of the thesis, I present the studies of atomic quasi-stable states, which refer to those Rydberg states of an atom that are relatively stable in the presence of strong fields. Through spectrally probing the quasi-stable states, series of survival peaks are found. If the quasi-stable electrons were created by ultraviolet (UV) lasers with two different frequencies, the survival peaks could be modulated by continuously changing the phase difference between the UV and the IR laser. The quantum simulation, through directly solving the Schrodinger equation, matches the experimental results performed with microwave fields, and our studies should provide a guidance for future experiments. Despite the huge achievements in the application of quantum theory, there are still some fundamental problems that remain unresolved. One of them is the so-called quantum-to-classical transition, which refers to the expectation that the system behaves in a more classical manner when the system size increases. This basic question was not well answered until decoherence theory was proposed, which states that the coherence of a quantum system tends to be destroyed by environmental interruptions. Thus, if a system is well isolated from its environment, it is in principle possible to observe macroscopic quantum coherence. Quite recently, testing quantum principles in the macroscale has become a hot topic due to rapic technological developments. A very promising platform for testing macroscale quantum physics is a laser levitated nanoparticle, and cooling its mechanical motion to the ground state is the first

  13. Boundary Closures for Fourth-order Energy Stable Weighted Essentially Non-Oscillatory Finite Difference Schemes

    NASA Technical Reports Server (NTRS)

    Fisher, Travis C.; Carpenter, Mark H.; Yamaleev, Nail K.; Frankel, Steven H.

    2009-01-01

    A general strategy exists for constructing Energy Stable Weighted Essentially Non Oscillatory (ESWENO) finite difference schemes up to eighth-order on periodic domains. These ESWENO schemes satisfy an energy norm stability proof for both continuous and discontinuous solutions of systems of linear hyperbolic equations. Herein, boundary closures are developed for the fourth-order ESWENO scheme that maintain wherever possible the WENO stencil biasing properties, while satisfying the summation-by-parts (SBP) operator convention, thereby ensuring stability in an L2 norm. Second-order, and third-order boundary closures are developed that achieve stability in diagonal and block norms, respectively. The global accuracy for the second-order closures is three, and for the third-order closures is four. A novel set of non-uniform flux interpolation points is necessary near the boundaries to simultaneously achieve 1) accuracy, 2) the SBP convention, and 3) WENO stencil biasing mechanics.

  14. Stable Liquid Glucagon: Beyond Emergency Hypoglycemia Rescue.

    PubMed

    Wilson, Leah M; Castle, Jessica R

    2018-02-01

    Glycemic control is the mainstay of preventing diabetes complications at the expense of increased risk of hypoglycemia. Severe hypoglycemia negatively impacts the quality of life of patients with type 1 diabetes and can lead to morbidity and mortality. Currently available glucagon emergency kits are effective at treating hypoglycemia when correctly used, however use is complicated especially by untrained persons. Better formulations and devices for glucagon treatment of hypoglycemia are needed, specifically stable liquid glucagon. Out of the scope of this review, other potential uses of stable liquid glucagon include congenital hyperinsulinism, post-bariatric surgery hypoglycemia, and insulinoma induced hypoglycemia. In the 35 years since Food and Drug Administration (FDA) approval of the first liquid stable human recombinant insulin, we continue to wait for the glucagon counterpart. For mild hypoglycemia, a commercially available liquid stable glucagon would enable more widespread implementation of mini-dose glucagon use as well as glucagon in dual hormone closed-loop systems. This review focuses on the current and upcoming pharmaceutical uses of glucagon in the treatment of type 1 diabetes with an outlook on stable liquid glucagon preparations that will hopefully be available for use in patients in the near future.

  15. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion.

    PubMed

    Burg, Matthew M; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W; Schwartz, Joseph E; Soufer, Robert

    2014-10-30

    Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Patients (N=146) completed the Beck Depression Inventory-I (BDI-I), a measure of depression linked to recurrent ACS and post-ACS mortality, and underwent single-photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI-I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI-I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression-associated risk for ACS recurrence and mortality. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  16. A white super-stable source for the metrology of astronomical photometers

    NASA Astrophysics Data System (ADS)

    Wildi, F. P.; Deline, A.; Chazelas, B.

    2015-09-01

    The testing of photometers and in particular the testing of high precision photometers for the detection of planetary transits requires a light source which photometric stability is to par or better than the goal stability of the photometer to be tested. In the frame of the CHEOPS mission, a comprehensive calibration bench has been developed. Aside from measuring the sensibility of the CHEOPS payload to the different environmental conditions, this bench will also be used to test the relative accuracy of the payload. A key element of this bench is an extremely stable light source that is used to create an artificial star which is then projected into the payload's telescope. We present here the development of this payload and the performance achieved.

  17. Applications of stable isotopes in clinical pharmacology

    PubMed Central

    Schellekens, Reinout C A; Stellaard, Frans; Woerdenbag, Herman J; Frijlink, Henderik W; Kosterink, Jos G W

    2011-01-01

    This review aims to present an overview of the application of stable isotope technology in clinical pharmacology. Three main categories of stable isotope technology can be distinguished in clinical pharmacology. Firstly, it is applied in the assessment of drug pharmacology to determine the pharmacokinetic profile or mode of action of a drug substance. Secondly, stable isotopes may be used for the assessment of drug products or drug delivery systems by determination of parameters such as the bioavailability or the release profile. Thirdly, patients may be assessed in relation to patient-specific drug treatment; this concept is often called personalized medicine. In this article, the application of stable isotope technology in the aforementioned three areas is reviewed, with emphasis on developments over the past 25 years. The applications are illustrated with examples from clinical studies in humans. PMID:21801197

  18. Stable glow discharge detector

    DOEpatents

    Koo, Jackson C.; Yu, Conrad M.

    2004-05-18

    A highly sensitive electronic ion cell for the measurement of trace elements in He carrier gas which involves glow discharge. A constant wave (CW) stable glow discharge detector which is controlled through a biased resistor, can detect the change of electron density caused by impurities in the He carrier gas by many orders of magnitude larger than that caused by direct ionization or electron capture. The stable glow discharge detector utilizes a floating pseudo-electrode to form a probe in or near the plasma and a solid rod electrode. By using this probe, the large variation of electron density due to trace amounts of impurities can be directly measured. The solid rod electrode provides greater stability and thus easier alignment.

  19. Stable isotopes in mineralogy

    USGS Publications Warehouse

    O'Neil, J.R.

    1977-01-01

    Stable isotope fractionations between minerals are functions of the fundamental vibrational frequencies of the minerals and therefore bear on several topics of mineralogical interest. Isotopic compositions of the elements H, C, O, Si, and S can now be determined routinely in almost any mineral. A summary has been made of both published and new results of laboratory investigations, analyses of natural materials, and theoretical considerations which bear on the importance of temperature, pressure, chemical composition and crystal structure to the isotopic properties of minerals. It is shown that stable isotope studies can sometimes provide evidence for elucidating details of crystal structure and can be a powerful tool for use in tracing the reaction paths of mineralogical reactions. ?? 1977 Springer-Verlag.

  20. High HbA1c levels correlate with reduced plaque regression during statin treatment in patients with stable coronary artery disease: results of the coronary atherosclerosis study measuring effects of rosuvastatin using intravascular ultrasound in Japanese subjects (COSMOS).

    PubMed

    Daida, Hiroyuki; Takayama, Tadateru; Hiro, Takafumi; Yamagishi, Masakazu; Hirayama, Atsushi; Saito, Satoshi; Yamaguchi, Tetsu; Matsuzaki, Masunori

    2012-07-25

    The incidence of cardiac events is higher in patients with diabetes than in people without diabetes. The Coronary Atherosclerosis Study Measuring Effects of Rosuvastatin Using Intravascular Ultrasound in Japanese Subjects (COSMOS) demonstrated significant plaque regression in Japanese patients with chronic coronary disease after 76 weeks of rosuvastatin (2.5 mg once daily, up-titrated to a maximum of 20 mg/day to achieve LDL cholesterol <80 mg/dl). In this subanalysis of COSMOS, we examined the association between HbA1c and plaque regression in 40 patients with HbA1c ≥6.5% (high group) and 86 patients with HbA1c <6.5% (low group). In multivariate analyses, HbA1c and plaque volume at baseline were major determinants of plaque regression. LDL cholesterol decreased by 37% and 39% in the high and low groups, respectively, while HDL cholesterol increased by 16% and 22%, respectively. The reduction in plaque volume was significantly (p = 0.04) greater in the low group (from 71.0 ± 39.9 to 64.7 ± 34.7 mm(3)) than in the high group (from 74.3 ± 34.2 to 71.4 ± 32.3 mm(3)). Vessel volume increased in the high group but not in the low group (change from baseline: +4.2% vs -0.8%, p = 0.02). Change in plaque volume was significantly correlated with baseline HbA1c. Despite similar improvements in lipid levels, plaque regression was less pronounced in patients with high HbA1c levels compared with those with low levels. Tight glucose control during statin therapy may enhance plaque regression in patients with stable coronary disease. ClinicalTrials.gov, Identifier NCT00329160.