Efficacy and safety of different ticagrelor regimens versus clopidogrel in patients with coronary artery disease: a retrospective multicenter study (SUPERIOR).

Current guidelines favor dual anti-platelet therapy with ticagrelor 90 mg BID (T90BID) over clopidogrel 75 mg QD (C75QD) in addition to aspirin for acute coronary syndrome. However, an increased risk of ticagrelor-related adverse events prompted the evaluation of low-dose regimens. This study (NCT03381742) retrospectively analyzed the data from 11 hospitals on 3,043 patients with coronary artery disease, who received C75QD, T90BID, ticagrelor 45 mg BID (T45BID), or ticagrelor 90 mg QD (T90QD). Compared with C75QD, both T45BID and T90QD showed significantly higher inhibition of platelet aggregation (P < .0001) and lower platelet-fibrin clot strength (P < .0001) induced by adenosine diphosphate. Furthermore, compared with T90BID, two low-dose regimens had a much lower minor bleeding rate and a significantly higher proportion of patients within the therapeutic window for P2Y12 receptor reactivity. There were no significant differences between T45BID and T90QD in the trough plasma concentrations of ticagrelor and its active metabolite. Similar efficacy and safety outcomes were observed in the propensity score-matched analysis. In conclusion, the low-dose ticagrelor regimen, either T45BID or T90QD, may provide a more attractive benefit-risk profile than C75QD or T90BID.

Metoprolol has a similar therapeutic effect as amlodipine on BP lowering in hypertensive patients with obstructive sleep apnea.

PURPOSE: ß-Blocker use has been controversial for a long time in the management of hypertensive patients with obstructive sleep apnea (OSA). The aim of present study was to compare the effects of metoprolol on BP lowering with amlodipine in hypertensive OSA patients. METHODS: Hypertensive subjects with OSA were randomly assigned to metoprolol and amlodipine groups, receiving 12 weeks of oral either metoprolol (47.5 mg once daily) or amlodipine (5 mg once daily) treatment. At baseline and after the 12-week treatment period, 24-h ambulatory blood pressure monitoring was performed in both groups. RESULTS: Both of metoprolol and amlodipine treatments significantly lowered 24-h blood pressure (BP) (from 143/88 to 132.3/81.6 mmHg; from 141.3/84.5 to 133.7/80.8 mmHg), daytime BP (from 146/90.2 to 136.4/84.6 mmHg; from 145.1/87.6 to 138.2/84.1 mmHg), and nighttime BP (from 139.1/83.9 to 125.7/76.2 mmHg; from 134.5/78.5 to 125.8/74.1 mmHg) (all P < 0.05). But there were no significant differences between the groups in BP variability (P > 0.05). Besides, metoprolol significantly reduced daytime heart rate (HR) (P < 0.05), while 24-h and nighttime HR values had no remarkable changes compared with baseline (P > 0.05). CONCLUSIONS: Metoprolol had similar therapeutic effects on BP lowering as amlodipine and could not decrease HR during the nighttime in hypertensive patients with OSA.

EKC hypothesis testing and environmental impacts of transportation infrastructure investments in China, Turkey, India, and Japan.

A key strategy for social development and sustainable urban expansion is building sustainable and affordable transport systems. In this study, we aim to test the validity of the environmental Kuznets curve (EKC) hypothesis and reveal the impact of infrastructure investment in transportation systems in China, Turkey, India, and Japan over the period 1995-2020 on environmental degradation. According to dynamic ordinary least squares (DOLS) method analysis, per capita GDP and per capita GDP3 have a significant positive impact on per capita CO2 emission, while per capita GDP2 has a significant adverse impact on per capita CO2 emission. These results confirm the validity of the N-shaped EKC assumption, while inconsistent with the results of the FMOLS technique, showing that per capita GDP is significantly positive, while per capita GDP2 and per capita GDP3 have a significant negative impact on per capita carbon emissions. Moreover, as clarified by the fully modified ordinary least squares (FMOLS) and DOLS methods, road infrastructure investment (RO), aviation infrastructure investment, trade openness, and foreign direct investment (FDI) have significant positive effects, while railway infrastructure investment (RA) has a significant negative effect on per capita carbon emission. Country-level estimates of per capita carbon emission-based DOLS strategies in the model show that only China and Japan have N-shaped EKC hypothesis. Road infrastructure investment, aviation infrastructure investment, and trade openness have significant positive effects, while railway infrastructure investment has a significant negative effect on per capita CO2 emission in selected central and east Asian countries. The latest electrified rail systems are well thought out and less polluting, so the contribution of rail infrastructure investment to the transport mix can support sustainable and safe transport systems at city center and intercity levels and reduce environmental pollution in central and east Asian countries. Moreover, the implementation of the basic environmental settings of trade agreements should be strengthened to condense the growing impact of free trade on environmental pollution.

Effects of Rumen-Protected Methionine Supplementation on Growth Performance, Nutrient Digestion, Nitrogen Utilisation and Plasma Amino Acid Profiles of Liaoning Cashmere Goats.

This study determined the effects of rumen-protected methionine (RPM) supplementation on the growth performance, nutrient digestibility, nitrogen (N) utilisation and plasma amino acid profiles of Liaoning cashmere goats during cashmere fibre growth. Twenty-four yearling male cashmere goats (body weight: 35.41 ± 1.13 kg) were randomly assigned to four dietary treatments: a corn-soybean meal basal diet deficient in methionine (negative control, NC) and a basal diet supplemented with 1, 2 and 3 g/kg of RPM. The RPM supplementation quadratically increased the average daily gain (ADG) and decreased the feed to gain ratio (p = 0.001) without affecting the final body weight and dry matter intake. In particular, compared to NC, 2 g/kg RPM supplementation increased the ADG by 35 g/d (p < 0.001) and resulted in the lowest feed to gain ratio (p < 0.001). RPM increased the apparent total tract digestibility of N and decreased the faecal N levels, both in a linear fashion (p = 0.005). Urinary N levels did not have an effect, but the N retention levels increased linearly with PRM (p = 0.032). Moreover, the RPM decreased the plasma urea N levels (p < 0.001) and increased the plasma Met levels quadratically (p < 0.001). In conclusion, RPM supplementation in the diet of cashmere goats can enhance the utilisation of N and improve ADG during the cashmere fibre growing period, and 2 g/kg of RPM in the diet is suggested.

Blockchain Data Secure Transmission Method Based on Homomorphic Encryption.

To ensure the security of data transmission and recording in Internet environment monitoring systems, this paper proposes a study of a secure method of blockchain data transfer based on homomorphic encryption. Blockchain data transmission is realized through homomorphic encryption. Homomorphic encryption can not only encrypt the original data, but also ensure that the data result after decrypting the data is the same as the original data. The asymmetric encrypted public key is collected by Internet of things (IoT) equipment to realize the design of blockchain data secure transmission method based on homomorphic encryption. The experimental results show that the accuracy of the first transmission is as high as 88% when using the transmission method in this paper. After several experiments, the transmission accuracy is high by using the design method in this paper. In the last test, the transmission accuracy is still 88%, and the data transmission effect is relatively stable. At the same time, compared to the management method used in this article, the transfer method used in this paper is more reliable than the original transfer method and is not prone to data distortion. It can be seen that this method has high transmission accuracy and short transmission time, which effectively avoids the data tampering caused by too long time in the transmission process.

Cross-Subject Seizure Detection in EEGs Using Deep Transfer Learning.

Electroencephalography (EEG) plays an import role in monitoring the brain activities of patients with epilepsy and has been extensively used to diagnose epilepsy. Clinically reading tens or even hundreds of hours of EEG recordings is very time consuming. Therefore, automatic detection of seizure is of great importance. But the huge diversity of EEG signals belonging to different patients makes the task of seizure detection much challenging, for both human experts and automation methods. We propose three deep transfer convolutional neural networks (CNN) for automatic cross-subject seizure detection, based on VGG16, VGG19, and ResNet50, respectively. The original dataset is the CHB-MIT scalp EEG dataset. We use short time Fourier transform to generate time-frequency spectrum images as the input dataset, while positive samples are augmented due to the infrequent nature of seizure. The model parameters pretrained on ImageNet are transferred to our models. And the fine-tuned top layers, with an output layer of two neurons for binary classification (seizure or nonseizure), are trained from scratch. Then, the input dataset are randomly shuffled and divided into three partitions for training, validating, and testing the deep transfer CNNs, respectively. The average accuracies achieved by the deep transfer CNNs based on VGG16, VGG19, and ResNet50 are 97.75%, 98.26%, and 96.17% correspondingly. On those results of experiments, our method could prove to be an effective method for cross-subject seizure detection.

Effects of doxazosin mesylate versus nifedipine on blood pressure variability in hypertensive patients: a randomized crossover study (SIMILAR).

OBJECTIVE: Blood pressure variability (BPV) is a powerful predictor of end-organ damage, cardiovascular events and mortality independently of the BP level. Calcium channel blockers may offer an advantage over other first-line antihypertensive drugs by preventing increased BPV. But the effect of alpha-receptor blockers on BPV in hypertensive patients is still unclear. METHODS: In this crossover trial, 36 hypertensive patients were randomly assigned to two groups, receiving doxazosin mesylate gastrointestinal therapeutic system (GITS) (4 mg/day) or nifedipine GITS (30 mg/day) for 12 weeks, followed by a 2-week washout period then a 12-week crossover phase. At baseline and after 12-week treatment, 24-hour ambulatory BP monitoring was performed. BPV was evaluated through standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic BP (SBP) and diastolic BP (DBP) during daytime, nighttime and over 24 hours. RESULTS: After 12-week treatment, both doxazosin and nifedipine significantly decreased SBP and DBP (P < 0.05), whereas no between-group differences were shown (P>0.05). Systolic BPV (24-hour SD, CV, and ARV; daytime SD; nighttime SD and CV) and diastolic BPV (24-hour SD and ARV) were significantly lowered by nifedipine (P < 0.05); doxazosin resulted in significant reductions of systolic BPV (24-hour SD, CV and ARV; daytime SD; nighttime SD) and diastolic BPV (nighttime SD and CV) (P < 0.05). Doxazosin was revealed to be as effective as nifedipine for reducing BPV (P > 0.05) except for 24-hour SBP ARV. CONCLUSIONS: Doxazosin mesylate GITS had similar therapeutic effects on BP, BP SD, and BP CV lowering as nifedipine GITS in patients with mild-to-moderate essential hypertension.