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1.
Med Eng Phys ; 130: 104204, 2024 08.
Artículo en Inglés | MEDLINE | ID: mdl-39160017
2.
Plant Sci ; 349: 112232, 2024 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-39214468

RESUMEN

Three plant pathways for the synthesis of putrescine have been described to date. These are the synthesis of putrescine from ornithine, by ornithine decarboxylase (ODC); the synthesis of putrescine from arginine by arginine decarboxylase, agmatine iminohydrolase (AIH) and N-carbamoylputrescine amidohydrolase (NLP1); and arginine decarboxylase and agmatinase. To address how these pathways are organized in plants, we have used transient expression analysis of these genes in the leaves of Nicotiana benthamiana. Brassicas do not have ODC, but the single ODC gene from rice and one of the soybean genes, were localized to the ER. Transient expression of the rice agmatinase gene showed that it was localized to the mitochondria. In A. thaliana there are five isoforms of AIH and three isoforms of NLP1. Stable GFP-tagged transformants of the longest isoforms of AIH and NLP1 showed that both proteins were localized to the ER, but in tissues with chloroplasts, the localization was concentrated to lamellae adjacent to chloroplasts. Transient expression analyses showed that four of the isoforms of AIH and all of the isoforms of NLP1 were localized to the ER. However, AIH.4 was localized to the chloroplast. Combining these results with other published data, reveal that putrescine synthesis is excluded from the cytoplasm and is spatially localized to the chloroplast, ER, and likely the mitochondria. Synthesis of putrescine in the ER may facilitate cell to cell transport via plasmodesmata, or secretion via vesicles. Differential expression of these pathways may enable putrescine-mediated activation of hormone-responsive genes.

3.
BMJ Open ; 14(8): e085528, 2024 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-39107022

RESUMEN

INTRODUCTION: Traditionally, wards in acute care hospitals consist predominately of multioccupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals, with the UK National Health Service (NHS) advocating for single-room provision in all new hospital builds. There is limited evidence on the impact of a ward environment incorporating mostly single and some multioccupancy bays on patient care and organisational outcomes. METHODS AND ANALYSES: This study will assess the impact of a newly designed 28-bedded ward environment, with 20 single rooms and two four-bedded bays, on patient and staff experiences and outcomes in an acute NHS Trust in East England. The study is divided into two work packages (WP)-WP1 is a quantitative data extraction of routinely collected patient and staff data while WP2 is a mixed-methods process evaluation consisting of one-to-one, in-depth, semistructured interviews with staff, qualitative observations of work processes on the ward and a quantitative data evaluation of routinely collected process evaluation data from patients and staff. ETHICS AND DISSEMINATION: Ethical approval was obtained from the UK Health Research Authority (IRAS ID: 334395). Study findings will be shared with key stakeholders, published in peer-reviewed high-impact journals and presented at relevant conferences.


Asunto(s)
Habitaciones de Pacientes , Medicina Estatal , Humanos , Inglaterra , Ocupación de Camas , Arquitectura y Construcción de Hospitales , Reino Unido , Proyectos de Investigación , Satisfacción del Paciente
4.
Cytopathology ; 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-39091111

RESUMEN

INTRODUCTION: The risk of malignancy (ROM) remains an area of interest for further evaluation in reporting systems including in International System for reporting serous fluid cytopathology (TIS), which is a standardized system for reporting effusion cytology. Herein, we report our findings in further investigation of ROM in TIS by studying on paired pleural effusion specimens and corresponding pleural biopsies with emphasis on negative for malignancy, and atypia of undetermined significance categories. MATERIALS AND METHODS: The  Johns Hopkins Hospital pathology database was retrospectively searched for patients with a pleural biopsy (PBX) and a paired pleural effusion (PF) cytology specimens over a 4-year period. We employed the TIS categories. The following statistical parameters were evaluated: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM. RESULTS: A total of 223 patient cases were included. Effusions TIS reclassification and ROM were as follows: 1.8% non-diagnostic (ROM 75%), 75.8% negative for malignancy (ROM 23%), 4.9% atypical cells of undetermined significance (ROM 45%), 2.2% suspicious for malignancy (ROM 80%), and 15.2% malignant (ROM 100%). Overall accuracy, sensitivity, specificity, PPV and NPV were calculated and were 79.4%, 45%, 97.7%, 91.2% and 77%, respectively. Among, discordant cases diagnosed negative for malignancy on PF and positive for malignancy on PBX, there were significant number of lymphomas, mesotheliomas, and sarcomas. Lung cancer was the most common carcinoma; however, rare types of carcinomas were noted. Cells blocks and immunohistochemistry (IHC) studies were utilized to confirm either malignant conditions or rule out malignancy in both cell blocks and histology biopsies. CONCLUSION: This study demonstrates the high specificity and ROM for 'malignant' and 'suspicious for malignancy' categories in the TIS reporting system and highlights the modest negative predictive value for the 'negative for malignancy' category. Although Tissue biopsies are usually considered as 'gold standard', any definitive diagnosis of malignancy of body fluid should be considered positive for malignancy in further clinical decision-making.

5.
J Urol ; 212(3): 483-493, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39115125

RESUMEN

PURPOSE: We sought to evaluate the technical feasibility of performing a combined robotically assisted mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopy (URS) procedure by a single urologist using the MONARCH Platform, Urology (Johnson & Johnson MedTech, Redwood City, California). MATERIAL AND METHODS: In this prospective, first-in-human clinical trial, 13 patients underwent robotically-assisted PCNL for renal calculi at the University of California-Irvine, Department of Urology. Successful completion of the procedure was assessed as the primary endpoint. Postoperative adverse events were monitored for 30 days following the completion of the procedure. Stone ablation efficiency was evaluated on postoperative day 30 with low-dose 2-3 mm slice CT scans. Patients were classified according to the maximum length of their residual stone fragments as either absolute stone-free (Grade A), < 2 mm remnants (Grade B), or 2.1-4.0 mm remnants (Grade C). RESULTS: The combined robotic mini-PCNL and URS procedure was successfully completed in 12 of 13 procedures. No robotic device-related adverse events occurred. Preoperative stone burden was quantified by both maximum linear measurement (median 32.8 mm) as well as by CT-based volume (median 1645.9 mm3). Using the unique robotically assisted targeting system, percutaneous access was gained directly through the center of the renal papilla in a single pass in all cases. Median operative time was 187 minutes (range: 83-383 minutes). On postoperative day 30, a 98.7% (range: 72.9%-100.0%) volume reduction was achieved, with 5 Grade A (38.5%), 1 Grade B (7.7%), and 2 Grade C (15.4%). Three patients experienced complications (2 grade 1 and one grade 2 Clavien-Dindo). CONCLUSIONS: Our preliminary investigation demonstrates the safety, efficacy, and feasibility of a unique robotic-assisted combined mini-PCNL and URS platform.


Asunto(s)
Estudios de Factibilidad , Cálculos Renales , Nefrolitotomía Percutánea , Procedimientos Quirúrgicos Robotizados , Ureteroscopía , Humanos , Ureteroscopía/métodos , Ureteroscopía/instrumentación , Estudios Prospectivos , Nefrolitotomía Percutánea/métodos , Nefrolitotomía Percutánea/instrumentación , Masculino , Cálculos Renales/cirugía , Persona de Mediana Edad , Femenino , Procedimientos Quirúrgicos Robotizados/métodos , Adulto , Litotricia/métodos , Litotricia/instrumentación , Anciano , Ureteroscopios , Diseño de Equipo , Resultado del Tratamiento
6.
Br J Nurs ; 33(15): 718-725, 2024 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-39141333

RESUMEN

BACKGROUND: Health and care staff have limited opportunities to design, deliver and lead critical enquiry activities. AIMS: To explore barriers and enablers of building capacity, capability and confidence of these practitioners who wish to undertake critical enquiry activity. METHODS: A realist conceptual framework including the development of middle range theory allowed analysis of the scholarship process and outcomes. Data were collected through snap surveys, interviews (face to face and online) and project output (posters). RESULTS: Nine scholars completed the programme and all participated in the study. They all experienced an increase in capacity, capability and confidence in critical enquiry activity. Six overarching themes arose from analysis of the interviews and snap survey data: value; expertise; attitudes; meaningful, responsive support; brain space; and skill and knowledge acquisition. DISCUSSION: A combined focus on people and project while staff remained embedded in their work area was key for the growth of skills and knowledge and creating impact from projects. Guilt at having dedicated time to take part in the programme was a self-imposed barrier to building capacity and capability. Social capital (gained from bringing together individuals from different groups with shared values) facilitated bonding, which increased psychological safety and helped enable capability and confidence. CONCLUSION: The combination of theory and practice embedded in a real-world context led to positive outcomes for staff, patients, carers and the facilitation team as real-life changes were made in clinical environments.


Asunto(s)
Creación de Capacidad , Humanos , Reino Unido , Competencia Clínica
7.
Nat Rev Cardiol ; 21(10): 667-681, 2024 10.
Artículo en Inglés | MEDLINE | ID: mdl-39030270

RESUMEN

For more than 60 years, humans have travelled into space. Until now, the majority of astronauts have been professional, government agency astronauts selected, in part, for their superlative physical fitness and the absence of disease. Commercial spaceflight is now becoming accessible to members of the public, many of whom would previously have been excluded owing to unsatisfactory fitness or the presence of cardiorespiratory diseases. While data exist on the effects of gravitational and acceleration (G) forces on human physiology, data on the effects of the aerospace environment in unselected members of the public, and particularly in those with clinically significant pathology, are limited. Although short in duration, these high acceleration forces can potentially either impair the experience or, more seriously, pose a risk to health in some individuals. Rather than expose individuals with existing pathology to G forces to collect data, computational modelling might be useful to predict the nature and severity of cardiovascular diseases that are of sufficient risk to restrict access, require modification, or suggest further investigation or training before flight. In this Review, we explore state-of-the-art, zero-dimensional, compartmentalized models of human cardiovascular pathophysiology that can be used to simulate the effects of acceleration forces, homeostatic regulation and ventilation-perfusion matching, using data generated by long-arm centrifuge facilities of the US National Aeronautics and Space Administration and the European Space Agency to risk stratify individuals and help to improve safety in commercial suborbital spaceflight.


Asunto(s)
Enfermedades Cardiovasculares , Vuelo Espacial , Humanos , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/diagnóstico , Medición de Riesgo , Simulación por Computador , Astronautas , Modelos Cardiovasculares , Ingravidez/efectos adversos
8.
Nat Commun ; 15(1): 6336, 2024 Jul 27.
Artículo en Inglés | MEDLINE | ID: mdl-39068146

RESUMEN

Oomycete pathogens deliver many effectors to enhance virulence or suppress plant immunity. Plant immune networks are interconnected, in which a few effectors can trigger a strong defense response when recognized by immunity-related proteins. How effectors activate plant defense response remains poorly understood. Here we report Phytophthora capsici effector RxLR23KM can induce plant cell death and plant immunity. RxLR23KM specifically binds to ERD15La, a regulator of abscisic acid and salicylic acid pathway, and the binding intensity depends on the amino acid residues (K93 and M320). NbNAC68, a downstream protein of ERD15La, can stimulate plant immunity that is compromised after binding with ERD15La. Silencing of NbNAC68 substantially prevents the activation of plant defense response. RxLR23KM binds to ERD15La, releasing NbNAC68 to activate plant immunity. These findings highlight a strategy of plant defense response that ERD15La as a central regulator coordinates RxLR23KM to regulate NbNAC68-triggered plant immunity.


Asunto(s)
Arabidopsis , Phytophthora , Enfermedades de las Plantas , Inmunidad de la Planta , Phytophthora/patogenicidad , Enfermedades de las Plantas/microbiología , Enfermedades de las Plantas/inmunología , Arabidopsis/inmunología , Arabidopsis/metabolismo , Arabidopsis/genética , Arabidopsis/microbiología , Nicotiana/metabolismo , Nicotiana/inmunología , Nicotiana/genética , Nicotiana/microbiología , Proteínas de Arabidopsis/metabolismo , Proteínas de Arabidopsis/genética , Ácido Salicílico/metabolismo , Oomicetos , Proteínas de Plantas/metabolismo , Proteínas de Plantas/genética , Ácido Abscísico/metabolismo , Regulación de la Expresión Génica de las Plantas
9.
Expert Rev Cardiovasc Ther ; 22(7): 339-345, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38949642

RESUMEN

BACKGROUND: Triple antithrombotic therapy (TAT) with aspirin, a P2Y12 inhibitor, and oral anticoagulation in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) raises concerns about increased bleeding. Regimens incorporating more potent P2Y12 inhibitors over clopidogrel have not been investigated adequately. RESEARCH DESIGN AND METHODS: A retrospective observational study was performed on 387 patients with AF receiving TAT for 1 month (n = 236) or ≤1 week (n = 151) after PCI. Major and clinically relevant non-major bleeding and major adverse cardiac and cerebrovascular events (MACCE) were assessed up to 30 days post-procedure. RESULTS: Bleeding was less frequent with ≤1 week versus 1 month of TAT (3.3 vs 9.3%; p = 0.025) while MACCE were similar (4.6 vs 4.7%; p = 0.998). No differences in bleeding or MACCE were observed between ticagrelor/prasugrel and clopidogrel regimens. For patients receiving ≤1 week of TAT, no excess of MACCE was seen in the subgroup given no further aspirin post-PCI compared with those given aspirin for up to 1 week (3.6 vs 5.2%). CONCLUSIONS: TAT post-PCI for ≤1 week was associated with less bleeding despite greater use of ticagrelor/prasugrel but similar MACCE versus 1-month TAT. These findings support further studies on safety and efficacy of dual therapy with ticagrelor/prasugrel immediately after PCI.


Asunto(s)
Anticoagulantes , Aspirina , Fibrilación Atrial , Clopidogrel , Quimioterapia Combinada , Hemorragia , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria , Antagonistas del Receptor Purinérgico P2Y , Humanos , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Intervención Coronaria Percutánea/métodos , Masculino , Femenino , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Hemorragia/inducido químicamente , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Aspirina/efectos adversos , Clopidogrel/administración & dosificación , Clopidogrel/uso terapéutico , Clopidogrel/efectos adversos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Antagonistas del Receptor Purinérgico P2Y/administración & dosificación , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Antagonistas del Receptor Purinérgico P2Y/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Fibrinolíticos/administración & dosificación , Fibrinolíticos/uso terapéutico , Fibrinolíticos/efectos adversos , Anciano de 80 o más Años , Ticagrelor/administración & dosificación , Ticagrelor/uso terapéutico , Ticagrelor/efectos adversos
10.
Am J Physiol Heart Circ Physiol ; 327(1): H182-H190, 2024 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-38787386

RESUMEN

Murray's law has been viewed as a fundamental law of physiology. Relating blood flow ([Formula: see text]) to vessel diameter (D) ([Formula: see text]·âˆ·D3), it dictates minimum lumen area (MLA) targets for coronary bifurcation percutaneous coronary intervention (PCI). The cubic exponent (3.0), however, has long been disputed, with alternative theoretical derivations, arguing this should be closer to 2.33 (7/3). The aim of this meta-analysis was to quantify the optimum flow-diameter exponent in human and mammalian coronary arteries. We conducted a systematic review and meta-analysis of all articles quantifying an optimum flow-diameter exponent for mammalian coronary arteries within the Cochrane library, PubMed Medline, Scopus, and Embase databases on 20 March 2023. A random-effects meta-analysis was used to determine a pooled flow-diameter exponent. Risk of bias was assessed with the National Institutes of Health (NIH) quality assessment tool, funnel plots, and Egger regression. From a total of 4,772 articles, 18 were suitable for meta-analysis. Studies included data from 1,070 unique coronary trees, taken from 372 humans and 112 animals. The pooled flow diameter exponent across both epicardial and transmural arteries was 2.39 (95% confidence interval: 2.24-2.54; I2 = 99%). The pooled exponent of 2.39 showed very close agreement with the theoretical exponent of 2.33 (7/3) reported by Kassab and colleagues. This exponent may provide a more accurate description of coronary morphometric scaling in human and mammalian coronary arteries, as compared with Murray's original law. This has important implications for the assessment, diagnosis, and interventional treatment of coronary artery disease.


Asunto(s)
Circulación Coronaria , Vasos Coronarios , Animales , Humanos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Modelos Cardiovasculares , Intervención Coronaria Percutánea
11.
Surg Endosc ; 38(7): 3645-3653, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38772960

RESUMEN

BACKGROUND: The field of robotic-assisted surgery is rapidly growing as many robotic surgical devices are in development and about to enter the market. Currently, there is no universally accepted language for labeling the different robotic systems. To facilitate this communication, we created what is, to our knowledge, the first classification of surgical robotic technologies that organizes and classifies surgical robots used for endoscopy, laparoscopy and thoracoscopy. METHODS: We compiled a list of surgical robots intended to be used for endoscopy, laparoscopy, and/or thoracoscopy by searching United States, European, Hong Kong, Japan, and Korean databases for approved devices. Devices showcased at the 2023 Annual Meeting for the Society of Robotic Surgery were added. We also systematically reviewed the literature for any existing surgical robotic classifications or categorizations. We then created a multidisciplinary committee of 8 surgeons and 2 engineers to construct a proposed classification of the devices included in our search. RESULTS: We identified 40 robotic surgery systems intended to be used for endoscopy, laparoscopy and/or thoracoscopy. The proposed classification organizes robotic devices with regard to architecture, port design, and configuration (modular carts, multi-arm integrated cart, table-attachable or arm-table integration). CONCLUSION: This 3-level classification of robotic surgical devices used for endoscopy, laparoscopy and/or thoracoscopy describes important characteristics of robotic devices systematically.


Asunto(s)
Laparoscopía , Procedimientos Quirúrgicos Robotizados , Toracoscopía , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Laparoscopía/métodos , Toracoscopía/métodos , Diseño de Equipo , Endoscopía/métodos
12.
Syst Rev ; 13(1): 128, 2024 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-38725074

RESUMEN

BACKGROUND: Binary outcomes are likely the most common in randomized controlled trials, but ordinal outcomes can also be of interest. For example, rather than simply collecting data on diseased versus healthy study subjects, investigators may collect information on the severity of disease, with no disease, mild, moderate, and severe disease as possible levels of the outcome. While some investigators may be interested in all levels of the ordinal variable, others may combine levels that are not of particular interest. Therefore, when research synthesizers subsequently conduct a network meta-analysis on a network of trials for which an ordinal outcome was measured, they may encounter a network in which outcome categorization varies across trials. METHODS: The standard method for network meta-analysis for an ordinal outcome based on a multinomial generalized linear model is not designed to accommodate the multiple outcome categorizations that might occur across trials. In this paper, we propose a network meta-analysis model for an ordinal outcome that allows for multiple categorizations. The proposed model incorporates the partial information provided by trials that combine levels through modification of the multinomial likelihoods of the affected arms, allowing for all available data to be considered in estimation of the comparative effect parameters. A Bayesian fixed effect model is used throughout, where the ordinality of the outcome is accounted for through the use of the adjacent-categories logit link. RESULTS: We illustrate the method by analyzing a real network of trials on the use of antibiotics aimed at preventing liver abscesses in beef cattle and explore properties of the estimates of the comparative effect parameters through simulation. We find that even with the categorization of the levels varying across trials, the magnitudes of the biases are relatively small and that under a large sample size, the root mean square errors become small as well. CONCLUSIONS: Our proposed method to conduct a network meta-analysis for an ordinal outcome when the categorization of the outcome varies across trials, which utilizes the adjacent-categories logit link, performs well in estimation. Because the method considers all available data in a single estimation, it will be particularly useful to research synthesizers when the network of interest has only a limited number of trials for each categorization of the outcome.


Asunto(s)
Metaanálisis en Red , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Evaluación de Resultado en la Atención de Salud , Modelos Estadísticos
13.
Heart ; 110(16): 1048-1055, 2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-38754969

RESUMEN

BACKGROUND: The practical application of 'virtual' (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential of vFFR to guide the management of unselected patients undergoing ICA. The hypothesis was that it changes management in >10% of cases. METHODS: vFFR was computed using the Sheffield VIRTUheart system, at five hospitals in the North of England, on 'all-comers' undergoing ICA for non-ST-elevation myocardial infarction acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The cardiologists' management plan (optimal medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass surgery or 'more information required') and confidence level were recorded after ICA, and again after vFFR disclosure. RESULTS: 517 patients were screened; 320 were recruited: 208 with ACS and 112 with CCS. The median vFFR was 0.82 (0.70-0.91). vFFR disclosure did not change the mean number of significantly stenosed vessels per patient (1.16 (±0.96) visually and 1.18 (±0.92) with vFFR (p=0.79)). A change in intended management following vFFR disclosure occurred in 22% of all patients; in the ACS cohort, there was a 62% increase in the number planned for medical management, and in the CCS cohort, there was a 31% increase in the number planned for PCI. In all patients, vFFR disclosure increased physician confidence from 8 of 10 (7.33-9) to 9 of 10 (8-10) (p<0.001). CONCLUSION: The addition of vFFR to ICA changed intended management strategy in 22% of patients, provided a detailed and specific 'all-in-one' anatomical and physiological assessment of coronary artery disease, and was accompanied by augmentation of the operator's confidence in the treatment strategy.


Asunto(s)
Síndrome Coronario Agudo , Angiografía Coronaria , Reserva del Flujo Fraccional Miocárdico , Humanos , Reserva del Flujo Fraccional Miocárdico/fisiología , Femenino , Masculino , Persona de Mediana Edad , Síndrome Coronario Agudo/terapia , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/diagnóstico por imagen , Anciano , Intervención Coronaria Percutánea/métodos , Inglaterra , Infarto del Miocardio/terapia , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia
14.
Comput Biol Med ; 173: 108299, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38537564

RESUMEN

BACKGROUND: Myocardial ischaemia results from insufficient coronary blood flow. Computed virtual fractional flow reserve (vFFR) allows quantification of proportional flow loss without the need for invasive pressure-wire testing. In the current study, we describe a novel, conductivity model of side branch flow, referred to as 'leak'. This leak model is a function of taper and local pressure, the latter of which may change radically when focal disease is present. This builds upon previous techniques, which either ignore side branch flow, or rely purely on anatomical factors. This study aimed to describe a new, conductivity model of side branch flow and compare this with established anatomical models. METHODS AND RESULTS: The novel technique was used to quantify vFFR, distal absolute flow (Qd) and microvascular resistance (CMVR) in 325 idealised 1D models of coronary arteries, modelled from invasive clinical data. Outputs were compared to an established anatomical model of flow. The conductivity model correlated and agreed with the reference model for vFFR (r = 0.895, p < 0.0001; +0.02, 95% CI 0.00 to + 0.22), Qd (r = 0.959, p < 0.0001; -5.2 mL/min, 95% CI -52.2 to +13.0) and CMVR (r = 0.624, p < 0.0001; +50 Woods Units, 95% CI -325 to +2549). CONCLUSION: Agreement between the two techniques was closest for vFFR, with greater proportional differences seen for Qd and CMVR. The conductivity function assumes vessel taper was optimised for the healthy state and that CMVR was not affected by local disease. The latter may be addressed with further refinement of the technique or inferred from complementary image data. The conductivity technique may represent a refinement of current techniques for modelling coronary side-branch flow. Further work is needed to validate the technique against invasive clinical data.


Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Humanos , Vasos Coronarios , Angiografía Coronaria/métodos , Hemodinámica , Valor Predictivo de las Pruebas
15.
J Invasive Cardiol ; 2024 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-38471155

RESUMEN

OBJECTIVES: Cardiac surgery for coronary artery disease was dramatically reduced during the first wave of the COVID-19 pandemic. Many patients with disease ordinarily treated with coronary artery bypass grafting (CABG) instead underwent percutaneous coronary intervention (PCI). We sought to describe 12-month outcomes following PCI in patients who would typically have undergone CABG. METHODS: Between March 1 and July 31, 2020, patients who received revascularization with PCI when CABG would have been the primary choice of revascularization were enrolled in the prospective, multicenter UK-ReVasc Registry. We evaluated the following major adverse cardiovascular events at 12 months: all-cause mortality, myocardial infarction, repeat revascularization, stroke, major bleeding, and stent thrombosis. RESULTS: A total of 215 patients were enrolled across 45 PCI centers in the United Kingdom. Twelve-month follow up data were obtained for 97% of the cases. There were 9 deaths (4.3%), 5 myocardial infarctions (2.4%), 12 repeat revascularizations (5.7%), 1 stroke (0.5%), 3 major bleeds (1.4%), and no cases of stent thrombosis. No difference in the primary endpoint was observed between patients who received complete vs incomplete revascularization (residual SYNTAX score £ 8 vs > 8) (P = .22). CONCLUSIONS: In patients with patterns of coronary disease in whom CABG would have been the primary therapeutic choice outside of the pandemic, PCI was associated with acceptable outcomes at 12 months of follow-up. Contemporary randomized trials that compare PCI to CABG in such patient cohorts may be warranted.

16.
Sci Rep ; 14(1): 6031, 2024 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-38472404

RESUMEN

The dysfunction of ion channels is a causative factor in a variety of neurological diseases, thereby defining the implicated channels as key drug targets. The detection of functional changes in multiple specific ionic currents currently presents a challenge, particularly when the neurological causes are either a priori unknown, or are unexpected. Traditional patch clamp electrophysiology is a powerful tool in this regard but is low throughput. Here, we introduce a single-shot method for detecting alterations amongst a range of ion channel types from subtle changes in membrane voltage in response to a short chaotically driven current clamp protocol. We used data assimilation to estimate the parameters of individual ion channels and from these we reconstructed ionic currents which exhibit significantly lower error than the parameter estimates. Such reconstructed currents thereby become sensitive predictors of functional alterations in biological ion channels. The technique correctly predicted which ionic current was altered, and by approximately how much, following pharmacological blockade of BK, SK, A-type K+ and HCN channels in hippocampal CA1 neurons. We anticipate this assay technique could aid in the detection of functional changes in specific ionic currents during drug screening, as well as in research targeting ion channel dysfunction.


Asunto(s)
Canales Iónicos , Neuronas , Electrofisiología , Canales Iónicos/metabolismo , Neuronas/metabolismo , Membrana Celular/metabolismo , Transporte Iónico
17.
Microbiol Resour Announc ; 13(4): e0109423, 2024 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-38411068

RESUMEN

Organism abundance and diversity were assessed in Lake Erie ice samples using sequences derived from a combined metagenomic and metatranscriptomic analysis. The 68,417 unique sequences were from Bacteria (77.5%), Eukarya (22.3%), and Archaea (0.2%) and indicated diverse species of organisms from 32 bacterial, 8 eukaryotic, and 2 archaeal taxonomic groups.

18.
Animals (Basel) ; 14(2)2024 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-38254402

RESUMEN

We evaluated an active participatory design for the regional surveillance of notifiable swine pathogens based on testing 10 samples collected by farm personnel in each participating farm. To evaluate the performance of the design, public domain software was used to simulate the introduction and spread of a pathogen among 17,521 farms in a geographic region of 1,615,246 km2. Using the simulated pathogen spread data, the probability of detecting ≥ 1 positive farms in the region was estimated as a function of the percent of participating farms (20%, 40%, 60%, 80%, 100%), farm-level detection probability (10%, 20%, 30%, 40%, 50%), and regional farm-level prevalence. At 0.1% prevalence (18 positive farms among 17,521 farms) and a farm-level detection probability of 30%, the participatory surveillance design achieved 67%, 90%, and 97% probability of detecting ≥ 1 positive farms in the region when producer participation was 20%, 40%, and 60%, respectively. The cost analysis assumed that 10 individual pig samples per farm would be pooled into 2 samples (5 pigs each) for testing. Depending on the specimen collected (serum or swab sample) and test format (nucleic acid or antibody detection), the cost per round of sampling ranged from EUR 0.017 to EUR 0.032 (USD 0.017 to USD 0.034) per pig in the region. Thus, the analysis suggested that an active regional participatory surveillance design could achieve detection at low prevalence and at a sustainable cost.

19.
Endocrinology ; 164(12)2023 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-37936337

RESUMEN

The mechanism by which arcuate kisspeptin (ARNKISS) neurons co-expressing glutamate, neurokinin B, and dynorphin intermittently synchronize their activity to drive pulsatile hormone secretion remains unclear in females. In order to study spontaneous synchronization within the ARNKISS neuron network, acute brain slices were prepared from adult female Kiss1-GCaMP6 mice. Analysis of both spontaneous synchronizations and those driven by high frequency stimulation of individual ARNKISS neurons revealed that the network exhibits semi-random emergent excitation dependent upon glutamate signaling through AMPA receptors. No role for NMDA receptors was identified. In contrast to male mice, ongoing tachykinin receptor tone within the slice operated to promote spontaneous synchronizations in females. As previously observed in males, we found that ongoing dynorphin transmission in the slice did not contribute to synchronization events. These observations indicate that a very similar AMPA receptor-dependent mechanism underlies ARNKISS neuron synchronizations in the female mouse supporting the "glutamate two-transition" model for kisspeptin neuron synchronization. However, a potentially important sex difference appears to exist with a more prominent facilitatory role for tachykinin transmission in the female.


Asunto(s)
Dinorfinas , Kisspeptinas , Ratones , Femenino , Masculino , Animales , Kisspeptinas/metabolismo , Dinorfinas/metabolismo , Núcleo Arqueado del Hipotálamo/metabolismo , Neuroquinina B/metabolismo , Encéfalo/metabolismo , Neuronas/metabolismo , Glutamatos , Hormona Liberadora de Gonadotropina/metabolismo
20.
Glob Chang Biol ; 29(23): 6812-6827, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37815703

RESUMEN

Peatlands of the central Congo Basin have accumulated carbon over millennia. They currently store some 29 billion tonnes of carbon in peat. However, our understanding of the controls on peat carbon accumulation and loss and the vulnerability of this stored carbon to climate change is in its infancy. Here we present a new model of tropical peatland development, DigiBog_Congo, that we use to simulate peat carbon accumulation and loss in a rain-fed interfluvial peatland that began forming ~20,000 calendar years Before Present (cal. yr BP, where 'present' is 1950 CE). Overall, the simulated age-depth curve is in good agreement with palaeoenvironmental reconstructions derived from a peat core at the same location as our model simulation. We find two key controls on long-term peat accumulation: water at the peat surface (surface wetness) and the very slow anoxic decay of recalcitrant material. Our main simulation shows that between the Late Glacial and early Holocene there were several multidecadal periods where net peat and carbon gain alternated with net loss. Later, a climatic dry phase beginning ~5200 cal. yr BP caused the peatland to become a long-term carbon source from ~3975 to 900 cal. yr BP. Peat as old as ~7000 cal. yr BP was decomposed before the peatland's surface became wetter again, suggesting that changes in rainfall alone were sufficient to cause a catastrophic loss of peat carbon lasting thousands of years. During this time, 6.4 m of the column of peat was lost, resulting in 57% of the simulated carbon stock being released. Our study provides an approach to understanding the future impact of climate change and potential land-use change on this vulnerable store of carbon.


Asunto(s)
Carbono , Humedales , Congo , Suelo , Ciclo del Carbono
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