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1.
Chemphyschem ; 25(1): e202300636, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-37955910

RESUMO

The availability of high-resolution 3D structural information is crucial for investigating guest-host systems across a wide range of fields. In the context of drug discovery, the information is routinely used to establish and validate structure-activity relationships, grow initial hits from screening campaigns, and to guide molecular docking. For the generation of protein-ligand complex structural information, X-ray crystallography is the experimental method of choice, however, with limited information on protein flexibility. An experimentally verified structural model of the binding interface in the native solution-state would support medicinal chemists in their molecular design decisions. Here we demonstrate that protein-bound ligand 1 H NMR chemical shifts are highly sensitive and accurate probes for the immediate chemical environment of protein-ligand interfaces. By comparing the experimental ligand 1 H chemical shift values with those computed from the X-ray structure using quantum mechanics methodology, we identify significant disagreements for parts of the ligand between the two experimental techniques. We show that quantum mechanics/molecular mechanics (QM/MM) molecular dynamics (MD) ensembles can be used to refine initial X-ray co-crystal structures resulting in a better agreement with experimental 1 H ligand chemical shift values. Overall, our findings highlight the usefulness of ligand 1 H NMR chemical shift information in combination with a QM/MM MD workflow for generating protein-ligand ensembles that accurately reproduce solution structural data.


Assuntos
Imageamento por Ressonância Magnética , Proteínas , Simulação de Acoplamento Molecular , Ligantes , Espectroscopia de Ressonância Magnética/métodos , Proteínas/química
2.
Catheter Cardiovasc Interv ; 103(1): 186-193, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38140761

RESUMO

BACKGROUND: Patients undergoing transcatheter aortic valve implantation (TAVI) frequently have coronary artery disease requiring percutaneous coronary intervention (PCI). Usually, PCI and TAVI are performed in two separate procedures and current studies are investigating potential benefits regarding the order. However, the two interventions may also be performed simultaneously, thereby limiting the risk associated with repeated vascular access. Data evaluating benefit and harm of concomitant procedures are scarce. AIMS: Therefore, this study aimed to evaluate concomitant PCI (coPCI) in TAVI patients regarding Valve Academic Research Consortium 3 (VARC-3) endpoints and long-term mortality. METHODS: A total of 2233 consecutive TAVI patients from the EVERY-VALVE registry were analyzed according to the VARC-3 endpoint definitions. A total of 274 patients had undergone TAVI and concomitant PCI (coPCI group). They were compared to 226 TAVI patients who had received PCI within 60 days before TAVI in a stepwise approach (swPCI group) and to the remaining 1733 TAVI patients who had not undergone PCI recently (noPCI group). RESULTS: Overall median age was 81.4 years, median Society of Thoracic Surgeons score was 4.0%. Patients in the coPCI and in the swPCI group were predominantly male with reduced left-ventricular ejection fraction. Rates of VARC-3 composite endpoints technical success and 30-day device success were comparable between all three groups. Mortality rates at 3 years after TAVI were similar (coPCI, 34.2% vs. swPCI, 31.9% vs. noPCI, 34.0% p = 0.84). CONCLUSIONS: coPCI during TAVI seems comparable in a retrospective analysis. Compared to a stepwise approach, it has similar rates of composite endpoints technical success and device success as well as long-term mortality.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter , Humanos , Masculino , Idoso de 80 Anos ou mais , Feminino , Estudos Retrospectivos , Volume Sistólico , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Resultado do Tratamento , Função Ventricular Esquerda , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Fatores de Risco
3.
Eur Heart J ; 44(10): 822-832, 2023 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-36445158

RESUMO

AIMS: The impact of sexuality in patients with significant tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI) is unknown. The aim of this study was to investigate sex-specific outcomes in patients with significant TR treated with TTVI vs. medical therapy alone. METHODS AND RESULTS: The Transcatheter Tricuspid Valve Therapies (TriValve) registry collected data on patients with significant TR from 24 centres who underwent TTVI from 2016 to 2021. A control cohort was formed by medically managed patients with ≥severe isolated TR diagnosed in 2015-18. The primary endpoint was freedom from all-cause mortality. Secondary endpoints were heart failure (HF) hospitalization, New York Heart Association (NYHA) functional status, and TR severity. One-year outcomes were assessed for the TriValve cohort and compared with the control cohort with the inverse probability of treatment weighting (IPTW). A total of 556 and 2072 patients were included from the TriValve and control groups, respectively. After TTVI, there was no difference between women and men in 1-year freedom from all-cause mortality 80.9% vs. 77.9%, P = 0.56, nor in HF hospitalization (P = 0.36), NYHA Functional Classes III and IV (P = 0.17), and TR severity >2+ at last follow-up (P = 0.42). Multivariable Cox-regression weighted by IPTW showed improved 1-year survival after TTVI compared with medical therapy alone in both women (adjusted hazard ratio 0.45, 95% confidence interval 0.23-0.83, P = 0.01) and men (adjusted hazard ratio 0.42, 95% confidence interval 0.18-0.89, P = 0.03). CONCLUSION: After TTVI in high-risk patients, there were no sex-related differences in terms of survival, HF hospitalization, functional status, and TR reduction up to 1 year. The IPTW analysis shows a survival benefit of TTVI over medical therapy alone in both women and men.


Assuntos
Insuficiência Cardíaca , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Masculino , Humanos , Feminino , Valva Tricúspide/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Resultado do Tratamento , Sistema de Registros , Insuficiência Cardíaca/complicações
4.
Circulation ; 145(16): 1254-1284, 2022 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-35436135

RESUMO

The Impella device (Impella, Abiomed, Danvers, MA) is a percutaneous transvalvular microaxial flow pump that is currently used for (1) cardiogenic shock, (2) left ventricular unloading (combination of venoarterial extracorporeal membrane oxygenation and Impella concept), (3) high-risk percutaneous coronary interventions, (4) ablation of ventricular tachycardia, and (5) treatment of right ventricular failure. Impella-assisted forward blood flow increased mean arterial pressure and cardiac output, peripheral tissue perfusion, and coronary blood flow in observational studies and some randomized trials. However, because of the need for large-bore femoral access (14 F for the commonly used Impella CP device) and anticoagulation, the incidences of bleeding and ischemic complications are as much as 44% and 18%, respectively. Hemolysis is reported in as many as 32% of patients and stroke in as many as 13%. Despite the rapidly growing use of the Impella device, there are still insufficient data on its effect on outcome and complications on the basis of large, adequately powered randomized controlled trials. The only 2 small and also underpowered randomized controlled trials in cardiogenic shock comparing Impella versus intra-aortic balloon pump did not show improved mortality. Several larger randomized controlled trials are currently recruiting patients or are in preparation in cardiogenic shock (DanGer Shock [Danish-German Cardiogenic Shock Trial; NCT01633502]), left ventricular unloading (DTU-STEMI [Door-To-Unload in ST-Segment-Elevation Myocardial Infarction; NCT03947619], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO], and REVERSE [A Prospective Randomised Trial of Early LV Venting Using Impella CP for Recovery in Patients With Cardiogenic Shock Managed With VA ECMO; NCT03431467]) and high-risk percutaneous coronary intervention (PROTECT IV [Impella-Supported PCI in High-Risk Patients With Complex Coronary Artery Disease and Reduced Left Ventricular Function; NCT04763200]).


Assuntos
Cardiologia , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Oxigenação por Membrana Extracorpórea/efeitos adversos , Coração Auxiliar/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico , Resultado do Tratamento
5.
PLoS Comput Biol ; 18(10): e1010585, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36227842

RESUMO

While traditional theories of sensorimotor processing have often assumed a serial decision-making pipeline, more recent approaches have suggested that multiple actions may be planned concurrently and vie for execution. Evidence for the latter almost exclusively stems from electrophysiological studies in posterior parietal and premotor cortex of monkeys. Here we study concurrent prospective motor planning in humans by recording functional magnetic resonance imaging (fMRI) during a delayed response task engaging movement sequences towards multiple potential targets. We find that also in human posterior parietal and premotor cortex delay activity modulates both with sequence complexity and the number of potential targets. We tested the hypothesis that this modulation is best explained by concurrent prospective planning as opposed to the mere maintenance of potential targets in memory. We devise a bounded rationality model with information constraints that optimally assigns information resources for planning and memory for this task and determine predicted information profiles according to the two hypotheses. When regressing delay activity on these model predictions, we find that the concurrent prospective planning strategy provides a significantly better explanation of the fMRI-signal modulations. Moreover, we find that concurrent prospective planning is more costly and thus limited for most subjects, as expressed by the best fitting information capacities. We conclude that bounded rational decision-making models allow relating both behavior and neural representations to utilitarian task descriptions based on bounded optimal information-processing assumptions.


Assuntos
Córtex Motor , Lobo Parietal , Mapeamento Encefálico , Humanos , Imageamento por Ressonância Magnética/métodos , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiologia , Movimento/fisiologia , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiologia , Estudos Prospectivos , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia
6.
Proc Natl Acad Sci U S A ; 117(11): 5907-5912, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32127487

RESUMO

Frameshifts in protein coding sequences are widely perceived as resulting in either nonfunctional or even deleterious protein products. Indeed, frameshifts typically lead to markedly altered protein sequences and premature stop codons. By analyzing complete proteomes from all three domains of life, we demonstrate that, in contrast, several key physicochemical properties of protein sequences exhibit significant robustness against +1 and -1 frameshifts. In particular, we show that hydrophobicity profiles of many protein sequences remain largely invariant upon frameshifting. For example, over 2,900 human proteins exhibit a Pearson's correlation coefficient R between the hydrophobicity profiles of the original and the +1-frameshifted variants greater than 0.7, despite an average sequence identity between the two of only 6.5% in this group. We observe a similar effect for protein sequence profiles of affinity for certain nucleobases as well as protein sequence profiles of intrinsic disorder. Finally, analysis of significance and optimality demonstrates that frameshift stability is embedded in the structure of the universal genetic code and may have contributed to shaping it. Our results suggest that frameshifting may be a powerful evolutionary mechanism for creating new proteins with vastly different sequences, yet similar physicochemical properties to the proteins from which they originate.


Assuntos
Fenômenos Químicos , Mutação da Fase de Leitura , Proteínas/química , Sequência de Aminoácidos , Evolução Molecular , Código Genético , Humanos , Interações Hidrofóbicas e Hidrofílicas , Fases de Leitura Aberta , Proteínas/genética
7.
J Interv Cardiol ; 2022: 9915247, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35360094

RESUMO

Background: The impact of devices for vessel closure on the safety and efficacy of cannula removal in VA-ECMO patients is unknown. Methods: We retrospectively analyzed 180 consecutive patients weaned from VA-ECMO after cardiac arrest or cardiogenic shock from January 2012 to June 2020. In the first period (historical technique group), from January 2012 to December 2018, primary decannulation strategy was manual compression. In the second period (current technique group), from January 2019 to June 2020, decannulation was performed either by a conventional approach with manual compression or by a suture-mediated closure device technique. Results: A femoral compression system was necessary in 71% of patients in the historical group compared to 39% in the current technique group (p < 0.01). Vascular surgery was performed in 12% in the historical cohort and 2% in the current technique cohort, which indicated a clear trend, albeit it did not reach significance (p = 0.07). Conclusion: We illustrated that a suture-mediated closure device technique for VA-ECMO decannulation was feasible, safe, and may have reduced the need of surgical interventions compared to manual compression alone.


Assuntos
Oxigenação por Membrana Extracorpórea , Oxigenação por Membrana Extracorpórea/métodos , Artéria Femoral/cirurgia , Humanos , Estudos Retrospectivos , Técnicas de Sutura , Suturas
8.
Platelets ; 33(3): 371-380, 2022 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941008

RESUMO

While previous reports showed ADP-induced platelet reactivity to be an independent predictor of bleeding after PCI in stable patients, this has never been investigated in patients with cardiogenic shock. The association of bleeding events with respect to ADP-induced platelet aggregation was investigated in patients undergoing primary PCI for acute myocardial infarction complicated by cardiogenic shock and with available on-treatment ADP-induced platelet aggregation measurements. Out of 233 patients, 74 suffered from a severe BARC3 or higher bleed. ADP-induced platelet aggregation was significantly lower in patients with BARC≥3 bleedings (p < .001). Multivariate analysis identified on-treatment ADP-induced platelet aggregation as an independent risk factor for bleeding (HR = 0.968 per AU). An optimal cutoff value of <12 AU for ADP-induced platelet aggregation to predict BARC≥3 bleedings was identified via ROC analysis. Moreover, the use of VA-ECMO (HR 1.972) or coaxial left ventricular pump (HR 2.593), first lactate (HR 1.093 per mmol/l) and thrombocyte count (HR 0.994 per G/l) were independent predictors of BARC≥3 bleedings. In conclusion, lower on-treatment ADP-induced platelet aggregation was independently associated with severe bleeding events in patients with AMI-CS. The value of platelet function testing for bleeding risk prediction and guidance of anti-thrombotic treatment in cardiogenic shock warrants further investigation.


Assuntos
Difosfato de Adenosina/metabolismo , Plaquetas/metabolismo , Hemorragia/etiologia , Infarto do Miocárdio/complicações , Choque Cardiogênico/etiologia , Doença Aguda , Idoso , Feminino , Hemorragia/fisiopatologia , Humanos , Masculino , Infarto do Miocárdio/patologia , Choque Cardiogênico/fisiopatologia
9.
Entropy (Basel) ; 24(12)2022 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-36554136

RESUMO

We define common thermodynamic concepts purely within the framework of general Markov chains and derive Jarzynski's equality and Crooks' fluctuation theorem in this setup. In particular, we regard the discrete-time case, which leads to an asymmetry in the definition of work that appears in the usual formulation of Crooks' fluctuation theorem. We show how this asymmetry can be avoided with an additional condition regarding the energy protocol. The general formulation in terms of Markov chains allows transferring the results to other application areas outside of physics. Here, we discuss how this framework can be applied in the context of decision-making. This involves the definition of the relevant quantities, the assumptions that need to be made for the different fluctuation theorems to hold, as well as the consideration of discrete trajectories instead of the continuous trajectories, which are relevant in physics.

10.
Proc Biol Sci ; 288(1962): 20212094, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34727714

RESUMO

The Nash equilibrium is one of the most central solution concepts to study strategic interactions between multiple players and has recently also been shown to capture sensorimotor interactions between players that are haptically coupled. While previous studies in behavioural economics have shown that systematic deviations from Nash equilibria in economic decision-making can be explained by the more general quantal response equilibria, such deviations have not been reported for the sensorimotor domain. Here we investigate haptically coupled dyads across three different sensorimotor games corresponding to the classic symmetric and asymmetric Prisoner's Dilemma, where the quantal response equilibrium predicts characteristic shifts across the three games, although the Nash equilibrium stays the same. We find that subjects exhibit the predicted deviations from the Nash solution. Furthermore, we show that taking into account subjects' priors for the games, we arrive at a more accurate description of bounded rational response equilibria that can be regarded as a quantal response equilibrium with non-uniform prior. Our results suggest that bounded rational response equilibria provide a general tool to explain sensorimotor interactions that include the Nash equilibrium as a special case in the absence of information processing limitations.


Assuntos
Cognição , Dilema do Prisioneiro , Teoria dos Jogos , Humanos
11.
Catheter Cardiovasc Interv ; 97(6): 1281-1289, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33660364

RESUMO

OBJECTIVES: We investigated the durability of tricuspid regurgitation (TR) reduction and the clinical outcomes through 12 months after transcatheter tricuspid valve repair (TTVr) with the PASCAL Transcatheter Valve Repair System. BACKGROUND: TTVr has rapidly developed and demonstrated favorable acute outcomes, but longer follow-up data are needed. METHODS: Overall, 30 patients (age 77 ± 6 years; 57% female) received PASCAL implantation from September 2017 to May 2019 and completed a clinical follow-up at 12 months. RESULTS: The TR etiology was functional in 25 patients (83%), degenerative in three (10%), and mixed in two (7%). All patients had TR severe or greater (massive or torrential in 80%) and heart failure symptoms (90% in NYHA III or IV) under optimal medical treatment. Single-leaflet device attachment occurred in two patients. Moderate or less TR was achieved in 23/28 patients (82%) at 30 days, which was sustained at 12 months (86%). Two patients underwent repeat TTVr due to residual torrential TR (day 173) and recurrence of severe TR (day 280), respectively. One-year survival rate was 93%; 6 patients required rehospitalization due to acute heart failure. NYHA functional class I or II was achieved in 90% and 6-minute walk distance improved from 275 ± 122 m at baseline to 347 ± 112 m at 12-month (+72 ± 82 m, p < .01). There was no stroke, endocarditis, or device embolization during the follow-up. CONCLUSIONS: Twelve-month outcomes from this multicenter compassionate use experience with the PASCAL System demonstrated high procedural success, acceptable safety, and significant clinical improvement.


Assuntos
Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
12.
PLoS Comput Biol ; 16(12): e1008420, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33270644

RESUMO

The concept of free energy has its origins in 19th century thermodynamics, but has recently found its way into the behavioral and neural sciences, where it has been promoted for its wide applicability and has even been suggested as a fundamental principle of understanding intelligent behavior and brain function. We argue that there are essentially two different notions of free energy in current models of intelligent agency, that can both be considered as applications of Bayesian inference to the problem of action selection: one that appears when trading off accuracy and uncertainty based on a general maximum entropy principle, and one that formulates action selection in terms of minimizing an error measure that quantifies deviations of beliefs and policies from given reference models. The first approach provides a normative rule for action selection in the face of model uncertainty or when information processing capabilities are limited. The second approach directly aims to formulate the action selection problem as an inference problem in the context of Bayesian brain theories, also known as Active Inference in the literature. We elucidate the main ideas and discuss critical technical and conceptual issues revolving around these two notions of free energy that both claim to apply at all levels of decision-making, from the high-level deliberation of reasoning down to the low-level information processing of perception.


Assuntos
Teorema de Bayes , Entropia , Modelos Neurológicos , Humanos , Probabilidade , Incerteza
13.
Eur Heart J ; 41(29): 2785-2795, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32176280

RESUMO

AIMS: Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for TTVR. METHODS AND RESULTS: A total of 243 patients underwent TTVR at two centres. One hundred twenty-one patients were grouped as iPHT+ [invasive systolic pulmonary artery pressures (PAPs) ≥50 mmHg]. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, and reintervention) was investigated during a follow-up of 330 (interquartile range 175-402) days. iPHT+ patients were at higher preoperative risk (P < 0.01), had more severe symptoms (P = 0.01), higher N-terminal pro-B-type natriuretic peptide levels (P < 0.01), more impaired right ventricular (RV) function (P < 0.01), and afterload corrected RV function (P < 0.01). Procedural TTVR success was similar in iPHT+ and iPHT- patients (84 vs. 84%, P = 0.99). The echocardiographic diagnostic accuracy to detect iPHT was only 55%. During follow-up, 35% of patients reached the combined clinical endpoint. The discordant diagnosis of iPHT+/ePHT- carried the highest risk for the combined clinical endpoint [HR 3.76 (CI 2.25-6.37), P < 0.01], while iPHT+/ePHT+ patients had a similar survival-free time from the combined endpoint compared to iPHT- patients (P = 0.48). In patients with isolated tricuspid procedure (n = 131) a discordant iPHT+/ePHT- diagnosis and an impaired afterload corrected RV function (P < 0.01 for both) were independent predictors for the occurrence of the combined endpoint. CONCLUSION: The discordant echocardiographic and invasive diagnosis of PHT in severe TR predicts outcomes after TTVR.


Assuntos
Implante de Prótese de Valva Cardíaca , Hipertensão Pulmonar , Insuficiência da Valva Tricúspide , Cateterismo Cardíaco , Humanos , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
14.
N Engl J Med ; 375(4): 345-56, 2016 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-27299809

RESUMO

BACKGROUND: Two phase 3 trials (UNCOVER-2 and UNCOVER-3) showed that at 12 weeks of treatment, ixekizumab, a monoclonal antibody against interleukin-17A, was superior to placebo and etanercept in the treatment of moderate-to-severe psoriasis. We report the 60-week data from the UNCOVER-2 and UNCOVER-3 trials, as well as 12-week and 60-week data from a third phase 3 trial, UNCOVER-1. METHODS: We randomly assigned 1296 patients in the UNCOVER-1 trial, 1224 patients in the UNCOVER-2 trial, and 1346 patients in the UNCOVER-3 trial to receive subcutaneous injections of placebo (placebo group), 80 mg of ixekizumab every 2 weeks after a starting dose of 160 mg (2-wk dosing group), or 80 mg of ixekizumab every 4 weeks after a starting dose of 160 mg (4-wk dosing group). Additional cohorts in the UNCOVER-2 and UNCOVER-3 trials were randomly assigned to receive 50 mg of etanercept twice weekly. At week 12 in the UNCOVER-3 trial, the patients entered a long-term extension period during which they received 80 mg of ixekizumab every 4 weeks through week 60; at week 12 in the UNCOVER-1 and UNCOVER-2 trials, the patients who had a response to ixekizumab (defined as a static Physicians Global Assessment [sPGA] score of 0 [clear] or 1 [minimal psoriasis]) were randomly reassigned to receive placebo, 80 mg of ixekizumab every 4 weeks, or 80 mg of ixekizumab every 12 weeks through week 60. Coprimary end points were the percentage of patients who had a score on the sPGA of 0 or 1 and a 75% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at week 12. RESULTS: In the UNCOVER-1 trial, at week 12, the patients had better responses to ixekizumab than to placebo; in the 2-wk dosing group, 81.8% had an sPGA score of 0 or 1 and 89.1% had a PASI 75 response; in the 4-wk dosing group, the respective rates were 76.4% and 82.6%; and in the placebo group, the rates were 3.2% and 3.9% (P<0.001 for all comparisons of ixekizumab with placebo). In the UNCOVER-1 and UNCOVER-2 trials, among the patients who were randomly reassigned at week 12 to receive 80 mg of ixekizumab every 4 weeks, 80 mg of ixekizumab every 12 weeks, or placebo, an sPGA score of 0 or 1 was maintained by 73.8%, 39.0%, and 7.0% of the patients, respectively. Patients in the UNCOVER-3 trial received continuous treatment of ixekizumab from weeks 0 through 60, and at week 60, at least 73% had an sPGA score of 0 or 1 and at least 80% had a PASI 75 response. Adverse events reported during ixekizumab use included neutropenia, candidal infections, and inflammatory bowel disease. CONCLUSIONS: In three phase 3 trials involving patients with psoriasis, ixekizumab was effective through 60 weeks of treatment. As with any treatment, the benefits need to be weighed against the risks of adverse events. The efficacy and safety of ixekizumab beyond 60 weeks of treatment are not yet known. (Funded by Eli Lilly; UNCOVER-1, UNCOVER-2, and UNCOVER-3 ClinicalTrials.gov numbers NCT01474512, NCT01597245, and NCT01646177, respectively.).


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Psoríase/tratamento farmacológico , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Candidíase/etiologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/induzido quimicamente , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Índice de Gravidade de Doença
15.
Phys Rev Lett ; 123(25): 250502, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31922770

RESUMO

We study quantum metrology for unitary dynamics. Analytic solutions are given for both the optimal unitary state preparation starting from an arbitrary mixed state and the corresponding optimal measurement precision. This represents a rigorous generalization of known results for optimal initial states and upper bounds on measurement precision which can only be saturated if pure states are available. In particular, we provide a generalization to mixed states of an upper bound on measurement precision for time-dependent Hamiltonians that can be saturated with optimal Hamiltonian control. These results make precise and reveal the full potential of mixed states for quantum metrology.

16.
Neural Comput ; 31(2): 440-476, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30576612

RESUMO

Specialization and hierarchical organization are important features of efficient collaboration in economical, artificial, and biological systems. Here, we investigate the hypothesis that both features can be explained by the fact that each entity of such a system is limited in a certain way. We propose an information-theoretic approach based on a free energy principle in order to computationally analyze systems of bounded rational agents that deal with such limitations optimally. We find that specialization allows a focus on fewer tasks, thus leading to a more efficient execution, but in turn, it requires coordination in hierarchical structures of specialized experts and coordinating units. Our results suggest that hierarchical architectures of specialized units at lower levels that are coordinated by units at higher levels are optimal, given that each unit's information-processing capability is limited and conforms to constraints on complexity costs.

17.
Catheter Cardiovasc Interv ; 93(5): E318-E319, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30196581

RESUMO

Percutaneous edge-to-edge repair of severe mitral regurgitation has been established as an alternative treatment option for patients at high risk for cardiac surgery. More recently, the introduction of the Cardioband system enabled percutaneous direct annuloplasty. Here, we present a case of simultaneous percutaneous direct annuloplasty with edge-to-edge repair. Moreover, annuloplasty did facilitate clip implantation bei approximating the anterior and posterior mitral leaflet. In conclusion, the combination of direct annuloplasty with edge-to-edge repair is feasible in a single procedure.


Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento
18.
Phys Chem Chem Phys ; 21(8): 4435-4443, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30729972

RESUMO

The time-dependent Stokes shift (TDSS) has attracted increasing interest for measuring hydration dynamics around biomolecules during the last decades. Its ability to report on hydration dynamics around proteins, however, was questioned recently since the experimental signal stems from both water and protein motion with an unknown ratio of contribution. Using large-scale computer simulations, we examine the ability of the TDSS to capture local hydration dynamics at nine different sites around the protein ubiquitin. By computationally constraining protein motion, it is shown that the remaining water component is meaningful and in line with the picture of a heterogeneous yet overall mobile hydration layer. However, protein contributions are excessively large and cannot be removed in an experimental context, thus obscuring the water component. Consequently, we conclude that the experimental TDSS may not be suitable for the investigation of hydration dynamics around proteins.

19.
J Chem Phys ; 150(17): 175102, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31067863

RESUMO

The bioprotective nature of monosaccharides and disaccharides is often attributed to their ability to slow down the dynamics of adjacent water molecules. Indeed, solvation dynamics close to sugars is indisputably retarded compared to bulk water. However, further research is needed on the qualitative and quantitative differences between the water dynamics around different saccharides. Current studies on this topic disagree on whether the disaccharide trehalose retards water to a larger extent than other isomers. Based on molecular dynamics simulation of the time-dependent Stokes shift of a chromophore close to the saccharides trehalose, sucrose, maltose, and glucose, this study reports a slightly stronger retardation of trehalose compared to other sugars at room temperature and below. Calculation and analysis of the intermolecular nuclear Overhauser effect, nuclear quadrupole relaxation, dielectric relaxation spectroscopy, and first shell residence times at room temperature yield further insights into the hydration dynamics of different sugars and confirm that trehalose slows down water dynamics to a slightly larger extent than other sugars. Since the calculated observables span a wide range of timescales relevant to intermolecular nuclear motion, and correspond to different kinds of motions, this study allows for a comprehensive view on sugar hydration dynamics.

20.
Entropy (Basel) ; 21(4)2019 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33267089

RESUMO

In its most basic form, decision-making can be viewed as a computational process that progressively eliminates alternatives, thereby reducing uncertainty. Such processes are generally costly, meaning that the amount of uncertainty that can be reduced is limited by the amount of available computational resources. Here, we introduce the notion of elementary computation based on a fundamental principle for probability transfers that reduce uncertainty. Elementary computations can be considered as the inverse of Pigou-Dalton transfers applied to probability distributions, closely related to the concepts of majorization, T-transforms, and generalized entropies that induce a preorder on the space of probability distributions. Consequently, we can define resource cost functions that are order-preserving and therefore monotonic with respect to the uncertainty reduction. This leads to a comprehensive notion of decision-making processes with limited resources. Along the way, we prove several new results on majorization theory, as well as on entropy and divergence measures.

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