Cyclosporin A inhibits PGE2 release from vascular smooth muscle cells

The influence of the fungoid undecapeptide cyclosporin A (CyA) on PGE2 release from cultured rat aortic smooth muscle cells was investigated in this study. We found that CyA time and concentration dependently (ED50:500 ng/ml) inhibited PGE2 release from the cells. CyA attenuated both basal and PGE2 release evoked by angiotensin II (10(-10)-10(-6) M), arginine vasopressin (10(-10)-10(-6) M) and ionomycin (10(-9)-10(-6) M). CyA (1 microgram/ml) did not affect the conversion of exogenous arachidonic acid (1 microM) into PGE2. The inhibitory effect of CyA was neutralized by high concentrations of the calcium ionophore ionomycin (greater than 3 X 10(-6) M). Taken together our results indicate that CyA inhibits both basal and vasoconstrictor evoked PGE2 release from vascular smooth muscle by impairing the availability of free arachidonic acid rather than by inhibiting the conversion of arachidonic acid into PGE2

Optimising Rolling Stock Planning including Maintenance with Constraint Programming and Quantum Annealing

We propose and compare Constraint Programming (CP) and Quantum Annealing (QA) approaches for rolling stock assignment optimisation considering necessary maintenance tasks. In the CP approach, we model the problem with an Alldifferent constraint, extensions of the Element constraint, and logical implications, among others. For the QA approach, we develop a quadratic unconstrained binary optimisation (QUBO) model. For evaluation, we use data sets based on real data from Deutsche Bahn and run the QA approach on real quantum computers from D-Wave. Classical computers are used to evaluate the CP approach as well as tabu search for the QUBO model. At the current development stage of the physical quantum annealers, we find that both approaches tend to produce comparable results

Effects of ultrafine particles on the allergic inflammation in the lung of asthmatics : results of a double-blinded randomized cross-over clinical pilot study

Background: Epidemiological and experimental studies suggest that exposure to ultrafine particles (UFP) might aggravate the allergic inflammation of the lung in asthmatics. Methods: We exposed 12 allergic asthmatics in two subgroups in a double-blinded randomized cross-over design, first to freshly generated ultrafine carbon particles (64 μg/m3; 6.1 ± 0.4 × 105 particles/cm3 for 2 h) and then to filtered air or vice versa with a 28-day recovery period in-between. Eighteen hours after each exposure, grass pollen was instilled into a lung lobe via bronchoscopy. Another 24 hours later, inflammatory cells were collected by means of bronchoalveolar lavage (BAL). (Trial registration: NCT00527462) Results: For the entire study group, inhalation of UFP by itself had no significant effect on the allergen induced inflammatory response measured with total cell count as compared to exposure with filtered air (p = 0.188). However, the subgroup of subjects, which inhaled UFP during the first exposure, exhibited a significant increase in total BAL cells (p = 0.021), eosinophils (p = 0.031) and monocytes (p = 0.013) after filtered air exposure and subsequent allergen challenge 28 days later. Additionally, the potential of BAL cells to generate oxidant radicals was significantly elevated at that time point. The subgroup that was exposed first to filtered air and 28 days later to UFP did not reveal differences between sessions. Conclusions: Our data demonstrate that pre-allergen exposure to UFP had no acute effect on the allergic inflammation. However, the subgroup analysis lead to the speculation that inhaled UFP particles might have a long-term effect on the inflammatory course in asthmatic patients. This should be reconfirmed in further studies with an appropriate study design and sufficient number of subjects

RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings

BACKGROUND Non-technical skills (NTS) are essential for safe surgical practice as they impact workflow and patient outcomes. Observational tools to measure operating room (OR) teams' NTS have been introduced. However, there are none that account for the specific teamwork challenges introduced by robotic-assisted surgery (RAS). We set out to develop and content-validate a tool to assess multidisciplinary NTS in RAS. METHODOLOGY Stepwise, multi-method procedure. Observations in different surgical departments and a scoping literature review were first used to compile a set of RAS-specific teamwork behaviours. This list was refined and expert validated using a Delphi consensus approach consisting of qualitative interviews and a quantitative survey. Then, RAS-specific behaviours were merged with a well-established assessment tool on OR teamwork (NOTECHS II). Finally, the new tool-RAS-NOTECHS-was applied in standardized observations of real-world procedures to test its reliability (inter-rater agreement via intra-class correlations). RESULTS Our scoping review revealed 5242 articles, of which 21 were included based on pre-established inclusion criteria. We elicited 16 RAS-specific behaviours from the literature base. These were synthesized with further 18 behavioural markers (obtained from 12 OR-observations) into a list of 26 behavioural markers. This list was reviewed by seven RAS experts and condensed to 15 expert-validated RAS-specific behavioural markers which were then merged into NOTECHS II. For five observations of urologic RAS procedures (duration: 13~h and 41~min), inter-rater agreement for identification of behavioural markers was strong. Agreement of RAS-NOTECHS scores indicated moderate to strong agreement. CONCLUSIONS RAS-NOTECHS is the first observational tool for multidisciplinary NTS in RAS. In preliminary application, it has been shown to be reliable. Since RAS is rapidly increasing and challenges for effective and safe teamwork remain at the forefront of quality and safety of surgical care, RAS-NOTECHS may contribute to training and improvement efforts in technology-facilitated surgeries

The use of external controls: To what extent can it currently be recommended?

With more and better clinical data being captured outside of clinical studies and greater data sharing of clinical studies, external controls may become a more attractive alternative to randomized clinical trials. Both industry and regulators recognize that in situations where a randomized study cannot be performed, external controls can provide the needed contextualization to allow a better interpretation of studies without a randomized control. It is also agreed that external controls will not fully replace randomized clinical trials as the gold standard for formal proof of efficacy in drug development and the yardstick of clinical research. However, it remains unclear in which situations conclusions about efficacy and a positive benefit/risk can reliably be based on the use of an external control. This paper will provide an overview on types of external control, their applications and the different sources of bias their use may incur, and discuss potential mitigation steps. It will also give recommendations on how the use of external controls can be justified

Effect of Acute Ozone Induced Airway Inflammation on Human Sympathetic Nerve Traffic: A Randomized, Placebo Controlled, Crossover Study

Background: Ozone concentrations in ambient air are related to cardiopulmonary perturbations in the aging population. Increased central sympathetic nerve activity induced by local airway inflammation may be one possible mechanism. Methodology/Principal Findings: To elucidate this issue further, we performed a randomized, double-blind, cross-over study, including 14 healthy subjects (3 females, age 22-47 years), who underwent a 3 h exposure with intermittent exercise to either ozone (250 ppb) or clean air. Induced sputum was collected 3 h after exposure. Nineteen to 22 hours after exposure, we recorded ECG, finger blood pressure, brachial blood pressure, respiration, cardiac output, and muscle sympathetic nerve activity (MSNA) at rest, during deep breathing, maximum-inspiratory breath hold, and a Valsalva maneuver. While the ozone exposure induced the expected airway inflammation, as indicated by a significant increase in sputum neutrophils, we did not detect a significant estimated treatment effect adjusted for period on cardiovascular measurements. Resting heart rate (clean air: 59 +/- 62, ozone 60 +/- 62 bpm), blood pressure (clean air: 121 +/- 3/71 +/- 2 mmHg; ozone: 121 +/- 2/71 +/- 2mmHg), cardiac output (clean air: 7.42 +/- 0.29 mmHg; ozone: 7.98 +/- 0.60 l/min), and plasma norepinephrine levels (clean air: 213 +/- 21 pg/ml; ozone: 202 +/- 16 pg/ml), were similar on both study days. No difference of resting MSNA was observed between ozone and air exposure (air: 2362, ozone: 2362 bursts/min). Maximum MSNA obtained at the end of apnea (air: 44 +/- 4, ozone: 48 +/- 4 bursts/min) and during the phase II of the Valsalva maneuver (air: 64 +/- 5, ozone: 57 +/- 6 bursts/min) was similar. Conclusions/Significance: Our study suggests that acute ozone-induced airway inflammation does not increase resting sympathetic nerve traffic in healthy subjects, an observation that is relevant for environmental health. However, we can not exclude that chronic airway inflammation may contribute to sympathetic activation

Deep Learning based Model Predictive Control for Compression Ignition Engines

Machine learning (ML) and a nonlinear model predictive controller (NMPC) are used in this paper to minimize the emissions and fuel consumption of a compression ignition engine. In this work machine learning is applied in two methods. In the first application, ML is used to identify a model for implementation in model predictive control optimization problems. In the second application, ML is used as a replacement of the NMPC where the ML controller learns the optimal control action by imitating or mimicking the behavior of the model predictive controller. In this study, a deep recurrent neural network including long-short term memory (LSTM) layers are used to model the emissions and performance of an industrial 4.5 liter 4-cylinder Cummins diesel engine. This model is then used for model predictive controller implementation. Then, a deep learning scheme is deployed to clone the behavior of the developed controller. In the LSTM integration, a novel scheme is used by augmenting hidden and cell states of the network in an NMPC optimization problem. The developed LSTM-NMPC and the imitative NMPC are compared with the Cummins calibrated Engine Control Unit (ECU) model in an experimentally validated engine simulation platform. Results show a significant reduction in Nitrogen Oxides (\nox) emissions and a slight decrease in the injected fuel quantity while maintaining the same load. In addition, the imitative NMPC has a similar performance as the NMPC but with a two orders of magnitude reduction of the computation time.Comment: Submitted to Control engineering Practice (Submission date: March 9, 2022) Revised version (Submission date: June 18, 2022) Accepted on July 30, 202

Machine Learning Integrated with Model Predictive Control for Imitative Optimal Control of Compression Ignition Engines

The high thermal efficiency and reliability of the compression-ignition engine makes it the first choice for many applications. For this to continue, a reduction of the pollutant emissions is needed. One solution is the use of machine learning (ML) and model predictive control (MPC) to minimize emissions and fuel consumption, without adding substantial computational cost to the engine controller. ML is developed in this paper for both modeling engine performance and emissions and for imitating the behaviour of an Linear Parameter Varying (LPV) MPC. Using a support vector machine-based linear parameter varying model of the engine performance and emissions, a model predictive controller is implemented for a 4.5 Cummins diesel engine. This online optimized MPC solution offers advantages in minimizing the \nox~emissions and fuel consumption compared to the baseline feedforward production controller. To reduce the computational cost of this MPC, a deep learning scheme is designed to mimic the behavior of the developed controller. The performance in reducing NOx emissions at a constant load by the imitative controller is similar to that of the online optimized MPC compared to the Cummins production controller. In addition, the imitative controller requires 50 times less computation time compared to that of the online MPC optimization.Comment: Submitted to Advances in Automotive Control - 10th AAC 202

ACEMg-mediated hearing preservation in cochlear implant patients receiving different electrode lengths (PROHEARING): study protocol for a randomized controlled trial

Abstract Background The indications for a cochlear implant (CI) have been extended to include patients with some residual hearing. Shorter and thinner atraumatic electrodes have been designed to preserve the residual hearing in the implanted ear. However, the insertion of the electrode array into the cochlea, with potential mechanical trauma and the presence of this foreign body inside the cochlea, may lead to free radical formation and reduced blood perfusion of the cochlea which can result in the loss of residual hearing. Methods/design In this single-center, randomized, placebo-controlled, double-blind phase II clinical trial the effect of free radical scavengers and a vasodilator on the residual hearing of 140 CI patients will be evaluated. The formulation is composed of β-carotene (vitamin A), ascorbic acid (vitamin C), dl-α-tocopherol acetate (vitamin E) and the vasodilator magnesium (Mg), or ACEMg. Medication is administered twice daily per os for approximately 3 months. The primary measure is based upon the reduction in postoperative low-frequency air-conducted pure-tone thresholds compared to preoperative thresholds in ACEMg-treated patients compared to those of a placebo group. Additionally, the effect of different electrode lengths (20, 24 and 28 mm) is analyzed. Study visits are scheduled 2 days before surgery, at first fitting, which is the adjustment and start of stimulation via CI 4 weeks after surgery and 3, 6, 9 and 12 months after first fitting. The primary endpoint is the air-conduction hearing loss at 500 Hz 3 months after first fitting. Additionally, speech recognition tests, hearing aid benefit in the implanted ear and electrophysiological measurements of implant function are assessed. Since this is a blinded clinical trial and recruitment is still ongoing, data continue to accrue and we cannot yet analyze the outcome of the ACEMg treatment. Discussion There is an unfulfilled need for new strategies to preserve acoustic hearing in CI patients. This study will provide first-in-man data on ACEMg-mediated protection of residual hearing in CI patients. Performing all surgeries and patient follow-up at one study site improves consistency in diagnosis and therapy and less variability in surgery, audiological test techniques and fitting. This approach will allow investigation of the influence of ACEMg on residual hearing in CI patients. Trial registration The German Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) application number 4039192, was registered on 6 December 2013 with protocol amendment version 3.0 from 19 August 2014. EudraCT number: 2012-005002-22 .http://deepblue.lib.umich.edu/bitstream/2027.42/134623/1/13063_2016_Article_1526.pd

Nitrogen Doping Improves the Immobilization and Catalytic Effects of Co9S8 in Li-S Batteries

Several critical issues, such as the shuttling effect and the sluggish reaction kinetics, exist in the design of high-performance lithium–sulfur (Li-S) batteries. Here, it is reported that nitrogen doping can simultaneously and significantly improve both the immobilization and catalyzation effects of Co9S8 nanoparticles in Li-S batteries. Combining the theoretical calculations with experimental investigations, it is revealed that nitrogen atoms can increase the binding energies between LiPSs and Co9S8, and as well as alleviate the sluggish kinetics of Li-S chemistry in the Li2S6 cathode. The same effects are also observed when adding N-Co9S8 nanoparticles into the commercial Li2S cathode (which has various intrinsic advantages, but unfortunately a high overpotential). A remarkable improvement in the battery performances in both cases is observed. The work brings heteroatom-doped Co9S8 to the attention of designing high-performance Li-S batteries. A fundamental understanding of the inhibition of LiPSs shuttle and the catalytic effect of Li2S in the newly developed system may encourage more effort along this interesting direction. © 2020 The Authors. Published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinhei