Aortic stiffness in type-1 diabetes mellitus; beware of hypertension

Cardiolog

Paroxysmal mechanical aortic valve prosthesis dysfunction: capturing the right moment

Cardiolog

Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey

Aims Due to a lack of clinical trials, scientific evidence regarding the management of patients with chronic heart failure and preserved left ventricular function (PLVF) is scarce. The EuroHeart Failure Survey provided information on the characteristics, treatment and outcomes of patients with PLVF as compared to patients with a left ventricular systolic dysfunction (LVSD). Methods and results We performed a secondary analysis using data from the EuroHeart Failure Survey, only including patients with a measurement of LV function \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $(n=6806)$ \end{document}. We selected two groups: patients with LVSD (54%) and patients with a PLVF (46%). Patients with a PLVF were, on average, 4 years older and more often women (55% vs. 29%, respectively, p <0.001) as compared to LVSD patients, and were more likely to have hypertension (59% vs. 50%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $p{<}0.001$ \end{document}) and atrial fibrillation (25% vs. 23%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $p=0.01$ \end{document}). PLVF patients received less cardiovascular medication compared to PLVF patients, with the exception of calcium antagonists. Multivariate analysis revealed that LVSD was an independent predictor for mortality, while no differences in treatment effect on mortality between the two groups was observed. A sensitivity analysis, using different thresholds to separate patients with and without LVSD revealed comparable findings. Conclusions In the EuroHeart Failure Survey, a high percentage of heart failure patients had PLVF. Although major clinical differences were seen between the groups, morbidity and mortality was high in both group

It’s not just the Therapist: Therapist and Country-Wide Experience Predict Therapist Adherence and Adolescent Outcome

Contains fulltext : 173905.pdf (publisher's version ) (Open Access)Objective: Therapist adherence is a quality indicator in routine clinical care when evaluating the success of the implementation of an intervention. The current study investigated whether therapist adherence mediates the association between therapist, team, and country-wide experience (i.e. number of years since implementation in the country) on the one hand, and treatment outcome on the other hand. We replicated and extended a study by Löfholm et al. (2014). Method: Data over a 10-year period were obtained from 4290 adolescents (12-17 years) with antisocial or delinquent problem behavior, who were treated with Multisystemic Therapy (MST) by 222 therapists, working in 27 different teams in the Netherlands. Multilevel structural equation modeling was used to assess the associations between experience, therapist adherence, and post-treatment outcomes. Results: Treatment outcomes were directly predicted by therapist experience, countrywide experience, and therapist adherence, but not by team experience. Moreover, therapist adherence mediated the association between therapist and country-wide experience, and treatment outcomes. The association between therapist experience and therapist adherence was not affected by the number of years of team experience or country-wide experience. Conclusion: The effect of country-wide experience on outcome may reflect increasing experience of training and supporting the therapists. It suggests that nation-wide quality control may relate to better therapist adherence and treatment outcome for adolescents treated with systemic therapy.17 p

Entomopathogenic Fungus as a Biological Control for an Important Vector of Livestock Disease: The Culicoides Biting Midge

BACKGROUND: The recent outbreak of bluetongue virus in northern Europe has led to an urgent need to identify control measures for the Culicoides (Diptera: Ceratopogonidae) biting midges that transmit it. Following successful use of the entomopathogenic fungus Metarhizium anisopliae against larval stages of biting midge Culicoides nubeculosus Meigen, we investigated the efficacy of this strain and other fungi (Beauveria bassiana, Isaria fumosorosea and Lecanicillium longisporum) as biocontrol agents against adult C. nubeculosus in laboratory and greenhouse studies. METHODOLOGY/FINDINGS: Exposure of midges to 'dry' conidia of all fungal isolates caused significant reductions in survival compared to untreated controls. Metarhizium anisopliae strain V275 was the most virulent, causing a significantly decrease in midge survival compared to all other fungal strains tested. The LT(50) value for strain V275 was 1.42 days compared to 2.21-3.22 days for the other isolates. The virulence of this strain was then further evaluated by exposing C. nubeculosus to varying doses (10(8)-10(11) conidia m(-2)) using different substrates (horse manure, damp peat, leaf litter) as a resting site. All exposed adults were found to be infected with the strain V275 four days after exposure. A further study exposed C. nubeculosus adults to 'dry' conidia and 'wet' conidia (conidia suspended in 0.03% aq. Tween 80) of strain V275 applied to damp peat and leaf litter in cages within a greenhouse. 'Dry' conidia were more effective than 'wet' conidia, causing 100% mortality after 5 days. CONCLUSION/SIGNIFICANCE: This is the first study to demonstrate that entomopathogenic fungi are potential biocontrol agents against adult Culicoides, through the application of 'dry' conidia on surfaces (e.g., manure, leaf litter, livestock) where the midges tend to rest. Subsequent conidial transmission between males and females may cause an increased level of fungi-induced mortality in midges thus reducing the incidence of disease

Elements of care that matter:Perspectives of families with multiple problems

The severe and often persistent problems of families with multiple problems (FMP) call for better understanding of how interventions can improve outcomes in these families. Perspectives of FMP on the crucial elements of interventions may strongly support improvement by providing cues on how to realize positive change. We therefore explored the views of parents and children in FMP regarding helpful and less helpful elements of various interventions. We interviewed 24 parents and 4 children about their perspectives, using a semi-structured interview guide comprising themes that were chosen by the target group. Participants reported 11 elements that contribute to the effectiveness of care, categorized under three main themes: the characteristics of the practitioner, the content of interventions, and the structure of interventions. The perspectives of FMP show the following activities to be promising: routine reflection on the non-judgmental and positive approach of practitioners, more direct focus on children, focus on the underlying cause of behavior, activation of families’ social network, the school and other professionals around the family, and creation of more possibilities for long-term and flexible support. Perspectives of FMP on the content and provision of care should be better embedded in interventions. This may help to tailor interventions to their wishes and needs, which in turn can contribute to more positive outcomes of care

Neonatal cardiomyopathy and lactic acidosis responsive to thiamine

A congestive cardiomyopathy was diagnosed in a girl at the age of 4 weeks. In the weeks following she developed general muscle hypotonia and plasma lactate increased to 8.5 mmol/L. Biochemical investigations of a muscle biopsy at the age of 3 months showed a deficiency in the oxidation of all substrates tested: pyruvate plus malate, 2-ketoglutarate and palmitate plus malate. After freezing and thawing of the homogenate and the addition of essential cofactors, the oxidation of the ketoacids normalized. The oxidation defect in the untreated homogenate can be explained by a deficiency in one of the cofactors (such as thiamine pyrophosphate, NAD+ or CoASH), or by a defect in the oxidative phosphorylation. Treatment with thiamine and carnitine resulted in a decrease in blood lactate to normal levels and a dramatic clinical improvement. Suspension of thiamine caused deterioration of her clinical condition and lactic acidaemia. The thiamine therapy was then continued. The girl is now 6 years old and in perfect health

Physics and Technology Research for Liquid-Metal Divertor Development, Focused on a Tin-Capillary Porous System Solution, at the OLMAT High Heat-Flux Facility

The operation of the Optimization of Liquid Metal Advanced Targets (OLMAT) facility began in April 2021 with the scientific objective of exposing liquid-metal plasma facing components (PFCs) to the particle and power fluxes provided by one of the hydrogen neutral beam injectors of the TJ-II stellarator. The system can deliver heat fluxes from 5 to 58 MW m−2 of high energy hydrogen neutral particles (≤ 33 keV) with fluxes up to 1022m2s−1 (containing an ion fraction ≤ 33% in some instances), pulsed operation of 30–150 ms duration and repetition rates up to 2 min−1. These characteristics enable OLMAT as a high heat flux (HHF) facility for PFC evaluation in terms of power exhaust capabilities, thermal fatigue and resilience to material damage. Additionally, the facility is equipped with a wide range of diagnostics that includes tools for analyzing the thermal response of the targets as well as for monitoring atomic/plasma physics phenomena. These include spectroscopy, pyrometry, electrical probing and visualization (fast and IR cameras) units. Such particularities make OLMAT a unique installation that can combine pure technological PFC research with the investigation of physical phenomena such as vapor shielding, thermal sputtering, the formation/characterization of plasma plumes with significant content of evaporated metal and the detection of impurities in front of the studied targets. Additionally, a myriad of surface characterization techniques as SEM/EDX for material characterization of the exposed PFC prototypes are available at CIEMAT. In this article, first we provide an overview of the current facility upgrade in which a high-power CW laser, that can be operated in continuous and pulsed modes (0.2–10 ms), dump and electrical (single Langmuir) probe embedded on the target surface have been installed. This laser operation will allow simulating more relevant heat loading scenarios such as nominal steady-state divertor heat fluxes (10–20 MW m−2 in continuous mode) and transients including ELM loading and disruption-like events (ms time scales and power densities up to GW m−2 range). The work later focuses on the more recent experimentation (2022 fall campaign) where a 3D printed Tungsten (W) Capillary Porous System (CPS) target, with approximated 30 μm pore size and a 37% porosity and filled with liquid tin. This porous surface was a mock-up of the PFC investigated in the ASDEX Upgrade divertor manipulator. The target composed with this element was eventually exposed to a sequence of shots with the maximum heat flux that OLMAT provides (58 ± 14 MWm−2). Key questions as resilience to dry-out and particle ejection of the liquid metal layer, its refilling, the induced damage/modification of the porous W matrix and the global performance of the component are addressed, attempting to shed light on the issues encountered with the PFC at tokamak scale testing.</p

A novel method for standardized application of fungal spore coatings for mosquito exposure bioassays

<p>Abstract</p> <p>Background</p> <p>Interest in the use of fungal entomopathogens against malaria vectors is growing. Fungal spores infect insects via the cuticle and can be applied directly on the insect to evaluate infectivity. For flying insects such as mosquitoes, however, application of fungal suspensions on resting surfaces is more realistic and representative of field settings. For this type of exposure, it is essential to apply specific amounts of fungal spores homogeneously over a surface for testing the effects of fungal dose and exposure time. Contemporary methods such as spraying or brushing spore suspensions onto substrates do not produce the uniformity and consistency that standardized laboratory assays require. Two novel fungus application methods using equipment developed in the paint industry are presented and compared.</p> <p>Methods</p> <p>Wired, stainless steel K-bars were tested and optimized for coating fungal spore suspensions onto paper substrates. Different solvents and substrates were evaluated. Two types of coating techniques were compared, i.e. manual and automated coating. A standardized bioassay set-up was designed for testing coated spores against malaria mosquitoes.</p> <p>Results</p> <p>K-bar coating provided consistent applications of spore layers onto paper substrates. Viscous Ondina oil formulations were not suitable and significantly reduced spore infectivity. Evaporative Shellsol T solvent dried quickly and resulted in high spore infectivity to mosquitoes. Smooth proofing papers were the most effective substrate and showed higher infectivity than cardboard substrates. Manually and mechanically applied spore coatings showed similar and reproducible effects on mosquito survival. The standardized mosquito exposure bioassay was effective and consistent in measuring effects of fungal dose and exposure time.</p> <p>Conclusions</p> <p>K-bar coating is a simple and consistent method for applying fungal spore suspensions onto paper substrates and can produce coating layers with accurate effective spore concentrations. The mosquito bioassay was suitable for evaluating fungal infectivity and virulence, allowing optimizations of spore dose and exposure time. Use of this standardized application method will help achieve reliable results that are exchangeable between different laboratories.</p