Long-term oral nitrate therapy is associated with adverse outcome in diabetic patients following elective percutaneous coronary intervention

<p>Abstract</p> <p>Background</p> <p>To assess the impact of long-term oral nitrate therapy on clinical outcome following percutaneous coronary intervention (PCI) in patients with type II diabetes.</p> <p>Methods</p> <p>The incidence of major adverse cardiovascular events (MACEs) following elective PCI for stable coronary artery disease was evaluated in 108 patients with type II diabetes (age 64.6 ± 10.5 years, 67.7% men). Major adverse cardiovascular events were defined as the need for revascularization, non-fatal myocardial infarction or cardiovascular death. Multivariate Cox regression analysis was used to evaluate the predictive value of MACEs by clinical characteristics and the prescription of long-term nitrate therapy.</p> <p>Results</p> <p>Isosorbide mononitrate (ISMN) was prescribed to 46 patients with an average dose of 44.3 ± 15.2 mg/day. After a mean follow up of 25.3 ± 25 months, 16 patients developed MACEs. Patients who received ISMN were more likely to suffer from MACEs (26.1% vs. 6.5%, P = 0.01), mainly driven by a higher rate of acute coronary syndrome (13.0 vs 0%, P = 0.01). Average daily dose of nitrate and other cardiovascular medication was not associated with MACEs. Multivariate Cox regression analysis revealed that prescription of only ISMN (Hazard Ratio 3.09, 95% CI 1.10-10.21, P = 0.04) was an independent predictor for the development of MACEs.</p> <p>Conclusion</p> <p>Long-term oral nitrate therapy was associated with MACEs following elective coronary artery revascularization by PCI in patients with type II diabetes.</p

Monotonicity preserving SIRMs-connected fuzzy inference systems with a new monotonicity index: Learning and tuning

Recent research on Single Input Rule Modules (SIRMs)-connected fuzzy inference system (FIS) focuses on its monotonicity property fulfillment. The aim of this paper is to propose an alternative approach for modeling of monotonicity-preserving SIRMs-connected FIS. A new monotonicity index (MI) for approximating the monotonicity property fulfillment of an SIRMs-connected FIS is proposed. A hybrid of Harmony Search (HS), SIRMs-connected FIS, and the new MI is investigated. A proposed data-driven monotonicity-preserving SIRMs-connected FIS model with HS is then presented. The use of MI for tuning of an SIRMs-connected FIS is demonstrated too

Impact of glycemic control on circulating endothelial progenitor cells and arterial stiffness in patients with type 2 diabetes mellitus

<p>Abstract</p> <p>Background</p> <p>Patients with type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction and arterial stiffness. Levels of circulating endothelial progenitor cells (EPCs) are also reduced in hyperglycemic states. However, the relationships between glycemic control, levels of EPCs and arterial stiffness are unknown.</p> <p>Methods</p> <p>We measured circulating EPCs and brachial-ankle pulse wave velocity (baPWV) in 234 patients with type 2 DM and compared them with 121 age- and sex-matched controls.</p> <p>Results</p> <p>Patients with DM had significantly lower circulating Log CD34/KDR⁺and Log CD133/KDR⁺EPC counts, and higher Log baPWV compared with controls (all <it>P < 0.05</it>). Among those 120/234 (51%) of DM patients with satisfactory glycemic control (defined by Hemoglobin A1c, HbA1c < 6.5%), they had significantly higher circulating Log CD34/KDR⁺and Log CD133/KDR⁺EPC counts, and lower Log baPWV compared with patients with poor glycemic control (all <it>P < 0.05)</it>. The circulating levels of Log CD34/KDR⁺EPC (r = -0.46, <it>P < 0.001</it>) and Log CD133/KDR⁺EPC counts (r = -0.45, <it>P < 0.001</it>) were negatively correlated with Log baPWV. Whilst the level of HbA1c positively correlated with Log baPWV (r = 0.20, <it>P < 0.05</it>) and negatively correlated with circulating levels of Log CD34/KDR⁺EPC (r = -0.40, <it>P < 0.001</it>) and Log CD133/KDR⁺EPC (r = -0.41, <it>P < 0.001</it>). Multivariate analysis revealed that HbA1c, Log CD34/KDR⁺and Log CD133/KDR⁺EPC counts were independent predictors of Log baPWV (<it>P < 0.05</it>).</p> <p>Conclusions</p> <p>In patients with type 2 DM, the level of circulating EPCs and arterial stiffness were closely related to their glycemic control. Furthermore, DM patients with satisfactory glycemic control had higher levels of circulating EPCs and were associated with lower arterial stiffness.</p

Diffusion Coatings for Corrosion-Resistant Components in Coal Gasification Systems Quarterly Report

Heat-exchangers, particle filters, turbines, and other components in integrated coal gasification combined cycle system must withstand the highly sulfiding conditions of the high temperature coal gas over an extended period of time. The performance of components degrades significantly with time unless expensive high alloy materials are used. Deposition of a suitable coating on a low cost alloy may improve is resistance to such sulfidation attack and decrease capital and operating costs. The alloys used in the gasifier service include austenitic and ferritic stainless steels, nickel-chromium-iron alloys, and expensive nickel-cobalt alloys. During this reporting period we conducted two exposure tests with coated and uncoated coupons. The first one was aborted after a short period, because of a leak in the pressure regulator of a CO/CO{sub 2}/H{sub 2} gas mixture gas cylinder that was used to prepare the simulated coal gas stream. Nevertheless, this run was very instructive as it showed that during the brief exposure when the concentration of H{sub 2}S increased to 8.6%, even specialty alloys such as HR160 and I800 were badly corroded, yet the sample of a SS405-steel that was coated with Ti/Ta showed no signs of corrosion. After replacing the pressure regulator, a second run was conducted with a fresh set of coated and uncoated samples. The Ti/Ta-coated on to SS405 steel from the earlier runs was also exposed in this test. The run proceeded smoothly, and at the end of test the uncoated steels were badly damaged, some evidence of corrosion was found on coupons of HR160 and I800 alloys and the Cr-coated steels, but again, the Ti/Ta-coated sample appeared unaffected

Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with type 2 diabetes.

published_or_final_versio

Roles of the CHADS2 and CHA2DS2-VASc scores in post-myocardial infarction patients: Risk of new occurrence of atrial fibrillation and ischemic stroke

Background: Patients with myocardial infarction (MI) are at risk of the development of atrial fibrillation (AF) and ischemic stroke. We sought to evaluate the prognostic performance of the CHADS2 and CHA2DS2-VASc scores in predicting new AF and/or ischemic stroke in post-ST segment elevation MI (STEMI) patients. Six hundred and seven consecutive post-STEMI patients with no previously documented AF were studied.Methods and Results: After a follow-up of 63 months (3,184 patient-years), 83 (13.7%) patients developed new AF (2.8% per year). Patients with a high CHADS2 and/or CHA2DS2-VASc score were more likely to develop new AF. The annual incidence of new AF was 1.18%, 2.10%, 4.52%, and 7.03% in patients with CHADS2 of 0, 1, 2, and ≥ 3; and 0.39%, 1.72%, 1.83%, and 5.83% in patients with a CHA2DS2-VASc score of 1, 2, 3 and ≥ 4. The CHA2DS2-VASc score (C-statistic = 0.676) was superior to the CHADS2 (C-statistic = 0.632) for discriminating new AF. Ischemic stroke occurred in 29 patients (0.9% per year), the incidence increasing in line with the CHADS2 (0.41%, 1.02%, 1.11%, and 1.95% with score of 0, 1, 2, and ≥ 3) and CHA2DS2-VASc scores (0.39%, 0.49%, 1.02%, and 1.48% with score of 1, 2, 3 and ≥ 4). The C-statistic of the CHA2DS2-VASc score as a predictor of ischemic stroke was 0.601, superior to that of CHADS2 score (0.573). CHADS2 and CHA2DS2-VASc scores can identify post-STEMI patients at high risk of AF and stroke.Conclusions: The CHADS2 and CHA2DS2-VASc scores can identify post-STEMI patients at high risk of AF and ischemic stroke. This enables close surveillance and prompt anticoagulation for stroke prevention

Diffusion Coatings for Corrosion-Resistant Components in Coal Gasification Systems

Heat-exchangers, particle filters, turbines, and other components in integrated coal gasification combined cycle system must withstand the highly sulfiding conditions of the hightemperature coal gas over an extended period of time. The performance of components degrades significantly with time unless expensive high alloy materials are used. Deposition of a suitable coating on a low-cost alloy may improve its resistance to such sulfidation attack, and decrease capital and operating costs. The alloys used in the gasifier service include austenitic and ferritic stainless steels, nickel-chromium-iron alloys, and expensive nickel-cobalt alloys. During this period, we analyzed several 409 low alloy steel samples after coating them in our fluidized bed reactor and also after exposing them to our corrosion test. We report the following findings: 1. A protective coating was deposited inside a porous 409 steel sample to protect it from sulfidation attack. The coating was based on a combination of Si diffusion layer, Nb interlayer and nitrides of titanium and silicon. 2. Analysis of solid coupons exposed to simulated coal gas at 900 C for 300 h showed that multilayer metal/ceramic coatings provide a better protection than ceramic coatings. 3. Deposition of several ceramic/metal multilayer coatings showed that coatings with niobium and tantalum interlayers have good adhesion. However, coatings with a tungsten interlayer suffered localized delaminating and coatings with Zr interlayers showed poor adhesion. 4. Analysis of solid coupons, coated with the above-mentioned multilayer films, after exposure to simulated coal gas at 900 C for 300 h showed that niobium is the best candidate for interlayer material

Bacterial Microbiota Profiling in Gastritis without Helicobacter pylori Infection or Non-Steroidal Anti-Inflammatory Drug Use

Recent 16S ribosomal RNA gene (rRNA) molecular profiling of the stomach mucosa revealed a surprising complexity of microbiota. Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) use are two main contributors to gastritis and peptic ulcer. However, little is known about the association between other members of the stomach microbiota and gastric diseases. In this study, cloning and sequencing of the 16S rRNA was used to profile the stomach microbiota from normal and gastritis patients. One hundred and thirty three phylotypes from eight bacterial phyla were identified. The stomach microbiota was found to be closely adhered to the mucosa. Eleven Streptococcus phylotypes were successfully cultivated from the biopsies. One to two genera represented a majority of clones within any of the identified phyla. We further developed two real-time quantitative PCR assays to quantify the relative abundance of the Firmicutes phylum and the Streptococcus genus. Significantly higher abundance of the Firmicutes phylum and the Streptococcus genus within the Firmicutes phylum was observed in patients with antral gastritis, compared with normal controls. This study suggests that the genus taxon level can largely represent much higher taxa such as the phylum. The clinical relevance and the mechanism underlying the altered microbiota composition in gastritis require further functional studies

Association between the risk of seizure and COVID-19 vaccinations: A self-controlled case-series study

OBJECTIVE: The risk of seizure following BNT162b2 and CoronaVac vaccinations has been sparsely investigated. This study aimed to evaluate this association. METHOD: Patients who had their first seizure-related hospitalization between February 23, 2021 and January 31, 2022 were identified in Hong Kong. All seizure episodes happening on the day of vaccination (day 0) were excluded since clinicians validated that most of the cases on day 0 were syncopal episodes. Within-individual comparison using a modified self-controlled case series analysis was applied to estimate the incidence rate ratio (IRR) with 95% confidence intervals (CI) of seizure using conditional Poisson regression. RESULTS: We identified 1656 individuals who had their first seizure-related hospitalization (BNT162b2: 426; CoronaVac: 263; unvaccinated: 967) within the observation period. The incidence of seizure was 1.04 (95% CI: 0.80-1.33) and 1.11 (95% CI: 0.80-1.50) per 100,000 doses of BNT162b2 and CoronaVac administered respectively. 16 and 17 individuals received second dose after having first seizure within 28 days after first dose of BNT162b2 and CoronaVac vaccinations, respectively. None had recurrent seizures after the second dose. There was no increased risk during day 1-6 after the first (BNT162b2: IRR=1.39, 95% CI=0.75-2.58; CoronaVac: IRR=1.19, 95% CI=0.50-2.83) and second doses (BNT162b2: IRR=1.36, 95% CI 0.72-2.57; CoronaVac: IRR=0.71, 95% CI=0.22-2.30) of vaccinations. During 7-13, 14-20- and 21-27-days post-vaccination, no association was observed for both vaccines. SIGNIFICANCE: The findings demonstrated no increased risk of seizure following BNT162b2 and CoronaVac vaccinations. Future studies will be warranted to evaluate the risk of seizure following COVID-19 vaccinations in different populations with subsequent doses to ensure the generalizability

Association between BNT162b2 and CoronaVac vaccination and risk of CVD and mortality after COVID-19 infection: A population-based cohort study

It is unknown if vaccination affects the risk of post-COVID-19 cardiovascular diseases (CVDs). Therefore, this retrospective cohort study examines the short-term and long-term risks of post-infection CVD among COVID-19 patients with different vaccination status utilizing data from electronic health databases in Hong Kong. Cox proportional hazards regression adjusted with inverse probability of treatment weighting is used to evaluate the risks of incident CVD (coronary heart disease, stroke, heart failure) and all-cause mortality in COVID-19 patients. Compared with unvaccinated patients, vaccinated patients have a lower risk of CVD and all-cause mortality, and the lowest risk is observed in those who completed three doses of vaccine. Similar patterns in the subgroups of different vaccine platforms, age, gender, Charlson comorbidity index, and disease severity are observed. These findings highlight a positive dose-response relationship between overall CVD risk reduction and the number of vaccine doses received