Physicians’ misperceived cardiovascular risk and therapeutic inertia as determinants of low LDL-cholesterol targets achievement in diabetes

Background: Greater efforts are needed to overcome the worldwide reported low achievement of LDL-c targets. This survey aimed to dissect whether and how the physician-based evaluation of patients with diabetes is associated with the achievement of LDL-c targets. Methods: This cross-sectional self-reported survey interviewed physicians working in 67 outpatient services in Italy, collecting records on 2844 patients with diabetes. Each physician reported a median of 47 records (IQR 42–49) and, for each of them, the physician specified its perceived cardiovascular risk, LDL-c targets, and the suggested refinement in lipid-lowering-treatment (LLT). These physician-based evaluations were then compared to recommendations from EAS/EASD guidelines. Results: Collected records were mostly from patients with type 2 diabetes (94%), at very-high (72%) or high-cardiovascular risk (27%). Physician-based assessments of cardiovascular risk and of LDL-c targets, as compared to guidelines recommendation, were misclassified in 34.7% of the records. The misperceived assessment was significantly higher among females and those on primary prevention and was associated with 67% lower odds of achieving guidelines-recommended LDL-c targets (OR 0.33, p < 0.0001). Peripheral artery disease, target organ damage and LLT-initiated by primary-care-physicians were all factors associated with therapeutic-inertia (i.e., lower than expected probability of receiving high-intensity LLT). Physician-suggested LLT refinement was inadequate in 24% of overall records and increased to 38% among subjects on primary prevention and with misclassified cardiovascular risk. Conclusions: This survey highlights the need to improve the physicians’ misperceived cardiovascular risk and therapeutic inertia in patients with diabetes to successfully implement guidelines recommendations into everyday clinical practice

Hydrodynamics and Brownian motions of a spheroid near a rigid wall

In this work, we study in detail the hydrodynamics and the Brownian motions of a spheroidal particle suspended in a Newtonian fluid near a flat rigid wall. We employ 3D Finite Element Method (FEM) simulations to compute how the mobility tensor of the spheroid varies with both the particle-wall separation distance and the particle orientation. We then study the Brownian motion of the spheroid by means of a discretized Langevin equation. We specifically focus on the additional drift terms arising from the position and orientational dependence of the mobility matrix. In this respect, we also propose a numerically convenient approximation of the orientational divergence of the mobility matrix that is required in the solution of the Langevin equation. Our results illustrate that both hydrodynamics and Brownian motions of a spheroidal particle near a confining wall display novel features from those of a sphere in the same type of confinement

A versatile and customizable low-cost printed multipass microrheometer for high-throughput polymers rheological experimentation

We report the design of a multipass microrheometer that can be fully customizable at a low cost and reasonable time, which allows us to perform experiments rapidly and in a broad range of shear rates (i.e., from 0.1 to 100 s(-1)), using small amounts of material (i.e., just some milligrams). Additionally, the low-cost approach opens for an easy parallelization of the setup that makes it suitable for high-throughput rheological experimentation of polymer melts (HT-Rheo-E). The novel rheometer consists of a microchannel (i.e., a microcapillary or a microslit) in which the fluid flows driven by two controlled millimetric pistons (diameter of 2 mm). Two piezoelectric miniaturized pressure sensors are placed at the microchannel entrance and exit to record the pressure drop across the capillary during the motion. The current work reports the design of the rheometer with two different cross sections of the microchannel, i.e., circular and rectangular, and measurements of the shear viscosity with a Newtonian and a non-Newtonian polymer over a wide range of shear rates using less than 1 g of sample. We demonstrate that the current multipass microrheometer can measure viscoelastic properties of polymers by applying an oscillatory flow. The printed setup is of potential interest for applications in quality control in industrial production, in natural systems (such as starch-based mixtures) and academic research where rapid and repeated measurements using limited milligrams of polymer are required (e.g., biological systems)

Numerical simulations on the dynamics of trains of particles in a viscoelastic fluid flowing in a microchannel

The formation of equally-spaced structures (trains) of rigid, spherical particles suspended in a viscoelastic fluid flowing in a cylindrical microchannel is investigated by numerical simulations. Direct Numerical Simulations (DNS) have been employed to accurately compute the translational velocities of a system made by three particles aligned along a cylindrical channel for different interparticle distances. A shear-thinning, elastic fluid, modeled by the Giesekus costitutive equation, is considered. The DNS results are collected in a database used for simulating the dynamics of a multi-particle system. The evolution of the particle microstructure through the channel is presented in terms of interparticle distance distributions. The effects of the Deborah number (defined as the ratio between the fluid and flow characteristic times), the volume fraction, and the initial particle distribution on the train dynamics are investigated