Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015

Aim: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015. Methods: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. Results: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: −0.5 to −0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. Conclusions: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.Centro de Endocrinología Experimental y Aplicad

Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015

Aim: Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015. Methods: Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. Results: From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: −0.5 to −0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. Conclusions: Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.Centro de Endocrinología Experimental y Aplicad

Tumor response and endogenous immune reactivity after administration of HER2 CAR T cells in a child with metastatic rhabdomyosarcoma

Refractory metastatic rhabdomyosarcoma is largely incurable. Here we analyze the response of a child with refractory bone marrow metastatic rhabdomyosarcoma to autologous HER2 CAR T cells. Three cycles of HER2 CAR T cells given after lymphodepleting chemotherapy induces remission which is consolidated with four more CAR T-cell infusions without lymphodepletion. Longitudinal immune-monitoring reveals remodeling of the T-cell receptor repertoire with immunodominant clones and serum autoantibodies reactive to oncogenic signaling pathway proteins. The disease relapses in the bone marrow at six months off-therapy. A second remission is achieved after one cycle of lymphodepletion and HER2 CAR T cells. Response consolidation with additional CAR T-cell infusions includes pembrolizumab to improve their efficacy. The patient described here is a participant in an ongoing phase I trial (NCT00902044; active, not recruiting), and is 20 months off T-cell infusions with no detectable disease at the time of this report

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on 10^3 pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype

Microcontroller based oscillation monitoring system for the safety of railway vehicles with high storage capacity and real time warning facility

An Advanced portable instrument to monitor, detect, and record the horizontal and vertical accelerations of the railway vehicles (railway coaches, wagons and locomotives, etc.) as well as of railway tracks has been designed and developed by incorporating the state of the art technology suitable for this purpose. The design/technology has been perfected by conducting repeated field trials on the instrument in association with the engineers of RDSO, Lucknow. The designed instrument based on 89C52 Micro-controller technology, is a major step in the direction of advance instrumentation for Indian Railways. Oscillation monitoring system continuously measures vertical and lateral accelerations at any desired location on the floor of a railway vehicle and simultaneous measurement of distance from fixed points of track on real time basis. It is an advanced portable instrument to measure and record oscillations of railway vehicle, while in motion. The system is so rugged that it can work in non air-conditioned environment and withstand vibration of ‘1g’ in all three orthogonal axes without any problem. Based on this measurement, analysis can be carried out on railway track conditions. The unit has been designed with large storage capacity and displays locations of bad spots along with other required information, which are registered over the threshold value

Modelling the quantitative evaluation of soil nutrient supply, nutrient use efficiency, and fertilizer requirements of wheat in India

Wheat yields in many parts of India are stagnant. The main reason for this is conventional blanket fertilizer recommendation, lower fertilizer use efficiency, and imbalanced use of fertilizers. Estimation of fertilizer requirements based on quantitative approaches can assist in improving wheat yields and increasing nutrient use efficiency. We used the QUEFTS (QUantitative Evaluation of Fertility of Tropical Soils) model for estimation of nitrogen (N), phosphorus (P), and potassium (K) requirements and fertilizer recommendations for a target yield of wheat. The model considers the interactions of N, P, and K, and climate adjusted potential yield of the region. Published data from several field experiments dealing with N, P, and K conducted during the years 1970 to 1998 across wheat-growing environments of India, covering a wide range of soil and climatic conditions, were used to reflect the environmental variability. The relationships between indigenous N, P, and K supply and soil organic carbon, Olsen P, and ammonium acetate-extractable K, respectively, were established. The required N, P, and K accumulation in the plant for 1 tonne grain yield was 23.1, 3.5, and 28.5 kg, respectively, suggesting an average NPK ratio in the plant dry matter of about 6.6:1:8.1. The constants for minimum and maximum accumulation (kg grain kg-1) of N (27 and 60), P (162 and 390), and K (20 and 59) were derived as the standard model parameters in QUEFTS for fertilizer recommendation for irrigated wheat in the tropical and subtropical regions of India. Relationships of apparent recovery efficiencies of fertilizer N, P, and K with levels of their application were also determined. The observed yields of wheat with different amounts of these nutrients were in good agreement with the values predicted by the model, indicating that the model can be used for fertilizer recommendations