MSSM-inspired multifield inflation

Despite the fact that experimentally with a high degree of statistical significance only a single Standard Model--like Higgs boson is discovered at the LHC, extended Higgs sectors with multiple scalar fields not excluded by combined fits of the data are more preferable theoretically for internally consistent realistic models of particle physics. We analyze the inflationary scenarios which could be induced by the two-Higgs doublet potential of the Minimal Supersymmetric Standard Model (MSSM) where five scalar fields have nonminimal couplings to gravity. Observables following from such MSSM-inspired multifield inflation are calculated and a number of consistent inflationary scenarios are constructed. Cosmological evolution with different initial conditions for the multifield system leads to consequences fully compatible with observational data on the spectral index and the tensor-to-scalar ratio. It is demonstrated that the strong coupling approximation is precise enough to describe such inflationary scenarios.Comment: 27 pages, 4 figures, 5 tables. Version to appear in JHEP. Additions made to the text of the Introduction dealing with the issues of conformity of this multifield model and models of N=1 supergravity (pages 2-3). Added new inflationary scenarios, which are an artifact of such analysis (pages 11-12, Tables 1-4). Additional comments on page 9 and page 13. New references adde

Outpatient management of patients with peripheral artery disease by cardiologists or surgeons: influence on the prognosis and prevalence of surgical interventions

Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p<0.001), death from cardiac causes (p = 0.045), from stroke (p><0.001), as well as the total number of adverse events (p><0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery>˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries.Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p<0.001), death from cardiac causes (p = 0.045), from stroke (p><0.001), as well as the total number of adverse events (p><0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery>˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries

Simulating diverse native C4 perennial grasses with varying rainfall

AbstractRainfall is recognized as a major factor affecting the rate of plant growth development. The impact of changes in amount and variability of rainfall on growth and production of different forage grasses needs to be quantified to determine how climate change can impact rangelands. Comparative studies to evaluate the growth of several perennial forage species at different rainfall rates will provide useful information by identifying forage management strategies under various rainfall scenarios. In this study, the combination of rainfall changes and soil types on the plant growth of 10 perennial forage species was investigated with both the experimental methods, using rainout shelters, and with the numerical methods using the plant growth simulation model, ALMANAC. Overall, most species significantly increased basal diameter and height as rainfall increased. Like measured volume, simulated yields for all species generally increased as rainfall increased. But, large volume and yield increases were only observed between 350 and 850 mm/yr. Simulating all species growing together competing agrees relatively well with observed plant volumes at low rainfall treatment, while simulating all species growing separately was slightly biased towards overestimation on low rainfall effect. Both simulations agree relatively well with observed plant volume at high rainfall treatment

Assessment of Pre-test and Clinical Probability in the Diagnosis of Chronic Coronary Syndrome — What's New?

In the 2019 European Society of Cardiology (ESC) guidelines, the diagnostic algorithm for chronic coronary syndrome (CCS) was significantly changed, a significant revision of the pretest probability assessment scale (PTP) was made, an assessment of the clinical probability of obstructive coronary artery disease was proposed, the recommendations on the use of diagnostic tests in various groups of patients were updated. Such a radical change in approaches to the diagnosis of CCS raised many questions that had to be answered by further studies conducted in the past two years. The review provides data on the validation of the new PTP scale and the proposed assessment of the clinical probability of obstructive coronary artery disease, taking into account risk factors and with the additional inclusion of information on the calcium index of coronary arteries. The proposals of experts on new algorithms for the choice of non-invasive / invasive examination of this category of patients were also considered. Overall, the new PTV rating scale (ECS 2019) has been validated and validated in retrospective analyzes of cohort studies. The scale for assessing the clinical likelihood of obstructive coronary artery disease makes it possible to classify 3.8-5 times more patients as a low probability of coronary artery disease compared to the assessment of PTP alone. Assessment of the post-test probability of coronary artery disease does not allow to confirm the presence of obstructive lesion and was not used. The experts proposed new modifications of the diagnostic algorithm (with a detailed assessment of the clinical probability, as well as without taking it into account), which require verification in further studies. Therefore, it is advisable to conduct prospective studies to confirm the possibility of reducing the total number of non-invasive and invasive studies in patients with suspected coronary heart disease, as well as the safety of such a decrease in diagnostic procedures

Forage Yield Estimation with a Process-Based Simulation Model

A process-based simulation model of natural grasslands and improved pastures can be used to compare mean productivity and stability of forage productivity across years, agroecological regions, and management approaches. Model simulations can help farmers develop management practices to optimize livestock stocking rates and nutrient management for native and improved grasses on different soils with varying rainfall amounts. Likewise, forages are adapted to a wide variety of soils, rainfall zones, and latitudes. The objective of this chapter is to describe the Agricultural Land Management Alternative with Numerical Assessment Criteria (ALMANAC) model that simulates a wide variety of environmental and management impacts on forage production, soil health, and conservation concerns, including nutrient and sediment losses. We describe the various processes simulated in the model and input data requirements. We also describe how to derive plant parameters for various forage plant species. The model has been applied to simulate forage yields across years and diverse environments in the U.S. and tested using published forage yield data from Natural Resources Conservation Service, United States Dept. of Agric. Many common native and introduced grasses or grass mixtures in the U.S. have been successfully simulated. We also describe and discuss knowledge gaps for the model that future research should address to improve this and similar simulation models

Genetic basis of anthracyclines cardiotoxicity: Literature review

The purpose of this review was to systematize data on molecular genetic markers of increased risk of cardiotoxic effects, as well as to search for risk and protective variants of candidate genes. Today, the therapy of malignant neoplasms is based on the use of anthracyclines – drugs of the cytostatic mechanism of action. Along with their effectiveness, these drugs can have a cardiotoxic effect on cardiomyocytes by increasing the amount of reactive oxygen species and disrupting mitochondrial biogenesis. Pathological disorders lead to an increased risk of myocardial dysfunction and a number of other cardiovascular pathologies in patients receiving chemotherapy using anthracyclines. The cardiotoxic effect of anthracyclines leads to cardiomyopathy, heart failure, myocardial infarction, and thrombosis. Early detection of cardiotoxic damage leads to reducing the negative effects of these drugs due to changes in chemotherapy tactics. It is known that the risk of cardiotoxic myocardial damage is genetically determined and controlled by more than 80 genes. In this review, the description of basic molecules such as ATP-binding cassette transporters and solute carrier family (SLC transporters), carbonyl reductase, molecules of antioxidant defense, xenobiotic and iron metabolism was performed. In addition, a special attention is paid to the study of epigenetic and post-translational regulation. The available data are characterized by some inconsistency that may be explained by the ethnic differences of the studied populations. Thus, a more detailed research of various ethnic groups, gene-gene interactions between potential candidate genes and epigenetic regulation is necessary. Thus, understanding the contribution of genetic polymorphism to the development of cardiotoxicity will help to assess the individual risks of cardiovascular pathology in patients with various types of cancer, as well as reduce the risk of myocardial damage by developing individual preventive measures and correcting chemotherapy

Clinical symptoms and ECG data in women with acute coronary syndrome

Background. There are many differences in chest pain symptoms between men and women in terms of location, nature, and additional symptoms. The issue of describing the differences in chest pain in men and women with acute coronary syndrome (ACS), as well as their correlation with changes in the electrocardiogram (ECG) and coronary angiography (CAG) remains relevant.Methods. The study included 588 patients of the cardiology department of the Novokuznetsk City Clinical Hospital No. 1 from 2013 to 2017 with a diagnosis of ACS. Depending on the gender, the subjects were divided into two groups: Group I – 330 men; Group II – 258 women.Results. ACS with ST elevation was more common in men (45.8 %) than in women (33.3 %; p = 0.002). There were no pathological ECG changes in women in 58.1 % of cases, in men – in 45.5 % (p < 0.001). ECG type Q/ST elevation was detected more often in men (45.8 %) than in women (33.3 %; p = 0.002). The absence of coronary artery lesions was observed in 27.9 % of men and 44.2 % of women (p < 0.001). Hemodynamically significant coronary artery stenosis was more common in men (57.6 %) than in women (38.7 %; p < 0.001). In a typical angina clinic, hemodynamically significant coronary artery disease in patients with Q/without ST elevation ACS was detected in 40.2 % of men and in 58.5 % of women (p = 0.002). In the atypical angina clinic, hemodynamically significant lesions of coronary artery were more common in men (40.6 %) than in women (34.1 %; p = 0.02).Conclusion. In women atypical chest pains and intact coronary arteries were detected more often than in men, and hemodynamically significant coronary artery stenosis were found less often than in men. In men, a more pronounced pathology of the coronary arteries in ACS was revealed, in women – great difficulties in diagnosing ACS

The role of newly diagnosed diabetes mellitus for poor in-hospital prognosis of coronary artery bypass grafting

Background: The management of coronary artery disease in patients with type 2 diabetes (T2DM) who need myocardial revascularization is a great challenge. Aims: To study the role of newly diagnosed T2DM in the development of in-hospital adverse outcomes after coronary artery surgery (CABG). Methods: 708 consecutive patients underwent CABG were included. All patients without history of T2DM and with border fasting hyperglycemia underwent an oral glucose tolerance test. Results: The screening allowed to diagnose T2DM in 8.9% and prediabetes in 10.4% of the study population. The the number of patients with T2DM increased from 15.2% to 24.1%, and with prediabetes from 3.0% to 13.4%. The total number of patients with carbohydrate metabolism disorders increased from 18.2% to 37.5%. The trend towards higher rate of in-hospital complications after CABG was defined among patients with newly diagnosed and previously diagnosed T2DM. The regression analysis demonstrated the presence of the relationships between the previously diagnosed T2DM and the total number of significant complications (odds ratio (OR) 1.350, 95% confidence interval (CI): 1.0571.723, p=0.020) and prolonged in-hospital stay (OR 1.609, 95%CI 1.2022.155, p=0.001). The significance of these relationships increased with the addition of newly diagnosed T2DM to the regression model (for in-hospital complications: OR 1.731, 95% CI 1.1312.626, p=0.012; for prolonged in-hospital stay: OR 2.229, 95%CI 1.4123.519, p0.001). Moreover, additional associations between T2DM and the risk of developing multiple organ dysfunction (OR 2.911, 95% CI 1.0727.901, p=0.039), urgent lower extremity surgery (OR 1.638, 95%CI 1.00915.213, p=0.020) and the need for extracorporeal correction of hemostasis (OR 3.472, 95%CI 1.04211.556, p=0.044) have been defined. Importantly, the presence of these associations would not have been identified without including newly diagnosed DM in the regression model. Conclusion: The newly diagnosed T2DM affects the prognosis of CABG as well as the previously diagnosed T2DM. The obtained results suggest the importance of active preoperative T2DM screening

Assessment of left ventricular diastolic dysfunction following anthracyclinebased chemotherapy in breast cancer patients

Cardiotoxicity is a side effect of anthracycline-based chemotherapy. Clinical and prognostic significance of left ventricular diastolic dysfunction in heart failure patients is undeniable.The aim. To assess dynamic changes in the left ventricular diastolic function after anthracycline-based chemotherapy (ANT) in breast cancer patients.Material and methods. The study included 40 women aged 35 to 72 years with breast cancer (BC) undergoing ANT chemotherapy. The main group (n = 40) consisted of women with breast cancer examined at admission, after 6 months the same women (n = 37) were examined again. Women without breast cancer (n = 25) were used as the control group.Results. Dynamic changes in mitral annular velocities were revealed by Doppler tissue imaging. Lateral early diastolic mitral annular velocity (e’ lateral) was significantly lower in breast cancer patients as compared to the control group (p = 0.031). Six months after ANT chemotherapy, there was a definite increase in the lateral late diastolic mitral annular velocity (a’ lateral) (p = 0.033). Average early diastolic transmitral flow velocity to early diastolic velocity (E/e’ lateral) ratio was within the normative values in all groups, but E/e’ lateral in the main group was higher compared to the control group (p = 0.003). In the main group, septal early diastolic mitral annular velocity (e’ septal) was lower compared to the control group (p = 0.0005). Moreover, an increase in the septal mitral annular velocity (a’ septal) (p = 0.01) and higher E/e’ septal ratio (p = 0.011) were revealed during dynamic observation. Multiple logistic regression disclosed that E/A, e’ lateral, e’/a’ lateral, and E/e’ lateral were affected by heart rate, psychological status, age, hypertension, and body mass index, but not anthracycline chemotherapy. The total dose of anthracycline was independently associated with e’ septal and E/e’ septal: F(4.18) = 16.466 (p < 0.001; R2 = 0.775) and F(3.16) = 7.271 (p = 0.004; R2 = 0.627).Conclusion. Left ventricular diastolic function worsens in women undergoing anthracycline-based chemotherapy for breast cancer (lower e’, e’/a’ lateral, and e’ septal, higher E/e’ septal ratio). However, anthracycline does not significantly affect LVEF and LV deformation indicators. E/e’ septalande’ septal are independently associated with the total dose of anthracycline

АКТУАЛЬНЫЕ ВОПРОСЫ ДИАГНОСТИКИ ИБС В МАТЕРИАЛАХ РОССИЙСКОГО КОНГРЕССА КАРДИОЛОГОВ (Г. ЕКАТЕРИНБУРГ, 20-23 СЕНТЯБРЯ 2016)

Currently, one of the problems of diagnosis of CHD is a significant percentage of detection of non-obstructive lesions of coronary arteries (CA) for invasive coronary angiography (CAG). In register trials intact CA rate reaches 42%, in the analysis of our clinical data - 37.9%. In the materials of the past of the Russian Cardiology Congress, solutions to this problem were considered from different points of view, both by improving the diagnostic algorithms in primary care, and using high-tech methods of diagnosis. A number of breakout sessions was devoted to the modern possibilities and prospects of development of MSCT-angiography, stress echocardiography in the diagnosis of coronary atherosclerosis; clinical value assessment of left ventricular mechanics (LV) in CHD; modern trends radionuclide diagnosis of CHD; methods of contrast enhancement in radiation pathophysiological assessment of coronary atherosclerosis and myocardial viability; as well as the characteristics of non-invasive diagnosis of stable coronary artery disease in Russia. In addition, in one of the workshops reminded us that in the absence of stenosis of large CA do not forget about the possible presence of a particular form of ischemic heart disease - microvascular angina (MVA). The reports of the current understanding of the pathogenesis and diagnosis of MVA were recorded, especially pain and determination of nociceptive disorders in patients with MVA, new opportunities in drug therapy MVA. Participation in the Congress allowed us to compare our views on ways to reduce the frequency of intact CA detection with the position of the leading Russian experts. This review will help clinicians to better navigate the current state of the real problem.В настоящее время одной из проблем диагностики ИБС является существенный процент выявления необструктивных поражений коронарных артерий (КА) при инвазивной коронароангиографии (КАГ). В регистровых исследованиях частота интактных КА достигает 42%, в анализе данных нашей клиники – 37,9%. В материалах прошедшего Российского конгресса кардиологов пути решения этой проблемы рассматривались с разных точек зрения – как с помощью улучшения диагностических алгоритмов в первичном звене, так и с использованием высокотехнологических методов диагностики. Ряд секционных заседаний был посвящен современным возможностям и перспективам развития МСКТ-ангиографии, стресс-эхокардиографии в диагностике коронарного атеросклероза; клиническому значению оценки механики левого желудочка (ЛЖ) при ИБС; современным трендам радионуклидной диагностики ИБС; методам контрастного усиления в лучевой патофизиологической оценке коронарного атеросклероза и жизнеспособности миокарда; а также особенностям неинвазивной диагностики стабильной ИБС в России. Кроме того, на одном из симпозиумов нам напомнили, что при отсутствии стенозов крупных КА не стоит забывать о возможном наличии особой формы ИБС – микрососудистой стенокардии (МСС). В докладах были отражены современные представления о патогенезе и диагностике МСС, особенности болевого синдрома и определение ноцицептивных нарушений у больных с МСС, новые возможности в медикаментозной терапии МСС. Участие в конгрессе РКО позволило сопоставить наши взгляды на пути снижения частоты выявления интактных КА с позицией ведущих отечественных экспертов по данному вопросу. Представленный обзор поможет практическим врачам лучше ориентироваться в современном состоянии настоящей проблемы