Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

An effective passive islanding detection algorithm for distributed generations

Different issues will be raised and highlighted by emerging distributed generations (DGs) into modern power systems in which the islanding detection is the most important. In the islanding situation, a part of the system which consists of at least one DG, passive grid, and local load, becomes fully separated from the main grid. Several detection methods of islanding have been proposed in recent researches based on measured electrical parameters of the system. However, islanding detection based on local measurements suffers from the non-detection zone (NDZ) and undesirable detection during grid-connected events. This paper proposes a passive islanding detection algorithm for all types of DGs by appropriate combining the measured frequency, voltage, current, and phase angle and their rate of changes at the point of common coupling (PCC). The proposed algorithm detects the islanding situation, even with the exact zero power mismatches. Proposed algorithm discriminates between the islanding situation and non-islanding disturbances, such as short circuit faults, capacitor faults, and load switching in a proper time and without mal-operation. In addition, the performance of the proposed algorithm has been evaluated under different scenarios by performing the algorithm on the IEEE 13-bus distribution system.fi=vertaisarvioitu|en=peerReviewed

Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition.

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

A Novel DC Transmission System Fault Location Technique for Offshore Renewable Energy Harvesting

Advances in renewable energy recourses technologies have paved the way for increased utilization of DC grids in modern power systems. In particular, high voltage DC (HVDC) transmission cables are used to harvest offshore energy. Since failure diagnosis and repair of the buried offshore cables under the sea bed involve quite laborious tasks, accurate fault location is of vital importance. This paper proposes a novel fault location method based on the synchronized measurement of conductors and sheaths currents in each terminal without requiring the voltage signal. Unlike the traveling-wave-based methods, the proposed method is developed for multi-terminal HVDC systems without requiring any high precision measurement infrastructure. The proposed method can be implemented for different system topologies as well as fault resistance and fault distance. The fault location method can provide accurate results even if 10 ms time window samples are imported into the proposed algorithm. In addition, accuracy of the fault location using the proposed method is not affected significantly by noisy condition. Different test systems have been simulated to evaluate performance of the proposed method in various scenarios. Obtained results confirm that the proposed practical method can provide the accurate fault location for all different scenarios and conditions. 1986-2012 IEEE.This work was supported by the National Priorities Research Program under Grant 11S-1125-170027 from the Qatar National Research Fund (a member of Qatar Foundation). Paper no. TPWRD-00061-2020.Scopus2-s2.0-8509777644

Advances in Transmission Network Fault Location in Modern Power Systems: Review, Outlook and Future Works

Faults in the power system need appropriate maintenance actions at the fault point to fix the problem immediately. A high percentage of the short circuit faults in power systems occur on the transmission system where the lines pass through different harsh climates and experience outdoor environmental conditions. The repairing procedure of the faulty line requires determining the accurate fault location. Fast and accurate fault location of transmission networks play an important role in modern power systems to improve the system reliability and stability. A fault locator is an apparatus that determines the location of the fault in the transmission system by acquiring the proper measured quantities, i.e. the voltages and currents at the lines terminals. As such, the utilities can repair and fix the problem rapidly after determining the location of the fault using the analytical and numerical methods provided in fault locators. This research explores various fault location techniques of transmission networks in detail as a vital requirement for operating the modern power system more secure and reliable. In this survey, different new methods of fault location such as i) distance relay algorithm, ii) traveling wave, iii) artificial intelligence, iv) wide-area, v) time reversal theory, vi) differential equations, and vii) impedance calculation methods are reviewed and investigated to illustrate their pros and cons inaccurate fault location for complex modern power networks. In addition, these methods are assessed to compare their requirements, abilities and shortcomings. Moreover, using the provided extensive analysis in the paper, and based on the useful experiences of the authors, some beneficial topics and suggestions are proposed for future works and improved algorithms in the field of fault location. 2013 IEEE.This work was supported by the National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation) under Grant 11S-1125-170027.Scopus2-s2.0-8512004578

The impact of stress on body function

Any intrinsic or extrinsic stimulus that evokes a biological response is known as stress. The compensatory responses to these stresses are known as stress responses. Based on the type, timing and severity of the applied stimulus, stress can exert various actions on the body ranging from alterations in homeostasis to life-threatening effects and death. In many cases, the pathophysiological complications of disease arise from stress and the subjects exposed to stress, e.g. those that work or live in stressful environments, have a higher likelihood of many disorders. Stress can be either a triggering or aggravating factor for many diseases and pathological conditions. In this study, we have reviewed some of the major effects of stress on the primary physiological systems of humans