Long-Term Prognostic Value of Restitution Slope in Patients with Ischemic and Dilated Cardiomyopathies

Background

An action potential duration (APD) restitution curve with a steep slope ≥1 has been associated with increased susceptibility for malignant ventricular arrhythmias. We aimed to evaluate the “restitution hypothesis” and tested ventricular APD restitution slope as well as effective refractory period (ERP)/APD ratio for long-term prognostic value in patients with ischemic (ICM) or dilated cardiomyopathy (DCM).

Methodology/Principal Findings

Monophasic action potentials were recorded in patients with ICM (n = 32) and DCM (n = 42) undergoing routine programmed ventricular stimulation (PVS). Left ventricular ejection fraction was 32±7% and 28±9%, respectively. APD and ERP were measured at baseline stimulation (S₁) and upon introduction of one to three extrastimuli (S₂–S₄). ERP/APD ratios and the APD restitution curve were calculated and the maximum restitution slope was determined. After a mean follow-up of 6.1±3.0 years, the combined end-point of mortality and and/or implantable cardioverter-defibrillator shock was not predicted by restitution slope or ERP/APD ratios. Comparing S₂ vs. S₃ vs. S₄ extrastimuli for restitution slope (1.5±0.6 vs. 1.4±0.4 vs. 1.3±0.5; p = NS), additional extrastimuli did not lead to a steepening restitution slope. ERP/APD ratio decreased with additional extrastimuli (0.98±0.09 [S₁] vs. 0.97±0.10 [S₂] vs. 0.93±0.11 [S₃]; p = 0.03 S₁ vs. S₃). Positive PVS was strongly predictive of outcome (p = 0.006).

Conclusions/Significance

Neither ventricular APD restitution slope nor ERP/APD ratios predict outcome in patients with ICM or DCM.     

Soil carbon sequestration and land use change associated with biofuel production: empirical evidence

Soil organic carbon (SOC) change can be a major impact of land use change (LUC) associated with biofuel feedstock production. By collecting and analyzing data from worldwide field observations of major LUCs from cropland, grassland, and forest to lands producing biofuel crops (i.e. corn, switchgrass, Miscanthus, poplar, and willow), we were able to estimate SOC response ratios and sequestration rates and evaluate the effects of soil depth and time scale on SOC change. Both the amount and rate of SOC change were highly dependent on the specific land transition. Irrespective of soil depth or time horizon, cropland conversions resulted in an overall SOC gain of 6–14% relative to initial SOC level, while conversion from grassland or forest to corn (without residue removal) or poplar caused significant carbon loss (9–35%). No significant SOC changes were observed in land converted from grasslands or forests to switchgrass, Miscanthus, or willow. The SOC response ratios were similar in both 0–30 and 0–100 cm soil depths in most cases, suggesting SOC changes in deep soil and that use of top soil only for SOC accounting in biofuel life cycle analysis (LCA) might underestimate total SOC changes. Soil carbon sequestration rates varied greatly among studies and land transition types. Generally, the rates of SOC change tended to be the greatest during the 10 years following land conversion and had declined to approach 0 within about 20 years for most LUCs. Observed trends in SOC change were generally consistent with previous reports. Soil depth and duration of study significantly influence SOC change rates and so should be considered in carbon emission accounting in biofuel LCA. High uncertainty remains for many perennial systems and forest transitions, additional field trials, and modeling efforts are needed to draw conclusions about the site‐ and system‐specific rates and direction of change.     

Influence of spatially dependent,modeled soil carbon emission factors on life‐cycle greenhouse gas emissions of corn and cellulosic ethanol

Converting land to biofuel feedstock production incurs changes in soil organic carbon (SOC) that can influence biofuel life‐cycle greenhouse gas (GHG) emissions. Estimates of these land use change (LUC) and life‐cycle GHG emissions affect biofuels' attractiveness and eligibility under a number of renewable fuel policies in the USA and abroad. Modeling was used to refine the spatial resolution and depth extent of domestic estimates of SOC change for land (cropland, cropland pasture, grassland, and forest) conversion scenarios to biofuel crops (corn, corn stover, switchgrass, Miscanthus, poplar, and willow) at the county level in the USA. Results show that in most regions, conversions from cropland and cropland pasture to biofuel crops led to neutral or small levels of SOC sequestration, while conversion of grassland and forest generally caused net SOC loss. SOC change results were incorporated into the Greenhouse Gases, Regulated Emissions, and Energy use in Transportation (GREET) model to assess their influence on life‐cycle GHG emissions of corn and cellulosic ethanol. Total LUC GHG emissions (g CO₂eq MJ^?1) were 2.1–9.3 for corn‐, ?0.7 for corn stover‐, ?3.4 to 12.9 for switchgrass‐, and ?20.1 to ?6.2 for Miscanthus ethanol; these varied with SOC modeling assumptions applied. Extending the soil depth from 30 to 100 cm affected spatially explicit SOC change and overall LUC GHG emissions; however, the influence on LUC GHG emission estimates was less significant in corn and corn stover than cellulosic feedstocks. Total life‐cycle GHG emissions (g CO₂eq MJ^?1, 100 cm) were estimated to be 59–66 for corn ethanol, 14 for stover ethanol, 18–26 for switchgrass ethanol, and ?7 to ?0.6 for Miscanthus ethanol. The LUC GHG emissions associated with poplar‐ and willow‐derived ethanol may be higher than that for switchgrass ethanol due to lower biomass yield.     

Affective Computing and the Impact of Gender and Age

Affective computing aims at the detection of users’ mental states, in particular, emotions and dispositions during human-computer interactions. Detection can be achieved by measuring multimodal signals, namely, speech, facial expressions and/or psychobiology. Over the past years, one major approach was to identify the best features for each signal using different classification methods. Although this is of high priority, other subject-specific variables should not be neglected. In our study, we analyzed the effect of gender, age, personality and gender roles on the extracted psychobiological features (derived from skin conductance level, facial electromyography and heart rate variability) as well as the influence on the classification results. In an experimental human-computer interaction, five different affective states with picture material from the International Affective Picture System and ULM pictures were induced. A total of 127 subjects participated in the study. Among all potentially influencing variables (gender has been reported to be influential), age was the only variable that correlated significantly with psychobiological responses. In summary, the conducted classification processes resulted in 20% classification accuracy differences according to age and gender, especially when comparing the neutral condition with four other affective states. We suggest taking age and gender specifically into account for future studies in affective computing, as these may lead to an improvement of emotion recognition accuracy.     

Caries-Preventive Effect of High-Viscosity Glass Ionomer and Resin-Based Fissure Sealants on Permanent Teeth: A Systematic Review of Clinical Trials

Background

Glass-ionomers are traditionally regarded to be inferior to resin as fissure sealants in protecting teeth from dental caries, due to their comparatively lower retention rate. Unlike low-viscosity glass-ionomers, high-viscosity glass-ionomer cements (HVGIC) are placed as sealants by pressing the material into pits and fissures with a petroleum-jelly-coated index finger. Hence, HVGIC sealants are assumed to penetrate pits and fissures deeper, resulting in a higher material retention rate, which may increase its caries-preventive effect.

Methods

The aim of this review was to answer the question as to whether, in patients with fully erupted permanent molar teeth, HVGIC based fissure sealants are less effective to protect against dental carious lesions in occlusal pits and fissures than resin-based fissure sealants? A systematic literature search in eight databases was conducted. Heterogeneity of accepted trials and imprecision of the established evidence were assessed. Extracted sufficiently homogenous datasets were pooled by use of a random-effects meta-analysis. Internal trial validity was evaluated. The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO / Nr.: CRD42015016007).

Results

Seven clinical trials were provisionally included for further review. Of these, one was excluded. Seven trial reports reporting on six trials were accepted. From these, 11 datasets were extracted and pooled in four meta-analyses. The results suggest no statistically significant differences after up to 48 months and borderline significant differences in favour of HVGIC sealants after 60 months (RR 0.29; 95% CI: 0.09–0.95; p = 0.04 / RD -0.07; 95% CI: -0.14, -0.01). The point estimates and upper confidence levels after 24, 36, 48 and 60 months of RR 1.36; RR 0.90; RR 0.62; RR 0.29 and 2.78; 1.67; 1.21; 0.95, respectively, further suggest a chronological trend in favour of HVGIC above resin-based sealants. The internal trial validity was judged to be low and the bias risk high for all trials. Imprecision of results was considered too high for clinical guidance.

Conclusion

It can be concluded that: (i) Inferiority claims against HVGIC in comparison to resin-based sealants as current gold-standard are not supported by the clinical evidence; (ii) The clinical evidence suggests similar caries-preventive efficacy of HVGIC and resin-based sealants after a period of 48 months in permanent molar teeth but remains challenged by high bias risk; (iii) Evidence concerning a possible superiority of HVGIC above resin-based sealants after 60 months is poor (even if the high bias risk is disregarded) due to imprecision and requires corroboration through future research.     

Run-Off Computed Tomography Angiography (CTA) for Discriminating the Underlying Causes of Intermittent Claudication

AimTo evaluate run-off computed tomography angiography (CTA) of abdominal aorta and lower extremities for detecting musculoskeletal pathologies and clinically relevant extravascular incidental findings in patients with intermittent claudication (IC) and suspected peripheral arterial disease (PAD). Does run-off CTA allow image-based therapeutic decision making by discriminating the causes of intermittent claudication in patients with suspected peripheral arterial disease PAD?ResultsWhile focused on vascular imaging, CTA image quality was sufficient for evaluation of the MSK system in all cases. The underlying cause of IC was diagnosed in run-off CTA as vascular, MSK and a combination in n = 138 (65%), n = 10 (4%), and n = 66 (31%) cases, respectively. Specific vascular or MSK therapy was recorded in n = 123 and n = 9 cases. In n = 82, no follow-up was possible. Clinically relevant extravascular incidental findings were detected in n = 65 patients (30%) with neoplasia, ascites and pleural effusion being the most common findings.DiscussionRun-off CTA allows identification of vascular, MSK, and combined causes of IC in patients with suspected PAD and can guide specific therapy. CTA also allowed confident detection of crEVIF although detection did not necessarily trigger workup or treatment.     

Environmental and spatial characterisation of an unknown fauna using DNA sequencing – an example with Himalayan Hydropsychidae (Insecta: Trichoptera)

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