Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions. Clopidogrel, in combination with aspirin, is ...currently the antiplatelet treatment of choice for prevention of stent thrombosis, and clinical trials have shown that, in high-risk patients, prolonged dual antiplatelet treatment is more effective than aspirin alone in preventing major cardiovascular events. However, despite the use of clopidogrel, a considerable number of patients continue to have cardiovascular events. Numerous in vitro studies have shown that individual responsiveness to clopidogrel is not uniform in all patients and is subject to inter- and intraindividual variability. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to clopidogrel. The mechanisms leading to poor clopidogrel effects are not fully elucidated and are likely multifactorial. Although the gold standard definition to assess antiplatelet drug response has not been fully established, there is sufficient evidence to support that persistence of enhanced platelet reactivity despite the use of clopidogrel is a clinically relevant entity. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management.
Objectives We compared intravascular ultrasound (IVUS) and 2 different generations of optical coherence tomography (OCT)—time-domain OCT (TD-OCT) and frequency-domain OCT (FD-OCT)—for the assessment ...of coronary disease and percutaneous coronary intervention (PCI) using stents. Background OCT is a promising light-based intravascular imaging modality with higher resolution than IVUS. However, the paucity of data on OCT image quantification has limited its application in clinical practice. Methods A total of 227 matched OCT and IVUS pull backs were studied. One hundred FD-OCT and IVUS pull backs in nonstented (n = 56) and stented (n = 44) vessels were compared. Additionally, 127 matched TD-OCT and IVUS images were compared in stented vessels. Results FD-OCT depicted more severe native coronary disease than IVUS; minimal lumen area (MLA) was 2.33 ± 1.56 mm2 versus 3.32 ± 1.92 mm2 , respectively (p < 0.001). Reference vessel dimensions were equivalent between FD-OCT and IVUS in both native and stented coronaries, but TD-OCT detected smaller reference lumen size compared with IVUS. Immediately post-PCI, in-stent MLAs were similar between FD-OCT and IVUS, but at follow-up, both FD-OCT and TD-OCT detected smaller MLAs than did IVUS, likely due to better detection of neointimal hyperplasia (NIH). Post-PCI malapposition and tissue prolapse were more frequently identified by FD-OCT. Conclusions FD-OCT generates similar reference lumen dimensions but higher degrees of disease severity and NIH, as well as better detection of malapposition and tissue prolapse compared with IVUS. First-generation TD-OCT was associated with smaller reference vessel dimensions compared with IVUS.
This article presents an LED driver for lighting and visible light communication (VLC), which utilizes the light of the LEDs to wirelessly transmit data by modulating their instantaneous current. The ...solution proposed in this article seeks to unite the high efficiency of switched-mode power supplies with the wide bandwidth of linear power amplifiers (LPAs) to achieve high-speed communications. The hybrid converter processes the energy from a 48-V dc bus with an efficiency of 94% while supplying a 20-W LED load, and providing 3.68 MHz of bandwidth for VLC. Details regarding frequency limitations are provided in terms of a Laplace model. The impact of the LPA on the overall efficiency is mitigated by adopting specific design constraints. Finally, experimental results are shown from a prototype working with signals aimed at multicarrier multilevel modulations based on orthogonal frequency division multiplexing.
This article presents a design methodology to improve the power density of integrated converters operating at universal input voltage fulfilling the standards of connection to the grid and load. The ...proposed integrated two-stage converter is composed of the power factor correction (PFC) stage behaving as a current source to the bus, and the power control (PC) stage which provides continuous energy to the LED load. Traditionally, the low-frequency ripple (LFR) filtering process is performed by the bus capacitor placed in the output of the PFC stage, while the PC stage output capacitor works only as a high-frequency (HF) filter. The idea is to explore the lower and fixed operating voltage characteristics of the PC stage to share the LFR filtering with the PFC stage. Thus, a mathematical analysis is carried out, considering the influence of the LED characteristics, bus voltage, and capacitances to predict the LFR in the LED current. A case study, composed of an integrated buck and buck-boost converter to supply a 75 W LED load, is presented. For the traditional design method, the LED driver needs an 820 uF/160 V PFC bus capacitor and a 10 uF/80 V output capacitor to filter the HF components, representing a total capacitors' volume of 17.9 cm 3 . With the proposed analysis, the optimized driver circuit requires a 220 uF/160 V PFC bus capacitor and a 470 uF/80 V output capacitor, resulting in a total capacitors' volume of 9.7 cm 3 , providing a volume reduction of approximately 45%.
Abstract
The impact of the broad disjunction between Amazonia and the Atlantic Forest on biodiversity has been the theme of several discussions in recent decades. Here, we evaluate the effects of ...dependence on humid environments and the role of historical factors on the level, distribution and structuring of genetic variation in widely distributed Neotropical insects. For such, we test whether climatically stable zones (i.e. refuges) in both Amazonia and the Atlantic Forest concentrate higher genetic diversity in the social paper wasps Angiopolybia pallens and Synoeca surinama. We found that historical events have avoided the interchange of A. pallens between both rainforests at least since the Early Pliocene and that ancient colonization in north-western Amazonia and the Bahia refuge significantly predicts genetic diversity in populations of this species. Conversely, the split between the Atlantic Forest and remaining western populations of S. surinama is more recent (Plio-Pleistocene); this species has considerably lower genetic diversity than A. pallens and such diversity is mostly concentrated in Amazonia and in the cerrado biome (savanna) than in the Atlantic Forest. Finally, we propose that the occurrence of species that exhibit such distribution patterns should be taken into consideration when establishing areas for conservation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Aim
Investigating the association between sugar‐sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship.
Materials and Methods
Cross‐sectional ...analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30–50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC‐AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self‐reported diabetes.
Results
Among 4473 cases analysed, 198 self‐reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval CI = 1.30–2.06), ≥7 (OR 1.92; 95% CI = 1.50–2.46) and ≥14 (OR 2.19; 95% CI = 1.50–3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self‐reported diabetes had less impact than the cumulative effect.
Conclusions
SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used for refractory cardiogenic shock; however, it is associated with increased left ventricular afterload. Outcomes associated ...with the combination of a percutaneous left ventricular assist device (Impella) and VA-ECMO remains largely unknown. We retrospectively reviewed patients treated for refractory cardiogenic shock with VA-ECMO (2014–2016). The primary outcome was all-cause mortality within 30 days of VA-ECMO implantation. Secondary outcomes included duration of support, stroke, major bleeding, hemolysis, inotropic score, and cardiac recovery. Outcomes were compared between the VA-ECMO cohort and VA-ECMO + Impella (ECPELLA cohort). Sixty-six patients were identified36 VA-ECMO and 30 ECPELLA. Fifty-eight percent of VA-ECMO patients (n = 21) had surgical venting, as compared to 100% of the ECPELLA cohort (n = 30) which had Impella (±surgical vent). Both cohorts demonstrated relatively similar baseline characteristics except for higher incidence of ST-elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) in the ECPELLA cohort. Thirty-day all-cause mortality was significantly lower in the ECPELLA cohort (57% vs. 78%; hazard ratio HR 0.51 0.28–0.94, log rank p = 0.02), and this difference remained intact after correcting for STEMI and PCI. No difference between secondary outcomes was observed, except for the inotrope score which was greater in VA-ECMO group by day 2 (11 vs. 0; p = 0.001). In the largest US-based retrospective study, the addition of Impella to VA-ECMO for patients with refractory cardiogenic shock was associated with lower all-cause 30 day mortality, lower inotrope use, and comparable safety profiles as compared with VA-ECMO alone.
The identification of discrete neutrophil populations, as well as the characterization of their immunoregulatory properties, is an emerging topic under extensive investigation. In such regard, the ...presence of circulating CD66b+ neutrophil populations, exerting either immunosuppressive or proinflammatory functions, has been described in several acute and chronic inflammatory conditions. However, due to the lack of specific markers, the precise phenotype and maturation status of these neutrophil populations remain unclear. Herein, we report that CD10, also known as common acute lymphoblastic leukemia antigen, neutral endopeptidase, or enkephalinase, can be used as a marker that, within heterogeneous populations of circulating CD66b+ neutrophils present in inflammatory conditions, clearly distinguishes the mature from the immature ones. Accordingly, we observed that the previously described immunosuppressive neutrophil population that appears in the circulation of granulocyte colony-stimulating factor (G-CSF)–treated donors (GDs) consists of mature CD66b+CD10+ neutrophils displaying an activated phenotype. These neutrophils inhibit proliferation and interferon γ (IFNγ) production by T cells via a CD18-mediated contact-dependent arginase 1 release. By contrast, we found that immature CD66b+CD10− neutrophils, also present in GDs, display an immature morphology, promote T-cell survival, and enhance proliferation and IFNγ production by T cells. Altogether, our findings uncover that in GDs, circulating mature and immature neutrophils, distinguished by their differential CD10 expression, exert opposite immunoregulatory properties. Therefore, CD10 might be used as a phenotypic marker discriminating mature neutrophils from immature neutrophil populations present in patients with acute or chronic inflammatory conditions, as well as facilitating their isolation, to better define their specific immunoregulatory properties.
•CD10 as a marker discriminating mature from immature neutrophils within heterogeneous neutrophil populations in pathological settings.•Immunosuppressive mature CD66b+CD10+ and immunostimulatory immature CD66b+CD10− neutrophils coexist in G-CSF–treated donors.
Although advantageous in several aspects, the integration of converters leads to a loss of independence between the converter's stages, since both stages are controlled by the same active switch. ...This condition makes it impractical to adopt control techniques that act on the duty-cycle to mitigate the low-frequency ripple at the output current without distorting the line current. The low-frequency ripple transferred from the bus voltage to the LED current has been studied for integrated converters operated at constant duty-cycle. To comply with IEEE 1789-2015 recommendation, the integrated converters use large capacitors to mitigate the low-frequency ripple. Converters operating in discontinuous conduction mode (DCM) have been widely adopted because they transfer less ripple to the output than converters operating in continuous conduction mode (CCM). A novel circuit arrangement for the buck-boost power control (PC) stage integrated with a buck-boost power factor correction (PFC) stage is explored in this paper as a technique to minimize the low-frequency output ripple for converters operating at constant duty-cycle and CCM. The proposed circuit provides current feedback to the bus capacitor, acting to reduce the output current and bus voltage low-frequency ripple. A dynamic model for the proposed converter in CCM is obtained and used to determine the output current modulation as a function of converter parameters. It is shown that the proposed topology leads to a smaller low-frequency ripple than a conventional counterpart at the same operating point. A 95 W design example and a prototype supplying an LED load of 98.8 V/960 mA for the proposed circuit and the conventional counterpart are presented. The experimental results show that the proposed arrangement can achieve similar results to the conventional circuit in efficiency, THD, or semiconductor stress, while the obtained output current modulation equals to 8.66% is 3.5 times lower than that in the conventional circuit at same operating point and component values.
This paper presents a study of the losses in the integrated buck-flyback converter (IBFC) used as high-power-factor LED driver. The aim of the study is to investigate the possibilities of increasing ...the efficiency of the IBFC converter. The procedure of the improvement is done by obtaining the equations of the current through each component in terms of converter parameters. The current is found in an average value or rms value, depending on the type of the parasitic component, whether it is modeled by a parasitic forward voltage source or by a parasitic resistance, respectively. Using these equations and the parasitic model, the losses of each element of the converter are estimated. This paper proposes a technique to increase the efficiency of the IBFC by redesigning the converter parameters. Furthermore, this paper presents a case of study with a step-by-step efficiency enhancement process of an existing driver. The driver is operating under universal input conditions, and 38 V output, supplying an LED luminary of 26.5 W. The new design shows an improvement of the efficiency from 82% in the old design to 89% in the proposed one. Moreover, the new design shows an improvement in the power factor and the THD and a 50% reduction in the output current ripple. Furthermore, a reduction in the number of components has been achieved, as it is found by the analysis that by adjusting the converter parameters, one diode can be removed. Finally, the presented methodology is explained in detail so that it can easily be applied to other dc-dc converters.
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