Smartwatch allows easy detection of arrhythmia. Such an approach is widely used for detecting atrial fibrillation. However, there has been no consensus on the diagnostic power of smartwatch‐detected ...supraventricular tachycardia (SVT). We reported three patients of SVT presenting with infrequent palpitations. Their SVTs were not documented with single‐lead or standard ECG in hospital before, but only recorded by the single‐lead ECG on smartwatches. Electrophysiological studies confirmed the mechanisms of these SVTs and led to successful catheter ablations. In conclusion, in patients with recurrent symptomatic tachycardia and a smartwatch‐detected SVT, an electrophysiological study is indicated rather than to wait for a standard ECG for clinical decision. This approach might prevent the delay for successful treatment.
Abstract
Context
Angiopoietin-like protein 6 (ANGPTL6) is a hepatokine that improves insulin sensitivity in animals. However, serum ANGPTL6 concentration was found to be higher in human participants ...with diabetes or metabolic syndrome in cross-sectional studies, implying that ANGPTL6 may be induced to counteract hyperglycemia.
Objective
To investigate whether serum ANGPTL6 can predict incident diabetes and explore whether glucose or insulin can regulate ANGPTL6 expression and secretion.
Design
This cohort study included adults without diabetes at baseline who were followed every 2 years for incident diabetes. Serum ANGPTL6 concentrations were measured at baseline and during oral glucose tolerance tests (OGTTs). A hepatic cell line, HepG2, and diet-induced obesity mouse model were used to evaluate the response of ANGPTL6 expression and secretion to hyperglycemia and the metabolic syndrome.
Results
We recruited 1103 participants without diabetes at baseline. During the 4.22-year follow-up, 113 (10.2%) participants developed incident diabetes. Serum ANGPTL6 was negatively associated with the incidence of diabetes (adjusted hazard ratio, 0.77; P = 0.042). However, serum ANGPTL6 level was higher in participants with prediabetes (P = 0.018) and was elevated during OGTT. In HepG2 cells, treatment with glucose, but not insulin, induced ANGPTL6 expression. Hepatic ANGPTL6 expression and serum ANGPTL6 concentrations were significantly higher in mice fed with a high-fat diet than in those fed with a standard chow (both P < 0.05).
Conclusion
A high serum ANGPTL6 level is associated with a low incidence of diabetes in humans. ANGPTL6 is expressed and secreted in response to hyperglycemia to maintain glucose homeostasis.
Sandwich panel structures (SPSs) with lattice cores can considerably lower material consumption while simultaneously maintaining adequate mechanical properties. Compared with extruded lattice types, ...triply periodic minimal surface (TPMS) lattices have light weight but better controllable mechanical properties. In this study, the different types of TPMS lattices inside an SPS were analysed comprehensively. Each SPS comprised two face sheets and a core filled with 20×5×1 TPMS lattices. The types of TPMS lattices considered included the Schwarz primitive (SP), Scherk’s surface type 2 (S2), Schoen I-graph-wrapped package (I-WP), and Schoen face-centred cubic rhombic dodecahedron (F-RD). The finite element method was applied to determine the mechanical performance of different TPMS lattices at different relative densities inside the SPS under a three-point bending test, and the results were compared with the values calculated from analytical equations. The results showed a difference of less than 21% between the analytical and numerical results for the deformation. SP had the smallest deformation among the TPMS lattices, and F-RD can withstand the highest allowable load. Different failure modes were proposed to predict potential failure mechanisms. The results indicated that the mechanical performances of the TPMS lattices were mainly influenced by the lattice geometry and relative density.
Replication stress causes replication fork stalling, resulting in an accumulation of single-stranded DNA (ssDNA). Replication protein A (RPA) and CTC1-STN1-TEN1 (CST) complex bind ssDNA and are found ...at stalled forks, where they regulate RAD51 recruitment and foci formation in vivo. Here, we investigate crosstalk between RPA, CST, and RAD51. We show that CST and RPA localize in close proximity in cells. Although CST stably binds to ssDNA with a high affinity at low ionic strength, the interaction becomes more dynamic and enables facilitated dissociation at high ionic strength. CST can coexist with RPA on the same ssDNA and target RAD51 to RPA-coated ssDNA. Notably, whereas RPA-coated ssDNA inhibits RAD51 activity, RAD51 can assemble a functional filament and exhibit strand-exchange activity on CST-coated ssDNA at high ionic strength. Our findings provide mechanistic insights into how CST targets and tethers RAD51 to RPA-coated ssDNA in response to replication stress.
Abstract Objectives This study sought to determine predictors for successful endovascular treatment in patients with chronic carotid artery occlusion (CAO). Background Endovascular recanalization in ...patients with chronic CAO has been reported to be feasible, but technically challenging. Methods Endovascular attempts in 138 consecutive chronic CAO patients with impaired ipsilateral hemisphere perfusion were reviewed. We analyzed potential variables including epidemiology, symptomatology, angiographic morphology, and interventional techniques in relation to the technical success. Results The technical success rate was 61.6%. Multivariate analysis showed absence of prior neurologic event (odds ratio OR: 0.27; 95% confidence interval CI: 0.10 to 0.76), nontapered stump (OR: 0.18; 95% CI: 0.05 to 0.67), distal internal carotid artery (ICA) reconstitution via contralateral injection (OR: 0.19; 95% CI: 0.05 to 0.75), and distal ICA reconstitution at communicating or ophthalmic segments (OR:0.12; 95% CI: 0.04 to 0.36) to be independent factors associated with lower technical success. Point scores were assigned proportional to model coefficients, and technical success rates were >80% and <40% in patients with scores of ≤1 and ≥4, respectively. The c-indexes for this score system in predicting technical success was 0.820 (95% CI: 0.748 to 0.892; p < 0.001) with a sensitivity of 84.7% and a specificity of 67.9%. Conclusions Absence of prior neurologic event, nontapered stump, distal ICA reconstitution via contralateral injection, and distal ICA reconstitution at communicating or ophthalmic segments were identified as independent negative predictors for technical success in endovascular recanalization for CAO.
Lateral ankle instability (LAI) compromises the normal kinematics of the ankle, affecting activities of daily living. In vitro kinematics of ankles with LAI during single‐plane motions are available, ...but the active control stability of these motions remains unclear. The current study measured the 3D ankle kinematics during unresisted single‐plane motion tests using a bi‐plane fluoroscope with a CT model‐based 2D/3D registration method in 12 patients with LAI and 14 healthy peers. The coupling of the kinematic components at the talocrural and subtalar joints was quantified by the path difference between the forward and return paths of the coupled motion. Significantly increased path differences were found in the subtalar dorsiflexion/plantarflexion and inversion/eversion components during internal/external rotation tests (p < 0.05). During inversion/eversion, significantly reduced tibiocalcaneal ranges of motion and the path differences in the talocrural and subtalar dorsiflexion/plantarflexion components were noted (p < 0.05). The current results suggest that chronic LAI had compromised control stability at the subtalar joint during internal/external rotation tests and a conservative motion control strategy with significantly reduced ranges of motion to maintain good control of out‐of‐plane motion components in response to direct challenges of the anterior talofibular ligament during inversion/eversion tests. The current results also suggest that, compared to kinematic patterns of individual components, the path difference of the coupled motion may serve as a better measure of the motion control stability of the ankle in differentiating LAI from healthy controls.
Gear transmission is widely used in mechanical equipment. In practice, if the gearbox is damaged, it not only affects the yield rate but also damages other parts of machines; thus, increases the cost ...and difficulty of maintenance. With the advancement of technology, the concept of unmanned factories has been proposed; an automatic diagnosis system for the health management of gearboxes becomes necessary. In this paper, a compound fault diagnosis system for the gearbox based on convolutional neural network (CNN) is developed. Specifically, three-axis vibration signals measured by accelerometers are used as the input of the one-dimensional CNN; the detection of the existence and type of the fault is directly output. In testing, the model achieved nearly 100% accuracy on the fault samples we captured. Experimental evidence also shows that the frequency-domain data can provide better diagnostic results than the time-domain data due to the stable characteristics in the frequency spectrum. For practical usage, we demonstrated a remote fault diagnosis system through a local area network on an embedded platform. Furthermore, optimization of convolution kernels was also investigated. When moderately reducing the number of convolution kernels, it does not affect the diagnostic accuracy but greatly reduces the training time of the model.
Mud volcanoes provide an accessible channel through which deep subsurface environments can be observed. The manner in which deeply sourced materials shape biogeochemical processes and microbial ...communities in such geological features remains largely unknown. This study characterized redox transitions, biogeochemical fluxes and microbial communities for samples collected from a methane-rich mud volcano in southwestern Taiwan. Our results indicated that oxygen penetration was confined within the upper 4 mm of fluids/muds and counteracted by the oxidation of pyrite, dissolved sulfide, methane and organic matter at various degrees. Beneath the oxic zone, anaerobic sulfur oxidation, sulfate reduction, anaerobic methanotrophy and methanogenesis were compartmentalized into different depths in the pool periphery, forming a metabolic network that efficiently cycles methane and sulfur. Community members affiliated with various Proteobacteria capable of aerobic oxidation of sulfur, methane and methyl compounds were more abundant in the anoxic zone with diminished sulfate and high methane. These findings suggest either the requirement of alternative electron acceptors or a persistent population that once flourished in the oxic zone. Overall, this study demonstrates the distribution pattern for a suite of oxidative and reductive metabolic reactions along a steep redox gradient imposed by deep fluids in a mud volcano ecosystem.
The implementation of National Health Insurance in Taiwan has affected the medical industry by significantly depleting the supply chain's profits. Service providers in the medical industry must meet ...the dual-service expectation of serving as medical manufacturers with upper reaches and as suppliers in the downstream marketing channel. As a result, service providers must anticipate customer requirements, offer new service items that align with customer demands and improve the quality of existing services. This study aims to examine consumer perspectives about service satisfaction in the domestic medical industry using Kano's two-dimensional model. In addition, it employs the importance-satisfaction model to determine service items that need improvement. The empirical findings show that consumer perceptions about service quality attributes vary and thus, service items may be categorized differently in Kano's model. Further, the reliability of service quality significantly affects customer satisfaction. Thus, service providers can gain a competitive edge and maintain their market position by offering high value added and critical quality attributes. Finally, analyzing customer attitudes toward new service items for indifference quality will help service providers determine effective tactics in a competitive market. In general, service providers should assign higher priority to items that customers consider in need of improvement.
Chronic obstructive pulmonary disease (COPD) mainly affects middle-age and elderly adults. It is unclear if the presence of muscle wasting and fat accumulation in patients with COPD is age or ...disease-related. This study investigated the effect of age and COPD disease severity on body composition with the aim of identifying a biomarker(s) for COPD.
Healthy subjects and patients with COPD of different severity were recruited. Dual-energy X-ray absorptiometry was used to analyze total and segmental body composition. Subjects included in the analysis were classified into four groups: healthy young (aged 20-45 years) (n = 35), healthy old (aged ≥ 60 years) (n = 37), moderate COPD (n = 40), and severe COPD (n = 14).
In healthy old adults, leg and limb lean masses were lower by 10.6% and 8.5%, respectively, compared with healthy young adults (P < 0.05). Appendicular lean outcomes were significantly lower in the moderate COPD compared to the healthy old group and were significant lower in subjects with severe COPD compared to those with moderate COPD. All fat depots were similar for both young and old healthy subjects and subjects with moderate COPD, but significantly decreased in patients with severe COPD.
This study examined the changes in total and segmental body composition with aging and COPD severity. It found that aging and COPD altered the body composition differently, and the effect was most pronounced in leg lean mass. Remarkably, differences in appendicular lean masses were seen in mild COPD although no changes in body weight or BMI were apparent compared with healthy young adults. In contrast, fat depot changes were only observed in severe COPD. Aging and COPD processes are multifactorial and additional longitudinal studies are required to explore both the quantitative and qualitative changes in body composition with aging and disease process.
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