Objective
The ‘Detroit Cardiogenic Shock Initiative’ is a single‐arm, multicenter study to assess the feasibility of early mechanical circulatory support (MCS) in patients who present with acute ...myocardial infarction complicated by cardiogenic shock (AMICS) who undergo percutaneous coronary intervention.
Methods
Between July 2016 and February 2017, 4 metro Detroit sites participated in the study. The centers agreed to treat patients with AMICS using a mutually agreed‐upon protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those from the ‘SHOCK’ trial with an additional exclusion criteria being use of intra‐aortic balloon pump counter pulsation prior to MCS.
Results
A total of 41 consecutive patients were included. Patients had an average age of 65 ± 14 years, 71% were male and 59% of patients were admitted to the hospital in cardiogenic shock. Prior to receiving MCS, 93% of patients were on vasopressors or inotropes, 15% of patients had a witnessed out of hospital cardiac arrest, 27% of patients had an in‐hospital cardiac arrest, and 17% were under active cardiopulmonary resuscitation while MCS was being implanted. In accordance to the protocol recommendation, 66% of patients had a MCS device inserted prior to PCI. Right heart catheterization and hemodynamic monitoring was performed in 83% of patients. Door to support times averaged 83 ± 58 minutes and 71% of patients were able to reduce the levels of inotropes and vasopressors within the first 24‐hours of their index procedure. Pre‐procedure cardiac power output (CPO) was 0.57 W and post‐procedure CPO was 0.95 W, a 67% increase (p < 0.001). Survival to explant for the entire cohort was 85% a significant improvement from institutional historical controls (85% vs 51% p < 0.001) and survival to discharge was 76%.
Conclusion
Centers who adopted a regional shock protocol emphasizing the delivery of early MCS with invasive hemodynamic monitoring can achieve rapid door to support times and can improve survival in patients who present with AMICS. Larger national studies will be needed to further validate this pilot feasibility study.
Whether the fossil record should be read at face value or whether it presents a distorted view of the history of life is an argument seemingly as old as many fossils themselves. In the late 1700s, ...Georges Cuvier argued for a literal interpretation, but in the early 1800s, Charles Lyell's gradualist view of the earth's history required a more nuanced interpretation of that same record. To this day, the tension between literal and interpretive readings lies at the heart of paleontological research, influencing the way scientists view extinction patterns and their causes, ecosystem persistence and turnover, and the pattern of morphologic change and mode of speciation. With Stratigraphic Paleobiology, Mark E. Patzkowsky and Steven M. Holland present a critical framework for assessing the fossil record, one based on a modern understanding of the principles of sediment accumulation. Patzkowsky and Holland argue that the distribution of fossil taxa in time and space is controlled not only by processes of ecology, evolution, and environmental change, but also by the stratigraphic processes that govern where and when sediment that might contain fossils is deposited and preserved. The authors explore the exciting possibilities of stratigraphic paleobiology, and along the way demonstrate its great potential to answer some of the most critical questions about the history of life: How and why do environmental niches change over time? What is the tempo and mode of evolutionary change and what processes drive this change? How has the diversity of life changed through time, and what processes control this change? And, finally, what is the tempo and mode of change in ecosystems over time?
MicroRNAs (miRNAs) are small, non-coding RNAs that mediate mRNA cleavage, translational repression or mRNA destabilisation and are around 22-25 nucleotides in length via partial complementary binding ...to the 3' untranslated region in target transcripts. They are master regulators of gene expression. Fibrosis is an important cause of morbidity and mortality in the world, and there are currently no accepted treatments for fibrosis. Many novel miRNAs are now associated with fibrosis, both organ-specific and systemic, as in the prototypical fibrotic disease systemic sclerosis. Recently, the targets of these altered miRNAs have been validated and defined new biochemical pathways. Dysregulated miRNAs are amenable to therapeutic modulation. This review will examine the role of miRNAs in fibrosis and the opportunities and challenges of targeting them.
A most critical and important issue surrounding the design of automatic control systems with the successively increasing complexity is guaranteeing a high system performance over a wide operating ...range and meeting the requirements on system reliability and dependability. As one of the key technologies for the problem solutions, advanced fault detection and identification (FDI) technology is receiving considerable attention. The objective of this book is to introduce basic model-based FDI schemes, advanced analysis and design algorithms and the needed mathematical and control theory tools at a level for graduate students and researchers as well as for engineers.
Long-term loss of arm function after ischaemic stroke is common and might be improved by vagus nerve stimulation paired with rehabilitation. We aimed to determine whether this strategy is a safe and ...effective treatment for improving arm function after stroke.
In this pivotal, randomised, triple-blind, sham-controlled trial, done in 19 stroke rehabilitation services in the UK and the USA, participants with moderate-to-severe arm weakness, at least 9 months after ischaemic stroke, were randomly assigned (1:1) to either rehabilitation paired with active vagus nerve stimulation (VNS group) or rehabilitation paired with sham stimulation (control group). Randomisation was done by ResearchPoint Global (Austin, TX, USA) using SAS PROC PLAN (SAS Institute Software, Cary, NC, USA), with stratification by region (USA vs UK), age (≤30 years vs >30 years), and baseline Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score (20–35 vs 36–50). Participants, outcomes assessors, and treating therapists were masked to group assignment. All participants were implanted with a vagus nerve stimulation device. The VNS group received 0·8 mA, 100 μs, 30 Hz stimulation pulses, lasting 0·5 s. The control group received 0 mA pulses. Participants received 6 weeks of in-clinic therapy (three times per week; total of 18 sessions) followed by a home exercise programme. The primary outcome was the change in impairment measured by the FMA-UE score on the first day after completion of in-clinic therapy. FMA-UE response rates were also assessed at 90 days after in-clinic therapy (secondary endpoint). All analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT03131960.
Between Oct 2, 2017, and Sept 12, 2019, 108 participants were randomly assigned to treatment (53 to the VNS group and 55 to the control group). 106 completed the study (one patient for each group did not complete the study). On the first day after completion of in-clinic therapy, the mean FMA-UE score increased by 5·0 points (SD 4·4) in the VNS group and by 2·4 points (3·8) in the control group (between group difference 2·6, 95% CI 1·0–4·2, p=0·0014). 90 days after in-clinic therapy, a clinically meaningful response on the FMA-UE score was achieved in 23 (47%) of 53 patients in the VNS group versus 13 (24%) of 55 patients in the control group (between group difference 24%, 6–41; p=0·0098). There was one serious adverse event related to surgery (vocal cord paresis) in the control group.
Vagus nerve stimulation paired with rehabilitation is a novel potential treatment option for people with long-term moderate-to-severe arm impairment after ischaemic stroke.
MicroTransponder.
The ability of IL-2 to expand T cells with maintenance of functional activity has been translated into the first reproducible effective human cancer immunotherapies. The administration of IL-2 can ...lead to durable, complete, and apparently curative regressions in patients with metastatic melanoma and renal cancer. The growth of large numbers of tumor-infiltrating lymphocytes with in vitro anti-cancer activity in IL-2 has led to the development of cell transfer therapies that are highly effective in patients with melanoma. The genetic modification of T cells with genes encoding αβ TCRs or chimeric Ag receptors and the administration of these cells after expansion in IL-2 have extended effective cell transfer therapy to other cancer types.
Deep Learning for Image Super-Resolution: A Survey Wang, Zhihao; Chen, Jian; Hoi, Steven C. H.
IEEE transactions on pattern analysis and machine intelligence,
10/2021, Letnik:
43, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Image Super-Resolution (SR) is an important class of image processing techniqueso enhance the resolution of images and videos in computer vision. Recent years have witnessed remarkable progress of ...image super-resolution using deep learning techniques. This article aims to provide a comprehensive survey on recent advances of image super-resolution using deep learning approaches. In general, we can roughly group the existing studies of SR techniques into three major categories: supervised SR, unsupervised SR, and domain-specific SR. In addition, we also cover some other important issues, such as publicly available benchmark datasets and performance evaluation metrics. Finally, we conclude this survey by highlighting several future directions and open issues which should be further addressed by the community in the future.
Epidemiological study using national administrative data.
To evaluate the temporal trends in on-label and off-label bone morphogenetic protein (BMP) usage in primary and revision spine fusion by ...spine region and surgical approach, and nonspine applications in the United States from 2002 to 2007.
The prevalence of BMP usage for spine fusion has been on the rise, but its use has not been stratified by surgical approach, particularly for lumbar fusion where it has only been Food And Drug Administration-approved for anterior lumbar interbody fusion (ALIF).
The prevalence of BMP usage in the United States was evaluated using the Nationwide Inpatient Sample between October 1, 2002 and December 31, 2007. The Nationwide Inpatient Sample is the single largest all-payer inpatient care database in the United States. The principal procedure associated with BMP use was determined, and the prevalence of BMP use was calculated for various population subgroups.
A total of 340,251 inpatient procedures with BMP usage were identified. Between 2003 and 2007, the annual number of procedures involving BMP increased by 4.3-fold from 23,900 to 103,194. Spine fusion accounted for the vast majority (92.8%) of principal procedures with BMP. The predominant use of BMP was in primary posterior lumbar interbody fusion or transforaminal lumbar interbody fusion (PLIF/TLIF) (30.0%), followed by primary posterolateral spine fusion (20.4%), primary ALIF (16.6%), primary cervical fusions (13.6%), and primary thoracolumbar fusions (3.9%). Of primary ALIF with BMP, 19.3% did not involve the implantation of an interbody device.
At least 85% of principal procedures using BMP were for off-label applications. With uncertainty regarding the risks of using BMP in certain off-label applications, further research will be needed to better define the appropriate indications. Our study also demonstrates that disparities in the differential rates of BMP use exist in the spine fusion population.
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•Peribiliary macrophages are increased in PSC and animal models of PSC.•Both M1-like and M2-like peribiliary macrophages are increased.•Genetic and pharmacologic CCR2 inhibition ...restrains monocyte recruitment.•CCR2 inhibition reduces fibrosis and cholestasis in animal models of PSC.•These studies support the use of CCR2 inhibitors in human PSC.
Macrophages contribute to liver disease, but their role in cholestatic liver injury, including primary sclerosing cholangitis (PSC), is unclear. We tested the hypothesis that macrophages contribute to the pathogenesis of, and are therapeutic targets for, PSC.
Immune cell profile, hepatic macrophage number, localization and polarization, fibrosis, and serum markers of liver injury and cholestasis were measured in an acute (intrabiliary injection of the inhibitor of apoptosis antagonist BV6) and chronic (Mdr2−/− mice) mouse model of sclerosing cholangitis (SC). Selected observations were confirmed in liver specimens from patients with PSC. Because of the known role of the CCR2/CCL2 axis in monocyte/macrophage chemotaxis, therapeutic effects of the CCR2/5 antagonist cenicriviroc (CVC), or genetic deletion of CCR2 (Ccr2−/− mice) were determined in BV6-injected mice.
We found increased peribiliary pro-inflammatory (M1-like) and alternatively-activated (M2-like) monocyte-derived macrophages in PSC compared to normal livers. In both SC models, genetic profiling of liver immune cells identified a predominance of monocytes/macrophages; immunohistochemistry confirmed peribiliary monocyte-derived macrophage recruitment (M1>M2-polarized), which paralleled injury onset and was reversed upon resolution in acute SC mice. PSC, senescent and BV6-treated human cholangiocytes released monocyte chemoattractants (CCL2, IL-8) and macrophage-activating factors in vitro. Pharmacological inhibition of monocyte recruitment by CVC treatment or CCR2 genetic deletion attenuated macrophage accumulation, liver injury and fibrosis in acute SC.
Peribiliary recruited macrophages are a feature of both PSC and acute and chronic murine SC models. Pharmacologic and genetic inhibition of peribiliary macrophage recruitment decreases liver injury and fibrosis in mouse SC. These observations suggest monocyte-derived macrophages contribute to the development of SC in mice and in PSC pathogenesis, and support their potential as a therapeutic target.
Primary sclerosing cholangitis (PSC) is an inflammatory liver disease which often progresses to liver failure. The cause of the disease is unclear and therapeutic options are limited. Therefore, we explored the role of white blood cells termed macrophages in PSC given their frequent contribution to other human inflammatory diseases. Our results implicate macrophages in PSC and PSC-like diseases in mice. More importantly, we found that pharmacologic inhibition of macrophage recruitment to the liver reduces PSC-like liver injury in the mouse. These exciting observations highlight potential new strategies to treat PSC.
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