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We investigate the solvability of a general class of mixed Hessian type equations on compact Kähler manifolds. Based on an observation in Guan and Zhang [Pure Appl. Math. Q. 17 (2021), pp. 865–907], the mixed Hessian equations can be rewritten as elliptic and concave equations which satisfy the general framework in Székelyhidi [J. Differential Geom. 109 (2018), pp. 337–378] and Phong and Tô [Ann. Sci. Éc. Norm. Supér. (4) 54 (2021), pp. 793–829] except one condition. We notice that the absence of this condition can be overcome by using the particular structure of the mixed Hessian equations. As an application, the solvability of the deformed Hermitian Yang-Mills equations in dimension three was also studied. [ABSTRACT FROM AUTHOR]

Prevention for contrast-induced nephropathy (CIN) is limited by the lack of a single predictor. As activin A is upregulated in heart failure and chronic kidney disease, we aimed to clarify the association between activin A levels and renal outcomes after coronary angiography (CAG). This prospective observational study included 267 patients who received CAG between 2009 and 2015. CIN was defined as elevation of serum creatinine to >0.5 mg/dL or to >25% above baseline within 48 hours after CAG. During follow-up, laboratory parameters were measured every 3–6 months. Renal decline was defined as>2-fold increase in serum creatinine or initiation of dialysis. The patients were stratified into tertiles according to serum activin A levels at baseline. High activin A tertile was significantly associated more CIN and renal function decline compared to low activin A tertile (all p < 0.001). After adjusting potential confounding factors, high serum activin A tertiles was associated to CIN (Odds ratio 4.49, 95% CI 1.07–18.86, p = 0.040) and renal function decline (Hazard ratio 4.49, 95% CI 1.27–11.41, p = 0.017) after CAG. [ABSTRACT FROM AUTHOR]

Abstract Toluene, a commonly used organic solvent, produces a variety of behavioral disturbances in both humans and animals comparable to noncompetitive N-methyl-D-aspartate receptor (NMDARs) antagonists, such as phencyclidine (PCP). N-acetylcysteine (NAC) is capable of reversing the psychotomimetic effects of PCP via activation of cystine-glutamate antiporters (xCT). The present study examined whether NAC is capable of attenuating the toluene-induced brain stimulation reward enhancement and behavioral manifestations. Male mice received various doses of NAC prior to toluene exposure for assessment of intracranial self-stimulation (ICSS) thresholds, rotarod test, novel object recognition task and social interaction test. NAC ameliorated the lowering of ICSS thresholds, motor incoordination, object recognition memory impairments and social withdrawal induced by toluene. Furthermore, the capacity of NAC to ameliorate acute toluene-induced deficits in object recognition and social interaction was blocked by the xCT inhibitor (S)-4-carboxyphenylglycine and the mGluR2/3 antagonist LY341495. These results indicate that NAC could prevent toluene-induced reward facilitation and behavioral disturbances and its beneficial effects, at least for cognitive function and social interaction, are associated with activation of the xCT and mGluR2/3. These findings show the potential promise for NAC to treat toluene dependence and to prevent toluene intoxication caused by unintentional or deliberate inhalation. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia, a gram-negative bacterium, has increasingly emerged as an important nosocomial pathogen. It is well-known for resistance to a variety of antimicrobial agents including cationic antimicrobial polypeptides (CAPs). Resistance to polymyxin B, a kind of CAPs, is known to be controlled by the two-component system PhoPQ. To unravel the role of PhoPQ in polymyxin B resistance of S. maltophilia, a phoP mutant was constructed. We found MICs of polymyxin B, chloramphenicol, ampicillin, gentamicin, kanamycin, streptomycin and spectinomycin decreased 2–64 fold in the phoP mutant. Complementation of the phoP mutant by the wild-type phoP gene restored all of the MICs to the wild type levels. Expression of PhoP was shown to be autoregulated and responsive to Mg2+ levels. The polymyxin B and gentamicin killing tests indicated that pretreatment of low Mg2+ can protect the wild-type S. maltophilia from killing but not phoP mutant. Interestingly, we found phoP mutant had a decrease in expression of SmeZ, an efflux transporter protein for aminoglycosides in S. maltophilia. Moreover, phoP mutant showed increased permeability in the cell membrane relative to the wild-type. In summary, we demonstrated the two-component regulator PhoP of S. maltophilia is involved in antimicrobial susceptibilities and low Mg2+ serves as a signal for triggering the pathway. Both the alteration in membrane permeability and downregulation of SmeZ efflux transporter in the phoP mutant contributed to the increased drug susceptibilities of S. maltophilia, in particular for aminoglycosides. This is the first report to describe the role of the Mg2+-sensing PhoP signaling pathway of S. maltophilia in regulation of the SmeZ efflux transporter and in antimicrobial susceptibilities. This study suggests PhoPQ TCS may serve as a target for development of antimicrobial agents against multidrug-resistant S. maltophilia. [ABSTRACT FROM AUTHOR]

Using the standard methods for the determination of approximate analysis, ultimate analysis, chemical composition, heating value and inorganic elements, the thermochemical properties of three air-dried napier grass samples have been analyzed in the present study. The results showed that thermochemical characteristics of all samples were found to be similar. The energy grass obviously comprised a large percentage of volatile matter at 72.72 ± 0.73 wt%. The molar rations of hydrogen to carbon (H/C) ranging from 1.60 to 1.73 are close to those of cellulose (H/C = 1.67) and hemicellulose (H/C = 1.6), which was in accordance with its higher heating value (16.3 MJ/kg). However, the contents of nitrogen and chlorine were significantly high, suggesting that the emissions of acidic gases and chlorinated organics from biomass-to-heat facilities will arouse concern. Based on the 100,000 ha fallow farmland cultivated into the energy grass in Taiwan and the Tier 1 method recommended by the Intergovernmental Panel on Climate Change, the environmental benefit of mitigating CO2emissions and the economic benefit of oil equivalent were calculated to be around 5.0 × 106Gg/yr and 1.1 × 107barrels/yr, respectively. [ABSTRACT FROM AUTHOR]

Proteus mirabilis isolates commonly have decreased susceptibility to imipenem. Previously, we found P. mirabilis hfq mutant was more resistant to imipenem and an outer membrane protein (OMP) could be involved. Therefore, we investigated the role of this OMP in carbapenem susceptibility. By SDS-PAGE we found this OMP (named ImpR) was increased in hfq mutant and LC-MS/MS revealed it to be the homologue of Salmonella YbfM, which is a porin for chitobiose and subject to MicM (a small RNA) regulation. We demonstrated that ImpR overexpression resulted in increased carbapenem MICs in the laboratory strain and clinical isolates. Chitobiose induced expression of chb (a chitobiose utilization operon). Real-time RT-PCR and SDS-PAGE were performed to elucidate the relationship of hfq, impR, chb and MicM in P. mirabilis. We found MicM RNA was decreased in hfq mutant and chbBC-intergenic region (chbBC-IGR) overexpression strain (chbIGRov), while impR mRNA was increased in hfq mutant, micM mutant and chbIGRov strain. In addition, mutation of hfq or micM and overexpression of chbBC-IGR increased ImpR protein level. Accordingly, chitobiose made wild-type have higher levels of ImpR protein and are more resistant to carbapenems. Hfq- and MicM-complemented strains restored wild-type MICs. Mutation of both impR and hfq eliminated the increase in carbapenem MICs observed in hfq mutant and ImpR-complementation of hfq/impR double mutant resulted in MICs as hfq mutant, indicating that the ImpR-dependent decreased carbapenem susceptibility of hfq mutant. These indicate MicM was antisense to impR mRNA and was negatively-regulated by chbBC-IGR. Together, overexpression of ImpR contributed to the decreased carbapenem susceptibility in P. mirabilis. [ABSTRACT FROM AUTHOR]

Abstract: Threshold group testing introduced by Damaschke (2006) is a generalization of classical group testing where a group test yields a positive (negative) outcome if it contains at least (at most ) positive items, and an arbitrary outcome for otherwise. Motivated by applications to DNA sequencing, group testing with consecutive positives has been proposed by Balding and Torney (1997) and Colbourn (1999) where items are linearly ordered and up to positive items are consecutive in the order. In this paper, we introduce threshold-constrained group tests to group testing with consecutive positives. We prove that all positive items can be identified in tests for the gap-free case ( ) while the information-theoretic lower bound is when and for the best adaptive algorithm provided by Juan and Chang (2008) takes at most tests. We further show that the case with a gap ( ) can be dealt with by the subroutines used to conquer the gap-free case. [Copyright &y& Elsevier]

An amendment to this paper has been published and can be accessed via a link at the top of the paper. [ABSTRACT FROM AUTHOR]

Inherently, piezoelectric actuator is one of the devices equipped with the micrometer positioning capability and characterized by small size, fast response, high stiffness, and large blocking force. These advantages give piezoelectric actuator the possibility of being high-accuracy industrial machineries. However, factors of nonlinear hysteresis, modeling uncertainties, and environmental disturbances result in unacceptable positioning errors and greatly increase the control difficulties. In this paper, a hybrid nonlinear robust control design that integrates a feedback linearization control method and a robust compensator is proposed. It aims to eliminate above-mentioned impacts and tackle the micrometer (μm) positioning design of piezoelectric actuators. The feedback linearization controller is developed for converging of positioning errors exponentially. The robust compensator is used to mitigate the total impact of hysteresis, modeling uncertainties and environmental disturbances and carry out the fine tuning of positioning errors to zero. Simulation results and practical tests reveal that the controlled piezoelectric actuator reaches 1 μm positioning accuracy, and the proposed robust control law delivers promising positioning performance under impacts of hysteresis, modeling uncertainties and environmental disturbances. [ABSTRACT FROM AUTHOR]

Background: Ruling out obstructive coronary artery disease (CAD) using coronary computed tomography angiography (CCTA) is time‐consuming and challenging. This study developed a deep learning (DL) model to assist in detecting obstructive CAD on CCTA to streamline workflows. Methods: In total, 2929 DICOM files and 7945 labels were extracted from curved planar reformatted CCTA images. A modified Inception V3 model was adopted. To validate the artificial intelligence (AI) model, two cardiologists labelled and adjudicated the classification of coronary stenosis on CCTA. The model was trained to differentiate the coronary artery into binary stenosis classifications <50% and ≥50% stenosis. Using the quantitative coronary angiography (QCA) consensus results as a reference standard, the performance of the AI model and CCTA radiology readers was compared by calculating Cohen's kappa coefficients at patient and vessel levels. The net reclassification index was used to evaluate the net benefit of the DL model. Results: The diagnostic accuracy of the AI model was 92.3% and 88.4% at the patient and vessel levels, respectively. Compared with CCTA radiology readers, the AI model had a better agreement for binary stenosis classification at both patient and vessel levels (Cohen kappa coefficient:.79 vs..39 and.77 vs..40, p <.0001). The AI model also exhibited significantly improved model discrimination and reclassification (Net reclassification index =.350; Z = 4.194; p <.001). Conclusions: The developed AI model identified obstructive CAD, and the model results correlated well with QCA results. Incorporating the model into the reporting system of CCTA may improve workflows. [ABSTRACT FROM AUTHOR]

The currently observed developments in Artificial Intelligence (AI) and its influence on different types of industries mean that human-robot cooperation is of special importance. Various types of robots have been applied to the so-called field of Edutainment, i.e., the field that combines education with entertainment. This paper introduces a novel fuzzy-based system for a human-robot cooperative Edutainment. This co-learning system includes a brain-computer interface (BCI) ontology model and a Fuzzy Markup Language (FML)-based Reinforcement Learning Agent (FRL-Agent). The proposed FRL-Agent is composed of (1) a human learning agent, (2) a robotic teaching agent, (3) a Bayesian estimation agent, (4) a robotic BCI agent, (5) a fuzzy machine learning agent, and (6) a fuzzy BCI ontology. In order to verify the effectiveness of the proposed system, the FRL-Agent is used as a robot teacher in a number of elementary schools, junior high schools, and at a university to allow robot teachers and students to learn together in the classroom. The participated students use handheld devices to indirectly or directly interact with the robot teachers to learn English. Additionally, a number of university students wear a commercial EEG device with eight electrode channels to learn English and listen to music. In the experiments, the robotic BCI agent analyzes the collected signals from the EEG device and transforms them into five physiological indices when the students are learning or listening. The Bayesian estimation agent and fuzzy machine learning agent optimize the parameters of the FRL agent and store them in the fuzzy BCI ontology. The experimental results show that the robot teachers motivate students to learn and stimulate their progress. The fuzzy machine learning agent is able to predict the five physiological indices based on the eight-channel EEG data and the trained model. In addition, we also train the model to predict the other students' feelings based on the analyzed physiological indices and labeled feelings. The FRL agent is able to provide personalized learning content based on the developed human and robot cooperative edutainment approaches. To our knowledge, the FRL agent has not applied to the teaching fields such as elementary schools before and it opens up a promising new line of research in human and robot co-learning. In the future, we hope the FRL agent will solve such an existing problem in the classroom that the high-performing students feel the learning contents are too simple to motivate their learning or the low-performing students are unable to keep up with the learning progress to choose to give up learning. [ABSTRACT FROM AUTHOR]

Insulin resistance (IR) is associated with cardiovascular disease in non-diabetic patients. The triglyceride-glucose (TyG) index, incorporating serum glucose and insulin concentrations, is a surrogate insulin resistance marker. We investigated its association with obstructive coronary artery disease (CAD) and sex differences therein. Patients with stable angina pectoris requiring invasive coronary angiography between January 2010 and December 2018 were enrolled. They were divided into two groups according to TyG index. Two interventional cardiologists diagnosed obstructive CAD by angiography review. Demographic characteristics and clinical outcomes were compared between groups. Relative to lower index, patients with higher (≥ 8.60) TyG index had higher BMIs and more prevalent hypertension, diabetes, and elevated lipid profiles [total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), fasting plasma glucose (FPG)]. Higher TyG index increased women's obstructive CAD risk after multivariate adjustment (adjusted odds ratio (aOR) 2.15, 95% confidence interval (95% CI) 1.08–4.26, p = 0.02) in non-diabetic populations compared with men. No sex difference was found for diabetic patients. Higher TyG index significantly increased the obstructive CAD risk, overall and for non-diabetic women. Larger-scale studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

NORYL™ SA9000 resin is a commercialized telechelic PPO oligomer with phenyl methacrylate end groups. However, neat SA9000 thermoset is brittle after thermally curing. To find a method to enhance the toughness of neat SA9000 thermoset, three model reactions are designed. The first one is the 4-dimethylaminopyridine (DMAP)-catalyzed homopolymerization of glycidyl phenyl ether. The second one is the reaction of glycidyl phenyl ether and phenyl acetate in the presence of DMAP. The third one is the reaction of glycidyl phenyl ether and phenyl methacrylate in the presence DMAP. Through 1 H NMR analysis, the product is 1,3-diphenoxy-2-acetoxypropane and 1,3-diphenoxy-2-methacryalatepropane, respectively, for model reactions 2 and 3. According to the structure of products, we identify the reaction mechanisms between the phenyl acetate and epoxy, and between the phenyl methacrylate and epoxy. Based on the knowledge, we used two commercialized epoxy resin (DGEBA and HP7200) to copolymerize with SA9000 in the presence of DMAP and tert -butyl cumyl peroxide (TBCP). The toughness of the thermosets are significantly improved, which means the brittle drawback of neat SA9000 thermoset has been solved. Homogeneous, flexible thermosetting films with high glass transition temperatures, low dielectric constants, and extremely low dissipation factors are obtained. [ABSTRACT FROM AUTHOR]

Aims: Trimethylamine-N-oxide (TMAO) is a metabolite generated from dietary choline, betaine, and l-carnitine, after their oxidization in the liver. TMAO has been identified as a novel independent risk factor for atherosclerosis through the induction of vascular inflammation. However, the effect of TMAO on neointimal formation in response to vascular injury remains unclear. Results: This study was conducted using a murine model of acutely disturbed flow-induced atherosclerosis induced by partial carotid artery ligation. 3,3-Dimethyl-1-butanol (DMB) was used to reduce TMAO concentrations. Wild-type mice were divided into four groups [regular diet, high-TMAO diet, high-choline diet, and high-choline diet+DMB] to investigate the effects of TMAO elevation and its inhibition by DMB. Mice fed high-TMAO and high-choline diets had significantly enhanced neointimal hyperplasia and advanced plaques, elevated arterial elastin fragmentation, increased macrophage infiltration and inflammatory cytokine secretion, and enhanced activation of nuclear factor (NF)-κB, the NLRP3 inflammasome, and endoplasmic reticulum (ER) stress relative to the control group. Mice fed high-choline diets with DMB treatment exhibited attenuated flow-induced atherosclerosis, inflammasome expression, ER stress, and reactive oxygen species expression. Human aortic smooth muscle cells (HASMCs) were used to investigate the mechanism of TMAO-induced injury. The HASMCs were treated with TMAO with or without an ER stress inhibitor to determine whether inhibition of ER stress modulates the TMAO-induced inflammatory response. Innovation: This study demonstrates that TMAO regulates vascular remodeling via ER stress. Conclusion: Our findings demonstrate that TMAO elevation promotes disturbed flow-induced atherosclerosis and that DMB administration mitigates vascular remodeling, suggesting a rationale for a TMAO-targeted strategy for the treatment of atherosclerosis. Antioxid. Redox Signal. 38, 215–233. [ABSTRACT FROM AUTHOR]

Background: The results of the recent Amsterdam Investigator-Initiated Absorb Strategy All-Comers trial showed that the predilatation, sizing, and postdilatation (PSP) technique did not lower the long-term rates of scaffold thrombosis and adverse events. We evaluated the impact of aggressive PSP bioresorbable vascular scaffold (BRS) implantation on the short- and long-term clinical outcomes. Methods: From June 2014 to December 2016, 150 patients with BRS implantation were enrolled and received successful percutaneous coronary intervention (PCI), of whom 104 received aggressive PSP technique (high-pressure predilatation and lesion preparation in addition to the traditional PSP technique). Short- and long-term outcomes were compared. Results: All patients underwent successful PCI and BRS implantation with final Thrombolysis in Myocardial Infarction grade 3 flow. The baseline and procedure characteristics were similar in both groups. Debulking techniques were used in 13 (8.7%) patients. Intracoronary imaging modalities were used in 73 (48.7%) patients. After BRS implantation, no adverse events were observed within 30 days in both groups. During the mean follow-up period of 2.98 ± 0.77 years, 12 (8.0%) patients experienced major adverse cardiovascular events (MACEs), including one cardiovascular death (0.6%), three nonfatal myocardial infarction (2.0 %), and 11 target-vessel revascularization (7.3 %). Multivariate Cox regression analysis showed that aggressive PSP remained an independent protective factor for MACEs. Moreover, the use of intracoronary imaging and rotablation atherectomy was associated with better clinical outcomes. Conclusion: Lesion preparation by aggressive PSP in BRS implantation was associated with better long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

A cover-free family is a family of subsets of a finite set in which no one is covered by the union of r others. We study a variation of cover-free family: A binary matrix is ( r, w] -consecutive-disjunct if for any w cyclically consecutive columns and another r cyclically consecutive columns , there exists one row intersecting but none of . In group testing, the goal is to determine a small subset of positive items D in a large population by group tests. By applying consecutive-disjunct matrices, we solve threshold group testing of consecutive positives in group tests nonadaptively, and the decoding complexity is where u is a threshold parameter in threshold group testing and it is assumed that | D|≤ d and . Meanwhile, we obtain that for group testing of consecutive positives, all positives can be identified in group tests nonadaptively and the decoding complexity is . [ABSTRACT FROM AUTHOR]

Background: Obesity is associated with metabolic syndrome which increases further risk of coronary artery disease and adverse cardiovascular events. Impact of body mass index (BMI) on long‐term outcome in patients with coronary chronic total occlusion (CTO) is less clear. Method and results: From January 2005 to November 2020, a total of 1301 patients with coronary angiographic confirmed CTO were enrolled in our study. Patients were divided into two groups: low BMI group: 18–24.99 kg/m2 and high BMI group ≥25 kg/m2. Clinical outcomes were 3‐year all‐cause mortality, 3‐year cardiovascular mortality and 3‐year non‐fatal myocardial infarct. During the 3‐year follow‐up period, all‐cause mortality was significantly higher in patients with low BMI group compared to those in high BMI groups (14% vs. 6%, p =.0001). Kaplan–Meier analysis showed patients with high BMI groups had significant better survival compared with those in low BMI group (p =.0001). In multivariate analysis, higher BMI was independently associated with decreased risk of 3‐year all‐cause mortality (Hazard ratio [HR]: 0.534; 95% confidence interval [CI]: 0.349–0.819, p =.004) after controlling for age, renal function, prior history of stroke, coronary artery bypass graft, co‐morbidities with peripheral arterial disease, heart failure and revascularization status for CTO. In propensity‐matched multivariate analysis, high BMI remained a significant predictor of 3‐year all‐cause mortality (HR, 0.525; 95% CI, 0.346–0.795, p =.002). Conclusion: Higher BMI was associated with better long‐term outcome in patients with coronary CTO. [ABSTRACT FROM AUTHOR]

Hfq is a bacterial RNA chaperone involved in the riboregulation of diverse genes via small noncoding RNAs. Here, we show that Hfq is critical for the uropathogenic Proteus mirabilis to effectively colonize the bladder and kidneys in a murine urinary tract infection (UTI) model and to establish burned wound infection of the rats. In this regard, we found the hfq mutant induced higher IL-8 and MIF levels of uroepithelial cells and displayed reduced intra-macrophage survival. The loss of hfq affected bacterial abilities to handle H2O2 and osmotic pressures and to grow at 50°C. Relative to wild-type, the hfq mutant had reduced motility, fewer flagella and less hemolysin expression and was less prone to form biofilm and to adhere to and invade uroepithelial cells. The MR/P fimbrial operon was almost switched to the off phase in the hfq mutant. In addition, we found the hfq mutant exhibited an altered outer membrane profile and had higher RpoE expression, which indicates the hfq mutant may encounter increased envelope stress. With the notion of envelope disturbance in the hfq mutant, we found increased membrane permeability and antibiotic susceptibilities in the hfq mutant. Finally, we showed that Hfq positively regulated the RpoS level and tolerance to H2O2 in the stationary phase seemed largely mediated through the Hfq-dependent RpoS expression. Together, our data indicate that Hfq plays a critical role in P. mirabilis to establish UTIs by modulating stress responses, surface structures and virulence factors. This study suggests Hfq may serve as a scaffold molecule for development of novel anti-P. mirabilis drugs and P. mirabilis hfq mutant is a vaccine candidate for preventing UTIs. [ABSTRACT FROM AUTHOR]

Abstract: In this work, the yield and chemical characterization of pyrolytic products from the induction-heating pyrolysis of napier grass, one of potential energy grasses, have been studied at the specified conditions. Although the yields of bio-oil and char were a little related to the feedstock size less than 1mm, it was observed that the yield of liquid products increased with heating rates ranging from 50 to 150°C/min. Using the gas chromatography–mass spectrometry (GC–MS), the analytical results showed that the bio-oils were acidic and dark brown liquids with complex mixtures of organic compounds, including acetic acid and a large variety of oxygenated and nitrogenated compounds such as phenols, pyridines, pyrazoles, imidazoles, amines, and ketones. These organic hydrocarbons should be derived from the biopolymer textures of napier grass. On the other hand, the non-condensed devolatilization fractions were primarily composed of 3-methyl-1,2-butadiene, furans and one-ring aromatic compounds. [Copyright &y& Elsevier]

Abstract: Silicon (Si) exhibits promising prospects due to its largest capacity among all known anode materials of lithium ion batteries. Carbon-coated silicon/graphite composites with titanium nitride (TiN) additives were synthesized from pyrolyzing phenolic resin. Pyrolyzed carbon acts as a mechanical and electrochemical buffer that enhances cycling performance and the morphology of composites. In addition, inactive TiN serves as a buffer matrix that efficiently prevents Si from cracking during the charging/discharging process and enhances the electrochemical properties of composites. Optimal composition of the composite, 45wt.% phenolic resin, 25wt.% graphite, 10wt.% silicon and 20wt.% TiN, exhibits a charging capacity about 650mAh/g in the first cycling test and 443mAh/g after seven cycling tests and maintains a higher coulombic efficiency. [Copyright &y& Elsevier]

Background: Trimethylamine N-oxide (TMAO) is a microbiota-derived metabolite, which is linked to vascular inflammation and atherosclerosis in cardiovascular (CV) diseases. But its effect in infectious diseases remains unclear. We conducted a single-center prospective study to investigate association of TMAO with in-hospital mortality in septic patients admitted to an intensive care unit (ICU). Methods: Totally 95 septic, mechanically ventilated patients were enrolled. Blood samples were obtained within 24 h after ICU admission, and plasma TMAO concentrations were determined. Septic patients were grouped into tertiles according to TMAO concentration. The primary outcome was in-hospital death, which further classified as CV and non-CV death. Besides, we also compared the TMAO concentrations of septic patients with 129 non-septic patients who were admitted for elective coronary angiography (CAG). Results: Septic patients had significantly lower plasma TMAO levels than did subjects admitted for CAG (1.0 vs. 3.0 μmol/L, p < 0.001). Septic patients in the lowest TMAO tertile (< 0.4 μmol/L) had poorer nutrition status and were given longer antibiotic courses before ICU admission. Circulating TMAO levels correlated positively with daily energy intake, the albumin and prealbumin concentration. Compared with those in the highest TMAO tertile, septic patients in the lowest TMAO tertile were at greater risk of non-CV death (hazard ratio 2.51, 95% confidence interval 1.21–5.24, p = 0.014). However, TMAO concentration was no longer an independent predictor for non-CV death after adjustment for disease severity and nutritional status. Conclusion: Plasma TMAO concentration was inversely associated with non-CV death among extremely ill septic patients, which could be characterized as TMAO paradox. For septic patients, the impact of malnutrition reflected by circulating TMAO levels was greater than its pro-inflammatory nature. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is a known risk factor for cardiovascular disease (CVD) in non-diabetic patients through the association of hyperglycemia or associated metabolic factors. The triglyceride glucose (TyG) index, which was defined by incorporating serum glucose and insulin concentrations, was developed as a surrogate marker of insulin resistance. We aimed to investigate the association between the TyG index and the early phase of subclinical atherosclerosis (SA) between the sexes. Methods: The I-Lan Longitudinal Aging Study (ILAS) enrolled 1457 subjects aged 50–80 years. For each subject, demographic data and the TyG index {ln[fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)]/2} were obtained. Patients were further stratified according to sex and the 50th percentile of the TyG index (≥ 8.55 or < 8.55). SA was defined as the mean carotid intima-media thickness (cIMT) at the 75th percentile of the entire cohort. Demographic characteristics and the presence of SA were compared between the groups. Logistic regression analysis was performed to assess the relationship between TyG index and SA. Results: Patients with a higher TyG index (≥ 8.55) had a higher body mass index (BMI), hypertension (HTN) and diabetes mellitus (DM). They had higher lipid profiles, including total cholesterol (T-Chol) and low-density lipoprotein (LDL), compared to those with a lower TyG index (< 8.55). Gender disparity was observed in non-diabetic women who had a significantly higher prevalence of SA in the high TyG index group than in the low TyG index group. In multivariate logistic regression analysis, a high TyG index was independently associated with SA in non-diabetic women after adjusting for traditional risk factors [adjusted odds ratio (OR): 1.510, 95% CI 1.010–2.257, p = 0.045] but not in non-diabetic men. The TyG index was not associated with the presence of SA in diabetic patients, irrespective of sex. Conclusion: A high TyG index was significantly associated with SA and gender disparity in non-diabetic patients. This result may highlight the need for a sex-specific risk management strategy to prevent atherosclerosis. [ABSTRACT FROM AUTHOR]

Activin A, a cytokine belonging to the transforming growth factor-β family, has been shown to play pivotal roles in tissue remodeling after renal injury and is present in elevated levels in diabetic patients. However, the association between activin A and albuminuria remains unclear. We aimed to evaluate their association by using cross-sectional data from community-dwelling middle-aged and older adults in Taiwan. We assessed 466 participants (67% male; mean age 71 ± 13 years) from the I-Lan Longitudinal Aging study for whom data pertaining to serum activin A level and urine albumin-to-creatinine ratio (UACR) were available. Of these, 323 (69%) had normal albuminuria, 123 (26%) had microalbuminuria, and 20 (4%) had overt albuminuria. Patients with overt albuminuria and microalbuminuria had significantly higher activin A concentrations than those in the normal albuminuria group (p < 0.001). Circulating activin A was significantly correlated with multiple risk factors, including higher systolic blood pressure and higher UACR. Univariate and multivariate results indicated that activin A level was an independent variable for albuminuria. The cutoff value of 602 pg/mL of activin A demonstrated a sensitivity of 70.6% and specificity of 75.7% (AUC 0.774) in diagnosing overt albuminuria. In conclusion, middle-aged and older adults with elevated activin A levels were associated with a higher incidence of albuminuria. [ABSTRACT FROM AUTHOR]

Background: Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods: From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results: Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion: Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission. [ABSTRACT FROM AUTHOR]

Background: β-blockers may protect against catecholaminergic myocardial injury in critically ill patients. Long-term β-blocker users are known to have lower lactate concentrations and favorable sepsis outcomes. However, the effects of β1-selective and nonselective β-blockers on sepsis outcomes have not been compared. This study was conducted to investigate the impacts of different β-blocker classes on the mortality rate in septic patients. Methods: We retrospectively screened 2678 patients admitted to the medical or surgical intensive care unit (ICU) between December 2015 and July 2017. Data from patients who met the Sepsis-3 criteria at ICU admission were included in the analysis. Premorbid β-blocker exposure was defined as the prescription of any β-blocker for at least 1 month. Bisoprolol, metoprolol, and atenolol were classified as β1-selective β-blockers, and others were classified as nonselective β-blockers. All patients were followed for 28 days or until death. Results: Among 1262 septic patients, 209 (16.6%) patients were long-term β-blocker users. Patients with premorbid β-blocker exposure had lower heart rates, initial lactate concentrations, and ICU mortality. After adjustment for disease severity, comorbidities, blood pressure, heart rate, and laboratory data, reduced ICU mortality was associated with premorbid β1-selective [adjusted hazard ratio, 0.40; 95% confidence interval (CI), 0.18–0.92; P = 0.030], but not non-selective β-blocker use. Conclusion: Premorbid β1-selective, but not non-selective, β-blocker use was associated with improved mortality in septic patients. This finding supports the protective effect of β1-selective β-blockers in septic patients. Prospective studies are needed to confirm it. [ABSTRACT FROM AUTHOR]

Aims: Atrial fibrillation (AF) is a frequent comorbidity among patients with severe mitral regurgitation (MR). Direct current (DC) cardioversion is one of the strategies for rhythm control. However, the safety and feasibility of immediate DC cardioversion after MitraClip are not elucidated. Methods and Results: In this study, patients with symptomatic severe MR who underwent MitraClip were included. After fixing the MR, synchronized DC cardioversion was attempted for those with AF. A total of consecutive 60 patients, 36 subjects (60%), comorbid with AF. DC cardioversion was performed in 30 patients (mean age of 76.0 ± 9.3 years), and the successful conversion was achieved in 15 patients (50%). There was no any adverse event related to the cardioversion. Subjects with sustained conversion to SR experienced significant improvement in 6MWT (failed: 285 ± 110‐308 ± 135 m, P =.278; successful: 269 ± 109 m‐328 ± 78, P =.047) and reduction in NT‐proBNP level (failed: 4411 ± 7401‐3296 ± 4299 ng/mL, P =.217; successful: 4094 ± 2735‐2353 ± 2856 ng/mL, P =.026) at 1 month. Conclusions: Direct current cardioversion seemed to be safe and feasible immediately after the transcatheter edge‐to‐edge mitral valve repairs. Subjects who maintain SR experienced better functional improvement. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. Methods and results: From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1–10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (hazard ratio (HR): 0.593, 95% confidence interval (CI) 0.349–0.008, P: 0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI 0.156–0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI 0.095–0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn't improve outcomes in non-diabetics (all P > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI 0.125–0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI 0.142–0.851, P: 0.021). Conclusions: Successful CTO revascularization in diabetes may be related to better long term survival benefit but not in non-diabetic population. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate efficacy of antithrombotic agents in critically ill patients with elevated troponin I level during intensive care unit (ICU) admission. Methods and results: It was a retrospective observational study which was conducted in a tertiary teaching hospital in Taipei, Taiwan. All patients hospitalized in ICU for >3 days and with available serum troponin I data from December 2015 to July 2017 were included. Patients with definite diagnosis of acute myocardial infarction (AMI) were excluded. We divided patients with troponin I elevation into three groups; no prescription, chronic prescription and new prescription of antithrombotic agents during ICU admission. We defined new prescription when patients were on antithrombotic agents, including antiplatelet agents, direct oral anticoagulants, and warfarin after troponin I was found to be elevated at ICU admission and chronic prescription, if antithrombotic agents were on medication list more than 30 days before ICU admission. Primary outcomes were 30-day and one-year all-cause mortality. Of 597 subjects who met inclusion criteria, 407 (68%) patients had elevated troponin I (>0.1 ng/mL) on ICU admission. These patients had increased 30-day [hazard ratio (HR), 1.679; 95% confidence interval (CI), 1.132–2.491; p = 0.009] and one-year (HR, 1.568; 95% CI, 1.180–2.083; p = 0.002) all-cause mortality compared with those without elevated troponin I. In patients with elevated troponin I, there was no significant difference of 30-day all-cause mortality among three groups (p = 0.051) whereas patients on chronic prescription showed significant survival benefit in one-year all-cause mortality when compared to those without or with new prescription (p = 0.008). Conclusions: In critically ill patients, elevated troponin I in the absence of AMI was associated with poor prognosis. Newly prescribed antithrombotic agents in ICU didn't reveal the difference in short and long-term prognosis while chronic antithrombotic agent use was associated with better one-year survival rate, suggesting that these drugs play a protective role in this high-risk population. [ABSTRACT FROM AUTHOR]

To evaluate the risk of coronary artery disease (CAD), the traditional approach involves assessing the patient's symptoms, traditional cardiovascular risk factors (CVRFs), and a 12-lead electrocardiogram (ECG). However, currently, there are no established criteria for interpreting an ECG to diagnose CAD. Therefore, we sought to develop an artificial intelligence (AI)-enabled ECG model to assist in identifying patients with CAD. In this study, we included patients who underwent coronary angiography (CAG) at a single center between 2017 and 2019. Preprocedural 12-lead ECG performed within 24 h was obtained. Obstructive CAD was defined as ≥ 50% diameter stenosis. Using age, gender and ECG data, we developed stacking models using both deep learning and machine learning. Then we compared the performance of our models with CVRFs and with cardiologists' ECG interpretation. Additionally, we validated our model on an external cohort from a different hospital. We included 4951 patients with a mean age of 65.5 ± 12.5 years, of whom 67.0% were men. Based on CAG, obstructive CAD was confirmed in 2637 patients (53.2%). Our best AI model demonstrated comparable performance to CVRFs in predicting CAD, with an AUC of 0.70 (95% CI: 0.66–0.75) compared to 0.71 (95% CI: 0.66–0.76). The sensitivity and specificity of the AI model were 0.75 and 0.54, respectively, while those of CVRFs were 0.67 and 0.63. Compared to cardiologists, the AI model showed better performance with an F1 score of 0.68 vs 0.41. The external validation showed generally consistent diagnostic findings, although there was a slightly lower level of agreement observed in the external cohort. Incorporating ECG and CVRFs improved the AUC to 0.72. Our study suggests that an AI-enabled ECG model can assist in identifying patients with obstructive CAD, with diagnostic performance similar to that of the traditional approach based on CVRFs. This model could serve as a useful clinical tool in an outpatient setting to identify patients who require further diagnostic tests. [Display omitted] • We built an AI-enabled ECG stacking model to assist in identifying obstructive CAD. • Our model had comparable diagnostic performance to the traditional risk factor-based approach for identifying obstructive CAD. • This model could be readily used in outpatient settings as a clinical tool to assist in patient diagnosis. [ABSTRACT FROM AUTHOR]

Bacterial sensing of environmental signals through the two-component system (TCS) plays a key role in modulating virulence. In the search for the host hormone-sensing TCS, we identified a conserved qseEGF locus following glmY, a small RNA (sRNA) gene in uropathogenic Proteus mirabilis. Genes of glmY-qseE-qseG-qseF constitute an operon, and QseF binding sites were found in the glmY promoter region. Deletion of glmY or qseF resulted in reduced swarming motility and swarming-related phenotypes relative to the wild-type and the respective complemented strains. The qseF mutant had decreased glmYqseEGF promoter activity. Both glmY and qseF mutants exhibited decreased flhDC promoter activity and mRNA level, while increased rcsB mRNA level was observed in both mutants. Prediction by TargetRNA2 revealed cheA as the target of GlmY. Then, construction of the translational fusions containing various lengths of cheA 5′UTR for reporter assay and site-directed mutagenesis were performed to investigate the cheA-GlmY interaction in cheA activation. Notably, loss of glmY reduced the cheA mRNA level, and urea could inhibit swarming in a QseF-dependent manner. Altogether, this is the first report elucidating the underlying mechanisms for modulation of swarming motility by a QseEF-regulated sRNA GlmY, involving expression of cheA, rcsB and flhDC in uropathogenic P. mirabilis. [ABSTRACT FROM AUTHOR]

Abstract: Biochars have received increasing attention in recent years because of their properties pertaining to soil fertility and contaminant immobilization as well as serving as carbon sinks. In this work, a series of biochars were produced from dried swine manure waste by slow pyrolysis at different temperatures (i.e., 673–1073K). The characterization of the resulting biochars was examined for its relevance to its potential use as soil amendment. It was found that the pore properties, ash contents and pH values of all swine-manure-derived biochars basically increased as temperature increased, while the yield and nitrogen/oxygen contents decreased with increasing temperature as a result of pyrolytic volatilization during pyrolysis. From the organic and inorganic elements analyses, the manure-derived biochar was rich in soil nutrients such as N, P, Ca, Mg, and K. Furthermore, the pore, surface and chemical properties were also consistent with the observations of the SEM-EDS, XRD and FTIR. This result suggested that the mesoporous manure-derived biochar could be used as an excellent medium to soil environment. [Copyright &y& Elsevier]

Galectin-1, a β-galactoside-binding lectin mediating inflammation and neovascularization, is reported to attenuate ventricular remodeling after myocardial infarction. But its role in stable coronary artery disease (CAD) has not been fully elucidated. This study aimed to identify the relationship between the circulating galectin-1 level and the severity of CAD in patients with suspected CAD. Pre-procedure galectin-1 and high-sensitivity C-reactive protein (hs-CRP) concentrations were measured in 834 subjects who underwent scheduled coronary angiography. Subjects were grouped into tertiles of the galectin-1 levels. SYNTAX scores were calculated to evaluate the severity of CAD. All patients were followed until January 2019 or the occurrence of major adverse cardiovascular events (MACE). Patients with higher galectin-1 concentrations were older; had greater prevalence of hypertension, diabetes, chronic kidney disease, and heart failure; and were more likely to present with higher hs-CRP levels and SYNTAX scores. During the follow-up period of 1.3 ± 1.1 years, patients in the highest tertile of galectin-1 were associated with a greater risk of MACE after adjustment for age, sex, comorbidities, co-medications, serum levels of hemoglobin, creatinine, hs-CRP, ejection fraction, SYNTAX scores, and revascularization modalities (adjusted hazard ratio 10.95, 95% confidence interval 2.29–52.47, p = 0.003). Galectin-1 showed better discriminatory performance than hs-CRP, and non-inferior performance to SYNTAX scores, in predicting the incidence of MACE. [ABSTRACT FROM AUTHOR]