Modeling the effect of glucagon on endogenous glucose production in type 1 diabetes: On the role of glucagon receptor dynamics

This paper validates a glucoregulatory model including glucagon receptors dynamics in the description of endogenous glucose production (EGP). A set of models from literature are selected for a head-to-head comparison in order to evaluate the role of glucagon receptors. Each EGP model is incorporated into an existing glucoregulatory model and validated using a set of clinical data, where both insulin and glucagon are administered. The parameters of each EGP model are identified in the same optimization problem, minimizing the root mean square error (RMSE) between the simulation and the clinical data. The results show that the RMSE for the proposed receptors-based EGP model was lower when compared to each of the considered models (Receptors approach: 7.13±1.71 mg/dl vs. 7.76±1.45 mg/dl (p=0.066), 8.45±1.38 mg/dl (p=0.011) and 8.99±1.62 mg/dl (p=0.007)). This raises the possibility of considering glucagon receptors dynamics in type 1 diabetes simulators.

Near-optimal feedback control for postprandial glucose regulation in type 1 diabetes

This paper is focused on feedback control of postprandial glucose levels for patients with type 1 Diabetes Mellitus. There are two important limitations that make this a challenging problem. First, the slow subcutaneous insulin pharmacokinetics that introduces a significant lag into the control loop. Second, the positivity constraint on the control action, meaning that it is not possible to remove insulin from the body. In this paper, both issues are explicitly considered in the design process using the internal model control framework, to derive a near-optimal feedback controller. Optimality is understood here as minimizing the blood glucose peak after a meal intake and, at the same time, preventing glucose values below a prescribed threshold. It is shown how the proposed controller approaches the optimal closed-loop performance as a limit case. The theoretical results are supported by a numerical example and the feasibility of the overall strategy under uncertainties is illustrated using an extended version UVa/Padova metabolic simulator.

Analysis of architectures implemented for IIoT

Several technological blocks are being developed to provide solutions to the requirements necessary for the implementation of industrial IoT. However, this is feasible with the resources offered by the Cloud, such as processing, applications and services. Despite this, there are negative aspects such as bandwidth, Internet service variability, latency, lack of filtering of junk data transmitted to the cloud and security. From another perspective, these situations emerge as challenges that are being studied to meet the needs of this new industrial era, which means that the important contribution of academia, companies and consortiums, are achieving a change of course, by taking advantage of the potential of the Cloud but now from the vicinity or perimeter of a production plant. To achieve this task, some pillars of IoT technology are being used as a basis, such as the designs of Fog Computing Platforms (FCP), Edge Computing (EC) and considering the need for cooperation between IT and operation technologies (IT and OT), with which it is intended to accelerate the paradigm shift that this situation has generated. The objective of this study is to show a systematic literature review (SLR) of recent studies on hierarchical and flat peer-to-peer (P2P) architectures implemented for manufacturing IIoT, analyzing those successes and weaknesses derived from them such as latency, security, computing methodologies, virtualization architectures, Fog Computing (FC) in Manufacturing Execution Systems (MES), Quality of Service (QoS) and connectivity, with the aim of motivating possible research points when implementing IIoT with these new technologies.

Comparison of Tinnitus Handicap Inventory and Tinnitus Functional Index as Treatment Outcomes

BACKGROUND

Tinnitus is an audiological disorder for which there are no objective measuring tools. Thus, many self-report questionnaires have been proposed to assess its severity. These questionnaires have been judged for their capacity to assess the tinnitus severity at baseline, their sensitivity to treatment-related changes (responsiveness), and their resolution.

METHODS

The most widely used questionnaires for clinical and research studies are the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI). While both questionnaires have been recognized as good evaluators of the baseline tinnitus severity, the latter is considered to be more responsive to changes following treatments.

OBJECTIVES

The aim of this work is to provide a preliminary comparison of the performance of both questionnaires in the initial and final tinnitus severity assessment of a cohort of patients undergoing a four-month Enriched Acoustic Environment (EAE) therapy.

RESULTS

The EAE therapy provided a 30 and 26 point reduction in THI and TFI, respectively. A good correlation is obtained between the THI and TFI questionnaires at baseline and after the treatment.

CONCLUSION

At baseline, the THI provided a higher score than the TFI for a higher degree of tinnitus but a lower score for lower tinnitus severity. Both THI and TFI were good questionnaires for baseline assessment and for treatment-related changes. The THI provided a slightly higher score drop than the TFI following the treatment, although the TFI had better resolution.

Bases for pesticide dose expression and adjustment in 3D crops and comparison of decision support systems

Authorities around the world have committed to limiting the use of chemical pesticides by reducing doses, among other strategies. Nevertheless, different dose expression models and decision support systems (DSSs) for dose adjustment coexist for high growing crops (3D crops). Among them, leaf wall area (LWA) and tree row volume (TRV) models have recently been proposed by the European and Mediterranean Plant Protection Organization (EPPO) for pre-registration trials. In this paper, the background and technical bases of six dose adjustment DSSs in fruit crops (PACE, AGMET, DOSA3D, OMAX and PULVARBO) and four in grape orchards (AGMET, OPTIDOSE, DOSAVIÑA and DOSA3D) are described and compared. The discussion leads to the conclusion that LWA and TRV represents a substantial improvement compared to the former crop ground area-based dose expression model. However, total leaf area is the most important parameter for dose adjustment, while sprayer efficiency is also a key factor. Additionally, it is suggested that deposition on leaves (mean values and variability) should be reported in pesticide efficacy evaluations in order to establish the required doses independently from the dose expression mode. The DOSA3D system, based on leaf area index estimation, was found to be the most conservative DSS regarding the spraying volume ratio to TRV because low spraying efficiencies are considered. Instead, AGMET was found to be the most effective for dose adjustment. However, despite the differences between the recommendations, all the analysed DSSs are useful tools for rational decision making about spraying volume rate and pesticide doses at national level. Their use should be promoted by the competent authorities.

L-Dopa release from mesoporous silica nanoparticles engineered through the concept of drug-structure-directing agents for Parkinson's disease

Parkinson's disease (PD) is a progressive neurodegenerative disease, the 2nd most common after Alzheimer's disease, the main effect of which is the loss of dopaminergic neurons. Levodopa or l-Dopa is an amino acid used in the treatment of PD that acts as the immediate precursor to dopamine. However, over time the efficacy of the medication gradually decreases requiring modified delivery methods. One of the major challenges for the medication to work is to achieve a gradual continuous supply of l-Dopa to the brain to minimise symptoms. Herein, mesoporous silica nanoparticles (MSNs) were engineered through the concept of drug-structure-directing agents (DSDAs) with inherent therapeutic activity. The DSDA used was l-Dopa drug modified by amidation with fatty acids to build anionic surfactants that were able to form micelles as templates for the assembly of inorganic precursors to form the silica framework. This templating route produced MSNs with tunable sizes ranging from 100 nm to 1 μm and with different shapes: spherical, with either solid structures with radial mesopores and porous shells, or hollow-shells with inside large void cavities; and elongated, characterized by long hollows covered by mesoporous shells. The concept of using DSDAs to synthesize drug nanocarriers can be used to avoid the surfactant removal and subsequent drug loading steps involved in the synthesis of conventional MSNs. We hypothesized that the l-Dopa released from MSN materials is mediated by the size and solubility of the DSDAs, and the surface chemical interactions between the DSDAs and MSN hosts. Different pHs (acidic and neutral) simulating gastrointestinal tract conditions were tested, and the results showed hardly any release for gastric conditions at pH 1.2, avoiding the premature release in the stomach typical of conventional MSNs, while for intestinal conditions of pH 7.4, the release of l-Dopa occurred in a continuous and sustained manner, which is well suited to the drug's application and delivery route, and matches well with achieving a sustained l-Dopa delivery to relief symptoms. This could open up new uses for MSNs synthesized by this approach to treat PD.

Reverse remodeling of the atria in patients with rheumatic mitral stenosis: impact of balloon mitral commissurotomy plus atrial fibrillation ablation

Introduction

Chronic Atrial stretch is an important determinant for atrial fibrillation (AF) in patients with rheumatic mitral stenosis (RMS).

Purpose

We analysed the effect of balloon mitral commissurotomy (BMC) plus atrial fibrillation ablation on the long-term occurrence of AF as compared to isolated BMC.

Methods

We prospectively included 20 patients with severe RMS undergoing BMC+AF ablation (Intervention) and compared it with a retrospective sample of 53 RMS patients that underwent BMC (Control). AF ablation consisted in pulmonary vein isolation and driver ablation identified using intracardiac basket mapping. We followed patients for 1 year after the procedure in both groups. Clinical values were evaluated in both groups. Propensity score matching was computed in order to evaluate the effect of the intervention and to analyse the impact of clinical properties of each group.

Results

At baseline, there were no statistical differences in gender (90% vs. 85%) and mitral valve area (1.2±0.18 vs. 1.17±0.18 cm2) between intervention and control groups, respectively. In contrast, there were differences in age (65±12 vs. 72±12; p=0.01) and AF incidence prior to the procedure (90% vs. 62%; p=0.001) between intervention and control groups, respectively. Patients undergoing AF ablation underwent successful pulmonary vein isolation in all cases and driver ablation at sites located in the right atrium (RA) in 7 (35%) patients. Median dominant frequency was significantly higher in the right atrium (DF RA 4.9±0.6 vs. DF LA 3.9±0.7 Hz; p=0.003) prior the intervention. After the intervention, it was significantly reduced only in the left atrium (LA) (DF RA 4.5±1 vs. DF LA 3.2±0.6 Hz; p=0.02 for Pre vs. Post DF LA). Three (15%) patients converted to sinus rhythm during ablation, the remaining were cardioverted. After 1-year follow-up, the proportion of patients in sinus rhythm was significantly higher in patients undergoing BMC+AF (90%) vs. isolated BMC (45%; p<0.001) (Graph). In the isolated BMC group, 4 patients converted to sinus rhythm and 1 patient in sinus rhythm prior to the procedure converted to AF at 1-year.

Conclusion

This observational study demonstrates that the combination of BMC+AF ablation significantly increses the proportion of patients in sinus rhythm at 1-year as compared to isolated BMC. Reverse remodelling of the atrial substrate following isolated BMC also converted to sinus rhythm a small proportion of patients with persistent AF at baseline. Thus, although reversal of atrial stretch changes by BMC could potentially terminate AF in some patients, the combined intervention with catheter ablation will successfully maintain sinus rhythm in the majority of patients in the study.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): FIS by Instituto de Salud Carlos III

Sex differences in patients with ischemia and no obstructive coronary disease subjected to intracoronary acetylcholine test in a multicenter registry

Background

Ischemia with no obstructive coronary disease (INOCA) is increasingly diagnosed because of wide performance of coronary angiography. Prevalence of INOCA is higher in women than in men, however the exact pathophysiological mechanisms which may explain this phenomenon are still not very well understood.

Objective

To evaluate differences in clinical and procedural characteristics between men and women with INOCA subjected to intracoronary acetylcholine test (Ach).

Methods

A total of 210 women and 148 men with INOCA diagnosed with coronary angiography, were prospectively enrolled in a multicenter, observational registry. Ach test was performed according to clinical indications in all included patients. After 1-year patients were re-evaluated for major cardiovascular events, angina symptoms and prescribed medical treatment.

Results

Mean age of 60.6±13.6 years old was similar in both populations, but differences were observed in the prevalence of risk factors: active smoking was more frequent among men (43% vs. 17%, p<0.001), who had also a higher number of associated risk factors (≥3 risk factors were present in 31.2% of men vs. 20.2% of women, p<0.01) and more frequent history of percutaneous coronary revascularization (14.2% vs. 6.7%, p=0.03). Women were more prone to have dyspnea than men (35.5% vs. 20.8%, p=0.01). Men had more coronary atherosclerosis in angiography (57.9% vs. 43.7%, p=0.01) and more slow flow in the left anterior descending artery (21.6% vs. 9.0%, p=0.001). Ach was positive in 36.5% of patients, similar in both sexes, with no differences in the type of induced coronary spasm. Among those with a positive Ach test, at one-year, 36% of women vs. 43.6% of men were on optimal medical treatment for vasospasm although the difference was not statistically significant. Importantly, 41.5% of women and 38.1% of men experienced severe symptoms of angina during follow-up.

Conclusions

Although men with INOCA have a higher risk profile than women and more coronary atherosclerosis, one third of patients present endothelial dysfunction, similar in both groups, indicating that probably other pathophysiological mechanisms are responsible for it in females. Treatment in these patients remains suboptimal and associated with highly impaired quality of life.

Funding Acknowledgement

Type of funding source: None

Spontaneous coronary artery dissection and takotsubo syndrome: comparison of baseline clinical and angiographic characteristics and in-hospital outcomes

Background

Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two relatively common non-atherosclerotic causes of acute cardiac syndrome particularly frequent in women.

Methods

Herein we compared the baseline clinical and angiographic characteristics and in-hospital outcomes of 2 large prospective registries on SCAD and TTS.

Results

A total of 318 SCAD and 106 TTS patients were included (88% women). Patients in the TTS group were older (Table) and presented a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients (42% vs. 56%, P=0.009) but emotional stress was more common in the SCAD group (25% vs. 15%, P=0.037). SCAD patients had higher troponin and creatine-kinase levels. The left anterior descending coronary artery was the most frequently involved vessel (44%). Left ventricular dysfunction (ejection fraction 57±10 vs. 40±10%, P<0.001) was more frequently in TTS patients. Major adverse cardiovascular events (including death, myocardial infarction, ischemia-driven revascularization, development of heart failure and stroke during hospitalization) (4.7% vs. 12.3%, P<0.001) occurred more frequently in TTS patients, that also developed more frequently heart failure (<1% vs. 10%, P<0.001) and atrial fibrillation (1% vs. 11%, P<0.001). No differences were found in the rate of stroke in the 2 groups.

Conclusions

TTS patients are older and present a higher prevalence of cardiovascular risk factors than SCAD patients. They also present a worse in-hospital prognosis with higher mortality.

Funding Acknowledgement

Type of funding source: None

Clinical profile and predictors of positivity of acetylcholine test in patients with angina and no obstructive coronary artery disease. Results of a multi-center mediterranean registry

Background

Coronary endothelial dysfunction and vasospasm are potential causes of ischemia in no obstructive coronary disease (INOCA) and are now known to be associated with an increased risk of major cardiovascular events (MACE) and impaired quality of life. The recent guidelines recommend the use of intracoronary acetylcholine to unravel the underlying pathophysiology of INOCA, by identifying those with endothelial dysfunction, and to guide future treatment in these patients.

Objective

To evaluate the clinical profile and prevalence of endothelial dysfunction in patients with INOCA, and to identify the predictors of positivity of the acetylcholine test.

Methods

A total of 358 patients with INOCA were prospectively enrolled in a multicenter observational study. Coronary angiography and acetylcholine test were performed according to clinical indications in all included patients. Patients were followed-up for 1-year for MACE and clinical reevaluation of symptoms.

Results

Patients' mean age was 60.6±13.5 y.o. and 58.7% were females, with no previous history of coronary heart disease in 76% of cases. Regarding clinical presentation, 56.9% had angina at rest, 59.9% exertional angina, and 29.5% dyspnea. In 39% the EKG was abnormal, and in 10.9% there was a troponin rise.

Coronary endothelial dysfunction –defined as a vasoconstriction over 30%– was observed in 129 (36%) patients, and severe vasoconstriction (>70%) in 75 (21%). Of positive cases, 47 (36%) focal vasoconstriction, and 90 (70%) diffuse. On follow-up, patients with a positive Ach test were treated differently, with a lower prescription of betablockers (12% vs. 24%, p=0.01) and a higher use of vasodilators (47% vs. 28.5%, p=0.001). Guidelines-recommended optimal treatment was prescribed to 39.2% of patients with a positive acetylcholine test. Patients with positive acetylcholine test were more prone to having worsening angina (25.6% vs. 12.8%, p<0.01) and minimal exertion angina (40% vs. 26.7%, p=0.03) on follow-up. Multivariable regression analysis showed that acetylcholine test positivity was predicted by the presence of diabetes (OR 1.7, p=0.04), exertional angina (OR 1.2, p=0.04), coronary atherosclerosis (OR 1.8, p=0.02) and coronary milking (OR 2.6, p=0.04).

Conclusions

Endothelial dysfunction detected by acetylcholine test was present in one third of patients with INOCA and was associated with more severe and worsening symptoms. Although Ach test positivity influenced the pharmacological treatment at discharge, a large room for optimization still remained.

Funding Acknowledgement

Type of funding source: None

Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events

INTRODUCTION AND OBJECTIVES

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown.

METHODS

We present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory.

RESULTS

Between June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non-ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028).

CONCLUSIONS

In Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events. Registered at ClnicalTrials.gov (Identifier: NCT03607981).

P5621Diagnostic accuracy of resting full-cycle ratio in the non-culprit artery of acute patients

Introduction

Resting full-cycle ratio (RFR) is a novel non-hyperemic index of coronary stenosis severity, independent of the timing within the cardiac cycle. Recent data has demonstrated good correlation between RFR and Fractional Flow Reserve (FFR) in stable coronary disease (SCD). However, there are no data regarding the reliability of RFR in non-culprit arteries of patients presenting with acute myocardial infarction (AMI).

Purpose

To study the diagnostic accuracy of RFR versus FFR in the non-culprit artery in AMI compared to stable lesions.

Methods

RFR, FFR, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistance Reserve Ratio (RRR) were calculated in 67 patients with AMI and an intermediate lesion in a non-culprit artery (median time from primary PCI to study: 48 hours). Data were compared with those of a retrospective group of 66 patients with SCD.

Results

There was a higher proportion of males among patients of the AMI group (85% vs 62%, p=0.0026). Mean age was 64.5±11 years, being AMI cohort younger at presentation [62±11 vs 67±12 years in SCD cohort (p=0.04)]. Patients with AMI had a significantly lower prevalence of hypertension (52% vs 75%, p=0.006), diabetes (10% vs 32%), p=0.002) and hyperlipemia (37% vs 79%, p=0.002).

Coronary physiology parameters showed a non-normal distribution, and are expressed as median [IQR] (Table 1). In patients with AMI, FFR was lower than in patients with SCD. In contrast, RFR showed no significant difference. Both CFR and RRR were higher in the AMI group. No significant differences in IMR were found between cohorts.

Importantly, in the AMI group the correlation between RFR and FFR was 0.84 and the overall agreement 82%, with rates of false positive and negative of 15% and 3%, respectively. In SCD the correlation was 0.81 with a lower overall agreement of 69%, due mostly to a higher rate of false positive RFR (28%) (Figure 1).

Table 1. Microcirculatory parameters in non-culprit artery (AMI) and stable coronary disease (SCD) AMI (N=66) Stable (N=67) p value FFR 0.84 [0.76–0.9] 0.84 [0.76–0.9] 0.006 RFR 0.89 [0.82–0.94] 0,9 [0.84–0.94] 0.24 CFR 2.2 [1.7–3.1] 1.8 [1.1–2.6] 0.011 IMR 17 [14–27] 25 [14–38] 0.051 RRR 2.7 [2.17 - 3.9] 2.1 [1.4–3.1] 0.005 Median [IQR].

Figure 1. Correlation between RFR and FFR valueS

Conclusions

RFR shows a good correlation with FFR in AMI. Surprisingly, overall agreement is higher in the non-culprit artery in an acute setting, with a lower percentage of false positive results.

Acknowledgement/Funding

None

6115Influence of microvascular function and coronary flow in the diagnostic precision of resting full-cycle ratio

Introduction

Resting full-cycle ratio (RFR) has been recently described as a non-hyperemic index of coronary stenosis with good concordance with Fractional Flow Reserve (FFR). However, there is no information concerning the influence of microvascular function and coronary flow on RFR results.

Purpose

To determine if the accuracy of this novel parameter might be influenced by changes in microvascular function.

Methods

133 patients admitted in our center between July 2016 and December 2017 underwent coronary physiology study of an angiographically intermediate lesion. 67 subjects presented with AMI and an intermediate lesion in a non-culprit artery, and 66 subjects stable coronary disease. We performed FFR, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR) and Resistance Reserve Ratio (RRR) in all of them. We calculated RFR retrospectively from the pressure tracings.

Results

Coronary physiology parameters showed a non-normal distribution and are presented as median [IQR]: FFR 0.86 [0.79–0.92]; CFR 2.05 [1.4–2.95]; IMR 20.5 [14–32.55]; RRR 2.5 [1.85–3.63]; RFR 0.897 [0.83–0.94]. Patients with abnormal CFR displayed lower RFR values although FFR was not markedly affected (Table 1). These findings remained irrespective of the clinical scenario at presentation.

61 patients had a CFR lower than 2. Correlation between RFR and FFR was not significantly different in patients with abnormal CFR than in those with normal CFR (0,73 vs 0,88; p=0,067) (Figure 1); however, overall binary agreement between RFR and FFR was worse in patients with a low CFR (69% vs 83%; p=0,047).

48 patients had a high IMR (>25). Linear correlation between RFR and FFR was similar in patients with high and normal IMR (0,81 vs 0,83; p=0,784); likewise, binary concordance showed no significant difference between both groups (77% vs 75%, p=0,78).

The mean difference between RFR and FFR was 0,025. This was only influenced by CFR: patients with a low CFR had a smaller difference than those with a normal CFR (0,012 vs 0,035; p=0,019).

Physiology parameters by CFR group Normal CFR (≥2) Low CFR (<2) P-value FFR 0.88 [0.82–0.93] 0.84 [0.79–0.92] 0.14 RFR 0.91 [0.88–0.95] 0.86 [0.80–0.92] 0.0009 IMR 16.5 [13–27] 25 [16–45.5] 0.002 RRR 3.6 [2.7–4.9] 1.7 [1.3–2.1] <0.0001 Physiological coronary parameters (Median [IQR]) according to CFR.

Correlation between RFR and FFR by CFR

Conclusion

RFR has good overall correlation and concordance with FFR. However, RFR has a lower diagnostic accuracy in patients with a low CFR.

Acknowledgement/Funding

None

AdNut study: effectiveness of a high calorie and protein oral nutritional supplement with β-hydroxy-β-methylbutyrate in an older malnourished population in usual clinical practice

Objective

To evaluate the effectiveness of a high calorie and protein, β-hydroxy-β-methylbutyrate containing oral nutritional supplement (HP-HMB-ONS), on nutritional status, activities of daily living and quality of life (QoL) in old malnourished subjects.

Methods

We conducted an observational, prospective, open label, multicenter study. Participants were > 65 years, undernourished or at nutritional risk [Nutrition Risk Score (NRS) ≥ 3] and had been included on an ONS (HP-HMB-ONS twice daily for 12 weeks) per standard of care. Visits at baseline (V1), 6 weeks (V2) and 12 weeks (V3) were performed. The primary endpoints were gain of body weight, change in body mass index (BMI) and NRS 2002 index. Data from QoL (EQ-5D-3L) and activities of daily living (Katz index) were also collected.

Results

A total of 235 participants were included in the study. Of these 148 took at least a 75% of the HP-HMB-ONS and were included in the analysis (per protocol); median age was 80.0 (SD:8.3) years, 65.5% (n = 97) were female, 67.6% (n = 100) had 2 or more diseases. At V3, a statistically significant increase in weight (2.1 kg; SD: 3.8) (p < 0.001) and BMI (0.8 kg/m²; SD: 1.45) were found compared to V1, whereas NRS 2002 values decreased by 0.9 (SD: 1.2). A significant (p < 0.001) improvement in Katz index (mean change = 0.3; SD:1.4) and EQ-5D scoring (mean change = 0.5; SD:1.9) compared to V1, were also reported.

Conclusions

The results suggest that administration of a HP-HMB-ONS improve the nutritional status and may led to a significant improvement in patients' activities of daily living and QoL, independent of baseline BMI.

Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.

Enhanced extended state observer-based control for systems with mismatched uncertainties and disturbances

This paper presents an enhanced Extended State Observer (ESO)-based control strategy to deal with the disturbance attenuation problem for a class of non integral-chain systems subject to non-linear mismatched uncertainties and external disturbances. The proposed control strategy does not assume the integral-chain form and it is formed by a state-feedback plus a dynamic disturbance compensation term, which is designed to reject the disturbance effect in the system output. From a theoretical point of view, the proposed strategy is reduced to the conventional ESO when the integral chain form and the matched condition hold. In this sense, this paper is presented as an extension of the ESO principles to cover a wider class of systems. The theoretical results show that the internal zero-dynamics plays an important role in ESO-based control design. Also, the closed-loop stability is analyzed and some numerical simulations show the effectiveness of the proposal in comparison with previous ESO-based techniques.

A generalized smith predictor for unstable time-delay SISO systems

In this work, a generalization of the Smith Predictor (SP) is proposed to control linear time-invariant (LTI) time-delay single-input single-output (SISO) systems. Similarly to the SP, the combination of any stabilizing output-feedback controller for the delay-free system with the proposed predictor leads to a stabilizing controller for the delayed system. Furthermore, the tracking performance and the steady-state disturbance rejection capabilities of the equivalent delay-free loop are preserved. In order to place this contribution in context, some modifications of the SP are revisited and recast under the same structure. The features of the proposed scheme are illustrated through simulations, showing a comparison with respect to the corresponding delay-free loop, which is here considered to be the ideal scenario. In order to emphasize the feasibility of this approach, a successful experimental implementation in a laboratory platform is also reported.

The Role of Predictability in Saccadic Eye Responses in the Suppression Head Impulse Test of Horizontal Semicircular Canal Function

Background

In the suppression head impulse paradigm (SHIMP) vHIT protocol, the participant is instructed to follow with his gaze a mobile target generated by a laser placed on the participant's head. Recent studies have reported that the refixation saccade latencies are in relation with the time evolution of the vestibular dysfunction in both (standard and SHIMP) procedures. We hypothesized that some central mechanisms like head impulse prediction could be one of the causes for the differences in the saccadic eye responses.

Methods

A prospective cohort non-randomized study was designed. For the SHIMP protocol, recorded with the ICS Impulse ver. 4.0^® (Otometrics A/S, Taastrup, Denmark) vHIT device, three different algorithms were performed: "predictable," "less predictable," and "unpredictable" depending on the target's predictability. A mathematical method was developed to analyze the SHIMP responses. The method was implemented as an additional tool to the MATLAB open source script for the extended analysis of the vHIT responses named HITCal.

Results

In cohort 1, 52 participants were included in "predictable" SHIMP protocol. In cohort 2, 60 patients were included for the "less predictable" and 35 patients for the "unpredictable" SHIMP protocol. The participants made more early saccades when instructed to perform the "predictable" paradigm compared with the "less predictable" paradigm (p < 0.001). The less predictable protocol did not reveal any significant difference when compared with the unpredictable protocol (p = 0.189). For the latency of the first saccade, there was statistical difference between the "unpredictable" and "predictable" protocols (p < 0.001) and between the "less predictable" and "predictable" protocols (p < 0.001). Finally, we did not find any relationship between the horizontal vestibulo-ocular reflex (hVOR) gain and the latency of the saccades.

Conclusion

We developed a specific method to analyze and detect early SHIMP saccades. Our findings offer evidence regarding the influence of predictability on the latency of the SHIMP saccadic responses, suggesting that early saccades are probably caused by a conditioned response of the participant. The lack of relationship between the hVOR gain and the latency of the saccades suggests that the predictive behavior that caused the early eye saccades are independent of the vestibular function.

Small-Molecule Stabilization of 14-3-3 Protein-Protein Interactions Stimulates Axon Regeneration

Damaged central nervous system (CNS) neurons have a poor ability to spontaneously regenerate, causing persistent functional deficits after injury. Therapies that stimulate axon growth are needed to repair CNS damage. 14-3-3 adaptors are hub proteins that are attractive targets to manipulate cell signaling. We identify a positive role for 14-3-3s in axon growth and uncover a developmental regulation of the phosphorylation and function of 14-3-3s. We show that fusicoccin-A (FC-A), a small-molecule stabilizer of 14-3-3 protein-protein interactions, stimulates axon growth in vitro and regeneration in vivo. We show that FC-A stabilizes a complex between 14-3-3 and the stress response regulator GCN1, inducing GCN1 turnover and neurite outgrowth. These findings show that 14-3-3 adaptor protein complexes are druggable targets and identify a new class of small molecules that may be further optimized for the repair of CNS damage.

Postural stability in a population of dancers, healthy non-dancers, and vestibular neuritis patients

INTRODUCTION

Several studies have indicated better balance control in dancers than in control participants, but some controversy remains. The aim of our study is to evaluate the postural stability in a cohort of dancers, non-dancers, compensated, and non-compensated unilateral vestibular neuritis (VN).

METHODS

This is a prospective study of control subjects, dancers, and VN patients between June 2009 and December 2015. Dancers from the Dance Conservatory of Madrid and VN patients were referred to our department for analysis. After the clinical history, neuro-otological examination, audiogram, and caloric tests, the diagnosis was done. Results from clinical examination were used for the categorization of compensation situation. A computerized dynamic posturography was performed to every subject.

RESULTS

Forty dancers and 38 women formed both 'dancer' and 'normal' cohorts. Forty-two compensated and 39 uncompensated patients formed both 'compensated' and 'uncompensated' cohorts. Dancers had significantly greater antero-posterior (AP) body sway than controls during condition 5 and 6 in the Sensory Organization Test (SOT) (p < .05). When we compared the uncompensated cohort with both control and dancers groups, we found significant greater body sway in every SOT studied condition (p < .05). While mean AP body say in SOT 5 and 6, showed greater values in compensated patients than the control group, the mean analysis did not show any statistical difference between the compensated and dancer groups, in such SOT conditions.

CONCLUSIONS

Dancers demonstrated greater sways than non-dancers when they relied their postural control on vestibular input alone. Compensated patients had a similar posturographic pattern that the dancers cohort, suggesting a similar shift from visual to somatosensory information.

Is the use of long-acting injectable antipsychotic extended in the outpatient treatment of bipolar disorder? A brief description

Aims

Obtain and analyze information on treatment guidelines, with particular emphasis on the use of antipsychotics, in patients diagnosed with bipolar disorder I and bipolar disorder II who are treated at a mental health center in a district of Madrid (Spain) under the conditions of habitual clinical practice.

Then, compare with recently published literature.

Methods

We performed a descriptive study of a sample of 100 patients diagnosed with bipolar disorder (type I and type II) at any stage of the disease who receive regular treatment in a mental health center in a district of Madrid. Information regarding the treatment used, especially the use of antipsychotics (either in a single therapy or in combination with other drugs such as mood stabilizers, antidepressants, hypnotics or anxiolytics), was collected retrospectively from the data obtained from the medical record.

Results

Ninety-four percent of patients are taking mood stabilizer treatment (68% lithium, 24% valproate, 1% and 1% carbamazepine and lamotrigine). Four percent take lithium and valproate in combination. Forty-eight percent of patients are taking some antipsychotic (atypical about 90%). Of these, only 10% in injectable form, and 5% take both oral and injectable antipsychotics.

Conclusions

The diminished use of injectable antipsychotics, well below recent publications, draws the attention. You can probably explain this low proportion of injectable medication because we are generally dealing with stable patients with a long-term disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Correction: Single-crystal TiO2 nanowires by seed assisted thermal oxidation of Ti foil: synthesis and photocatalytic properties

Correction for ‘Single-crystal TiO₂ nanowires by seed assisted thermal oxidation of Ti foil: synthesis and photocatalytic properties’ by E. Arcadipane et al., RSC Adv., 2016, 6, 55490–55498.

Mapping Vineyard Leaf Area Using Mobile Terrestrial Laser Scanners: Should Rows be Scanned On-the-Go or Discontinuously Sampled?

The leaf area index (LAI) is defined as the one-side leaf area per unit ground area, and is probably the most widely used index to characterize grapevine vigor. However, LAI varies spatially within vineyard plots. Mapping and quantifying this variability is very important for improving management decisions and agricultural practices. In this study, a mobile terrestrial laser scanner (MTLS) was used to map the LAI of a vineyard, and then to examine how different scanning methods (on-the-go or discontinuous systematic sampling) may affect the reliability of the resulting raster maps. The use of the MTLS allows calculating the enveloping vegetative area of the canopy, which is the sum of the leaf wall areas for both sides of the row (excluding gaps) and the projected upper area. Obtaining the enveloping areas requires scanning from both sides one meter length section along the row at each systematic sampling point. By converting the enveloping areas into LAI values, a raster map of the latter can be obtained by spatial interpolation (kriging). However, the user can opt for scanning on-the-go in a continuous way and compute 1-m LAI values along the rows, or instead, perform the scanning at discontinuous systematic sampling within the plot. An analysis of correlation between maps indicated that MTLS can be used discontinuously in specific sampling sections separated by up to 15 m along the rows. This capability significantly reduces the amount of data to be acquired at field level, the data storage capacity and the processing power of computers.

Single-crystal TiO2 nanowires by seed assisted thermal oxidation of Ti foil: synthesis and photocatalytic properties

TiO₂ nanowires growth was investigated varying the synthesis parameters. Nanowires demonstrated improved photocatalytic activity, especially when treated in forming gas.

Hierarchical ZSM-5 zeolite with uniform mesopores and improved catalytic properties

Uniform mesopores are generated in hierarchical ZSM-5 by a mesopore narrowing treatment, showing enhanced activity in the acylation of 2-methoxynaphthalene.

Eye-safe lidar system for pesticide spray drift measurement

Spray drift is one of the main sources of pesticide contamination. For this reason, an accurate understanding of this phenomenon is necessary in order to limit its effects. Nowadays, spray drift is usually studied by using in situ collectors which only allow time-integrated sampling of specific points of the pesticide clouds. Previous research has demonstrated that the light detection and ranging (lidar) technique can be an alternative for spray drift monitoring. This technique enables remote measurement of pesticide clouds with high temporal and distance resolution. Despite these advantages, the fact that no lidar instrument suitable for such an application is presently available has appreciably limited its practical use. This work presents the first eye-safe lidar system specifically designed for the monitoring of pesticide clouds. Parameter design of this system is carried out via signal-to-noise ratio simulations. The instrument is based on a 3-mJ pulse-energy erbium-doped glass laser, an 80-mm diameter telescope, an APD optoelectronic receiver and optomechanically adjustable components. In first test measurements, the lidar system has been able to measure a topographic target located over 2 km away. The instrument has also been used in spray drift studies, demonstrating its capability to monitor the temporal and distance evolution of several pesticide clouds emitted by air-assisted sprayers at distances between 50 and 100 m.

An investigation of the textural properties of mesostructured silica-based adsorbents for predicting CO2 adsorption capacity

The CO₂ uptake of more than 30 physisorbents was found to correlate with their textural parameters, namely the product of the available surface area (S_BET) and the affinity of the surface toward adsorptives (C parameter).

IgLON cell adhesion molecules are shed from the cell surface of cortical neurons to promote neuronal growth

Matrix metalloproteinases and a disintegrin and metalloproteinases are members of the zinc endopeptidases, which cleave components of the extracellular matrix as well as cell surface proteins resulting in degradation or release of biologically active fragments. Surface ectodomain shedding affects numerous biological processes, including survival, axon outgrowth, axon guidance, and synaptogenesis. In this study, we evaluated the role of metalloproteinases in regulating cortical neurite growth. We found that treatment of mature cortical neurons with pan-metalloproteinase inhibitors or with tissue inhibitors of metalloproteinase-3 reduced neurite outgrowth. Through mass spectrometry, we characterized the metalloproteinase-sensitive cell surface proteome of mature cortical neurons. Members of the IgLON family of glycosylphosphatidylinositol-anchored neural cell adhesion molecules were identified and validated as proteins that were shed from the surface of mature cortical neurons in a metalloproteinase-dependent manner. Introduction of two members of the IgLON family, neurotrimin and NEGR1, in early embryonic neurons was sufficient to confer sensitivity to metalloproteinase inhibitors in neurite outgrowth assays. Outgrowth experiments on immobilized IgLON proteins revealed a role for all IgLON family members in promoting neurite extension from cortical neurons. Together, our findings support a role for metalloproteinase-dependent shedding of IgLON family members in regulating neurite outgrowth from mature cortical neurons.

Influence of the structural and textural properties of ordered mesoporous materials and hierarchical zeolitic supports on the controlled release of methylprednisolone hemisuccinate

To alleviate the chronic inflammation, nasal obstruction, and loss of sense of smell that produces the rhinosinusitis disease, ordered mesoporous materials and hierarchical zeolites could be used for slow and sustained corticoid (methylprednisolone hemisuccinate conjugate) release. The correlations between the delivery performance of methylprednisolone hemisuccinate and the physicochemical properties of carriers' release systems, including pore mesostructure, texture and size, and surface chemistry, have been well established. Different two-dimensional (2-D) and three-dimensional (3-D) mesostructured materials (MCM-41, SBA-15, expanded SBA-15, FDU-12, and SBA-16) were employed. In addition, for the first time to the best of our knowledge, materials based on hierarchical zeolites with additional mesoporosity (h-ZSM-5 and h-BETA zeolites) were also tested. In particular, two materials (3-D cubic mesoporous silica SBA-16 and hierarchical Beta zeolite) have been probed to be potential candidates, exhibiting high drug adsorption capacities and slow drug release rates, which is the most favourable way of drug release in the particular rhinosinusitis application. Solid-state ¹H-²⁹Si HETCOR NMR analyses confirm the strong interactions of the drug with the surface of h-BETA and 3-D SBA-16 materials, via hydrogen bonding of carboxylic, ketone, and aliphatic moieties of the methylprednisolone hemisuccinate at surface silanol sites. Because of the remarkable release performance, it is expected that 3-D mesoporous silica SBA-16 and hierarchical Beta zeolite can be attractive candidates for current applications in nasal inflammation treatments. The drug release rate can be further retarded by decreasing the pH to around 4.6; at this point more attraction forces were detected as proved by zeta-potential measurements. Therefore, a slower delivery trend of methylprednisolone hemisuccinate has been observed for all the materials, which is more pronounced in the case of SBA-15 and SBA-16.

Human BRS-3 receptor: functions/role in cell signaling pathways and glucose metabolism in obese or diabetic myocytes

Several studies showed that the orphan Bombesin Receptor Subtype-3 (BRS-3) - member of the bombesin receptor family - has an important role in glucose homeostasis (v.g.: BRS-3-KO mice developed mild obesity, and decreased levels of BRS-3 mRNA/protein have been described in muscle from obese (OB) and type 2 diabetic (T2D) patients). In this work, to gain insight into BRS-3 receptor cell signaling pathways, and its implication on glucose metabolism, primary cultured myocytes from normal subjects, OB or T2D patients were tested using high affinity ligand - [d-Tyr(6),β-Ala(11),Phe(13),Nle(14)]bombesin6-14. In muscle cells from all metabolic conditions, the compound significantly increased not only MAPKs, p90RSK1, PKB and p70s6K phosphorylation levels, but also PI3K activity; moreover, it produced a dose-response stimulation of glycogen synthase a activity and glycogen synthesis. Myocytes from OB and T2D patients were more sensitive to the ligand than normal, and T2D cells even more than obese myocytes. These results widen the knowledge of human BRS-3 cell signaling pathways induced by a BRS-3 agonist, described its insulin-mimetic effects on glucose metabolism, showed the role of BRS-3 receptor in glucose homeostasis, and also propose the employing of BRS-3/ligand system, as participant in the obese and diabetic therapies.

Neurite outgrowth and growth cone collapse assays to assess neuronal responses to extracellular cues

The identification of molecular processes involved in regulating neurite outgrowth is an active area of interest for investigators studying neural development and regeneration. In vitro assays designed to measure growth cone morphology and neurite length are frequently used to assess neuronal responses to developmental guidance cues and inhibitory cues that exist in the adult CNS. Here, we describe the procedures to assess morphological responses of cultured dorsal root ganglion neurons to attractive and repellent cues, with a focus on repellents found in the injured adult CNS. The chapter describes methods to culture the DRGs, apply inhibitory ligands, and assess morphological responses. These assays provide biological readouts to assess the capacity of a molecule to act as an inhibitory or growth promoting cue. The readouts can be used as screening tools to aid in the identification of novel targets or drugs for promoting nerve regeneration.

The use of electrocochleography to monitor the response of Ménière's disease patients to intratympanic steroids

CONCLUSIONS

Intratympanic (IT) dexamethasone provides an alternative for patients with Ménière's disease (MD). A reduction of the endolymphatic hydrops is detected by the EcohG 1 month after the treatment.

OBJECTIVE

The use of intratympanic corticoid injections for MD has become popular due to the lack of reported adverse effects, but the mechanism of action is not well established. This study aimed to evaluate the changes in electrocochleography (EcohG) measurements during IT dexamethasone therapy.

METHODS

This study included 53 patients with unilateral MD refractory to medical therapy for at least 1 year. Each patient was treated with a fixed protocol of three consecutive weekly injections of a commercial 4 mg/ml dexamethasone preparation. EcohG measurements were performed 1 month before and 1 month after IT steroid therapy. The SP/AP ratio was measured before and after the IT treatment. A Kaplan-Meier analysis was used to evaluate the control of vertigo over a 2-year period.

RESULTS

Complete vertigo control (class A) was achieved in 22 patients (41.5%) at the 12-month follow-up and 8 patients (15.1%) at the 24-month follow-up. A significant reduction (p < 0.01) in the SP/AP ratio after the IT steroid treatment was observed.