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High mannose has previously associated with insulin resistance and cardiovascular disease (CVD). Our objective is to establish whether mannose is associated with anatomical evidence of coronary artery disease (CAD).Plasma mannose concentrations were measured by liquid chromatography/tandem mass spectrometry in a discovery cohort (n = 513) and a validation cohort (n = 221) of carefully phenotyped individuals. In both cohorts CAD was quantitated using state-of-the-art imaging techniques (coronary computed coronary tomography angiography (CCTA), invasive coronary angiography and optical coherence tomography). Information on subsequent CVD events/death was collected. Associations of mannose with angiographic variables and biomarkers were tested using univariate and multivariate regression models. Survival analysis was performed using the Kaplan-Meier estimator.Mannose was related to indices of CAD and features of plaque vulnerability. In the discovery cohort, mannose was a marker of quantity and quality of CCTA-proven CAD and subjects with a mannose level in the top quartile had a significantly higher risk of CVD events/death (p = 3.6e-5). In the validation cohort, mannose was significantly associated with fibrous cap thickness 65 μm (odds ratio = 1.32 per each 10 μmol/L mannose change [95% confidence interval, 1.05-1.65]) and was an independent predictor of death (hazard ratio for mannose≥vs 84.6 μmol/L: 4.0(95%CI, 1.4-11.3), p = 0.006).The current data add novel evidence that high mannose is a signature of CAD with a vulnerable plaque phenotype, consistently across measures of severity of vessel involvement and independent of the traditional correlates of CVD, and that it is an independent predictor of incident adverse outcomes.

Background High-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA. Methods A consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0–1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (≥3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features. Results 528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p = 0.004 and 2.02, p = 0.012 for LAP and RI > 1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p = 0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p = 0.003 and 1.04, p = 0.002 for LAP-Vol, respectively). Conclusions Our results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis.

BACKGROUND: It is unclear if strategies to rule-out myocardial infarction (MI) based on a single high-sensitivity troponin T (hsTnT) measurement at the emergency department (ED) presentation may also exclude unstable angina. METHODS: We measured hsTnT ex-post on the admission frozen blood sample of 644 subjects with Braunwald IIIB CK-MB-negative unstable angina. This analysis included the 240 patients with hsTnT value ≤99th percentile reference limit (UA). We evaluated the clinical outcome of UA patients and the applicability of two rule-out strategies based on the combination of a non-ischemic ECG with (1) a single hsTnT value below the Limit-of-Detection (LoD), (2) a TIMI risk score ≤1. RESULTS: UA patients with hsTnT ≤99th percentile reference limit had a favorable 30-day outcome [0.8% MI, 0% cardiovascular death (CVD)], but the rate of CVD/MI at 180-day was 4.7%. Sensitivities for UA were 94.6% according to the 'TIMI ≤1-strategy' and 75.4% according to 'hsTnT-below-LoD-strategy', accounting for 5.4 and 24.6% missed diagnoses, respectively. A prognostic risk stratification to guide appropriate outpatient assessment in potential discharged unrecognized UA patients was developed: a risk score based on the combination of age >60 years and C-reactive protein >4.5 mg/L effectively stratified the 180-day CVD/MI occurrence: 0, 2.5 and 12.7% for score 0, 1 and 2 (log-rank = 0.001, C-statistic = 0.776). CONCLUSION: Single measurement hsTnT strategies, successfully tested to rule-out MI, may allow safe ED discharge of patients with a suspected acute coronary syndrome: even if UA may not be excluded, its short-term prognosis is favorable. UA patients with a C-reactive protein >4.5 mg/L and older than 60 years have a substantial medium-term cardiovascular risk and may benefit from a timely outpatient diagnostic assessment.

Background Traditional cardiovascular risk factors (RFs) and coronary artery disease (CAD) do not always run parallel. We investigated functional-metabolic correlations of CAD, RFs, or neither in the CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation) 2 × 2 phenotypic observational study. Methods Two hundred and fortyone subjects were included based on RF burden, presence/absence of CAD (assessed by computed tomography angiography), age and sex. Participants displayed one of four phenotypes: CAD with ≥3 RFs, no-CAD with ≥3 RFs, CAD with ≤1 RF and no-CAD with ≤1 RF. Metabolites were identified by gas chromatography–mass spectrometry and pathways by metabolite set enrichment analysis. Results Characteristic patterns and specific pathways emerged for each phenotypic group: amino sugars for CAD/high-RF; urea cycle for no-CAD/high-RF; glutathione for CAD/low-RF; glycine and serine for no-CAD/low-RF. Presence of CAD correlated with ammonia recycling; absence of CAD with the transfer of acetyl groups into mitochondria; high-risk profile with alanine metabolism (all p The comparative case-control analyses showed a statistically significant difference for the two pathways of phenylalanine, tyrosine and tryptophan biosynthesis and phenylalanine metabolism in the CAD/Low-RF vs NoCAD/Low-RF comparison. Conclusions The present 2 × 2 observational study identified specific metabolic pathways for each of the four phenotypes, providing novel functional insights, particularly on CAD with low RF profiles and on the absence of CAD despite high-risk factor profiles.

Background and aims The Mediterranean diet (MD) affects the risk of myocardial infarction and long-term prognosis after a coronary event. Limited data are available regarding the influence of MD on short-term prognosis. We assessed the impact of the MD adherence on in-hospital and short-term outcome in patients with first ST-elevation Myocardial Infarction (STEMI). Methods and results As many as 533 European patients with STEMI and no previous history of coronary artery disease were included in this analysis. Previous dietary habits of each patient were collected with a food frequency questionnaire from which we calculated the FAMI Mediterranean Diet Score (FAMI MD Score), according to the MD adherence. A blood sample was drawn to each patient within 6 h of symptoms onset. Levels of high-sensitivity C-Reactive Protein (hsCRP), Interleukin-6 (IL-6) were measured. Clinical outcome at 180 days and myocardial reperfusion were assessed. Patients with higher FAMI MD Score had lower levels of hsCRP; there were no differences between IL-6 level among FAMI MD Score quintiles. There were no associations between adherence to MD and 180-day adverse events. Lower FAMI MD Score was associated with a higher risk of ineffective myocardial reperfusion after thrombolysis or percutaneous coronary intervention. Similar results were observed for daily consumption of ≥4 portions of fruit and vegetable. Conclusions A positive effect of the Mediterranean diet, and fruit and vegetable intake was observed on hsCRP and the occurrence of effective myocardial reperfusion. These findings confirm the favorable impact of Mediterranean diet adherence not only in primary but also in secondary prevention.

Permeable pavements are a key Storm water management measure employed both to attenuate surface runoff in urban areas and to filter urban storm water pollutants. Existing permeable pavements (PP) are design with the specific percentage porosity whereby enabling excess rainwater to infiltrate through the system and acting as a depression storage at the same time. Depression storage basically refers to the volume of water trapped in the depression when the precipitation of a storm reaches the ground and filled up all the depression before it can flow over the surface. Cylindrical Detention Pond (CDP) is an alternative paving material that may alleviate many of the hydrological problems caused by urban runoff from developed areas. CDP consist of three basic component; top cover, bottom cover and hollow cylindrical at centre (300 mm thickness). The hollow cylindrical has approximate 50 percent porosity from the total solid of component, which is every 1 inch (25 mm) of pavement depth can hold 0.5 inches (12.5 mm) of rain in theoretical. In this study, the depression storage rate of CDP was investigated under three different rainfall intensity scenarios which are 77 mm/hr (low), 153 mm/hr (medium), and 230 mm/hr (heavy) respectively whereby it function to monitoring the analytical trend line. The experiment was conducted in model box in the laboratory under fully saturated condition. It found that the CDP can performed to detent the water until 180 min of excess rainfall for all 2 year ARI, 5 year ARI, 10 year ARI, 20 year ARI, 50 year ARI and 100 year ARI with different rates. CDP’s able to reduce the runoff up to 77% of the total rainfall volume. The result was proved the hollow cylindrical at centre of CDP very effective in runoff volume reduction according to the different ARI trend line projection.

BackgroundProteomics of atypical phenotypes may help unravel cardiovascular disease mechanisms.AimWe aimed to prospectively screen the proteome of four types of individuals: with or without coronary artery disease (CAD), each with or without multiple risk factors. Associations with individual risk factors and circulating biomarkers were also tested to provide a functional context to the protein hits.Materials and MethodsThe CAPIRE study (ClinicalTrials.gov Identifier: NCT02157662) is a cross-sectional study aimed at identifying possible new mechanisms promoting or protecting against atherothrombosis. Quantification (by aptamer technology), ranking (using partial least squares), and correlations (by multivariate regression) of ~5000 plasma proteins were performed in consecutive individuals aged 45–75 years, without previous cardiovascular disease, undergoing computed tomography angiography for suspected CAD, showing either >5/16 atherosclerotic segments (CAD+) or completely clean arteries (CAD−) and either ≤ 1 risk factor (RF+) or ≥3 risk factors (RF−) (based on history, blood pressure, glycemia, lipids, and smoking).ResultsOf 544 individuals, 39% were atypical (93 CAD+/RF−; 120 CAD−/RF+) and 61% typical (102 CAD+/RF+; 229 CAD−/RF−). In the comparison with CAD+/RF− adjusted for sex and age, CAD−/RF+ was associated with increased atrial myosin regulatory light chain 2 (MYO) and C-C motif chemokine-22 (C-C-22), and reduced protein shisa-3 homolog (PS-3) and platelet-activating factor acetylhydrolase (PAF-AH). Extending the analysis to the entire cohort, an additional 8 proteins were independently associated with CAD or RF; by logistic regression, the 12-protein panel alone discriminated the four groups with AUCROC's of 0.72–0.81 (overall p = 1.0e−38). Among them, insulin-like growth factor binding protein-3 is positively associated with RF, lower BMI, and HDL-cholesterol, renin with CAD higher glycated hemoglobin HbA1c, and smoking.ConclusionsIn a CCTA-based cohort, four proteins, involved in opposing vascular processes (healing vs. adverse remodeling), are specifically associated with low CAD burden in high CV-risk individuals (high MYO and C-C-22) and high CAD burden in low-risk subjects (high PS-3 and PAF-AH), in interaction with BMI, smoking, diabetes, HDL-cholesterol, and HbA1c. These findings could contribute to a deeper understanding of the atherosclerotic process beyond traditional risk profile assessment and potentially constitute new treatment targets.

Background: High-sensitivity cardiac troponin T (hsTnT) was recently approved for clinical use by the Food and Drug Administration. The transition from contemporary to hsTnT assays requires a thorough understanding of the clinical differences between these assays. Hypothesis: HsTnT may provide a more accurate prognostic stratification than contemporary cardiac troponin I (cTnI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Methods: HsTnT and cTnI were measured in 644 patients with CK-MB negative NSTE-ACS who were enrolled in the prospective multicenter SPAI (Stratificazione Prognostica dell'Angina Instabile) study. Patients were stratified at the 99th percentile reference limit for each assay. The primary endpoint was cardiovascular death (CVD) or non-fatal myocardial infarction (MI); the secondary endpoint was the occurrence of unstable angina (UA). Follow-up lasted 180 days. Results: Patients with hsTnT ≥99th percentile were at higher risk of CVD/MI (30-day: 5.9% vs 0.8%, p = 0.001; 180-day: 11.1% vs 4.7%, p = 0.004), also after adjusting for TIMI Risk Score. No significant difference in CVD/MI at 180-day was found between hsTnT-positive/cTnI-negative and hsTnT-negative/cTnI-negative patients (adjHR 1.61, 95% CI 0.74–3.49, p = 0.232). Occurrence of UA was not differently distributed between hsTnT groups dichotomized at the 99th percentile (12.4% vs 12.5% p = 0.54). Conclusions: Our investigation on a real-world NSTE-ACS population showed good prognostic performance of hsTnT in the risk stratification of the hard endpoint, but did not demonstrate the improved prognostic ability of hsTnT over contemporary cTn. Neither troponin assay predicted the recurrence of UA, suggesting the acute rise of cardiac troponin as a marker of severity, but not the occurrence of future coronary instability. Keywords: High-sensitivity cardiac troponin, Biomarkers, Acute coronary syndromes, Prognostic risk stratification

Multidrug resistance-associated protein 4 (MRP4), a member of the C subfamily of ATP-binding cassette transporters, is highly expressed in the kidneys of mammals and is responsible for renal elimination of numerous drugs. Adenosine deaminase acting on RNA 1 (ADAR1) has been reported to regulate gene expression by catalyzing adenosine-to-inosine RNA editing reactions; however, potential roles of ADAR1 in the regulation of MRP4 expression have not been investigated. In this study, we found that downregulation of ADAR1 increased the expression of MRP4 in human renal cells at the posttranscriptional level. Luciferase reporter assays and microarray analysis revealed that downregulation of ADAR1 reduced the levels of microRNA miR-381-3p, which led to the corresponding upregulation of MPR4 expression. Circular RNAs (circRNAs) are a type of closed-loop endogenous noncoding RNAs that play an essential role in gene expression by acting as miRNA sponges. We demonstrate that ADAR1 repressed the biogenesis of circRNA circHIPK3 through its adenosine-to-inosine RNA editing activity, which altered the secondary structure of the precursor of circHIPK3. Furthermore, in silico analysis suggested that circHIPK3 acts as a sponge of miR-381-3p. Indeed, we found overexpression of circHIPK3 induced the expression of MRP4 through its interference with miR-381-3p. Taken together, our study provides novel insights into regulation of the expression of xenobiotic transporters through circRNA expression by the RNA editing enzyme ADAR1.

This paper describes the performance analysis of designed speech recognition system whereby the front end method uses MFCCs feature extraction algorithm and defined HMM recognition as the back end. The dataset includes 30 phonemes and 2200 utterances by different speakers. Each speech signal is sampled to 16kHz, 16-bit PCM, and in a mono channel format. The extracted feature of each signal consists of 39 feature vectors which are 12 Mel Cepstrum Coefficients, Log Energy, Delta (first-order derivative) coefficients, and Acceleration coefficients (second-order derivative). The Baum-Welch algorithm is applied for HMM training and the Viterbi algorithms for decoding. The overall system performance accuracy of this experiment is 95.00%.

Tourism is one of the important sectors in giving good economic impacts for states such as Kelantan due to the existence of many tourism destinations and Gunung Stong State Park (GSSP) is one of the highly exposed ecotourism destination regarding the presence of second highest waterfall in Southeast Asia, Jelawang Waterfall. This study is to identify the benefits received by local communities and to determine the role of GSSP in providing income from sustainable tourism. This study also helps to identify the perception of local communities on tourism in GSSP. Questionnaires interviews and observation help in determining the perception of local communities on tourism in GSSP and its role in income from sustainable tourism. Results show that local communities receive benefits in term of road maintenance, exposure to tourists, improvement of infrastructure quality, enhancement of recreational activities and revenue potential. Result also shows that GSSP play roles in income from sustainable tourism and local communities have high awareness on the importance of GSSP. Entrepreneurship plays crucial factor in their income. This results show that entrepreneurship helps to improve the quality of life of local communities and GSSP plays important role to the local communities surrounding GSSP.

Flexible plate structure is a chosen technology used for many applications since past decades ago. However, this structure has a disadvantage that needs to be avoided which is easy to vibrate. Thus, this project presents the modelling of horizontal flexible plate system using bio-inspired flower pollination algorithm. The objective is to obtain an accurate model of the real system in the simulated environment. The collected of real vibration data through experimental study was then utilized to develop the dynamic system model based on linear autoregressive with exogenous (ARX) model structure and optimized by flower pollination algorithm (FPA). The algorithm is a novel bio-inspired optimization algorithm that mimics the real-life processes of the flower pollination. The gained model in this simulation is approved utilizing the most minimal mean squared error, correlation tests, and pole zero graph stability due to check the robustness of the model. The performance of the developed model was then compared with the conventional algorithm known as recursive least square (RLS). The best model achieved in this study will be used as a platform of controller development using active vibration control technique.

Soft set time complexity is become really a problem when the numbers of parameters are increased. In order to solve time complexity problem, it necessary to reduce the boundary of optimal soft set growth and due to this the time cost can be enhanced. Several soft set methods are determining the soft set reduction but in performing the reduction it spends more time to produce the result and this happens because the false candidate sets are a part of solution. So, if the boundary of candidate reduction is narrowed then the reduction process will speed up. In this paper, we proposed a new method which reducing the boundary of candidate reduction using Lipschitz constant and wavelet discrete transform to eliminate large false sets from the solution. In Lipschitz constant function the value of candidate implies are determined, where based on wavelet WDT the false sets which is not in the form of implies also can be determined. The proposed method remove an inconsistency noise from the soft set in a pre-processing filtering based on if then method which help to classify further reduction in short time. It found that by using Lipschitz constant function and wavelet discrete transform the reduction time can be enhanced several times comparing to previous reduction methods. The result indicates that Lipschitz constant function and wavelet WDT algorithm. It complements each other to determine candidate soft set reduction.

This paper overcome the false parameters from soft set which focuses on original decision partitions order whereas in some cases the decision partition order not induced original set extensions or the reductions of original set maybe not significant. Based on the priority the decision partition order can be constructed to match whether the sub set is the core of optimal decision or deciding for removing a particular sub set if their complement decision partition order status is match the original classifications. The proposed method has successfully maintained the optimal and sub optimal result. This method overcome the false parameters because it directly forwarded to reduction set. It has been validated that it is effective for parameter reduction even in large sub sets.

Replication is one of the mechanisms managing data since it improves data access and reliability. However, in recent years, with widely available, low-cost technology, the amount of various data grows rapidly. The problem is although we are packed with data, but we have lacked of knowledge. Nevertheless, if the impractical data is used in database replication, this will cause waste of data storage and the time taken for a replication process will be delayed. This paper propose a new algorithm namely Binary Vote Assignment on Grid Quorum with Association Rule (BVAGQ-AR) in order to handle fragmented database replication. BVAGQ-AR algorithm is capable of partitioning the database into disjoint fragments. Fragmentation in distributed database is very useful in terms of usage, reliability and efficiency. Handling fragmented database replication becomes challenging issue to administrator since the distributed database is scattered into split replica partitions or fragments. We address how to build reliable system by using the proposed BVAGQ-AR algorithm for distributed database fragmentation by using Malaysian Greater Research Network (MyGRANTS) data as a case study. The result shows that managing fragmented database replication through proposed BVAGQ-AR algorithm able to preserve MyGRANTS data consistency.

Parameter reduction has a significant role in making precision decisions. Several decisions making researches mine Boolean soft set with defined operations such as AND, OR, union and intersection to utilize their thinking in rough set theory for reducing parameters. Discovering false frequent sets in a soft set takes the right direction for parameter reduction. In this study, the false parameters of multi set are filtered for decision making based on decision partition order or the decision partition order can be configured predefined based on priority. The most important AND intersection results confirm the two sets relations that whether the extensions of original maps the original set characteristics. This contribution enhanced objects decision partition (Herawan et al. in Int J Database Theory Appl 3(2), 2010 [1]) from a multi set for constructing AND and OR filters with the help of decision partition order and then the decision partition order enhanced using user’s priority, and it shows better results in terms of objects reduction.

K-Means is one of the popular methods for generating clusters. It is very well-known and commonly used for its convenience and fastness. The main disadvantage of these criteria is that user should specify the number of cluster in enhance. As a repetitive clustering strategy, a K-Means criterion is very delicate to the preliminary beginning circumstances. In this paper, has been proposed a clustering strategy known as Multi-dimensional K-Means clustering criteria. This algorithm auto generates preliminary k (the preferred variety of cluster) without asking input from the user. It also used a novel strategy of establishing the preliminary centroids. The experiment of the proposed strategy has been conducted using synthetic data, which is taken form LIyod’s K-means experiments. The algorithm is suited for higher education for calculating the student’s CGPA and extracurricular activities with graphs.

The outcome of the reduction of soft data is dependent on the quality and discount evidence that increases with optimization analysis. There is a set of techniques that can be used to reduce the data, but the different techniques showed different results as each technique is focused on solving a particular problem. This paper proposed a parameter reduction algorithm, known as 3C algorithm, to circumvent the false frequent object in reduction. Results indicated that the proposed algorithm is easy to implement and perform better than the state-of-the-art parameter reduction algorithm. Also, the proposed algorithm can be used as an effective alternative method for reducing parameters in order to enhance the decision-making process based on decision partition order. Comparative analysis were performed between the proposed algorithm and the state-of-the-art parameter reduction algorithm using several soft set in terms of parameter reduction.

This paper is the current approach database security of organization need layers of security around their data, with each layer protecting a specific area. The current trend of security attack is targeting any valuable data stored in a database such as financial data and student mark, including data theft, data modification or replay and data disruption. To understand how the system works, the system setting and the weaknesses of Enterprise Distributed Database. This paper is about the design and development to secure database access, a framework based on packet and content filtering on IP address, port and SQL statement. And simulate the framework and design database security framework. We address how to build the outcome of this is to reduce the risk of data manipulation and reduce the impact of internal threat and malicious insiders. The result shows that the proposed method succeeded in meeting those aspects of information security.

Voluminous data are available in soft sets, which makes it difficult to recognize the soft set decisions of the data. The large increase in the volume of these soft set has made it necessary to enlarge the size of the storage media to store the data. Consequently, several researches have proposed oft set reduction of the data. This paper proposes uncertain soft set by hybridizing two soft set reduction techniques producing a significant result without affecting the decisive characteristics of the data. This proposed method utilizes advanced techniques to govern knowledge with proper reduction of related resources that can assist the decision-making process.

In the above article, all mentions of “cartilage intermediate-layer protein” refer to “cartilage intermediate-layer protein 2.” The isoform number was misstated in the abstract and one place in the …

This study sought to assess whether coronary atherosclerosis analysis by coronary computed tomography angiography (CTA) may improve prognostic stratification among patients with diffuse coronary artery disease (CAD) BACKGROUND: Coronary CTA has recently emerged as a promising noninvasive tool for advanced analysis of coronary atherosclerosis.The multicenter CAPIRE (Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation) study is part of the GISSI Outlier Project. A prospective cohort of subjects who underwent coronary CTA for suspected CAD was enrolled. Based on risk factor (RF) burden, patients were defined as having a low clinical risk (0 to 1 RF with the exclusion of patients with diabetes mellitus as single RF) or at high clinical risk (3 or more RFs). Patients with 2 RFs were not enrolled in the study. Coronary CTA advanced plaque assessment was performed. Outcome measures were 3 combined endpoints: acute coronary syndrome (ACS), cardiac death + ACS, and cardiac death + ACS + late revascularization.Among the 544 patients enrolled in the CAPIRE study, in 522 patients, a mean follow-up of 37 ± 10 months was obtained (16 patients were excluded due to 1 segment involvement score 5 at core lab coronary CTA analysis and 6 patients were lost at follow-up). Higher atherosclerotic burden was found in patients with higher clinical risk, but prevalence of elevated noncalcified plaque volume did not significantly differ between low- versus high-risk patients. Quantitative plaque parameters by coronary CTA were associated with composite endpoints at multivariable analysis when corrected for univariate predictors. Elevated noncalcified plaque volume, expressed as dichotomic variable, was associated with all combined endpoints. Even if the low absolute number of events represents a limitation to the present study, patients with low noncalcified plaque volume had similar risk of cardiac events independently from the presence of multivessel disease, while patients with high noncalcified plaque volume had higher rates of cardiac events.The CAPIRE study confirmed the prognostic value of atherosclerosis assessment by coronary CTA, demonstrating high noncalcified plaque volume as the most ACS-predictive parameter in patients with extensive CAD. (GISSE Outliers CAPIRE [CAPIRE]; NCT02157662).

This paper aims to discuss the implementation of Malay Language Speech Recognition (SR) using Hidden Markov Model (HMM) system training for Malay preschool children. The system is developed by implementing the architecture of HMM-based Recognizer with different feature extraction algorithm. The system is trained for 16 Malay words by collecting 704 speech samples (640 for training samples and 64 for testing samples). Data is collected from 20 preschool children aged between five to six years old in real time environments. The paper also describes the process flow to develop the architecture of the system. The experimental results show that the highest overall system performance is 94.86% - Train and 76.04% - Testing which is using MFCC (Mel-Frequency Cepstral Coefficient) with 39 extracted feature vectors (MFCC39).

Introduction: today, cultural changes may have changed the usual pattern of the mother as the accompanying person in the pediatric office. Objetives: descriptive analysis of the current situation in the pediatrics office. Material and methods: Las Delicias Health Center (health district of Malaga). Selected sample of 250 patients between the periods 1-15 July and 15-30 September, 2011. Results: in most cases (54.8%), the mother stands as the main accompanying person, appearing both parents in the consultation in 16.4% of cases. The figure of the grandparents is of special significance when the mother is an active worker. Most consultations were on-demand by appointment (82.4%), for acute symptoms, with symptoms lasting less than 3 days in most cases (59.2%). Discussion: the mother is presented as the main accompanying person in most cases. The father or grandparents will be present in front of social-cultural factors, mainly active employment status of the mother. Introducción: en la actualidad, los cambios socioculturales pueden haber modificado el habitual esquema de la madre como acompañante principal en la consulta pediátrica. Objetivo: análisis descriptivo de la situación actual en la consulta de Pediatría. Material y métodos: Centro de Salud Las Delicias (distrito sanitario de Málaga capital). Muestra de 250 pacientes seleccionados entre los periodos de 1-15 de julio y 15-30 de septiembre de 2011. Resultados: en la mayoría de los casos (54,8%), la madre se sitúa como acompañante principal; apareciendo ambos progenitores en la consulta en el 16,4% de los casos. La figura de los abuelos como acompañantes toma especial relevancia cuando la madre se encuentra laboralmente activa. La mayoría de las consultas realizadas fueron a demanda con cita (82,4%), por sintomatología aguda, con una duración de los síntomas inferior a tres días en la mayor parte de los casos (59,2%). Discusión: la madre se presenta como acompañante principal de los niños en la consulta de Pediatría de Atención Primaria (en la mayoría de los casos). La figura paterna o de los abuelos, estará presente ante factores socioculturales, principalmente el estado laboralmente activo de la madre. Yes

"Several lines of evidence suggest the involvement of infectious agents in the pathogenesis of atherosclerosis. Furthermore, a correlation between infection-driven inflammatory burden and acute manifestation of coronary artery disease has been hypothesized. The aim of this work was to assess whether human herpesvirus (HHV)-6 and HHV-8, two DNA viruses with a distinct tropism for endothelium and lymphocytes, may be associated with coronary instability. An age- and gender-matched cross-sectional study was undertaken in 70 patients with testing of plasma HHV-6 and HHV-8 DNA load in different cardiovascular clinical settings: 29 patients with acute myocardial infarction, 21 patients with stable coronary artery disease, and 20 patients without coronary and carotid artery atherosclerosis subjected to cardiac valve replacement. In all patients, HHV-6 and HHV-8 plasma DNA was tested by using highly sensitive, calibrated quantitative real-time PCR assays which employ a synthetic DNA calibrator to adjust for DNA extraction and amplification efficiency. HHV-8 viremia was undetectable in all three groups. HHV-6 viremia was detected in a substantial fraction of the samples examined (18.6%) without significant differences among the three groups (ST segment elevation myocardial infarction: 17.2%; stable coronary artery disease: 14.3%; patients without coronary and carotid artery atherosclerosis: 25%). Furthermore, no significant differences in plasma HHV-6 load were observed amongst the three groups of patients. These findings indicate that coronary instability is not associated specifically with active HHV-6 or HHV-8 infection. However, an unusually high rate of active HHV-6 infection was documented among patients without atherosclerosis admitted to hospital with cardiac disease. "

Background Adaptive T‐cell response is promoted during atherogenesis and results in the differentiation of naïve CD4 + T cells to effector and/or memory cells of specialized T‐cell subsets. Aim of this work was to investigate the relationship between circulating CD4 + T‐cell subsets and atherosclerosis. Methods and Results We analyzed 57 subsets of circulating CD4 + T cells by 10‐parameter/8‐color polychromatic flow cytometry (markers: CD3/CD4/CD45RO/CD45RA/CCR7/CCR5/CXCR3/HLA‐DR) in peripheral blood from 313 subjects derived from 2 independent cohorts. In the first cohort of subjects from a free‐living population ( n =183), effector memory T cells (T EM : CD3 + CD4 + CD45RA − CD45RO + CCR7 − cells) were strongly related with intima‐media thickness of the common carotid artery, even after adjustment for age ( r =0.27; P EM and low‐density lipoproteins was observed. In the second cohort ( n =130), T EM levels were significantly increased in patients with chronic stable angina or acute myocardial infarction compared with controls. HLA‐DR + T EM were the T EM subpopulation with the strongest association with the atherosclerotic process ( r =0.37; P EM (identified as CD4 + CD44 + CD62L − ) were significantly increased in low‐density lipoprotein receptor and apolipoprotein E deficient mice compared with controls and were correlated with the extent of atherosclerotic lesions in the aortic root ( r =0.56; P Conclusions Circulating T EM cells are associated with increased atherosclerosis and coronary artery disease in humans and in animal models and could represent a key CD4 + T‐cell subset related to the atherosclerotic process. ( J Am Heart Assoc 2012;1:27‐41.)

Several studies have evaluated the influence of different dietary habits on the risk of acute myocardial infarction and on the long-term prognosis after a coronary event, whilst no clear data are available on the in-hospital and short-term prognosis. We assessed the role of dietary habits and, in

The purpose of this study was to test the hypothesis that specific epicardial adipose tissue (EAT) proinflammatory adipokines might be implicated in acute coronary syndrome (ACS). We compared expression and protein secretion of several EAT adipokines of male ACS with those of matched stable coronary artery disease (CAD) patients and controls with angiographically normal coronary arteries. The effect of supernatant of cultured EAT on endothelial cell permeability in vitro was also evaluated in the three study groups. EAT of ACS patients showed significantly higher gene expression and protein secretion of resistin than patients with stable CAD. Interleukin-6, plasminogen activator inhibitor-1, and monocyte chemoattractant protein-1 genes were also significantly overexpressed in ACS compared with the control group but not when compared with stable CAD. Immunofluorescence of EAT sections revealed a significantly greater number of CD68+cells in ACS patients than stable CAD and control groups. The permeability of endothelial cells in vitro was significantly increased after exposure to supernatant of cultured EAT from ACS, but not control or stable CAD groups, and this effect was normalized by anti-resistin antiserum. We found that EAT of patients with ACS is characterized by increased expression and secretion of resistin and associated with increased in vitro endothelial cell permeability.

La vacunación es una de las medidas de salud más útiles que existe; permitiendo erradicar enfermedades infecciosas que afectan a la población infantil y provocan gran morbilidad, mortalidad y secuelas. Por otro lado, en las últimas décadas, estamos asistiendo a un aumento de los pacientes con enfermedades crónicas; precisando, la mayoría de ellos, una adaptación específica del calendario de vacunación. Por lo tanto, puede ocurrir que el paciente pediátrico afecto de una enfermedad crónica, pueda encontrarse en un estado de infravacunación; por lo que la optimización del calendario de vacunación en estos niños, se convierte en un aspecto prioritario para cualquier pediatra. OBJETIVOS: Analizar la situación de vacunación en el paciente pediátrico con una enfermedad crónica; tanto de las vacunas sistemáticas oficiales, como aquellas vacunas recomendadas y también las indicadas sólo para determinados grupos de riesgo. Además, como objetivo secundario, se pretende establecer la caracterización del paciente pediátrico afecto de una enfermedad crónica; así como definir los factores de riesgo que conllevan a una situación de infravacunación en el paciente pediátrico con una enfermedad crónica. MATERIAL Y MÉTODO: Estudio retrospectivo longitudinal observacional descriptivo y analítico; en una muestra de pacientes pediátricos afectos con una enfermedad crónica de las de mayor prevalencia, del Hospital Materno Infantil; durante el año 2011. Criterios de inclusión: niños ≥ 1 día y ≤ 14 años, con una enfermedad considerada como crónica, en seguimiento en alguna de las consultas externas más frecuentadas por estos pacientes. Criterios de exclusión: pacientes de origen no español; enfermedad oncológica maligna; una inmunodeficiencia innata o pacientes con pronóstico vital estimado < 6 meses. Variables principales: estado de vacunación sistemática, estado de vacunación frente a neumococo, estado de vacunación frente a varicela, estado de vacunación frente a gripe, estado de vacunación frente a hepatitis A y estado global de vacunación del paciente. Variables secundarias: variables demográficas propias del paciente y de su enfermedad de base. Análisis estadístico: En un primer momento se llevó a cabo el análisis descriptivo. Para las variables cualitativas se determinaron las distribuciones de frecuencia; y para las variables cuantitativas, una medida de tendencia central y una de dispersión. En el análisis univariante se realizaron contrastes de hipótesis con tablas de contingencia y test ji cuadrado para estudiar las variables cualitativas. Para las variables cuantitativas se utilizaron técnicas paramétricas T Student o análisis de la varianza de una vía (ANOVA), o técnicas no paramétricas, Test de Mann Withney o Kruskal Wallis. Como técnica multivariante se realizó un análisis, utilizando las técnicas de árboles de decisión procedimiento CHAID (CHi-squared Automatic Interaction Detection – Detector Automático de Interacción Chi-cuadrado) para los árboles de clasificación. RESULTADOS: desde el uno de enero hasta el 31 de diciembre de 2011, se reclutaron un total de 140 pacientes afectos de una enfermedad crónica; elegidos al azar, cumpliendo todos los criterios de inclusión y ninguno de exclusión. La edad media fue de 6,7 años, con un ligero predomino de sexo femenino (54,3%). El 86,4% de los pacientes no tenía antecedentes de prematuridad; sólo el 5,7% había presentado desnutrición; y el 14,3% de los pacientes se encontraba en tratamiento con corticoides y/o fármacos inmunosupresores. El 24,3% había sido sometido a alguna intervención quirúrgica; y el 67,9% de los casos había precisado ingreso hospitalario, debido a su enfermedad de base. En cuanto al análisis del estado de vacunación global del paciente, el 20% de los casos poseía un estado correcto de vacunación; el 17,9% de los pacientes se encontraba vacunado, pero de manera incompleta debido a ausencia o retraso de alguna dosis; y finalmente, el 62,1% de los casos se encontraban incorrectamente vacunados debido a la ausencia de la vacunación recomendada; a la vacunación propia de los grupos de riesgo; o ausencia de ambas. CONCLUSIONES: nuestros datos sugieren que el 80% de los pacientes presenta alguna deficiencia en su estado de vacunación; por lo que asegurar un correcto estado de inmunización en estos pacientes, se convierte en un objetivo prioritario. La edad del paciente, la prematuridad y el tratamiento con corticoides y/o inmunosupresores, suponen un factor de riesgo para el estado de vacunación. El nivel económico y educativo de los progenitores, parece ser un factor determinante en la vacunación recomendada (neumococo y varicela). El principal motivo de una vacunación incorrecta en el paciente pediátrico afecto de una enfermedad crónica es; su propia enfermedad de base, y, en segundo lugar, el desconocimiento por parte de los progenitores.

In earlier works, we demonstrated the potential of polysilazane (PSZ) coatings for a use as insulating layers in Cu(In,Ga)Se2 (CIGS) solar cells prepared on steels substrates and showed a good adhesion between PSZ coatings and both AISI316 and AISI430 steels. In the present paper, spectroscopic techniques are used to elucidate the reason of such adhesion. X-ray Photoelectron Spectroscopy (XPS) was used to investigate surfaces for the two steel substrates and showed the presence of metal oxides and metal hydroxides at the top surface. XPS has been also used to probe interfaces between substrates and PSZ, and metallosiloxane (Me-O-Si) covalent bonds have been detected. These results were confirmed by Infra-Red Reflection Absorption Spectroscopy (IRRAS) analyses since vibrations related to Cr-O-Si and Fe-O-Si compounds were detected. Thus, the good adhesion between steel substrates and PSZ coatings was explained by covalent bonding through chemical reactions between PSZ precursors and hydroxide functional groups present on top surface of the two types of steel. Based on these results, an adhesion mechanism between steel substrates and PSZ coatings is proposed.

Computational models of the artificial intelligence such as rough set theory have several applications. Rough set-based data clustering can be considered further as a technique for medical decision making. This paper presents the results of an experimental study of a rough-set based clustering technique using Variable Precision Rough Set (VPRS). Here, we employ our proposed clustering technique [12] through a medical dataset of patients suspected diabetic. Our results indicate that the VPRS-based technique is better than that the standard rough set-based techniques in the process of selecting a clustering attribute.

Replication in distributed database is the process of copying and maintaining database objects in multiple databases that make up a distributed database system. In this paper, we will manage fragmented database replication and transaction management for Malaysian Greater Research Network (MyGRANTS) using a new proposed algorithm called Binary Vote Assignment on Cloud Quorum (BVACQ). This technique will combine replication and fragmentation. Fragmentation in distributed database is very useful in terms of usage, efficiency, parallelism and also for security. This strategy will partition the database into disjoint fragments. The result shows that managing replication and transaction through proposed BVACQ able to preserve data consistency. It also increases the degrees of parallelism. This is because by using fragmentation, replication and transaction can be divided into several subqueries that operate on the fragments.

Background Cardiovascular disease is important in rheumatoid arthritis (RA). Tissue factor (TF) is expressed upon platelet activation and initiates coagulation. Anti-tumour necrosis factor-α (TNFα) agents seem to decrease RA-associated cardiovascular events. We investigated whether (1) TNFα activates human platelets and (2) TNFα pharmacological blockade modulates the platelet-leucocyte reciprocal activation in RA. Design The expression of platelet TNFα receptors has been assessed by flow cytometry and immunogold electron microscopy. Platelet and leucocyte activation has been assessed also in the presence of antibodies against the TNFα receptors 1 and 2 and of infliximab. TF expression, binding to fibrinogen and phosphatidylserine exposure, has been assessed by flow cytometry, TF activity by coagulation time and by endogenous thrombin generation. Markers of platelet and leucocyte activation have been assessed in 161 subjects: 42 patients with RA, 12 with osteoarthritis, 37 age-matched and sex-matched patients with chronic stable angina and 70 age-matched and sex-matched healthy subjects. Results TNFα elicited the platelet activation and the expression of TF, which in turn prompted thrombin generation and clot formation. Inhibition of the TNFα-induced activation restricted platelet ability to activate leucocytes and to induce leucocyte TF. TNFα inhibition did not influence platelet activation induced by collagen, ADP or thrombin receptor activating peptide-6. Platelets of patients with RA were more activated than those of controls. Activation was reduced in patients treated with TNFα inhibitors. Conclusions TNFα-dependent pathways control platelet activation and TF expression in RA. Further studies will verify whether the protective effect of TNFα inhibitors on cardiovascular events involves their ability to modulate platelet function.

Heart rate variability (HRV) and systemic markers of inflammation have prognostic value in patients with unstable angina pectoris (UAP). However, it is unknown whether any relation exists between HRV parameters and indexes of inflammation in this clinical context. We assessed HRV on 24-hour electrocardiographic Holter recordings, performed within 24 hours of admission, and measured C-reactive protein (CRP) serum levels by a high-sensitivity assay on admission, in 531 patients with UAP (65 +/- 10 years of age; 347 men) who were enrolled in the prospective multicenter study Stratificazione Prognostica dell'Angina Instabile (SPAI). A significant inverse correlation was found between CRP levels and all HRV parameters, with the highest r coefficient shown with SD of all RR intervals (r = -0.23; p < 0.001) in the time domain and with very low-frequency amplitude (r = -0.22; p < 0.001) in the frequency domain. When patients were categorized into 4 groups according to CRP quartile levels, statistically significant lower HRV values were observed in the upper CRP quartile. On separate multiple regression analyses, including the most important clinical and laboratory variables, SD of all RR intervals and very low-frequency amplitude were the most significant predictors of increasing CRP levels (p < 0.001 for the 2 comparisons). In contrast, in models with SD of all RR intervals and very low-frequency amplitude as dependent variables, CRP was a strong predictor of impaired cardiac autonomic function (p < 0.001 for the 2 comparisons). Thus, our data show that, in patients with UAP, high levels of serum CRP levels are significantly associated with decreased HRV, suggesting a possible pathophysiologic link between cardiac autonomic dysfunction and inflammatory activity. (c) 2006 Elsevier Inc. All rights reserved.

A previously unreported case of a complex congenital cardiac anomaly consisting of coronary and valvular angiodysplasia, complicated by an eosinophilic endomyocardial disease, is described. The disorder presented clinically with congestive heart failure, which was characterized by evidence of floating masses causing severe pulmonary stenosis and dysfunction of the mitral and aortic valves. Symptoms of cardiac failure disappeared following pulmonary valve replacement and steroid therapy.

One of the most important techniques to improve information management on the web in order to obtain better understanding of user's behaviour is clustering web data. Currently, the rough approximation-based clustering technique has been used to group web transactions into clusters. It is based on the similarity of upper approximations of transactions to merge between two or more clusters. However, in reviewing the technique, it has a weakness in terms of processing time in obtaining web clusters. In this paper, an alternative technique for grouping web transactions using rough set theory, named RMF is proposed. It is based on the rough membership function of a transaction similarity class with respect to the other classes. The two UCI benchmarks datasets are opted in the experimental processes. The experimental results reveal that the proposed technique has an benefit of low time complexity as compared to the baseline technique up to 67 %

For the fabrication of monolithically integrated flexible Cu(In, Ga)Se2, CIGS modules on stainless steel, individual photovoltaic cells must be insulated from metal substrates by a barrier layer that can sustain high thermal treatments. In this work, a combination of sol–gel (organosilane-sol) and sputtered SiAlxOy forming thin diffusion barrier layers (TDBL) was prepared on stainless steel substrates. The deposition of organosilane-sol dielectric layers on the commercial stainless steel (maximal roughness, Rz = 500 nm and Root Mean Square roughness, RMS = 56 nm) induces a planarization of the surface (RMS = 16.4 nm, Rz = 176 nm). The DC leakage current through the dielectric layers was measured for the metal-insulator-metal (MIM) junctions that act as capacitors. This method allowed us to assess the quality of our TDBL insulating layer and its lateral uniformity. Indeed, evaluating a ratio of the number of valid MIM capacitors to the number of tested MIM capacitors, a yield of ~ 95% and 50% has been reached respectively with non-annealed and annealed samples based on sol–gel double layers. A yield of 100% was achieved for sol–gel double layers reinforced with a sputtered SiAlxOy coating and a third sol–gel monolayer. Since this yield is obtained on several samples, it can be extrapolated to any substrate size. Furthermore, according to Glow Discharge Optical Emission Spectroscopy and Time of Flight Secondary Ion Mass Spectroscopy measurements, these barrier layers exhibit excellent barrier properties against the diffusion of undesired atoms which could otherwise spoil the electronic and optical properties of CIGS photovoltaic cells.

Atherosclerotic cardiovascular disease still represents the leading cause of death in western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proven effective in improving clinical outcomes. This document is focused on the clinical management of hypercholesterolemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors have considered with particular attention the role of hypercholesterolemia in the genesis of atherosclerotic cardiovascular disease. Besides, the implications of high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analyzed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been considered. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolemia.

Rationale: At the onset of ST-elevation acute myocardial infarction (STEMI), patients can present with very high circulating interleukin-6 (IL-6 + ) levels or very low-IL-6 – levels. Objective: We compared these 2 groups of patients to understand whether it is possible to define specific STEMI phenotypes associated with outcome based on the cytokine response. Methods and Results: We compared 109 patients with STEMI in the top IL-6 level (median, 15.6 pg/mL; IL-6 + STEMI) with 96 in the bottom IL-6 level (median, 1.7 pg/mL; IL-6 − STEMI) and 103 matched controls extracted from the multiethnic First Acute Myocardial Infarction study. We found minimal clinical differences between IL-6 + STEMI and IL-6 − STEMI. We assessed the inflammatory profiles of the 2 STEMI groups and the controls by measuring 18 cytokines in blood samples. We exploited clustering analysis algorithms to infer the functional modules of interacting cytokines. IL-6 + STEMI patients were characterized by the activation of 2 modules of interacting signals comprising IL-10, IL-8, macrophage inflammatory protein-1α, and C-reactive protein, and monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, and monokine induced by interferon-γ. IL-10 was increased both in IL-6 + STEMI and IL-6 − STEMI patients compared with controls. IL-6 + IL-10 + STEMI patients had an increased risk of systolic dysfunction at discharge and an increased risk of death at 6 months in comparison with IL-6 − IL-10 + STEMI patients. We combined IL-10 and monokine induced by interferon-γ (derived from the 2 identified cytokine modules) with IL-6 in a formula yielding a risk index that outperformed any single cytokine in the prediction of systolic dysfunction and death. Conclusions: We have identified a characteristic circulating inflammatory cytokine pattern in STEMI patients, which is not related to the extent of myocardial damage. The simultaneous elevation of IL-6 and IL-10 levels distinguishes STEMI patients with worse clinical outcomes from other STEMI patients. These observations could have potential implications for risk-oriented patient stratification and immune-modulating therapies.

K-means algorithm is very well-known in large data sets of clustering. This algorithm is popular and more widely used for its easy implementation and fast working. However, it is well known that in the k-means algorithm, the user should specify the number of clusters in advance. In order to improve the performance of the K-means algorithm, various methods have been proposed. In this paper, has been presented an improved parameter less data clustering technique based on maximum distance of data and Lioyd k-means algorithm. The experimental results show that the use of new approach to defining the centroids, the number of iterations has been reduced where the improvement was 60%.

Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or ≥2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p0.0001). Hs-cTnT was more accurate to detect patients with CAD in the low-RF group than in the multiple-RF group (p = 0.04). In multivariate analysis, higher level of hs-cTnT (6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden.

Giant cell arteritis (GCA) rapidly responds to high-dose corticosteroids. However, smouldering arterial inflammation can persist despite the absence of symptoms and altered acute phase reactants. In patients that are refractory, symptoms relapse during steroid tapering and vascular complications may develop. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level are not sensitive enough markers to detect refractory disease.1 The neuroendocrine system regulates innate and acquired immune responses, influencing cytokine synthesis and limiting tissue damage via release of neurotransmitters and peptides in peripheral tissues. Chromogranin A in particular is a candidate marker linking neurogenic inflammation and vascular inflammation.2 We investigated by ELISA, as described previously,3 the …

Objectives This study sought to assess the prevalence of normal levels of high sensitivity C-reactive protein (hsCRP) at the very onset of ST-segment elevation myocardial infarction (STEMI). Background Levels of hsCRP ≥2 mg/l identify individuals who benefit from lipid lowering and possibly anti-inflammatory agents, but how many patients develop infarction in spite of hsCRP levels Methods We studied 887 patients with unequivocally documented STEMI as the first manifestation of coronary disease and 887 matched control subjects from urban areas of Italy, Scotland, and China. Blood samples were obtained before reperfusion strategies Results hsCRP values were similar in samples obtained Conclusions The measurement of hsCRP, with a 2 mg/l cutoff, would not have predicted 41% of unequivocally documented STEMIs in 3 ethnic groups without evidence of previous coronary disease, thus indicating both its limitations as an individual prognostic marker and as an indicator of a generalized inflammatory pathogenetic component of STEMI. New specific prognostic and therapeutic approaches should be found for such a large fraction of patients at risk.

An efficient energy management of a building requires optimum use of the light energy, which is strongly dependent on optical properties of used materials. In the lighting sector, aluminium is generally employed as substrate for the reflectors. Nowadays, new steel substrates combining good corrosion resistance and flexibility are developed to answer the growing need of this market. Specific requirements for optical applications are a high reflectivity (total reflectivity >82%), a high superficial hardness and durability and also a suitable formability. The sol–gel layer is used in this particular application for its levelling properties before depositing of the reflective layer and good barrier properties to avoid contact between the metallic layers. The corrosion protection and the barrier properties of the sol–gel layer are investigated as a function of the thickness. The protection conferred by the sol–gel layer on stainless steel substrate is studied by the electrochemical measurements in a sodium chl...

Pentraxin 3 (PTX3) plays cardioprotective and anti-atherogenic roles in murine models. PTX3 blood levels raise during early acute myocardial infarction (AMI). Neutrophils from healthy subjects physiologically contain PTX3 in secondary (also called specific) granules. In this study, we report that circulating neutrophils release preformed PTX3 in the early phase of AMI (within 6 h from the onset of clinical symptoms). Depletion of intracellular PTX3 correlates with increased plasma levels and with platelet–neutrophil heterotypic aggregates. Neutrophil PTX3 returns to normal values 48 h after the onset of symptoms; concentration does not vary in matched healthy controls or in patients with chronic stable angina. In vitro, recognition of activated P-selectin+ platelets causes the formation of neutrophil–platelet heteroaggregates and the release of neutrophil PTX3. Purified or membrane-bound P-selectin triggers PTX3 release from resting neutrophils. Released PTX3 binds to activated platelets in vitro. Moreover, PTX3 binds to a substantial fraction of platelets from patients in the circulating blood. PTX3-bound activated platelets have a reduced ability to 1) form heterotypic aggregates with neutrophils and monocytes; 2) activate neutrophils, as evaluated assessing the upregulation of leukocyte β2 integrins; 3) aggregate with other platelets; and 4) bind to fibrinogen. Our results suggest that neutrophils early release prestored PTX3 in patients undergoing AMI. PTX3 binds to activated circulating platelets and dampens their proinflammatory and prothrombotic action, thus possibly contributing to its cardioprotective effects.