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ESC Heart Failure Jun 2024Acute myocarditis, although a rare disease, can be associated with sudden cardiac death or the need for transplantation in both children and young adults. To date, there...
AIMS
Acute myocarditis, although a rare disease, can be associated with sudden cardiac death or the need for transplantation in both children and young adults. To date, there is no definitive evidence to support the routine use of immunosuppressive therapy or treatment targeting inflammation in patients with myocarditis. Animal models of cardiovascular (CV), as well as neurological diseases, have demonstrated that cannabidiol has significant anti-inflammatory properties and may represent a promising therapy in acute myocarditis. This efficacy has been shown in a murine model of autoimmune myocarditis as well as in in vitro and in vivo models of heart failure (HF).
METHODS AND RESULTS
We present the rationale and design of the ARCHER Trial, an international multicentre, double-blind, randomized, placebo-controlled, phase II study examining the safety and efficacy of a pharmaceutically produced cannabidiol formulation, in patients with mild to moderate acute myocarditis. Eligible patients are those with acute myocarditis, randomized within 10 days of the diagnostic cardiac MRI (CMR), which has met defined diagnostic criteria for myocarditis. Oral treatment (cannabidiol or placebo) is titrated from 2.5 mg/kg of body weight up to 10 mg/kg of body weight b.i.d. (or highest tolerated dose) and taken for 12 weeks in addition to standard of care therapy for HF. The primary endpoints are defined as changes in global longitudinal strain (GLS) and extra cellular volume (ECV), measured by CMR at 12 weeks. Assuming 80% power, a 5% alpha risk and 25% missing CMR follow-up data at Week 12, 100 patients are required to demonstrate the desired treatment effect of 18%. The change in left ventricular ejection fraction (LVEF) from baseline to Week 12 was selected as the secondary endpoint. Additional exploratory endpoints include changes in hs-troponin, NT-proBNP, markers of inflammation and endothelial function during the 12-week treatment period. The trial is ongoing but is now more than 50% recruited. As enrolment in the trial continues, no interim data are available for inclusion in this Design paper.
CONCLUSIONS
The ongoing ARCHER Trial is an international, multicentre, double-blind, randomized, placebo-controlled phase II study, designed to determine the effect of a pharmaceutically produced cannabidiol formulation on CMR parameters in patients presenting with acute myocarditis. Enrolment of 100 patients is expected to conclude in Q3 2024. Study results will be available in early 2025.
PubMed: 38937900
DOI: 10.1002/ehf2.14889 -
BMC Cardiovascular Disorders Jun 2024The cardiac toxicity of radiotherapy (RT) can affect cancer survival rates over the long term. This has been confirmed in patients with breast cancer and lymphoma....
Application of two-dimensional speckle-tracking echocardiography in radiotherapy-related cardiac systolic dysfunction and analysis of its risk factors: a prospective cohort study.
BACKGROUND
The cardiac toxicity of radiotherapy (RT) can affect cancer survival rates over the long term. This has been confirmed in patients with breast cancer and lymphoma. However, there are few studies utilizing the two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate the risk factors affecting radiation induced heart disease (RIHD), and there is a lack of quantitative data. Therefore, we intend to explore the risk factors for RIHD and quantify them using 2D-STE technology.
METHODS
We ultimately enrolled 40 patients who received RT for thoracic tumors. For each patient, 2D-STE was completed before, during, and after RT and in the follow up. We analyzed the sensitivity of 2D-STE in predicting RIHD and the relationship between RT parameters and cardiac systolic function decline.
RESULTS
Left ventricle global longitudinal strain (LVGLS), LVGLS of the endocardium (LVGLS-Endo), LVGLS of the epicardium (LVGLS-Epi), and right ventricle free-wall longitudinal strain (RVFWLS) decreased mid- and post-treatment compared with pre-treatment, whereas traditional parameters such as left ventricular ejection fraction (LVEF), cardiac Tei index (Tei), and peak systolic velocity of the free wall of the tricuspid annulus (s') did not show any changes. The decreases in the LVGLS and LVGLS-Endo values between post- and pre-treatment and the ratios of the decreases to the baseline values were linearly correlated with mean heart dose (MHD) (all P values < 0.05). The decreases in the LVGLS-Epi values between post- and pre-treatment and the ratios of the decreases to the baseline values were linearly correlated with the percentage of heart volume exposed to 5 Gy or more (V5) (P values < 0.05). The decrease in RVFWLS and the ratio of the decrease to the baseline value were linearly related to MHD and patient age (all P values < 0.05). Endpoint events occurred more frequently in the right side of the heart than in the left side. Patients over 56.5 years of age had a greater probability of developing right-heart endpoint events. The same was true for patients with MHD over 20.2 Gy in both the left and right sides of the heart.
CONCLUSIONS
2D-STE could detect damages to the heart earlier and more sensitively than conventional echocardiography. MHD is an important prognostic parameter for LV systolic function, and V5 may also be an important prognostic parameter. MHD and age are important prognostic parameters for right ventricle systolic function.
Topics: Humans; Female; Male; Middle Aged; Prospective Studies; Predictive Value of Tests; Aged; Ventricular Function, Left; Radiation Injuries; Risk Assessment; Systole; Cardiotoxicity; Risk Factors; Adult; Time Factors; Thoracic Neoplasms; Radiotherapy; Ventricular Function, Right; Echocardiography; Heart Disease Risk Factors; Stroke Volume
PubMed: 38937716
DOI: 10.1186/s12872-024-03981-1 -
Scientific Reports Jun 2024Circulating proteins may provide insights into the varying biological mechanisms involved in heart failure (HF) with preserved ejection fraction (HFpEF) and reduced...
Circulating proteins may provide insights into the varying biological mechanisms involved in heart failure (HF) with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). We aimed to identify specific proteomic patterns for HF, by comparing proteomic profiles across the ejection fraction spectrum. We investigated 4210 circulating proteins in 739 patients with normal (Stage A/Healthy) or elevated (Stage B) filling pressures, HFpEF, or ischemic HFrEF (iHFrEF). We found 2122 differentially expressed proteins between iHFrEF-Stage A/Healthy, 1462 between iHFrEF-HFpEF and 52 between HFpEF-Stage A/Healthy. Of these 52 proteins, 50 were also found in iHFrEF vs. Stage A/Healthy, leaving SLITRK6 and NELL2 expressed in lower levels only in HFpEF. Moreover, 108 proteins, linked to regulation of cell fate commitment, differed only between iHFrEF-HFpEF. Proteomics across the HF spectrum reveals overlap in differentially expressed proteins compared to stage A/Healthy. Multiple proteins are unique for distinguishing iHFrEF from HFpEF, supporting the capacity of proteomics to discern between these conditions.
Topics: Humans; Heart Failure; Stroke Volume; Female; Proteomics; Male; Aged; Middle Aged; Proteome; Biomarkers; Blood Proteins
PubMed: 38937570
DOI: 10.1038/s41598-024-65667-0 -
Scientific Reports Jun 2024Experiments on ultrasound propagation through a gel doped with resonant encapsulated microbubbles provided evidence for a discontinuous transition between wave...
Experiments on ultrasound propagation through a gel doped with resonant encapsulated microbubbles provided evidence for a discontinuous transition between wave propagation regimes at a critical excitation frequency. Such behavior is unlike that observed for soft materials doped with non-resonant air or through liquid foams, and disagrees with a simple mixture model for the effective sound speed. Here, we study the discontinuous transition by measuring the transition as a function of encapsulated microbubble volume fraction. The results show the transition always occurs in the strong-scattering limit (l/λ < 1, l and λ are the mean free path and wavelength, respectively), that at the critical frequency the effective phase velocity changes discontinuously to a constant value with increasing microbubble volume fraction, and the measured critical frequency shows a power law dependence on microbubble volume fraction. The results cannot be explained by multiple scattering theory, viscous effects, mode decoupling, or a critical density of states. It is hypothesized the transition depends upon the microbubble on-resonance effective properties, and we discuss the results within the context of percolation theory. The results shed light on the discontinuous transition's physics, and suggest soft materials can be engineered in this manner to achieve a broad range of physical properties with potential application in ultrasonic actuators and switches.
PubMed: 38937552
DOI: 10.1038/s41598-024-63910-2 -
Journal of Radiation Research Jun 2024The aim of this study was to investigate planning target volume (PTV) margin in online adaptive radiation therapy (oART) for gastric mucosa-associated lymphoid tissue...
The aim of this study was to investigate planning target volume (PTV) margin in online adaptive radiation therapy (oART) for gastric mucosa-associated lymphoid tissue (MALT) lymphomas. Four consecutive patients with gastric MALT lymphoma who received oART (30 Gy in 15 fractions) on the oART system were included in this study. One hundred and twenty cone-beam computed tomography (CBCT) scans acquired pre- and post-treatment of 60 fractions for all patients were used to evaluate intra- and interfractional motions. Patients were instructed on breath-holding at exhalation during image acquisition. To assess the intrafraction gastric motion, different PTVs were created by isotropically extending the CTV contoured on a pre-CBCT image (CTVpre) at1 mm intervals. Intrafraction motion was defined as the amount of expansion covering the contoured CTV on post-CBCT images (CTVpost). Interfractional motion was defined as the amount of reference CTV expansion that could cover each CTVpre, as well as the evaluation of the intrafractional motion. PTV margins were estimated from the cumulative proportion of fraction covering the intra- and interfractional motions. The extent of expansion covering the CTVs in 90% of fractions was adopted as the PTV margin. The PTV margin for intrafractional gastric motion using the oART system with breath-holding was 14 mm. In contrast, the PTV margin for interfractional gastric organ motion without the oART system was 25 mm. These results indicated that the oART system can reduce the PTV margin by >10 mm. Our results could be valuable data for oART cases.
PubMed: 38934659
DOI: 10.1093/jrr/rrae052 -
Heliyon Jun 2024Modeling of proton exchange membrane (PEM) fuel cells is attracting more attention as fuel cell technology continues to develop. In this study, we considered a hybrid...
Using a three-dimensional computational fluid dynamics model and an agglomerate model to investigate the effect of varying agglomerate parameters and output voltages on proton exchange membrane fuel cell performance.
Modeling of proton exchange membrane (PEM) fuel cells is attracting more attention as fuel cell technology continues to develop. In this study, we considered a hybrid model that combines an agglomerate model based on the agglomeration of catalyst particles and the coverage-dependent kinetic equation of platinum oxide for ORR, and another 3D numerical model of a PEM fuel cell based on computational fluid dynamics (CFD). The obtained results from our developed models were validated with experimental results from literature. In fact, we investigated the effects of changing the agglomerate radius , the ionomer volume fraction within the agglomerate the effective agglomerate surface area , the distribution of the gases and the temperature on the cell performances. The results revealed that the cell performances are strongly influenced by changing and for medium and high current densities: The activation loss increases with increasing and decreasing . Also, increases with decreasing and increasing . In addition, the PEM fuel cell's power output is significantly enhanced when is decreased and is increased, the optimal power being obtained for values of and = 0.6. The numerical results also showed that decreasing the output voltage from 0.95V to 0.35V can accelerate the electrochemical reaction process.
PubMed: 38933966
DOI: 10.1016/j.heliyon.2024.e32277 -
Journal of Molecular and Cellular... Jun 2024Heart failure remains one of the largest clinical burdens globally, with little to no improvement in the development of disease-eradicating therapeutics. Integrin...
Heart failure remains one of the largest clinical burdens globally, with little to no improvement in the development of disease-eradicating therapeutics. Integrin targeting has been used in the treatment of ocular disease and cancer, but little is known about its utility in the treatment of heart failure. Here we sought to determine whether the second generation orally available, αvβ3-specific RGD-mimetic, , was cardioprotective. Male mice were subjected to transverse aortic constriction (TAC) and treated with 50 μg/kg or volume-matched saline as Vehicle control. At 3 weeks post-TAC, echocardiography showed that treatment significantly restored cardiac function and structure indicating the protective effect of treatment in this model of heart failure. Importantly, treatment improved cardiac function giving improved fractional shortening, ejection fraction, heart weight and lung weight to tibia length fractions, together with partial restoration of Ace and Mme levels, as markers of the TAC insult. At a tissue level, reduced cardiomyocyte hypertrophy and interstitial fibrosis, both of which are major clinical features of heart failure. RNA sequencing identified that, mechanistically, this occurred with concomitant alterations to genes involved molecular pathways associated with these processes such as metabolism, hypertrophy and basement membrane formation. Overall, targeting αvβ3 with provides a novel strategy to attenuate pressure-overload induced cardiac hypertrophy and fibrosis, providing a possible new approach to heart failure treatment.
PubMed: 38933087
DOI: 10.1016/j.jmccpl.2024.100069 -
Polymers Jun 2024Pultrusion is a highly efficient continuous process to manufacture advanced fiber-reinforced composites. The injection pultrusion variant permits a higher control of the...
Pultrusion is a highly efficient continuous process to manufacture advanced fiber-reinforced composites. The injection pultrusion variant permits a higher control of the resin flow, enabling the manufacturing of a high reinforcement volume fraction. Moreover, it reduces the emission of volatile compounds that are dangerous for the operators and for the working environment. The present study proposes an experimental analysis of injection pultrusion in three different operative conditions. In particular, the activity focused on the effects of the temperature setup on the thermochemical and rheological behaviors of the resin system and on the interaction between the processed materials and the pultrusion die wall. The setup of the parameters was selected to evidence the behavior of the viscous interaction during the thermoset transition to the solid state, which is particularly challenging due to the localization of high adhesive forces related to the sharp increase in resin viscosity. Microscope observations of the cross-sections were performed to discuss the effects of the process parameters.
PubMed: 38931992
DOI: 10.3390/polym16121642 -
Polymers Jun 2024Additive manufacturing (AM) has arisen as a transformative technology for manufacturing complex geometries with enhanced mechanical properties, particularly in the realm... (Review)
Review
Additive manufacturing (AM) has arisen as a transformative technology for manufacturing complex geometries with enhanced mechanical properties, particularly in the realm of continuous fiber-reinforced polymer composites (CFRPCs). Among various AM techniques, fused deposition modeling (FDM) stands out as a promising method for the fabrication of CFRPCs due to its versatility, ease of use, flexibility, and cost-effectiveness. Several research papers on the AM of CFRPs via FDM were summarized and therefore this review paper provides a critical examination of the process-printing parameters influencing the AM process, with a focus on their impact on mechanical properties. This review covers details of factors such as fiber orientation, layer thickness, nozzle diameter, fiber volume fraction, printing temperature, and infill design, extracted from the existing literature. Through a visual representation of the process parameters (printing and material) and properties (mechanical, physical, and thermal), this paper aims to separate out the optimal processing parameters that have been inferred from various research studies. Furthermore, this analysis critically evaluates the current state-of-the-art research, highlighting advancements, applications, filament production methods, challenges, and opportunities for further development in this field. In comparison to short fibers, continuous fiber filaments can render better strength; however, delamination issues persist. Various parameters affect the printing process differently, resulting in several limitations that need to be addressed. Signifying the relationship between printing parameters and mechanical properties is vital for optimizing CFRPC fabrication via FDM, enabling the realization of lightweight, high-strength components for various industrial applications.
PubMed: 38931971
DOI: 10.3390/polym16121622 -
Nutrients Jun 2024Diabetes mellitus (DM) is a major risk and prognostic factor for heart failure (HF). Insulin resistance (IR) is an important component of DM, but the relationship...
Diabetes mellitus (DM) is a major risk and prognostic factor for heart failure (HF). Insulin resistance (IR) is an important component of DM, but the relationship between IR and HF prognosis has not yet been established across a wide variety of HF populations. We retrospectively evaluated the relationship between IR and clinical outcomes of HF patients at our hospital between 2017 and 2021. IR was defined as a homeostatic model assessment of IR (HOMA-IR) index ≥ 2.5, calculated from fasting blood glucose and insulin concentrations. The primary outcome was a composite of all-cause death and hospitalisation for HF (HHF). Among 682 patients included in the analyses, 337 (49.4%) had IR. The median age was 70 [interquartile range (IQR): 59-77] years old, and 66% of the patients were men. Among the patients, 41% had a left ventricular ejection fraction below 40%, and 32% had DM. The median follow-up period was 16.5 [IQR: 4.4-37.3] months. IR was independently associated with the primary outcome (HR: 1.91, 95% CI: 1.39-2.62, < 0.0001), death (hazard ratio [HR]: 1.86, 95% confidence interval [CI]: 1.28-2.83, < 0.01), and HHF (HR: 1.91, 95% CI: 1.28-2.83, < 0.01). HOMA-IR is an independent prognostic factor of HF in a wide variety of HF populations.
Topics: Humans; Insulin Resistance; Heart Failure; Male; Female; Aged; Middle Aged; Prognosis; Japan; Retrospective Studies; Blood Glucose; Hospitalization; Insulin; Risk Factors; Stroke Volume
PubMed: 38931242
DOI: 10.3390/nu16121888