Damage Events Research Articles

Mitigating grapevine winter damage in cold climate areas

Growing grapes in cool climate areas is the same front type challenging due to the high risk of winter injury. Passive and active methods can be used to reduce or prevent cold damage and protect the vineyards. Passive protection methods are generally cultural practices and performed before cold damage events, such as cultivar and rootstock selection. The proper scion-rootstock combination would ideally help the vines acclimate earlier in the fall, allowing them to withstand colder weather in the fall and winter and de-acclimate later in the spring to minimise the late spring frost damage. The introduction of new North American hybrid cultivars accompanied with other cultural practices has increased the hope for developing viticulture in areas with lower cold hardiness zones. Furthermore, active protection methods are usually performed at the time of cold damage events to protect the vineyard by preventing or reducing the loss of thermal energy from vine tissues. The objective of this manuscript is to review the viticulture challenges in cold climates and mitigate the risks with Ontario, Canada as an example of a cold climate area.

Resilience and Risk Factors Predict Family Stress Among Married Palestinians in Israel During the COVID-19 Pandemic.

The present study examined effects of sociodemographic, risk, and resilience factors on marital, parental, and financial stress early in the COVID-19 pandemic. A cross-sectional online survey was conducted among 480 married Palestinians living in Israel, using self-report questionnaires. Descriptive statistics and bivariate correlations were computed. Then, hierarchical multiple regression analyses were conducted to predict each of the three stress measures. Finally, dominance analyses were conducted to compare the contributions of sociodemographic, risk, and resilience factors. The results showed considerable differences between predictors of marital and parental stress and predictors of financial stress. For marital and parental stress, resilience factors mainly family resilience were the strongest predictors, followed by risk factors and then sociodemographic characteristics. For financial stress, risk factors (mainly financial damage and prior stressful life events) were the strongest predictors, followed by sociodemographic characteristics and resilience factors (mainly individual resilience). These results suggest that family and individual resilience reduce marital and parental stress under difficult conditions, including the COVID-19 pandemic. Though resilience has been found to ameliorate financial stress to some extent, it appears that other measures are required to manage stress related to financial difficulties.

Prognostic Value of Arm Circumference for Cardiac Damage and Major Adverse Cardiovascular Events: A Friend or a Foe? A 2-Year Follow-Up in the Northern Shanghai Study.

BackgroundThe high prevalence of cardiovascular diseases globally causes a great social burden and much individual suffering. The effective recognition of high-risk subjects is critical for primary prevention in the general population. In the elderly cohort, anthropometric measurements may have different prognostic values. Our study aimed to find convincing anthropometric measures to supplement conventional risk factors for major adverse cardiovascular events (MACEs) in the elderly cohort.Materials and MethodsA total of 1,576 elderly participants (44.5% male, aged 72.0 ± 6.0 years) recruited into the Northern Shanghai Study (2014–2015) were followed up between 2016 and 2017. Following the standard guideline for cardiovascular risk evaluation, all conventional cardiovascular risk factors were assessed. The body measures were made up of body weight, body height, hip circumference, waist circumference, and middle-upper arm circumference (MUAC). Organ damage (OD) markers for cardiac, vascular, and renal diseases will be evaluated by the standardized methods.ResultsAfter the average 571 (±135) days of follow-up, a total of 90 MACEs (5.7%) occurred, i.e., 13 non-fatal myocardial infarction, 68 non-fatal stroke, and 9 cardiovascular deaths. Univariable COX survival analysis revealed that only MUAC could validly predict MACEs among anthropometric characters [adjusted hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82–0.96]. In Kaplan-Meier analysis, the group of high MUAC showed the lowest MACE risk (log-rank p = 0.01). Based on OD analysis, MUAC was independently linked to higher risk of left ventricular hypertrophy (LVH) in women and left ventricular diastolic dysfunction (LVDD) in both men and women. In adjusted COX analysis, only MUAC indicated statistical significance, but all other anthropometric parameters such as BMI, waist circumference, and waist-to-hip ratio (WHR) did not indicate significance. The higher level of MUAC remained a protective factor in fully adjusted models (HR: 0.73; 95% CI: 0.59–0.91), with p-values markedly significant in men (HR: 0.69; 95% CI: 0.49–0.97) and marginally significant in women (HR: 0.0.77; 95% CI: 0.59–1.01). After considering all factors (i.e., cardiovascular risk factors, MUAC, BMI, and WHR), the fully adjusted COX regression analysis demonstrated that the increased MUAC level was linked to decreased MACE risk in both men (HR: 0.57; 95% CI: 0.37–0.88) and women (aHR: 0.64; 95% CI: 0.46–0.93).ConclusionDespite being associated with a higher rate of cardiac damage, higher MUAC independently and significantly conferred protection against the MACE, in the elderly cohort.

Abstract 5545: Intestinal toxicity to CTLA-4 blockade driven by IL-6 and myeloid infiltration

Abstract Immunotherapies such as anti-CTLA-4 immune checkpoint blockade (ICB) have revolutionized cancer treatment, yet quality of life and continuation of therapy can be constrained by off-target tissue damage or immune-related adverse events (irAEs). At present, there is limited understanding of irAE mechanisms, hampering development of approaches to mitigate their damage. We addressed this problem by generating animal models of intestinal irAE. Our results show that disruption of homeostatic immunity by genetic predisposition to intestinal inflammation or acute gastrointestinal infection sensitizes mice to anti-CTLA-4-mediated intestinal toxicity. Inflammation-prone mice treated with anti-CTLA-4 showed neutrophil accumulation, systemic interleukin-6 (IL-6) release, and dysbiosis. Significantly, IL-6 blockade combined with antibiotic treatment improved anti-CTLA-4 therapeutic efficacy and reduced intestinal irAEs. Immune signatures were validated in biopsies from patients who developed colitis during ICB, supporting the utility of our models. This study provides new pre-clinical models, mechanistic insight into irAEs, and potential approaches to enhance ICB efficacy while mitigating irAEs. Citation Format: Yifan Zhou, Yusra B. Medik, Bhakti Patel, Daniel B. Zamler, Sijie Chen, Thomas Chapman, Sarah Schneider, Rachel L. Babcock, Taylor T. Chrisikos, Laura M. Kahn, Allison M. Dyevoich, Elizabeth M. Park, Alexandria P. Cogdill, Daniel H. Johnson, Sarah B. Johnson, Khalida M. Wani, Debora A. Ledesma, Courtney W. Hudgens, Jingjing Wang, Md Abdul Wadud Khan, Aron Y. Joon, Weiyi Peng, Haiyan S. Li, Reetakshi Arora, Ximing Tang, Maria Gabriela Raso, Xuegong Zhang, Wai Chin Foo, Michael T. Tetzlaff, Gretchen E. Diehl, Karen Clise-Dwyer, Elizabeth M. Whitley, Matthew M. Gubin, James P. Allison, Patrick Hwu, Nadim J. Ajami, Adi Diab, Jennifer A. Wargo, Stephanie S. Watowich. Intestinal toxicity to CTLA-4 blockade driven by IL-6 and myeloid infiltration [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5545.

Subacute Reperfusion in Ischemic Hearts: Study of Autophagy and its Possible Interconnection with Receptor-Interacting Protein Kinase 3.

The role of cardiac autophagy during ischemia and reperfusion (I/R) remains controversial. Furthermore, whether this cell death during I/R is also interconnected with other cell damaging event, such as necroptosis, is insufficiently known. Thus, the aim of this study was to investigate possible links between autophagy and necroptosis in the hearts under conditions of acute I/R injury. Langendorff-perfused male Wistar rat hearts were subjected to 30-min global ischemia followed by 10-min reperfusion in the presence of either vehicle or a drug inhibiting the pro-necroptotic receptor-interacting protein kinase 3 (RIP3). Hemodynamic parameters and lactate dehydrogenase (LDH) release were measured to assess heart function and non-specific cell death due to the disruption of plasma membrane. Immunoblot analysis of left ventricles revealed that early reperfusion suppressed the activation of autophagy as evidenced by the decreased protein expression of Beclin-1, pSer555-ULK1, pSer555-ULK1/ULK1 ratio, and LC3-II/LC3-I ratio. On the other hand, the molecular signalling responsible for autophagy inhibition did not appear to be affected in these I/R settings. RIP3 inhibition during reperfusion significantly mitigated the loss of the plasma membrane integrity but did not improve cardiac function. This pharmacological intervention targeting necroptosis-mediating protein decreased LC3-II expression in I/R hearts, suggesting some effect on autophagosome processing, but it did not significantly alter other signalling pathways involved in autophagy activation or inhibition. In summary, we showed for the first time that an early reperfusion phase does not promote autophagy and that there may be an interplay between pro-necroptotic protein RIP3 and autophagy with respect to the regulation of autophagosome processing.

Neuroinflammation in Vascular Cognitive Impairment and Dementia: Current Evidence, Advances, and Prospects.

Vascular cognitive impairment and dementia (VCID) is a major heterogeneous brain disease caused by multiple factors, and it is the second most common type of dementia in the world. It is caused by long-term chronic low perfusion in the whole brain or local brain area, and it eventually develops into severe cognitive dysfunction syndrome. Because of the disease’s ambiguous classification and diagnostic criteria, there is no clear treatment strategy for VCID, and the association between cerebrovascular pathology and cognitive impairment is controversial. Neuroinflammation is an immunological cascade reaction mediated by glial cells in the central nervous system where innate immunity resides. Inflammatory reactions could be triggered by various damaging events, including hypoxia, ischemia, and infection. Long-term chronic hypoperfusion-induced ischemia and hypoxia can overactivate neuroinflammation, causing apoptosis, blood–brain barrier damage and other pathological changes, triggering or aggravating the occurrence and development of VCID. In this review, we will explore the mechanisms of neuroinflammation induced by ischemia and hypoxia caused by chronic hypoperfusion and emphasize the important role of neuroinflammation in the development of VCID from the perspective of immune cells, immune mediators and immune signaling pathways, so as to provide valuable ideas for the prevention and treatment of the disease.

Rethinking Warning Compliance and Complacency by Examining How People Manage Risk and Vulnerability during Real-World Tornado Threats

Abstract The weather community has a keen interest in whether or not people comply with tornado warnings by taking shelter when a tornado threatens. When people do not seek shelter, a commonly attributed reason is that they are complacent due to overwarning, false alarms, routine exposure and experience with tornadoes and warnings, or time between damaging events. Yet, there is a lack of research that focuses on whether people are actually complacent, i.e., whether they ignore or are unwilling to prepare for the threat. We explore whether people exhibit these indicators of complacency by examining how people assessed their risk and responded during real-world tornado threats and how vulnerability influenced these processes. Our analysis is based on in-person interviews with 23 survivors of two deadly EF3 tornadoes that occurred approximately 50 miles apart and within 12 h of each other. Contrary to a threat-disbelieving, threat-ignoring, nonpreparing, and thus complacent public, we instead found that people actively managed their risk from the tornadoes, meaning they actively attended to, evaluated, and responded to the tornado risk as it evolved in space and time. We further found, however, that many people felt limited or lack of efficacy to respond due to static and situational factors that resulted in them having no safe place to seek protection from the threat. Based on this rich, nuanced analysis, we provide recommendations about important ways that the weather community and its partners can mitigate the risks people face from tornadoes, now and in the long term.

RELATIONSHIP OF 24-HOUR AMBULATORY BLOOD PRESSURE VARIABILITY WITH MICRO- AND MACROVASCULAR PARAMETERS AND HYPERTENSION STATUS

Objective: Existing evidence shows that increased values of blood pressure variability (BPV) are associated with a higher risk of subclinical organ damage and cardiovascular events, independently of elevated average BP values. We sought to investigate the relation of novel BPV indices with micro- and macrovascular parameters that have not all been previously studied and to identify differences according to hypertension status. Design and method: We evaluated the relationship between BPV indices and micro- and macrovascular parameters in a selected population of 344 individuals (233 never-treated, newly diagnosed hypertensive and 111 normotensive individuals).Using data from 24-h ambulatory blood pressure monitoring device, BPV was assessed by average real variability (ARV) during 24-hours, daytime and nighttime and as systolic weighted standard deviation (wSD). Nonmydriatic retinal photography was used to assess retinal microvascular diameters. Arterial stiffness was evaluated by measurement of pulse wave velocity(PWV) and aortic augmentation index (AIx). Myocardial perfusion was evaluated using subendocardial variability ratio (SEVR).The carotid intima-media thickness (cIMT) was measured by ultrasound. We performed a multiple regression analysis for all the parameters which were statistically significant in the univariate analyses. Results: After adjusting for potential confounders, all vascular parameters [venular retinal diameter (p = 0.036), PWV (p < 0.007), cIMT (p < 0.06)], except for SEVR were independently associated with ARV components in the total population. Further analysis based on hypertension status showed that in hypertensives only macrocirculation indices such as PWV and cIMT were independently associated with ARV (for PWV: 24-h systolic, p = 0.025, nighttime systolic, p = 0.001 and nighttime diastolic, p = 0.012 respectively; and for cIMT, p = 0.001 for both 24-h and daytime systolic). In normotensive individuals, venular diameter was associated with 24-h systolic and diastolic and daytime systolic and diastolic ARV (p = 0.004, p = 0.002, p = 0.001 and p = 0.049 respectively). The arteriovenous ratio was associated with daytime systolic ARV (p = 0.022), and AIx was associated with daytime diastolic ARV (p = 0.022). None of the univariate correlations between vascular parameters and wSD remained significant after adjustment for potential confounders. Conclusions: We concluded that short-term BPV represented by ARV is independently associated with macrovascular parameters in untreated hypertensive patients and microvascular parameters in normotensives.

Zoledronic Acid use and Adverse Drug Reaction (ADR)

Bone is the part of body that most common for metastasis solid tumors. Bisphosphonates are an effective treatment for preventing bone damage events and improve quality of life patients. Zoledronic acid (ZOL) is the third generation of nitrogen-containing bisphosphonates (NBPs) that can inhibit osteoclasts in the process of bone resorption. Mechanism action of this drug related to affinity with hydroxyapatite crystals of bone, through a high bone turnover result in reducing speed of bone remodeling. This drug has higher affinity compared with other bisphosphonates for bonding hydroxyapatite . Zoledronic acid internalizes into osteoclasts, which disrupts the metabolic process and function of osteoclast cells and accelerates the occurrence of apoptosis. In the other hand it has adverse drug reactions mild to moderate which have reported but the mechanism still unclear such as hypocalcaemia and secondary hypophosphatemia, acute phase response (APR), renal toxicity, and osteonecrosis of the jaw (ONJ). Adverse drug reaction can cause harm to patient indeed arise death, highly recommended to offer monitoring for patients.

Climate Adaptation in Terms of Water Security in the Danube Countries

In my article, I examine the characteristics of the Danube countries’ adaptation to climate change in terms of water security. Among the international strategic documents, I examine the EU Water Framework Directive (WFD, 2000), the Danube River Protection Convention, and the EU Strategy for the Danube Region (EUSDR, 2019). It is a European ambition to create adequate levels of drinking water, outdoor bathing water, and aquatic ecosystem security in EU member states by the end of 2027. Therefore, in my article I examine water safety, not only in terms of drinking water supply security, but also in terms of aquatic ecosystem security for the Danube countries. Based on the examples of recent years in Hungary, I present the damage events caused by high rainfall intensity fluctuations, which occurred from both excess and scarcity of water. I would like to draw your attention to the fact that, as Hungary is a downstream country, upstream interventions can cause more sudden flooding and subsidence in our area on the Danube.

Pathogenicity and Long-Term Outcomes of Liddle Syndrome Caused by a Nonsense Mutation of SCNN1G in a Chinese Family.

ObjectiveLiddle syndrome (LS) is a monogenic hypertension consistent with autosomal dominant inheritance, often with early onset high blood pressure in childhood or adolescence. This study aimed to identify the pathogenicity of a nonsense mutation in SCNN1G in a Chinese family with LS and the long-term outcomes of tailored treatment with amiloride.MethodsTo explore the pathogenicity of candidate variant reported in 2015 by our team, we constructed mutant and wild-type models in vitro and measured amiloride-sensitive current in Chinese Hamster Ovary (CHO) cells using patch clamp technique. Participants were followed up for 7 years after tailored treatment with amiloride.ResultsA nonsense variant was detected in six members, two of whom were pediatric patients. This mutation resulted in a termination codon at codon 572, truncating the Pro-Pro-Pro-X-Tyr motif. The mutant epithelial sodium channels displayed higher amiloride-sensitive currents than the wild-type channels (P < 0.05). Tailored treatment with amiloride achieved ideal blood pressure control in all patients with normal cardiorenal function, and no adverse events occurred during follow-up.ConclusionWe found the pathogenicity of a nonsense SCNN1G mutation (p.Glu571*) with enhanced amiloride-sensitive currents in a LS family with young patients. Tailored treatment with amiloride may be an effective strategy for the long-term control of blood pressure and protection from target organ damage or cardiovascular events, including children and youth patients with LS.

Post-traumatic headaches and vision: A review.

Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.

MO370: Perceptions of Barriers and Mitigating Strategies for Suboptimal Albuminuria Testing: A Global Survey of a Range of Specialists

Abstract BACKGROUND AND AIMS Regular estimated glomerular filtration rate (eGFR) and albuminuria testing in patients diagnosed with chronic kidney disease (CKD) and those with specific risk factors such as type 2 diabetes is recommended in The Kidney Disease Improving Global Outcomes (KDIGO) guidelines. An eGFR test can indicate kidney function decline, whereas albuminuria testing estimates kidney damage. Therefore, when used in combination an accurate understanding of CKD risk progression can be obtained. In addition, the European Society of Cardiology updated its guidelines in 2021 to recommend albuminuria testing for cardiovascular risk assessment in CKD patients, demonstrating growing awareness of the link between kidney damage and CV events. Evidence from real-world practice suggests albuminuria testing, specifically urine albumin-to-creatine ratio (UACR) testing is suboptimal. For example, UACR testing, is not regularly undertaken in clinical practice, with low rates of testing reported in the UK1 (67%), The Netherlands2 (57%), and France3 (29%). Until now, there have been limited data available that identifies perceptions—from both a global and multi-specialist perspective—around why UACR testing is so low, and what drives this non-adherence in type 2 diabetes patients. METHOD This global questionnaire was administered as an online survey to a range of cardiologists, endocrinologist or diabetologists, nephrologists and primary care physicians attending a kidney disease expert meeting organized by Bayer. RESULTS Of the 112 individuals who received the survey link, 56 responded to the questionnaire, consisting of 11 (20%) cardiologists, 17 (31%) endocrinologists or diabetologists, 24 (44%) nephrologists and 2 (4%) primary care physicians across 25 countries in Asia, Europe, North America, South America and Oceania. When asked the main reason for a lack of UACR testing in type 2 diabetes patients, 27% (n = 15) suggested it was due to lack of physician awareness of guidelines/the test (Asia [n = 3, 20%]; Europe [n = 7, 47%]; North America [n = 2, 13%]; South America [n = 2, 13%]; Oceania [n = 1, 7%]), 16% (n = 9) suggested that doctors forget to order a test, and 11% implied that doctors and/or patients find UACR testing an inconvenience. Following a UACR test, the majority of respondents (n = 35, 70%) believed that test results are not optimally incorporated into clinical practice (Asia [n = 8, 23%]; Europe [n = 20, 57%]; North America [n = 1, 3%]; South America [n = 4, 11%]; Oceania [n = 2, 6%]). Twenty-two respondents suggested opportunities to improve adherence incorporation of UACR test results, of whom 20 (87%) raised a need for increased awareness and education. Fifteen (30%) respondents believed that UACR test results are optimally incorporated into clinical practice, 7 of these were from physicians practicing in Asia. CONCLUSION This survey demonstrates that UACR tests are not being consistently and globally undertaken and integrated into clinical practice, with a lack of guideline and test awareness being a prominent contributor toward this. Physicians across a wide range of specialties and geographies suggested that there is a need for increased education to help target suboptimal testing rates. Funding: Bayer AG

Pilot Study on the Influence of Race and Sex on beat‐to‐beat Blood Pressure Variability in Healthy Young Adults

BACKGROUNDAugmented beat‐to‐beat blood pressure (BP) variability is prognostic of target organ damage and cardiovascular events. A recent study demonstrated greater BP variability in healthy young Black males compared to White males, but whether these differences appear in females remains unclear. Therefore, we sought to examine race and sex differences in beat‐to‐beat BP variability in healthy young Black and White adults.METHODS52 adults including 13 Black females (age 21.5 ± 0.8 yrs, BMI 27.0 ± 4.2 kg/m2, resting BP 126 ± 10/78 ± 12 mmHg; Mean ± SD), 13 White females (21.2 ± 0.7 yrs, 24.0 ± 3.8 kg/m2, 116 ± 8/66 ± 11 mmHg), 9 Black males (21.6 ± 0.7 yrs, 25.5 ± 4.3 kg/m2, 131 ± 11/75 ± 11 mmHg), and 17 White males (21.5 ± 0.7 yrs, 25.0 ± 3.7 kg/m2, 123 ± 11/67 ± 9 mmHg) participated in this study. Non‐invasive beat‐to‐beat BP was continuously measured at the participant’s middle finger via photoplethysmography (Finapres NOVA) for 10 minutes while sitting semi‐recumbent in a dimly lit room. The finger pressure was calibrated using resting oscillometric brachial BP. Heart rate was measured via 3‐lead electrocardiogram (ECG) and BP was gated to R‐waves from the ECG signal. BP variability was assessed with the average real variability (ARV) index and standard deviation (SD) of all BP readings. Statistical procedures included two‐way analysis of variance (sex x race) with Bonferroni post‐hoc test when appropriate (a priori α &lt; 0.05).RESULTSNo significant differences existed for systolic BP ARV (sex p= 0.85, race p= 0.41, interaction p= 0.63; Black females 2.02 ± 0.64, White females 1.84 ± 0.44, Black males 1.98 ± 0.24, White males 1.93 ± 0.44) or diastolic BP ARV (sex p= 0.31, race p= 0.76, interaction p= 0.51). For systolic BP SD, there was a significant main effect of sex (p= 0.008) suggesting greater systolic BP variability in males than females, and a trend for race by sex interaction (p= 0.08) but no difference for race (p= 0.79); (Black females 4.80 ± 1.07, White females 5.80 ± 2.10, Black males 7.77 ± 3.89, White males 6.42 ± 1.74). However, there were no significant differences for diastolic BP SD (sex p= 0.19, race p= 0.55, interaction p= 0.46).CONCLUSIONThese preliminary findings suggest males have significantly greater systolic BP variability than females from systolic BP ARV. No significant differences were identified for diastolic BP SD and BP ARV (systolic and diastolic) by race and sex, but additional data are needed.

2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension.

Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.

An international Delphi exercise to identify items of importance for measuring response to treatment in ANCA-associated vasculitis

ObjectiveANCA-associated vasculitis (AAV) is characterized by fluctuating levels of disease activity, but no formal criteria exist to measure response to treatment. This Delphi exercise aimed to reach consensus about which measures are considered by patients and physicians to be most important when assessing response to treatment in clinical trials of AAV. MethodsAn international 3-round online Delphi exercise was conducted. Survey participants included patients with AAV and physicians with expertise in AAV. Survey participants were asked to rate (on a scale of 1–9) the importance of each item when assessing response to treatment in AAV. Items scored 7–9 by ≥70% participants were considered highly important. Results89 patients and 176 physicians completed three rounds of the Delphi exercise. The most highly rated items of response involved disease activity [extent of organ involvement, physician global assessment], mortality [survival], and patient-reported outcomes [patient global assessment and health-related quality of life measures]. Achievement of specific BVAS scores were highly rated only by physicians. Items highly rated only by patients included laboratory measures [changes on urinalysis and acute phase reactants], pain, and fatigue. Additional items related to damage and adverse events were highly rated by both groups. ConclusionThere is consensus between patients and physicians on many items considered important to measure when assessing response to treatment in AAV. There are some items considered important by only patients or only physicians. These data will inform the next steps in the development criteria of response to treatment in AAV.

Self-healing of matrix cracking and delamination damage assessment in microcapsules reinforced carbon fibre epoxy composite under flexural loading

Structural integrity of micro cracked CFRP composite structures can be re-established by incorporating the microcapsules based self-healing system into the composite. In the current study, in order to fabricate capsules reinforced CFRP composite, 0.54: 0.39: 0.07 vol fractions of matrix, carbon fibre and separately encapsulated epoxy, hardener microcapsules were employed. Effect of microcapsules addition and induced damage on the flexural strength of the composite were investigated. It was noticed that flexural strength decreases with the increase in capsules concentration and for 5 wt% capsules reinforced composite flexural strength reduced by 21.73%, 29.32% due to induce of matrix cracking and delamination damage respectively. In order to assess self-healing performance of the composite, different damage events were induced in the composite and healing efficiency was evaluated based on the recovery in flexural strength. Effect of capsules wt%, healing temperature and pressure on the healing efficiency were assessed and noticed higher healing efficiencies at elevated temperature and pressure healing conditions. Healing efficiencies of 71.30%, 54.21% were obtained at optimal healing conditions for matrix cracking, delamination damage recovery respectively. Crack path deflection, crack pinning and capsules rupture mechanisms were observed in the microstructural investigation of fracture surface of capsule reinforced composite.

Changing patterns of conflict between humans, carnivores and crop-raiding prey as large carnivores recolonize human-dominated landscapes

Large carnivores are making remarkable comebacks in Europe, but how this affects human-wildlife conflict remains unclear. Rebounding carnivore populations lead to increasing livestock depredation, which in turn leads to greater economic losses for farmers. However, returning carnivores could also influence the behavior of wild ungulates, which are themselves responsible for major crop damage and associated economic losses. Here, we exploit the natural experiment of a rebounding wolf population in the Italian Apennines to study how this affected both types of human-wildlife conflic. We used large datasets of wolf occurrences (n = 351), livestock depredation events (n = 165), and crop damage events by wild boar (n = 3442) to independently model the determinants of livestock depredation and crop damage distribution in relation to wolf habitat suitability over a ten-year period of increasing wolf numbers. These analyses yielded two major insights. First, livestock depredations were mainly related to insufficient prevention measures (e.g. lacking fencing) rather than landscape context, providing a clear pathway to conflict mitigation. Second, crop damage decreased in areas of higher wolf habitat suitability and became more likely in areas of lower wolf habitat suitability, closer to settlements. This suggests increasing predation pressure forces wild boars to avoid the most suitable wolf habitat, leading to a redistribution of crop damage in the landscape. More generally, our study highlights complex human-wildlife interactions as large carnivores recover in human-dominated landscapes, suggesting that multiple, co-occurring conflicts need to be assessed jointly and adaptively in order to foster coexistence between humans and wildlife.

Low velocity impact and compressive response after impact of thin carbon fiber composite panels

Impact damage of laminated composite structures continues to be a challenging problem. The complexity of damage morphology, the sequence of damage events, and multiple damage modes pose significant challenges when it comes to design for damage tolerance. In an effort to reduce some of the complexity, a systematic experimental study was conducted to understand the sequence of damage during impact of a thin composite plate. Two configurations of carbon fiber reinforced epoxy composite panels were impacted with increasing impact energies. Digital image correlation (DIC), using high speed camera, was performed to measure plate deflection and strain evolution during the impact event. Detailed post impact measurement and imaging were conducted to quantify the extent of damage and delamination. Compression after impact (CAI) tests were conducted to ascertain the post impact compressive load carrying capability of the panel. The results of the experiments indicate a sequence of damage from back surface splitting, delamination and then impact surface compressive failure. Correlations were also found between impact energies, panel configuration and damage type and morphology. The data thus generated is useful for validating computational models for impact damage and CAI. An approach to performing such validation is also provided in this study.

The serum of COVID-19 asymptomatic patients up-regulates proteins related to endothelial dysfunction and viral response in circulating angiogenic cells ex-vivo

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already caused 6 million deaths worldwide. While asymptomatic individuals are responsible of many potential transmissions, the difficulty to identify and isolate them at the high peak of infection constitutes still a real challenge. Moreover, SARS-CoV-2 provokes severe vascular damage and thromboembolic events in critical COVID-19 patients, deriving in many related deaths and long-hauler symptoms. Understanding how these processes are triggered as well as the potential long-term sequelae, even in asymptomatic individuals, becomes essential.MethodsWe have evaluated, by application of a proteomics-based quantitative approach, the effect of serum from COVID-19 asymptomatic individuals over circulating angiogenic cells (CACs). Healthy CACs were incubated ex-vivo with the serum of either COVID-19 negative (PCR −/IgG −, n:8) or COVID-19 positive asymptomatic donors, at different infective stages: PCR +/IgG − (n:8) and PCR −/IgG + (n:8). Also, a label free quantitative approach was applied to identify and quantify protein differences between these serums. Finally, machine learning algorithms were applied to validate the differential protein patterns in CACs.ResultsOur results confirmed that SARS-CoV-2 promotes changes at the protein level in the serum of infected asymptomatic individuals, mainly correlated with altered coagulation and inflammatory processes (Fibrinogen, Von Willebrand Factor, Thrombospondin-1). At the cellular level, proteins like ICAM-1, TLR2 or Ezrin/Radixin were only up-regulated in CACs treated with the serum of asymptomatic patients at the highest peak of infection (PCR + /IgG −), but not with the serum of PCR −/IgG + individuals. Several proteins stood out as significantly discriminating markers in CACs in response to PCR or IgG + serums. Many of these proteins particiArticle title: Kindly check and confirm the edit made in the articletitle.pate in the initial endothelial response against the virus.ConclusionsThe ex vivo incubation of CACs with the serum of asymptomatic COVID-19 donors at different stages of infection promoted protein changes representative of the endothelial dysfunction and inflammatory response after viral infection, together with activation of the coagulation process. The current approach constitutes an optimal model to study the response of vascular cells to SARS-CoV-2 infection, and an alternative platform to test potential inhibitors targeting either the virus entry pathway or the immune responses following SARS-CoV-2 infection.