Several Classes Of Functions Research Articles

The role of malnutrition and dependence on outside help in hospitalized elderly patients with decompensated heart failure

Abstract Introduction Despite recent achievement in the diagnosis and treatment of heart failure, the prognosis for disease remains unfavorable especially in elderly patients. It has been recently actively proposed to introduce a comprehensive geriatric assessment to determine the group of adverse outcome and frailty, however the assessment of geriatric syndromes in acute decompensated heart failure (ADHF) among hospitalized patients is poor. Aim To assess the prognostic role of malnutrition and dependence on outside help in hospitalized elderly patients with ADHF. Materials and methods The study included 60 patients over 75 years old who were hospitalized for ADHF. The median [IQR] age was 83.0 [77.0-87.0] years, 41.7% (n=25) were men. The preserved left ventricular ejection fraction (LVEF) prevailed – 51.2% (n=22), moderately reduced and low LVEF – 23.3% (n=10) and 25.6% (n=11), respectively. Total/severe dependence on outside help was determined with Barthel Index of ≤60 points, malnutrition – with a Mini Nutritional Assessment Scale of <17 points, sarcopenia with SARC-F ≥4 points. At discharge, all patients underwent bioimpedance analysis of body composition (BIA). The primary endpoint was hospital mortality. Results 48.3% (n=29) of hospitalized elderly patients with ADHF had total/severe dependence on outside help. This group of patients had a higher risk of malnutrition (OP 2.01, 95% CI 1.49-2.83, p=0.04) and sarcopenia (OP 8.25, 95% CI 1.55-44.02, p=0.01). Elderly patients with ADHF and malnutrition had a more severe functional class (NYHA III-IV) than patients without malnutrition (97.1% vs. 66.7%, respectively, p=0.02). There were no differences in ADHF phenotypes depending on the presence of malnutrition. The ability to self-serve according to Barthel Index has positively correlated with the BIA Index (r=0.483, p=0.04). The risk of sarcopenia on the SARC-F scale has negatively correlated with fat, lean and active cell mass according to BIA (r=-0.538, r=-0.599 and r=-0.532, respectively, p<0.05). Elderly patients with ADHF and a combination of total/severe dependence on outside help and malnutrition (27.9%, n=12) had higher inflammation level (neutrophil-lymphocytic index 5.6 [2.6-7.7] vs. 3.9 [2.0-6.0], p=0.03, respectively) and the need for longer intravenous diuretic therapy (OP 4.38, 95% CI 1.21-15.81, p=0.03) compared with patients without these disorders (72.1%, n=31), The primary endpoint was reached by 4 patients, in 100% of cases there was a combination of total/severe dependence on outside help and malnutrition. Conclusion The combination of total/severe dependence on outside help and malnutrition is an unfavorable prognostic marker of hospital mortality in hospitalized elderly patients with ADHF. A comprehensive geriatric assessment and determination of body composition can identify a risk group for an adverse outcome.

Logarithmically complete monotonicity of reciprocal ARCTAN function

We prove the conjecture stated in F. Qi and R. Agarwal, On complete monotonicity for several classes of functions related to ratios of gamma functions, J. Inequal. Appl. (2019), that the function 1∕ arctan is logarithmically completely monotonic on (0,∞), but not a Stieltjes transform.

Bernstein–Remez inequality for algebraic functions: A topological approach

By taking full advantage of the structure of complex algebraic curves and by using compactness arguments, in this paper we give a self-contained proof that holomorphic algebraic functions verify a uniform Bernstein–Remez inequality. Namely, their growth over a bounded, open, complex set is uniformly controlled by their size on a compact complex subset of sufficiently high cardinality. Up to our knowledge, the first known demonstration on the existence of such an inequality for a specific subset of algebraic functions is contained in Nekhoroshev’s 1973 breakthrough on the genericity of close-to-integrable Hamiltonian systems that are stable over long time. Despite its pivotal rôle, this passage of Nekhoroshev’s proof has remained unnoticed so far. This work aims at extending and generalizing Nekhoroshev’s arguments to a modern framework. We stress the fact that our proof is different from the one contained in Roytwarf and Yomdin’s seminal work (1998), where Bernstein-type inequalities are proved for several classes of functions.

X-MODE: Extended Multi-operator Differential Evolution algorithm

During past years, multi-operator optimization techniques gained vast attention due to their flexible structure and self-adaptation. They yielded promising results when compared with the single-operator based methods. However, the existing multi-operator models can be further improved regarding exploration–exploitation equilibrium. Therefore, we propose a novel multi-operator algorithm for solving single-objective optimization problems that categorize differential evolution mutation strategies according to the purpose each of them fulfills. A new mutation scheme is also presented to promote the mutation across search space boundaries. A novel extended crossover technique is proposed in this study to retain the properties of applied mutation strategies, as well as develop the potential of the standard crossover function. The model is afterward evaluated on the CEC2020 benchmark test-suite. The proposed algorithm has overwhelming results while comparing single-operator and multi-operator algorithms for several classes of functions. It has been observed from the study that proposed mutation and crossover techniques help improve the efficiency of MODE variants.

ANALYSIS OF CLINICAL AND FUNCTIONAL INDICES OF CARDIOVASCULAR SYSTEM IN POST-COVID-19 EMERGENCY WORKERS OF THE CHORNOBYL ACCIDENT.

to determine which changes of cardiovascular system clinical, and structural, and functional state in emergency workers (EW) of the accident at the Chornobyl nuclear power plant (CNNP) can be associated with COVID-19 they suffered from and not with the natural progression of coronary heart disease (CHD). The study included 16 male EW who fell ill with mild and medium-severe COVID-19 (EWC group) in 2020-2021, which was confirmed by a PCR test (polymerase chain reaction). All these patients were observed in the NRCRM cardiology department before infection with the coronavirus. The comparison group consisted of 32 EW who did not suffer from COVID-19 and their age and examination dates corresponded to EWC. General clinical, laboratory, statistical methods and Doppler echocardiography were used for patients examination. In the post-covid period, EW-C observed a worsening of CHD clinical course, which consisted in an increase in the number of patients with severe functional class angina pectoris, with ventricular and supraventricular extrasystoles, as well as with more severe heart failure (HF). Since similar changes in the state of the cardiovascular system were found among EW who did not suffer from COVID-19, they can be attributed to the natural progression of CHD. In the EW-C group, there was an increase in the number of patients with atrial fibrillation (AF) by 4 times (up 37.5 %), while in the comparison group EW only by 1.1 times (up 3.1 %). The progression of CHD and HF in the examined patients was accompanied by an increase in the end-diastolic and end-systolic volumes of the left ventricle and the mass of the myocardium, the severity of which was not significantly different in patients with and without COVID-19. The number of post-covid patients with reduced ejection fraction (EF) during examination after COVID-19 increased by 31.3 %, and in the group of EW, which were examined at the same time, by 6.32 %. A significant increase in the number of patients with AF and a reduced EF in the EW-C compared with the EW can be attributed to the results of the SARS-CoV-2 virus influence on cardiovascular system.

Effect of 24-hour blood pressure and heart rate on the prognosis of patients with reduced and midrange LVEF.

Aim Optimal combination therapy for chronic heart failure (CHF) currently implies the mandatory use of at least four classes of drugs: renin-angiotensin-aldosterone (RAAS) system inhibitors or angiotensin receptor blocker neprilysin inhibitors (ARNI); beta-adrenoblockers (BAB); mineralocorticoid receptor antagonists; and sodium-glucose cotransporter 2 inhibitors. Furthermore, many of these drugs are able to decrease blood pressure even to hypotension and alleviate tachycardia. This study focused on the relationship of 24-h blood pressure (BP) and heart rate (HR) with the prognosis for CHF patients with sinus rhythm and left ventricular ejection fraction (LV EF) <50 % as well as on suggesting possible variants of safe therapy for CHF depending on the combination of studied factors.Material and methods Effects of clinical data, echocardiographic parameters, 24-h BP, and heart rhythm (data from 24-h BP and ECG monitors) on the prognosis of 155 patients with clinically pronounced CHF, LV EF <50 %, and sinus rhythm who were followed up for 5 years after discharge from the hospital.Results The one-factor analysis showed that the prognosis of CHF patients was statistically significantly influenced by the more severe functional class (FC) III CHF compared to FC II, reduced LV EF (<35 %), a lower 24-h systolic BP (SBP) (<103 mm Hg), the absence of hypotensive episodes in daytime, a low variability of nighttime BP (<7.5 mm Hg), a higher 24-h HR (>71 bpm vs. <60 bpm), the absence of therapy with RAAS inhibitors + BAB, and a lower body weight index. The multi-factor analysis showed that more severe CHF FC, lower LV EF, and the absence of RAAS inhibitors + BAB therapy retained the influence on the prognosis. After eliminating the influencing factor of drug therapy, also a low SBP variability significantly influenced the prognosis. An additional analysis determined the following four groups of CHF patients with reduced heart systolic function according to mean 24-h HR and SBP: the largest group (38.1 % of all patients) with controlled HR (≤69 bpm), preserved SBP (>103 mm Hg), and the lowest death rate of 15.3 %; the group with increased HR (>69 bpm) but preserved SBP (30.3 % of all patients) where the death rate was 44.7 %, which was significantly higher than in the first group; the group with normal HR (≤69 bpm) but reduced SBP (≤103 mm Hg) (16.1 % of patients) where the death rate was 40 %, which was comparable with the second group and significantly worse than in the first group; and the group with both increased HR (>69 bpm) and reduced SBP (≤103 mm Hg) (15.5 % of patients), which resulted in the maximal risk of death (70.8 % of patients with CHF and LV EF <50 %), which was significantly higher than in the three other groups.Conclusion Low SBP (including 24-h SBP with reduced variability in day- and nighttime) in combination with high HR (including by data of Holter monitoring), low LV EF, more severe clinical course of CHF, and the absence of an adequate treatment with neurohormonal modulators (RAAS inhibitors and BAB) significantly increased the risk of death. Isolating four types of FC II-III CHF with sinus rhythm and EF <50% based on the combination of HR and BP identifies patients with an unfavorable prognosis, which will help developing differentiated therapeutic approaches taking into account clinical features.

Influence of demographic characteristics on the clinical course and results of therapy in patients with precapillary pulmonary hypertension

To assess the clinical course of the disease and the features of the treatment goals achievement in patients with IPAH and inoperable CTEPH depending on gender and age at the time of diagnosis verification. The study included 88 patients with IPAH and 38 patients with inoperable CTEPH with a PAWP 12 mm Hg and the duration of PAH-specific therapy treatment more than 12 months. IPAH/CTEPH patients were divided into groups depending on age at the time of diagnosis verification: age 50 years (n=69)/ 50 years (n=57), and gender: 106 women/20 men. Patients with age 50 years at the time of diagnosis verification have significantly more severe functional class (WHO). In IPAH/CTEPH male patients a significant hemodynamic disorder also as significantly higher level of NT-proBNP at the time of diagnosis verification were observed. In men with IPAH/CTEPH and patients aged 50 years more pronounced deterioration of right ventricular systolic function was observed (ECHO). Patients with IPAH younger than 50 years were significantly more likely to achieve the treatment goals by the median 26.5 months of treatment compared to the patients aged 50 years (21% vs 6.45%). Men with IPAH/CTEPH were significantly more likely to have a high risk of death (90%) at baseline compared to the women (61%). IPAH/inoperable CTEPH patients with male sex, as well as the age 50 years and older at the time of diagnosis verification, compared with younger ones, are associated with a less favorable course of the disease.

Prescribing frequency and adherence to statins in outpatients with type 2 diabetes mellitus and comorbid cardiovascular diseases

BACKGROUND: Due to the high rate of growth in the incidence and burden of cardiovascular complications, type 2 diabetes mellitus (T2DM) is a significant medical problem in the world. Even in the absence of cardiovascular disease (CVD), patients with T2DM are classified as high and very high risk. In addition to glycemic control, an extremely important aspect of managing this group of patients is prevention of cardiovascular complications. T2DM and hyperlipidemia determines the target group for statins. At the same time, little is known about the frequency of administration of this class of drugs among people with T2DM.AIM: To study prescribing frequency and adherence to statins in outpatients with T2DM and comorbid cardiovascular diseases.METHODS: 156 patients with type 2 diabetes (87.2% — women, average age — 65.2 years) were examined as part of an outpatient appointment with an endocrinologist at the city polyclinic ofTomsk. We used a standard questionnaire compiled on the basis of adapted international methods, including information on cardiac pathology, medications, income level, and Morisky-Green test. Anthropometric parameters, fasting plasma glucose, glycated hemoglobin, lipid spectrum parameters were measured. Methods of parametric and nonparametric statistics were used for comparisons.RESULTS: Statins were prescribed to 45.0% of the surveyed, and 47.0% of them were constantly taking statins. In 41 and 39% of cases, statins were prescribed by an endocrinologist and a cardiologist, respectively. Those taking statins were characterized by a more severe functional class of angina pectoris (p=0.03), a higher prior myocardial infarction rate (p=0.01). For other concomitant diseases, and also indicators of carbohydrate metabolism, differences between the groups were not revealed. One third of patients were adherent (3–4 points), 2/3 were not adherent to treatment (0–2 points), respectively. Patients with incomes between 1 and 2 cost of living took statins more often than the rest (p=0.021).CONCLUSION: An insufficient frequency of prescription and adherence to statin therapy in patients with T2DM was revealed. In most cases, statins were prescribed by an endocrinologist or cardiologist. Functional class of angina pectoris, prior myocardial infarction and moderate income were associated with more frequent use of statins. To increase the coverage of patients with T2DM with statin treatment, more attention needs to be paid to the issues of CVD prevention from both medical professionals and patients.

BLOODSHED TREATED SUCCESSFULLY IN A HOUSE OF VILLAINS: A CHALLENGING AND UNUSUAL CASE OF HEMOPTYSIS IN A PATIENT WITH CONNECTIVE TISSUE DISEASE- PULMONARY ARTERIAL HYPERTENSION

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary arterial hypertension (PAH) is a progressive disease caused by a remodeling of precapillary arterioles that leads to a progressive increase in pulmonary vascular resistance and right ventricular failure. PAH can complicate any connective tissue disease, most frequently SSc as discussed above, but also SLE, MCTD, RA, or other diseases such as Sjogren’s syndrome (SS) and dermatomysositis with often a poor prognosis. Our case illustrates a case of Hemoptysis under uniquely complex circumstances. CASE PRESENTATION: 53-year-old Hispanic female initially presented with features of severe Acute right heart failure, cardiogenic shock and Hypoxemia. Pulmonary arterial hypertension (PAH) diagnosis was made and was stabilized on emergent parenteral prostacyclin therapy. We also found connective tissue disease (CTD) with Sjogren’s features. She had history of recurrent Venous thromboembolism (VTE) and was on rivaroxaban. PAH therapy - SQ Treprostinil (@ 60ng/kg/min) + tadalafil 40mg qd. A few months later, she developed (CNPA). She responded well to voriconazole with clinical & radiographic improvement. A significant cutaneous allergic reaction to voriconazole led to its cessation and substitution with posaconazole. She presented with large volume hemoptysis with preceding minor episodes for several days. She was hemodynamically stable with no constitutional symptoms. CT chest revealed a stable appearing right upper lobe pulmonary mass measuring 5.5 x 3.0 cm. BNP was 67. Anticoagulation was held and an IVC filter was placed emergently. Bronchoscopy revealed necrotic debris, tan purulent mucous, and blood in the anterior segment of the right upper lobe. Interventional radiology performed bronchial and subclavian angiography with chemoembolization (small branch of the right subclavian artery & the distal portion of the right bronchial artery) of the Aspergilloma. Anticoagulation was resumed after with no further episodes of hemoptysis and she was successfully discharged. DISCUSSION: In a review of patients with SS & PAH, the mean age at diagnosis of PAH was 50 and all female with severe functional class (FC III and IV) and hemodynamic impairment (1), strikingly similar to our case. Survival rate was low (66% at 3 years) as standard therapy of PAH was typically ineffective despite an initial improvement. However, Significant clinical improvement was noted in our patient with Parenteral prostacyclin therapy and PDE5 inhibitors. CONCLUSIONS: This case illustrates a complex unique clinical situation that was challenging – Hemoptysis from CNPA with a background of the following active diagnoses: PAH, CTD (Sjogren’s features), Recurrent VTE. Chemoembolization of feeding arteries + IVC filter placement + temporary cessation of anticoagulation was used with a successful outcome. Reference #1: Sato T, Hatano M, Iwasaki Y, et al. Prevalence of primary Sjögren's syndrome in patients undergoing evaluation for pulmonary arterial hypertension. PLoS One. 2018;13(5):e0197297. Published 2018 May 15. doi:10.1371/journal.pone.0197297 DISCLOSURES: Clinical Research - PI relationship with United Therapeutics Please note: 3 years Added 05/08/2020 by Vijay Balasubramanian, source=Web Response, value=Grant/Research Support Speaker relationship with Bayer Please note: 3 years Added 05/08/2020 by Vijay Balasubramanian, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $1001 - $5000 Added 05/08/2020 by Vijay Balasubramanian, source=Web Response, value=Honoraria No relevant relationships by Eric Reid, source=Web Response No relevant relationships by James Yang, source=Web Response

Completely monotonicity of class functions involving the polygamma and related functions

In this paper, the authors prove some inequalities and completely monotonic properties of polygamma functions. As an application, we give lower bound for the zeta function on natural numbers. Partially, we answer the fifth and sixth open problems listed in [F. Qi and R. P. Agarwal, On complete monotonicity for several classes of functions related to ratios of gamma functions, J. Inequalities Appl. 2019(36) (2019) 42]. We propose two open problems on completely monotonic functions related to polygamma functions.

Fractional Supersymmetric Hermite Polynomials

We provide a realization of fractional supersymmetry quantum mechanics of order r, where the Hamiltonian and the supercharges involve the fractional Dunkl transform as a Klein type operator. We construct several classes of functions satisfying certain orthogonality relations. These functions can be expressed in terms of the associated Laguerre orthogonal polynomials and have shown that their zeros are the eigenvalues of the Hermitian supercharge. We call them the supersymmetric generalized Hermite polynomials.

Dunkl-supersymmetric orthogonal functions associated with classical orthogonal polynomials

We consider the eigenvalue problem associated with the Dunkl-type differential operator (in which the reflection operator R is involved)in the context of supersymmetric quantum mechanical models. By solving this eigenvalue problem with the help of known exactly solvable potentials, we construct several classes of functions satisfying certain orthogonality relations. We call them the Dunkl-supersymmetric (Dunkl-SUSY) orthogonal functions. These functions can be expressed in terms of the classical orthogonal polynomials. The key feature of these functions is that they appear by pairs, i.e. Qn(x) and Qn(−x) are both the eigenfunctions of . A general formulation of the Dunkl-SUSY orthogonal polynomials is also presented.

Certain Results for the Class of Carathéodory Functions

We present some sufficient conditions for an analytic function p in $$|z| 0$$ in $$|z|<1$$. Several classes of functions may be described in terms of the class of Caratheodory functions. Therefore, these conditions may be reformulated to various sufficient conditions for starlikeness, convexity, etc.

Existence Theory for the Boussinesq Equation in Modulation Spaces

In this paper we study the Cauchy problem for the generalized Boussinesq equation with initial data in modulation spaces $$M^{s}_{p^\prime ,q}(\mathbb {R}^n),$$ $$n\ge 1.$$ After a decomposition of the Boussinesq equation in a $$2\times 2$$ -nonlinear system, we obtain the existence of global and local solutions in several classes of functions with values in $$ M^s_{p,q}\times D^{-1}JM^s_{p,q}$$ -spaces for suitable p, q and s, including the special case $$p=2,q=1$$ and $$s=0.$$ Finally, we prove some results of scattering and asymptotic stability in the framework of modulation spaces.

INDICATORS OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE MYOCARDIUM AS PREDICTORS OF THE ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION

&#x0D; &#x0D; &#x0D; A large number of recent trials suggested that atrial fibrillation (AF) and heart failure (HF) should be considered as two epidemic cardiovascular pathologies that are closely interrelated, each contributing to the development of the other. The purpose of our work was to analyze the peculiarities of the structural and functional parameters of the heart and blood vessels in patients with HFpEF, as well as to determine the most informative predictors of AF and their predictive value. A study of the literature indicates that AF has a close relationship with both HFpEF and the diagnostic criteria used to determine it. The relevance of the study of this pathology is that AF has a significant impact on the course and prognosis of HFpEF. The study was conducted on a case-control design. This work is based on the results of ex- amination of 115 hemodynamically stable patients with arterial hypertension (AH), clinical symptoms and signs of heart failure (HF), with left ventricular (LV) ejection fraction (EF) ≥ 50% and signs of diastolic dysfunction (DD) according to echocardiography data. Patients’ age ranged from 40 to 85 years (mean age 66.3 ± 10.8 years). For the first time, criteria for LV DD were analyzed as possible predictors of atrial fibrillation in patients with HFpEF and thresholds for some of them were determined. The study empirically confirms and theo- retically argues that the presence of atrial fibrillation in patients with HFpEF, in contrast to those with sinus rhythm, is associated with a more severe functional class of HF estimated by NYHA classification; higher by 28.1% NTprоBNP level; increased left ventricular filling pres- sure with LAVI thresholds &gt; 40 ml/m2 and E/e ‘&gt; 14.75; with impaired endothelium-depen- dent vasodilation and an initial decrease in glomerular filtration rate. The results of the study may be useful for the screening and detection of AF in patients with established HFpEF, by monitoring of ECG, in case of detection of threshold values of diastolic LV dysfunction.&#x0D; &#x0D; &#x0D;

A Solution to Qi’s Conjecture on a Double Inequality for a Function Involving the Tri- and Tetra-Gamma Functions

In the paper, the author gives a solution to a conjecture on a double inequality for a function involving the tri- and tetra-gamma functions, which was first posed in Remark 6 of the paper “Complete monotonicity of a function involving the tri- and tetragamma functions” (2015) and repeated in the seventh open problem of the paper “On complete monotonicity for several classes of functions related to ratios of gamma functions” (2019).

FEATURES OF THE DISEASE IN PATIENTS WITH PRECAPILLARY PULMONARY HYPERTENSION WITH ESSENTIAL HYPERTENSION AND CARBOHYDRATE METABOLISM DISORDERS

Objective: To evaluate the characteristics of the patients with idiopathic pulmonary arterial hypertension (IPAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH) depending on the comorbidity status Design and method: The study included patients with IPAH (n = 88) and inoperable CTEPH (n = 38) with median age 38.5[28.5;51] and 53.5[41;58] years, respectively. At the time of diagnosis verification the assessment of functional status with 6-minute walking test (6MWT) and desaturation index, 2D and 3D Echo, right heart catheterization (RHC) was made. All patients were divided into 5 groups according to the comorbidity status: group 1-pts with IPAH/CTEPH without comorbidity (n = 29); group 2 - with BMI>25 kg/m2 (n = 23); group 3 –with BMI>25 kg/m2 and dyslipidemia (n = 27); group 4 -with essential hypertension, BMI>25 kg/m2 and dyslipidemia (n = 30); group 5 –all of the above in group 4 plus carbohydrate metabolism disorders (n = 17). Results: The pts from group 4 and 5 had significantly more severe functional class (WHO) at baseline (3 [3; 3] and 3 [3; 3,5]) with more reduced distance in 6MWT (314[250;340] m and 280 [205,0; 346,0] m) compared to the pts from group 1 (3[2;3] and 409 [341; 455] m) and group 3 (3[2;3] and 407 [357; 467] m). The pts from group 5 had significantly more reduced SpO2 before the 6MWT (93 [92; 95] %) compared to the pts from group 1 and 3 (97[94; 98]% and 97[94; 98]%). According to 3D Echo the end-diastolic right ventricular volume was significantly larger in pts from group 4 and 5 (135 [92;192]/ 138 [106;170] ml) also as end-systolic right ventricular volume (95 [63; 138]/ 86,8 [68;137] ml, respectively) compared to the pts from group 1 (119 [80;138]/ 77,5 [44;90] ml) and 3 (99 [75;148]/ 59 [41; 84] ml). Belonging to the group 5 associated with an increase of systolic pulmonary arterial pressure (RHC) on B coefficient = 23,62 mmHg (p = 0,01) compared to the group 1.Conclusions: IPAH and inoperable CTEPH pts with BMI > 25 kg/m2, dyslipidemia, essential hypertension, also as with additional carbohydrate metabolism disorders have more severe status, that requires the more aggressive therapy and strict dynamic control.

New properties for several classes of functions related to the Fox–Wright functions

In this paper our aim is to establish several new properties for some class of functions related to the Fox–Wright functions. In particular, the monotonicity, convexity, sub-additivity and super-additivity properties involving the Fox–Wright functions are proved, These results are also closely connected with some functional inequalities (such as Turán-type inequalities). Moreover, we investigate certain criteria for the univalence and starlikeness for a certain class of functions associated with the Fox–Wright functions.

Titration of Medical Therapy for Heart Failure With Reduced Ejection Fraction

BackgroundGuidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) have medical therapy titrated to target doses derived from clinical trials, as tolerated. The degree to which titration occurs in contemporary U.S. practice is unknown. ObjectivesThis study sought to characterize longitudinal titration of HFrEF medical therapy in clinical practice and to identify associated factors and reasons for medication changes. MethodsAmong 2,588 U.S. outpatients with chronic HFrEF in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry with complete medication data and no contraindications to medical therapy, use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA) were examined at baseline and at 12-month follow-up. ResultsAt baseline, 658 (25%), 525 (20%), 287 (11%), and 45 (2%) patients were receiving target doses of MRA, beta-blocker, ACEI/ARB, and ARNI therapy, respectively. At 12 months, proportions of patients with medication initiation or dose increase were 6% for MRA, 10% for beta-blocker, 7% for ACEI/ARB, and 10% for ARNI; corresponding proportions with discontinuation or dose decrease were 4%, 7%, 11%, and 3%, respectively. Over 12 months, <1% of patients were simultaneously treated with target doses of ACEI/ARB/ARNI, beta-blocker, and MRA. In multivariate analysis, across the classes of medications, multiple patient characteristics were associated with a higher likelihood of initiation or dose increase (e.g., previous HF hospitalization, higher blood pressure, lower ejection fraction) and discontinuation or dose decrease (e.g., previous HF hospitalization, impaired quality of life, more severe functional class). Medical reasons were the most common reasons for discontinuations and dose decreases of each therapy, but the relative contributions from patient preference, health team, and systems-based reasons varied by medication. ConclusionsIn this contemporary U.S. registry, most eligible HFrEF patients did not receive target doses of medical therapy at any point during follow-up, and few patients had doses increased over time. Although most patients had no alterations in medical therapy, multiple clinical factors were independently associated with medication changes. Further quality improvement efforts are urgently needed to improve guideline-directed medication titration for HFrEF.

Differential microRNA expression between decidual and peripheral blood natural killer cells in early pregnancy.

Have decidual natural killer (dNK) cells a different microRNA (miRNA or miR) expression pattern compared to NK cells circulating in the peripheral blood (pb) of healthy pregnant women in the first trimester of gestation? dNK cells have a unique miRNA profile, showing exclusive expression of a set of miRNAs and significant up- or down-regulation of most of the miRNAs shared with pbNK cells. dNK cells differ from pbNK cells both phenotypically and functionally, and their origin is still debated. Many studies have indicated that miRNAs regulate several important aspects of NK cell biology, such as development, activation and effector functions. Decidua basalis and peripheral blood specimens were collected from women (n = 7) undergoing voluntary termination of gestation in the first trimester of pregnancy. dNK and pbNK cells were then highly purified by cell sorting. miRNAs expression was analysed by quantitative RT-PCR (qRT-PCR)-based arrays using RNA purified from freshly isolated and highly purified pbNK and dNK cells. Results from arrays were validated by qRT-PCR assays. The bioinformatics tool ingenuity pathway analysis (IPA) was applied to determine the cellular network targeted by validated miRNAs and the correlated biological functions. Herein, we identified the most differentially expressed miRNAs in NK cells isolated from peripheral blood and uterine decidua of pregnant women. We found that 36 miRNAs were expressed only in dNK cells and two miRNAs only in pbNK cells. Moreover, 48 miRNAs were commonly expressed by both NK cell preparations although at different levels: 28 were upregulated in dNK cells, while 15 were downregulated compared to pbNK cells. Validation of a selected set (n = 11) of these miRNAs confirmed the differential expression of nine miRNAs: miR-10b and miR-214 expressed only in dNK cells and miR-200a-3p expressed only in pbNK cells; miR-130b-3p, miR-125a-5p, miR-212-3p and miR-454 were upregulated while miR-210-3p and miR-132 were downregulated in dNK cells compared to pbNK cells. IPA network analysis identified a single network connecting all the miRNAs as well as their significant involvement in several classes of functions: 'Organismal injury, Reproductive system disease, Inflammatory disease' and 'Cellular development'. These miRNAs target molecules such as argonaute 2, tumour protein p53, insulin and other genes that belong to the same network and significantly influence cell differentiation and pregnancy. In the present study, the cellular network and biological functions modulated by miRNAs differentially expressed in dNK and pbNK cells were identified by IPA considering only molecules and relationships that were with confidence 'experimentally observed' in leucocytes. The decidual and pbNK cells that were analysed here are a heterogeneous population and further study will help to disentangle whether there are differences in miRNA production by the different subsets of NK cells. This is the first study describing a different miRNA expression profile in dNK cells compared to matched pbNK cells during the first trimester of pregnancy. Our findings improved the body of knowledge on dNK cell biology and strongly suggest further investigation into the roles of miRNAs that are differentially expressed in human dNK compared to pbNK cells. Our results suggest that specific miRNAs can modulate dNK cell origin and functions, highlighting a potential role of this miRNA signature in human development and diseases. This work was supported by grants from the Istituto Pasteur, Fondazione Cenci Bolognetti, the European NoE EMBIC within FP6 (Contract number LSHN-CT-2004-512040), Istituto Italiano di Tecnologia, and Ministero dell'Istruzione, dell'Università e della Ricerca (Ricerche Universitarie), and from Università Politecnica delle Marche. There are no conflicts of interest to declare.