Serum autotaxin levels are correlated with hepatic fibrosis and ballooning in patients with non-alcoholic fatty liver disease

AIM To examine the relationship between serum autotaxin(ATX) concentrations and clinicopathological findings in non-alcoholic fatty liver disease(NAFLD) patients.METHODS One hundred eighty-six NAFLD patients who had undergone liver biopsy between 2008 and 2017 were retrospectively enrolled.Serum samples were collected at the time of biopsy and ATX was measured by enzyme immunoassays.Sera obtained from 160 healthy,nonobese individuals were used as controls.Histological findings were graded according to an NAFLD scoring system and correlations with serum ATX were calculated by Spearman's test.Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve(AUC).Cut-off values were identified by the Youden index,and the nearest clinically applicable value to the cutoff was considered the optimal threshold for clinical convenience.RESULTS Serum ATX levels were significantly higher in NAFLD patients than in controls(0.86 mg/L vs 0.76 mg/L,P < 0.001) and correlated significantly with ballooning score and fibrosis stage(r = 0.36,P < 0.001 and r = 0.45,P < 0.001,respectively).Such tendencies were stronger in female patients.There were no remarkable relationships between ATX and serum alanine aminotransferase,lipid profiles,or steatosis scores.The AUC values of ATX for predicting the presence of fibrosis(≥ F1),significant fibrosis(≥ F2),severe fibrosis(≥ F3),and cirrhosis(F4),were all more than 0.70 in respective analyses.CONCLUSION Serum ATX levels may at least partially reflect histological severity in NAFLD.

Reverse or inverted apical ballooning in a case of refeeding syndrome

Takotsubo cardiomyopathy is characterized by the development of transient left ventricular regional wall motion abnormalities,in the absence of significant coronary artery obstruction. This syndrome usually occurs in women and is frequently associated with an intense emotional or physical stress. It usually involves apical segments,but in the recent years atypical forms have been described. Inverted or reverse Takotsubo is a variant in which the basal and midventricular segments are hypokinetic,sparing contractile function of the apex. In this report we describe the case of a 54-year-old woman,with chronic malnutrition,initially admitted because of hypoglycemia and severe electrolyte disturbance due to a refeeding syndrome. Within the next hours she experienced acute cardiac symptoms and developed heart failure with low cardiac output. Electrocardiogram(ECG),elevation of troponin and echocardiographic findings were consistent with inverted Takotsubo cardiomyopathy. To the best of our knowledge,this is the first incidence reported of inverted Takotsubo triggered by refeeding syndrome.

Stability of tokamak plasmas with internal transport barriers against high n ideal magnetohydrodynamic ballooning mode

A ballooning mode equation for tokamak plasma, with the toroidicity and the Shafranov shift effects included, is derived for a shift circular flux tokamak configuration. Using this equation, the stability of the plasma configuration with an internal transport barrier （ITB） against the high n （the toroidal mode number） ideal magnetohydrodynamic （MHD） ballooning mode is analysed. It is shown that both the toroidicity and the Shaftanov shift effects are stabilizing. In the ITB region, these effects give rise to a low shear stable channel between the first and the second stability regions. Out of the ITB region towards the plasma edge, the stabilizing effect of the Shaftanov shift causes the unstable zone to be significantly narrowed.

Numerical linear analysis of the effects of diamagnetic and shear flow on ballooning modes

The linear analysis of the influence of diamagnetic effect and toroidal rotation at the edge of tokamak plasmas with BOUT++ is discussed in this paper. This analysis is done by solving the dispersion relation, which is calculated through the numerical integration of the terms with different physics. This method is able to reveal the contributions of the different terms to the total growth rate. The diamagnetic effect stabilizes the ideal ballooning modes through inhibiting the contribution of curvature. The toroidal rotation effect is also able to suppress the curvaturedriving term, and the stronger shearing rate leads to a stronger stabilization effect. In addition,through linear analysis using the energy form, the curvature-driving term provides the free energy absorbed by the line-bending term, diamagnetic term and convective term.

On the stability of small-scale ballooning modes in axisymmetric mirror traps

It is shown that a steepening of the radial plasma pressure profile leads to a decrease in the critical value of beta,above which,small-scale balloon-type perturbations in a mirror trap become unstable.This may mean that small-scale ballooning instability leads to a smoothing of the radial plasma profile.The critical beta values for the real magnetic field of the gas-dynamic trap and various plasma pressure radial profiles was also calculated.For a plasma with a parabolic profile critical beta is evaluated at the level of 0.72.A previous theoretical prediction for this trap was almost two times lower than maximal beta 0.6 achieved experimentally.

GTC Simulation of Ideal Ballooning Mode in Tokamak Plasmas

In the present paper,we first derive the eigenmode equation of the ideal ballooning mode in tokamak plasmas using a gyrokinetic equation.It is shown that the gyrokinetic eigenmode equation can be reduced to the magnetohydrodynamic（MHD） form in the long wavelength limit when kinetic effects are ignored.Then,the global gyrokinetic toroidal code（GTC） is applied for simulations of the edge-localized ideal ballooning modes.The obtained mode structures are compared with the results of ideal MHD simulations.The observed scaling of the linear growth rate with the toroidal mode number is consistent with the ideal MHD theory.The simulation results verify the GTC capability of simulating MHD processes in toroidal plasmas.

Tokamak resistive magnetohydrodynamic ballooning instability in the negative shear regime

Improved confinement of tokamak plasma with central negative shear is checked against the resistive ballooning mode. In the negative shear regime, the plasma is always unstable for purely growing resistive ballooning mode. For a simplest tokamak equilibrium model, the s-α model, characteristics of this kind of instability are fully clarified by numerically solving the high n resistive magnetohydrodynamic ballooning eigen-equation. Dependences of the growth rate on the resistivity, the absolute shear value, the pressure gradient are scanned in detail. It is found that the growth rate is a monotonically increasing function of a while it is not sensitive to the changes of the shear s, the initial phase θ0 and the resistivity parameter εR.

Finite Larmor radius magnetohydrodynamic analysis of the ballooning modes in tokamaks

In this paper, the effect of finite Larmor radius （FLR） on high n ballooning modes is studied on the basis of FLR magnetohydrodynamic （FLR-MHD） theory. A linear FLR ballooning mode equation is derived in an ＇s^-- α＇ type equilibrium of circular-flux-surfaces, which is reduced to the ideal ballooning mode equation when the FLR effect is neglected. The present model reproduces some basic features of FLR effects on ballooning mode obtained previously by kinetic ballooning mode theories. That is, the FLR introduces a real frequency into ballooning mode and has a stabilising effect on ballooning modes （e.g., in the case of high magnetic shear s^- ≥ 0.8）. In particular, some new properties of FLR effects on ballooning mode are discovered in the present research. Here it is found that in a high magnetic shear region （s^- ≥ 0.8） the critical pressure gradient （αc,FLR） of ballooning mode is larger than the ideal one （αc,IMHD） and becomes larger and larger with the increase of FLR parameter b0. However, in a low magnetic shear region, the FLR ballooning mode is more unstable than the ideal one, and the αc,FLR is much lower than the αc,IMHD. Moreover, the present results indicate that there exist some new weaker instabilities near the second stability boundary （obtained from ideal MHD theory）, which means that the second stable region becomes narrow.

Apical Ballooning Syndrome: Recent Insights from a Consecutive Series of 104 Patients

Apical ballooning syndrome (Takotsubo cardiomyopathy) is an increasingly recognized form of acute systolic dysfunction which is usually reversible. It typically occurs in post-menopausal women following a major psychological stressor. We conducted a single center, retrospective analysis of all hospitalized patients from 2001-2012 and found 104 patients who met the diagnostic criteria for apical ballooning. In this current largest series of its kind, 83% of the patients were women. Among both men and women, an antecedent stressor was not always identified. The exact pathophysiologic mechanism resulting in apical ballooning remains poorly understood. These findings challenge the paradigm that catecholamine cardiotoxicity in the setting of relative estrogen deficiency results in the cardiomyopathy.

Gadolinium enhanced MRI in patients with left ventricular apical ballooning syndrome implicates myocarditis as an etiology

Aims: Left ventricular apical ballooning syndrome (LVABS) is a clinical condition of unknown etiology, characterized by acute onset of atypical apical wall motion and absence of coronary artery disease. Gadolinium-enhanced cardiac magnetic resonance imaging (Gd-MRI) may be used to identify patients with myocarditis. Using cardiac MRI, we evaluated whether acute myocarditis may be an etiology that underlies LVABS. Methods and Results: Consecutive patients who presented with LVABS during a three-year period were included. Demographic data was recorded and echocardiography, coronary angiography, and hemodynamic assessment performed. Gd-MRI was performed in all patients. The study was deemed consistent with myocarditis when global myocardial to skeletal muscle enhancement ratio was ≥3.5. Regional Gd-MRI analysis was also performed. Patients (n = 11) were female (100%) and of mean age 72 years (72 ± 11). Preceding febrile illness occurred in 4 (36.3%) and leukocytosis in 6 (54.4%) patients. Initial mean left ventricular ejection fraction (41% ± 12%) improved (70.2% ± 8%) upon follow-up (39 ± 43 days). Global MRI analysis was positive in 5/11 (45.5%) (mean relative enhancement ratio 4.8 ± 1.4). Regional MRI analysis was positive in 4/6 further patients (overall: 9/11 (82%)). Conclusions: Gadolinium enhanced MRI imaging in LVABS implicates myocarditis as a possible etiology. Regional MRI analysis adds sensitivity to global cardiac MRI evaluation.

Reversible transient apical ballooning syndrome with coronary lesions

Transient apical ballooning syndrome（Tako-Tsubo syndrome or ampulla cardiomyopathy） occurs predominantly in women over 60 years of age with a history of recent physical or psychological stress. We present a case of a male patient with reversible transient apical ballooning syndrome with significant coronary lesions and other ECG changes that did not explain the clinical symptoms.

Transient Mid-Ventricular Ballooning Due to Bad Dream in a Postmenopausal Woman

Mid ventricular ballooning syndrome (MBS) was diagnosed in a 55-year-old woman who was admitted to emergency room due to acute chest pain. The trigger for the chest pain was reported as “bad dream” about her husband. MBS, a variant of Tako-tsubo Cardiomyopathy is more common in postmenopausal women and the triggers have been linked to stress involving the husband. Sudden catecholamine surge during nightmare augmented by estrogen deficiency in postmenopausal women may be the underlying mechanism. There are many unanswered questions related to the etiology of MBS. With supportive treatment, prognosis is excellent.

Stability of Tokamak Equilibrium with Internal Transport Barrier against High n MHD Ballooning Mode

Internal transport barriers （ITBs） are phenomena associated with improved confinement mode of tokamak plasmas. Within the region where the ITB locates, the plasma pressure has a large gradient while the magnetic shear s has a minimum so that within and near the ITB, the absolute value of the shear is very low. Physics involved is plentiful, from the macroscopic （ MHD ） stability, to the suppression of microscopic instabilities thought to be responsible for anomalous transport. The treatment of very low shear also poses some theoretical difficulties.

c-Jun N-terminal kinase-mediated Rubicon expression enhances hepatocyte lipoapoptosis and promotes hepatocyte ballooning

AIM: To clarify the relationship between autophagy and lipotoxicity-induced apoptosis, which is termed "lipoapoptosis," in non-alcoholic steatohepatitis. METHODS: Male C57BL/6J mice were fed a high-fat diet(HFD) for 12 wk, after which the liver histology and expression of proteins such as p62 or LC3 were evaluated. Alpha mouse liver 12(AML12) cells treated with palmitate(PA) were used as an in vitro model. RESULTS: LC3-Ⅱ, p62, and Run domain Beclin-1 interacting and cysteine-rich containing(Rubicon) proteins increased in both the HFD mice and in AML12 cells in response to PA treatment. Rubicon expression was decreased upon c-Jun N-terminal kinase(JNK) inhibition at both the m RNA and the protein level in AML12 cells. Rubicon knockdown in AML12 cells with PA decreased the protein levels of both LC3-Ⅱ and p62. Rubicon expression peaked at 4 h of PA treatment in AML12, and then decreased. Treatment with caspase-9 inhibitor ameliorated the decrease in Rubicon protein expression at 10 h of PA and resulted in enlarged AML12 cells under PA treatment. The enlargement of AML12 cells by PA with caspase-9 inhibition was canceled by Rubicon knockdown.CONCLUSION: The JNK-Rubicon axis enhanced lipoapoptosis, and caspase-9 inhibition and Rubicon had effects that were cytologically similar to hepatocyte ballooning. As ballooned hepatocytes secrete fibrogenic signals and thus might promote fibrosis in the liver, the inhibition of hepatocyte ballooning might provide antifibrosis in the NASH liver.

Indian monsoon drove the dispersal of the thoracica group of Scytodes spitting spiders

We examined the global biogeography of the Scytodes thoracica group of spitting spiders based on 23 years of sampling at the species level(61 species in the thoracica group and 84 species of Scytodes)using DNA data from six loci.Our results indicated that the thoracica group initially dispersed from Southeast Asia to East Africa between 46.5 and 33.0 million years ago,and dispersal events intensified between Southeast/South Asia and East/South Africa from the early to late Miocene.The timing of these events indicates that Asian-African faunal exchange of the thoracica group was driven by the Indian monsoon,and the pattern of dispersal suggests that colonialization took root when the Indian monsoon shifted from a North-South direction to an East-West direction from the middle Eocene.

Investigation on the roles of equilibrium toroidal rotation during edge-localized mode mitigated by resonant magnetic perturbations

The effects of equilibrium toroidal rotation during edge-localized mode(ELM)mitigated by resonant magnetic perturbation(RMP)are studied with the experimental equilibria of the EAST tokamak based on the four-field model in the BOUT++code.As the two main parameters to determine the toroidal rotation profiles,the rotation shear and magnitudes were separately scanned to investigate their roles in the impact of RMPs on peeling-ballooning(P-B)modes.On one hand,the results show that strong toroidal rotation shear is favorable for the enhancement of the self-generated E×B shearing rate<ω_(E×B)>with RMPs,leading to significant ELM mitigation with RMP in the stronger toroidal rotation shear region.On the other hand,toroidal rotation magnitudes may affect ELM mitigation by changing the penetration of the RMPs,more precisely the resonant components.RMPs can lead to a reduction in the pedestal energy loss by enhancing the multimode coupling in the turbulence transport phase.The shielding effects on RMPs increase with the toroidal rotation magnitude,leading to the enhancement of the multimode coupling with RMPs to be significantly weakened.Hence,the reduction in pedestal energy loss by RMPs decreased with the rotation magnitude.In brief,the results show that toroidal rotation plays a dual role in ELM mitigation with RMP by changing the shielding effects of plasma by rotation magnitude and affecting<ω_(E×B)>by rotation shear.In the high toroidal rotation region,toroidal rotation shear is usually strong and hence plays a dominant role in the influence of RMP on P-B modes,whereas in the low rotation region,toroidal rotation shear is weak and has negligible impact on P-B modes,and the rotation magnitude plays a dominant role in the influence of RMPs on the P-B modes by changing the field penetration.Therefore,the dual role of toroidal rotation leads to stronger ELM mitigation with RMP,which may be achieved both in the low toroidal rotation region and the relatively high rotation region that has strong rotational shear.

Circulating microRNA expression and nonalcoholic fatty liver disease in adolescents with severe obesity

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is one of the most common chronic liver diseases in children and adolescents.NAFLD ranges in severity from isolated hepatic steatosis to nonalcoholic steatohepatitis(NASH),wherein hepatocellular inflammation and/or fibrosis coexist with steatosis.Circulating microRNA(miRNA)levels have been suggested to be altered in NAFLD,but the extent to which miRNA are related to NAFLD features remains unknown.This analysis tested the hypothesis that plasma miRNAs are significantly associated with histological features of NAFLD in adolescents.AIM To investigate the relationship between plasma miRNA expression and NAFLD features among adolescents with NAFLD.METHODS This study included 81 adolescents diagnosed with NAFLD and 54 adolescents without NAFLD from the Teen-Longitudinal Assessment of Bariatric Surgery study.Intra-operative core liver biopsies were collected from participants and used to characterize histological features of NAFLD.Plasma samples were collected during surgery for miRNA profiling.A total of 843 plasma miRNAs were profiled using the HTG EdgeSeq platform.We examined associations of plasma miRNAs and NAFLD features using logistic regression after adjusting for age,sex,race,and other key covariates.Ingenuity Pathways Analysis was used to identify biological functions of miRNAs that were associated with multiple histological features of NAFLD.RESULTS We identified 16 upregulated plasma miRNAs,including miR-193a-5p and miR-193b-5p,and 22 downregulated plasma miRNAs,including miR-1282 and miR-6734-5p,in adolescents with NAFLD.Moreover,52,16,15,and 9 plasma miRNAs were associated with NASH,fibrosis,ballooning degeneration,and lobular inflammation,respectively.Collectively,16 miRNAs were associated with two or more histological features of NAFLD.Among those miRNAs,miR-411-5p was downregulated in NASH,ballooning,and fibrosis,while miR-122-5p,miR-1343-5p,miR-193a-5p,miR-193b-5p,and miR-7845-5p were consistently and positively associated with all histological features of NAFLD.Pathway analysis revealed that most common pathways of miRNAs associated with multiple NAFLD features have been associated with tumor progression,while we also identified linkages between miR-122-5p and hepatitis C virus and between miR-199b-5p and chronic hepatitis B.CONCLUSION Plasma miRNAs were associated with NAFLD features in adolescent with severe obesity.Larger studies with more heterogeneous NAFLD phenotypes are needed to evaluate miRNAs as potential biomarkers of NAFLD.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

Chinese expert consensus on the clinical application of drugcoated balloon(2^(nd) Edition)

Percutaneous coronary interventions have progressed through the era of plain balloon dilation, bare-metal stent insertion to drug-eluting stent treatment, which has significantly reduced the acute occlusion and restenosis rates of target vessels and improved patient prognosis, making drug-eluting stents the mainstream interventional treatment for coronary artery disease. In recent years, drug-coated balloons(DCBs) have become a new treatment strategy for coronary artery disease, and the drugs used in the coating and the coating technology have progressed in the past years. Without permanent implant, a DCB delivers antiproliferative drugs rapidly and uniformly into the vessel wall via the excipient during a single balloon dilation. Many evidence suggests that DCB angioplasty is an effective measure for dealing with in-stent restenosis and de novo lesions in small coronary vessels.As more clinical studies are published, new evidence is emerging for the use of DCB angioplasty in a wide range of coronary diseases, and the indications are expanding internationally. Based on the latest research from China and elsewhere, the Expert Writing Committee of the Chinese Expert Consensus on Clinical Applications of Drug-Coated Balloon has updated the previous DCB consensus after evidence-based discussions and meetings in terms of adequate preparation of in-stent restenosis lesions, expansion of the indications for coronary de novo lesions, and precise guidance of DCB treatment by intravascular imaging and functional evaluation.

FlexCore: Dynamic Virtual Machine Scheduling Using VCPU Ballooning

As multi-core processors become the de-facto configuration in modern computers, the adoption of SMP Virtual Machines（VMs） has been increasing, allowing for more efficient use of computing resources. However,because of existence of schedulers in both the hypervisor and the guest VMs, this creates a new research problem,viz., double scheduling. Although double scheduling may cause many issues including lock-holder preemption,v CPU stacking, CPU fragmentation, and priority inversion, prior approaches have either introduced new problems and/or addressed the problem incompletely. In this paper, we describe the design and implementation of Flex Core,a new scheduling scheme using v CPU ballooning, which dynamically adjusts the number of v CPUs of a VM at runtime. This essentially eliminates unnecessary scheduling in the hypervisor layer, and thus, boosts performance significantly. An evaluation using a complete KVM-based implementation shows that the average performance improvement for PARSEC applications on a 12-core Intel machine is approximately 52.9%, ranging from 35.4% to79.6%.