The influence of "C-factor" and light activation technique on polymerization contraction forces of resin composite

Objectives: This study evaluated the influence of the cavity configuration factor ("C-Factor") and light activation technique on polymerization contraction forces of a Bis-GMA-based composite resin (Charisma, Heraeus Kulzer). Material and Methods: Three different pairs of steel moving bases were connected to a universal testing machine (Emic DL 500): groups A and B - 2x2 mm (CF=0.33), groups C and D - 3x2 mm (CF=0.66), groups E and F - 6x2 mm (CF=1.5). After adjustment of the height between the pair of bases so that the resin had a volume of 12 mm(3) in all groups, the material was inserted and polymerized by two different methods: pulse delay (100 mW/cm(2) for 5 s, 40 s interval, 600 mW/cm(2) for 20 s) and continuous pulse (600 mW/cm(2) for 20 s). Each configuration was light cured with both techniques. Tensions generated during polymerization were recorded by 120 s. The values were expressed in curves (Force(N) x Time(s)) and averages compared by statistical analysis (ANOVA and Tukey's test, p<0.05). Results: For the 2x2 and 3x2 bases, with a reduced C-Factor, significant differences were found between the light curing methods. For 6x2 base, with high C-Factor, the light curing method did not influence the contraction forces of the composite resin. Conclusions: Pulse delay technique can determine less stress on tooth/restoration interface of adhesive restorations only when a reduced C-Factor is present.

Shape isomerism and shape coexistence effects on the Coulomb energy differences in the N = Z nucleus As-66 and neighboring T=1 multiplets

Excited states of the N = Z = 33 nucleus As-66 have been populated in a fusion-evaporation reaction and studied using gamma-ray spectroscopic techniques. Special emphasis was put into the search for candidates for the T = 1 states. A new 3(+) isomer has been observed with a lifetime of 1.1(3) ns. This is believed to be the predicted oblate shape isomer. The excited levels are discussed in terms of the shell model and of the complex excited Vampir approaches. Coulomb energy differences are determined from the comparison of the T = 1 states with their analog partners. The unusual behavior of the Coulomb energy differences in the A = 70 mass region is explained through different shape components (oblate and prolate) within the members of the same isospin multiplets. This breaking of the isospin symmetry is attributed to the correlations induced by the Coulomb interaction.

Associations of the TNF-alpha-308 G/A, IL6-174 G/C and AdipoQ 45 T/G polymorphisms with inflammatory and metabolic responses to lifestyle intervention in Brazilians at high cardiometabolic risk

Background: Cytokines secreted by the adipose tissue influence inflammation and insulin sensitivity, and lead to metabolic disturbances. How certain single-nucleotide polymorphisms (SNPs) interfere on lifestyle interventions is unclear. We assessed associations of selected SNPs with changes induced by a lifestyle intervention. Methods: This 9-month intervention on diet and physical activity included 180 Brazilians at high cardiometabolic risk, genotyped for the TNF-alpha -308 G/A, IL-6 -174 G/C and AdipoQ 45 T/G SNPs. Changes in metabolic and inflammatory variables were analyzed according to these SNPs. Individuals with at least one variant allele were grouped and compared with those with the reference genotype. Results: In the entire sample (66.7% women; mean age 56.5 +/- 11.6 years), intervention resulted in lower energy intake, higher physical activity, and improvement in anthropometry, plasma glucose, HOMA-IR, lipid profile and inflammatory markers, except for IL-6 concentrations. After intervention, only variant allele carriers of the TNF-alpha -308 G/A decreased plasma glucose, after adjusting for age and gender (OR 2.96, p = 0.025). Regarding the IL-6 -174 G/C SNP, carriers of the variant allele had a better response of lipid profile and adiponectin concentration, but only the reference genotype group decreased plasma glucose. In contrast to individuals with the reference genotype, carriers of variant allele of AdipoQ 45 T/G SNP did not change plasma glucose, apolipoprotein B, HDL-c and adiponectin concentrations in response to intervention. Conclusion: The TNF alpha -308 G/A SNP may predispose a better response of glucose metabolism to lifestyle intervention. The IL-6 -174 G/C SNP may confer a beneficial effect on lipid but not on glucose metabolism. Our findings reinforce unfavorable effects of the AdipoQ 45 T/G SNP in lipid profile and glucose metabolism after intervention in Brazilians at cardiometabolic risk. Further studies are needed to direct lifestyle intervention to subsets of individuals at cardiometabolic risk.

Associations of the TNF-alpha -308 G/A, IL6 -174 G/C and AdipoQ 45 T/G polymorphisms with inflammatory and metabolic responses to lifestyle intervention in Brazilians at high cardiometabolic risk

Abstract Background Cytokines secreted by the adipose tissue influence inflammation and insulin sensitivity, and lead to metabolic disturbances. How certain single-nucleotide polymorphisms (SNPs) interfere on lifestyle interventions is unclear. We assessed associations of selected SNPs with changes induced by a lifestyle intervention. Methods This 9-month intervention on diet and physical activity included 180 Brazilians at high cardiometabolic risk, genotyped for the TNF-α -308 G/A, IL-6 -174 G/C and AdipoQ 45 T/G SNPs. Changes in metabolic and inflammatory variables were analyzed according to these SNPs. Individuals with at least one variant allele were grouped and compared with those with the reference genotype. Results In the entire sample (66.7% women; mean age 56.5 ± 11.6 years), intervention resulted in lower energy intake, higher physical activity, and improvement in anthropometry, plasma glucose, HOMA-IR, lipid profile and inflammatory markers, except for IL-6 concentrations. After intervention, only variant allele carriers of the TNF-α -308 G/A decreased plasma glucose, after adjusting for age and gender (OR 2.96, p = 0.025). Regarding the IL6 -174 G/C SNP, carriers of the variant allele had a better response of lipid profile and adiponectin concentration, but only the reference genotype group decreased plasma glucose. In contrast to individuals with the reference genotype, carriers of variant allele of AdipoQ 45 T/G SNP did not change plasma glucose, apolipoprotein B, HDL-c and adiponectin concentrations in response to intervention. Conclusion The TNFα -308 G/A SNP may predispose a better response of glucose metabolism to lifestyle intervention. The IL-6 -174 G/C SNP may confer a beneficial effect on lipid but not on glucose metabolism. Our findings reinforce unfavorable effects of the AdipoQ 45 T/G SNP in lipid profile and glucose metabolism after intervention in Brazilians at cardiometabolic risk. Further studies are needed to direct lifestyle intervention to subsets of individuals at cardiometabolic risk.

Previsione del comportamento dinamico e sismico di un edificio a tre piani in scala reale costituito da pareti sandwich in C.A. gettato in opera da provare su tavola vibrante

INDICE INTRODUZIONE 1 1. DESCRIZIONE DEL SISTEMA COSTRUTTIVO 5 1.1 I pannelli modulari 5 1.2 Le pareti tozze in cemento armato gettate in opera realizzate con la tecnologia del pannello di supporto in polistirene 5 1.3 La connessione tra le pareti e la fondazione 6 1.4 Le connessioni tra pareti ortogonali 7 1.5 Le connessioni tra pareti e solai 7 1.6 Il sistema strutturale così ottenuto e le sue caratteristiche salienti 8 2. RICERCA BIBLIOGRAFICA 11 2.1 Pareti tozze e pareti snelle 11 2.2 Il comportamento scatolare 13 2.3 I muri sandwich 14 2.4 Il “ferro-cemento” 15 3. DATI DI PARTENZA 19 3.1 Schema geometrico - architettonico definitivo 19 3.2 Abaco delle sezioni e delle armature 21 3.3 Materiali e resistenze 22 3.4 Valutazione del momento di inerzia delle pareti estese debolmente armate 23 3.4.1 Generalità 23 3.4.2 Caratteristiche degli elementi provati 23 3.4.3 Formulazioni analitiche 23 3.4.4 Considerazioni sulla deformabilità dei pannelli debolmente armati 24 3.4.5 Confronto tra rigidezze sperimentali e rigidezze valutate analiticamente 26 3.4.6 Stima di un modulo elastico equivalente 26 4. ANALISI DEI CARICHI 29 4.1 Stima dei carichi di progetto della struttura 29 4.1.1 Stima dei pesi di piano 30 4.1.2 Tabella riassuntiva dei pesi di piano 31 4.2 Analisi dei carichi da applicare in fase di prova 32 4.2.1 Pesi di piano 34 4.2.2 Tabella riassuntiva dei pesi di piano 35 4.3 Pesi della struttura 36 4.3.1 Ripartizione del carico sulle pareti parallele e ortogonali 36 5. DESCRIZIONE DEL MODELLO AGLI ELEMENTI FINITI 37 5.1 Caratteristiche di modellazione 37 5.2 Caratteristiche geometriche del modello 38 5.3 Analisi dei carichi 41 5.4 Modello con shell costituite da un solo layer 43 5.4.1 Modellazione dei solai 43 5.4.2 Modellazione delle pareti 44 5.4.3 Descrizione delle caratteristiche dei materiali 46 5.4.3.1 Comportamento lineare dei materiali 46 6. ANALISI DEL COMPORTAMENTO STATICO DELLA STRUTTURA 49 6.1 Azioni statiche 49 6.2 Analisi statica 49 7. ANALISI DEL COMPORTAMENTO DINAMICO DELLA STRUTTURA 51 7.1 Determinazione del periodo proprio della struttura con il modello FEM 51 7.1.1 Modi di vibrare corrispondenti al modello con solai e pareti costituiti da elementi shell 51 7.1.1.1 Modi di vibrare con modulo pari a E 51 7.1.1.2 Modi di vibrare con modulo pari a 0,5E 51 7.1.1.3 Modi di vibrare con modulo pari a 0,1E 51 7.1.2 Modi di vibrare corrispondenti al modello con solai infinitamente rigidi e pareti costituite da elementi shell 52 7.1.2.1 Modi di vibrare con modulo pari a E 52 7.1.2.2 Modi di vibrare con modulo pari a 0,5E 52 7.1.2.3 Modi di vibrare con modulo pari a 0,1E: 52 7.1.3 Modi di vibrare corrispondenti al modello con solai irrigiditi con bielle e pareti costituite da elementi shell 53 7.1.3.1 Modi di vibrare con modulo pari a E 53 7.1.3.2 Modi di vibrare con modulo pari a 0,5E 53 7.1.3.3 Modi di vibrare con modulo pari a 0,1E 53 7.2 Calcolo del periodo proprio della struttura assimilandola ad un oscillatore semplice 59 7.2.1 Analisi svolta assumendo l’azione del sisma in ingresso in direzione X-X 59 7.2.1.1 Analisi svolta assumendo il modulo elastico E pari a 300000 Kg/cm2 59 7.2.1.1.1 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari ad E 59 7.2.1.1.2 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari ad E 61 7.2.1.1.3 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari ad E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 63 7.2.1.1.4 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari ad E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 66 7.2.1.2 Analisi svolta assumendo il modulo elastico E pari a 150000 Kg/cm2 69 7.2.1.2.1 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari a 0,5E 69 7.2.1.2.2 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari a 0,5E 71 7.2.1.2.3 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari a 0,5 E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 73 7.2.1.2.4 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari a 0,5 E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 76 7.2.1.3 Analisi svolta assumendo il modulo elastico E pari a 30000 Kg/cm2 79 7.2.1.3.1 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari a 0,1E 79 7.2.1.3.2 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari a 0,1E 81 7.2.1.3.3 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari a 0,1E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 83 7.2.1.3.4 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari a 0,1E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 86 7.2.2 Analisi svolta assumendo l’azione del sisma in ingresso in direzione Y-Y 89 7.2.2.1 Analisi svolta assumendo il modulo elastico E pari a 300000 Kg/cm2 89 7.2.2.1.1 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari ad E 89 7.2.2.1.2 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari ad E 91 7.2.2.1.3 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari ad E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 93 7.2.2.1.4 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari ad E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 98 7.2.2.1.5 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari ad E 103 7.2.2.1.6 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari ad E 105 7.2.2.1.7 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari ad E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 107 7.2.2.1.8 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari ad E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 112 7.2.2.2 Analisi svolta assumendo il modulo elastico E pari a 150000 Kg/cm2 117 7.2.2.2.1 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari a 0,5E 117 7.2.2.2.2 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari a 0,5E 119 7.2.2.2.3 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari a 0,5 E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 121 7.2.2.2.4 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari a 0,5 E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 126 7.2.2.2.5 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari a 0,5 E 131 7.2.2.2.6 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari ad E 133 7.2.2.2.7 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari a 0,5E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 135 7.2.2.2.8 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari a 0,5E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 140 7.2.2.3 Analisi svolta assumendo il modulo elastico E pari a 30000 Kg/cm2 145 7.2.2.3.1 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari a 0,1E 145 7.2.2.3.2 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari a 0,1E 147 7.2.2.3.3 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari a 0,1E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 149 7.2.2.3.4 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari a 0,1E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 154 7.2.2.3.5 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H e modulo elastico assunto pari a 0,1 E 159 7.2.2.3.6 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H e modulo elastico assunto pari ad E 161 7.2.2.3.7 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 2/3 H, modulo elastico assunto pari a 0,1E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 163 7.2.2.3.8 Determinazione del periodo proprio della struttura considerando la massa complessiva concentrata a 1/2 H, modulo elastico assunto pari a 0,1E, e struttura resistente costituita dai soli “maschi murari” delle pareti parallele all’azione del sisma 168 7.3 Calcolo del periodo proprio della struttura approssimato utilizzando espressioni analitiche 174 7.3.1 Approssimazione della struttura ad una mensola incastrata di peso Q=ql avente un peso P gravante all’estremo libero 174 7.3.1.1 Riferimenti teorici: sostituzione di masse distribuite con masse concentrate 174 7.3.1.2 Applicazione allo specifico caso di studio in esame con modulo elastico E=300000 kg/cm2 177 7.3.1.3 Applicazione allo specifico caso di studio in esame con modulo elastico E=30000 kg/cm2 179 7.3.2 Approssimazione della struttura ad una mensola incastrata alla base, di peso Q=ql, avente un peso P gravante all’estremo libero e struttura resistente costituita dai soli “maschi murari”delle pareti parallele all’azione del sisma 181 7.3.2.1 Applicazione allo specifico caso di studio in esame con modulo elastico E=300000 kg/cm2 181 7.3.2.2 Applicazione allo specifico caso di studio in esame con modulo elastico E=30000 kg/cm2 186 7.3.3 Approssimazione della struttura ad un portale avente peso Qp = peso di un piedritto, Qt=peso del traverso e un peso P gravante sul traverso medesimo 191 7.3.3.1 Riferimenti teorici: sostituzione di masse distribuite con masse concentrate 191 7.3.3.2 Applicazione allo specifico caso di studio in esame con modulo ellastico E=300000 kg/cm2 192 7.3.3.3 Applicazione allo specifico caso di studio in esame con modulo ellastico E=30000 kg/cm2 194 7.3.4 Approssimazione della struttura ad un portale di peso Qp = peso di un piedritto, Qt=peso del traverso e avente un peso P gravante sul traverso medesimo e struttura resistente costituita dai soli “maschi murari”delle pareti parallele all’azione del sisma 196 7.3.4.1 Applicazione allo specifico caso di studio in esame con modulo elastico E=300000 kg/cm2 196 7.3.4.2 Applicazione allo specifico caso di studio in esame con modulo elastico E=30000 kg/cm2 201 7.3.5 Approssimazione della struttura ad una mensola incastrata di peso Q=ql avente le masse m1,m2....mn concentrate nei punti 1,2….n 206 7.3.5.1 Riferimenti teorici: metodo approssimato 206 7.3.5.2 Applicazione allo specifico caso di studio in esame con modulo elastico E=300000 kg/cm2 207 7.3.5.3 Applicazione allo specifico caso di studio in esame con modulo elastico E=30000 kg/cm2 209 7.3.6 Approssimazione della struttura ad un telaio deformabile con tavi infinitamente rigide 211 7.3.6.1 Riferimenti teorici: vibrazioni dei telai 211 7.3.6.2 Applicazione allo specifico caso di studio in esame con modulo elastico E=300000 kg/cm2 212 7.3.6.3 Applicazione allo specifico caso di studio in esame con modulo elastico E=30000 kg/cm2 215 7.3.7 Approssimazione della struttura ad una mensola incastrata di peso Q=ql avente masse m1,m2....mn concentrate nei punti 1,2….n e studiata come un sistema continuo 218 7.3.7.1 Riferimenti teorici: metodo energetico; Masse ripartite e concentrate; Formula di Dunkerley 218 7.3.7.1.1 Il metodo energetico 218 7.3.7.1.2 Masse ripartite e concentrate. Formula di Dunkerley 219 7.3.7.2 Applicazione allo specifico caso di studio in esame con modulo elastico E=300000 kg/cm2 221 7.3.7.3 Applicazione allo specifico caso di studio in esame con modulo elastico E=30000 kg/cm2 226 7.4 Calcolo del periodo della struttura approssimato mediante telaio equivalente 232 7.4.1 Dati geometrici relativi al telaio equivalente e determinazione dei carichi agenti su di esso 232 7.4.1.1 Determinazione del periodo proprio della struttura assumendo diversi valori del modulo elastico E 233 7.5 Conclusioni 234 7.5.1 Comparazione dei risultati relativi alla schematizzazione dell’edificio con una struttura ad un grado di libertà 234 7.5.2 Comparazione dei risultati relativi alla schematizzazione dell’edificio con una struttura a più gradi di libertà e a sistema continuo 236 8. ANALISI DEL COMPORTAMENTO SISMICO DELLA STRUTTURA 239 8.1 Modello con shell costituite da un solo layer 239 8.1.1 Analisi dinamica modale con spettro di risposta avente un valore di PGA pari a 0,1g 239 8.1.1.1 Generalità 239 8.1.1.2 Sollecitazioni e tensioni sulla sezione di base 242 8.1.1.2.1 Combinazione di carico ”Carichi verticali più Spettro di Risposta scalato ad un valore di PGA pari a 0,1g” 242 8.1.1.2.2 Combinazione di carico ”Spettro di Risposta scalato ad un valore di 0,1g di PGA” 245 8.1.1.3 Spostamenti di piano 248 8.1.1.4 Accelerazioni di piano 248 8.1.2 Analisi Time-History lineare con accelerogramma caratterizzato da un valore di PGA pari a 0,1g 249 8.1.2.1 Generalità 249 8.1.2.2 Sollecitazioni e tensioni sulla sezione di base 251 8.1.2.2.1 Combinazione di carico ” Carichi verticali più Accelerogramma agente in direzione Ye avente una PGA pari a 0,1g” 251 8.1.2.2.2 Combinazione di carico ” Accelerogramma agente in direzione Y avente un valore di PGA pari a 0,1g ” 254 8.1.2.3 Spostamenti di piano assoluti 257 8.1.2.4 Spostamenti di piano relativi 260 8.1.2.5 Accelerazioni di piano assolute 262 8.1.3 Analisi dinamica modale con spettro di risposta avente un valore di PGA pari a 0,3g 264 8.1.3.1 Generalità 264 8.1.3.2 Sollecitazioni e tensioni sulla sezione di base 265 8.1.

Estimating the net contribution of interleukin-28B variation to spontaneous hepatitis C virus clearance

The identification of associations between interleukin-28B (IL-28B) variants and the spontaneous clearance of hepatitis C virus (HCV) raises the issues of causality and the net contribution of host genetics to the trait. To estimate more precisely the net effect of IL-28B genetic variation on HCV clearance, we optimized genotyping and compared the host contributions in multiple- and single-source cohorts to control for viral and demographic effects. The analysis included individuals with chronic or spontaneously cleared HCV infections from a multiple-source cohort (n = 389) and a single-source cohort (n = 71). We performed detailed genotyping in the coding region of IL-28B and searched for copy number variations to identify the genetic variant or haplotype carrying the strongest association with viral clearance. This analysis was used to compare the effects of IL-28B variation in the two cohorts. Haplotypes characterized by carriage of the major alleles at IL-28B single-nucleotide polymorphisms (SNPs) were highly overrepresented in individuals with spontaneous clearance versus those with chronic HCV infections (66.1% versus 38.6%, P = 6 × 10(-9) ). The odds ratios for clearance were 2.1 [95% confidence interval (CI) = 1.6-3.0] and 3.9 (95% CI = 1.5-10.2) in the multiple- and single-source cohorts, respectively. Protective haplotypes were in perfect linkage (r(2) = 1.0) with a nonsynonymous coding variant (rs8103142). Copy number variants were not detected. CONCLUSION: We identified IL-28B haplotypes highly predictive of spontaneous HCV clearance. The high linkage disequilibrium between IL-28B SNPs indicates that association studies need to be complemented by functional experiments to identify single causal variants. The point estimate for the genetic effect was higher in the single-source cohort, which was used to effectively control for viral diversity, sex, and coinfections and, therefore, offered a precise estimate of the net host genetic contribution.

Stejnulxin, a novel snake C-type lectin-like protein from Trimeresurus stejnegeri venom is a potent platelet agonist acting specifically via GPVI

Stejnulxin, a novel snake C-type lectin-like protein with potent platelet activating activity, was purified and characterized from Trimeresurus stejnegeri venom. Under non-reducing conditions, it migrated on a SDS-polyacrylamide gel with an apparent molecular mass of 120 kDa. On reduction, it separated into three polypeptide subunits with apparent molecular masses of 16 kDa (alpha), 20 kDa (beta1) and 22 kDa (beta2), respectively. The complete amino acid sequences of its subunits were deduced from cloned cDNAs. The N-terminal sequencing and cDNA cloning indicated that beta1 and beta2 subunits of stejnulxin have identical amino acid sequences and each contains two N-glycosylation sites. Accordingly, the molecular mass difference between beta1 and beta2 is caused by glycosylation heterogenity. The subunit amino acid sequences of stejnulxin are similar to those of convulxin, with sequence identities of 52.6% and 66.4% for the alpha and beta, respectively. Stejnulxin induced human platelet aggregation in a dose-dependent manner. Antibodies against alphaIIbbeta3 inhibited the aggregation response to stejnulxin, indicating that activation of alphaIIbbeta3 and binding of fibrinogen are involved in stejnulxin-induced platelet aggregation. Antibodies against GPIbalpha or alpha2beta1 as well as echicetin or rhodocetin had no significant effect on stejnulxin-induced platelet aggregation. However, platelet activation induced by stejnulxin was blocked by anti-GPVI antibodies. In addition, stejnulxin induced a tyrosine phosphorylation profile in platelets that resembled that produced by convulxin. Biotinylated stejnulxin bound specifically to platelet membrane GPVI.

Genotype 3 is associated with accelerated fibrosis progression in chronic hepatitis C

BACKGROUND/AIMS: While several risk factors for the histological progression of chronic hepatitis C have been identified, the contribution of HCV genotypes to liver fibrosis evolution remains controversial. The aim of this study was to assess independent predictors for fibrosis progression. METHODS: We identified 1189 patients from the Swiss Hepatitis C Cohort database with at least one biopsy prior to antiviral treatment and assessable date of infection. Stage-constant fibrosis progression rate was assessed using the ratio of fibrosis Metavir score to duration of infection. Stage-specific fibrosis progression rates were obtained using a Markov model. Risk factors were assessed by univariate and multivariate regression models. RESULTS: Independent risk factors for accelerated stage-constant fibrosis progression (>0.083 fibrosis units/year) included male sex (OR=1.60, [95% CI 1.21-2.12], P<0.001), age at infection (OR=1.08, [1.06-1.09], P<0.001), histological activity (OR=2.03, [1.54-2.68], P<0.001) and genotype 3 (OR=1.89, [1.37-2.61], P<0.001). Slower progression rates were observed in patients infected by blood transfusion (P=0.02) and invasive procedures or needle stick (P=0.03), compared to those infected by intravenous drug use. Maximum likelihood estimates (95% CI) of stage-specific progression rates (fibrosis units/year) for genotype 3 versus the other genotypes were: F0-->F1: 0.126 (0.106-0.145) versus 0.091 (0.083-0.100), F1-->F2: 0.099 (0.080-0.117) versus 0.065 (0.058-0.073), F2-->F3: 0.077 (0.058-0.096) versus 0.068 (0.057-0.080) and F3-->F4: 0.171 (0.106-0.236) versus 0.112 (0.083-0.142, overall P<0.001). CONCLUSIONS: This study shows a significant association of genotype 3 with accelerated fibrosis using both stage-constant and stage-specific estimates of fibrosis progression rates. This observation may have important consequences for the management of patients infected with this genotype.

Elderly age is not a negative predictive factor for virological response to therapy with pegylated interferon-α and ribavirin in chronic hepatitis C virus patients

BACKGROUND & AIMS: Age is frequently discussed as negative host factor to achieve a sustained virological response (SVR) to antiviral therapy of chronic hepatitis C. However, elderly patients often show advanced fibrosis/cirrhosis as known negative predictive factor. The aim of this study was to assess age as an independent predictive factor during antiviral therapy. METHODS: Overall, 516 hepatitis C patients were treated with pegylated interferon-α and ribavirin, thereof 66 patients ≥60 years. We analysed the impact of host factors (age, gender, fibrosis, haemoglobin, previous hepatitis C treatment) and viral factors (genotype, viral load) on SVR per therapy course by performing a generalized estimating equations (GEE) regression modelling, a matched pair analysis and a classification tree analysis. RESULTS: Overall, SVR per therapy course was 42.9 and 26.1%, respectively, in young and elderly patients with hepatitis C virus (HCV) genotypes 1/4/6. The corresponding figures for HCV genotypes 2/3 were 74.4 and 84%. In the GEE model, age had no significant influence on achieving SVR. In matched pair analysis, SVR was not different in young and elderly patients (54.2 and 55.9% respectively; P = 0.795 in binominal test). In classification tree analysis, age was not a relevant splitting variable. CONCLUSIONS: Age is not a significant predictive factor for achieving SVR, when relevant confounders are taken into account. As life expectancy in Western Europe at age 60 is more than 20 years, it is reasonable to treat chronic hepatitis C in selected elderly patients with relevant fibrosis or cirrhosis but without major concomitant diseases, as SVR improves survival and reduces carcinogenesis.

Abhandlung über den Ursprung der Beschneidung bei wilden und halbwilden Völkern mit Beziehung auf die Beschneidung der Israeliten : mit e. Kritik von C. Chr. v. Flatt begleitet

verf. von J. H. F. v. Autenrieth

Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.

IMPORTANCE Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES Survival, stroke, and New York Heart Association functional class. RESULTS Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

All-Cause Mortality and Liver-Related Outcomes Following Successful Antiviral Treatment for Chronic Hepatitis C

BACKGROUND: Antiviral therapy for the hepatitis C virus (HCV) reduces all-cause and liver-related morbidity and mortality. Few studies are available from populations with multiple medical and psychiatric comorbidities where the impact of successful antiviral therapy might be limited. AIM: The purpose of this study was to determine the effect of sustained virologic response (SVR) on all-cause and liver-related mortality in a cohort of HCV patients treated in an integrated hepatitis/mental health clinic. METHODS: This was a retrospective review of all patients who initiated antiviral treatment for chronic HCV between January 1, 1997 and December 31, 2009. Cox regression analysis was used to determine factors involved in all-cause mortality, liver-related events and hepatocellular carcinoma. RESULTS: A total of 536 patients were included in the analysis. Median follow-up was 7.5 years. Liver and non-liver-related mortality occurred in 2.7 and 5.0 % of patients with SVR and in 17.8 and 6.4 % of patients without SVR. In a multivariate analysis, SVR was the only factor associated with reduced all-cause mortality (HR 0.47; 95 % CI 0.26-0.85; p = 0.012) and reduced liver-related events (HR 0.23; 95 % CI 0.08-0.66, p = 0.007). Having stage 4 liver fibrosis increased all-cause mortality (HR 2.50; 95 % CI 1.23-5.08; p = 0.011). Thrombocytopenia at baseline (HR 2.66; 95 % CI 1.22-5.79; p = 0.014) and stage 4 liver fibrosis (HR 4.87; 95 % CI 1.62-14.53; p = 0.005) increased liver-related events. CONCLUSIONS: Despite significant medical and psychiatric comorbidities, SVR markedly reduced liver-related outcomes without a significant change in non-liver-related mortality after a median follow-up of 7.5 years.