WorldWideScience

Sample records for major vascular events

  1. Prediction of Major Vascular Events after Stroke

    DEFF Research Database (Denmark)

    Ovbiagele, Bruce; Goldstein, Larry B.; Amarenco, Pierre

    2014-01-01

    BACKGROUND: Identifying patients with recent stroke or transient ischemic attack (TIA) at high risk of major vascular events (MVEs; stroke, myocardial infarction, or vascular death) may help optimize the intensity of secondary preventive interventions. We evaluated the relationships between...... the baseline Framingham Coronary Risk Score (FCRS) and a novel risk prediction model and with the occurrence of MVEs after stroke or TIA in subjects enrolled in the Stroke Prevention by Aggressive Reduction in Cholesterol Level (SPARCL) trial. METHODS: Data from the 4731 subjects enrolled in the SPARCL study...... were analyzed. Hazard ratios (HRs) from Cox regression models were used to determine the risk of subsequent MVEs based on the FCRS predicting 20% or more 10-year coronary heart disease risk. The novel risk model was derived based on multivariable modeling with backward selection. Model discrimination...

  2. Incidence of major vascular events after cardiac surgery: impact of preoperative monitoring with troponin and electrocardiogram

    International Nuclear Information System (INIS)

    Sandra M Quiroga; Juan C Villar; Luz X, Martinez

    2009-01-01

    Recent demographic changes have led to an increased risk of major vascular events among patients undergoing non-cardiac surgery. Troponin and electrocardiogram monitoring would further identify these major vascular events. Methods: we prospectively collected data on eligible patients (non-selected individuals aged 45 or older undergoing non-cardiac surgery under general or regional anesthesia in two hospitals in Bucaramanga, with expected length of stay longer than 24 hours) during a time-interrupted series,before and after postoperative diagnostic monitoring (blinded assessment of troponin T and electrocardiograms ignoring clinical data). For the period before the intervention (usual clinical care),two independent reviewers extracted clinical information from clinical histories (of all eligible patients from 3 randomly-selected months of 2005). For the period after diagnostic monitoring, we followed 100 consecutive eligible patients. Primary outcome was a composite of major vascular events within hospital, including myocardial infarction (defined as any troponin elevation associated with electrocardiographic changes suggesting ischemia, regardless of symptoms). Results: we included 534 clinical charts and 100 prospective surgical patients (mean age 62.2, SD 12.9 years; 56% women). The more frequent surgical procedures were orthopedics (26.8%) followed by abdominal (20.2%).The incidence of major vascular events recorded in clinical charts was 2.8%, compared with 7% among monitored patients (p=0,071). All four myocardial infarctions identified among the later group were silent. Conclusion: postoperative monitoring with troponin and electrocardiography identified a higher proportion of major vascular events, mainly silent myocardial infarctions.

  3. Interactions between the vascular endothelial growth factor gene polymorphism and life events in susceptibility to major depressive disorder in a Chinese population.

    Science.gov (United States)

    Han, Dong; Qiao, Zhengxue; Chen, Lu; Qiu, Xiaohui; Fang, Deyu; Yang, Xiuxian; Ma, Jingsong; Chen, Mingqi; Yang, Jiarun; Wang, Lin; Zhu, Xiongzhao; Zhang, Congpei; Yang, Yanjie; Pan, Hui

    2017-08-01

    Recent studies suggest that vascular endothelial growth factor (VEGF) is involved in the development of major depressive disorder. The aim of this study is to investigate the interaction between vascular endothelial growth factor (VEGF) polymorphism (+405G/C, rs2010963) and negative life events in the pathogenesis of major depressive disorder (MDD). DNA genotyping was performed on peripheral blood leukocytes in 274 patients with MDD and 273 age-and sex-matched controls. The frequency and severity of negative life events were assessed by the Life Events Scale (LES). A logistics method was employed to assess the gene-environment interaction (G×E). Differences in rs2010963 genotype distributions were observed between MDD patients and controls. Significant G×E interactions between allelic variation of rs2010963 and negative life events were observed. Individuals carrying the C alleles were susceptible to MDD only when exposed to high-negative life events. These results indicate that interactions between the VEGF rs2010963 polymorphism and environment increases the risk of developing MDD. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Incidencia de eventos vasculares mayores después de cirugía no cardiaca: impacto del monitoreo perioperatorio con troponina y electrocardiograma Incidence of major vascular events after cardiac surgery: impact of preoperative monitoring with troponin and electrocardiogram

    Directory of Open Access Journals (Sweden)

    Sandra M Quiroga

    2009-06-01

    led to an increased risk of major vascular events among patients undergoing non-cardiac surgery. Troponin and electrocardiogram monitoring would further identify these major vascular events. Methods: we prospectively collected data on elegible patients (non-selected individuals aged 45 or older undergoing non-cardiac surgery under general or regional anesthesia in two hospitals in Bucaramanga, with expected length of stay longer than 24 hours during a time-interrupted series, before and after postoperative diagnostic monitoring (blinded assessment of troponin T and electrocardiograms ignoring clinical data. For the period before the intervention (usual clinical care, two independent reviewers extracted clinical information from clinical histories (of all eligible patients from 3 randomly-selected months of 2005. For the period after diagnostic monitoring, we followed 100 consecutive eligible patients. Primary outcome was a composite of major vascular events within hospital, including myocardial infarction (defined as any troponin elevation associated with electrocardiographic changes suggesting ischemia, regardless of symptoms. Results: we included 534 clinical charts and 100 prospective surgical patients (mean age 62.2, SD 12.9 years; 56% women. The more frequent surgical procedures were orthopedics (26.8% followed by abdominal (20.2%. The incidence of major vascular events recorded in clinical charts was 2.8%, compared with 7% among monitored patients (p=0,071. All four myocardial infarctions identified among the later group were silent. Conclusion: postoperative monitoring with troponin and electrocardiography identified a higher proportion of major vascular events, mainly silent myocardial infarctions.

  5. Securing Major Events

    International Nuclear Information System (INIS)

    Loeoef, Susanna

    2013-01-01

    When asked why the IAEA should provide nuclear security support to countries that organize large public events, Nuclear Security Officer Sophia Miaw answers quickly and without hesitation. ''Imagine any major public event such as the Olympics, a football championship, or an Expo. If a dirty bomb were to be exploded at a site where tens of thousands of people congregate, the radioactive contamination would worsen the effects of the bomb, increase the number of casualties, impede a rapid emergency response, and cause long term disruption in the vicinity,'' she said. Avoiding such nightmarish scenarios is the driving purpose behind the assistance the IAEA offers States that host major sporting or other public events. The support can range from a single training course to a comprehensive programme that includes threat assessment, training, loaned equipment and exercises. The type and scope of assistance depends on the host country's needs. ''We incorporate nuclear security measures into their security plan. We don't create anything new,'' Miaw said

  6. Major Vascular Neurocognitive Disorder: A Reappraisal to Vascular Dementia

    Directory of Open Access Journals (Sweden)

    Emre Kumral

    2017-03-01

    Full Text Available Major vascular neurocognitive disorder (NCD is the second leading form of dementia after Alzheimer’s disease, accounting for 17-20% of all dementias. Vascular NCD is a progressive disease caused by reduced cerebral blood flow related to multiple large volume or lacunar infarcts that induce a sudden onset and stepwise decline in cognitive abilities. Despite its prevalence and clinical importance, there is still controversy in the terminology of vascular NCD. Only after the release of Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5 (2013 did the American Psychiatric Association define vascular dementia as “major vascular NCD”. This review includes an overview of risk factors, pathophysiology, types, diagnostic and clinical features of major vascular NCD, and current treatment options of vascular NCD regarding to DSM-5 criteria

  7. Effects of continuous positive airway pressure on anxiety, depression, and major cardiac and cerebro-vascular events in obstructive sleep apnea patients with and without coronary artery disease.

    Science.gov (United States)

    Lee, Ming-Chung; Shen, Yu-Chih; Wang, Ji-Hung; Li, Yu-Ying; Li, Tzu-Hsien; Chang, En-Ting; Wang, Hsiu-Mei

    2017-01-01

    Obstructive sleep apnea (OSA) is associated with bad cardiovascular outcomes and a high prevalence of anxiety and depression. This study investigated the effects of continuous positive airway pressure (CPAP) on the severity of anxiety and depression in OSA patients with or without coronary artery disease (CAD) and on the rate of cardio- and cerebro-vascular events in those with OSA and CAD. This prospective study included patients with moderate-to-severe OSA, with or without a recent diagnosis of CAD; all were started on CPAP therapy. Patients completed the Chinese versions of the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline and after 6-month follow-up. The occurrence of major adverse cardiac and cerebrovascular events (MACCE) was assessed every 3 months up to 1 year. BAI scores decreased from 8.5 ± 8.4 at baseline to 5.4 ± 6.9 at 6 months in CPAP-compliant OSA patients without CAD ( P < 0.05). BAI scores also decreased from 20.7 ± 14.9 to 16.1 ± 14.5 in CPAP-compliant OSA patients with CAD. BDI-II scores decreased in CPAP-compliant OSA patients without CAD (from 11.1 ± 10.7 at baseline to 6.6 ± 9.5 at 6 months) and in CPAP-compliant OSA patients with CAD (from 20.4 ± 14.3 to 15.9 ± 7.3). In addition, there was a large effect size (ES) of BAI and BDI in 6-month CPAP treatment of OSA patients with CAD and a large ES in those with OSA under CPAP treatment. In OSA patients with CAD, the occurrence of MACCE was significantly lower in CPAP-compliant patients than that in CPAP noncompliant patients (11% in CPAP compliant and 50% in noncompliant; P < 0.05). CPAP improved anxiety and depression in OSA patients regardless of CAD. In OSA patients with CAD, CPAP-compliant patients had a lower 1-year rate of MACCE than CPAP-noncompliant patients.

  8. Major lipids, apolipoproteins, and risk of vascular disease

    DEFF Research Database (Denmark)

    Collaboration, Emerging Risk Factors; Di Angelantonio, Emanuele; Sarwar, Nadeem

    2009-01-01

    CONTEXT: Associations of major lipids and apolipoproteins with the risk of vascular disease have not been reliably quantified. OBJECTIVE: To assess major lipids and apolipoproteins in vascular risk. DESIGN, SETTING, AND PARTICIPANTS: Individual records were supplied on 302,430 people without...

  9. Major events and minor episodes

    International Nuclear Information System (INIS)

    Amaldi, U.

    2014-01-01

    Bruno Pontecorvo was a freshly graduated twenty one years old physicist when he joined, in the summer of 1934, the research group led by Enrico Fermi. In October the Panisperna boys would make their most important discovery – radioactivity induced by slow neutrons – and shortly thereafter would be parted by personal and historical events. This paper describes some episodes of those early years and of later periods, sketching a portrait of the team: starting from the extraordinary human and scientific experience of via Panisperna, up to the patent negotiations in USA, to which Pontecorvo’s flight to URSS put an end with unexpected consequences; getting to his first return in Italy, allowed by the sovietic government in 1978, on the occasion of the conference celebrating Edoardo Amaldi’s 70. anniversary. That was the first of several encounters of the author of this paper with Bruno Pontecorvo, which are here briefly recounted, as minor episodes giving a personal perspective on the man.

  10. Brain Arterial Diameters as a Risk Factor for Vascular Events.

    Science.gov (United States)

    Gutierrez, Jose; Cheung, Ken; Bagci, Ahmet; Rundek, Tatjana; Alperin, Noam; Sacco, Ralph L; Wright, Clinton B; Elkind, Mitchell S V

    2015-08-06

    Arterial luminal diameters are routinely used to assess for vascular disease. Although small diameters are typically considered pathological, arterial dilatation has also been associated with disease. We hypothesize that extreme arterial diameters are biomarkers of the risk of vascular events. Participants in the Northern Manhattan Study who had a time-of-flight magnetic resonance angiography were included in this analysis (N=1034). A global arterial Z-score, called the brain arterial remodeling (BAR) score, was obtained by averaging the measured diameters within each individual. Individuals with a BAR score -2 and 2 SDs had the largest diameters. All vascular events were recorded prospectively after the brain magnetic resonance imaging. Spline curves and incidence rates were used to test our hypothesis. The association of the BAR score with death (P=0.001), vascular death (P=0.02), any vascular event (P=0.05), and myocardial infarction (P=0.10) was U-shaped except for ischemic stroke (P=0.74). Consequently, incidence rates for death, vascular death, myocardial infarction, and any vascular event were higher in individuals with the largest diameters, whereas individuals with the smallest diameters had a higher incidence of death, vascular death, any vascular event, and ischemic stroke compared with individuals with average diameters. The risk of death, vascular death, and any vascular event increased at both extremes of brain arterial diameters. The pathophysiology linking brain arterial remodeling to systemic vascular events needs further research. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  11. Sugar-sweetened beverages, vascular risk factors and events

    DEFF Research Database (Denmark)

    Keller, Amelie; Heitmann, Berit L; Olsen, Nanna

    2015-01-01

    , while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood...... pressure, blood lipid or blood sugar. CONCLUSIONS: The reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength......OBJECTIVE: A high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk...

  12. Brain Arterial Diameters as a Risk Factor for Vascular Events

    OpenAIRE

    Gutierrez, Jose; Cheung, Ken; Bagci, Ahmet; Rundek, Tatjana; Alperin, Noam; Sacco, Ralph L; Wright, Clinton B; Elkind, Mitchell S V

    2015-01-01

    Background Arterial luminal diameters are routinely used to assess for vascular disease. Although small diameters are typically considered pathological, arterial dilatation has also been associated with disease. We hypothesize that extreme arterial diameters are biomarkers of the risk of vascular events. Methods and Results Participants in the Northern Manhattan Study who had a time-of-flight magnetic resonance angiography were included in this analysis (N=1034). A global arterial Z-score, ca...

  13. Information support for major public events

    International Nuclear Information System (INIS)

    2010-01-01

    The unique capabilities of the IAEA illicit trafficking database is used to provide information on and assesment of illicit trafficking and other unauthorized activities involving nuclear and other radioactive materials to national authorities in charge of nuclear security of major public events. The information communicated to state parties cooperating with IAEA is on incidences confirmed to the agency on illicit trafficking of nuclear and other radioactive materials and also incidences reported in open sources which have not been confirmed.

  14. Effects of Tranexamic Acid on Death, Vascular Occlusive Events ...

    African Journals Online (AJOL)

    Background: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. Methods: This randomised controlled trial was ...

  15. Three-dimensional carotid ultrasound plaque texture predicts vascular events

    DEFF Research Database (Denmark)

    van Engelen, Arna; Wannarong, Thapat; Parraga, Grace

    2014-01-01

    BACKGROUND AND PURPOSE: Carotid ultrasound atherosclerosis measurements, including those of the arterial wall and plaque, provide a way to monitor patients at risk of vascular events. Our objective was to examine carotid ultrasound plaque texture measurements and the change in carotid plaque text...

  16. [Sickness absence associated with major life events].

    Science.gov (United States)

    Markussen, Simen; Røgeberg, Ole

    2012-05-29

    Sickness absence in the Norwegian workplace doubled in the period 1993-2003. However, the extent to which the driving factors were medical or non-medical remains unclear, as does the extent to which the cause may be found in the composition of the workforce. A differences-in-differences regression model was used to estimate the added sickness absence associated with major life events such as separation, death of spouse and pregnancy in the period 1993-2005. The data were obtained from administrative registers covering the entire Norwegian population, and include all absence periods of 16 days' duration or more reported by a doctor's medical certificate. The primary outcome measures were incidence (the proportion of absentees in a given time window) and absence (the proportion of sick days in a given time window). The level of absence among employees exposed to the specified life events was compared to control groups matched for gender, age, education and income. In 1993, people in each of the three groups exposed to major life events had more frequent and longer periods of absence than people in the control groups. This added sickness absence increased between 1993 and 2005. The changes in added sickness absence were at times significant, particularly for pregnant women. While sickness absence among pregnant women in 1993 was 15.4 percentage points higher than in the control group, the difference had increased to 24.8 percentage points in 2005. We find it improbable for the increase in added sickness absence to be caused by changes in the medical impact of life events or alterations in the workforce composition. We believe the increase is caused by changing attitudes among the working population and in the medical profession towards sickness absence on grounds that are not strictly medical, combined with improved social acceptance and diagnosis of mental health issues, and/or a medicalisation of natural health variations (pregnancy) and emotional distress (grief).

  17. The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Skov, Lone; Joshi, Aditya A.

    2017-01-01

    of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]). Limitations These studies utilized observational data. Conclusion We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic......Background Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized. Objectives We utilized two resources to understand the effect...... of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events. Methods First, patients with psoriasis (N = 190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β...

  18. Contraction of online response to major events.

    Science.gov (United States)

    Szell, Michael; Grauwin, Sébastian; Ratti, Carlo

    2014-01-01

    Quantifying regularities in behavioral dynamics is of crucial interest for understanding collective social events such as panics or political revolutions. With the widespread use of digital communication media it has become possible to study massive data streams of user-created content in which individuals express their sentiments, often towards a specific topic. Here we investigate messages from various online media created in response to major, collectively followed events such as sport tournaments, presidential elections, or a large snow storm. We relate content length and message rate, and find a systematic correlation during events which can be described by a power law relation--the higher the excitation, the shorter the messages. We show that on the one hand this effect can be observed in the behavior of most regular users, and on the other hand is accentuated by the engagement of additional user demographics who only post during phases of high collective activity. Further, we identify the distributions of content lengths as lognormals in line with statistical linguistics, and suggest a phenomenological law for the systematic dependence of the message rate to the lognormal mean parameter. Our measurements have practical implications for the design of micro-blogging and messaging services. In the case of the existing service Twitter, we show that the imposed limit of 140 characters per message currently leads to a substantial fraction of possibly dissatisfying to compose tweets that need to be truncated by their users.

  19. Contraction of online response to major events.

    Directory of Open Access Journals (Sweden)

    Michael Szell

    Full Text Available Quantifying regularities in behavioral dynamics is of crucial interest for understanding collective social events such as panics or political revolutions. With the widespread use of digital communication media it has become possible to study massive data streams of user-created content in which individuals express their sentiments, often towards a specific topic. Here we investigate messages from various online media created in response to major, collectively followed events such as sport tournaments, presidential elections, or a large snow storm. We relate content length and message rate, and find a systematic correlation during events which can be described by a power law relation--the higher the excitation, the shorter the messages. We show that on the one hand this effect can be observed in the behavior of most regular users, and on the other hand is accentuated by the engagement of additional user demographics who only post during phases of high collective activity. Further, we identify the distributions of content lengths as lognormals in line with statistical linguistics, and suggest a phenomenological law for the systematic dependence of the message rate to the lognormal mean parameter. Our measurements have practical implications for the design of micro-blogging and messaging services. In the case of the existing service Twitter, we show that the imposed limit of 140 characters per message currently leads to a substantial fraction of possibly dissatisfying to compose tweets that need to be truncated by their users.

  20. Sarcoidosis with Major Airway, Vascular and Nerve Compromise

    Directory of Open Access Journals (Sweden)

    Hiroshi Sekiguchi

    2013-01-01

    Full Text Available The present report describes a 60-year-old Caucasian woman who presented with progressive dyspnea, cough and wheeze. A computed tomography scan of the chest showed innumerable bilateral inflammatory pulmonary nodules with bronchovascular distribution and a mediastinal and hilar infiltrative process with calcified lymphadenopathy leading to narrowing of lobar bronchi and pulmonary arteries. An echocardiogram revealed pulmonary hypertension. Bronchoscopy showed left vocal cord paralysis and significant narrowing of the bilateral bronchi with mucosal thickening and multiple nodules. Transbronchial biopsy was compatible with sarcoidosis. Despite balloon angioplasty of the left lower lobe and pulmonary artery, and medical therapy with oral corticosteroids, her symptoms did not significantly improve. To the authors’ knowledge, the present report describes the first case of pulmonary sarcoidosis resulting in major airway, vascular and nerve compromise due to compressive lymphadenopathy and suspected concurrent granulomatous infiltration. Its presentation mimicked idiopathic mediastinal fibrosis.

  1. Insight into 144 patients with ocular vascular events during VEGF antagonist injections

    Directory of Open Access Journals (Sweden)

    Shami M

    2012-03-01

    Full Text Available Ahmad M Mansour1, Maha Shahin2, Peter K Kofoed3, Maurizio B Parodi4, Michel Shami5, Stephen G Schwartz6, Collaborative Anti-VEGF Ocular Vascular Complications GroupDepartment of Ophthalmology, 1American University of Beirut, Beirut, Lebanon, Rafic Hariri University Hospital, Beirut, Lebanon; 2Mansoura University, Mansoura City, Egypt; 3Glostrup Hospital, University of Copenhagen, Denmark, National Eye Clinic, Kennedy Center, Glostrup, Denmark; 4University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy; 5Texas Tech University Health Sciences Center, Lubbock, TX, USA; 6Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Naples and Miami, FL, USAAim: To record ocular vascular events following injections of vascular endothelium growth factor (VEGF antagonists.Methods: Collaborative multicenter case series (48 cases, literature reviews (32 cases, and reports to the FDA (64 cases of patients that had vascular occlusions during anti-VEGF therapy were collected and analyzed.Results: A total of 144 cases of ocular vascular events were identified, with these diagnosed a median of 15 days after anti-VEGF injection. The majority of patients had pre-existing risk factors for cardiovascular events and nine patients had a prior history of glaucoma. Mean visual acuity dropped by 6.4 lines with severe visual loss after injection to NLP (five eyes, LP (six eyes, and HM (two eyes. The overall risk of ocular vascular events following a VEGF antagonist injection was 0.108% in the general population and 2.61% in the diabetic population. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation = 27%, and mean retinal venous constriction was 8% (standard deviation = 30%.Conclusion: Ocular vascular events are rare during anti-VEGF therapy, but can lead to severe visual loss and may be caused by a number of factors including the vasoconstrictor effect of the drug, a post-injection rise

  2. The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events.

    Science.gov (United States)

    Egeberg, Alexander; Skov, Lone; Joshi, Aditya A; Mallbris, Lotus; Gislason, Gunnar H; Wu, Jashin J; Rodante, Justin; Lerman, Joseph B; Ahlman, Mark A; Gelfand, Joel M; Mehta, Nehal N

    2017-10-01

    Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized. We utilized two resources to understand the effect of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events. First, patients with psoriasis (N = 190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β-coefficient). Second, MACE risk was examined by using nationwide registries (adjusted hazard ratios in patients with psoriasis (n = 87,161) versus the general population (n = 4,234,793). In the human imaging study, patients were young, of low CV risk by traditional risk scores, and had a high prevalence of cardiometabolic diseases. Vascular inflammation by fludeoxyglucose F 18 positron emission tomography/computed tomography was significantly associated with disease duration (β = 0.171, P = .002). In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]). These studies utilized observational data. We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Providers should consider inquiring about duration of disease to counsel for heightened CVD risk in psoriasis. Copyright © 2017 American Academy of Dermatology, Inc. All rights reserved.

  3. Validity of vascular trauma codes at major trauma centres.

    Science.gov (United States)

    Altoijry, Abdulmajeed; Al-Omran, Mohammed; Lindsay, Thomas F; Johnston, K Wayne; Melo, Magda; Mamdani, Muhammad

    2013-12-01

    The use of administrative databases in vascular injury research has been increasing, but the validity of the diagnosis codes used in this research is uncertain. We assessed the positive predictive value (PPV) of International Classification of Diseases, tenth revision (ICD-10), vascular injury codes in administrative claims data in Ontario. We conducted a retrospective validation study using the Canadian Institute for Health Information Discharge Abstract Database, an administrative database that records all hospital admissions in Canada. We evaluated 380 randomly selected hospital discharge abstracts from the 2 main trauma centres in Toronto, Ont., St.Michael's Hospital and Sunnybrook Health Sciences Centre, between Apr. 1, 2002, and Mar. 31, 2010. We then compared these records with the corresponding patients' hospital charts to assess the level of agreement for procedure coding. We calculated the PPV and sensitivity to estimate the validity of vascular injury diagnosis coding. The overall PPV for vascular injury coding was estimated to be 95% (95% confidence interval [CI] 92.3-96.8). The PPV among code groups for neck, thorax, abdomen, upper extremity and lower extremity injuries ranged from 90.8 (95% CI 82.2-95.5) to 97.4 (95% CI 91.0-99.3), whereas sensitivity ranged from 90% (95% CI 81.5-94.8) to 98.7% (95% CI 92.9-99.8). Administrative claims hospital discharge data based on ICD-10 diagnosis codes have a high level of validity when identifying cases of vascular injury. Observational Study Level III.

  4. Academic search in response to major scientific events

    NARCIS (Netherlands)

    Li, X.; de Rijke, M.

    2017-01-01

    In this paper, we look at the search behavior of users of an academic search engine and in particular, their query patterns following the occurrence of major scientific events. We select Nobel Prize announcements as major scientific events and observe how academic searchers behave in response to

  5. Long-term risk of recurrent vascular events after young stroke: The FUTURE study

    NARCIS (Netherlands)

    Rutten-Jacobs, L.C.A.; Maaijwee, N.A.M.M.; Arntz, R.M.; Schoonderwaldt, H.C.; Dorresteijn, L.D.A.; Vlugt, M.J. van der; Dijk, E.J. van; Leeuw, F.E. de

    2013-01-01

    OBJECTIVE: Long-term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long-term risk of recurrent vascular events after young stroke. METHODS: We prospectively included 724 consecutive patients with a first-ever transient ischemic attack (TIA),

  6. Neurocognitive differential diagnosis of dementing diseases: Alzheimer's Dementia, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder.

    Science.gov (United States)

    Braaten, Alyssa J; Parsons, Thomas D; McCue, Robert; Sellers, Alfred; Burns, William J

    2006-11-01

    Similarities in presentation of Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder, pose differential diagnosis challenges. The current study identifies specific neuropsychological patterns of scores for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. Neuropsychological domains directly assessed in the study included: immediate memory, delayed memory, confrontational naming, verbal fluency, attention, concentration, and executive functioning. The results reveal specific neuropsychological comparative profiles for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. The identification of these profiles will assist in the differential diagnosis of these disorders and aid in patient treatment.

  7. Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries

    Directory of Open Access Journals (Sweden)

    Hanifah J

    2015-11-01

    Full Text Available High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.

  8. Pediatric emergency department census during major sporting events.

    Science.gov (United States)

    Kim, Tommy Y; Barcega, Besh B; Denmark, T Kent

    2012-11-01

    Our study attempted to evaluate the effects of major sporting events on the census of a pediatric emergency department (ED) in the United States specifically related to the National Football League Super Bowl, National Basketball Association (NBA) Finals, and Major League Baseball World Series. We performed a retrospective data analysis of our pediatric ED census on the number of visits during major sporting events over a 5-year period. Data during the same period 1 week after the major sporting event were collected for comparison as the control. We evaluated the medians of 2-hour increments around the event start time. Subgroup analysis was performed for games involving the local sporting teams. Our results showed no significant difference in ED census during the sporting events, except in the post 6 to 8 hours of the NBA finals. Subgroup analysis of the Los Angeles Lakers showed the same significant findings in the post 6 to 8 hours of the NBA finals. No major difference in pediatric ED census is observed during the most major sporting events in the United States.

  9. Changes in Appearance in the Presence of Major Stress Events

    Directory of Open Access Journals (Sweden)

    Megan E. Stitz

    2013-04-01

    Full Text Available The relationship between experiencing major stress events (MSEs and changes in appearance (CAs was studied in a sample of 128 participants. All participants completed the Major Stress Event and Changes in Appearance Inventory. Results indicated a significant correlation between experiencing MSEs and considered or actual CAs (r = .50 p < .01. Scores on the Changes in Appearance Inventory were significantly higher in groups with moderate to high scores on the Major Stress Event scale. This relationship between MSEs and CAs was affected by age but not gender. These results suggest that stressful life events may prompt body image dissatisfaction and underlie motivations for changes in body appearance to promote self-image. Successive or dramatic appearance changes may be an important signal of stressful experiences.

  10. Risk stratification for the development of respiratory adverse events following vascular surgery using the Society of Vascular Surgery's Vascular Quality Initiative.

    Science.gov (United States)

    Genovese, Elizabeth A; Fish, Larry; Chaer, Rabih A; Makaroun, Michel S; Baril, Donald T

    2017-02-01

    Postoperative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however, little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication, and the overall impact of RAEs on patient outcomes. The Vascular Quality Initiative was queried (2003-2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm repair, thoracic endovascular aortic repair, suprainguinal bypass, or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created, and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables, and other postoperative adverse events. The cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (9.9%), chronic obstructive pulmonary disease requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open abdominal aortic aneurysm repairs (17.6%), in situ suprainguinal bypasses (9.68%), and thoracic endovascular aortic repairs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, congestive heart failure severity, chronic obstructive pulmonary

  11. Major life events and development of major depression in Parkinson's disease patients

    DEFF Research Database (Denmark)

    Rod, Naja Hulvej; Bordelon, Y; Thompson, A

    2012-01-01

    BACKGROUND AND PURPOSE: Non-motor symptoms including depression are important features of Parkinson's disease (PD). We aim to address the relationship between major life events and depression amongst PD patients free of depressive symptoms at baseline. METHODS: New-onset PD patients from California...... were recruited in 2001-2007 and followed up for 3-4 years. The participants (n = 221) were examined by neurologists and responded to comprehensive interviews that included major life events, social support, and coping measures from validated scales. Major depression was assessed using the Structured...... Clinical Interview for the DSM-IV depression module (SCID). RESULTS: More than half of all patients had experienced major life events since diagnosed with PD, and 22 patients developed a major depression. The number of life events was associated with risk of depression in an exposure-dependent manner...

  12. Major life events and risk of Parkinson's disease

    DEFF Research Database (Denmark)

    Rod, Naja Hulvej; Hansen, Johnni; Schernhammer, Eva

    2010-01-01

    major life events are risk factors for Parkinson's disease. Between 1986 and 2006, we identified 13,695 patients with a (PD) primary diagnosis of PD in the Danish National Hospital Register. Each case was frequency matched by age and gender to five population controls. Information on major life events...... before onset of PD was ascertained from national registries. Among men, number of life events was associated with risk of Parkinson's disease in an inverse dose-response manner (P ....34-0.99). Life events were not associated with PD in women. In contrast, a higher risk of PD was observed among women who had never been married (1.16; 1.04-1.29) and among men (1.47; 1.18-1.82) and women (1.30; 1.05-1.61) who have never been employees. The lower risk of Parkinson's disease among men who had...

  13. Major life events and risk of alcohol use disorders

    DEFF Research Database (Denmark)

    Just-Østergaard, Emilie; Mortensen, Erik L.; Flensborg-Madsen, Trine

    2018-01-01

    , household income, cohabitation status and psychiatric comorbidity. Findings: Serious family conflicts in childhood [hazard ratio (HR) = 1.35; 95% confidence interval (CI) = 1.00, 1.83] and serious economic problems in adult life (HR = 2.22; 95% CI = 1.64, 3.01) were associated significantly with increased......Aims: To estimate associations of individual major life events as well as accumulated major life events in childhood, adult private life and adult work life with risk of alcohol use disorders (AUD). Design: Prospective cohort study with baseline examination in 1991–93 and linkage to national...

  14. Risk Stratification for the Development of Respiratory Adverse Events Following Vascular Surgery Using the Society of Vascular Surgery’s Vascular Quality Initiative

    Science.gov (United States)

    Genovese, Elizabeth A; Fish, Larry; Chaer, Rabih A; Makaroun, Michel S; Baril, Donald T

    2017-01-01

    Objective Post-operative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication and the overall impact of RAEs on patient outcomes. Methods The Vascular Quality Initiative was queried (2003–2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm (AAA) repair, thoracic endovascular aortic repair (TEVAR), suprainguinal bypass or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables and other post-operative adverse events. Results The cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (CHF) (9.9%), chronic obstructive pulmonary disease (COPD) requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open AAA repairs (17.6%), in-situ suprainguinal bypasses (9.68%) and TEVARs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, CHF severity, COPD severity, degree of renal insufficiency

  15. Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population

    NARCIS (Netherlands)

    Kaasenbrood, Lotte; Boekholdt, S. Matthijs; van der Graaf, Yolanda; Ray, Kausik K.; Peters, Ron J. G.; Kastelein, John J. P.; Amarenco, Pierre; LaRosa, John C.; Cramer, Maarten J. M.; Westerink, Jan; Kappelle, L. Jaap; de Borst, Gert J.; Visseren, Frank L. J.

    2016-01-01

    Among patients with clinically manifest vascular disease, the risk of recurrent vascular events is likely to vary. We assessed the distribution of estimated 10-year risk of recurrent vascular events in a secondary prevention population. We also estimated the potential risk reduction and residual

  16. Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population

    NARCIS (Netherlands)

    Kaasenbrood, Lotte; Boekholdt, S. Matthijs; Van Der Graaf, Yolanda; Ray, Kausik K.; Peters, Ron J G; Kastelein, John J P; Amarenco, Pierre; Larosa, John C.; Cramer, Maarten J M; Westerink, Jan; Kappelle, L. Jaap; De Borst, Gert J.; Visseren, Frank L J

    2016-01-01

    Background: Among patients with clinically manifest vascular disease, the risk of recurrent vascular events is likely to vary. We assessed the distribution of estimated 10-year risk of recurrent vascular events in a secondary prevention population. We also estimated the potential risk reduction and

  17. One-year progression of moderate asymptomatic carotid stenosis predicts the risk of vascular events.

    Science.gov (United States)

    Balestrini, Simona; Lupidi, Francesca; Balucani, Clotilde; Altamura, Claudia; Vernieri, Fabrizio; Provinciali, Leandro; Silvestrini, Mauro

    2013-03-01

    This study aimed at evaluating whether ultrasound monitoring of moderate asymptomatic carotid stenosis may help in identifying subjects at high risk for vascular events. We included 523 subjects with unilateral asymptomatic carotid stenosis of 50% to 69%. Follow-up carotid ultrasound was performed within 12 months from inclusion to detect the frequency and degree of stenosis progression. Subjects were prospectively evaluated for a median period of 42 months (interquartile range, 38-45) after a second ultrasound evaluation. Outcome measures were any stroke and transient ischemic attack, myocardial infarction, and death. Carotid stenosis progression was associated with the occurrence of vascular events (hazard ratio, 21.57; 95% confidence interval, 11.81-39.39; P<0.001). During follow-up, 96.7% of subjects without progressive carotid stenosis remained free from vascular events. Among patients with progressive stenosis, 53.7% experienced a vascular event and 27.1% experienced an ipsilateral stroke. One-year moderate asymptomatic carotid stenosis progression is related to higher risk of vascular events, including ipsilateral stroke.

  18. Understanding the NSAID related risk of vascular events

    NARCIS (Netherlands)

    Vonkeman, Harald Erwin; Brouwers, Jacobus R.B.J.; van de Laar, Mart A F J

    2006-01-01

    Concern is growing about an increased risk of thrombotic events (including myocardial infarction and stroke) during the use of non-steroidal anti-inflammatory drugs (NSAIDs), in particular the so called selective cyclo-oxygenase-2 (COX 2) inhibitors. Although clinical trials give conflicting results

  19. Effects of Vascular and Nonvascular Adverse Events and of Extended-Release Niacin With Laropiprant on Health and Healthcare Costs.

    Science.gov (United States)

    Kent, Seamus; Haynes, Richard; Hopewell, Jemma C; Parish, Sarah; Gray, Alastair; Landray, Martin J; Collins, Rory; Armitage, Jane; Mihaylova, Borislava

    2016-07-01

    Extended-release niacin with laropiprant did not significantly reduce the risk of major vascular events and increased the risk of serious adverse events in Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE), but its net effects on health and healthcare costs are unknown. 25 673 participants aged 50 to 80 years with previous cardiovascular disease were randomized to 2 g of extended-release niacin with 40 mg of laropiprant daily versus matching placebo, in addition to effective statin-based low-density lipoprotein cholesterol-lowering treatment. The net effects of niacin-laropiprant on quality-adjusted life years and hospital care costs (2012 UK £; converted into US $ using purchasing power parity index) during 4 years in HPS2-THRIVE were evaluated using estimates of the impact of serious adverse events on health-related quality of life and hospital care costs. During the study, participants assigned niacin-laropiprant experienced marginally but not statistically significantly lower survival (0.012 fewer years [standard error (SE) 0.007]), fewer quality-adjusted life years (0.023 [SE 0.007] fewer using UK EQ-5D scores; 0.020 [SE 0.006] fewer using US EQ-5D scores) and accrued greater hospital costs (UK £101 [SE £37]; US $145 [SE $53]). Stroke, heart failure, musculoskeletal events, gastrointestinal events, and infections were associated with significant decreases in health-related quality of life in both the year of the event and in subsequent years. All serious vascular and nonvascular events were associated with substantial increases in hospital care costs. In HPS2-THRIVE, the addition of extended-release niacin-laropiprant to statin-based therapy reduced quality of life-adjusted survival and increased hospital costs. URL: http://clinicaltrials.gov. Unique identifier: NCT00461630. © 2016 American Heart Association, Inc.

  20. Residents’ Support in Major Local Events: Leeds Pride.

    OpenAIRE

    Pappas, Nikolaos

    2016-01-01

    This article examines the extent to which community participation and perceived impacts have an influence on residents' support of major events, more specifically, the Leeds Pride celebration. The research examines the perspectives of 400 Leeds permanent residents. The study tests a structural equation model, which has its theoretical basis in social exchange theory. It examines the constructs of community participation, perceived positive and negative impacts, and community support, includin...

  1. No effect of melatonin to modify surgical-stress response after major vascular surgery

    DEFF Research Database (Denmark)

    Kücükakin, B.; Wilhelmsen, M.; Lykkesfeldt, Jens

    2010-01-01

    A possible mechanism underlying cardiovascular morbidity after major vascular surgery may be the perioperative ischaemia-reperfusion with excessive oxygen-derived free-radical production and increased levels of circulating inflammatory mediators. We examined the effect of melatonin infusion during...... surgery and oral melatonin treatment for 3 days after surgery on biochemical markers of oxidative and inflammatory stress....

  2. Measuring the impact of major life events upon happiness.

    Science.gov (United States)

    Ballas, Dimitris; Dorling, Danny

    2007-12-01

    In recent years there have been numerous attempts to define and measure happiness in various contexts and pertaining to a wide range of disciplines, ranging from neuroscience and psychology to philosophy, economics and social policy. This article builds on recent work by economists who attempt to estimate happiness regressions using large random samples of individuals in order to calculate monetary 'compensating amounts' for different life 'events'. We estimate happiness regressions using the 'major life event' and 'happiness' data from the British Household Panel Survey. The data and methods used in this article suggest that in contrast to living states such as 'being married', it is more events such as 'starting a new relationship' that have the highest positive effect on happiness. This is closely followed by 'employment-related gains' (in contrast to employment status). Also, women who become pregnant on average report higher than average levels of subjective happiness (in contrast to 'being a parent'). Other events that appear to be associated with happiness according to our analysis include 'personal education-related events' (e.g. starting a new course, graduating from University, passing exams) and 'finance/house related events' (e.g. buying a new house). On the other hand, the event that has the highest negative impact upon happiness according to our analysis is 'the end of my relationship' closely followed by 'death of a parent'. Adverse health events pertaining to the parents of the respondents also have a high negative coefficient and so does an employment-related loss. The analysis presented in this article suggests that what matters the most in people's lives in Britain is to have good dynamic interpersonal relationships and to be respected at work with that respect being constantly renewed. These 'goods' are as much reflected through dynamic events as static situations. Relationships at work appear to be of a similar order of importance to those at

  3. Association between homocyst(e)ine levels and risk of vascular events.

    Science.gov (United States)

    Kaplan, Eugene D

    2003-03-01

    Homocyst(e)ine is a novel risk factor in vascular disease. First observations of vascular lesions in children with high blood homocyst(e)ine levels due to severe inborn enzyme deficiencies led to the hypothesis that elevated blood homocyst(e)ine levels might be a risk factor for vascular disease. A substantial body of evidence on the role of the homocyst(e)ine in the development of coronary and carotid artery disease, myocardial infarction, stroke, deep vein thrombosis and other disorders has been accumulated over the last 30 years. Cross-sectional and case-control studies provide initial and the strongest support for the hypothesis, followed by results from the prospective cohorts. Infrequent cases of homozygous mutations of the key enzymes in the homocyst(e)ine metabolism chain are able to produce extreme homocyst(e)inemia and early vascular lesions. More frequently, heterozygous enzyme mutations and deficiencies of folate and vitamins B6 and B12 cause mild to moderate homocyst(e)inemia, which is still strongly associated with the increased risk of vascular events. Elevated homocyst(e)ine levels may be effectively managed with adequate folate, B12 and B6 intake in doses comparable to or above FDA recommendations. Whether correction of elevated homocyst(e)ine levels with vitamins is helpful in prevention and treatment of vascular events remains unknown and is under investigation in ongoing clinical trials (VISP, VITATOPS). No consensus on homocyst(e)ine management is available at the present time.

  4. The Clinical Impact of Cardiology Consultation Prior to Major Vascular Surgery.

    Science.gov (United States)

    Davis, Frank M; Park, Yeo June; Grey, Scott F; Boniakowski, Anna E; Mansour, M Ashraf; Jain, Krishna M; Nypaver, Timothy; Grossman, Michael; Gurm, Hitinder; Henke, Peter K

    2018-01-01

    To understand statewide variation in preoperative cardiology consultation prior to major vascular surgery and to determine whether consultation was associated with differences in perioperative myocardial infarction (poMI). Medical consultation prior to major vascular surgery is obtained to reduce perioperative risk. Despite perceived benefit of preoperative consultation, evidence is lacking specifically for major vascular surgery on the effect of preoperative cardiac consultation. Patient and clinical data were obtained from a statewide vascular surgery registry between January 2012 and December 2014. Patients were risk stratified by revised cardiac risk index category and compared poMI between patients who did or did not receive a preoperative cardiology consultation. We then used logistic regression analysis to compare the rate of poMI across hospitals grouped into quartiles by rate of preoperative cardiology consultation. Our study population comprised 5191 patients undergoing open peripheral arterial bypass (n = 3037), open abdominal aortic aneurysm repair (n = 332), or endovascular aneurysm repair (n = 1822) at 29 hospitals. At the patient level, after risk-stratification by revised cardiac risk index category, there was no association between cardiac consultation and poMI. At the hospital level, preoperative cardiac consultation varied substantially between hospitals (6.9%-87.5%, P 66%) had a reduction in poMI (OR, 0.52; confidence interval: 0.28-0.98; P cardiology consultation for vascular surgery varies greatly between institutions, and does not appear to impact poMI at the patient level. However, reduction of poMI was noted at the hospitals with the highest rate of preoperative cardiology consultation as well as a variety of medical services, suggesting that other hospital culture effects play a role.

  5. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Angela S. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); National Heart Centre Singapore, Singapore (Singapore); Murthy, Venkatesh L.; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Wu, Justina [Brigham and Women' s Hospital, Division of Cardiology, Department of Medicine, and the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Department of Radiology and the Division of Cardiology, Noninvasive Cardiovascular Imaging Section, Boston, MA (United States)

    2015-09-15

    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical {sup 82}Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function. (orig.)

  6. Vascular events in Korean patients with myeloproliferative neoplasms and their relationship to JAK2 mutation.

    Science.gov (United States)

    Bang, Soo-Mee; Lee, Jong-Seok; Ahn, Jeong Yeal; Lee, Jae Hoon; Hyun, Myung Soo; Kim, Bong Seog; Park, Moo Rim; Chi, Hyun-Sook; Kim, Ho Young; Kim, Hyo Jung; Lee, Moon Hee; Kim, Hwak; Won, Jong Ho; Yoon, Hwi Joong; Oh, Do-Yeun; Nam, Eun-Mi; Bae, Sung Hwa; Kim, Byoung-Kook

    2009-03-01

    Evaluation of the Janus kinase 2 (JAK2) V617F mutation has been widely used for the diagnosis of myeloproliferative neoplasms (MPN). However, its prognostic relevance to clinical outcome is not completely understood. We investigated the association of JAK2 V617F with vascular events in Korean patients with myeloproliferative neoplasms (MPN). We studied 283 patients from 15 centers, who were diagnosed with MPN. The JAK2 V617F status was evaluated by allele-specific polymerase chain reaction (PCR) and sequencing. The patients' diagnoses were essential thrombocythemia (ET n = 146), polycythemia vera (PV n = 120), primary myelofibrosis (n = 12), and unclassifiable MPN (MPNu n = 5). JAK2 V617F was detected in 89 (61%) patients with ET, 103 (86%) with PV, four (33%) with myelofibrosis, and four (80%) with MPNu. A higher number of leukocytes, haemoglobin levels and BM cellularity as well as an older age, lower platelet counts, and diagnosis of PV were significantly correlated with JAK2 V617F. Eighty-three and 43 episodes of thrombosis and bleeding occurred in 100 patients each before and after the diagnosis. Vascular events more frequently occurred in 37% of patients with JAK2 V617F than in 29% of those without the mutation (p = 0.045). Among 175 patients whose samples were available for sequencing, 28 patients with homozygous JAK2 V617F had vascular events more frequently (57%) than those who were heterozygotes (39%) or had the wild type (27%) (p = 0.03). The multivariate analysis showed that a JAK2 homozygous mutation, hypercholesterolemia and older age were independent risk factors for a vascular event. The results of this study showed that Korean patients with MPN had a similar JAK2 mutation rate and frequency of vascular events when compared to Western patients. The presence of V617F was significantly related to vascular events. Therefore, initial evaluation for the JAK2 mutation and careful monitoring for vascular events should be performed in MPN patients.

  7. Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease

    NARCIS (Netherlands)

    Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A.; Kappelle, L. Jaap; de Borst, Gert Jan; Cramer, Maarten J.; Visseren, Frank L.J.; Aboyans, Victor; Westerink, Jan

    2017-01-01

    Background Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and

  8. Prehospital severity scoring at major rock concert events.

    Science.gov (United States)

    Erickson, T B; Koenigsberg, M; Bunney, E B; Schurgin, B; Levy, P; Willens, J; Tanner, L

    1997-01-01

    Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing. To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events. Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadium's first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a "DRUG-ROCK" Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests. Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5 +/- 22.5 minutes (+/- standard deviation; range: 5-150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (+/- 2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1-4), with 27% rated as moderate (score = 5-9), and 6% severe (score > 10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p rock concerts.

  9. The future of gas and major current events

    International Nuclear Information System (INIS)

    Anon.

    2007-01-01

    Natural gas market has been completely open in France since July 1, 2007. Long-time operators like Gaz de France (GdF) and local distribution companies, have adapted to the new constraints mainly by meeting the requirement to separate the infrastructure business from the commercial activities. Newcomers, mostly well-known foreign companies, have joined the traditional operators. Overall, the French market is working well, rules have been implemented and are being adequately enforced. To support these changes, the French gas industry needs a recognised professional association. The French gas association (AFG) fills this role, and promotes the image of gas through various events, congresses and meetings. This paper expresses the AFG's position concerning the future of gas in relation to major current events: AFG estimates that gas should play a full role in the energy spectrum based on its unique properties and wishes that public authorities take into consideration all features of all energy sources in their strategies, in particular CO 2 emissions all along the energy processes. AFG requests public authorities to set up fair, motivative and stable operating rules at least to the medium term. AFG would like the Energy regulating committee (CRE) to set an investment return rate that gives investors a sufficient incentive without penalizing the gas consumer. The AFG requests also that the administrative procedures for investment are simplified, with clarified rules and a fast arbitration for not delaying the opening of infrastructures. (J.S.)

  10. Neuroprotection against vascular dementia after acupuncture combined with donepezil hydrochloride: P300 event related potential

    Directory of Open Access Journals (Sweden)

    Qiang Liu

    2016-01-01

    Full Text Available Acupuncture can be used to treat various nervous system diseases. Here, 168 vascular dementia patients were orally administered donepezil hydrochloride alone (5 mg/day, once a day for 56 days, or combined with acupuncture at Shenting (DU24, Tianzhu (BL10, Sishencong (Extra, Yintang (Extra, Renzhong (DU26, Neiguan (PC6, Shenmen (HT7, Fengchi (GB20, Wangu (GB12 and Baihui (DU20 (once a day for 56 days. Compared with donepezil hydrochloride alone, P300 event related potential latency was shorter with an increased amplitude in patients treated with donepezil hydrochloride and acupuncture. Mini-Mental State Examination score was also higher. Moreover, these differences in P300 latency were identified within different infarcted regions in patients treated with donepezil hydrochloride and acupuncture. These findings indicate that acupuncture combined with donepezil hydrochloride noticeably improves cognitive function in patients with vascular dementia, and exerts neuroprotective effects against vascular dementia.

  11. Clostridium sordellii lethal toxin kills mice by inducing a major increase in lung vascular permeability.

    Science.gov (United States)

    Geny, Blandine; Khun, Huot; Fitting, Catherine; Zarantonelli, Leticia; Mazuet, Christelle; Cayet, Nadège; Szatanik, Marek; Prevost, Marie-Christine; Cavaillon, Jean-Marc; Huerre, Michel; Popoff, Michel R

    2007-03-01

    When intraperitoneally injected into Swiss mice, Clostridium sordellii lethal toxin reproduces the fatal toxic shock syndrome observed in humans and animals after natural infection. This animal model was used to study the mechanism of lethal toxin-induced death. Histopathological and biochemical analyses identified lung and heart as preferential organs targeted by lethal toxin. Massive extravasation of blood fluid in the thoracic cage, resulting from an increase in lung vascular permeability, generated profound modifications such as animal dehydration, increase in hematocrit, hypoxia, and finally, cardiorespiratory failure. Vascular permeability increase induced by lethal toxin resulted from modifications of lung endothelial cells as evidenced by electron microscopy. Immunohistochemical analysis demonstrated that VE-cadherin, a protein participating in intercellular adherens junctions, was redistributed from membrane to cytosol in lung endothelial cells. No major sign of lethal toxin-induced inflammation was observed that could participate in the toxic shock syndrome. The main effect of the lethal toxin is the glucosylation-dependent inactivation of small GTPases, in particular Rac, which is involved in actin polymerization occurring in vivo in lungs leading to E-cadherin junction destabilization. We conclude that the cells most susceptible to lethal toxin are lung vascular endothelial cells, the adherens junctions of which were altered after intoxication.

  12. Informed decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.

    Science.gov (United States)

    Etchells, Edward; Ferrari, Michel; Kiss, Alex; Martyn, Nikki; Zinman, Deborah; Levinson, Wendy

    2011-06-01

    Prior studies show significant gaps in the informed decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate informed decision-making for major elective vascular surgery based on audiotapes of actual physician-patient conversations and, second, to compare ratings of informed decision-making for first visits to ratings for multiple visits by the same patient over time. We prospectively enrolled patients for whom vascular surgical treatment was a potential option at a tertiary care outpatient vascular surgery clinic. We audio-taped all surgeon-patient conversations, including multiple visits when necessary, until a decision was made. Using an existing method, we evaluated the transcripts for elements of decision-making, including basic elements (e.g., an explanation of the clinical condition), intermediate elements (e.g., risks and benefits) and complex elements (e.g., uncertainty around the decision). We analyzed 145 surgeon-patient consultations. Overall, 45% of consultations contained complex elements, whereas 23% did not contain the basic elements of decision-making. For the 67 consultations that involved multiple visits, ratings were significantly higher when evaluating all visits (50% complex elements) compared with evaluating only the first visit (33% complex elements, p decision-making over multiple visits yielded different results than analyzing decision-making for single visits.

  13. Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease.

    Science.gov (United States)

    Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A; Kappelle, L Jaap; de Borst, Gert Jan; Cramer, Maarten J; Visseren, Frank L J; Aboyans, Victor; Westerink, Jan

    2017-10-01

    Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and without manifest vascular disease. In a cohort of 7344 patients with manifest vascular disease or vascular risk factors alone enrolled in the Second Manifestations of ARTerial disease (SMART) study, single bilateral non-simultaneous blood pressure measurements were performed. Logistic and Cox regression was used to identify determinants of large inter-arm SBPD (≥15mmHg) and to investigate the relation between inter-arm SBPD and vascular events (composite of non-fatal myocardial infarction, stroke, and vascular mortality) and all-cause mortality. In all patients the median inter-arm SBPD was 7mmHg (IQR 3-11) and 1182 (16%) patients had inter-arm SBPD ≥15mmHg. Higher age, higher systolic blood pressure, diabetes mellitus, peripheral artery disease, carotid artery stenosis, higher carotid intima-media thickness, and lower ankle-brachial indices were related to large inter-arm SBPD (≥15mmHg). Each 5mmHg increase in inter-arm SBPD was related to a 12% higher risk of vascular events in patients without manifest vascular disease (HR 1.12; 95% CI 1.00-1.27), whereas no relation was apparent in patients with manifest vascular disease (HR 0.98; 95% CI 0.93-1.04, interaction p-value 0.036). Inter-arm SBPD was not related to all-cause mortality (HR 1.05; 95% CI 0.93-1.19). Inter-arm SBPD relates to a higher risk of vascular events in patients without manifest vascular disease, whereas this relation is not apparent in patients with manifest vascular disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Characterization of major pollution events (dust, haze, and two festival events) at Agra, India.

    Science.gov (United States)

    Pachauri, Tripti; Singla, Vyoma; Satsangi, Aparna; Lakhani, Anita; Kumari, K Maharaj

    2013-08-01

    Total suspended particulate (TSP) samples were collected during dust, haze, and two festival events (Holi and Diwali) from February 2009 to June 2010. Pollutant gases (NO2, SO2, and O3) along with the meteorological parameters were also measured during the four pollution events at Agra. The concentration of pollutant gases decreases during dust events (DEs), but the levels of the gases increase during other pollution events indicating the impact of anthropogenic emissions. The mass concentrations were about two times higher during pollution events than normal days (NDs). High TSP concentrations during Holi and Diwali events may be attributed to anthropogenic activities while increased combustion sources in addition to stagnant meteorological conditions contributed to high TSP mass during haze events. On the other hand, long-range transport of atmospheric particles plays a major role during DEs. In the dust samples, Ca(2+), Cl(-), NO3 (-), and SO4 (2-) were the most abundant ions and Ca(2+) alone accounted for 22 % of the total ionic mass, while during haze event, the concentrations of secondary aerosols species, viz., NO3 (-), SO4 (2-), and NH4 (+), were 3.6, 3.3, and 5.1 times higher than the normal days. During Diwali, SO4 (2-) concentration (17.8 μg m(-3)) was highest followed by NO3 (-), K(+), and Cl(-) while the Holi samples were strongly enriched with Cl(-) and K(+) which together made up 32.7 % of the total water-soluble ions. The ion balances indicate that the haze samples were acidic. On the other hand, Holi, Diwali, and DE samples were enriched with cations. The carbonaceous aerosol shows strong variation with the highest concentration during Holi followed by haze, Diwali, DEs, and NDs. However, the secondary organic carbon concentration follows the order haze > DEs > Diwali > Holi > NDs. The scanning electron microscope/EDX results indicate that KCl and carbon-rich particles were more dominant during Holi and haze events while DE samples were enriched

  15. "Physics and Life" - Teachers Meet Scientists at Major EIROforum Event [

    Science.gov (United States)

    2003-11-01

    (EPS) and the European Association for Astronomy Education (EAAE) . The project is funded in part by the European Commission and takes place under the auspices of the European Science and Technology Week 2003. It is directed by the EIROforum Working Group on Outreach that brings together key members of the seven organisations' respective outreach departments. The "Physics on Stage 3" festival will be opened on Monday, November 10, by His Royal Highness, Prince Johan Friso of the Netherlands. Among the distinguished guests will also be Her Excellency, Mrs. Maria van der Hoeven, the Dutch Minister of Education, Culture and Science, as well as several Directors-General of the EIROforum organisations. This "Physics on Stage 3" festival is the most visible event within a year-long programme with the very active involvement of National Committees in two dozen European countries, each of which organised national events or competitions, during which the 400 delegates to the festival were selected for their outstanding projects to promote science teaching. Among the many entries, for example, two young physicists from Germany focus on the beauty of physical phenomena, producing fractals and demonstrating the "Theremin", the only musical instrument played without being touched. In another demonstration, a team from the UK explore the nature of sound and the theme of genetics through drama, music and physical theatre. In this third international festival of physics education, biological and biochemical themes will also play a major role. As usual, the colourful centrepiece of the week is the Fair. Every country has its own stand where delegates show their new, exciting and surprising projects, innovative software, elegant experiments, etc. In this highly inspiring atmosphere, the teachers exchange practical experience and insights, learning from each other and preparing themselves to bring back to their respective countries a rich harvest of new ideas and inspiration for better

  16. Major Cardiac Events After Non-cardiac Surgery.

    Science.gov (United States)

    Sousa, Gabriela; Lopes, Ana; Reis, Pedro; Carvalho, Vasco; Santos, Alice; Abelha, Fernando José

    2016-08-01

    Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery. The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently. Multivariate logistic regression analysis was performed to assess the independent factors for MCE. A total of 107 people experienced MCE. The independent predictors for postoperative MCE were higher fraction of inspired oxygen (FiO2) (odds ratio [OR] 38.97; 95 % confidence interval [CI] 10.81-140.36), history of ischemic heart disease (OR 3.38; 95 % CI 2.12-5.39), history of congestive heart disease (OR 2.39; 95 % CI 1.49-3.85), history of insulin therapy for diabetes (OR 2.93; 95 % CI 1.66-5.19), and increased SAPS II (OR 1.03; 95 % CI 1.01-1.05). Having a MCE was associated with a longer length of stay in the surgical intensive care unit (OR 1.01, 95 % CI 1.00-1.01). FiO2, ischemic heart disease, congestive heart disease, insulin therapy for diabetes, SAPS II, and length of stay in the surgical intensive care unit were independent predictors for MCE.

  17. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity.

    Science.gov (United States)

    Koh, Angela S; Murthy, Venkatesh L; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Wu, Justina; Di Carli, Marcelo F; Dorbala, Sharmila

    2015-09-01

    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical (82)Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function.

  18. Personality, Stressful Life Events, and Treatment Response in Major Depression

    Science.gov (United States)

    Bulmash, Eric; Harkness, Kate L.; Stewart, Jeremy G.; Bagby, R. Michael

    2009-01-01

    The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were…

  19. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  20. Major life events as potential triggers of sudden cardiac arrest.

    Science.gov (United States)

    Wicks, April F; Lumley, Thomas; Lemaitre, Rozenn N; Sotoodehnia, Nona; Rea, Thomas D; McKnight, Barbara; Strogatz, David S; Bovbjerg, Viktor E; Siscovick, David S

    2012-05-01

    We investigated the risk of sudden cardiac arrest in association with the recent loss of, or separation from, a family member or friend. Our case-crossover study included 490 apparently healthy married residents of King County, Washington, who suffered sudden cardiac arrest between 1988 and 2005. We compared exposure to spouse-reported family/friend events occurring ≤ 1 month before sudden cardiac arrest with events occurring in the previous 5 months. We evaluated potential effect modification by habitual vigorous physical activity. Recent family/friend events were associated with a higher risk of sudden cardiac arrest (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.4). ORs for cases with and without habitual vigorous physical activity were 1.1 (0.6-2.2) and 2.0 (1.2-3.1), respectively (interaction P = 0.02). These results suggest family/friend events may trigger sudden cardiac arrest and raise the hypothesis that habitual vigorous physical activity may lower susceptibility to these potential triggers.

  1. Intraosseous vascular access in disasters and mass casualty events: A review of the literature.

    Science.gov (United States)

    Burgert, James M

    2016-01-01

    The intraosseous (IO) route of vascular access has been increasingly used to administer resuscitative fluids and drugs to patients in whom reliable intravenous (IV) access could not be rapidly or easily obtained. It is unknown that to what extent the IO route has been used to gain vascular access during disasters and mass casualty events. The purpose of this review was to examine the existing literature to answer the research question, "What is the utility of the IO route compared to other routes for establishing vascular access in patients resulting from disasters and mass casualty events?" Keyword-based online database search of PubMed, CINAHL, and the Cochrane Database of Systematic Reviews. University-based academic research cell. Included evidence were randomized and nonrandomized trials, systematic reviews with and without meta-analysis, case series, and case reports. Excluded evidence included narrative reviews and expert opinion. Not applicable. Of 297 evidence sources located, 22 met inclusion criteria. Located evidence was organized into four categories including chemical agent poisoning, IO placement, while wearing chemical protective clothing (PPE), military trauma, and infectious disease outbreak. Evidence indicates that the IO route of infusion is pharmacokinetically equal to the IV route and superior to the intramuscular (IM) and endotracheal routes for the administration of antidotal drugs in animal models of chemical agent poisoning while wearing full chemical PPE. The IO route is superior to the IM route for antidote administration during hypovolemic shock. Civilian casualties of explosive attacks and mass shootings would likely benefit from expanded use of the IO route and military resuscitation strategies. The IO route is useful for fluid resuscitation in the management of diarrheal and hemorrhagic infectious disease outbreaks.

  2. Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events?

    Directory of Open Access Journals (Sweden)

    Naveed Sattar

    2009-06-01

    Full Text Available BACKGROUND: Circulating inflammatory markers may more strongly relate to risk of fatal versus nonfatal cardiovascular disease (CVD events, but robust prospective evidence is lacking. We tested whether interleukin (IL-6, C-reactive protein (CRP, and fibrinogen more strongly associate with fatal compared to nonfatal myocardial infarction (MI and stroke. METHODS AND FINDINGS: In the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER, baseline inflammatory markers in up to 5,680 men and women aged 70-82 y were related to risk for endpoints; nonfatal CVD (i.e., nonfatal MI and nonfatal stroke [n = 672], fatal CVD (n = 190, death from other CV causes (n = 38, and non-CVD mortality (n = 300, over 3.2-y follow-up. Elevations in baseline IL-6 levels were significantly (p = 0.0009; competing risks model analysis more strongly associated with fatal CVD (hazard ratio [HR] for 1 log unit increase in IL-6 1.75, 95% confidence interval [CI] 1.44-2.12 than with risk of nonfatal CVD (1.17, 95% CI 1.04-1.31, in analyses adjusted for treatment allocation. The findings were consistent in a fully adjusted model. These broad trends were similar for CRP and, to a lesser extent, for fibrinogen. The results were also similar in placebo and statin recipients (i.e., no interaction. The C-statistic for fatal CVD using traditional risk factors was significantly (+0.017; p<0.0001 improved by inclusion of IL-6 but not so for nonfatal CVD events (p = 0.20. CONCLUSIONS: In PROSPER, inflammatory markers, in particular IL-6 and CRP, are more strongly associated with risk of fatal vascular events than nonfatal vascular events. These novel observations may have important implications for better understanding aetiology of CVD mortality, and have potential clinical relevance.

  3. Excess risk of major vascular diseases associated with airflow obstruction: a 9-year prospective study of 0.5 million Chinese adults

    Directory of Open Access Journals (Sweden)

    Kurmi OP

    2018-03-01

    .27, major coronary events (n=635, HR 1.33, 95% CI 1.22–1.45, and heart failure (n=543, HR 2.19, 95% CI 1.98–2.41. For each outcome, the risk increased progressively with increasing COPD severity and persisted among never-regular smokers. Conclusion: Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and treatment programs to improve long-term prognosis. Keywords: chronic obstructive pulmonary disease, exacerbation, vascular diseases, cohort, China

  4. The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study.

    Science.gov (United States)

    Blomster, J I; Zoungas, S; Woodward, M; Neal, B; Harrap, S; Poulter, N; Marre, M; Williams, B; Chalmers, J; Hillis, G S

    2017-05-01

    The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, peducation was weakest in Established Market Economies and strongest in East Europe. A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions. Copyright © 2017. Published by Elsevier B.V.

  5. Ophthalmic Vascular Events after Primary Unilateral Intra-arterial Chemotherapy for Retinoblastoma in Early and Recent Eras.

    Science.gov (United States)

    Dalvin, Lauren A; Ancona-Lezama, David; Lucio-Alvarez, J Antonio; Masoomian, Babak; Jabbour, Pascal; Shields, Carol L

    2018-06-16

    To assess risk factors for ophthalmic vascular events after intra-arterial chemotherapy (IAC) for retinoblastoma. Retrospective cohort study. Patients who received unilateral IAC as primary treatment for retinoblastoma from January 1, 2009, to November 30, 2017, at a single center. Records were reviewed for patient demographics, tumor features, IAC parameters, and treatment-related vascular events in the early IAC era (2009-2011) compared with the recent era (2012-2017) using the t test and Fisher exact test. Change in event rates over time was assessed using Poisson regression analysis, with Spearman's rho used to test correlation. Rate of IAC-induced ophthalmic vascular events. There were 243 chemotherapy infusions in 76 eyes of 76 patients, divided into early (22 eyes, 57 infusions) and recent (54 eyes, 186 infusions) eras. Intra-arterial chemotherapy consisted of melphalan (243 infusions), topotecan (124 infusions), and carboplatin (9 infusions). A comparison (early vs. recent era) revealed fewer mean number of infusions (2.6 vs. 3.4, P = 0.02) with similar mean patient age and presenting tumor features. Event rates decreased over time (P early era vs. recent era) in the recent era (59% vs. 9% per eye, 23% vs. 3% per infusion, P age (P = 0.75), tumor diameter (P = 0.32), tumor thickness (P = 0.59), or cumulative dosage of melphalan (P = 0.13) or topotecan (P = 0.59). There were no IAC-induced vascular events in 72 infusions of 21 consecutively treated eyes in 2016 to 2017. Ophthalmic vascular events after IAC have decreased from the early era (2009-2011) through the current era (2012-2017) at this center. Experience performing this highly specialized procedure could be an important factor predicting IAC-related vascular events. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  6. ENC 2002: Setting the scene for a major public event

    International Nuclear Information System (INIS)

    2001-01-01

    The series of European Conferences were coupled with the only major nuclear science and industry exhibitions of truly world dimension. They offer the perfect opportunity to serve as a platform for a clear and positive message on nuclear power in Europe to the public to promote an image of openness and sound business. Main objectives were: ease of access for the target groups; politically favourable environment; cost efficiency to be assured in the interest of the industry; state-of-the-art facilities; exhibition and conference under one roof

  7. The Heavy Links between Geological Events and Vascular Plants Evolution: A Brief Outline.

    Science.gov (United States)

    Piombino, Aldo

    2016-01-01

    Since the rise of photosynthesis, life has influenced terrestrial atmosphere, particularly the O2 and the CO2 content (the latter being originally more than 95%), changing the chemistry of waters, atmosphere, and soils. Billions of years after, a far offspring of these first unicellular forms conquered emerging lands, not only completely changing landscape, but also modifying geological cycles of deposition and erosion, many chemical and physical characteristics of soils and fresh waters, and, more, the cycle of various elements. So, there are no doubts that vascular plants modified geology; but it is true that also geology has affected (and, more, has driven) plant evolution. New software, PyRate, has determined vascular plant origin and diversification through a Bayesian analysis of fossil record from Silurian to today, particularly observing their origination and extinction rate. A comparison between PyRate data and geological history suggests that geological events massively influenced plant evolution and that also the rise of nonflowering seed plants and the fast diffusion of flowering plants can be explained, almost partly, with the environmental condition changes induced by geological phenomena.

  8. No effect of melatonin to modify surgical-stress response after major vascular surgery: a randomised placebo-controlled trial

    DEFF Research Database (Denmark)

    Kücükakin, B; Wilhelmsen, M; Lykkesfeldt, Jens

    2010-01-01

    A possible mechanism underlying cardiovascular morbidity after major vascular surgery may be the perioperative ischaemia-reperfusion with excessive oxygen-derived free-radical production and increased levels of circulating inflammatory mediators. We examined the effect of melatonin infusion during...... surgery and oral melatonin treatment for 3 days after surgery on biochemical markers of oxidative and inflammatory stress....

  9. Incremental value of a genetic risk score for the prediction of new vascular events in patients with clinically manifest vascular disease.

    Science.gov (United States)

    Weijmans, Maaike; de Bakker, Paul I W; van der Graaf, Yolanda; Asselbergs, Folkert W; Algra, Ale; Jan de Borst, Gert; Spiering, Wilko; Visseren, Frank L J

    2015-04-01

    Several genetic markers are related to incidence of cardiovascular events. We evaluated whether a genetic risk score (GRS) based on 30 single-nucleotide-polymorphisms associated with coronary artery disease (CAD) can improve prediction of 10-year risk of new cardiovascular events in patients with clinical manifest vascular disease. In 5742 patients with symptomatic vascular disease enrolled in the SMART study, we developed Cox regression models based on the SMART Risk Score (SRS) and based on the SRS plus the GRS in all patients, in patients with a history of acute arterial thrombotic events and in patients with a history of more stable atherosclerosis and without CAD. The discriminatory ability was expressed by the c-statistic. Model calibration was evaluated by calibration plots. The incremental value of adding the GRS was assessed by net reclassification index (NRI) and decision curve analysis. During a median follow-up of 6.5 years (IQR4.0-9.5), the composite outcome of myocardial infarction, stroke, or vascular death occurred in 933 patients. Hazard ratios of GRS ranging from 0.86 to 1.35 were observed. The discriminatory capacity of the SRS for prediction of 10-year risk of cardiovascular events was fairly good (c-statistic 0.70, 95%CI 0.68-0.72), similar to the model based on the SRS plus the GRS. Calibration of the models based on SRS and SRS plus GRS was adequate. No increase in c-statistics, categorical NRIs and decision curves was observed when adding the GRS. The continuous NRI improved only in patients with stable atherosclerosis (0.14, 95%CI 0.03-0.25), increasing further excluding patients with a history of CAD (0.21, 95%CI 0.06-0.36). In patients with symptomatic vascular disease, a GRS did not improve risk prediction of 10-year risk of cardiovascular events beyond clinical characteristics. The GRS might improve risk prediction of first vascular events in the subgroup of patients with a history of stable atherosclerosis. Copyright © 2015 Elsevier

  10. Combination of perindopril/indapamide in secondary prevention of stroke and other vascular events: A combined analysis of ADVANCE, PROGRESS and HYVET trials

    Directory of Open Access Journals (Sweden)

    Sougat Sourendra Sarkar

    2011-03-01

    Full Text Available Perindopril/indapamide combination has been shown to reduce cardiovascular risk in different groups of patients. A total of 18,529 patients (9,272 receiving perindopril/indapamide and 9,257 receiving placebo were included in this meta-analysis involving three large randomized clinical trials-ADVANCE, PROGRESS and HYVET. A non-significant reduction in fatal and non-fatal stroke was seen (Odds ratio 0.73; 95% Confidence Interval 0.49 to 1.09; z=1.52 and p= 0.13. The combination was associated with a significantly reduction of vascular death (Odds ratio 0.79; 95% Confidence Interval 0.69 to 0.90; z=3.48 and p=0.0005 and major cardio-vascular events (Odds ratio 0.72; 95% Confidence Interval 0.53 to 0.97; z=2.15 and p= 0.03. Fixed-combination of Perindopril and indapamide substantially reduced major cardiovascular event and vascular death. However, effect on stroke needs further evaluation.

  11. Donor-recipient human leukocyte antigen matching practices in vascularized composite tissue allotransplantation: a survey of major transplantation centers.

    Science.gov (United States)

    Ashvetiya, Tamara; Mundinger, Gerhard S; Kukuruga, Debra; Bojovic, Branko; Christy, Michael R; Dorafshar, Amir H; Rodriguez, Eduardo D

    2014-07-01

    Vascularized composite tissue allotransplant recipients are often highly sensitized to human leukocyte antigens because of multiple prior blood transfusions and other reconstructive operations. The use of peripheral blood obtained from dead donors for crossmatching may be insufficient because of life support measures taken for the donor before donation. No study has been published investigating human leukocyte antigen matching practices in this field. A survey addressing human leukocyte antigen crossmatching methods was generated and sent to 22 vascularized composite tissue allotransplantation centers with active protocols worldwide. Results were compiled by center and compared using two-tailed t tests. Twenty of 22 centers (91 percent) responded to the survey. Peripheral blood was the most commonly reported donor sample for vascularized composite tissue allotransplant crossmatching [78 percent of centers (n=14)], with only 22 percent (n=4) using lymph nodes. However, 56 percent of the 18 centers (n=10) that had performed vascularized composite tissue allotransplantation reported that they harvested lymph nodes for crossmatching. Of responding individuals, 62.5 percent (10 of 16 individuals) felt that lymph nodes were the best donor sample for crossmatching. A slight majority of vascularized composite tissue allotransplant centers that have performed clinical transplants have used lymph nodes for human leukocyte antigen matching, and centers appear to be divided on the utility of lymph node harvest. The use of lymph nodes may offer a number of potential benefits. This study highlights the need for institutional review board-approved crossmatching protocols specific to vascularized composite tissue allotransplantation, and the need for global databases for sharing of vascularized composite tissue allotransplantation experiences.

  12. Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review.

    Science.gov (United States)

    Aitken, Sarah Joy; Blyth, Fiona M; Naganathan, Vasi

    2017-10-01

    Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, pdelirium included increased age (OR 1.04, pdelirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.

  13. Near-Bed Monitoring of Suspended Sediment during a Major Flood Event Highlights Deficiencies in Existing Event-Loading Estimates

    Directory of Open Access Journals (Sweden)

    Alistair Grinham

    2018-01-01

    Full Text Available Rates of fluvial sediment discharge are notoriously difficult to quantify, particularly during major flood events. Measurements are typically undertaken using event stations requiring large capital investment, and the high cost tends to reduce the spatial coverage of monitoring sites. This study aimed to characterise the near-bed suspended sediment dynamics during a major flood event using a low-cost approach. Monitoring nodes consisted of a total suspended sediment (TSS logger, a single stage sampler, and a time-lapse camera for a total cost of less than US$420. Seven nodes were deployed across an elevation gradient on the stream bank of Laidley Creek, Queensland, Australia, and two of these nodes successfully characterised the near-bed suspended sediment dynamics across a major flood event. Near-bed TSS concentrations were closely related to stream flow, with the contribution of suspended bed material dominating the total suspended load during peak flows. Observed TSS concentrations were orders of magnitude higher than historical monitoring data for this site collected using the State government event station. This difference was attributed to the event station pump inlet screening the suspended bed material prior to sample collection. The ‘first flush’ phenomenon was detected and attributed to a local resuspension of muddy crusts immediately upstream of the study site. This low-cost approach will provide an important addition to the existing monitoring of fluvial sediment discharge during flood events.

  14. Alcohol consumption and risk of recurrent cardiovascular events and mortality in patients with clinically manifest vascular disease and diabetes mellitus: The Second Manifestations of ARTerial (SMART) disease study

    NARCIS (Netherlands)

    Beulens, J.W.J.; Algra, A.; Soedamah-Muthu, S.S.; Visseren, F.L.J.; Grobbee, D.E.; Graaf, van der Y.

    2010-01-01

    OBJECTIVE: This study investigated the relation between alcohol consumption and specific vascular events and mortality in a high risk population of patients with clinical manifestations of vascular disease and diabetes. METHODS: Patients with clinically manifest vascular disease or diabetes (n=5447)

  15. Cost-Effectiveness Comparison of Breast Cancer Screening and Vascular Event Primary Prevention with Aspirin in Wales

    Science.gov (United States)

    Morgan, Gareth

    2011-01-01

    Aim: For the first time, this article presents a cost-effectiveness comparison of a breast cancer screening programme with a possible health education programme with aspirin for vascular event primary prevention. Background: Breast cancer screening is a well established part of cancer control programmes yet recent evidence on this intervention has…

  16. Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Snygg-Martin, Ulrika; Olaison, Lars

    2009-01-01

    OBJECTIVES: To study the impact of anticoagulation on major cerebral events in patients with left-sided Staphylococcus aureus infective endocarditis (IE). METHODS: A prospective cohort study; the use of anticoagulation and the relation to major cerebral events was evaluated separately at onset...... of admission and during hospitalization. RESULTS: Overall, 70 out of 175 patients (40%; 95% CI: 33-47%) experienced major cerebral events during the course of the disease, cerebral ischaemic stroke occured in 59 patients (34%; 95% CI: 27-41%), cerebral infection in 23 patients (14%; 95% CI: 9...

  17. The Event Chain of Survival in the Context of Music Festivals: A Framework for Improving Outcomes at Major Planned Events.

    Science.gov (United States)

    Lund, Adam; Turris, Sheila

    2017-08-01

    Despite the best efforts of event producers and on-site medical teams, there are sometimes serious illnesses, life-threatening injuries, and fatalities related to music festival attendance. Producers, clinicians, and researchers are actively seeking ways to reduce the mortality and morbidity associated with these events. After analyzing the available literature on music festival health and safety, several major themes emerged. Principally, stakeholder groups planning in isolation from one another (ie, in silos) create fragmentation, gaps, and overlap in plans for major planned events (MPEs). The authors hypothesized that one approach to minimizing this fragmentation may be to create a framework to "connect the dots," or join together the many silos of professionals responsible for safety, security, health, and emergency planning at MPEs. Adapted from the well-established literature regarding the management of cardiac arrests, both in and out of hospital, the "chain of survival" concept is applied to the disparate groups providing services that support event safety in the context of music festivals. The authors propose this framework for describing, understanding, coordinating and planning around the integration of safety, security, health, and emergency service for events. The adapted Event Chain of Survival contains six interdependent links, including: (1) event producers; (2) police and security; (3) festival health; (4) on-site medical services; (5) ambulance services; and (6) off-site medical services. The authors argue that adapting and applying this framework in the context of MPEs in general, and music festivals specifically, has the potential to break down the current disconnected approach to event safety, security, health, and emergency planning. It offers a means of shifting the focus from a purely reactive stance to a more proactive, collaborative, and integrated approach. Improving health outcomes for music festival attendees, reducing gaps in planning

  18. Climatology and Meteorological Evolution of Major Wildfire Events over the Northeast United States

    Science.gov (United States)

    Joseph B. Pollina; Brian A. Colle; Joseph J. Charney

    2013-01-01

    This study presents a spatial and temporal climatology of major wildfire events, defined as >100 acres burned (>40.47 ha, where 1 ha = 2.47 acre), in the northeast United States from 1999 to 2009 and the meteorological conditions associated with these events. The northeast United States is divided into two regions: region 1 is centered over the higher terrain of...

  19. Going for gold : Investigating the (non)sense of increased advertising around major sports events

    NARCIS (Netherlands)

    Gijsenberg, Maarten J.

    Major sports events draw unsurpassed media attention. Companies are motivated to increase their advertising investments around these events to reach large audiences in a short period. Is such an advertising surge actually beneficial though, or should companies avoid advertising in these periods

  20. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Tully, Phillip J; Winefield, Helen R; Baker, Robert A

    2015-01-01

    anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure......BACKGROUND: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical...... and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease. RESULTS: In the total sample, there were 698 cumulative person years of survival for analysis with a median...

  1. Predictive value of reactive hyperemia for cardiovascular events in patients with peripheral arterial disease undergoing vascular surgery.

    Science.gov (United States)

    Huang, Alex L; Silver, Annemarie E; Shvenke, Elena; Schopfer, David W; Jahangir, Eiman; Titas, Megan A; Shpilman, Alex; Menzoian, James O; Watkins, Michael T; Raffetto, Joseph D; Gibbons, Gary; Woodson, Jonathan; Shaw, Palma M; Dhadly, Mandeep; Eberhardt, Robert T; Keaney, John F; Gokce, Noyan; Vita, Joseph A

    2007-10-01

    Reactive hyperemia is the compensatory increase in blood flow that occurs after a period of tissue ischemia, and this response is blunted in patients with cardiovascular risk factors. The predictive value of reactive hyperemia for cardiovascular events in patients with atherosclerosis and the relative importance of reactive hyperemia compared with other measures of vascular function have not been previously studied. We prospectively measured reactive hyperemia and brachial artery flow-mediated dilation by ultrasound in 267 patients with peripheral arterial disease referred for vascular surgery (age 66+/-11 years, 26% female). Median follow-up was 309 days (range 1 to 730 days). Fifty patients (19%) had an event, including cardiac death (15), myocardial infarction (18), unstable angina (8), congestive heart failure (6), and nonhemorrhagic stroke (3). Patients with an event were older and had lower hyperemic flow velocity (75+/-39 versus 95+/-50 cm/s, P=0.009). Patients with an event also had lower flow-mediated dilation (4.5+/-3.0 versus 6.9+/-4.6%, P<0.001), and when these 2 measures of vascular function were included in the same Cox proportional hazards model, lower hyperemic flow (OR 2.7, 95% CI 1.2 to 5.9, P=0.018) and lower flow-mediated dilation (OR 4.2, 95% CI: 1.8 to 9.8, P=0.001) both predicted cardiovascular events while adjusting for other risk factors. Thus, lower reactive hyperemia is associated with increased cardiovascular risk in patients with peripheral arterial disease. Furthermore, flow-mediated dilation and reactive hyperemia incrementally relate to cardiovascular risk, although impaired flow-mediated dilation was the stronger predictor in this population. These findings further support the clinical relevance of vascular function measured in the microvasculature and conduit arteries in the upper extremity.

  2. Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events.

    Science.gov (United States)

    Nazzal, Saleh; Hijazi, Basem; Khalila, Luai; Blum, Arnon

    2017-11-01

    Frank's sign was first described in 1973 by an American physician (Sonders T. Frank). It is a diagonal crease in the earlobe that starts from the tragus to the edge of the auricle in an angle of 45° in varying depths. Frank's sign was described as a predictor of future coronary heart disease and peripheral vascular diseases. The aim of the study was to examine the association between Frank's sign and the development of ischemic stroke. This was a prospective study that enrolled consecutive patients admitted with an acute ischemic stroke. Frank's sign was tested in both ears. Clinical data included age, gender, type 2 diabetes mellitus, and hypertension. The study was approved by the institutional review board (the institutional ethics committee). A total of 241 consecutive patients who were hospitalized with an acute stroke and were eligible to take part in the study were recruited. Frank's sign was present in 190 patients (78.8%). Patients were divided according to clinical findings and the findings from brain computed tomography. There were 153 patients with transient ischemic attacks (63.6% of the patients) and 88 with cerebrovascular accidents (36.4% of the patients). A total of 112 patients with transient ischemic attacks had Frank's sign (73.2%), and 78 patients with cerebrovascular accidents had Frank's sign (88.6%), with a statistically significant difference (P <.01). Frank's sign could predict ischemic cerebrovascular events. Patients with classical cardiovascular risk factors had Frank's sign at a higher frequency. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Major stressful life events and other risk factors for first admission with mania

    DEFF Research Database (Denmark)

    Kessing, L.V.; Agerbo, E.; Mortensen, P.B.

    2004-01-01

    OBJECTIVES: To investigate whether first admission with mania is associated with the occurrence of death in the family or with major stressful life events and to explore whether the associations change with age. METHODS: Case register study with linkage of the Danish Psychiatric Central Research...... was found on the association between life events and the first admission with mania, totally, or for men or women, separately regarding ageing. CONCLUSIONS: The occurrence of death in the family and the experience of major life events are associated with increased risk of first admission with bipolar...

  4. Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke.

    Science.gov (United States)

    Gonzalez-Valcarcel, Jaime; Sissani, Leila; Labreuche, Julien; Bousser, Marie-Germaine; Chamorro, Angel; Fisher, Marc; Ford, Ian; Fox, Kim M; Hennerici, Michael G; Mattle, Heinrich P; Rothwell, Peter M; Steg, Philippe Gabriel; Vicaut, Eric; Amarenco, Pierre

    2016-04-01

    The presumed safety of paracetamol in high-cardiovascular risk patients has been questioned. We determined whether paracetamol or ibuprofen use is associated with major cardiovascular events (MACE) or major bleeding in 19 120 patients with recent ischemic stroke or transient ischemic attack of mainly atherothrombotic origin included in the Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) trial. We performed 2 nested case-control analysis (2153 cases with MACE during trial follow-up and 4306 controls matched on Essen stroke risk score; 809 cases with major bleeding matched with 1616 controls) and a separate time-varying analysis. 12.3% were prescribed paracetamol and 2.5% ibuprofen. Median duration of treatment was 14 (interquartile range 5-145) days for paracetamol and 9 (5-30) days for ibuprofen. Paracetamol, but not ibuprofen, was associated with increased risk of MACE (odds ratio 1.21, 95% confidence interval [CI] 1.04-1.42) or a major bleeding (odds ratio 1.60, 95% CI 1.26-2.03), with no impact of daily dose and duration of paracetamol treatment. Time-varying analysis found an increased risk of MACE with both paracetamol (hazard ratio 1.22, 95% CI 1.05-1.43) and ibuprofen (hazard ratio 1.47, 95% CI 1.06-2.03) and of major bleeding with paracetamol (hazard ratio 1.95, 95% CI 1.45-2.62). There was a weak and inconsistent signal for association between paracetamol or ibuprofen and MACE or major bleeding, which may be related to either a genuine but modest effect of these drugs or to residual confounding. http://www.isrctn.com. Unique identifier: ISRCTN66157730. © 2016 American Heart Association, Inc.

  5. Major stressful life events and other risk factors for first admission with mania

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Agerbo, Esben; Mortensen, Preben Bo

    2004-01-01

    OBJECTIVES: To investigate whether first admission with mania is associated with the occurrence of death in the family or with major stressful life events and to explore whether the associations change with age. METHODS: Case register study with linkage of the Danish Psychiatric Central Research ...... disorder. The susceptibility to major life stressors of inducing mania does not seem to change throughout life....

  6. Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation

    International Nuclear Information System (INIS)

    Akutsu, Yasushi; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Kawamura, Mitsuharu; Asano, Taku; Hamazaki, Yuji; Tanno, Kaoru; Kobayashi, Youichi; Suyama, Jumpei; Shinozuka, Akira; Gokan, Takehiko

    2010-01-01

    Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using 123 I metaiodobenzylguanidine ( 123 I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF. 123 I-MIBG scintigraphy was performed in 69 consecutive patients (67 ± 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before 123 I-MIBG study. During a mean of 4.5 ± 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP (≥0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006). SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF. (orig.)

  7. Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Akutsu, Yasushi; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Kawamura, Mitsuharu; Asano, Taku; Hamazaki, Yuji; Tanno, Kaoru; Kobayashi, Youichi [Showa University School of Medicine, Division of Cardiology, Department of Medicine, Tokyo (Japan); Suyama, Jumpei; Shinozuka, Akira; Gokan, Takehiko [Showa University School of Medicine, Department of Radiology, Tokyo (Japan)

    2010-04-15

    Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using {sup 123}I metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF. {sup 123}I-MIBG scintigraphy was performed in 69 consecutive patients (67 {+-} 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before {sup 123}I-MIBG study. During a mean of 4.5 {+-} 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP ({>=}0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006). SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF. (orig.)

  8. Nuclear Security Systems and Measures for Major Public Events. Implementing Guide

    International Nuclear Information System (INIS)

    2012-01-01

    Terrorism remains a threat to international stability and security. High profile international and national major public events occur regularly, capturing great public interest and receiving intense media coverage. It is widely acknowledged that there is a substantial threat of a terrorist attack on major public events such as high profile political or economic summit meetings or major sporting contests. The threat of nuclear and radiological terrorism remains on the international security agenda. Nevertheless, to reduce this risk, the international community has made great progress in securing nuclear and other radioactive material that could otherwise be used in a terrorist act. This progress is contingent on the efforts of all States to adopt strong nuclear security systems and measures. There are large quantities of diverse radioactive material in existence, which are used in areas such as health, the environment, agriculture and industry. The hazards of this material vary according to composition and intensity. Additionally, the use of explosives in combination with this material can drastically enhance the impact of a criminal or terrorist act. If a criminal or terrorist group managed to detonate a so-called 'dirty' bomb in an urban area, the result could be mass panic, widespread radioactive contamination and major economic and social disruption. Major public events are seldom held in the same State or at the same location or even at the same venue. At the national level, the hosting of major public events with proper nuclear security arrangements can provide a foundation on which to build an enduring national framework for nuclear security; one that can exist long after the event. The organization of a major public event in which large numbers of people congregate presents complex security challenges for the State hosting such an event. Criminal or terrorist acts involving nuclear or other radioactive material at any major public event could result in

  9. Nuclear Security Systems and Measures for Major Public Events. Implementing Guide (Russian Edition)

    International Nuclear Information System (INIS)

    2014-01-01

    Terrorism remains a threat to international stability and security. High profile international and national major public events occur regularly, capturing great public interest and receiving intense media coverage. It is widely acknowledged that there is a substantial threat of a terrorist attack on major public events such as high profile political or economic summit meetings or major sporting contests. The threat of nuclear and radiological terrorism remains on the international security agenda. Nevertheless, to reduce this risk, the international community has made great progress in securing nuclear and other radioactive material that could otherwise be used in a terrorist act. This progress is contingent on the efforts of all States to adopt strong nuclear security systems and measures. There are large quantities of diverse radioactive material in existence, which are used in areas such as health, the environment, agriculture and industry. The hazards of this material vary according to composition and intensity. Additionally, the use of explosives in combination with this material can drastically enhance the impact of a criminal or terrorist act. If a criminal or terrorist group managed to detonate a so-called 'dirty' bomb in an urban area, the result could be mass panic, widespread radioactive contamination and major economic and social disruption. Major public events are seldom held in the same State or at the same location or even at the same venue. At the national level, the hosting of major public events with proper nuclear security arrangements can provide a foundation on which to build an enduring national framework for nuclear security; one that can exist long after the event. The organization of a major public event in which large numbers of people congregate presents complex security challenges for the State hosting such an event. Criminal or terrorist acts involving nuclear or other radioactive material at any major public event could result in

  10. Cognitive complexity of the medical record is a risk factor for major adverse events.

    Science.gov (United States)

    Roberson, David; Connell, Michael; Dillis, Shay; Gauvreau, Kimberlee; Gore, Rebecca; Heagerty, Elaina; Jenkins, Kathy; Ma, Lin; Maurer, Amy; Stephenson, Jessica; Schwartz, Margot

    2014-01-01

    Patients in tertiary care hospitals are more complex than in the past, but the implications of this are poorly understood as "patient complexity" has been difficult to quantify. We developed a tool, the Complexity Ruler, to quantify the amount of data (as bits) in the patient’s medical record. We designated the amount of data in the medical record as the cognitive complexity of the medical record (CCMR). We hypothesized that CCMR is a useful surrogate for true patient complexity and that higher CCMR correlates with risk of major adverse events. The Complexity Ruler was validated by comparing the measured CCMR with physician rankings of patient complexity on specific inpatient services. It was tested in a case-control model of all patients with major adverse events at a tertiary care pediatric hospital from 2005 to 2006. The main outcome measure was an externally reported major adverse event. We measured CCMR for 24 hours before the event, and we estimated lifetime CCMR. Above empirically derived cutoffs, 24-hour and lifetime CCMR were risk factors for major adverse events (odds ratios, 5.3 and 6.5, respectively). In a multivariate analysis, CCMR alone was essentially as predictive of risk as a model that started with 30-plus clinical factors. CCMR correlates with physician assessment of complexity and risk of adverse events. We hypothesize that increased CCMR increases the risk of physician cognitive overload. An automated version of the Complexity Ruler could allow identification of at-risk patients in real time.

  11. Major geological events and uranium metallogenesis in South-west China

    International Nuclear Information System (INIS)

    Zhang Chengjiang; Xu Zhengqi; Ni Shijun; Chen Youliang

    2012-01-01

    Uranium is widely distributed in South-west China, with all types but on a not-so-large scale. South-west China is located on the combining site of several large tectonic elements and every tectonic movement has different effects on different regions. To study and clarify the correlation between the major geological events in South-west China and the Uranium metallogenesis, comprehensive research and field investigation are made besides collecting a lot of materials. Through analysis and research on the major geological events in South-west China, the evolution of those e vents is basically clarified and the events closely related with uranium mineralization are determined. It is discovered that there are several ore-forming geologic events in the geological history of South-west China; almost every major tectonic movement cycle is accompanied with uranium metallogenesis, from Jinning Movement to Chengjiang Movement, to Hercynian Movement, to Indosinian Movement. to Yanshan Movement. to Himalayan movement. Even though every major tectonic cycle is accompanied with uranium mineralization, three major geological events are generally obviously related with uranium metallogenesis, i.e. the Rodinian supercontinent breakup even in Jinning-Chengjiang Period, Yanshan Movement and Himalayan movement, in which the first one is the process of uranium pre-enrichment and provides the source of uranium. Yanshan Movement and Himalayan movement are the important processes for mineralization, mainly the hydrothermal superimposed mineralization. (authors)

  12. Effect of long-term hydroxychloroquine on vascular events in patients with systemic lupus erythematosus: a database prospective cohort study.

    Science.gov (United States)

    Hsu, Chung-Yuan; Lin, Yu-Sheng; Su, Yu-Jih; Lin, Hsing-Fen; Lin, Ming-Shyan; Syu, Ya-Jhu; Cheng, Tien-Tsai; Yu, Shan-Fu; Chen, Jia-Feng; Chen, Tien-Hsing

    2017-12-01

    The incidence of thromboembolism in patients with SLE is higher than that in the general population. HCQ, widely used to treat lupus, may have vascular protective effects. The aim of this study was to determine whether long-term HCQ exposure is associated with decreased thromboembolism risk in SLE. We designed a prospective cohort study within an SLE population based on the National Health Insurance Research Database in Taiwan. We divided participants into HCQ and control groups according to HCQ prescription during the first year. These groups were defined by medication possession ratio (MPR) ⩾80% and MPR = 0%, respectively. Patients with an MPR between 0 and 80% were excluded. The primary outcome was a composite vascular event, including acute coronary syndrome, ischaemic stroke, pulmonary embolism, deep vein thrombosis and peripheral arterial disease 1 year after inclusion. We excluded patients from the cohort if they had outcomes within the first year. A total of 8397 patients were eligible for analysis. After propensity-score matching, we included 1946 patients in each group. During a mean follow-up of 7.4 years, the number of events was 139 in the HCQ group (7.1%) and 149 in the control group (7.7%). The risk of vascular events in the HCQ group was similar to that in the control group (hazard ratio = 0.91; 95% CI: 0.72, 1.15). Further subgroup analyses confirmed no statistically significant differences between the groups. Long-term HCQ appears to have no vascular protective effect in patients with SLE. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  13. Locating and mitigating risks to children associated with major sporting events

    OpenAIRE

    Brackenridge, CH; Rhind, D; Palmer-Felgate, S

    2014-01-01

    Despite recent efforts to blend sport and human rights, activism for children's rights in sport has historically been marginalised. The positive 'social legacy' of sport events frequently masks more problematic issues, including child exploitation. We argue that harms to children in hosting communities of major sporting events (MSEs) should be a focus for both research and intervention since the plight of such children is currently a political blind spot. The article examines the evidence for...

  14. Survey of the incidence and effect of major life events on graduate medical education trainees

    Directory of Open Access Journals (Sweden)

    Lars J. Grimm

    2015-06-01

    Full Text Available Purpose: This study aims to assess the incidence of major life events during graduate medical education (GME training and to establish any associations with modifiable activities and career planning. Methods: The authors surveyed graduating GME trainees from their parent institution in June 2013. Demographic information (clinical department, gender, training duration and major life events (marriage, children, death/illness, home purchase, legal troubles, property loss were surveyed. Respondents were queried about the relationship between life events and career planning. A multivariable logistic regression model tested for associations. Results: A total of 53.2% (166/312 of graduates responded to the survey. 50% (83/166 of respondents were female. Major life events occurred in 96.4% (160/166 of respondents. Male trainees were more likely (56.1% [46/82] vs. 30.1% [25/83] to have a child during training (p=0.01. A total of 41.6% (69/166 of responders consciously engaged or avoided activities during GME training, while 31.9% (53/166 of responders reported that life events influenced their career plans. Trainees in lifestyle residencies (p=0.02, those who experienced the death or illness of a close associate (p=0.01, and those with legal troubles (p=0.04 were significantly more likely to consciously control life events. Conclusion: Major life events are very common and changed career plans in nearly a third of GME trainees. Furthermore, many trainees consciously avoided activities due to their responsibilities during training. GME training programs should closely assess the institutional support systems available to trainees during this difficult time.

  15. Identification of major cardiovascular events in patients with diabetes using primary care data.

    Science.gov (United States)

    Pouwels, Koen Bernardus; Voorham, Jaco; Hak, Eelko; Denig, Petra

    2016-04-02

    Routine primary care data are increasingly being used for evaluation and research purposes but there are concerns about the completeness and accuracy of diagnoses and events captured in such databases. We evaluated how well patients with major cardiovascular disease (CVD) can be identified using primary care morbidity data and drug prescriptions. The study was conducted using data from 17,230 diabetes patients of the GIANTT database and Dutch Hospital Data register. To estimate the accuracy of the different measures, we analyzed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) relative to hospitalizations and/or records with a diagnosis indicating major CVD, including ischaemic heart diseases and cerebrovascular events. Using primary care morbidity data, 43% of major CVD hospitalizations could be identified. Adding drug prescriptions to the search increased the sensitivity up to 94%. A proxy of at least one prescription of either a platelet aggregation inhibitor, vitamin k antagonist or nitrate could identify 85% of patients with a history of major CVD recorded in primary care, with an NPV of 97%. Using the same proxy, 57% of incident major CVD recorded in primary or hospital care could be identified, with an NPV of 99%. A substantial proportion of major CVD hospitalizations was not recorded in primary care morbidity data. Drug prescriptions can be used in addition to diagnosis codes to identify more patients with major CVD, and also to identify patients without a history of major CVD.

  16. Examining the influence of major life events as drivers of residential mobility and neighbourhood transitions

    Directory of Open Access Journals (Sweden)

    Timothy Morris

    2017-03-01

    Full Text Available Background: Residential mobility and internal migration have long been key foci of research across a range of disciplines. However, the analytical strategies adopted in many studies are unable to unpick the drivers of mobility in sufficient detail because of two issues prevalent within the literature: a lack of detailed information on the individual context of people's lives and a failure to apply longitudinal methods. Methods: Using detailed data from a UK birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC, and a multilevel recurrent-event history analysis approach, this paper overcomes these two major limitations and presents a number of findings. Results: Most life events increase the likelihood of moving, even though there is little evidence that they precede upwards or downwards mobility into more or less deprived neighbourhoods. The findings also suggest that families living in poor homes and neighbourhoods are more likely to be stuck in place following certain negative life events than those in good environments. Conclusions: While broad demographic and socioeconomic characteristics reliably account for mobility patterns, the occurrence of life events and a person's attitudes towards their living environment are necessary for a full understanding of mobility patterns. Future studies should strive to account for such detailed data. Contribution: We demonstrate the important impact that a wide range of life events has on the mobility of families and provide evidence that studies unable to account for major life events likely do not suffer strong bias results through unobserved confounding.

  17. Nuclear Security Systems and Measures for Major Public Events. Implementing Guide (French Edition)

    International Nuclear Information System (INIS)

    2017-01-01

    This publication provides an overview, based on practical experience and lessons learned, for establishing nuclear security systems and measures for major public events. It covers technical and administrative nuclear security measures for developing the necessary organizational structure, developing plans, strategies and concepts of operations, and making arrangements for implementing the developed plans, strategies and concepts.

  18. Identification of major cardiovascular events in patients with diabetes using primary care data

    NARCIS (Netherlands)

    Pouwels, Koen Bernardus; Voorham, Jaco; Hak, Eelko; Denig, Petra

    2016-01-01

    Background: Routine primary care data are increasingly being used for evaluation and research purposes but there are concerns about the completeness and accuracy of diagnoses and events captured in such databases. We evaluated how well patients with major cardiovascular disease (CVD) can be

  19. Major stressful life events in adulthood and risk of multiple sclerosis

    DEFF Research Database (Denmark)

    Nielsen, Nete Munk; Bager, Peter; Simonsen, Jacob

    2014-01-01

    It is unclear whether psychological stress is associated with increased risk of multiple sclerosis (MS). We studied the association between major stressful life events and MS in a nationwide cohort study using death of a child or a spouse or marital dissolution as indicators of severe stress....

  20. Negative Emotionality and Disconstraint Influence PTSD Symptom Course via Exposure to New Major Adverse Life Events

    Science.gov (United States)

    Sadeh, Naomi; Miller, Mark W.; Wolf, Erika J.; Harkness, Kate L.

    2015-01-01

    Identifying the factors that influence stability and change in chronic posttraumatic stress disorder (PTSD) is important for improving clinical outcomes. Using a cross-lagged design, we analyzed the reciprocal effects of personality and PTSD symptoms over time and their effects on stress exposure in a sample of 222 trauma-exposed veterans (ages 23 – 68; 90.5% male). Personality functioning and PTSD were measured approximately 4 years apart, and self-reported exposure to major adverse life events during the interim was also assessed. Negative emotionality positively predicted future PTSD symptoms, and this effect was partially mediated by exposure to new events. Constraint (negatively) indirectly affected PTSD via its association with exposure to new events. There were no significant effects of positive emotionality nor did PTSD symptom severity exert influences on personality over time. Results indicate that high negative affect and disconstraint influence the course of PTSD symptoms by increasing exposure to stressful life events. PMID:25659969

  1. Early snowmelt events: detection, distribution, and significance in a major sub-arctic watershed

    International Nuclear Information System (INIS)

    Semmens, Kathryn Alese; Ramage, Joan; Bartsch, Annett; Liston, Glen E

    2013-01-01

    High latitude drainage basins are experiencing higher average temperatures, earlier snowmelt onset in spring, and an increase in rain on snow (ROS) events in winter, trends that climate models project into the future. Snowmelt-dominated basins are most sensitive to winter temperature increases that influence the frequency of ROS events and the timing and duration of snowmelt, resulting in changes to spring runoff. Of specific interest in this study are early melt events that occur in late winter preceding melt onset in the spring. The study focuses on satellite determination and characterization of these early melt events using the Yukon River Basin (Canada/USA) as a test domain. The timing of these events was estimated using data from passive (Advanced Microwave Scanning Radiometer—EOS (AMSR-E)) and active (SeaWinds on Quick Scatterometer (QuikSCAT)) microwave remote sensors, employing detection algorithms for brightness temperature (AMSR-E) and radar backscatter (QuikSCAT). The satellite detected events were validated with ground station meteorological and hydrological data, and the spatial and temporal variability of the events across the entire river basin was characterized. Possible causative factors for the detected events, including ROS, fog, and positive air temperatures, were determined by comparing the timing of the events to parameters from SnowModel and National Centers for Environmental Prediction North American Regional Reanalysis (NARR) outputs, and weather station data. All melt events coincided with above freezing temperatures, while a limited number corresponded to ROS (determined from SnowModel and ground data) and a majority to fog occurrence (determined from NARR). The results underscore the significant influence that warm air intrusions have on melt in some areas and demonstrate the large temporal and spatial variability over years and regions. The study provides a method for melt detection and a baseline from which to assess future change

  2. Role of Peripheral Vascular Resistance for the Association Between Major Depression and Cardiovascular Disease

    DEFF Research Database (Denmark)

    Bouzinova, Elena; Wiborg, Ove; Aalkjær, Christian

    2015-01-01

    Major depression and cardiovascular diseases are 2 of the most prevalent health problems in Western society, and an association between them is generally accepted. Although the specific mechanism behind this comorbidity remains to be elucidated, it is clear that it has a complex multifactorial....... The changes in arterial structure, contractile and relaxing functions associated with depression symptoms are discussed, and the role of these abnormalities for the pathology of major depression and cardiovascular diseases are suggested....... character including a number of neuronal, humoral, immune, and circulatory pathways. Depression-associated cardiovascular abnormalities associate with cardiac dysfunctions and with changes in peripheral resistance. Although cardiac dysfunction in association with depression has been studied in detail...

  3. The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008)

    Science.gov (United States)

    Thomas, Sian; Thomson, Hilary; Scott, John; Hamilton, Val; Hanlon, Phil; Morrison, David S; Bond, Lyndal

    2010-01-01

    Objective To assess the effects of major multi-sport events on health and socioeconomic determinants of health in the population of the city hosting the event. Design Systematic review. Data sources We searched the following sources without language restrictions for papers published between 1978 and 2008: Applied Social Science Index and Abstracts (ASSIA), British Humanities Index (BHI), Cochrane database of systematic reviews, Econlit database, Embase, Education Resources Information Center (ERIC) database, Health Management Information Consortium (HMIC) database, International Bibliography of the Social Sciences (IBSS), Medline, PreMedline, PsycINFO, Sociological Abstracts, Sportdiscus, Web of Knowledge, Worldwide Political Science Abstracts, and the grey literature. Review methods Studies of any design that assessed the health and socioeconomic impacts of major multi-sport events on the host population were included. We excluded studies that used exclusively estimated data rather than actual data, that investigated host population support for an event or media portrayals of host cities, or that described new physical infrastructure. Studies were selected and critically appraised by two independent reviewers. Results Fifty four studies were included. Study quality was poor, with 69% of studies using a repeat cross-sectional design and 85% of quantitative studies assessed as being below 2+ on the Health Development Agency appraisal scale, often because of a lack of comparison group. Five studies, each with a high risk of bias, reported health related outcomes, which were suicide, paediatric health service demand, presentations for asthma in children (two studies), and problems related to illicit drug use. Overall, the data did not indicate clear negative or positive health impacts of major multi-sport events on host populations. The most frequently reported outcomes were economic outcomes (18 studies). The outcomes used were similar enough to allow us to perform a

  4. The health and socioeconomic impacts of major multi-sport events: systematic review (1978-2008).

    Science.gov (United States)

    McCartney, Gerry; Thomas, Sian; Thomson, Hilary; Scott, John; Hamilton, Val; Hanlon, Phil; Morrison, David S; Bond, Lyndal

    2010-05-20

    To assess the effects of major multi-sport events on health and socioeconomic determinants of health in the population of the city hosting the event. Systematic review. We searched the following sources without language restrictions for papers published between 1978 and 2008: Applied Social Science Index and Abstracts (ASSIA), British Humanities Index (BHI), Cochrane database of systematic reviews, Econlit database, Embase, Education Resources Information Center (ERIC) database, Health Management Information Consortium (HMIC) database, International Bibliography of the Social Sciences (IBSS), Medline, PreMedline, PsycINFO, Sociological Abstracts, Sportdiscus, Web of Knowledge, Worldwide Political Science Abstracts, and the grey literature. Review methods Studies of any design that assessed the health and socioeconomic impacts of major multi-sport events on the host population were included. We excluded studies that used exclusively estimated data rather than actual data, that investigated host population support for an event or media portrayals of host cities, or that described new physical infrastructure. Studies were selected and critically appraised by two independent reviewers. Fifty four studies were included. Study quality was poor, with 69% of studies using a repeat cross-sectional design and 85% of quantitative studies assessed as being below 2+ on the Health Development Agency appraisal scale, often because of a lack of comparison group. Five studies, each with a high risk of bias, reported health related outcomes, which were suicide, paediatric health service demand, presentations for asthma in children (two studies), and problems related to illicit drug use. Overall, the data did not indicate clear negative or positive health impacts of major multi-sport events on host populations. The most frequently reported outcomes were economic outcomes (18 studies). The outcomes used were similar enough to allow us to perform a narrative synthesis, but the overall

  5. Variabilities of mesospheric tides and equatorial electrojet strength during major stratospheric warming events

    Directory of Open Access Journals (Sweden)

    S. Sridharan

    2009-11-01

    Full Text Available The present study demonstrates the relationship between the high latitude northern hemispheric major sudden stratospheric warming (SSW events and the reversal in the afternoon equatorial electrojet (EEJ, often called the counter-electrojet (CEJ, during the winter months of 1998–1999, 2001–2002, 2003–2004 and 2005–2006. As the EEJ current system is driven by tidal winds, an investigation of tidal variabilities in the MF radar observed zonal winds during the winters of 1998–1999 and 2005–2006 at 88 km over Tirunelveli, a site close to the magnetic equator, shows that there is an enhancement of semi-diurnal tidal amplitude during the days of a major SSW event and a suppression of the same immediately after the event. The significance of the present results lies in demonstrating the latitudinal coupling between the high latitude SSW phenomenon and the equatorial ionospheric current system with clear evidence for major SSW events influencing the day-to-day variability of the CEJ.

  6. Overview of results and perspectives from the Shoreham major common-cause initiating events study

    International Nuclear Information System (INIS)

    Joksimovich, V.; Orvis, D.D.; Paccione, R.J.

    1986-01-01

    This study represents the continuation of a large effort by LILCO to fully understand the potential hazards posed by future operation of the Shoreham Nuclear Power Stations (SNPS). The Shoreham Probabilistic Risk Assessment, a level 3 PRA without external events, provided a characterization of the accident sequences that could leave the core in a condition in which it would be vulnerable to severe damage if further mitigating actions were not taken. It estimated the frequency and magnitude of the potential radioactivity releases associated with such sequences. The study was limited to accident sequences initiated by so called internal events to the plant including a loss of offsite power. It also characterized the public risk associated with those accident sequences. The ''Major Common-Cause Initiating Events Study'' (MCCI) for the Shoreham plant was performed to obtain insights into the plant's susceptibility to, and inherent defenses against, certain MCCIs. Major common-cause initiating events are occurrences which have the potential to initiate a plant transient or LOCA and, also, damage one or more plant systems needed to mitigate the effects of a transient or LOCA. The scope of the MCCI study included detailed analyses of seismic events and fires through the severe core damage and bounding analyses of aircraft crashes, windstorms, turbine missiles and release of hazardous materials near the plant

  7. Prognostic table for predicting major cardiac events based on J-ACCESS investigation

    International Nuclear Information System (INIS)

    Nakajima, Kenichi; Nishimura, Tsunehiko

    2008-01-01

    The event risk of patients with coronary heart disease may be estimated by a large-scale prognostic database in a Japanese population. The aim of this study was to create a heart risk table for predicting the major cardiac event rate. Using the Japanese-assessment of cardiac event and survival study (J-ACCESS) database created by a prognostic investigation involving 117 hospitals and >4000 patients in Japan, multivariate logistic regression analysis was performed. The major event rate over a 3-year period that included cardiac death, non-fatal myocardial infarction, and severe heart failure requiring hospitalization was predicted by the logistic regression equation. The algorithm for calculating the event rate was simplified for creating tables. Two tables were created to calculate cardiac risk by age, perfusion score category, and ejection fraction with and without the presence of diabetes. A relative risk table comparing age-matched control subjects was also made. When the simplified tables were compared with the results from the original logistic regression analysis, both risk values and relative risks agreed well (P<0.0001 for both). The Heart Risk Table was created for patients suspected of having ischemic heart disease and who underwent myocardial perfusion gated single-photon emission computed tomography. The validity of risk assessment using a J-ACCESS database should be validated in a future study. (author)

  8. Effect of darapladib on major coronary events after an acute coronary syndrome

    DEFF Research Database (Denmark)

    O'Donoghue, Michelle L; Braunwald, Eugene; White, Harvey D

    2014-01-01

    ]) at 868 sites in 36 countries. INTERVENTIONS: Patients were randomized to either once-daily darapladib (160 mg) or placebo on a background of guideline-recommended therapy. Patients were followed up for a median of 2.5 years between December 7, 2009, and December 6, 2013. MAIN OUTCOMES AND MEASURES......: The primary end point (major coronary events) was the composite of coronary heart disease (CHD) death, MI, or urgent coronary revascularization for myocardial ischemia. Kaplan-Meier event rates are reported at 3 years. RESULTS: During a median duration of 2.5 years, the primary end point occurred in 903...

  9. Association of Selected Antipsychotic Agents With Major Adverse Cardiovascular Events and Noncardiovascular Mortality in Elderly Persons

    DEFF Research Database (Denmark)

    Sahlberg, Marie; Holm, Ellen; Gislason, Gunnar H

    2015-01-01

    events and noncardiovascular mortality associated with individual APs (ziprasidone, olanzapine, risperidone, quetiapine, levomepromazine, chlorprothixen, flupentixol, and haloperidol) in Danish treatment-naïve patients aged ≥70 years. METHODS AND RESULTS: We followed all treatment-naïve Danish citizens...... of treatment, compared with risperidone, incidence rate ratios of major adverse cardiovascular events were higher with use of levomepromazine (3.80, 95% CI 3.43 to 4.21) and haloperidol (1.85, 95% CI 1.67 to 2.05) and lower for treatment with flupentixol (0.54, 95% CI 0.45 to 0.66), ziprasidone (0.31, 95% CI 0...

  10. Low vascularization of the nephrogenic zone of the fetal kidney suggests a major role for hypoxia in human nephrogenesis.

    Science.gov (United States)

    Gerosa, C; Fanni, D; Faa, A; Van Eyken, P; Ravarino, A; Fanos, V; Faa, G

    2017-09-01

    CD31 reactivity is generally utilized as a marker of endothelial cells. CD31 immunoreactivity in the developing human kidney revealed that fetal glomerular capillary endothelial cells change their immunohistochemical phenotype during maturation. The aim of this study was to analyze CD31 reactivity in the fetal human kidney in the different stages of intrauterine development: We observed different distribution of CD31-reactive vascular progenitors in the different areas of the developing kidney. In particular, the nephrogenic zone and the renal capsule were characterized by a scarcity of CD31-reactive cells at all gestational ages. These data suggest the hypothesis that nephrogenesis does not need high oxygen levels and confirms a major role of hypoxia in nephrogenesis.

  11. Vascular dysfunction associated with major depression-like symptoms: monoamine homeostasis and endothelial dysfunction

    DEFF Research Database (Denmark)

    Bouzinova, Elena; Andresen, Jørgen; Wiborg, Ove

    Major depression and cardiovascular diseases have strong co-morbidity but the reason for this is unknown. In Chronic Mild Stress (CMS) model of depression only some rats develop depression-like symptoms (i.e. anhedonia, measured by sucrose intake) while others are resilient to 8 weeks of CMS...... and reduced expression of extra-neuronal transporter (OCT-2) in anhedonic arteries. The contractility of middle cerebral arteries to 5-HT was reduced by CMS but recovered by anti-depressant treatment. Resistance arteries from anhedonic rats were less sensitive to acetylcholine compared to non......-like response) was significantly reduced in anhedonic rats. This was associated with decreased transcription of intermediate-conductance Ca2+-activated K+ channels. Our results indicate that CMS-induced depression-like symptoms in rats are associated with changes in monoamine uptake and endothelial dysfunctions...

  12. Stressful life events preceding the onset of depression in Asian patients with major depressive disorder.

    Science.gov (United States)

    Park, Subin; Hatim, Ahmad; Si, Tian-Mei; Jeon, Hong Jin; Srisurapanont, Manit; Bautista, Dianne; Liu, Shen-ing; Chua, Hong Choon; Hong, Jin Pyo

    2015-12-01

    Previous studies have identified the significant role of stressful life events in the onset of depressive episodes. However, there is a paucity of cross-national studies on stressful life events that precede depression. We aimed to compare types of stressful life events associated with the onset of depressive episodes in patients with major depressive disorder (MDD) in five Asian countries. A total of 507 outpatients with MDD were recruited in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Thailand (n = 103) and Taiwan (n = 99). All patients were assessed with the Mini-International Neuropsychiatric Interview and the List of Threatening Experiences. The prevalence of each type of stressful life events was calculated and compared between each country. The type of stressful life event that preceded the onset of a depressive episode differed between patients in China and Taiwan and those in South Korea, Malaysia and Thailand. Patients in China and Taiwan were less likely to report interpersonal relationship problems and occupational/financial problems than patients in South Korea, Malaysia and Thailand. Understanding the nature and basis of culturally determined susceptibilities to specific stressful life events is critical for establishing a policy of depression prevention and providing effective counseling services for depressed patients. © The Author(s) 2015.

  13. 76 FR 38552 - Amendments to Regulations Regarding Major Life-Changing Events Affecting Income-Related Monthly...

    Science.gov (United States)

    2011-07-01

    ... provides that major life-changing events include marriage, divorce, death of spouse, or other events..., we require evidence documenting the settlement and the reason(s) for the settlement. These changes... major life-changing events if the reasons for such loss are due to the ordinary risk of investment...

  14. Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery.

    Science.gov (United States)

    Tan, Hung-Jui; Saliba, Debra; Kwan, Lorna; Moore, Alison A; Litwin, Mark S

    2016-04-10

    Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer. Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes. Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84). Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care. © 2016 by

  15. Morphometric analysis of vascular pathology in the orbitofrontal cortex of older subjects with major depression.

    Science.gov (United States)

    Miguel-Hidalgo, Jose Javier; Jiang, Wei; Konick, Lisa; Overholser, James C; Jurjus, George J; Stockmeier, Craig A; Steffens, David C; Krishnan, K Ranga R; Rajkowska, Grazyna

    2013-09-01

    Late-life depression has been associated with risk for cerebrovascular pathology, as demonstrated in neuroimaging studies of older depressed patients, as well as mood disorder following cerebrovascular accidents. However, more research is needed on neuroanatomical changes in late-life depression, where there has been no clearly documented link to brain injury. Such studies should examine morphological changes in medium and small sized vessels that supply the cortical gray and white matter. The present study used a non-specific histological Nissl staining and a more vessel-specific immunolabeling with endothelial marker von Willebrand Factor (vWF) to estimate density and size of blood vessel segments in the orbitofrontal cortex of 16 older subjects with major depressive disorder (MDD) and 9 non-psychiatric comparison subjects. The density of Nissl-stained vessel segments and of segments with perivascular spaces was higher in subjects with MDD than in comparison subjects in gray (GM) and white matter (WM). In GM, the density of vWF-immunoreactive segments with cross-sectional areas greater than 800 µm2 was higher in MDD. In WM, only the density of vWF-immunoreactive segments with patent perivascular spaces and diameters larger than 60 µm was higher in subjects with MDD. Also in the WM, only subjects with late-onset MDD presented a significantly higher density of vWF-positive segments than comparison subjects. In older subjects with MDD, there appear to be morphological changes that increase visibility of medium-sized vessel segments with some labeling techniques, and this increased visibility may be related to increased patency of perivascular spaces around arterioles. Copyright © 2012 John Wiley & Sons, Ltd.

  16. MORPHOMETRIC ANALYSIS OF VASCULAR PATHOLOGY IN THE ORBITOFRONTAL CORTEX OF ELDERLY SUBJECTS WITH MAJOR DEPRESSION

    Science.gov (United States)

    Miguel-Hidalgo, Jose Javier; Jiang, Wei; Konick, Lisa; Overholser, James C.; Jurjus, George J.; Stockmeier, Craig A.; Steffens, David; Krishnan, K. Ranga R.; Rajkowska, Grazyna

    2012-01-01

    Objective Late-life depression has been associated with risk for cerebrovascular pathology, as demonstrated in neuroimaging studies of older depressed patients, as well as mood disorder following cerebrovascular accidents. However, more research is needed on neuroanatomical changes in late-life depression, where there has been no clearly documented link to brain injury. Such studies should examine morphological changes in medium and small sized vessels that supply the cortical gray and white matter. Methods The present study used a non-specific histological Nissl staining and a more vessel-specific immunolabeling with endothelial marker von Willebrand Factor (vWF) to estimate density and size of blood vessel segments in the orbitofrontal cortex of 16 elderly subjects with major depressive disorder (MDD) and 9 non-psychiatric comparison subjects. Results The density of Nissl-stained vessel segments and of segments with perivascular spaces was higher in subjects with MDD than in comparison subjects in gray (GM) and white matter (WM). In GM, the density of vWF-immunoreactive segments with cross-sectional areas greater than 800 μm2 was higher in MDD. In WM, only the density of vWF-immunoreactive segments with patent perivascular spaces and diameters larger than 60 μm was higher in subjects with MDD. Also in the WM, only subjects with late-onset MDD presented a significantly higher density of vWF-positive segments than comparison subjects. Conclusions In elderly subjects with MDD, there appear to be morphological changes that increase visibility of medium-sized vessel segments with some labeling techniques, and this increased visibility may be related to increased patency of perivascular spaces around arterioles. PMID:23208772

  17. Individuals' quality of life linked to major life events, perceived social support, and personality traits.

    Science.gov (United States)

    Pocnet, Cornelia; Antonietti, Jean-Philippe; Strippoli, Marie-Pierre F; Glaus, Jennifer; Preisig, Martin; Rossier, Jérôme

    2016-11-01

    The aim of this study was to investigate the relationship between major recent life events that occurred during the last 5 years, social and personal resources, and subjective quality of life (QoL). A total of 1801 participants from the general population (CoLaus/PsyCoLaus study) completed the Life Events Questionnaire, the Social Support Questionnaire, the NEO Five-Factor Inventory Revised, and the Manchester Short Assessment of Quality of Life. Major life events were modestly associated with the QoL (about 5 % of the explained variance). However, QoL was significantly related to perceived social support and personality traits (about 37 % of the explained variance). Particularly, perceived social support, extraversion and conscientiousness personality dimensions were positively linked to life satisfaction, whereas a high level of neuroticism was negatively associated with QoL. This study highlights the negative but temporary association between critical events and QoL. However, a combination of high conscientiousness and extraversion, and positive social support may explain better variances for a high-perceived QoL.

  18. Increased Risk of Vascular Events in Emergency Room Patients Discharged Home with Diagnosis of Dizziness or Vertigo: A 3-Year Follow-Up Study

    Science.gov (United States)

    Lee, Ching-Chih; Ho, Hsu-Chueh; Su, Yu-Chieh; Chiu, Brian C-H; Su, Yung-Cheng; Lee, Yi-Da; Chou, Pesus

    2012-01-01

    Background Dizziness and vertigo symptoms are commonly seen in emergency room (ER). However, these patients are often discharged without a definite diagnosis. Conflicting data regarding the vascular event risk among the dizziness or vertigo patients have been reported. This study aims to determine the risk of developing stroke or cardiovascular events in ER patients discharged home with a diagnosis of dizziness or vertigo. Methodology A total of 25,757 subjects with at least one ER visit in 2004 were identified. Of those, 1,118 patients were discharged home with a diagnosis of vertigo or dizziness. A Cox proportional hazard model was performed to compare the three-year vascular event-free survival rates between the dizziness/vertigo patients and those without dizziness/vertigo after adjusting for confounding and risk factors. Results We identified 52 (4.7%) vascular events in patients with dizziness/vertigo and 454 (1.8%) vascular events in patients without dizziness/vertigo. ER patients discharged home with a diagnosis of vertigo or dizziness had 2-fold (95% confidence interval [CI], 1.35–2.96; pvertigo during the first year. Conclusions ER patients discharged home with a diagnosis of dizziness or vertigo were at a increased risk of developing subsequent vascular events than those without dizziness/vertigo after the onset of dizziness or vertigo. Further studies are warranted for developing better diagnostic and follow-up strategies in increased risk patients. PMID:22558272

  19. Evaluation of Life Events in Major Depression: Assessing Negative Emotional Bias.

    Science.gov (United States)

    Girz, Laura; Driver-Linn, Erin; Miller, Gregory A; Deldin, Patricia J

    2017-05-01

    Overly negative appraisals of negative life events characterize depression but patterns of emotion bias associated with life events in depression are not well understood. The goal of this paper is to determine under which situations emotional responses are stronger than expected given life events and which emotions are biased. Depressed (n = 16) and non-depressed (n = 14) participants (mean age = 41.4 years) wrote about negative life events involving their own actions and inactions, and rated the current emotion elicited by those events. They also rated emotions elicited by someone else's actions and inactions. These ratings were compared with evaluations provided by a second, 'benchmark' group of non-depressed individuals (n = 20) in order to assess the magnitude and direction of possible biased emotional reactions in the two groups. Participants with depression reported greater anger and disgust than expected in response to both actions and inactions, whereas they reported greater guilt, shame, sadness, responsibility and fear than expected in response to inactions. Relative to non-depressed and benchmark participants, depressed participants were overly negative in the evaluation of their own life events, but not the life events of others. A standardized method for establishing emotional bias reveals a pattern of overly negative emotion only in depressed individuals' self-evaluations, and in particular with respect to anger and disgust, lending support to claims that major depressives' evaluations represent negative emotional bias and to clinical interventions that address this bias. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  20. Proteome-based systems biology analysis of the diabetic mouse aorta reveals major changes in fatty acid biosynthesis as potential hallmark in diabetes mellitus-associated vascular disease.

    Science.gov (United States)

    Husi, Holger; Van Agtmael, Tom; Mullen, William; Bahlmann, Ferdinand H; Schanstra, Joost P; Vlahou, Antonia; Delles, Christian; Perco, Paul; Mischak, Harald

    2014-04-01

    Macrovascular complications of diabetes mellitus are a major risk factor for cardiovascular morbidity and mortality. Currently, studies only partially described the molecular pathophysiology of diabetes mellitus-associated effects on vasculature. However, better understanding of systemic effects is essential in unraveling key molecular events in the vascular tissue responsible for disease onset and progression. Our overall aim was to get an all-encompassing view of diabetes mellitus-induced key molecular changes in the vasculature. An integrative proteomic and bioinformatics analysis of data from aortic vessels in the low-dose streptozotocin-induced diabetic mouse model (10 animals) was performed. We observed pronounced dysregulation of molecules involved in myogenesis, vascularization, hypertension, hypertrophy (associated with thickening of the aortic wall), and a substantial reduction of fatty acid storage. A novel finding is the pronounced downregulation of glycogen synthase kinase-3β (Gsk3β) and upregulation of molecules linked to the tricarboxylic acid cycle (eg, aspartate aminotransferase [Got2] and hydroxyacid-oxoacid transhydrogenase [Adhfe1]). In addition, pathways involving primary alcohols and amino acid breakdown are altered, potentially leading to ketone-body production. A number of these findings were validated immunohistochemically. Collectively, the data support the hypothesis that in this diabetic model, there is an overproduction of ketone-bodies within the vessels using an alternative tricarboxylic acid cycle-associated pathway, ultimately leading to the development of atherosclerosis. Streptozotocin-induced diabetes mellitus in animals leads to a reduction of fatty acid biosynthesis and an upregulation of an alternative ketone-body formation pathway. This working hypothesis could form the basis for the development of novel therapeutic intervention and disease management approaches.

  1. Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

    Science.gov (United States)

    Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

    2016-04-01

    To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

  2. Use of virtual simulator for agent training in radiation protection actions in major events

    International Nuclear Information System (INIS)

    Passos, Claudio Azevedo; Mol, Antonio Carlos A.; Carvalho, Paulo V.R.; Lima, Fabio Almeida; Rocha, Tiago Lima

    2015-01-01

    With the proximity of the events of the Olympic Games, Brazil can become a great place of visibility for running dirty bombs or any other radiation mode proliferation by terrorists. Aware of these problems, the government and the organizations created managements of emergencies to ensure that these events elapse in an orderly and safe manner. The management of emergency situations at an event is a complex problem, which involves dynamic, unforeseen and unintended situations, emphasizing the potential complexity of the contexts in which organizations operate and, as a consequence, the people involved in the execution of multiple tasks from activities that require intense cognitive effort, are often challenged to adapt dynamically to maintain the productivity of the organization at satisfactory levels of performance usually impedes these people reflect on the results of their actions and learn from them. Therefore, it is extremely important to create tools that address the methods and techniques of Cognitive Task Analysis (CTA) to assist in the previous training of the security agents, for example, detection and approaches of people who carry radioactive elements. One of the possible ways to accomplish this training is through the use of virtual reality. Virtual environments bring some advantages like reducing costs and risks. The aim of this paper is to present a virtual simulator to evaluate the use in training agents in major events. As a case study, the Maracana and the agents of the National Nuclear Energy Commission (CNEN) was chosen. (author)

  3. Use of virtual simulator for agent training in radiation protection actions in major events

    Energy Technology Data Exchange (ETDEWEB)

    Passos, Claudio Azevedo, E-mail: cpassos.cp2@gmail.com [Universidade Federal do Rio de Janeiro (CCMN/NCE/UFRJ), Rio de Janeiro, RJ (Brazil); Mol, Antonio Carlos A.; Carvalho, Paulo V.R., E-mail: mol@ien.gov.br, E-mail: paulov@ien.gov.br [nstituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Lima, Fabio Almeida; Rocha, Tiago Lima, E-mail: profantoniocarlosmol@gmail.com, E-mail: falmeida@unicarioca.edu.br, E-mail: tlrtiago@gmail.com [Centro Universitario Carioca (Unicarioca), Rio de Janeiro, RJ (Brazil)

    2015-07-01

    With the proximity of the events of the Olympic Games, Brazil can become a great place of visibility for running dirty bombs or any other radiation mode proliferation by terrorists. Aware of these problems, the government and the organizations created managements of emergencies to ensure that these events elapse in an orderly and safe manner. The management of emergency situations at an event is a complex problem, which involves dynamic, unforeseen and unintended situations, emphasizing the potential complexity of the contexts in which organizations operate and, as a consequence, the people involved in the execution of multiple tasks from activities that require intense cognitive effort, are often challenged to adapt dynamically to maintain the productivity of the organization at satisfactory levels of performance usually impedes these people reflect on the results of their actions and learn from them. Therefore, it is extremely important to create tools that address the methods and techniques of Cognitive Task Analysis (CTA) to assist in the previous training of the security agents, for example, detection and approaches of people who carry radioactive elements. One of the possible ways to accomplish this training is through the use of virtual reality. Virtual environments bring some advantages like reducing costs and risks. The aim of this paper is to present a virtual simulator to evaluate the use in training agents in major events. As a case study, the Maracana and the agents of the National Nuclear Energy Commission (CNEN) was chosen. (author)

  4. Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events?

    LENUS (Irish Health Repository)

    Sattar, Naveed

    2009-06-23

    Circulating inflammatory markers may more strongly relate to risk of fatal versus nonfatal cardiovascular disease (CVD) events, but robust prospective evidence is lacking. We tested whether interleukin (IL)-6, C-reactive protein (CRP), and fibrinogen more strongly associate with fatal compared to nonfatal myocardial infarction (MI) and stroke.

  5. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein

    NARCIS (Netherlands)

    Ridker, Paul M.; Danielson, Eleanor; Fonseca, Francisco A. H.; Genest, Jacques; Gotto, Antonio M.; Kastelein, John J. P.; Koenig, Wolfgang; Libby, Peter; Lorenzatti, Alberto J.; Macfadyen, Jean G.; Nordestgaard, Børge G.; Shepherd, James; Willerson, James T.; Glynn, Robert J.; Ridker, P. M.; Fonseca, F. A. H.; Genest, J.; Gotto, A. M.; Koenig, W.; Libby, P.; Lorenzatti, A. J.; Nordestgaard, B. G.; Shepherd, J.; Willerson, J. T.; Danielson, E.; Glynn, R. J.; MacFadyen, J. G.; Mora, S.; Collins, R.; Bailey, K.; Gersh, B.; Lamas, G.; Smith, S.; Vaughan, D.; Mahaffey, K.; Brown, P.; Montgomery, D.; Wilson, M.; Wood, F.; Altamirano, J.; Boskis, P.; Colombo, H.; Cuneo, C.; Diaz, M.; Esper, R.; Trip, M.; Hoekstra, J.; Koch, S.; Lucas, M.; van de Beek, M.

    2008-01-01

    BACKGROUND: Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels

  6. Major life events: their personal meaning, resolution, and mental health significance.

    Science.gov (United States)

    Reynolds, John R; Turner, R Jay

    2008-06-01

    Researchers have employed varying strategies in an effort to better understand variation in responses to stress. This article argues that crisis theory makes a useful contribution to these efforts, particularly when studying variable response to major life events that are of high threat potential. Regression analyses of depressive symptomatology, mastery, and self-esteem in a community sample of adults (n = 1,542) provide preliminary support for the central tenets of crisis theory that specify the conditions under which experienced events are minimally and maximally hazardous. The results also offer mixed support for the proposition that successfully resolved crises can even yield emotional and coping benefits. Longitudinal models and further development of survey-based measures for distinguishing the occurrence of a crisis and assessing the adequacy of its resolution are needed to more thoroughly test crisis theory.

  7. Can discrete event simulation be of use in modelling major depression?

    Directory of Open Access Journals (Sweden)

    François Clément

    2006-12-01

    Full Text Available Abstract Background Depression is among the major contributors to worldwide disease burden and adequate modelling requires a framework designed to depict real world disease progression as well as its economic implications as closely as possible. Objectives In light of the specific characteristics associated with depression (multiple episodes at varying intervals, impact of disease history on course of illness, sociodemographic factors, our aim was to clarify to what extent "Discrete Event Simulation" (DES models provide methodological benefits in depicting disease evolution. Methods We conducted a comprehensive review of published Markov models in depression and identified potential limits to their methodology. A model based on DES principles was developed to investigate the benefits and drawbacks of this simulation method compared with Markov modelling techniques. Results The major drawback to Markov models is that they may not be suitable to tracking patients' disease history properly, unless the analyst defines multiple health states, which may lead to intractable situations. They are also too rigid to take into consideration multiple patient-specific sociodemographic characteristics in a single model. To do so would also require defining multiple health states which would render the analysis entirely too complex. We show that DES resolve these weaknesses and that its flexibility allow patients with differing attributes to move from one event to another in sequential order while simultaneously taking into account important risk factors such as age, gender, disease history and patients attitude towards treatment, together with any disease-related events (adverse events, suicide attempt etc.. Conclusion DES modelling appears to be an accurate, flexible and comprehensive means of depicting disease progression compared with conventional simulation methodologies. Its use in analysing recurrent and chronic diseases appears particularly useful

  8. Can discrete event simulation be of use in modelling major depression?

    Science.gov (United States)

    Le Lay, Agathe; Despiegel, Nicolas; François, Clément; Duru, Gérard

    2006-12-05

    Depression is among the major contributors to worldwide disease burden and adequate modelling requires a framework designed to depict real world disease progression as well as its economic implications as closely as possible. In light of the specific characteristics associated with depression (multiple episodes at varying intervals, impact of disease history on course of illness, sociodemographic factors), our aim was to clarify to what extent "Discrete Event Simulation" (DES) models provide methodological benefits in depicting disease evolution. We conducted a comprehensive review of published Markov models in depression and identified potential limits to their methodology. A model based on DES principles was developed to investigate the benefits and drawbacks of this simulation method compared with Markov modelling techniques. The major drawback to Markov models is that they may not be suitable to tracking patients' disease history properly, unless the analyst defines multiple health states, which may lead to intractable situations. They are also too rigid to take into consideration multiple patient-specific sociodemographic characteristics in a single model. To do so would also require defining multiple health states which would render the analysis entirely too complex. We show that DES resolve these weaknesses and that its flexibility allow patients with differing attributes to move from one event to another in sequential order while simultaneously taking into account important risk factors such as age, gender, disease history and patients attitude towards treatment, together with any disease-related events (adverse events, suicide attempt etc.). DES modelling appears to be an accurate, flexible and comprehensive means of depicting disease progression compared with conventional simulation methodologies. Its use in analysing recurrent and chronic diseases appears particularly useful compared with Markov processes.

  9. Unsafe and violent behavior in commercials aired during televised major sporting events.

    Science.gov (United States)

    Tamburro, Robert F; Gordon, Patricia L; D'Apolito, James P; Howard, Scott C

    2004-12-01

    Injuries are the leading cause of death in children, and media exposure seems to increase children's risk-taking behavior. Televised sports are commonly viewed by children. The objective of this study was to determine the proportion of commercials that depict violence or other unsafe behavior during major televised sporting events that are aired before 9:00 pm. We obtained a list of the 50 sports programs that were most highly rated by Nielsen Media Research and that were televised between September 1, 2001, and September 1, 2002. These 50 programs included Winter Olympics events (n = 15), National Football League (NFL) regular season games (n = 14), NFL playoff games (n = 10), Major League Baseball World Series and playoff games (n = 7), the NFL Super Bowl (n = 1), the National Basketball Association Western Conference Final Game (n = 1), the College Football Rose Bowl (n = 1), and the National Collegiate Athletic Association Basketball Championship game (n = 1). Two other events were reviewed as well: the final round of the Masters Golf Championship, because it was the only sporting event rated in the top 50 of the previous year that was not represented by a similar sporting event in the study year, and the Daytona 500 National Association for Stock Car Auto Racing race, because it was the only event rated among the top 75 of the study year that was not represented by a similar event (ie, there were no other golfing or auto racing events reviewed). These events were included because different sporting events may attract different viewers and different advertisements; thus, their inclusion provides a more comprehensive evaluation of the topic. For sporting events with >3 programs in the top 50 (NFL regular season games, NFL playoff games, Winter Olympic events, and Major League Baseball World Series), representative samples of events were assessed. Surrogate events were analyzed for programs that were aired after 9:00 PM (Eastern Time) to control for the reduced

  10. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  11. [Is a patient's knowledge of cardiovascular risk factors better after the occurrence of a major ischemic event? Survey of 135 cases and 260 controls].

    Science.gov (United States)

    Lensel, A-S; Lermusiaux, P; Boileau, C; Feugier, P; Sérusclat, A; Zerbib, Y; Ninet, J

    2013-12-01

    We hypothezised that patients (cases) who are hospitalized for a major ischemic event--myocardial infarction, stroke, decompensation of peripheral arterial disease--acquire better knowledge than a control population--atheromatous patients without a major ischemic event, patients consulting for a vein disease or a diabetes evaluation, and accompanists--about cardiovascular risk factors (smoking, hypertension, diabetes, dyslipidemia, obesity) and have a better understanding of the usefulness of making changes in their lifestyle (quit smoking, regular exercise, Mediterranean diet, low salt diet, weight control, diabetes care). A questionnaire was proposed at vascular surgery consultations and vascular and cardiac functional explorations, at the M Pavillon of the Édouard-Herriot hospital, Lyon, France. In five months, 395 questionnaires (135 cases and 260 controls) were analyzed. The global knowledge score was statistically higher for cases than for controls (cases 3.23±1.81; controls 2.77±2.03; P=0.037). Cases did not abide by monitoring and dietary rules better, except as regards the management of diabetes. Regular physical activity was statistically more prevalent among controls than among cases. Cases mainly received their information from their doctors (general practitioner for 59% of controls and 78% of cases, cardiologist for 25% of controls and 57% of cases) while controls got their information more through magazines or advertising. Our results show that after a major ischemic event, cases' knowledge of risk factors is better than the rest of the population without improved rules lifestyle changes. This suggests the usefulness of evaluating a therapeutic education program for atheromatous disease. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  12. Susceptibility of central Red Sea corals during a major bleaching event

    KAUST Repository

    Furby, Kathryn A.

    2013-01-04

    A major coral bleaching event occurred in the central Red Sea near Thuwal, Saudi Arabia, in the summer of 2010, when the region experienced up to 10-11 degree heating weeks. We documented the susceptibility of various coral taxa to bleaching at eight reefs during the peak of this thermal stress. Oculinids and agaricids were most susceptible to bleaching, with up to 100 and 80 % of colonies of these families, respectively, bleaching at some reefs. In contrast, some families, such as mussids, pocilloporids, and pectinids showed low levels of bleaching (<20 % on average). We resurveyed the reefs 7 months later to estimate subsequent mortality. Mortality was highly variable among taxa, with some taxa showing evidence of full recovery and some (e. g., acroporids) apparently suffering nearly complete mortality. The unequal mortality among families resulted in significant change in community composition following the bleaching. Significant factors in the likelihood of coral bleaching during this event were depth of the reef and distance of the reef from shore. Shallow reefs and inshore reefs had a higher prevalence of bleaching. This bleaching event shows that Red Sea reefs are subject to the same increasing pressures that reefs face worldwide. This study provides a quantitative, genus-level assessment of the vulnerability of various coral groups from within the Red Sea to bleaching and estimates subsequent mortality. As such, it can provide valuable insights into the future for reef communities in the Red Sea. © 2013 Springer-Verlag Berlin Heidelberg.

  13. Family history predicts major adverse cardiovascular events (MACE) in young adults with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Bruun, Louise E; Mallbris, Lotus

    2016-01-01

    BACKGROUND: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE. OBJECTIVE: We investigated the risk of first-time MACE in patients with psoriasis with or without a fami....... The findings call for increased focus on a family history of CVD in CV risk assessment of patients with psoriasis.......BACKGROUND: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE. OBJECTIVE: We investigated the risk of first-time MACE in patients with psoriasis with or without a family...... history of CVD. METHODS: Between January 1, 1997, and December 31, 2011, we identified 2,722,375 individuals, including 25,774 and 4504 patients with mild and severe psoriasis, through administrative registers. Incidence rate ratios were estimated by Poisson regression. RESULTS: Mean baseline age was 26...

  14. The Combined Effects of Daily Stressors and Major Life Events on Daily Subjective Ages.

    Science.gov (United States)

    Bellingtier, Jennifer A; Neupert, Shevaun D; Kotter-Grühn, Dana

    2017-07-01

    Stressors may be a contributing factor in determining how old an individual feels, looks, or would like to be. Currently, little research has been devoted to understanding the relationship between stressors and subjective age in older adults. We focus on the combined impact of major life-event stressors and daily stressors on multiple indicators of subjective age: felt age, ideal age, and look age. Furthermore, we examine the process by which daily stressors relate to subjective ages by testing whether positive affect, control, and negative affect mediate this relationship. Using a daily-diary design, the current study measured older adults' (60-96 years old) stressors, subjective ages, personal control, and affect. Felt, ideal, and look ages each demonstrated a unique pattern of interactions between daily stressors and major life-event stressors. Furthermore, our findings suggest that on the daily level, the relationship between stressors and felt age is mediated by negative affect but not by control and positive affect. Findings indicate the need to consider the broader contextual picture of stressors, as well as their differential impact on multiple indicators of subjective age. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Thromboembolic and Major Bleeding Events With Rivaroxaban Versus Warfarin Use in a Real-World Setting.

    Science.gov (United States)

    Russo-Alvarez, Giavanna; Martinez, Kathryn A; Valente, Megan; Bena, James; Hu, Bo; Luxenburg, Jennifer; Chaitoff, Alexander; Ituarte, Catherine; Brateanu, Andrei; Rothberg, Michael B

    2018-01-01

    Although randomized trials demonstrate the noninferiority of rivaroxaban compared with warfarin in the context of nonvalvular atrial fibrillation (AF), little is known about how these drugs compare in practice. To assess the relative effectiveness and safety of rivaroxaban versus warfarin in a large health system and to evaluate this association by time in therapeutic range (TTR). We conducted a retrospective cohort study with propensity matching in the Cleveland Clinic Health System. The study included patients initiated on warfarin or rivaroxaban for thromboembolic prevention in nonvalvular AF between January 2012 and July 2016. The main outcomes were thromboembolic events and major bleeds. Analyses were stratified by warfarin patients' TTR. The cohort consisted of 472 propensity-matched pairs. The mean age was 73.6 years (SD = 11.7), and the mean CHADS 2 score was 1.8. The median TTR for warfarin patients was 64%. In the propensity-matched analysis, there was no significant difference in thromboembolic or major bleeding events between groups. Among warfarin patients with a TTR warfarin and rivaroxaban were associated with similar safety and effectiveness, even among those with suboptimal therapeutic control. Individualized decision making, taking into account the nontherapeutic tradeoffs associated with these medications (eg, monitoring, half-life, cost) is warranted.

  16. Simulation of rainfall-runoff for major flash flood events in Karachi

    Science.gov (United States)

    Zafar, Sumaira

    2016-07-01

    Metropolitan city Karachi has strategic importance for Pakistan. With the each passing decade the city is facing urban sprawl and rapid population growth. These rapid changes directly affecting the natural resources of city including its drainage pattern. Karachi has three major cities Malir River with the catchment area of 2252 sqkm and Lyari River has catchment area about 470.4 sqkm. These are non-perennial rivers and active only during storms. Change of natural surfaces into hard pavement causing an increase in rainfall-runoff response. Curve Number is increased which is now causing flash floods in the urban locality of Karachi. There is only one gauge installed on the upstream of the river but there no record for the discharge. Only one gauge located at the upstream is not sufficient for discharge measurements. To simulate the maximum discharge of Malir River rainfall (1985 to 2014) data were collected from Pakistan meteorological department. Major rainfall events use to simulate the rainfall runoff. Maximum rainfall-runoff response was recorded in during 1994, 2007 and 2013. This runoff causes damages and inundation in floodplain areas of Karachi. These flash flooding events not only damage the property but also cause losses of lives

  17. Core discrete event simulation model for the evaluation of health care technologies in major depressive disorder.

    Science.gov (United States)

    Vataire, Anne-Lise; Aballéa, Samuel; Antonanzas, Fernando; Roijen, Leona Hakkaart-van; Lam, Raymond W; McCrone, Paul; Persson, Ulf; Toumi, Mondher

    2014-03-01

    A review of existing economic models in major depressive disorder (MDD) highlighted the need for models with longer time horizons that also account for heterogeneity in treatment pathways between patients. A core discrete event simulation model was developed to estimate health and cost outcomes associated with alternative treatment strategies. This model simulated short- and long-term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined on the basis of fictitious antidepressants with three levels of efficacy, tolerability, and price (low, medium, and high) from first line to third line. The model was populated with input data from the literature for the UK setting. Model outputs include time in different health states, quality-adjusted life-years (QALYs), and costs from National Health Service and societal perspectives. The codes are open source. Predicted costs and QALYs from this model are within the range of results from previous economic evaluations. The largest cost components from the payer perspective were physician visits and hospitalizations. Key parameters driving the predicted costs and QALYs were utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between two strategies with different effectiveness increased approximately twofold when the time horizon increased from 1 to 5 years. The discrete event simulation model can provide a more comprehensive evaluation of different therapeutic options in MDD, compared with existing Markov models, and can be used to compare a wide range of health care technologies in various groups of patients with MDD. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  18. Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

    Science.gov (United States)

    Manan, Norhafizah A.; Abidin, Basir

    2015-02-01

    Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

  19. Experience of major life events during childhood and development of obesity in adulthood

    DEFF Research Database (Denmark)

    Petersen, Jindong Ding; Heitmann, B. L.; Kyle, R.

    2015-01-01

    Background: The etiology of adult obesity is still poorly understood, even if often simply attributed to too much food and too little exercise. A few studies have suggested that adverse psychological factors may predispose the development of adult obesity among normal weight children Aims The aim...... of this study was to examine if separation from parents, parental loss and living in a "children's home" during childhood could be associated with development of adult obesity Key Methods: A total of 146 complete adult twin pairs discordant for BMI (one had a normal BMI and the co-twin a BMI > 30 kg/m) were...... separation from mother and paternal death was related to less discordance. However, none of these differences were significant. Conclusion: The present study did not demonstrate independent effects of major life events during childhood and development of obesity in adulthood....

  20. Male Patient Visits to the Emergency Department Decline During the Play of Major Sporting Events

    Directory of Open Access Journals (Sweden)

    Jerrard, David A

    2009-05-01

    Full Text Available OBJECTIVES: To study whether emergency department (ED visits by male patients wane simultaneously with the play of scheduled professional and college sports events.METHODS: Retrospective cohort analysis looked at ED male patient registration rates during a time block lasting from two hours before, during, and two hours after the play of professional football games (Monday night, Sundays, post-season play, major league baseball, and a Division I college football and basketball team, respectively. These registration rates were compared to rates at similar times on similar days of the week during the year devoid of a major sporting contest. Games were assumed to have a play time of three hours. Data was collected from April 2000 through March 2003 at an urban academic ED seeing 33,000 male patients above the age of 18 years annually.RESULTS: A total of 782 games were identified and used for purposes of the study. Professional football game dates had a mean of 17.9 males (95% confidence interval [CI] 17.4-18.4 registering vs. 26.8 males (95% CI 25.9-27.6 on non-game days. A registration rate for major league baseball was 18.4 patients (95% CI 17.6-18.4. The mean for registration on comparable non-game days was 23.9 patients (95% CI 22.8-24.3. For the regional Division I college football team, the mean number of patients registering on game days and non-game days was 21.7 (95% CI 20.9-22.4 and 23.4 (95% CI 22.9-23.7, respectively. Division I college basketball play for game and non-game days had mean rates of registration of 14.5 (95% CI 13.9-15.1 and 15.5 (95% CI 15.1-15.9 patients, respectively. For all sports dates collectively, a comparison of two means yielded a mean of 18.2 patients (95% CI 17.4-18.8 registering during the study hours on game days vs. 23.3 patients (95% CI 22.0-23.7 on non-game days. The mean difference was 5.1 patients (95% CI 3.7 to 7.0 with p < .000074.CONCLUSION: Male patient visits to the ED decline during major sporting

  1. Stress Echocardiography and Major Cardiac Events in Patients with Normal Exercise Test

    Science.gov (United States)

    Calasans, Flávia Ricci; Santos, Bruno Fernandes de Oliveira; Silveira, Débora Consuelo Rocha; de Araújo, Ana Carla Pereira; Melo, Luiza Dantas; Barreto-Filho, José Augusto; Sousa, Antônio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2013-01-01

    Background Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. Objective To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. Methods 397 patients with intermediate CAD pretest probability, estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). Results G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). Conclusion Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET. PMID:23765384

  2. Symptomatological and cognitive correlates of vascular comorbidity in older-elderly (at least 75 years old) men with major depressive disorder.

    Science.gov (United States)

    Wang, Yu-Yuan; Chang, Yun-Hsuan; Lee, Sheng-Yu; Huang, Chih-Chun; Lee, I-Hui; Yeh, Tzung-Lieh; Yang, Yen-Kuang; Ku, Yan-Chiou; Lu, Ru-Band

    2012-11-01

    Depression is a common geriatric psychiatric disorder increasing with age among elderly people (≥ 75 years old), especially those with medical comorbidities. They have higher suicide rates than younger men, but these are paid less attention. Elderly men (n=141) who were newly admitted residents of the Veterans' Home in Tainan, Taiwan from 2004 to 2006 were recruited and screened for major depression. Specialist physicians obtained past histories of medical illnesses through chart reviews, interview, and health examinations. Fifty-nine of the 141 elderly people had major depression and participated in this study. Thirty-nine men in the group with vascular comorbidities (VC), and 20 in the group without (NVC) vascular comorbidities were compared. The VC group had more time-orientation impairment, greater psychomotor retardation, and diminished concentration/decision-making than did the NVC group. Psychomotor retardation and other cognitive function impairments (e.g., concentration and decision-making) are characteristic manifestations among patients with major depression and vascular comorbidity compared with those without vascular comorbidity. Copyright © 2012. Published by Elsevier B.V.

  3. South Asian Ethnicity as a Risk Factor for Major Adverse Cardiovascular Events after Renal Transplantation

    Science.gov (United States)

    Vangala, Sai K.; Silver, Samuel A.; Wong, Steven C.W.; Huang, Michael; Rapi, Lindita; Nash, Michelle M.; Zaltzman, Jeffrey S.

    2011-01-01

    Summary Background and objectives South Asians (SAs) comprise 25% of all Canadian visible minorities. SAs constitute a group at high risk for cardiovascular disease in the general population, but the risk in SA kidney transplant recipients has never been studied. Design, setting, participants, & measurements In a cohort study of 864 kidney recipients transplanted from 1998 to 2007 and followed to June 2009, we identified risk factors including ethnicity associated with major cardiac events (MACEs, a composite of nonfatal myocardial infarction, coronary intervention, and cardiac death) within and beyond 3 months after transplant. Kaplan-Meier methodology and multivariate Cox regression analysis were used to determine risk factors for MACEs. Results There was no difference among SAs (n = 139), whites (n = 550), blacks (n = 65), or East Asians (n = 110) in baseline risk, including pre-existing cardiac disease. Post-transplant MACE rate in SAs was 4.4/100 patient-years compared with 1.31, 1.16, and 1.61/100 patient-years in whites, blacks, and East Asians, respectively (P diabetes, systolic BP, and prior cardiac disease. SAs also experienced more MACEs within 3 months after transplant compared with whites (P < 0.0001), blacks (P = 0.04), and East Asians (P = 0.006). However, graft and patient survival was similar to other groups. Conclusions SA ethnicity is an independent risk factor for post-transplant cardiac events. Further study of this high-risk group is warranted. PMID:20884776

  4. Quality of life and mortality assessment in patients with major cardiac events in the postoperative period.

    Science.gov (United States)

    Abelha, Fernando José; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

    2010-01-01

    Cardiovascular complications in the postoperative period are associated with high mortality and morbidity. Few studies have assessed the degree of dependence in these patients and their perception of health. The objective of this study was to assess the mortality and the quality of life in patients who developed major cardiac events (MCE) in the postoperative period. Retrospective study carried out in a Surgical Intensive Care Unit (SICU), between March 2006 and March 2008. The patients were assessed regarding the occurrence of CE. Six months after the hospital discharge, the Short-Form-36 (SF-36) questionnaire was filled out and dependence was assessed in relation to activities of daily living (ADL). The comparisons between independent groups of patients were carried out using Student's t test. The comparison between each variable and the occurrence of CE was carried out by logistic regression and included all patients. Of the 1,280 patients that met the inclusion criteria, 26 (2%) developed MCE. The univariate analysis identified as independent determinants for the development of major cardiac events: ASA physical status, hypertension, ischemic heart disease, congestive heart disease and score of the Revised Cardiac Risk Index (RCRI). The six-month mortality after the SICU discharge was 35%. Of the 17 surviving patients, 13 completed the questionnaires. Thirty-one percent of them reported that their general health was better on the day they answered the questionnaire, when compared to 12 months before. Sixty-nine percent of the patients were dependent in instrumental ADL e 15% in personal ADL. The development of MCE has a significant impact on the duration of hospital stay and mortality rates. Six months after the discharge from the SICU, more than 50% of the patients were dependent in at least one instrumental ADL. Copyright 2010 Elsevier Editora Ltda. All rights reserved.

  5. Managing the Organizational and Cultural Precursors to Major Events — Recognising and Addressing Complexity

    International Nuclear Information System (INIS)

    Taylor, R. H.; Carhart, N.; May, J.; Wijk, L. G. A. van

    2016-01-01

    Research at the University of Bristol, Safety Systems Research Centre has drawn out the key organizational and cultural precursors leading to major events in several industries (nuclear, petrochemical, transport and major civil engineering projects). It has shown that these are strikingly similar. The research built on preliminary work reported to the IAEA in 2004. Organizational and cultural findings contributing to each event were assembled from the published reports for twelve events and grouped under eight generic headings. These were: 1. leadership issues; 2. ‘local’ operational attitudes and behaviours (operational ‘culture’); 3. the impact of the business environment (often commercial and budgetary pressures); 4. oversight and scrutiny; 5. competence and training (at all levels); 6. risk assessment and risk management (also at all levels); 7. organizational learning; 8. communication issues. From the findings, sets of ‘Expectations’ were then developed as statements of good practice, which if recognised and implemented, should enable organizations to build stronger defences against the occurrence of future events. To probe operational reality, these were reformulated and developed into sets of draft ‘penetrating’ questions which explore whether ‘reality aligns with expectation’. Initial work has been carried out to refine some of these expectations and question sets by working with industry and further work is planned. The questions can be used by both duty holders and regulators to assess the vulnerability of organizations (‘condition monitoring’). Examples will be given in the presentation and full paper. To enable organizations to address these often neglected factors, new tools are being developed that can be employed to address the risks systematically. This might be regarded as analogous to the use of systematic processes (e.g., fault and event trees) to assess risks arising from engineering and human factors-related issues. An

  6. Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial: a multi-centred, randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Thompson Kara

    2010-12-01

    Full Text Available Abstract Background Despite lack of outward signs, most individuals after non-disabling stroke (NDS and transient ischemic attack (TIA have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke, hospitalization for other vascular events, or death. Most have multiple modifiable risk factors (e.g., hypertension, physical inactivity, hyperlipidaemia, diabetes, tobacco consumption, psychological stress. In addition, accelerated rates of depression, cognitive decline, and poor quality of sleep have been reported following TIA, which correlate with poor functional outcomes and reduced quality of life. Thus, NSD and TIA are important warning signs that should not be overlooked. The challenge is not unlike that facing other 'silent' conditions - to identify a model of care that is effective in changing people's current behaviors in order to avert further morbidity. Methods/Design A single blind, randomized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA. 250 adults within 90 days of being diagnosed with NDS/TIA will be randomly allocated to a 12-week program of exercise and education (PREVENT or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated (USUAL CARE. Primary outcome measures will include blood pressure, waist circumference, 12-hour fasting lipid profile, and 12-hour fasting glucose/hemoglobin A1c. Secondary measures will include exercise capacity, walking endurance, physical activity, cognitive function, depression, goal attainment and health-related quality of life. Outcome assessment will be conducted at baseline, post-intervention, and 6- and 12-month follow-ups. Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be

  7. Metabolic syndrome definitions and components in predicting major adverse cardiovascular events after kidney transplantation.

    Science.gov (United States)

    Prasad, G V Ramesh; Huang, Michael; Silver, Samuel A; Al-Lawati, Ali I; Rapi, Lindita; Nash, Michelle M; Zaltzman, Jeffrey S

    2015-01-01

    Metabolic syndrome (MetS) associates with cardiovascular risk post-kidney transplantation, but its ambiguity impairs understanding of its diagnostic utility relative to components. We compared five MetS definitions and the predictive value of constituent components of significant definitions for major adverse cardiovascular events (MACE) in a cohort of 1182 kidney transplant recipients. MetS definitions were adjusted for noncomponent traditional Framingham risk factors and relevant transplant-related variables. Kaplan-Meier, logistic regression, and Cox proportional hazards analysis were utilized. There were 143 MACE over 7447 patient-years of follow-up. Only the World Health Organization (WHO) 1998 definition predicted MACE (25.3 vs 15.5 events/1000 patient-years, P = 0.019). Time-to-MACE was 5.5 ± 3.5 years with MetS and 6.8 ± 3.9 years without MetS (P < 0.0001). MetS was independent of pertinent MACE risk factors except age and previous cardiac disease. Among MetS components, dysglycemia provided greatest hazard ratio (HR) for MACE (1.814 [95% confidence interval 1.26-2.60]), increased successively by microalbuminuria (HR 1.946 [1.37-2.75]), dyslipidemia (3.284 [1.72-6.26]), hypertension (4.127 [2.16-7.86]), and central obesity (4.282 [2.09-8.76]). MetS did not affect graft survival. In summary, although the WHO 1998 definition provides greatest predictive value for post-transplant MACE, most of this is conferred by dysglycemia and is overshadowed by age and previous cardiac disease. © 2014 Steunstichting ESOT.

  8. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study.

    Science.gov (United States)

    Li, Linxin; Geraghty, Olivia C; Mehta, Ziyah; Rothwell, Peter M

    2017-07-29

    Lifelong antiplatelet treatment is recommended after ischaemic vascular events, on the basis of trials done mainly in patients younger than 75 years. Upper gastrointestinal bleeding is a serious complication, but had low case fatality in trials of aspirin and is not generally thought to cause long-term disability. Consequently, although co-prescription of proton-pump inhibitors (PPIs) reduces upper gastrointestinal bleeds by 70-90%, uptake is low and guidelines are conflicting. We aimed to assess the risk, time course, and outcomes of bleeding on antiplatelet treatment for secondary prevention in patients of all ages. We did a prospective population-based cohort study in patients with a first transient ischaemic attack, ischaemic stroke, or myocardial infarction treated with antiplatelet drugs (mainly aspirin based, without routine PPI use) after the event in the Oxford Vascular Study from 2002 to 2012, with follow-up until 2013. We determined type, severity, outcome (disability or death), and time course of bleeding requiring medical attention by face-to-face follow-up for 10 years. We estimated age-specific numbers needed to treat (NNT) to prevent upper gastrointestinal bleeding with routine PPI co-prescription on the basis of Kaplan-Meier risk estimates and relative risk reduction estimates from previous trials. 3166 patients (1582 [50%] aged ≥75 years) had 405 first bleeding events (n=218 gastrointestinal, n=45 intracranial, and n=142 other) during 13 509 patient-years of follow-up. Of the 314 patients (78%) with bleeds admitted to hospital, 117 (37%) were missed by administrative coding. Risk of non-major bleeding was unrelated to age, but major bleeding increased steeply with age (≥75 years hazard ratio [HR] 3·10, 95% CI 2·27-4·24; pbleeds (5·53, 2·65-11·54; pbleeds (≥75 years HR 4·13, 2·60-6·57; pbleeds were mostly disabling or fatal (45 [62%] of 73 patients vs 101 [47%] of 213 patients with recurrent ischaemic stroke), and outnumbered

  9. Plaque Structural Stress Estimations Improve Prediction of Future Major Adverse Cardiovascular Events After Intracoronary Imaging.

    Science.gov (United States)

    Brown, Adam J; Teng, Zhongzhao; Calvert, Patrick A; Rajani, Nikil K; Hennessy, Orla; Nerlekar, Nitesh; Obaid, Daniel R; Costopoulos, Charis; Huang, Yuan; Hoole, Stephen P; Goddard, Martin; West, Nick E J; Gillard, Jonathan H; Bennett, Martin R

    2016-06-01

    Although plaque rupture is responsible for most myocardial infarctions, few high-risk plaques identified by intracoronary imaging actually result in future major adverse cardiovascular events (MACE). Nonimaging markers of individual plaque behavior are therefore required. Rupture occurs when plaque structural stress (PSS) exceeds material strength. We therefore assessed whether PSS could predict future MACE in high-risk nonculprit lesions identified on virtual-histology intravascular ultrasound. Baseline nonculprit lesion features associated with MACE during long-term follow-up (median: 1115 days) were determined in 170 patients undergoing 3-vessel virtual-histology intravascular ultrasound. MACE was associated with plaque burden ≥70% (hazard ratio: 8.6; 95% confidence interval, 2.5-30.6; P<0.001) and minimal luminal area ≤4 mm(2) (hazard ratio: 6.6; 95% confidence interval, 2.1-20.1; P=0.036), although absolute event rates for high-risk lesions remained <10%. PSS derived from virtual-histology intravascular ultrasound was subsequently estimated in nonculprit lesions responsible for MACE (n=22) versus matched control lesions (n=22). PSS showed marked heterogeneity across and between similar lesions but was significantly increased in MACE lesions at high-risk regions, including plaque burden ≥70% (13.9±11.5 versus 10.2±4.7; P<0.001) and thin-cap fibroatheroma (14.0±8.9 versus 11.6±4.5; P=0.02). Furthermore, PSS improved the ability of virtual-histology intravascular ultrasound to predict MACE in plaques with plaque burden ≥70% (adjusted log-rank, P=0.003) and minimal luminal area ≤4 mm(2) (P=0.002). Plaques responsible for MACE had larger superficial calcium inclusions, which acted to increase PSS (P<0.05). Baseline PSS is increased in plaques responsible for MACE and improves the ability of intracoronary imaging to predict events. Biomechanical modeling may complement plaque imaging for risk stratification of coronary nonculprit lesions. © 2016

  10. The Knowledge-Integrated Network Biomarkers Discovery for Major Adverse Cardiac Events

    Science.gov (United States)

    Jin, Guangxu; Zhou, Xiaobo; Wang, Honghui; Zhao, Hong; Cui, Kemi; Zhang, Xiang-Sun; Chen, Luonan; Hazen, Stanley L.; Li, King; Wong, Stephen T. C.

    2010-01-01

    The mass spectrometry (MS) technology in clinical proteomics is very promising for discovery of new biomarkers for diseases management. To overcome the obstacles of data noises in MS analysis, we proposed a new approach of knowledge-integrated biomarker discovery using data from Major Adverse Cardiac Events (MACE) patients. We first built up a cardiovascular-related network based on protein information coming from protein annotations in Uniprot, protein–protein interaction (PPI), and signal transduction database. Distinct from the previous machine learning methods in MS data processing, we then used statistical methods to discover biomarkers in cardiovascular-related network. Through the tradeoff between known protein information and data noises in mass spectrometry data, we finally could firmly identify those high-confident biomarkers. Most importantly, aided by protein–protein interaction network, that is, cardiovascular-related network, we proposed a new type of biomarkers, that is, network biomarkers, composed of a set of proteins and the interactions among them. The candidate network biomarkers can classify the two groups of patients more accurately than current single ones without consideration of biological molecular interaction. PMID:18665624

  11. Radiation detectors for use in major public events: classification, requirements, main features, tests and lessons learned

    International Nuclear Information System (INIS)

    Souza, Elder Magalhães de

    2017-01-01

    Since September 11, 2001, we have entered a new terrorism era. The possibility of the use of lost/stolen radioactive materials increases the probability of a radiological threat. The real goal intended with the use of a Radiological Dispersal Device (RRD or dirty bomb) or a Radiation Exposure Device (RDE) could be psychological in nature. Panic in the venues and surrounding area would cause more deaths than the RDD itself, therefore these attempts could cause chaos, injury, fear and terror, the main target of terrorists. The response of the national authorities with the support and aid of the IAEA served as an increase of the capability of detection and identification of nuclear and radiological materials. But this response could not be limited only to the MPE, because if the country has radioactive or nuclear facilities they also should be considered in terms of theft, sabotage, illegal transfer, unauthorized access, and any other malicious acts. In 2007, Rio de Janeiro, received the first Brazilian Major Public Event in this new era. This was the first Brazilian operation which largely utilized detectors (personal radiations detectors -PRD- radiological identification detectors, -RID or RIID- and spectral radiations scanners, -backpacks-, HPGe detectors, car-borne and air-borne systems) to protect the venues, the athletes, the population and the environment. (author)

  12. Radiation detectors for use in major public events: classification, requirements, main features, tests and lessons learned

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Elder Magalhães de, E-mail: elder@ird.gov.br [Instituto de Radioproteção e Dosimetria (DIRAD/IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Div. de Radiometria

    2017-07-01

    Since September 11, 2001, we have entered a new terrorism era. The possibility of the use of lost/stolen radioactive materials increases the probability of a radiological threat. The real goal intended with the use of a Radiological Dispersal Device (RRD or dirty bomb) or a Radiation Exposure Device (RDE) could be psychological in nature. Panic in the venues and surrounding area would cause more deaths than the RDD itself, therefore these attempts could cause chaos, injury, fear and terror, the main target of terrorists. The response of the national authorities with the support and aid of the IAEA served as an increase of the capability of detection and identification of nuclear and radiological materials. But this response could not be limited only to the MPE, because if the country has radioactive or nuclear facilities they also should be considered in terms of theft, sabotage, illegal transfer, unauthorized access, and any other malicious acts. In 2007, Rio de Janeiro, received the first Brazilian Major Public Event in this new era. This was the first Brazilian operation which largely utilized detectors (personal radiations detectors -PRD- radiological identification detectors, -RID or RIID- and spectral radiations scanners, -backpacks-, HPGe detectors, car-borne and air-borne systems) to protect the venues, the athletes, the population and the environment. (author)

  13. Association between influenza vaccination and reduced risks of major adverse cardiovascular events in elderly patients.

    Science.gov (United States)

    Chiang, Ming-Hsien; Wu, Hau-Hsin; Shih, Chia-Jen; Chen, Yung-Tai; Kuo, Shu-Chen; Chen, Te-Li

    2017-11-01

    This study was conducted to determine the protective effect of influenza vaccine against primary major adverse cardiovascular events (MACEs) in elderly patients, especially those with influenza-like illness (ILI). This retrospective, population-based case-control study of an elderly population (age≥65 years) was conducted using Taiwan's National Health Insurance Research Database (2000-2013). One control was selected for each MACE case (n=80,363 each), matched according to age, year of study entry, and predisposing factors for MACEs. ILI and MACEs (myocardial infarction [MI] and ischemic stroke) were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Odds ratios (ORs) were calculated for the association between MACEs and vaccination. Influenza vaccination received in the previous year was associated with reduced risks of primary MACEs overall (adjusted OR [aOR] 0.80, 95% CI 0.78-0.82, Prisks of MACEs (aOR 1.24, 95% CI 1.18-1.29, PVaccination attenuated the heightened risks associated with ILI (MACEs: aOR 0.99, 95% CI 0.92-1.07, P=.834; MI: aOR 1.05, 95% CI 0.92-1.21, P=.440; ischemic stroke: aOR 0.96, 95% CI 0.89-1.05, P=.398). Results of this study suggest that influenza vaccination is associated with reduced primary MACE risks in the elderly population, including those with ILI. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Safety culture in nuclear installations: Bangladesh perspectives and key lessons learned from major events

    International Nuclear Information System (INIS)

    Jalil, A.; Rabbani, G.

    2002-01-01

    Steps necessary to be taken to ensure safety in nuclear installations are suggested. One of the steps suggested is enhancing the safety culture. It is necessary to gain a common understanding of the concept itself, the development stages of safety culture by way of good management practices and leadership for safety culture improvement in the long-term. International topical meetings on safety culture may serve as an important forum for exchange of experiences. From such conventions new initiatives and programmes may crop up which when implemented around the world is very likely to improve safety management and thus boost up the safety culture in nuclear installations. International co-operation and learning are to be prompted to facilitate the sharing of the achievements to face the challenges involved in the management of safety and fixing priorities for future work and identify areas of co-operations. Key lessons learned from some major events have been reported. Present status and future trend of nuclear safety culture in Bangladesh have been dealt with. (author)

  15. Costs of major intracranial, gastrointestinal and other bleeding events in patients with atrial fibrillation - a nationwide cohort study.

    Science.gov (United States)

    Jakobsen, Marie; Kolodziejczyk, Christophe; Klausen Fredslund, Eskild; Poulsen, Peter Bo; Dybro, Lars; Paaske Johnsen, Søren

    2017-06-12

    Use of oral anticoagulation therapy in patients with atrial fibrillation (AF) involves a trade-off between a reduced risk of ischemic stroke and an increased risk of bleeding events. Different anticoagulation therapies have different safety profiles and data on the societal costs of both ischemic stroke and bleeding events are necessary for assessing the cost-effectiveness and budgetary impact of different treatment options. To our knowledge, no previous studies have estimated the societal costs of bleeding events in patients with AF. The objective of this study was to estimate the 3-years societal costs of first-incident intracranial, gastrointestinal and other major bleeding events in Danish patients with AF. The study was an incidence-based cost-of-illness study carried out from a societal perspective and based on data from national Danish registries covering the period 2002-2012. Costs were estimated using a propensity score matching and multivariable regression analysis (first difference OLS) in a cohort design. Average 3-years societal costs attributable to intracranial, gastrointestinal and other major bleeding events were 27,627, 17,868, and 12,384 EUR per patient, respectively (2015 prices). Existing evidence shows that the corresponding costs of ischemic stroke were 24,084 EUR per patient (2012 prices). The average costs of bleeding events did not differ between patients with AF who were on oral anticoagulation therapy prior to the event and patients who were not. The societal costs attributable to major bleeding events in patients with AF are significant. Intracranial haemorrhages are most costly to society with average costs of similar magnitude as the costs of ischemic stroke. The average costs of gastrointestinal and other major bleeding events are lower than the costs of intracranial haemorrhages, but still substantial. Knowledge about the relative size of the costs of bleeding events compared to ischemic stroke in patients with AF constitutes

  16. Major adverse cardiovascular event reduction with GLP-1 and SGLT2 agents: evidence and clinical potential

    Science.gov (United States)

    Røder, Michael E.

    2017-01-01

    Treatment of patients with type 2 diabetes is directed against treating symptoms of hyperglycemia, minimizing the risk of hypoglycemia, and the risk of microvascular and macrovascular complications. The majority of patients with type 2 diabetes die from cardiovascular or cerebrovascular disease. Future therapies should therefore focus on reducing cardiovascular morbidity in this high-risk population. Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2-i) are two drug classes with proven antihyperglycemic effect in type 2 diabetes. However, these drugs seem to have other effects such as weight reduction, low risk of hypoglycemia, and blood pressure reduction. Emerging evidence suggests pleiotropic effects, which potentially could be important in reducing cardiovascular risk. Prompted by regulatory authorities demanding cardiovascular outcome trials (CVOTs) assessing the cardiovascular safety of new antihyperglycemic drug candidates, many CVOTs are ongoing and a few of these are finalized. Somewhat surprising recent CVOTs in both drug classes have shown promising data on cardiovascular morbidity and mortality in patients with a very high risk of cardiovascular events. It is uncertain whether this is a class effect of the two drug classes, and it is yet unproven whether long-term cardiovascular benefits of these drugs can be extrapolated to populations at lower risk of cardiovascular disease. The aim of the present review is to give an overview of our current knowledge of the GLP-1RA and SGLT2-i classes, with specific focus on mechanisms of action, effects on cardiovascular risk factors and cardiovascular morbidity and mortality from the CVOTs presently available. The clinical potential of these data is discussed. PMID:29344329

  17. Clinical and genetic predictors of major cardiac events in patients with Anderson-Fabry Disease.

    Science.gov (United States)

    Patel, Vimal; O'Mahony, Constantinos; Hughes, Derralynn; Rahman, Mohammad Shafiqur; Coats, Caroline; Murphy, Elaine; Lachmann, Robin; Mehta, Atul; Elliott, Perry M

    2015-06-01

    Anderson-Fabry Disease (AFD) is an X linked lysosomal storage disorder caused by mutations in the α-galactosidase A gene. Some mutations are associated with prominent and, in many cases, exclusive cardiac involvement. The primary aims of this study were to determine the incidence of major cardiac events in AFD and to identify clinical and genetic predictors of adverse outcomes. We studied 207 patients with AFD (47% male, mean age 44 years, mean follow-up 7.1 years). Fifty-eight (28%) individuals carried mutations that have been previously associated with a cardiac predominant phenotype. Twenty-one (10%) developed severe heart failure (New York Heart Association functional class (NYHA) ≥3), 13 (6%) developed atrial fibrillation (AF), 13 (6%) received devices for the treatment of bradycardia; there were a total of 7 (3%) cardiac deaths. The incidence of the primary endpoint (a composite of new onset AF, NYHA ≥ 3 symptoms, device insertion for bradycardia and cardiac death) was 2.64 per 100 person-years (CI 1.78 to 3.77). Age (HR 1.04, CI 1.01 to 1.08, p=0.004), Mainz Severity Score Index score (HR 1.05, CI 1.01 to 1.09, p=0.012) and QRS duration (HR 1.03, CI 1.00 to 1.05, p=0.020) were significant independent predictors of the primary endpoint. The presence of a cardiac genetic variant did not predict the primary end point. AFD is associated with a high burden of cardiac morbidity and mortality. Adverse cardiac outcomes are associated with age, global disease severity and advanced cardiac disease but not the presence of cardiac genetic variants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Auditory selective attention in adolescents with major depression: An event-related potential study.

    Science.gov (United States)

    Greimel, E; Trinkl, M; Bartling, J; Bakos, S; Grossheinrich, N; Schulte-Körne, G

    2015-02-01

    Major depression (MD) is associated with deficits in selective attention. Previous studies in adults with MD using event-related potentials (ERPs) reported abnormalities in the neurophysiological correlates of auditory selective attention. However, it is yet unclear whether these findings can be generalized to MD in adolescence. Thus, the aim of the present ERP study was to explore the neural mechanisms of auditory selective attention in adolescents with MD. 24 male and female unmedicated adolescents with MD and 21 control subjects were included in the study. ERPs were collected during an auditory oddball paradigm. Depressive adolescents tended to show a longer N100 latency to target and non-target tones. Moreover, MD subjects showed a prolonged latency of the P200 component to targets. Across groups, longer P200 latency was associated with a decreased tendency of disinhibited behavior as assessed by a behavioral questionnaire. To be able to draw more precise conclusions about differences between the neural bases of selective attention in adolescents vs. adults with MD, future studies should include both age groups and apply the same experimental setting across all subjects. The study provides strong support for abnormalities in the neurophysiolgical bases of selective attention in adolecents with MD at early stages of auditory information processing. Absent group differences in later ERP components reflecting voluntary attentional processes stand in contrast to results reported in adults with MD and may suggest that adolescents with MD possess mechanisms to compensate for abnormalities in the early stages of selective attention. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Events that lead university students to change their major to Information Systems: A retroductive South African case

    Directory of Open Access Journals (Sweden)

    Lisa Florence Seymour

    2016-07-01

    Full Text Available Shortage of computing skills is a global concern as it affects national development and business success. Yet, despite high job availability and high salaries in computing professions, insufficient numbers of students are choosing to study the various computing disciplines. This South African study looks at the Information Systems (IS major which is misunderstood by high school students. This retroductive case study identifies the events which lead students to change their major to IS. The study confirms the importance of interest in a major as well as the perceived high value of a major, which feature as dominant factors in the literature. Yet these are not the initial events that lead to students changing their major to IS. Events that initiate the process include losing passion for a previous major, experiencing difficulty in a previous major as well as enjoying the introductory IS course. The paper has practical advice for IS Departments and argues for a generic first year for students as well as a focus on enjoyment and skills aligned to IS professional practice in introductory IS courses. These findings can be generalised to other majors and, hence, the theoretical contribution adds to the literature on career choice in general.

  20. Effect of intravitreal anti-vascular endothelial growth factor therapy on the risk of arterial thromboembolic events: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jin-Wei Cheng

    Full Text Available Intravitreal anti-vascular endothelial growth factor (VEGF monoclonal antibodies are used in ocular neovascular diseases. A consensus has emerged that intravenous anti-VEGF can increase the risk of arterial thromboembolic events. However, the role of intravitreal anti-VEGF in arterial thromboembolism is controversial. Therefore, we did a systematic review and meta-analysis to investigate the effects of intravitreal anti-VEGF on the risk of arterial thromboembolic events.Electronic databases were searched to identify relevant randomized clinical trials comparing intravitreal anti-VEGF with controls. Criteria for inclusion in our meta-analysis included a study duration of no less than 12 months, the use of a randomized control group not receiving any intravitreal active agent, and the availability of outcome data for arterial thromboembolic events, myocardial infarction, cerebrovascular accidents, and vascular death. The risk ratios and 95% CIs were calculated using a fixed-effects or random-effects model, depending on the heterogeneity of the included studies.A total of 4942 patients with a variety of ocular neovascular diseases from 13 randomized controlled trials were identified and included for analysis. There was no significant difference between intravitreal anti-VEGF and control in the risk of all events, with risk ratios of 0.87 (95% CI, 0.64 to 1.19 for arterial thromboembolic events, 0.96 (95% CI, 0.55-1.68 for cerebrovascular accidents, 0.69 (95% CI 0.40-1.21 for myocardial infarctions, and 0.68 (95% CI, 0.37-1.27 for vascular death.The strength evidence suggests that the intravitreal use of anti-VEGF antibodies is not associated with an increased risk of arterial thromboembolic events.

  1. The association between idiopathic environmental intolerance and psychological distress, and the influence of social support and recent major life events

    DEFF Research Database (Denmark)

    Skovbjerg, Sine; Rasmussen, Alice; Zachariae, Robert

    2012-01-01

    this association has not been clarified. The objective of this study was to examine the association between psychological distress and IEI and to determine whether the association is confounded by social support and major life events. Methods Data were collected by postal questionnaires; other results from...... consequences, as the dependent variables, and psychological distress, social support and major life events as the independent variables. Results Our study confirmed positive and statistically significant associations between psychological distress and IEI. The associations remained statistically significant...... after adjusting for major life events and social support. Conclusions The results suggest that the association between IEI and psychological distress cannot be explained by known risk factors. More studies, including longitudinal studies, are needed to determine the role of psychological distress...

  2. High Triglycerides Predicts Arteriogenic Erectile Dysfunction and Major Adverse Cardiovascular Events in Subjects With Sexual Dysfunction.

    Science.gov (United States)

    Corona, Giovanni; Cipriani, Sarah; Rastrelli, Giulia; Sforza, Alessandra; Mannucci, Edoardo; Maggi, Mario

    2016-09-01

    The atherogenic role of triglycerides (TG) remains controversial. The aim of the present study is to analyze the contribution of TG in the pathogenesis of erectile dysfunction (ED) and to verify the value of elevated TG in predicting major adverse cardiovascular events (MACE). An unselected series of 3,990 men attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (n = 1,687) was enrolled in a longitudinal study. Several clinical, biochemical, and instrumental (penile color Doppler ultrasound; PCDU) factors were evaluated. Among the patients studied, after adjustment for confounders, higher TG levels were associated with arteriogenic ED and a higher risk of clinical and biochemical hypogonadism. Conversely, no association between TG and other sexual dysfunctions was observed. When pathological PCDU parameters-including flaccid acceleration (<1.17 m/sec(2)) or dynamic peak systolic velocity (PSV <35 cm/sec)-were considered, the negative association between impaired penile flow and higher TG levels was confirmed, even when subjects taking lipid-lowering drugs or those with diabetes were excluded from the analysis (OR = 6.343 [1.243;32.362], P = .026 and 3.576 [1.104;11.578]; P = .34 for impaired acceleration and PSV, respectively). Similarly, when the same adjusted models were applied, TG levels were associated with a higher risk of hypogonadism, independently of the definition criteria (OR = 2.892 [1.643;5.410], P < .0001 and 4.853 [1.965;11.990]; P = .001 for total T <12 and 8 nM, respectively). In the longitudinal study, after adjusting for confounders, elevated TG levels (upper quartile: 162-1686 mg/dL) were independently associated with a higher incidence of MACE (HR = 2.469 [1.019;5.981]; P = .045), when compared to the rest of the sample. Our data suggest an association between elevated TG and arteriogenic ED and its cardiovascular (CV) risk stratification. Whether the use of TG lowering drugs

  3. The preventing recurrent vascular events and neurological worsening through intensive organized case-management (PREVENTION trial protocol [clinicaltrials.gov identifier: NCT00931788

    Directory of Open Access Journals (Sweden)

    Tsuyuki Ross

    2010-04-01

    Full Text Available Abstract Background Survivors of transient ischemic attack (TIA or stroke are at high risk for recurrent vascular events and aggressive treatment of vascular risk factors can reduce this risk. However, vascular risk factors, especially hypertension and high cholesterol, are not managed optimally even in those patients seen in specialized clinics. This gap between the evidence for secondary prevention of stroke and the clinical reality leads to suboptimal patient outcomes. In this study, we will be testing a pharmacist case manager for delivery of stroke prevention services. We hypothesize this new structure will improve processes of care which in turn should lead to improved outcomes. Methods We will conduct a prospective, randomized, controlled open-label with blinded ascertainment of outcomes (PROBE trial. Treatment allocation will be concealed from the study personnel, and all outcomes will be collected in an independent and blinded manner by observers who have not been involved in the patient's clinical care or trial participation and who are masked to baseline measurements. Patients will be randomized to control or a pharmacist case manager treating vascular risk factors to guideline-recommended target levels. Eligible patients will include all adult patients seen at stroke prevention clinics in Edmonton, Alberta after an ischemic stroke or TIA who have uncontrolled hypertension (defined as systolic blood pressure (BP > 140 mm Hg or dyslipidemia (fasting LDL-cholesterol > 2.00 mmol/L and who are not cognitively impaired or institutionalized. The primary outcome will be the proportion of subjects who attain 'optimal BP and lipid control'(defined as systolic BP Conclusions Nearly one-quarter of those who survive a TIA or minor stroke suffer another vascular event within a year. If our intervention improves the provision of secondary prevention therapies in these patients, the clinical (and financial implications will be enormous.

  4. Coding of adverse events of suicidality in clinical study reports of duloxetine for the treatment of major depressive disorder

    DEFF Research Database (Denmark)

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn

    2014-01-01

    OBJECTIVE: To assess the effects of coding and coding conventions on summaries and tabulations of adverse events data on suicidality within clinical study reports. DESIGN: Systematic electronic search for adverse events of suicidality in tables, narratives, and listings of adverse events...... identification number, we attempted to reconcile data on the same event between the different formats for presenting data on adverse events within the clinical study report. SETTING: 9 randomised placebo controlled trials of duloxetine for major depressive disorder submitted to the European Medicines Agency...... for marketing approval. DATA SOURCES: Clinical study reports obtained from the EMA in 2011. RESULTS: Six trials used the medical coding dictionary COSTART (Coding Symbols for a Thesaurus of Adverse Reaction Terms) and three used MedDRA (Medical Dictionary for Regulatory Activities). Suicides were clearly...

  5. A methodology for the quantitative risk assessment of major accidents triggered by seismic events

    International Nuclear Information System (INIS)

    Antonioni, Giacomo; Spadoni, Gigliola; Cozzani, Valerio

    2007-01-01

    A procedure for the quantitative risk assessment of accidents triggered by seismic events in industrial facilities was developed. The starting point of the procedure was the use of available historical data to assess the expected frequencies and the severity of seismic events. Available equipment-dependant failure probability models (vulnerability or fragility curves) were used to assess the damage probability of equipment items due to a seismic event. An analytic procedure was subsequently developed to identify, evaluate the credibility and finally assess the expected consequences of all the possible scenarios that may follow the seismic events. The procedure was implemented in a GIS-based software tool in order to manage the high number of event sequences that are likely to be generated in large industrial facilities. The developed methodology requires a limited amount of additional data with respect to those used in a conventional QRA, and yields with a limited effort a preliminary quantitative assessment of the contribution of the scenarios triggered by earthquakes to the individual and societal risk indexes. The application of the methodology to several case-studies evidenced that the scenarios initiated by seismic events may have a relevant influence on industrial risk, both raising the overall expected frequency of single scenarios and causing specific severe scenarios simultaneously involving several plant units

  6. Multichannel linear descriptors analysis for event-related EEG of vascular dementia patients during visual detection task.

    Science.gov (United States)

    Lou, Wutao; Xu, Jin; Sheng, Hengsong; Zhao, Songzhen

    2011-11-01

    Multichannel EEG recorded in a task condition could contain more information about cognition. However, that has not been widely investigated in the vascular-dementia (VaD)- related studies. The purpose of this study was to explore the differences of brain functional states between VaD patients and normal controls while performing a detection task. Three multichannel linear descriptors, i.e. spatial complexity (Ω), field strength (Σ) and frequency of field changes (Φ), were applied to analyse four frequency bands (delta, theta, alpha and beta) of multichannel event-related EEG signals for 12 VaD patients (mean age ± SD: 69.25 ± 10.56 years ; MMSE score ± SD: 22.58 ± 4.42) and 12 age-matched healthy subjects (mean age ± SD: 67.17 ± 5.97 years ; MMSE score ± SD: 29.08 ± 0.9). The correlations between the three measures and MMSE scores were also analysed. VaD patients showed a significant higher Ω value in the delta (p = 0.013) and theta (p = 0.021) frequency bands, a lower Σ value (p = 0.011) and a higher Φ (p = 0.008) value in the delta frequency band compared with normal controls. The MMSE scores were negatively correlated with the Ω (r = -0.52, p = 0.01) and Φ (r = -0.47, p = 0.02) values in the delta frequency band. The results indicated the VaD patients presented a reduction of synchronization in the slow frequency band during target detection, and suggested more neurons might be activated in VaD patients compared with normal controls. The Ω and Φ measures in the delta frequency band might be used to evaluate the degree of cognitive dysfunction. The multichannel linear descriptors are promising measures to reveal the differences in brain functions between VaD patients and normal subjects, and could potentially be used to evaluate the degree of cognitive dysfunction in VaD patients. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality

    DEFF Research Database (Denmark)

    Ekeloef, S; Alamili, M; Devereaux, P J

    2016-01-01

    -analysis was conducted in January 2016 according to the Meta-analysis Of Observational Studies in Epidemiology guidelines. Both interventional and observational studies measuring troponin within the first 4 days after surgery were eligible. A systematic search was performed in PubMed, EMBASE, Scopus, and the Cochrane...

  8. Major consequences of an intense dense shelf water cascading event on deep-sea benthic trophic conditions and meiofaunal biodiversity

    Directory of Open Access Journals (Sweden)

    A. Pusceddu

    2013-04-01

    Full Text Available Numerous submarine canyons around the world are preferential conduits for episodic dense shelf water cascading (DSWC, which quickly modifies physical and chemical ambient conditions while transporting large amounts of material towards the base of slope and basin. Observations conducted during the last 20 yr in the Lacaze-Duthiers and Cap de Creus canyons (Gulf of Lion, NW Mediterranean Sea report several intense DSWC events. The effects of DSWC on deep-sea ecosystems are almost unknown. To investigate the effects of these episodic events, we analysed changes in the meiofaunal biodiversity inside and outside the canyon. Sediment samples were collected at depths varying from ca. 1000 to > 2100 m in May 2004 (before a major event, April 2005 (during a major cascading event and in October 2005, August 2006, April 2008 and April 2009 (after a major event. We report here that the late winter–early spring 2005 cascading led to a reduction of the organic matter contents in canyon floor sediments down to 1800 m depth, whereas surface sediments at about 2200 m depth showed an increase. Our findings suggest that the nutritional material removed from the shallower continental shelf, canyon floor and flanks, and also the adjacent open slope was rapidly transported to the deep margin. During the cascading event the meiofaunal abundance and biodiversity in the studied deep-sea sediments were significantly lower than after the event. Benthic assemblages during the cascading were significantly different from those in all other sampling periods in both the canyon and deep margin. After only six months from the cessation of the cascading, benthic assemblages in the impacted sediments were again similar to those observed in other sampling periods, thus illustrating a quick recovery. Since the present climate change is expected to increase the intensity and frequency of these episodic events, we anticipate that they will increasingly affect benthic bathyal

  9. Caplacizumab reduces the frequency of major thromboembolic events, exacerbations and death in patients with acquired thrombotic thrombocytopenic purpura.

    Science.gov (United States)

    Peyvandi, F; Scully, M; Kremer Hovinga, J A; Knöbl, P; Cataland, S; De Beuf, K; Callewaert, F; De Winter, H; Zeldin, R K

    2017-07-01

    Essentials Acquired thrombotic thrombocytopenic purpura (aTTP) is linked with significant morbidity/mortality. Caplacizumab's effect on major thromboembolic (TE) events, exacerbations and death was studied. Fewer caplacizumab-treated patients had a major TE event, an exacerbation, or died versus placebo. Caplacizumab has the potential to reduce the acute morbidity and mortality associated with aTTP. Background Acquired thrombotic thrombocytopenic purpura (aTTP) is a life-threatening autoimmune thrombotic microangiopathy. In spite of treatment with plasma exchange and immunosuppression, patients remain at risk for thrombotic complications, exacerbations, and death. In the phase II TITAN study, treatment with caplacizumab, an anti-von Willebrand factor Nanobody ® was shown to reduce the time to confirmed platelet count normalization and exacerbations during treatment. Objective The clinical benefit of caplacizumab was further investigated in a post hoc analysis of the incidence of major thromboembolic events and exacerbations during the study drug treatment period and thrombotic thrombocytopenic purpura-related death during the study. Methods The Standardized Medical Dictionary for Regulatory Activities (MedDRA) Query (SMQ) for 'embolic and thrombotic events' was run to investigate the occurrence of major thromboembolic events and exacerbations in the safety population of the TITAN study, which consisted of 72 patients, of whom 35 received caplacizumab and 37 received placebo. Results Four events (one pulmonary embolism and three aTTP exacerbations) were reported in four patients in the caplacizumab group, and 20 such events were reported in 14 patients in the placebo group (two acute myocardial infarctions, one ischemic stroke, one hemorrhagic stroke, one pulmonary embolism, one deep vein thrombosis, one venous thrombosis, and 13 aTTP exacerbations). Two of the placebo-treated patients died from aTTP during the study. Conclusion In total, 11.4% of caplacizumab

  10. Prey selection of corallivorous muricids at Koh Tao (Gulf of Thailand) four years after a major coral bleaching event

    NARCIS (Netherlands)

    Moerland, M.S.; Scott, C.M.; Hoeksema, B.W.

    2016-01-01

    Corallivorous Drupella (Muricidae) snails at Koh Tao are reported to have extended their range of prey species following a major coral bleaching event in 2010. Populations of their preferred Acropora prey had locally diminished in both size and abundance, and the snails had introduced free-living

  11. The transition to adulthood: A game changer? Panel analyses of the impact of major life events on sport participation

    NARCIS (Netherlands)

    Houten, J.M.A. van

    2017-01-01

    In this study, we investigated changes in and differences between the sport participation of individuals during the transition to adulthood, and the role of major life events that mark this transition. We employ a neo-Weberian theoretical framework related to changes in temporal and social resources

  12. Major adverse cardiac and cerebrovascular events after the ross procedure: A report from the german-dutch ross registry

    NARCIS (Netherlands)

    H. Sievers (Hans Hinrich); U. Stierle (Ulrich); E.I. Charitos (Efstratios); T. Hanke; M. Misfeld (Martin); J.F.M. Bechtel (Matthias); A. Gorski (Armin); U.F. Franke (Ulrich); B. Graf (Bernhard); D.R. Robinson (Derek); A.J.J.C. Bogers (Ad); A. Dodge-Khatami (Ali); J.O. Boehm (Juergen); J.G. Rein (Joachim); C.A. Botha (Cornelius); R. Lange (Rüdiger); J. Hoerer (Juergen); A. Moritz (Anton); T. Wahlers (Thorsten); M. Breuer (Martin); K. Ferrari-Kuehne (Katharina); R. Hetzer (Roland); M. Huebler (Michael); G. Ziemer (Gerhard); J.J.M. Takkenberg (Hanneke); W. Hemmer

    2010-01-01

    textabstractBackground-: The purpose of the study is to report major cardiac and cerebrovascular events after the Ross procedure in the large adult and pediatric population of the German-Dutch Ross registry. These data could provide an additional basis for discussions among physicians and a source

  13. Thrombotic recurrences and bleeding events in APS vascular patients: a review from the literature and a comparison with the APS Piedmont Cohort.

    Science.gov (United States)

    Bazzan, M; Vaccarino, A; Stella, S; Bertero, M T; Carignola, R; Montaruli, B; Roccatello, D; Shoenfeld, Y

    2013-06-01

    In APS vascular patients, thrombotic recurrences are more frequent than in non-APS thrombotic patients. To better define this clinical setting, a systematic review of the literature after 1999 was performed: 8 cohort studies (including the recent APS Piedmont Cohort) and 6 intervention studies were selected and evaluated. Thrombotic recurrences, bleeding events, therapeutic strategies, antiphospholipid (aPL) profile, inherited and acquired risk factors (when present) were calculated and compared. Emerging risk factors for thrombotic recurrences include withdrawal of oral anticoagulant therapy (OAT), high intensity OAT (INR range 3-4), aPL profile (triple positivity, Miyakis types 1 and 2a profiles) and association with inherited or acquired pro-thrombotic risk factors. Moreover, there are evidences that high risk (mainly for aPL profile) APS vascular patients have a high recurrence rate in spite of correct OAT treatment. Clinical trials in this clinical setting are needed. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. The usefulness of dipyridamole thallium-201 single photon emission computed tomography for predicting perioperative cardiac events in patients undergoing non-cardiac vascular surgery

    International Nuclear Information System (INIS)

    Chen Tao; Huang Gang

    2004-01-01

    The aim of this study was to evaluate the usefulness of dipyridamole Tl-201 myocardium single photon emission computed tomography (201Tl-SPECT) for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) and abdominal aortic aneurysm (AAA) undergoing non-cardiac vascular surgery. Methods: Preoperative dipyridamole 201Tl-SPECT imaging in association with clinical risk assessment was performed in 224 consecutive patients (97 ASO and 127 AAA). Results: The patients were classified into three groups, including low-risk (n=173, 77%), intermediate-risk (n=39, 18%), and high-risk (n=12, 5%) groups according to the clinical risk stratification. The prevalence of reversible Tl-201 defect was significantly higher in the high-risk group than that in the low-risk group (83% vs. 14%, p<0.001). In 180 patients who underwent vascular surgery, 9 patients (5.0%) had perioperative cardiac events, including heart failure (n=l), unstable angina (n=2), and other cardiac events such as arrhythmias (n=6). The clinical variables including the clinical risk stratification did not significantly correlate with the perioperative cardiac events. In contrast, the reversible defect on 201Tl-SPECT was the only variable to predict perioperative cardiac events by a stepwise logistic regression analysis (odds ratio 7.0, 95% confidence interval l.7-28.0, p=0.007). It was also a significant predictor of perioperative cardiac events in a subgroup of low risk patients (odds ratio 11.6, 95% confidence interval 2.3-57.4, p=0.004). The sensitivity and specificity of the reversible defect for predicting perioperative cardiac events were 55.6% and 84.8% in all operated patients, and 57.1% and 89.7% in low risk patients, respectively. Conclusions: The preoperative dipyridamole 201Tl-SPECT was useful for predicting perioperative cardiac events in patients with vascular diseases, even in patients identified as having a low risk based on the clinical risk assessment. (authors)

  15. Spatially Explicit Modelling of the Belgian Major Endurance Event 'The 100 km Dodentocht'.

    Directory of Open Access Journals (Sweden)

    Steffie Van Nieuland

    Full Text Available 'The 100 km Dodentocht', which takes place annually and has its start in Bornem, Belgium, is a long distance march where participants have to cover a 100 km trail in at most 24 hours. The approximately 11 000 marchers per edition are tracked by making use of passive radio-frequency-identification (RFID. These tracking data were analyzed to build a spatially explicit marching model that gives insights into the dynamics of the event and allows to evaluate the effect of changes in the starting procedure of the event. For building the model, the empirical distribution functions (edf of the marching speeds at every section of the trail in between two consecutive checkpoints and of the checkpoints where marchers retire, are determined, taking into account age, gender, and marching speeds at previous sections. These distribution functions are then used to sample the consecutive speeds and retirement, and as such to simulate the times when individual marchers pass by the consecutive checkpoints. We concluded that the data-driven model simulates the event reliably. Furthermore, we tested three scenarios to reduce the crowdiness along the first part of the trail and in this way were able to conclude that either the start should be moved to a location outside the town center where the streets are at least 25% wider, or that the marchers should start in two groups at two different locations, and that these groups should ideally merge at about 20 km after the start. The crowdiness at the start might also be reduced by installing a bottleneck at the start in order to limit the number of marchers that can pass per unit of time. Consequently, the operating hours of the consecutive checkpoints would be longer. The developed framework can likewise be used to analyze and improve the operation of other endurance events if sufficient tracking data are available.

  16. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials.

    Science.gov (United States)

    Campos, Carlos M; Caixeta, Adriano; Franken, Marcelo; Bartorelli, Antonio L; Whitbourn, Robert J; Wu, Chiung-Jen; Li Paul Kao, Hsien; Rosli, Mohd Ali; Carrie, Didier; De Bruyne, Bernard; Stone, Gregg W; Serruys, Patrick W; Abizaid, Alexandre

    2018-02-15

    to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Time to Wound Healing and Major Adverse Limb Events in Patients with Critical Limb Ischemia Treated with Endovascular Revascularization.

    Science.gov (United States)

    Reed, Grant W; Salehi, Negar; Giglou, Pejman R; Kafa, Rami; Malik, Umair; Maier, Michael; Shishehbor, Mehdi H

    2016-10-01

    There are few studies that quantify the impact of time to wound healing on outcomes after endovascular revascularization of critical limb ischemia (CLI). In this retrospective study, 179 patients with CLI and tissue loss were assessed for adverse events after endovascular therapy. Associations between time to wound healing and outcomes were determined via Cox proportional hazards analysis. The long-term probability of events was assessed with Kaplan-Meier analysis. The primary end point was major adverse limb events (MALE-major amputation, surgical endarterectomy, or bypass). Secondary end points were major amputation, need for repeat endovascular therapy, and mortality. After multivariable adjustment for time-dependent wound healing, age, renal function, diabetes, and Rutherford class, independent predictors of MALE included the presence of an unhealed wound (hazard ratio [HR], 5.2; 95% confidence interval (CI), 2.3-11.8; P wounds compared with healed wounds (log-rank P wounds healed within 4 months had a lower probability of MALE than patients who did not heal by 4 months (log-rank, P = 0.04). Unhealed wounds were also independently associated with major amputation (HR, 9.0; 95% CI, 2.6-31.1; P = 0.0004), and patients whose wounds healed by 3 months had less major amputation (log-rank, P = 0.04). Unhealed wounds were independently associated with increased risk of mortality (HR, 42.7; 95% CI, 5.7-319.0; P = 0.002) but not repeat revascularization. Unhealed wounds are an independent risk factor for MALE, major amputation, and mortality after endovascular treatment of CLI. Wound healing within 3 months is associated with less risk of major amputation, and within 4 months less risk of MALE. A focus should be on achieving wound healing as fast as possible in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Socioeconomic variation in incidence of primary and secondary major cardiovascular disease events: an Australian population-based prospective cohort study.

    Science.gov (United States)

    Korda, Rosemary J; Soga, Kay; Joshy, Grace; Calabria, Bianca; Attia, John; Wong, Deborah; Banks, Emily

    2016-11-21

    Cardiovascular disease (CVD) disproportionately affects disadvantaged people, but reliable quantitative evidence on socioeconomic variation in CVD incidence in Australia is lacking. This study aimed to quantify socioeconomic variation in rates of primary and secondary CVD events in mid-age and older Australians. Baseline data (2006-2009) from the 45 and Up Study, an Australian cohort involving 267,153 men and women aged ≥ 45, were linked to hospital and death data (to December 2013). Outcomes comprised first event - death or hospital admission - for major CVD combined, as well as myocardial infarction and stroke, in those with and without prior CVD (secondary and primary events, respectively). Cox regression estimated hazard ratios (HRs) for each outcome in relation to education (and income and area-level disadvantage), separately by age group (45-64, 65-79, and ≥ 80 years), adjusting for age and sex, and additional sociodemographic factors. There were 18,207 primary major CVD events over 1,144,845 years of follow-up (15.9/1000 person-years), and 20,048 secondary events over 260,357 years (77.0/1000 person-years). For both primary and secondary events, incidence increased with decreasing education, with the absolute difference between education groups largest for secondary events. Age-sex adjusted hazard ratios were highest in the 45-64 years group: for major CVDs, HR (no qualifications vs university degree) = 1.62 (95% CI: 1.49-1.77) for primary events, and HR = 1.49 (1.34-1.65) for secondary events; myocardial infarction HR = 2.31 (1.87-2.85) and HR = 2.57 (1.90-3.47) respectively; stroke HR = 1.48 (1.16-1.87) and HR = 1.97 (1.42-2.74) respectively. Similar but attenuated results were seen in older age groups, and with income. For area-level disadvantage, CVD gradients were weak and non-significant in older people (> 64 years). Individual-level data are important for quantifying socioeconomic variation in CVD incidence, which

  19. The usefulness of dipyridamole thallium-201 single photon emission computed tomography for predicting perioperative cardiac events in patients undergoing non-cardiac vascular surgery

    International Nuclear Information System (INIS)

    Chen, Tao; Kuwabara, Yasuo; Tsutsui, Hiroyuki; Sasaki, Masayuki; Nakagawa, Makoto; Koga, Hirofumi; Kaneko, Kouichirou; Komori, Kimihiro; Masuda, Kouji

    2002-01-01

    The aim of this study was to evaluate the usefulness of dipyridamole Tl-201 myocardium single photon emission computed tomography ( 201 Tl-SPECT) for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) and abdominal aortic aneurysm (AAA) undergoing non-cardiac vascular surgery. Preoperative dipyridamole 201 Tl-SPECT imaging in association with clinical risk assessment was performed in 224 consecutive patients (97 ASO and 127 AAA). The patients were classified into three groups, including low-risk (n=173, 77%), intermediate-risk (n=39, 18%), and high-risk (n=12, 5%) groups according to the clinical risk stratification. The prevalence of reversible Tl-201 defect was significantly higher in the high-risk group than that in the low-risk group (83% vs. 14%, p 201 Tl-SPECT was the only variable to predict perioperative cardiac events by a stepwise logistic regression analysis (odds ratio 7.0, 95% confidence interval 1.7-28.0, p=0.007). It was also a significant predictor of perioperative cardiac events in a subgroup of low risk patients (odds ratio 11.6, 95% confidence interval 2.3-57.4, p=0.004). The sensitivity and specificity of the reversible defect for predicting perioperative cardiac events were 55.6% and 84.8% in all operated patients, and 57.1% and 89.7% in low risk patients, respectively. The preoperative dipyridamole 201 Tl-SPECT was useful for predicting perioperative cardiac events in patients with vascular diseases, even in patients identified as having a low risk based on the clinical risk assessment. (author)

  20. Managing the risk of extreme climate events in Australian major wheat production systems

    Science.gov (United States)

    Luo, Qunying; Trethowan, Richard; Tan, Daniel K. Y.

    2018-06-01

    Extreme climate events (ECEs) such as drought, frost risk and heat stress cause significant economic losses in Australia. The risk posed by ECEs in the wheat production systems of Australia could be better managed through the identification of safe flowering (SFW) and optimal time of sowing (TOS) windows. To address this issue, three locations (Narrabri, Roseworthy and Merredin), three cultivars (Suntop and Gregory for Narrabri, Mace for both Roseworthy and Merredin) and 20 TOS at 1-week intervals between 1 April and 12 August for the period from 1957 to 2007 were evaluated using the Agricultural Production System sIMulator (APSIM)-Wheat model. Simulation results show that (1) the average frequency of frost events decreased with TOS from 8 to 0 days (d) across the four cases (the combination of locations and cultivars), (2) the average frequency of heat stress events increased with TOS across all cases from 0 to 10 d, (3) soil moisture stress (SMS) increased with earlier TOS before reaching a plateau and then slightly decreasing for Suntop and Gregory at Narrabri and Mace at Roseworthy while SMS increased with TOS for Mace at Merredin from 0.1 to 0.8, (4) Mace at Merredin had the earliest and widest SFW (216-260) while Mace at Roseworthy had latest SFW (257-280), (5) frost risk and heat stress determine SFW at wetter sites (i.e. Narrabri and Roseworthy) while frost risk and SMS determine SFW at drier site (i.e. Merredin) and (6) the optimal TOS (window) to maximise wheat yield are 6-20 May, 13-27 May and 15 April at Narrabri, Roseworthy and Merredin, respectively. These findings provide important and specific information for wheat growers about the management of ECE risk on farm. Furthermore, the coupling of the APSIM crop models with state-of-the-art seasonal and intra-seasonal climate forecast information provides an important tool for improved management of the risk of ECEs in economically important cropping industries in the foreseeable future.

  1. Admission hyperglycemia predicts inhospital mortality and major adverse cardiac events after primary percutaneous coronary intervention in patients without diabetes mellitus.

    Science.gov (United States)

    Ekmekci, Ahmet; Cicek, Gokhan; Uluganyan, Mahmut; Gungor, Baris; Osman, Faizel; Ozcan, Kazim Serhan; Bozbay, Mehmet; Ertas, Gokhan; Zencirci, Aycan; Sayar, Nurten; Eren, Mehmet

    2014-02-01

    Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose 145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.

  2. Solar sources of interplanetary southward B/sub z/ events responsible for major magnetic storms (1978--1979)

    International Nuclear Information System (INIS)

    Tang, F.; Tsurutani, B.T.; Gonzalez, W.D.; Akasofu, S.I.; Smith, E.J.

    1989-01-01

    Tsurutani et al. [1988] analyzed the 10 intense interplanetary southward B/sub z/ events that led to major magnetic storms (Dst 3.0) are associated with prominence eruptions. For three of the five southward B/sub z/ events in which the driver gases are the causes of the intense southward field leading to magnetic storms, the photospheric fields of the solar sources have no dominant southward component, indicating the driver gas fields do not always result from a simple outward convection of solar magnetic fields. Finally we compare the solar events and their resulting interplanetary shocks and find that the standard solar parameters do not correlate with the strengths of the resulting shocks at 1 AU. The implications are discussed. copyright American Geophysical Union 1989

  3. Cloud Formation and Water Transport on Mars after Major Outflow Events

    Science.gov (United States)

    Santiago, D. L.; Colaprete, A.; Kreslavsky, M.; Kahre, M. A.; Asphaug, E.

    2012-01-01

    The triggering of a robust water cycle on Mars might have been caused by the gigantic flooding events evidenced by outflow channels. We use the Ames Mars General Circulation Model (MGCM) to test this hypothesis, studying how these presumably abrupt eruptions of water might have affected the climate of Mars in the past. We model where the water ultimately went as part of a transient atmospheric water cycle, to answer questions including: (1) Can sudden introductions of large amounts of water on the Martian surface lead to a new equilibrated water cycle? (2) What are the roles of water vapor and water ice clouds to sudden changes in the water cycle on Mars? (3) How are radiative feedbacks involved with this? (4) What is the ultimate fate of the outflow water? (5) Can we tie certain geological features to outflow water redistributed by the atmosphere?

  4. The influence of a major sporting event upon emergency department attendances; A retrospective cross-national European study

    Science.gov (United States)

    Colón-González, Felipe J.; Fouillet, Anne; Elliot, Alex J.; Caserio-Schonemann, Céline; Hughes, Thomas C.; Gallagher, Naomh; Morbey, Roger A.; Smith, Gillian E.; Thomas, Daniel Rh.; Lake, Iain R.

    2018-01-01

    Major sporting events may influence attendance levels at hospital emergency departments (ED). Previous research has focussed on the impact of single games, or wins/losses for specific teams/countries, limiting wider generalisations. Here we explore the impact of the Euro 2016 football championships on ED attendances across four participating nations (England, France, Northern Ireland, Wales), using a single methodology. Match days were found to have no significant impact upon daily ED attendances levels. Focussing upon hourly attendances, ED attendances across all countries in the four hour pre-match period were statistically significantly lower than would be expected (OR 0.97, 95% CI 0.94–0.99) and further reduced during matches (OR 0.94, 95% CI 0.91–0.97). In the 4 hour post-match period there was no significant increase in attendances (OR 1.01, 95% CI 0.99–1.04). However, these impacts were highly variable between individual matches: for example in the 4 hour period following the final, involving France, the number of ED attendances in France increased significantly (OR 1.27, 95% CI 1.13–1.42). Overall our results indicate relatively small impacts of major sporting events upon ED attendances. The heterogeneity observed makes it difficult for health providers to predict how major sporting events may affect ED attendances but supports the future development of compatible systems in different countries to support cross-border public health surveillance. PMID:29898000

  5. The influence of a major sporting event upon emergency department attendances; A retrospective cross-national European study.

    Science.gov (United States)

    Hughes, Helen E; Colón-González, Felipe J; Fouillet, Anne; Elliot, Alex J; Caserio-Schonemann, Céline; Hughes, Thomas C; Gallagher, Naomh; Morbey, Roger A; Smith, Gillian E; Thomas, Daniel Rh; Lake, Iain R

    2018-01-01

    Major sporting events may influence attendance levels at hospital emergency departments (ED). Previous research has focussed on the impact of single games, or wins/losses for specific teams/countries, limiting wider generalisations. Here we explore the impact of the Euro 2016 football championships on ED attendances across four participating nations (England, France, Northern Ireland, Wales), using a single methodology. Match days were found to have no significant impact upon daily ED attendances levels. Focussing upon hourly attendances, ED attendances across all countries in the four hour pre-match period were statistically significantly lower than would be expected (OR 0.97, 95% CI 0.94-0.99) and further reduced during matches (OR 0.94, 95% CI 0.91-0.97). In the 4 hour post-match period there was no significant increase in attendances (OR 1.01, 95% CI 0.99-1.04). However, these impacts were highly variable between individual matches: for example in the 4 hour period following the final, involving France, the number of ED attendances in France increased significantly (OR 1.27, 95% CI 1.13-1.42). Overall our results indicate relatively small impacts of major sporting events upon ED attendances. The heterogeneity observed makes it difficult for health providers to predict how major sporting events may affect ED attendances but supports the future development of compatible systems in different countries to support cross-border public health surveillance.

  6. The major stressful life events and cancer: stress history and cancer.

    Science.gov (United States)

    Tas, Faruk; Karalar, Umran; Aliustaoglu, Mehmet; Keskin, Serkan; Can, Gulbeyaz; Cinar, Fatma Ebru

    2012-06-01

    The objective of this study was to analyze the extent of stressful life events' etiology and to compare socio-demographic and medical characteristics of the presence and absence of stress in Turkish cancer patients. Patients with cancer who attended ambulatory patient care units answered the questionnaires. Medical information was reviewed from chart data. The study population comprised 465 women (60.5%) and 303 men (39.5%), in total 768 cases. The median age was 53 years, ranging between 18 and 94. Three-hundred and twenty patients (41.7%) had at least one type of stress since last year of the time of initial diagnosis. Among patients had stress, the median number of stress modalities presented was 1 (range 1-6). Death, lack of livelihood, quarrel, illness, and debt almost always consisted of stress types. History of stress within last year was found more in women (66.3% vs. 56.5%, P = 0.006) and overweight patients (57.5% vs. 47.2%, P = 0.005). Similarly, among cancer types, only patients with breast cancer (41.9% vs. 31.7%, P = 0.04) had lived more stressful situation. However, the married patients (72.2% vs. 80.6%, P = 0.03) had less stress. Patients with gastric cancer had more frequent debt (29.0%, P history (21.4%, P = 0.001). Additionally, in lung cancer patients, their rate of livelihood difficulty was highly less than average (2.4%, P = 0.003). We found that overweight patients had more illness history (68.9% vs. 51.6%, P = 0.004), patients who were not working had more death history (89.7% vs. 78%, P = 0.01), and female patients had more quarrel history (78.2% vs. 60.5%, P = 0.002). Likewise, history of debt in patients who is a member of large family (56.2% vs. 27.4%, P = 0.01) was more frequent. Additionally, the lack of livelihood was prominent in urban patients (92.8% vs. 78.6%, P = 0.002) and in patients with low income (48.5% vs. 66.7%, P = 0.004). The question of whether or not psychological factors originated from stressful life events have an

  7. Does organisational justice protect from sickness absence following a major life event? A Finnish public sector study.

    Science.gov (United States)

    Elovainio, M; Kivimäki, M; Linna, A; Brockner, J; van den Bos, K; Greenberg, J; Pentti, J; Virtanen, M; Vahtera, J

    2010-05-01

    It has been shown that fairness perceptions have a strong impact on health, especially under conditions of great work stress. The aim of this study was to extend previous research in studying whether working in high justice workplace would protect from health effects following environmental stressors outside work. Using a prospective longitudinal design, the relationships between organisational justice and sickness-related absences both before and after a major life event among 25 459 public sector employees working in 2551 work units were studied. Sickness absences covered the period from 36 months before the event until 30 months after the event. The increase in sickness absences after the event was larger and stayed at a higher level even 30 months after the event, among those who perceived the management practices in their work unit to be relatively unfair. Similar patterns were found for each of the distributive, procedural and interactional dimensions of organisational justice. Fair organisational and managerial procedures may buffer the negative health effects of psychosocial health risks outside work.

  8. The interaction of combined effects of the BDNF and PRKCG genes and negative life events in major depressive disorder.

    Science.gov (United States)

    Yang, Chunxia; Sun, Ning; Liu, Zhifen; Li, Xinrong; Xu, Yong; Zhang, Kerang

    2016-03-30

    Major depressive disorder (MDD) is a mental disorder that results from complex interplay between multiple and partially overlapping sets of susceptibility genes and environmental factors. The brain derived neurotrophic factor (BDNF) and Protein kinase C gamma type (PRKCG) are logical candidate genes in MDD. Among diverse environmental factors, negative life events have been suggested to exert a crucial impact on brain development. In the present study, we hypothesized that interactions between genetic variants in BDNF and PRKCG and negative life events may play an important role in the development of MDD. We recruited a total of 406 patients with MDD and 391 age- and gender-matched control subjects. Gene-environment interactions were analyzed using generalized multifactor dimensionality reduction (GMDR). Under a dominant model, we observed a significant three-way interaction among BDNF rs6265, PRKCG rs3745406, and negative life events. The gene-environment combination of PRKCG rs3745406 C allele, BDNF rs6265 G allele and high level of negative life events (C-G-HN) was significantly associated with MDD (OR, 5.97; 95% CI, 2.71-13.15). To our knowledge, this is the first report of evidence that the BDNF-PRKCG interaction may modify the relationship between negative life events and MDD in the Chinese population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Dipyridamole thallium-201 single-photon emission computed tomography for prediction of perioperative cardiac events in patients with arteriosclerosis obliterans undergoing vascular surgery

    International Nuclear Information System (INIS)

    Ziyang, Huang; Komori, Sadayoshi; Sawanobori, Takao

    1998-01-01

    The aim of the study was to determine whether or not dipyridamole thallium-201 single-photon emission computed tomography ( 201 Tl-SPECT) has significant additive value for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) undergoing vascular surgery. Routine preoperative 201 Tl-SPECT was performed in 106 consecutive patients with ASO (age 68±8.9 years; 91 men and 15 women). The frequency of reversible defects in a clinical high-risk group (n=44) was significantly higher than in a low-risk group (n=62; 55% vs 24%, p 201 Tl-SPECT data to clinical risk-stratified patients with ASO allows better prediction of perioperative cardiac events. (author)

  10. Short-term degradation of air quality during major firework events in Delhi, India

    Science.gov (United States)

    Shivani; Gadi, Ranu; Saxena, Mohit; Sharma, Sudhir Kumar; Mandal, Tuhin Kumar

    2018-04-01

    The effect of firework events on air quality was assessed from ambient fine particulate matter (PM2.5) collected during the Diwali period in two consecutive years, i.e., November 2015 and October 2016. The extensive firework activities led to the short-term degradation of air quality during the Diwali days. PM2.5 samples were chemically characterised for elements, water-soluble ionic species, organic carbon (OC) and elemental carbon (EC). Ba, K, Sr, S, Mg and Na showed significant increases in concentration on Diwali days compared to pre-Diwali days which revealed their association with firecrackers. Concentration of SO4 2-, NO3 -, Cl-, K+ and NH4 + ions contributed to the increases in PM2.5 concentration on Diwali days. Higher OC/EC ratios indicated the formation of secondary organic carbon during the Diwali period. This study concludes that the high PM2.5 level during Diwali 2016 was a result of contribution from fireworks on the Diwali night, trans-regional movement of pollutants due to crop residue burning, low wind speed (0.15 m s-1), and high humidity. It was observed that short-term exposure to Diwali is plausible to generate 1.3% increase in non-carcinogenic hazard index due to elements Al and Ba during Diwali 2016, whereas no significant variation was observed for the carcinogenic risk due to Pb. However, in 2015, the increase in non-carcinogenic hazard index was appreciably lower as compared to 2016.

  11. Proatherogenic pathways leading to vascular calcification

    International Nuclear Information System (INIS)

    Mazzini, Michael J.; Schulze, P. Christian

    2006-01-01

    Cardiovascular disease is the leading cause of morbidity and mortality in the western world and atherosclerosis is the major common underlying disease. The pathogenesis of atherosclerosis involves local vascular injury, inflammation and oxidative stress as well as vascular calcification. Vascular calcification has long been regarded as a degenerative process leading to mineral deposition in the vascular wall characteristic for late stages of atherosclerosis. However, recent studies identified vascular calcification in early stages of atherosclerosis and its occurrence has been linked to clinical events in patients with cardiovascular disease. Its degree correlates with local vascular inflammation and with the overall impact and the progression of atherosclerosis. Over the last decade, diverse and highly regulated molecular signaling cascades controlling vascular calcification have been described. Local and circulating molecules such as osteopontin, osteoprogerin, leptin and matrix Gla protein were identified as critical regulators of vascular calcification. We here review the current knowledge on molecular pathways of vascular calcification and their relevance for the progression of cardiovascular disease

  12. Oil and gas: year full of major events and dramatic changes

    International Nuclear Information System (INIS)

    Hirman, K.

    2004-01-01

    European gas industry encountered a historical precedent this February. Russian gas concern Gazprom has for the first time in its over thirty-year history of gas delivery from Siberia to Europe deliberately stopped the export. Even though this did not last for more then one day, customers in Latvia immediately noticed problems and also Polish customers mentioned some losses. Slovakia, still fully dependent on Russian gas supplies and at the same time major transported of Russian gas to European, was not touched by this situation as the deliveries were stopped on gas pipeline Jamal-Europe delivering gas to Germany through Belarus and Poland. But this affair can become a major issue in gas and political relations between Russia, Belarus and Ukraine and can also have a long-term impact on a dialog between Europe and Russia and consequently on building of new gas pipelines. And that could have a major impact on Slovakia's position as a transit country. Important for Slovakia is also the ongoing discussion about Ukrainian pipeline Odessa-Brody. A political decision made by Ukrainian cabinet that this pipeline should only be used to transport oil from Caspian Sea can give Slovakia the opportunity to diversify its oil import and at the same time increase the transit volumes should German refineries show interest in this transit route. On the other hand ratification of an intergovernmental agreement on integration of pipelines Druzba and Adria by Ukrainian Parliaments is also good news for Bratislava. This step politically opened the possibility to deliver Russian oil through Slovakia to Croatian Omisajl and from there with tankers to Europe and Northern America. The capacity of pipeline Druzba in Ukraine and Slovakia is not sufficient to take both the increased volumes of Russian and Caspian oil these two projects are competing for the free capacity. And the process and outcome of this competition may be of direct influence on Slovak interests. At the moment there are

  13. Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002-2014).

    Science.gov (United States)

    de Miguel-Yanes, José M; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Méndez-Bailón, Manuel; de Miguel-Díez, Javier; Lopez-de-Andrés, Ana

    2017-10-10

    Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients. Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year. We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non

  14. Major Sports events in Brazil: from the expression of brazilian sports policy to the urban neodevelopmentalist planning concept

    Directory of Open Access Journals (Sweden)

    Lino Castellani Filho

    2014-06-01

    Full Text Available We will seek some considerations about the major sports events in the Brazilian  territory as  the main expression of a particular logic of urban development and less of a sports policy itself, focusing on its impact in South America. In particular, we will focus on the paradox of the official discourse centered on the recognition of the Sport as Social Right and of a practice committed to the neodevelopmentalist conception of urban planning, ratifying its apprehension as a product likely to be commercialized having high appeal in the field of business.

  15. Does the Impact of Major Stressful Life Events on the Risk of Developing Depression Change Throughout Life?

    DEFF Research Database (Denmark)

    Kessing, L.V.; Agerbo, E.; Mortensen, P.B.

    2003-01-01

    for Longitudinal Labour Market Research. The study includes data on all admissions at psychiatric wards in Denmark from 1981 to 1998 and data on sociodemographic variables and death/suicide of first-degree relatives. RESULTS: A total of 13 006 patients who received a diagnosis of depression at the first ever...... at a psychiatric ward with a diagnosis of depression whereas death of a relative by causes other than suicide had no significant effect. In general, no interaction was found with age with any of the variables, totally, or for men or women, separately. CONCLUSIONS: The susceptibility to major life stressors does......BACKGROUND: It is unclear whether there is an interaction of ageing on the association between major life events and onset of depression. METHOD: This was a population-based nested case-control study with linkage of the Danish Psychiatric Central Research Register and the Integrated Database...

  16. Major dust events in Europe during marine isotope stage 5 (130–74 ka: a climatic interpretation of the "markers"

    Directory of Open Access Journals (Sweden)

    D.-D. Rousseau

    2013-09-01

    Full Text Available At present, major dust storms are occurring at mid-latitudes in the Middle East and Asia, as well as at low latitudes in Northern Africa and in Australia. Western Europe, though, does not experience such dramatic climate events, except for some African dust reaching it from the Sahara. This modern situation is of particular interest, in the context of future climate projections, since the present interglacial is usually interpreted, in this context, as an analog of the warm Eemian interval. European terrestrial records show, however, major dust events during the penultimate interglacial and early glacial. These events are easily observed in loess records by their whitish-color deposits, which lie above and below dark chernozem paleosols in Central European records of Marine Isotope Stage (MIS 5 age. We describe here the base of the Dolni Vestonice (DV loess sequence, Czech Republic, as the reference of such records. The dust is deposited during intervals that are characterized by poor vegetation – manifested by high δ13C values and low magnetic susceptibility – while the fine sand and clay in the deposits shows grain sizes that are clearly different from the overlying pleniglacial loess deposits. Some of these dust events have been previously described as "Markers" or Marker Silts (MS by one of us (G. Kukla, and are dated at about 111–109 ka and 93–92 ka, with a third and last one slightly visible at about 75–73 ka. Other events correspond to the loess material of Kukla's cycles, and are described as eolian silts (ES; they are observed in the same DV sequence and are dated at about 106–105 ka, 88–86 ka, and 78.5–77 ka. These dates are determined by considering the OSL ages with their errors measured on the studied sequence, and the comparison with Greenland ice-core and European speleothem chronologies. The fine eolian deposits mentioned above, MS as well as ES, correspond to short events that lasted about 2 ka; they are

  17. THE POLICING OF MAJOR EVENTS IN CANADA: LESSONS FROM TORONTO’S G20 AND VANCOUVER’S OLYMPICS

    Directory of Open Access Journals (Sweden)

    Wes Pue

    2015-10-01

    Full Text Available Major events ranging from sporting events to major international conferences too often result in disorder, deployment of riot squads, and mass arrests. Events surrounding a meeting of the G20 in Toronto and those at Vancouver’s Winter Olympics provide insight into the ways in which things can go wrong and the ways in which they can go well at major events. This article employs a “thick history” of events in order to explore gaps in Canadian law, including gaps between “law in the books” and “law in action.”      The legal frameworks governing large-scale events affect the likelihood of success measured in public safety, minimization of disorder, and protection of basic liberties. Surprisingly, large events often proceed without the benefit of a developed legal framework, leading to confusion among federal police, local police, and civil authority. We assess past reliance on the common law, a Vancouver City bylaw, Ontario’s Public Works Protection Act [PWPA], and the policing and security provisions of the federal Foreign Missions and International Organizations Act (Foreign Missions Act in order to determine which sorts of legal arrangements are most conducive to successful event management. Since major events in Canada are most often developed in law’s penumbra, without the benefit of clear legal authority or statutory direction governing the measures that are required, both effective management and ordinary liberties are compromised. A “worst of both worlds” outcome destabilizes police–citizen relationships and leaves individuals uncertain as to the durability of their rights of property, speech, assembly, movement, and personal integrity. Equally, police forces are left insecure as to the lawful means by which they should perform their duties. A comparison of the two events provides the pathology and a prescription, illustrating the need for legislation to govern the management of major events.   Trop souvent, la

  18. Analysis on the nitrogen drilling accident of Well Qionglai 1 (I: Major inducement events of the accident

    Directory of Open Access Journals (Sweden)

    Yingfeng Meng

    2015-12-01

    Full Text Available Nitrogen drilling in poor tight gas sandstone should be safe because of very low gas production. But a serious accident of fire blowout occurred during nitrogen drilling of Well Qionglai 1. This is the first nitrogen drilling accident in China, which was beyond people's knowledge about the safety of nitrogen drilling and brought negative effects on the development of gas drilling technology still in start-up phase and resulted in dramatic reduction in application of gas drilling. In order to form a correct understanding, the accident was systematically analyzed, the major events resulting in this accident were inferred. It is discovered for the first time that violent ejection of rock clasts and natural gas occurred due to the sudden burst of downhole rock when the fractured tight gas zone was penetrated during nitrogen drilling, which has been named as “rock burst and blowout by gas bomb”, short for “rock burst”. Then all the induced events related to the rock burst are as following: upthrust force on drilling string from rock burst, bridging-off formed and destructed repeatedly at bit and centralizer, and so on. However, the most direct important event of the accident turns out to be the blockage in the blooie pipe from rock burst clasts and the resulted high pressure at the wellhead. The high pressure at the wellhead causes the blooie pipe to crack and trigged blowout and deflagration of natural gas, which is the direct presentation of the accident.

  19. Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women☆

    Science.gov (United States)

    Tao, Ming; Li, Yihan; Xie, Dong; Wang, Zhiyang; Qiu, Jianying; Wu, Wenyuan; Sun, Jing; Wang, Zhoubing; Tao, Danhong; Zhao, Hongsu; Tian, Tian; Zhang, Jingxuan; Gao, Chengge; Niu, Qihui; Li, Qiang; Liu, Shanming; Liu, Jia; Zhang, Yunshu; He, Qiang; Rong, Han; Gan, Zhaoyu; Li, Jianying; Chen, Xiansheng; Pan, Jiyang; Li, Yi; Cui, Yanping; Han, Wei; Ma, Huan; Xie, Shoufu; Jin, Guixing; Li, Ling; Zhang, Ruiling; Tan, Qingrong; Zhang, Jun; Guan, Jing; Shi, Shenxun; Chen, Yiping; Kendler, Kenneth S.; Flint, Jonathan; Gao, Jingfang

    2011-01-01

    Background In European and US studies, patients with major depressive disorder (MDD) report more stressful life events (SLEs) than controls, but this relationship has rarely been studied in Chinese populations. Methods Sixteen lifetime SLEs were assessed at interview in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MDD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression. Results 60% of controls and 72% of cases reported at least one lifetime SLE. Fourteen of the sixteen SLEs occurred significantly more frequently in those with MDD (median odds ratio of 1.6). The three SLEs most strongly associated with risk for MDD (OR > 3.0) preceded the onset of MDD the majority of the time: rape (82%), physical abuse (100%) and serious neglect (99%). Limitations Our results may apply to females only. SLEs were rated retrospectively and are subject to biases in recollection. We did not assess contextual information for each life event. Conclusions More severe SLEs are more strongly associated with MDD. These results support the involvement of psychosocial adversity in the etiology of MDD in China. PMID:21821294

  20. Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women.

    Science.gov (United States)

    Tao, Ming; Li, Yihan; Xie, Dong; Wang, Zhiyang; Qiu, Jianying; Wu, Wenyuan; Sun, Jing; Wang, Zhoubing; Tao, Danhong; Zhao, Hongsu; Tian, Tian; Zhang, Jingxuan; Gao, Chengge; Niu, Qihui; Li, Qiang; Liu, Shanming; Liu, Jia; Zhang, Yunshu; He, Qiang; Rong, Han; Gan, Zhaoyu; Li, Jianying; Chen, Xiansheng; Pan, Jiyang; Li, Yi; Cui, Yanping; Han, Wei; Ma, Huan; Xie, Shoufu; Jin, Guixing; Li, Ling; Zhang, Ruiling; Tan, Qingrong; Zhang, Jun; Guan, Jing; Shi, Shenxun; Chen, Yiping; Kendler, Kenneth S; Flint, Jonathan; Gao, Jingfang

    2011-12-01

    In European and US studies, patients with major depressive disorder (MDD) report more stressful life events (SLEs) than controls, but this relationship has rarely been studied in Chinese populations. Sixteen lifetime SLEs were assessed at interview in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MDD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression. 60% of controls and 72% of cases reported at least one lifetime SLE. Fourteen of the sixteen SLEs occurred significantly more frequently in those with MDD (median odds ratio of 1.6). The three SLEs most strongly associated with risk for MDD (OR>3.0) preceded the onset of MDD the majority of the time: rape (82%), physical abuse (100%) and serious neglect (99%). Our results may apply to females only. SLEs were rated retrospectively and are subject to biases in recollection. We did not assess contextual information for each life event. More severe SLEs are more strongly associated with MDD. These results support the involvement of psychosocial adversity in the etiology of MDD in China. Copyright © 2011 Elsevier B.V. All rights reserved.

  1. Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults.

    Science.gov (United States)

    Pezzini, Alessandro; Grassi, Mario; Lodigiani, Corrado; Patella, Rosalba; Gandolfo, Carlo; Zini, Andrea; Delodovici, Maria Luisa; Paciaroni, Maurizio; Del Sette, Massimo; Toriello, Antonella; Musolino, Rossella; Calabrò, Rocco Salvatore; Bovi, Paolo; Adami, Alessandro; Silvestrelli, Giorgio; Sessa, Maria; Cavallini, Anna; Marcheselli, Simona; Bonifati, Domenico Marco; Checcarelli, Nicoletta; Tancredi, Lucia; Chiti, Alberto; Del Zotto, Elisabetta; Spalloni, Alessandra; Giossi, Alessia; Volonghi, Irene; Costa, Paolo; Giacalone, Giacomo; Ferrazzi, Paola; Poli, Loris; Morotti, Andrea; Rasura, Maurizia; Simone, Anna Maria; Gamba, Massimo; Cerrato, Paolo; Micieli, Giuseppe; Melis, Maurizio; Massucco, Davide; De Giuli, Valeria; Iacoviello, Licia; Padovani, Alessandro

    2014-04-22

    Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0- to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65). Among patients with ischemic stroke aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific risk factors. The IPSYS score may serve as a simple tool for risk estimation.

  2. Elevated serum osteoprotegerin levels predict in-hospital major adverse cardiac events in patients with ST elevation myocardial infarction.

    Science.gov (United States)

    Çanga, Aytun; Durakoğlugil, Murtaza Emre; Erdoğan, Turan; Kirbaş, Aynur; Yilmaz, Adnan; Çiçek, Yüksel; Ergül, Elif; Çetin, Mustafa; Kocaman, Sinan Altan

    2012-11-01

    The aim of our study was to investigate whether osteoprotegerin (OPG) is related to in-hospital major adverse cardiac events (MACE) and reperfusion parameters in patients with ST elevation myocardial infarction (STEMI). The OPG/receptor activator of nuclear factor-κB (RANK)/RANK ligand pathway has recently been associated with atherosclerosis. OPG is a predictor of cardiovascular events in patients with acute coronary syndrome. This study included 96 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Two groups with equal number of patients were formed according to median OPG level. The association of OPG levels on admission with post-procedural reperfusion parameters, and in-hospital MACE were investigated. Patients with higher OPG levels displayed higher neutrophil/lymphocyte ratio, admission troponin, admission glucose, and high-sensitive C-reactive protein. Higher OPG levels were associated with increased thrombolysis in myocardial infarction (TIMI) risk score, TIMI risk index, pain to balloon time, need for inotropic support, shock, and MACE, mainly driven by death. Reperfusion parameters were not different between the two groups. TIMI risk score, TIMI risk index, myocardial blush grade, estimated glomerular filtration rate (eGFR), number of obstructed vessels, and OPG significantly predicted adverse cardiac events. Multiple logistic regression analysis revealed OPG as an independent predictor of MACE as well as eGFR, number of obstructed vessels, and corrected TIMI frame count. OPG, a bidirectional molecule displaying both atheroprotective and pro-atherosclerotic properties, is currently known as a marker of inflammation and a predictor of cardiovascular mortality. The present study, for the first time, demonstrated that an increased OPG level is related to in-hospital adverse cardiovascular events after primary PCI in patients with STEMI. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd

  3. Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, Christopher L. [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg (Germany); Nance, John W. Jr. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); O’Brien, Terrence X. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (United States); Ebersberger, Ullrich [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich (Germany); Headden, Gary F. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bamberg, Fabian [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Radiology, University of Munich, Grosshadern Campus, and Munich Heart Alliance, Munich (Germany); Department of Radiology, University of Tuebingen (Germany)

    2014-07-15

    Highlights: • Patients developing UAP had overall more atherosclerosis as patients without any events. • Patients developing MACE had only more mixed plaque as those developing UAP. • Different atherosclerotic plaque components by CTA carry different prognostic value. - Abstract: Objective: CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE). Methods: We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied. Results: Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders. Conclusion: The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology.

  4. Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events.

    Science.gov (United States)

    Tresoldi, Silvia; Di Leo, Giovanni; Zoffoli, Elena; Munari, Alice; Primolevo, Alessandra; Cornalba, Gianpaolo; Sardanelli, Francesco

    2014-11-01

    There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events. To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events. One hundred and forty-eight non-cardiac patients (78 men; 67 ± 12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWTref) and at the maximum AWT (AWTmax). Correlation with clinical CCV patients' history was estimated. The value of AWTmax and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis. Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥ 30 kg/m(2); 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWTmax and AWTref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWTmax median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWTmax was the only independent variable associated to the frequency of CCV events. Patients with increased thoracic

  5. Events

    Directory of Open Access Journals (Sweden)

    Igor V. Karyakin

    2016-02-01

    Full Text Available The 9th ARRCN Symposium 2015 was held during 21st–25th October 2015 at the Novotel Hotel, Chumphon, Thailand, one of the most favored travel destinations in Asia. The 10th ARRCN Symposium 2017 will be held during October 2017 in the Davao, Philippines. International Symposium on the Montagu's Harrier (Circus pygargus «The Montagu's Harrier in Europe. Status. Threats. Protection», organized by the environmental organization «Landesbund für Vogelschutz in Bayern e.V.» (LBV was held on November 20-22, 2015 in Germany. The location of this event was the city of Wurzburg in Bavaria.

  6. Ultimate resources of drinking water in the event of a major pollution crisis: the role of bottled water

    International Nuclear Information System (INIS)

    Collin, J.J.; Comte, J.P.; Daum, J.R.; Lopoukhine, M.; Mesny, M.

    1995-01-01

    In the event of a serious and widespread pollution incident - on the level of the ''Chernobyl cloud'' - most of the drinking water resources in France could be contaminated : surface water immediately, ground water in a few days... or a few months. Therefore on the initiative of the Ministry of the Environment's Director for Defence, a study has been initiated as to what might be qualified as ''final emergency resources''. An inventory and map of protected resources have been prepared. In this context it seems reasonable to show bottled water as a resource meeting the necessary protection criteria. However it seems that these criteria are not all, nor always, relevant for defining a ''ultimate emergency resource'' not contaminated by a major incident. This article outlines a typology of situations and defines the main criteria necessary for bottled water to be able to constitute an ultimate resource

  7. Accumulation of Major Life Events in Childhood and Adult Life and Risk of Type 2 Diabetes Mellitus.

    Directory of Open Access Journals (Sweden)

    Jolene Masters Pedersen

    Full Text Available The aim of the study was to estimate the effect of the accumulation of major life events (MLE in childhood and adulthood, in both the private and working domains, on risk of type 2 diabetes mellitus (T2DM. Furthermore, we aimed to test the possible interaction between childhood and adult MLE and to investigate modification of these associations by educational attainment.The study was based on 4,761 participants from the Copenhagen City Heart Study free of diabetes at baseline and followed for 10 years. MLE were categorized as 0, 1, 2, 3 or more events. Multivariate logistic regression models adjusted for age, sex, education and family history of diabetes were used to estimate the association between MLE and T2DM.In childhood, experiencing 3 or more MLE was associated with a 69% higher risk of developing T2DM (Odds Ratio (OR 1.69; 95% Confidence Interval (CI 1.60, 3.27. The accumulation of MLE in adult private (p-trend = 0.016 and work life (p-trend = 0.049 was associated with risk of T2DM in a dose response manner. There was no evidence that experiencing MLE in both childhood and adult life was more strongly associated with T2DM than experiencing events at only one time point. There was some evidence that being simultaneously exposed to childhood MLE and short education (OR 2.28; 95% C.I. 1.45, 3.59 and work MLE and short education (OR 2.86; 95% C.I. 1.62, 5.03 was associated with higher risk of T2DM, as the joint effects were greater than the sum of their individual effects.Findings from this study suggest that the accumulation of MLE in childhood, private adult life and work life, respectively, are risk factors for developing T2DM.

  8. The drone as an additional risk factor due to conditions not provided for in radiological safety at major events

    International Nuclear Information System (INIS)

    Oliveira, Gilberto de Jesus

    2015-01-01

    Major international events are potential targets of terrorist actions, seeking instant publicity that events of this magnitude provide, with the intention of causing terror and disseminate its power to a large number of people worldwide. In this context, the critical analysis of additional risk factor linked to procedures and protocols adopted on radiation safety is important. The possibility of unforeseen situations of risk, especially those resulting from the current global technological development, is a fact. Radioactive material can be used in this type of terrorism in a wide range of devices and illicit trafficking of this material is a reality that worries the International Atomic Energy Agency. In the current technological development scenario of the world, the potential occurrence of terrorist acts using drones combined with radioactive material dispersal devices, is real. The recent history of drones incidents presents cases where, despite not having been necessarily terrorist motivation, their circumstances and characteristics favor the occurrence of malicious acts. This paper proposes to alert the need of updating the current security protocols, considering the potential association of this technology with radioactive dispersal devices. (author)

  9. Circulating CD4+CD28null T Cells May Increase the Risk of an Atherosclerotic Vascular Event Shortly after Kidney Transplantation

    Directory of Open Access Journals (Sweden)

    Michiel G. H. Betjes

    2013-01-01

    Full Text Available Proinflammatory CD4+ T cells without the costimulatory molecule CD28 (CD4+CD28null T cells are expanded in patients with end-stage renal disease (ESRD and associated with atherosclerotic vascular events (AVE. In a prospective study, the number of circulating CD4+CD28null T cells was established in 295 ESRD patients prior to receiving a kidney allograft. Within the first year after transplantation, an AVE occurred in 20 patients. Univariate analysis showed that besides a history of cardiovascular disease (CVDpos, HR 8.1, , age (HR 1.04, , dyslipidaemia (HR 8.8, , and the % of CD4+CD28null T cells (HR 1.04 per % increase, 95% CI 1.00–1.09, were significantly associated with the occurrence of a posttransplantation AVE. In a multivariate analysis, only CVDpos remained a significant risk factor with a significant and positive interaction between the terms CVDpos and the % of CD4+CD28null T cells (HR 1.05, 95% CI 1.03–1.11, . Within the CVDpos group, the incidence of an AVE was 13% in the lowest tertile compared to 25% in the highest tertile of % of CD4+CD28null T cells. In conclusion, the presence of circulating CD4+CD28null T cells is associated with an increased risk for a cardiovascular event shortly after kidney transplantation.

  10. Bioprinting for vascular and vascularized tissue biofabrication.

    Science.gov (United States)

    Datta, Pallab; Ayan, Bugra; Ozbolat, Ibrahim T

    2017-03-15

    Bioprinting is a promising technology to fabricate design-specific tissue constructs due to its ability to create complex, heterocellular structures with anatomical precision. Bioprinting enables the deposition of various biologics including growth factors, cells, genes, neo-tissues and extra-cellular matrix-like hydrogels. Benefits of bioprinting have started to make a mark in the fields of tissue engineering, regenerative medicine and pharmaceutics. Specifically, in the field of tissue engineering, the creation of vascularized tissue constructs has remained a principal challenge till date. However, given the myriad advantages over other biofabrication methods, it becomes organic to expect that bioprinting can provide a viable solution for the vascularization problem, and facilitate the clinical translation of tissue engineered constructs. This article provides a comprehensive account of bioprinting of vascular and vascularized tissue constructs. The review is structured as introducing the scope of bioprinting in tissue engineering applications, key vascular anatomical features and then a thorough coverage of 3D bioprinting using extrusion-, droplet- and laser-based bioprinting for fabrication of vascular tissue constructs. The review then provides the reader with the use of bioprinting for obtaining thick vascularized tissues using sacrificial bioink materials. Current challenges are discussed, a comparative evaluation of different bioprinting modalities is presented and future prospects are provided to the reader. Biofabrication of living tissues and organs at the clinically-relevant volumes vitally depends on the integration of vascular network. Despite the great progress in traditional biofabrication approaches, building perfusable hierarchical vascular network is a major challenge. Bioprinting is an emerging technology to fabricate design-specific tissue constructs due to its ability to create complex, heterocellular structures with anatomical precision

  11. The impact of major life events on the use of complementary and alternative medicine among individuals with chronic pain: a cross-sectional study.

    Science.gov (United States)

    Wang, Shu-Ming; Fortier, Michelle A; Cheng, David Y; Perret, Danielle; Hata, Justin; Tan, Edwin T; Kain, Zeev N

    2013-01-01

    Chronic pain affects millions of Americans. Treating chronic pain can be difficult because it is a complex condition influenced by genetic makeup and physiological and psychological factors. The experience of major life events has also been found to affect the psychosocial functioning, health, and health behaviors of patients. Whereas the impact of major life events on the use of traditional medical practices has been explored, only one study to date has examined the relationship between major life events and use of complementary and alternative medicine (CAM). This study examined the impact of major life events on the use of CAM among patients with chronic pain syndromes. Participants were consecutive patients seeking treatment at a pain clinic. The study occurred at a tertiary center for pain management in Southern California. Participants were adult patients experiencing chronic pain for at least 6 mo, seeking treatment at a pain center. Participants completed a measure assessing their use of CAM modalities as well as their receptiveness to using previously unused CAM modalities, and they provided demographic information, including the occurrence of major life events, such as a job loss. A total of 199 adults with chronic pain participated in the study. The majority (91.6%) of chronic pain patients in the study reported using at least one form of CAM, with an average of at least five different forms of CAM. Individuals reported receptiveness to CAM modalities that they had not previously used (P CAM use were greater among those that had experienced a major life event in the prior 6 mo (P chronic pain frequently use CAM therapies, especially those who had recently experienced a major life event. Major life events may motivate patients with chronic pain to seek out different forms of CAM as a way to manage their pain.

  12. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery : A five year longitudinal cohort study

    NARCIS (Netherlands)

    Tully, P.J.; Winefield, H.R.; Baker, R.A.; Denollet, Johan; Pedersen, S.S.; Wittert, G.A.; Turnbull, D.

    2015-01-01

    Background Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical

  13. Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Mi Jung Lee

    2017-12-01

    Full Text Available Background: Geriatric nutritional risk index (GNRI is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD patients. Methods: We reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0 and worsening/stationary (delta GNRI ≤ 0 groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs. Results: During a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%. The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40. However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004. Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15–5.29; P = 0.02. In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04 and higher (P = 0.01 baseline GNRI groups. Conclusion: Baseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.

  14. Measurement of mean cardiac dose for various breast irradiation techniques and corresponding risk of major cardiovascular event.

    Directory of Open Access Journals (Sweden)

    Tomas Rodrigo Merino Lara

    2014-10-01

    Full Text Available After breast conserving surgery, early stage breast cancer patients are currently treated with a wide range of radiation techniques including whole breast irradiation (WBI, accelerated partial breast irradiation (APBI using high dose rate (HDR brachytherapy, or 3D conformal radiotherapy (3D-CRT. This study compares the mean heart’s doses for a left breast irradiated with different breast techniques.An anthropomorphic Rando phantom was modified with gelatin-based breast of different sizes and tumors located medially or laterally. The breasts were treated with WBI, 3D-CRT or HDR APBI. The heart’s mean doses were measured with Gafchromic films and controlled with optically stimulated luminescent dosimeters (OSLDs. Following the model reported by Darby (16, major cardiac were estimated assuming a linear risk increase with the mean dose to the heart of 7.4% per gray.Whole breast irradiation lead to the highest mean heart dose (2.99 Gy compared to 3D-CRT APBI, (0.51 Gy, multicatheter (1.58 Gy and balloon HDR (2.17 Gy for a medially located tumor. This translated into long-term coronary event increases of 22%, 3.8%, 11.7%, and 16% respectively. The sensitivity analysis showed that the tumor location had almost no effect on the mean heart dose for 3D-CRT APBI and a minimal impact for HDR APBI. For WBI large breast size and set-up errors lead to sharp increases of the mean heart dose. Its value reached 10.79 Gy for women with large breast and a set-up error of 1.5 cm. Such a high value could increase the risk of having long-term coronary events by 80%.Comparison among different irradiation techniques demonstrates that 3D-CRT APBI appears the safest one with less probability of having cardiovascular events in the future. A sensitivity analysis showed that WBI is the most challenging technique for patients with large breasts or when significant set-up errors are anticipated. In those cases additional heart shielding techniques are required.

  15. [Association between MAOA-u VNTR polymorphism and its interaction with stressful life events and major depressive disorder in adolescents].

    Science.gov (United States)

    Ma, Jing; Yu, Shun-Ying; Liang, Shan; Ding, Jun; Feng, Zhe; Yang, Fan; Gao, Wei-Jia; Lin, Jia-Ni; Huang, Chun-Xiang; Liu, Xue-Jun; Su, Lin-Yan

    2013-07-01

    To investigate whether the genetic polymorphism, upstream variable number of tandem repeats (uVNTR), in the monoamine oxidase A (MAOA) gene, is associated with major depressive disorder (MDD) in adolescents and to test whether there is gene-environment interaction between MAOA-uVNTR polymorphism and stressful life events (SLEs). A total of 394 Chinese Han subjects, including 187 adolescent patients with MDD and 207 normal students as a control group, were included in the study. Genotyping was performed by SNaP-shot assay. SLEs in the previous 12 months were evaluated. The groups were compared in terms of the frequency distributions of MAOA-uVNTR genotypes and alleles using statistical software. The binary logistic regression model of gene-environment interaction was established to analyze the association of the gene-environment interaction between MAOA-u VNTR genotypes and SLEs with adolescent MDD. The distribution profiles of MAOA-u VNTR genotypes and alleles were not related to the onset of MDD, severity of depression, comorbid anxiety and suicidal ideation/behavior/attempt in adolescents. The gene-environment interaction between MAOA-u VNTR genotypes and SLEs was not associated with MDD in male or female adolescents. It is not proven that MAOA-u VNTR polymorphism is associated with adolescent MDD. There is also no gene-environment interaction between MAOA-u VNTR polymorphism and SLEs that is associated with adolescent MDD.

  16. Deficits in cue detection underlie event-based prospective memory impairment in major depression: an eye tracking study.

    Science.gov (United States)

    Chen, Siyi; Zhou, Renlai; Cui, Hong; Chen, Xinyin

    2013-10-30

    This study examined the cue detection in the non-focal event-based prospective memory (PM) of individuals with and without a major depressive disorder using behavioural and eye tracking assessments. The participants were instructed to search on each trial for a different target stimulus that could be present or absent and to make prospective responses to the cue object. PM tasks included cue only and target plus cue, whereas ongoing tasks included target only and distracter only. The results showed that a) participants with depression performed more poorly than those without depression in PM; b) participants with depression showed more fixations and longer total and average fixation durations in both ongoing and PM conditions; c) participants with depression had lower scores on accuracy in target-plus-cue trials than in cue-only trials and had a higher gaze rate of targets on hits and misses in target-plus-cue trials than did those without depression. The results indicate that the state of depression may impair top-down cognitive control function, which in turn results in particular deficits in the engagement of monitoring for PM cues. Copyright © 2013. Published by Elsevier Ireland Ltd.

  17. Abnormal self-schema in semantic memory in major depressive disorder: Evidence from event-related brain potentials.

    Science.gov (United States)

    Kiang, Michael; Farzan, Faranak; Blumberger, Daniel M; Kutas, Marta; McKinnon, Margaret C; Kansal, Vinay; Rajji, Tarek K; Daskalakis, Zafiris J

    2017-05-01

    An overly negative self-schema is a proposed cognitive mechanism of major depressive disorder (MDD). Self-schema - one's core conception of self, including how strongly one believes one possesses various characteristics - is part of semantic memory (SM), our knowledge about concepts and their relationships. We used the N400 event-related potential (ERP) - elicited by meaningful stimuli, and reduced by greater association of the stimulus with preceding context - to measure association strength between self-concept and positive, negative, and neutral characteristics in SM. ERPs were recorded from MDD patients (n=16) and controls (n=16) who viewed trials comprising a self-referential phrase followed by a positive, negative, or neutral adjective. Participants' task was to indicate via button-press whether or not they felt each adjective described themselves. Controls endorsed more positive adjectives than did MDD patients, but the opposite was true for negative adjectives. Patients had smaller N400s than controls specifically for negative adjectives, suggesting that MDD is associated with stronger than normal functional neural links between self-concept and negative characteristics in SM. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Event-related potentials in response to emotional words in patients with major depressive disorder and healthy controls.

    Science.gov (United States)

    Liu, Hong; Yin, Hui-fang; Wu, Da-xing; Xu, Shu-jing

    2014-01-01

    Dysfunctional cognitive processing and abnormal brain activation in response to emotional stimuli have long been recognized as core features of the major depressive disorder (MDD). The aim of this study was to examine how Chinese patients with MDD process Chinese emotional words presented to either the left (LH) or right hemisphere (RH). Reaction time (RT) and the late positive component of the event-related potential were measured while subjects judged the valence (positive or negative) of emotional words written in Chinese. Compared to healthy controls, patients with MDD exhibited slower RTs in response to negative words. In all subjects, the RTs in response to negative words were significantly faster than RTs in response to positive words presented to the LH, as well as significantly faster than responses to negative words presented to the RH. Compared to healthy controls, MDD patients exhibited reduced activation of the central and left regions of the brain in response to both negative and positive words. In healthy controls, the posterior brain areas were more active than the anterior brain areas when responding to negative words. All individuals showed faster RTs in response to negative words compared to positive words. In addition, MDD patients showed lateralization of brain activity in response to emotional words, whereas healthy individuals did not show this lateralization. Posterior brain areas appear to play an especially important role in discriminating and experiencing negative emotional words. This study provides further evidence in support of the negative bias hypothesis and the emotional processing theory.

  19. A New Computational Model for Neuro-Glio-Vascular Coupling: Astrocyte Activation Can Explain Cerebral Blood Flow Nonlinear Response to Interictal Events.

    Directory of Open Access Journals (Sweden)

    Solenna Blanchard

    Full Text Available Developing a clear understanding of the relationship between cerebral blood flow (CBF response and neuronal activity is of significant importance because CBF increase is essential to the health of neurons, for instance through oxygen supply. This relationship can be investigated by analyzing multimodal (fMRI, PET, laser Doppler… recordings. However, the important number of intermediate (non-observable variables involved in the underlying neurovascular coupling makes the discovery of mechanisms all the more difficult from the sole multimodal data. We present a new computational model developed at the population scale (voxel with physiologically relevant but simple equations to facilitate the interpretation of regional multimodal recordings. This model links neuronal activity to regional CBF dynamics through neuro-glio-vascular coupling. This coupling involves a population of glial cells called astrocytes via their role in neurotransmitter (glutamate and GABA recycling and their impact on neighboring vessels. In epilepsy, neuronal networks generate epileptiform discharges, leading to variations in astrocytic and CBF dynamics. In this study, we took advantage of these large variations in neuronal activity magnitude to test the capacity of our model to reproduce experimental data. We compared simulations from our model with isolated epileptiform events, which were obtained in vivo by simultaneous local field potential and laser Doppler recordings in rats after local bicuculline injection. We showed a predominant neuronal contribution for low level discharges and a significant astrocytic contribution for higher level discharges. Besides, neuronal contribution to CBF was linear while astrocytic contribution was nonlinear. Results thus indicate that the relationship between neuronal activity and CBF magnitudes can be nonlinear for isolated events and that this nonlinearity is due to astrocytic activity, highlighting the importance of astrocytes in

  20. Case history of an anticipated event: The major (Mw = 7.0) Vrancea, Romania earthquake of 1986 - revisited

    International Nuclear Information System (INIS)

    Marza, V.; Burlacu, B V.; Pantea, A; Malita, Z.

    2002-01-01

    This is a reissue of a paper initially published in the European Seismological Commission Proceedings of the XXI General Assembly held on 23-27 August 1988 in Sofia, Bulgaria, p. 515-523, and released in 1989. We present here an excerpt of the original paper, taking only advantage of the modern digital graphics, removing some 'typing' mistakes or adding some explanatory late notes, in order to remember the conspicuous earthquake prediction research results done by Romanian seismology after the forecasted 1977 Vrancea major event. For the sake of understanding we distinguish between earthquake forecasting (long-term prediction, that is a time-window of years, but less than 20% of the mean return period for the involved magnitude and a lead time of years) and earthquake anticipation (medium-term prediction, i.e. a time-window of a few months and a lead time of months), stages what proved to be feasible for Vrancea seismogenic zone. Analysis and discussion of a variety of precursory seismicity patterns (p.s.p.) belonging to all temporal developmental stages of the preparatory (geo)physical process leading to the killer and damaging major subcrustal Vrancea, Romania, earthquake of August 30, 1986 (epicenter = 45.5 angle N/26.4 angle E; depth 144 km; magnitude(s) m w =7.0, M w =7.3, M L =7.0; I o =VIII 1/2 MSK) are performed and documented, clearly proving that the earthquake would not has been unexpected. The salient features of the Vrancea Seismogenic Zone (VSZ) and its tectonic setting have been presented elsewhere. The seismological data base used in this study is the earthquake master catalogue of Constantinescu and Marza, updated on the basis of the data supplied by the real-time telemetered seismographic network of Romania, centered on VSZ. The contents of the paper is as follows: 1. Introduction; 2. The Vrancea 1986 Major (m w =7.0) Subcrustal Earthquake Related Precursors; 2.1. Regularity Patterns; 2.2. Preseismic Quiescence; 2.3. Hypocentral migration

  1. The impact of chronic kidney disease as a predictor of major cardiac events in patients with no evidence of coronary artery disease

    International Nuclear Information System (INIS)

    Furuhashi, Tatsuhiko; Moroi, Masao; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Nakazato, Ryo; Fukuda, Hiroshi; Sugi, Kaoru

    2010-01-01

    Normal stress myocardial perfusion images (MPI) generally show good prognosis for cardiovascular events. However, chronic kidney disease (CKD) is one of the important risk factors for coronary artery disease (CAD), and the interpretation of normal stress MPI has not been well established in CKD patients with no evidence of CAD. The purpose of this study was to evaluate the long-term prognostic value of stress MPI in CKD patients with no evidence of myocardial ischemia or infarction. Patients who had no history but were suspected of CAD and had normal stress MPI (n=307, male=208, age=67 years, CKD/non-CKD=46/261) were followed-up for 4.5 years. CKD was defined as a glomerular filtration ratio of 2 and/or persistent proteinuria. Cardiac death, non-fatal myocardial infarction, and unstable angina requiring hospitalization were defined as major cardiac events. Major cardiac events were observed in 3 of 261 (1.1%) non-CKD patients and 6 of 46 (13%) CKD patients (p<0.001, with log-rank test). CKD was an independent risk factor for major cardiac events (hazard ratio=13.1, p<0.001, multivariate Cox regression analysis). Normal stress MPI does not always promise a good prognosis for major cardiac events. Even in patients with no evidence of CAD from stress MPI, CKD can be an independent and significant risk factor for major cardiac events. (author)

  2. Relationship of testis size and LH levels with incidence of major adverse cardiovascular events in older men with sexual dysfunction.

    Science.gov (United States)

    Rastrelli, Giulia; Corona, Giovanni; Lotti, Francesco; Boddi, Valentina; Mannucci, Edoardo; Maggi, Mario

    2013-11-01

    Measurement of testis volume (TV) is a reliable clinical procedure that predicts reproductive fitness. However, the role of TV in overall and cardiovascular (CV) fitness has never been studied. The study aims to analyze the clinical correlates of TV in patients with sexual dysfunction (SD) and to verify the value of this parameter and its determinants (i.e., luteinizing hormone [LH] levels) in predicting major adverse CV events (MACE). A consecutive series of 2,809 subjects without testiculopathy (age 51.2 ± 13.1) consulting for SD was retrospectively studied. A subset of this sample (n=1,395) was enrolled in a longitudinal study. Several clinical and biochemical parameters were investigated. After adjusting for confounders, TV was negatively associated with both LH (Adj. r=-0.234; PTV (hazard ratio [HR]=1.041 [1.021-1.061], PTV (Adj. r=0.157; PTV were only partially related to changes in gonadotropin levels. In the longitudinal analysis, after adjusting for confounders, TV was associated with a higher incidence of MACE (HR=1.066 [1.013-1.122]; P=0.014), and the stepwise introduction in the Cox model of lifestyle factors, mean blood pressure and body mass index progressively smoothed out the association, which was no longer statistically significant in the fully adjusted model. Conversely, the association of higher LH levels with increased incidence of MACE was not attenuated by the progressive introduction of the aforementioned confounders in the model. Our data show that in SD subjects, TV and LH are associated with an adverse CV risk profile that mediate the higher TV-associated incidence of MACE. High LH levels are an independent marker of CV risk. Further studies are needed for clarifying determinants and mechanisms of testis enlargement that, beyond gonadotropins, could mediate the increased incidence of MACE. © 2013 International Society for Sexual Medicine.

  3. The predictive value of arterial stiffness on major adverse cardiovascular events in individuals with mildly impaired renal function

    Directory of Open Access Journals (Sweden)

    Han J

    2016-08-01

    Full Text Available Jie Han,* Xiaona Wang,* Ping Ye, Ruihua Cao, Xu Yang, Wenkai Xiao, Yun Zhang, Yongyi Bai, Hongmei Wu Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Objectives: Despite growing evidence that arterial stiffness has important predictive value for cardiovascular disease in patients with advanced stages of chronic kidney disease, the predictive significance of arterial stiffness in individuals with mildly impaired renal function has not been established. The aim of this study was to evaluate the predictive value of arterial stiffness on cardiovascular disease in this specific population. Materials and methods: We analyzed measurements of arterial stiffness (carotid–femoral pulse-wave velocity [cf-PWV] and the incidence of major adverse cardiovascular events (MACEs in 1,499 subjects from a 4.8-year longitudinal study. Results: A multivariate Cox proportional-hazard regression analysis showed that in individuals with normal renal function (estimated glomerular filtration rate [eGFR] ≥90 mL/min/1.73 m2, the baseline cf-PWV was not associated with occurrence of MACEs (hazard ratio 1.398, 95% confidence interval 0.748–2.613; P=0.293. In individuals with mildly impaired renal function (eGFR <90 mL/min/1.73 m2, a higher baseline cf-PWV level was associated with a higher risk of MACEs (hazard ratio 2.334, 95% confidence interval 1.082–5.036; P=0.031. Conclusion: Arterial stiffness is a moderate and independent predictive factor for MACEs in individuals with mildly impaired renal function (eGFR <90 mL/min/1.73 m2. Keywords: epidemiology, arterial stiffness, impaired renal function, predictive value, MACEs

  4. Clinical implication and prognosis of normal baseline cerebral blood flow with impaired vascular reserve in patients with major cerebral artery occlusive disease

    International Nuclear Information System (INIS)

    Isozaki, Makoto; Arai, Yoshikazu; Kubota, Toshihiko; Kikuta, Ken-ichiro; Kudo, Takashi; Kiyono, Yasushi; Kobayashi, Masato; Okazawa, Hidehiko

    2010-01-01

    To investigate the prognosis of patients with cerebrovascular steno-occlusive disease who have preserved baseline cerebral blood flow (CBF) and reduced cerebral vasoreactivity (CVR), they were followed up after scans of positron emission tomography (PET). Fifty-seven patients with symptomatic unilateral major cerebral arterial occlusion or severe stenosis underwent O-15 gas and water PET scans to measure cerebral blood volume, metabolic rate of oxygen, oxygen extraction fraction (OEF), and CBF at the baseline and after acetazolamide administration. Thirty of them (mean age 60±10 years) had normal ipsilateral CBF, and were followed prospectively at least 30 months from the last ischemic event. They were medically treated for cerebral circulation and underlying diseases during follow-up periods. The primary endpoint was determined as stroke recurrence during the follow-up. Thirty patients were divided into two groups of reduced CVR (N=16, 63±8 years) and normal CVR (N=14, 56±10 years) on the basis of CVR values from healthy volunteers. None of them showed significant laterality in baseline CBF and OEF between the hemispheres although patients with reduced CVR showed a tendency of ipsilateral increases in OEF and CBV. Patients were followed up for 50.5±19.0 and 48.1±12.4 months in the reduced and normal CVR groups, respectively. Although one patient with reduced CVR died of heart disease, there was no incidence of ischemic events during follow-up periods for either group. In the present prospective study, patients with sufficient baseline CBF showed good prognosis and no difference in recurrent stroke risks even though they had poor CVR in the affected hemisphere, indicating that these patients can be treated by medication for cerebral circulation and baseline diseases if they have high risk factors for neurosurgical treatment. (author)

  5. A retrospective analysis of the impact of treatments and blood counts on survival and the risk of vascular events during the course of polycythaemia vera

    DEFF Research Database (Denmark)

    Enblom-Larsson, Anneli; Girodon, Francois; Bak, Marie

    2017-01-01

    Vascular and non-vascular complications are common in patients with polycythaemia vera. This retrospective study of 217 patients with polycythaemia vera aimed to determine whether blood counts with respect to different treatments influenced the complication rate and survival. We found that 78 (36...

  6. Coding of adverse events of suicidality in clinical study reports of duloxetine for the treatment of major depressive disorder: descriptive study.

    Science.gov (United States)

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn; Lundh, Andreas; Gøtzsche, Peter C

    2014-06-04

    To assess the effects of coding and coding conventions on summaries and tabulations of adverse events data on suicidality within clinical study reports. Systematic electronic search for adverse events of suicidality in tables, narratives, and listings of adverse events in individual patients within clinical study reports. Where possible, for each event we extracted the original term reported by the investigator, the term as coded by the medical coding dictionary, medical coding dictionary used, and the patient's trial identification number. Using the patient's trial identification number, we attempted to reconcile data on the same event between the different formats for presenting data on adverse events within the clinical study report. 9 randomised placebo controlled trials of duloxetine for major depressive disorder submitted to the European Medicines Agency for marketing approval. Clinical study reports obtained from the EMA in 2011. Six trials used the medical coding dictionary COSTART (Coding Symbols for a Thesaurus of Adverse Reaction Terms) and three used MedDRA (Medical Dictionary for Regulatory Activities). Suicides were clearly identifiable in all formats of adverse event data in clinical study reports. Suicide attempts presented in tables included both definitive and provisional diagnoses. Suicidal ideation and preparatory behaviour were obscured in some tables owing to the lack of specificity of the medical coding dictionary, especially COSTART. Furthermore, we found one event of suicidal ideation described in narrative text that was absent from tables and adverse event listings of individual patients. The reason for this is unclear, but may be due to the coding conventions used. Data on adverse events in tables in clinical study reports may not accurately represent the underlying patient data because of the medical dictionaries and coding conventions used. In clinical study reports, the listings of adverse events for individual patients and narratives

  7. Prognostic value of blood glucose in emergency room and glycosylated hemoglobin in patients who have suffered an acute cerebro-vascular event.

    Science.gov (United States)

    Ernaga Lorea, Ander; Hernández Morhain, María Cecilia; Ollero García-Agulló, María Dolores; Martínez de Esteban, Juan Pablo; Iriarte Beroiz, Ana; Gállego Culleré, Jaime

    2017-07-07

    Stress hyperglycemia has been associated with a worse prognosis in patients hospitalized in critical care units. The aim of this study is to evaluate the impact of blood glucose and glycosylated hemoglobin (HbA1c) levels on the mortality of patients suffering a acute cerebro-vascular event, and to determine if this relationship depends on the presence of diabetes. A retrospective analysis of 255 patients admitted to the ER for stroke was performed. Venous plasma glucose levels in the emergency room and HbA1c levels within the first 48hours were analyzed. The presence of diabetes was defined in terms of the patients' medical history, as well as their levels of fasting plasma glucose and HbA1c. Mortality was assessed within the first 30 months after the onset of the acute event. 28.2% of patients had diabetes. Higher mortality was observed in patients who had been admitted with plasma glucose levels≥140mg/dl (hazard ratio [HR]=2.22, 95% CI: 1.18-4.16, P=.013) after adjusting for various factors. This relationship was not confirmed in diabetic patients (HR=2.20, 95% CI: 0.66-7.40, P=.201) and was in non-diabetics (HR=2.55, 95% CI: 1.11-5.85, P=.027). In diabetics, HbA1c≥7% was not associated with poor prognosis (HR=0.68, 95% CI: 0.23-1.98, P=.475), whereas non-diabetics with admission levels of HbA1c falling within the pre-diabetes range (5.7% -6.4%) had a higher mortality (HR=2.62, 95% CI: 1.01-6.79, P=.048). Admission hyperglycemia is associated with a worse prognosis in patients without diabetes admitted for stroke, but this relationship was not seen in diabetics. In non-diabetic patients, HbA1c levels in the pre-diabetes range is associated with higher mortality. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. A major 2.1 Ga event of mafic magmatism in west Africa: An Early stage of crustal accretion

    Science.gov (United States)

    Abouchami, Wafa; Boher, Muriel; Michard, Annie; Albarede, Francis

    1990-10-01

    environments. Back-arc or low-Ti continental flood basalts provide a marginally good agreement but still face some difficulties. Oceanic flood basalts similar to those which form oceanic plateaus (e.g. in the Nauru basin) and later accreted to continents as allochtonous terranes represent the most acceptable modern analogue of many Proterozoic basalts. It is suggested that deep plumes piercing young lithosphere can generate huge amounts of tholeiites in a short time. Birimian basalts, like many Early Proterozoic basalts, may also be viewed as recent equivalents of the Archean greenstone belts. The modern komatiite of Gorgona Island is suggested to fit this model of intraplate volcanism. Although the 2.1 Ga magmatic event in West Africa has gone virtually unnoticed in the literature, it extends over several thousand kilometers and compares with the distribution of mantle-derived magmatic activity in other major orogenic provinces (e.g. Superior). It shows that the growth rate of continents cannot be extrapolated from the data obtained solely from the best studied continents (North America, Europe, Australia). If such large crustal segments were overlooked, a spurious pattern of episodic activity of the mantle could arise.

  9. The effect of lowering LDL cholesterol on vascular access patency

    DEFF Research Database (Denmark)

    Herrington, William; Emberson, Jonathan; Staplin, Natalie

    2014-01-01

    BACKGROUND AND OBJECTIVES: Reducing LDL cholesterol (LDL-C) with statin-based therapy reduces the risk of major atherosclerotic events among patients with CKD, including dialysis patients, but the effect of lowering LDL-C on vascular access patency is unclear. DESIGN, SETTING, PARTICIPANTS...

  10. Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study.

    Science.gov (United States)

    Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria; Tsivgoulis, Georgios; Furie, Karen L; Tadi, Prasanna; Becattini, Cecilia; Falocci, Nicola; Zedde, Marialuisa; Abdul-Rahim, Azmil H; Lees, Kennedy R; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Mosconi, Maria Giulia; Cimini, Ludovica Anna; Procopio, Antonio; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Cappellari, Manuel; Putaala, Jukka; Tomppo, Liisa; Tatlisumak, Turgut; Bandini, Fabio; Marcheselli, Simona; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Masotti, Luca; Vannucchi, Vieri; Sohn, Sung-Il; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Acampa, Maurizio; Martini, Giuseppe; Ntaios, George; Karagkiozi, Efstathia; Athanasakis, George; Makaritsis, Kostantinos; Vadikolias, Kostantinos; Liantinioti, Chrysoula; Chondrogianni, Maria; Mumoli, Nicola; Consoli, Domenico; Galati, Franco; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Corea, Francesco; Ageno, Walter; Bellesini, Marta; Colombo, Giovanna; Silvestrelli, Giorgio; Ciccone, Alfonso; Scoditti, Umberto; Denti, Licia; Mancuso, Michelangelo; Maccarrone, Miriam; Orlandi, Giovanni; Giannini, Nicola; Gialdini, Gino; Tassinari, Tiziana; De Lodovici, Maria Luisa; Bono, Giorgio; Rueckert, Christina; Baldi, Antonio; D'Anna, Sebastiano; Toni, Danilo; Letteri, Federica; Giuntini, Martina; Lotti, Enrico Maria; Flomin, Yuriy; Pieroni, Alessio; Kargiotis, Odysseas; Karapanayiotides, Theodore; Monaco, Serena; Baronello, Mario Maimone; Csiba, Laszló; Szabó, Lilla; Chiti, Alberto; Giorli, Elisa; Del Sette, Massimo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Michel, Patrik; Vanacker, Peter; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Gourbali, Vanessa; Yaghi, Shadi

    2017-03-01

    This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P =0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P =0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P =0.10) for major bleedings. The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P =0.009) for ischemic outcome events and 0.407 (0.275-0.540; P =0.14) for hemorrhagic outcome events. In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings. © 2017 American Heart Association, Inc.

  11. Planning of traumatological hospital resources for a major winter sporting event as illustrated by the 2005 Winter Universiad.

    Science.gov (United States)

    Oberladstaetter, J; Kamelger, F S; Rosenberger, R; Dallapozza, Ch; Struve, P; Luger, T; Fink, Ch; Attal, R

    2009-03-01

    The 22nd Student World Winter Games took place in January 2005 in Innsbruck and Seefeld, Austria. Exactly 1,500 athletes of 50 nationalities competed in 69 events in ten winter sports. A total number of 750 functionaries, 800 volunteers and 85,000 spectators participated in the second largest winter sports event behind the Olympic winter games. The aim of this study was to evaluate the needed resources to ensure traumatological care for an event of that size. At the medical "call-center" all consultations, as well as patient data, diagnosis, and medical treatment were recorded using a preset protocol. Further, all patients treated in the University Hospital Innsbruck were registered with an emphasis on trauma patients. Forty-eight of 65 patients transported to the hospital as a result of the Universiade were trauma patients, 37 of whom were athletes. The gender distribution was 34:14 (m:f). Ice hockey players had the highest rate of injury (25% of all injured athletes), followed by alpine skiers (20.8% of injured athletes). The highest ISS was nine. Forty-three patients got ambulatory treatment, five were admitted to the hospital and surgical treatment was conducted in three cases. Mean patient number was 4.8 per day. No additional personnel, structural, or technical hospital resources were needed to accommodate a large winter sports event like the Universiad. Thus, a level-B trauma center with an emergency room and independent traumatological department with around the clock surgical capability seems to be sufficient to provide traumatological care for an event of this size if the possibility of patient transport to a larger facility exists in the case of catastrophic events.

  12. Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis. A long-term historical cohort study

    NARCIS (Netherlands)

    van Dam, GM; Gips, CH; Reisman, Y; Maas, KW; Purmer, IM; Huizenga, [No Value; Verbaan, BW

    1999-01-01

    BACKGROUND/AIMS: One of the prognostic methods for survival in primary biliary cirrhosis (PBC) is the Mayo model, with a time-scale limited to 7 years. The aim of our study was to assess how major clinical events, signs, several severity assessment methods and Mayo survival probabilities fit in with

  13. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: A five year longitudinal cohort study

    NARCIS (Netherlands)

    P.J. Tully (Phillip); H.R. Winefield (Helen); R.A. Baker (Robert); J. Denollet (Johan); S.S. Pedersen (Susanne); G.A. Wittert (Gary); D.A. Turnbull (Deborah)

    2015-01-01

    textabstractBackground: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between

  14. Prognostic value of combined CT angiography and myocardial perfusion imaging versus invasive coronary angiography and nuclear stress perfusion imaging in the prediction of major adverse cardiovascular events

    DEFF Research Database (Denmark)

    Chen, Marcus Y.; Rochitte, Carlos E.; Arbab-Zadeh, Armin

    2017-01-01

    Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial p...

  15. Equivalencies Regarding the Measurement and Constructs of Self-Esteem and Major Life Events in an Asian-Pacific Islander Sampler.

    Science.gov (United States)

    Miyamoto, Robin H.; Hishinuma, Earl S.; Nishimura, Stephanie T.; Nahulu, Linda B.; Andrade, Naleen N.; Johnson, Ronald C.; Makini, George K., Jr.; Yuen, Noelle Y. C.; Kim, S. Peter; Goebert, Deborah A.; Carlton, Barry S.; Bell, Cathy K.

    2001-01-01

    Examines aspects of self-esteem measures and major life events using the 10-item Rosenberg Self-Esteem Scale (RSES) with Hawaiian, part-Hawaiian, and non-Hawaiian high school students (N=816). There was a lack of consensus regarding the dimensions of RSES as previously reported. Measurement equivalency findings concerning RSES caution against…

  16. The interplay and etiological continuity of neuroticism, difficulties, and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life

    NARCIS (Netherlands)

    Ormel, J; Oldehinkel, AJ; Brilman, EI

    Objective: Stressful life events, longterm difficulties, and high neuroticism are established risk factors for depression. Less is known about their role in late-life depression, how they modify or mediate one another's effects, and whether this differs between major and subsyndromal, first and

  17. Atypical antipsychotics olanzapine, quetiapine, and risperidone and risk of acute major cardiovascular events in young and middle-aged adults

    DEFF Research Database (Denmark)

    Pasternak, Björn; Svanström, Henrik; Ranthe, Mattis F

    2014-01-01

    BACKGROUND: A number of serious cardiovascular safety concerns related to the use of atypical antipsychotics, compared with no use, have emerged, but nearly all reports are from studies of older patients. We aimed to compare the risk of cardiovascular events between the three most commonly used...

  18. Combining satellite imagery with forest inventory data to assess damage severity following a major blowdown event in northern Minnesota, USA

    Science.gov (United States)

    Mark D. Nelson; Sean P. Healey; W. Keith Moser; Mark H. Hansen

    2009-01-01

    Effects of a catastrophic blowdown event in northern Minnesota, USA were assessed using field inventory data, aerial sketch maps and satellite image data processed through the North American Forest Dynamics programme. Estimates were produced for forest area and net volume per unit area of live trees pre- and post-disturbance, and for changes in volume per unit area and...

  19. Coding of adverse events of suicidality in clinical study reports of duloxetine for the treatment of major depressive disorder

    DEFF Research Database (Denmark)

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn

    2014-01-01

    in individual patients within clinical study reports. Where possible, for each event we extracted the original term reported by the investigator, the term as coded by the medical coding dictionary, medical coding dictionary used, and the patient's trial identification number. Using the patient's trial...... for marketing approval. DATA SOURCES: Clinical study reports obtained from the EMA in 2011. RESULTS: Six trials used the medical coding dictionary COSTART (Coding Symbols for a Thesaurus of Adverse Reaction Terms) and three used MedDRA (Medical Dictionary for Regulatory Activities). Suicides were clearly...... identifiable in all formats of adverse event data in clinical study reports. Suicide attempts presented in tables included both definitive and provisional diagnoses. Suicidal ideation and preparatory behaviour were obscured in some tables owing to the lack of specificity of the medical coding dictionary...

  20. Performance of Earthquake Early Warning Systems during the Major Events of the 2016-2017 Central Italy Seismic Sequence.

    Science.gov (United States)

    Festa, G.; Picozzi, M.; Alessandro, C.; Colombelli, S.; Cattaneo, M.; Chiaraluce, L.; Elia, L.; Martino, C.; Marzorati, S.; Supino, M.; Zollo, A.

    2017-12-01

    Earthquake early warning systems (EEWS) are systems nowadays contributing to the seismic risk mitigation actions, both in terms of losses and societal resilience, by issuing an alert promptly after the earthquake origin and before the ground shaking impacts the targets to be protected. EEWS systems can be grouped in two main classes: network based and stand-alone systems. Network based EEWS make use of dense seismic networks surrounding the fault (e.g. Near Fault Observatory; NFO) generating the event. The rapid processing of the P-wave early portion allows for the location and magnitude estimation of the event then used to predict the shaking through ground motion prediction equations. Stand-alone systems instead analyze the early P-wave signal to predict the ground shaking carried by the late S or surface waves, through empirically calibrated scaling relationships, at the recording site itself. We compared the network-based (PRESTo, PRobabilistic and Evolutionary early warning SysTem, www.prestoews.org, Satriano et al., 2011) and the stand-alone (SAVE, on-Site-Alert-leVEl, Caruso et al., 2017) systems, by analyzing their performance during the 2016-2017 Central Italy sequence. We analyzed 9 earthquakes having magnitude 5.0 security actions. PRESTo also evaluated the accuracy of location and magnitude. Both systems well predict the ground shaking nearby the event source, with a success rate around 90% within the potential damage zone. The lead-time is significantly larger for the network based system, increasing to more than 10s at 40 km from the event epicentre. The stand-alone system better performs in the near-source region showing a positive albeit small lead-time (operational in Italy, based on the available acceleration networks, by improving the capability of reducing the lead-time related to data telemetry.

  1. The Influence of Major Life Events on Economic Attitudes in a World of Gene-Environment Interplay.

    Science.gov (United States)

    Hatemi, Peter K

    2013-10-01

    The role of "genes" on political attitudes has gained attention across disciplines. However, person-specific experiences have yet to be incorporated into models that consider genetic influences. Relying on a gene-environment interplay approach, this study explicates how life-events, such as losing one's job or suffering a financial loss, influence economic policy attitudes. The results indicate genetic and environmental variance on support for unions, immigration, capitalism, socialism and property tax is moderated by financial risks. Changes in the magnitude of genetic influences, however, are temporary. After two years, the phenotypic effects of the life events remain on most attitudes, but changes in the sources of individual differences do not. Univariate twin models that estimate the independent contributions of genes and environment on the variation of attitudes appear to provide robust baseline indicators of sources of individual differences. These estimates, however, are not event or day specific. In this way, genetic influences add stability, while environment cues change, and this process is continually updated.

  2. Vascular malformations in pediatrics

    International Nuclear Information System (INIS)

    Reith, W.; Shamdeen, M.G.

    2003-01-01

    Vascular malformations are the cause of nearly all non-traumatic intracranial hemorrhage in children beyond the neonatal stage. Therefore, any child presenting with spontaneous intracranial hemorrhage should be evaluated for child abuse and for vascular malformations. Intracerebral malformations of the cerebral vasculature include vein of Galen malformations, arteriovenous malformation (AVM), cavernomas, dural arteriovenous fistulas, venous anomalies (DVA), and capillary teleangiectasies. Although a few familial vascular malformation have been reported, the majority are sporadic. Clinical symptoms, diagnostic and therapeutic options are discussed. (orig.) [de

  3. Alcohol intoxication in the context of major public holidays, sporting and social events: a time-series analysis in Melbourne, Australia, 2000-2009.

    Science.gov (United States)

    Lloyd, Belinda; Matthews, Sharon; Livingston, Michael; Jayasekara, Harindra; Smith, Karen

    2013-04-01

    To assess the relationship between ambulance attendances, emergency department (ED) presentations and hospital admissions for acute alcohol intoxication and the timing of public holidays, sporting and social events. Time-series analysis was used to explore trends in intoxication in the context of major events. Population of Melbourne, Victoria, Australia between 2000 and 2009. All patients attended by ambulance, presenting to hospital EDs, or admitted to hospital who were classified as acutely alcohol intoxicated. Analysis of daily numbers of presentations for acute alcohol intoxication associated with major events were undertaken, including lead and lag effects. Analyses controlled for day of week and month of year to address temporal and seasonal variations. Alcohol intoxication presentations were significantly elevated the day before all public holidays, with intoxication cases on the day of public holidays only higher on New Year's Day (ambulance 6.57, 95% confidence intervals (CI): 3.4-9.74; ED 3.34, 95% CI: 1.28-5.4) and ANZAC Day (ambulance 3.71, 95% CI: 0.68-6.75). The Australian Football League (AFL) Grand Final (ED 2.37, 95% CI: 0.55-4.19), Commonwealth Games (ED 2.45, 95% CI: 0.6-4.3) and Melbourne Cup Day (ambulance 6.14, 95% CI: 2.42-9.85) represented the sporting events with significant elevations in acute intoxication requiring medical attention. The last working day before Christmas was the only social event where a significant increase in acute intoxication occurred (ambulance 8.98, 95% CI: 6.8-11.15). Acute alcohol intoxication cases requiring ambulance, emergency department and hospital in-patient treatment increase substantially on the day preceding public holidays and other major social events. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  4. Calcium dynamics in vascular smooth muscle

    OpenAIRE

    Amberg, Gregory C.; Navedo, Manuel F.

    2013-01-01

    Smooth muscle cells are ultimately responsible for determining vascular luminal diameter and blood flow. Dynamic changes in intracellular calcium are a critical mechanism regulating vascular smooth muscle contractility. Processes influencing intracellular calcium are therefore important regulators of vascular function with physiological and pathophysiological consequences. In this review we discuss the major dynamic calcium signals identified and characterized in vascular smooth muscle cells....

  5. Nuclear security and radiological preparedness for the olympic games, athens 2004: lessons learned for organizing major public events.

    Science.gov (United States)

    Kamenopoulou, Vassiliki; Dimitriou, Panayiotis; Hourdakis, Constantine J; Maltezos, Antonios; Matikas, Theodore; Potiriadis, Constantinos; Camarinopoulos, Leonidas

    2006-10-01

    In light of the exceptional circumstances that arose from hosting the Olympic Games in Athens in 2004 and from recent terrorist events internationally, Greece attributes the highest priority to security issues. According to its statutory role, the Greek Atomic Energy Commission is responsible for emergency preparedness and response in case of nuclear and radiological events, and advises the Government on the measures and interventions necessary to protect the public. In this context, the Commission participated in the Nuclear, Radiological, Biological, and Chemical Threat National Emergency Plan, specially developed for the Olympic Games, and coordinated by the Olympic Games Security Division. The objective of this paper is to share the experience gained during the organization of the Olympic Games and to present the nuclear security program implemented prior to, during, and beyond the Games, in order to prevent, detect, assess, and respond to the threat of nuclear terrorism. This program adopted a multi-area coverage of nuclear security, including physical protection of nuclear and radiological facilities, prevention of smuggling of radioactive materials through borders, prevention of dispersion of these materials into the Olympic venues, enhancement of emergency preparedness and response to radiological events, upgrading of the technical infrastructure, establishment of new procedures for assessing the threat and responding to radiological incidents, and training personnel belonging to several organizations involved in the National Emergency Response Plan. Finally, the close cooperation of Greek Authorities with the International Atomic Energy Agency and the U.S. Department of Energy, under the coordination of the Greek Atomic Energy Commission, is also discussed.

  6. The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing.

    Science.gov (United States)

    Zhan, Luke X; Branco, Bernardino C; Armstrong, David G; Mills, Joseph L

    2015-04-01

    The purpose of this study was to evaluate whether the new Society for Vascular Surgery (SVS) Wound, Ischemia, and foot Infection (WIfI) classification system correlates with important clinical outcomes for limb salvage and wound healing. A total of 201 consecutive patients with threatened limbs treated from 2010 to 2011 in an academic medical center were analyzed. These patients were stratified into clinical stages 1 to 4 on the basis of the SVS WIfI classification. The SVS objective performance goals of major amputation, 1-year amputation-free survival (AFS) rate, and wound healing time (WHT) according to WIfI clinical stages were compared. The mean age was 58 years (79% male, 93% with diabetes). Forty-two patients required major amputation (21%); 159 (78%) had limb salvage. The amputation group had a significantly higher prevalence of advanced stage 4 patients (P healing. As the clinical stage progresses, the risk of major amputation increases, 1-year AFS declines, and WHT is prolonged. We further demonstrated benefit of revascularization to improve WHT in selected patients, especially those in stage 3. Future efforts are warranted to incorporate the SVS WIfI classification into clinical decision-making algorithms in conjunction with a comorbidity index and anatomic classification. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  7. Carotid Artery Intima-Media Thickness Predicts Major Cardiovascular Events During 7-Year Follow-Up in 64-Year-Old Women Irrespective of Other Glucometabolic Factors.

    Science.gov (United States)

    Schmidt, Caroline; Bergström, Göran

    2017-07-01

    Cardiovascular (CV) disease (CVD) is a leading cause of morbidity and mortality worldwide. Most CV events are caused by atherosclerosis. Diabetes and impaired glucose tolerance are associated with greater carotid intima-media thickness (IMT) and increased risk for CVD. The present study examined if common carotid artery IMT (CCAIMT) is predictive of CVD irrespective of glucose tolerance category and glycated hemoglobin (HbA1c) in a sample of 639 women with different glucose tolerance categories. During 7-year follow-up, 30 events in the cardiac and 32 events in the cerebral territory were documented. Unadjusted Cox hazard models showed that CCAIMT, glucose tolerance category, and HbA1c were associated with increased risk. An adjusted and extended model, including CCAIMT, glucose tolerance category, and HbA1c, showed that CCAIMT was still associated with events with an almost unchanged hazard ratio. In conclusion, this study suggests that CCAIMT is predictive of major CV events during 7-year follow-up, irrespective of glucose tolerance category, HbA1c, and other established risk factors in a cohort of 64-year-old women.

  8. The association of suicide risk with negative life events and social support according to gender in Asian patients with major depressive disorder.

    Science.gov (United States)

    Park, Subin; Hatim Sulaiman, Ahmad; Srisurapanont, Manit; Chang, Sung-man; Liu, Chia-Yih; Bautista, Dianne; Ge, Lan; Choon Chua, Hong; Pyo Hong, Jin

    2015-08-30

    We investigated the associations between negative life events, social support, depressive and hostile symptoms, and suicide risk according to gender in multinational Asian patients with major depressive disorder (MDD). A total of 547 outpatients with MDD (352 women and 195 men, mean age of 39.58±13.21 years) were recruited in China, South Korea, Malaysia, Singapore, Thailand, and Taiwan. All patients were assessed with the Mini-International Neuropsychiatric Interview, the Montgomery-Asberg Depression Rating Scale, the Symptoms Checklist 90-Revised, the Multidimensional Scale of Perceived Social Support, and the List of Threatening Experiences. Negative life events, social support, depressive symptoms, and hostility were all significantly associated with suicidality in female MDD patients. However, only depressive symptoms and hostility were significantly associated with suicidality in male patients. Depression severity and hostility only partially mediated the association of negative life events and poor social support with suicidality in female patients. In contrast, hostility fully mediated the association of negative life events and poor social support with suicidality in male patients. Our results highlight the need of in-depth assessment of suicide risk for depressed female patients who report a number of negative life events and poor social supports, even if they do not show severe psychopathology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique.

    Science.gov (United States)

    Kueper, Janina; Fantini, Gary A; Walker, Brendon R; Aichmair, Alexander; Hughes, Alexander P

    2015-04-01

    This article examines the incidence and management of vascular injury during Lateral Lumbar Interbody Fusion (LLIF). The details of the mini-open access technique are presented. A total of 900 patients who underwent a LLIF at an average 1.94 levels (range: 1-5 levels) by one of six fellowship trained surgeons on 1,754 levels from 2006 to 2013 were identified. The incidence of intraoperative vascular injury was retrospectively determined from the Operative Records. The management of vascular injury was evaluated. The mini-open access adapted by our institution for LLIF is described. The incidence of major vascular complication in our series was 1/900. The incidence of minor vascular injury was 4/900. The overall incidence of vascular injury was calculated to be 0.056 % per case and 0.029 % per level. All minor vascular injuries were identified to be segmental vessel lacerations, which were readily ligated under direct visualization without further extension of the incision with no clinical sequelae. The laceration of the abdominal aorta, the major vascular complication of this series, was emergently repaired through an exploratory laparotomy. None of the patients suffered long-term sequelae from their intraoperative vascular injuries. The mini-open lateral access technique for LLIF provides for minimal risk of vascular injury to the lumbar spine. In the rare event of minor vascular injury, the mini-open access approach allows for immediate visualization, confirmation and repair of the vessel with no long-term sequelae.

  10. Springtime major pollution events by aerosol over Paris Area: From a case study to a multiannual analysis

    Science.gov (United States)

    Chazette, Patrick; Royer, Philippe

    2017-08-01

    A study of the intense spring pollution events occurring between 2007 and 2016 on the Paris Area is presented using ground-based and spaceborne measurements. Emphasis is placed on 2011 where data included ground-based lidar measurements. This last period corresponds with the highest regional pollution levels of the past decade. The information threshold (daily average of (mass concentration of particles with aerodynamic diameter less than 10 μm) PM10 > 50 μg m-3) was exceeded 16 times, while the alert threshold (daily average of PM10 > 80 μg m-3) was exceeded twice. The information (alert) threshold exists to protect the most fragile people (the entire population). Ground-based and spaceborne measurements demonstrate the benefit of their synergy as each is representative of specific space and time scales. The operational products of the spaceborne instruments Cloud-Aerosol LIdar with Orthogonal Polarization (CALIOP) and the Moderate Resolution Imaging Spectroradiometer are used. For 2011, CALIOP vertical profiles are inversed to assess the backscatter to extinction ratio, which is then successfully compared with similar results derived from the CALIOP operational products, a ground-based lidar and Sun photometers. The aerosols are identified to be polluted continental and polluted dust aerosols following the criteria used for the inversion of the CALIOP profiles. Aerosol typing is consistent between the ground-based and spaceborne lidars, demonstrating the importance of CALIOP for other years where the ground-based lidar was not in operation. The main pollution sources responsible for the spring aerosol pollution, occurring during anticyclonic meteorological conditions, are identified as coming from Western Europe: Benelux, Rhine-Ruhr area, and the Lorraine area.

  11. The 2005 and 2012 major drought events in Iberia: monitoring vegetation dynamics and crop yields using satellite data.

    Science.gov (United States)

    Gouveia, Célia M.; Trigo, Ricardo M.

    2014-05-01

    large sectors of Iberia for up to seven months (out of eleven) of the vegetative cycle. While in the case of the drought episode of 2005 the impact on vegetation covered roughly 2/3 of the Iberian Peninsula (Gouveia et al., 2012), whereas in the recent episode of 2012 the deficit in greenness affected a more restrictive area located in central Iberia. The vegetation response to water stress was also analysed and compared for different land cover types. Results revealed a stronger vulnerability to drought events for arable land with severe impacts on cereals crop productions and yield (namely wheat), for Portugal and Spain in both years, however slightly less severe for 2012. In conclusion, and from an operational point of view, our results reveal the ability of the developed methodology to monitor vegetation stress and droughts in Iberia. Acknowledgments: This work was partially supported by national funds through FCT (Fundação para a Ciência e a Tecnologia, Portugal) under project QSECA (PTDC/AAG-GLO/4155/2012) Garcia-Herrera R., Paredes D., Trigo R. M., Trigo I. F., Hernandez E., Barriopedro D. and Mendes M. A., 2007: The Outstanding 2004/05 Drought in the Iberian Peninsula: Associated Atmospheric Circulation, J. Hydrometeorol., 8, 483-498. Gouveia C., Trigo R. M., and DaCamara C. C., 2009: Drought and vegetation stress monitoring in Portugal using satellite data, Nat. Hazards Earth Syst. Sci., 9, 185-195, doi:10.5194/nhess-9-185- 2009. Gouveia C.M., Bastos A., Trigo R.M., DaCamara C.C., 2012: Drought impacts on vegetation in the pre and post-fire events over Iberian Peninsula". Natural Hazards Earth System Sciences, 12, 3123-3137, 2012, doi:10.5194/nhess-12-3123-2012. Hoerling M., Eischeid J., Perlwitz J., Quan X., Zhang T., Pegion P., 2012: On the Increased Frequency of Mediterranean Drought. J. Climate, 25, 2146-2161. doi: http://dx.doi.org/10.1175/JCLI-D-11-00296.1 Trigo R.M., Añel J., Barriopedro D., García-Herrera R., Gimeno L., Nieto R., Castillo R., Allen

  12. South Africa's marketing strategies towards major African regional economic players: the case of the 2010 FIFA World Cup –was it truly an African event?

    Directory of Open Access Journals (Sweden)

    PPS Sifolo

    2014-01-01

    Full Text Available This article critically examines the effect and the dynamics of the 2010 FIFA World Cup in relation to major African regional economic players. It was conducted with an assumption that the branding of the 2010 FIFA World Cup as „Africa‟s Time‟, „Africa‟s moment‟, and „Africa‟s turn‟ to the benefit of the continent would be viewed with pessimism, at least by the (Egypt, Algeria, Kenya, Ethiopia, Ghana and Nigeria major African regional economic players, as an event that did not benefit the continent as a whole but South Africa and the Southern African Development Community (SADC region. This article used phenomenological strategy under qualitative methods whereby face to face interviews were conducted from a sample drawn from the pool of diplomatic community and the staff of relevant Non-Governmental Organisations (NGOs and Inter-Governmental Organisations (IGOs in Addis Ababa, Ethiopia. The results revealed that an event was a tremendous boost to the pride and confidence of Africa and its people. Credit should be given to South Africa for taking the leading role in marketing an event as African and not as South African. Such marketing strategy did not only ensure African ownership but instilled the sense of African pride.

  13. Tree-ring based reconstruction of the seasonal timing, major events and origin of rockfall on a case-study slope in the Swiss Alps

    Directory of Open Access Journals (Sweden)

    D. M. Schneuwly

    2008-03-01

    Full Text Available Tree-ring analysis has been used to reconstruct 22 years of rockfall behavior on an active rockfall slope near Saas Balen (Swiss Alps. We analyzed 32 severely injured trees (L. decidua, P. abies and P. cembra and investigated cross-sections of 154 wounds.

    The intra-annual position of callus tissue and of tangential rows of traumatic resin ducts was determined in order to reconstruct the seasonality of past rockfall events. Results indicate strong intra- and inter-annual variations of rockfall activity, with a peak (76% observed in the dormant season (early October – end of May. Within the growth season, rockfall regularly occurs between the end of May and mid July (21.4%, whereas events later in the season appear to be quite rare (2.6%. Findings suggest that rockfall activity at the study site is driven by annual thawing processes and the circulation of melt water in preexisting fissures. Data also indicate that 43% of all rockfall events occurred in 1995, when two major precipitation events are recorded in nearby meteorological stations. Finally, data on impact angles are in very good agreement with the geomorphic situation in the field.

  14. Application of probabilistic event attribution in the summer heat extremes in the western US to emissions traced to major industrial carbon producers

    Science.gov (United States)

    Mera, R. J.; Allen, M. R.; Mote, P.; Ekwurzel, B.; Frumhoff, P. C.; Rupp, D. E.

    2015-12-01

    Heat waves in the western US have become progressively more severe due to increasing relative humidity and nighttime temperatures, increasing the health risks of vulnerable portions of the population, including Latino farmworkers in California's Central Valley and other socioeconomically disadvantaged communities. Recent research has shown greenhouse gas emissions doubled the risk of the hottest summer days during the 2000's in the Central Valley, increasing public health risks and costs, and raising the question of which parties are responsible for paying these costs. It has been argued that these costs should not be taken up solely by the general public through taxation, but that additional parties can be considered, including multinational corporations who have extracted and marketed a large proportion of carbon-based fuels. Here, we apply probabilistic event attribution (PEA) to assess the contribution of emissions traced to the world's 90 largest major industrial carbon producers to the severity and frequency of these extreme heat events. Our research uses very large ensembles of regional climate model simulations to calculate fractional attribution of policy-relevant extreme heat variables. We compare a full forcings world with observed greenhouse gases, sea surface temperatures and sea ice extent to a counter-factual world devoid of carbon pollution from major industrial carbon producers. The results show a discernable fraction of record-setting summer temperatures in the western US during the 2000's can be attributed to emissions sourced from major carbon producers.

  15. The Species Richness of Vascular Plants and Amphibia in Major Plant Communities in Temperate to Tropical Australia: Relationship with Annual Biomass Production

    International Nuclear Information System (INIS)

    Specht, R. L.; Tyler, M.J.

    2010-01-01

    Aerodynamic fluxes (frictional, thermal, evaporative) in the atmosphere as it flows over and through a plant community determine the Foliage Projective Covers and eco-morphological attributes of new leaves developed annually in overstorey and understorey strata. The number of leaves produced on vertical foliage shoots depends on available soil water and nutrients, also ambient temperature, during this short growth season. Stem density (number of stems per hectare) and species richness (number of species per hectare) in the overstorey of major Floristic Groups are correlated with annual shoot growth (ASG, t ha-1) in that stratum. Species richness in the overstorey increases in the climatic gradient from the arid to the humid zone as well as with increasing air temperatures (about 10 degree C) from temperate to tropical Australia. Species richness in the understorey is highest in plant communities in temperate Australia, decreasing in the temperature gradient towards the tropics. As with other major plant and animal groups within an ecosystem, the species richness of Amphibia is correlated with the amount of solar energy fixed (per annum) by the major plant formation in the regional photosynthetic potential determined by the foliage shoots (ASG, t ha-1) produced annually in the overstorey.

  16. The Species Richness of Vascular Plants and Amphibia in Major Plant Communities in Temperate to Tropical Australia: Relationship with Annual Biomass Production

    Directory of Open Access Journals (Sweden)

    R. L. Specht

    2010-01-01

    Full Text Available Aerodynamic fluxes (frictional, thermal, evaporative in the atmosphere as it flows over and through a plant community determine the Foliage Projective Covers and eco-morphological attributes of new leaves developed annually in overstorey and understorey strata. The number of leaves produced on vertical foliage shoots depends on available soil water and nutrients, also ambient temperature, during this short growth season. Stem density (number of stems per hectare and species richness (number of species per hectare in the overstorey of major Floristic Groups are correlated with annual shoot growth (ASG, t ha−1 in that stratum. Species richness in the overstorey increases in the climatic gradient from the arid to the humid zone as well as with increasing air temperatures (about 10oC from temperate to tropical Australia. Species richness in the understorey is highest in plant communities in temperate Australia, decreasing in the temperature gradient towards the tropics. As with other major plant and animal groups within an ecosystem, the species richness of Amphibia is correlated with the amount of solar energy fixed (per annum by the major plant formation in the region—a photosynthetic potential determined by the foliage shoots (ASG, t ha−1 produced annually in the overstorey.

  17. The nature of delayed dream incorporation ('dream-lag effect'): Personally significant events persist, but not major daily activities or concerns.

    Science.gov (United States)

    Eichenlaub, Jean-Baptiste; van Rijn, Elaine; Phelan, Mairéad; Ryder, Larnia; Gaskell, M Gareth; Lewis, Penelope A; P Walker, Matthew; Blagrove, Mark

    2018-04-22

    Incorporation of details from waking life events into rapid eye movement (REM) sleep dreams has been found to be highest on the 2 nights after, and then 5-7 nights after, the event. These are termed, respectively, the day-residue and dream-lag effects. This study is the first to categorize types of waking life experiences and compare their incorporation into dreams across multiple successive nights. Thirty-eight participants completed a daily diary each evening and a dream diary each morning for 14 days. In the daily diary, three categories of experiences were reported: major daily activities (MDAs), personally significant events (PSEs) and major concerns (MCs). After the 14-day period each participant identified the correspondence between items in their daily diaries and subsequent dream reports. The day-residue and dream-lag effects were found for the incorporation of PSEs into dreams (effect sizes of .33 and .27, respectively), but only for participants (n = 19) who had a below-median total number of correspondences between daily diary items and dream reports (termed "low-incorporators" as opposed to "high-incorporators"). Neither the day-residue or dream-lag effects were found for MDAs or MCs. This U-shaped timescale of incorporation of events from daily life into dreams has been proposed to reflect REM sleep-dependent memory consolidation, possibly related to emotional memory processing. This study had a larger sample size of dreams than any dream-lag study hitherto with trained participants. Coupled with previous successful replications, there is thus substantial evidence supporting the dream-lag effect and further explorations of its mechanism, including its neural underpinnings, are warranted. © 2018 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

  18. Effects of the major sudden stratospheric warming event of 2009 on the subionospheric very low frequency/low frequency radio signals

    Science.gov (United States)

    Pal, S.; Hobara, Y.; Chakrabarti, S. K.; Schnoor, P. W.

    2017-07-01

    This paper presents effects of the major sudden stratospheric warming (SSW) event of 2009 on the subionospheric very low frequency/low frequency (VLF/LF) radio signals propagating in the Earth-ionosphere waveguide. Signal amplitudes from four transmitters received by VLF/LF radio networks of Germany and Japan corresponding to the major SSW event are investigated for possible anomalies and atmospheric influence on the high- to middle-latitude ionosphere. Significant anomalous increase or decrease of nighttime and daytime amplitudes of VLF/LF signals by ˜3-5 dB during the SSW event have been found for all propagation paths associated with stratospheric temperature rise at 10 hPa level. Increase or decrease in VLF/LF amplitudes during daytime and nighttime is actually due to the modification of the lower ionospheric boundary conditions in terms of electron density and electron-neutral collision frequency profiles and associated modal interference effects between the different propagating waveguide modes during the SSW period. TIMED/SABER mission data are also used to investigate the upper mesospheric conditions over the VLF/LF propagation path during the same time period. We observe a decrease in neutral temperature and an increase in pressure at the height of 75-80 km around the peak time of the event. VLF/LF anomalies are correlated and in phase with the stratospheric temperature and mesospheric pressure variation, while minimum of mesospheric cooling shows a 2-3 day delay with maximum VLF/LF anomalies. Simulations of VLF/LF diurnal variation are performed using the well-known Long Wave Propagating Capability (LWPC) code within the Earth-ionosphere waveguide to explain the VLF/LF anomalies qualitatively.

  19. Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome.

    Science.gov (United States)

    Jakimov, Tamara; Mrdović, Igor; Filipović, Branka; Zdravković, Marija; Djoković, Aleksandra; Hinić, Saša; Milić, Nataša; Filipović, Branislav

    2017-12-31

    To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC=0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC=0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC=0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC=0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC=0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC=0.88; 95% CI 1.018-1.072) and on discharge (AUC=0.78; 95% CI 1.000-1.058). In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR.

  20. Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study

    OpenAIRE

    Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria; Tsivgoulis, Georgios; Furie, Karen L; Tadi, Prasanna; Becattini, Cecilia; Falocci, Nicola; Zedde, Marialuisa; Abdul-Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo

    2017-01-01

    Background and Purposes—This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.\\ud \\ud Methods—The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlar...

  1. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting.

    Science.gov (United States)

    Mathioudakis, Nestoras; Hicks, Caitlin W; Canner, Joseph K; Sherman, Ronald L; Hines, Kathryn F; Lum, Ying W; Perler, Bruce A; Abularrage, Christopher J

    2017-06-01

    The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification has been shown to correlate well with risk of major amputation and time to wound healing in heterogeneous diabetic and nondiabetic populations. Major amputation continues to plague the most severe stage 4 WIfI patients, with 1-year amputation rates of 20% to 64%. Our aim was to determine the association between WIfI stage and wound healing and major amputation among patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. All patients presenting to our multidisciplinary DFU clinic from July 2012 to December 2015 were enrolled in a prospective database. Wound healing and major amputation were compared for patients stratified by WIfI classification. There were 217 DFU patients with 439 wounds (mean age, 58.3 ± 0.8 years; 58% male, 63% black) enrolled, including 28% WIfI stage 1, 11% stage 2, 33% stage 3, and 28% stage 4. Peripheral arterial disease and dialysis were more common in patients with advanced (stage 3 or 4) wounds (P ≤ .05). Demographics of the patients, socioeconomic status, and comorbidities were otherwise similar between groups. There was a significant increase in the number of active wounds per limb at presentation with increasing WIfI stage (stage 1, 1.1 ± 0.1; stage 4, 1.4 ± 0.1; P = .03). Mean wound area (stage 1, 2.6 ± 0.6 cm 2 ; stage 4, 15.3 ± 2.8 cm 2 ) and depth (stage 1, 0.2 ± 0.0 cm; stage 4, 0.8 ± 0.1 cm) also increased progressively with increasing wound stage (P healing (P healing time was 190 ± 17 days, and risk of major amputation at 1 year was 5.7% ± 3.2%. Among patients with DFU, the WIfI classification system correlated well with wound healing but was not associated with risk of major amputation at 1 year. Although further prospective research is warranted, our results suggest that use of a multidisciplinary approach for DFUs may augment healing time and reduce amputation

  2. The pathology and pathophysiology of vascular dementia.

    Science.gov (United States)

    Kalaria, Raj N

    2017-12-19

    Vascular dementia (VaD) is widely recognised as the second most common type of dementia. Consensus and accurate diagnosis of clinically suspected VaD relies on wide-ranging clinical, neuropsychological and neuroimaging measures in life but more importantly pathological confirmation. Factors defining subtypes of VaD include the nature and extent of vascular pathologies, degree of involvement of extra and intracranial vessels and the anatomical location of tissue changes as well as time after the initial vascular event. Atherosclerotic and cardioembolic diseases combined appear the most common subtypes of vascular brain injury. In recent years, cerebral small vessel disease (SVD) has gained prominence worldwide as an important substrate of cognitive impairment. SVD is characterised by arteriolosclerosis, lacunar infarcts and cortical and subcortical microinfarcts and diffuse white matter changes, which involve myelin loss and axonal abnormalities. Global brain atrophy and focal degeneration of the cerebrum including medial temporal lobe atrophy are also features of VaD similar to Alzheimer's disease. Hereditary arteriopathies have provided insights into the mechanisms of dementia particularly how arteriolosclerosis, a major contributor of SVD promotes cognitive impairment. Recently developed and validated neuropathology guidelines indicated that the best predictors of vascular cognitive impairment were small or lacunar infarcts, microinfarcts, perivascular space dilation, myelin loss, arteriolosclerosis and leptomeningeal cerebral amyloid angiopathy. While these substrates do not suggest high specificity, VaD is likely defined by key neuronal and dendro-synaptic changes resulting in executive dysfunction and related cognitive deficits. Greater understanding of the molecular pathology is needed to clearly define microvascular disease and vascular substrates of dementia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. CIRSE Vascular Closure Device Registry

    NARCIS (Netherlands)

    Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2011-01-01

    Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. The CIRSE registry of closure devices

  4. Nuclear security in major public events: the XV Pan American Games and the III Para-Pan American Games in Brazil

    International Nuclear Information System (INIS)

    Mello, Luiz A. de; Monteiro Filho, Joselio S.; Belem, Lilia M.J.; Torres, Luiz F.B.

    2009-01-01

    The organization of a major public event involving large numbers of spectators and participants, presents important security challenges. Taking this into consideration, the Brazilian Nuclear Energy Commission (CNEN) has been requested, by the National Secretary of Public Security/ Ministry of Justice (SENASP/MJ), by the end of 2006, to participate on the security actions to be implemented in both the XV Pan American Games and III Para Pan American Games. The XV Pan American Games 2007 and the III Para Pan American Games were held in Rio de Janeiro, Brazil from 13 to 29 July 2007 and from 12 to 19 August 2007, respectively. Those events had 8700 participants between athletes, coaches and referees from 42 countries. More than 300 competition events were held at 17 different venues and were covered by 4910 professionals from TV, radio and written press. Around 2 million tickets have been sold or distributed and 18,000 volunteers participated on the organization. The participation of CNEN was concentrated on the implementation of specific nuclear and radiological security measures to be applied at those events. This was part of a multi-institutional plan for the security of the Games, coordinated by the National Secretary of Public Security of the Ministry of Justice (SENASP/MJ). The support provided by IAEA under a Cooperation Arrangement with the Brazilian authorities was a key factor for the success of the whole operation. The actions taken and the lessons identified by the Brazilian Nuclear Energy Commission related to nuclear and radiological security for the Pan American Games and for the Para Pan American Games are presented. (author)

  5. Female sex work and international sport events - no major changes in demand or supply of paid sex during the 2010 Soccer World Cup: a cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background Important unanswered questions remain on the impact of international sporting events on the sex industry. Speculation about increased demand and supply of sex work often generates significant attention, but also additional funding for HIV programmes. This study assessed whether changes occurred in the demand and supply of paid sex during the 2010 Soccer World Cup in South Africa. Methods Trained sex worker interviewers conducted face-to-face semi-structured interviews among consenting female sex workers during May-September 2010. Using bivariate analyses we compared supply, demand, sexual risk-taking, and police and health services contact pre-World Cup, to levels during the World Cup and after the event. Results No increases were detected in indicators of sex work supply, including the proportion of sex workers newly arrived in the city ( 92.4% in all phases). Health-care utilisation decreased non-significantly from the pre- to during World Cup period (62.4% to 57.0%; P = 0.075). Across all periods, about thirty percent of participants had interacted with police in the preceding month, two thirds of whom had negative interactions. Conclusions Contrary to public opinion, no major increases were detected in the demand or supply of paid sex during the World Cup. Although the study design employed was unable to select population-based samples, these findings do not support the public concern and media speculation prior to the event, but rather signal a missed opportunity for public health action. Given the media attention on sex work, future sporting events offer strategic opportunities to implement services for sex workers and their clients, especially as health service utilisation might decrease in this period. PMID:22967260

  6. The effects of transboundary air pollution following major events in China on air quality in the U.S.: Evidence from Chinese New Year and sandstorms.

    Science.gov (United States)

    Ngo, N S; Zhong, N; Bao, X

    2018-04-15

    Transboundary air pollution is a global environmental and public health problem including in the U.S., where pollution emissions from China, the largest emitter of anthropogenic air pollution in the world, can travel across the Pacific Ocean and reach places like California and Oregon. We examine the effects of transboundary air pollution following major events in China, specifically sandstorms, a natural-occurring source of air pollution, and Chinese New Year, a major 7-day holiday, on background air quality in the U.S. We focus on high elevation sites on the west coast between 2000 and 2013. We use regression analysis and a natural experiment to exploit the variation in the timing of these events in China, which are plausibly uncorrelated to other factors that affect air quality in China and the U.S. We find that sandstorms are associated with statistically significant increases in background coarse and fine particulate matter (PM) in the U.S., representing between 16 and 39% of average weekly PM levels. We also find Chinese New Year is associated with modest reductions in background air quality in the U.S., representing between 0.4 and 2.5% of PM levels. Findings are robust to different models and falsification tests. These results suggest that regression analysis could be a powerful tool to complement other, more widely used techniques in the environmental sciences that study this problem. This also has important implications for policymakers, who could track major sandstorms in China and prepare for possible increased foreign pollution emissions in the U.S. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Asteroids and Archaean crustal evolution: Tests of possible genetic links between major mantle/crust melting events and clustered extraterrestrial bombardments

    Science.gov (United States)

    Glikson, A. Y.

    1992-01-01

    Since the oldest intact terrestrial rocks of ca. 4.0 Ga and oldest zircon xenocrysts of ca. 4.3 Ga measured to date overlap with the lunar late heavy bombardment, the early Precambrian record requires close reexamination vis a vis the effects of megaimpacts. The identification of microtektite-bearing horizons containing spinals of chondritic chemistry and Ir anomalies in 3.5-3.4-Ga greenstone belts provides the first direct evidence for large-scale Archaean impacts. The Archaean crustal record contains evidence for several major greenstone-granite-forming episodes where deep upwelling and adiabatic fusion of the mantle was accompanied by contemporaneous crustal anatexis. Isotopic age studies suggest evidence for principal age clusters about 3.5, 3.0, and 2.7 (+/- 0.8) Ga, relics of a ca. 3.8-Ga event, and several less well defined episodes. These peak events were accompanied and followed by protracted thermal fluctuations in intracrustal high-grade metamorphic zones. Interpretations of these events in terms of internal dynamics of the Earth are difficult to reconcile with the thermal behavior of silicate rheologies in a continuously convecting mantle regime. A triggering of these episodes by mantle rebound response to intermittent extraterrestrial asteroid impacts is supported by (1) identification of major Archaean impacts from microtektite and distal ejecta horizons marked by Ir anomalies; (2) geochemical and experimental evidence for mantle upwelling, possibly from levels as deep as the transition zone; and (3) catastrophic adiabatic melting required to generate peridotitic komatites. Episodic differentiation/accretion growth of sial consequent on these events is capable of resolving the volume problem that arises from comparisons between modern continental crust and the estimated sial produced by continuous two-stage mantle melting processes. The volume problem is exacerbated by projected high accretion rates under Archaean geotherms. It is suggested that

  8. VASCULAR SURGERY

    African Journals Online (AJOL)

    2016-06-02

    Jun 2, 2016 ... with the literature from South Africa over the last four decades, and reflects the high rate of interpersonal violence in the country.14,15 As expected, cervical ... via the intact circle of Willis in young patients is the most likely explanation for the lack of strokes. Five patients were referred to the Durban vascular ...

  9. Vascular Disorders

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Vascular Disorders Email to a friend * required fields ...

  10. Relation of Serum Adiponectin Levels to Number of Traditional Atherosclerotic Risk Factors and All-Cause Mortality and Major Adverse Cardiovascular Events (from the Copenhagen City Heart Study)

    DEFF Research Database (Denmark)

    Lindberg, Soren; Mogelvang, Rasmus; Pedersen, Sune H

    2013-01-01

    adiponectin has been associated with increased mortality and an increasing number of major adverse CV events (MACE). Because of these conflicting results, the true role of adiponectin remains to be elucidated. In the Copenhagen City Heart Study, we prospectively followed up 5,624 randomly selected men...... and women from the community without CV disease. Plasma adiponectin was measured at the beginning of the study. The median follow-up time was 7.8 years (interquartile range 7.3 to 8.3). The end point was all-cause mortality (n = 801), and the combined end point was MACE, consisting of CV mortality...... or nonfatal myocardial infarction or ischemic stroke (n = 502). High adiponectin was inversely associated with an increasing number of traditional CV risk factors (p...

  11. The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

    Science.gov (United States)

    Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace

    2018-04-01

    To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient

  12. [Prediction value of deceleration capacity of rate and GRACE risk score on major adverse cardiac events in patients with acute myocardial infarction].

    Science.gov (United States)

    Gao, L; Chen, Y D; Shi, Y J; Xue, H; Wang, J L

    2016-07-24

    To investigate the prediction value of deceleration capacity of rate (DC) and GRACE risk score for cardiovascular events in AMI patients. Consecutive AMI patients with sinus rhythm hospitalized in our department during August 2012 to August 2013 were included in this prospective study. 24-hour ECG Holter monitoring was performed within 1 week, and the DC value was analyzed, GRACE risk score was acquired with the application of GRACE risk score calculator. Patients were followed up for more than 1 year and major adverse cardiac events (MACE) were obtained. Analysised the Kaplan Meier survival according to DC and GRACE score risk stratification respectively. A total of 157 patients were enrolled in the study (average age: (58.9±12.7)years old). The average follow-up was (20.54±2.85) months. Mortality during follow-up was significantly higher in patients with DC>2.5 compared to patients with DC≤2.5 (Prisk stratification was 0.898 (95%CI 0.840-0.940, Prisk stratification was 0.786 (95%CI 0.714-0.847, Prisk stratification was 0.708 (95%CI 0.652-0.769, Prisk patients than those with intermediate and low risk patients according to DC risk stratification in intermediate and low risk patients by GRACE risk stratification (Prisk stratification is superior to GRACE risk score on outcome assessment in this AMI patient cohort.

  13. Long-term major adverse cardiovascular events and quality of life after coronary angiography in elderly patients with acute coronary syndrome.

    Science.gov (United States)

    Sigurjonsdottir, R; Barywani, S; Albertsson, P; Fu, M

    2016-11-01

    Although the elderly comprise the majority of acute coronary syndrome (ACS) patients, limited data exist on major adverse cardiovascular events (MACEs) and quality of life (QoL). To study MACEs and QoL prospectively in ACS patients >70years referred for coronary angiography. A prospective observational study that included ACS patients >70years undergoing coronary angiography. The outcomes were MACEs and QoL 3years after inclusion. MACEs were defined as death, recurrent ACS, new-onset of heart failure and repeated revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). A QoL questionnaire was completed by the patients along with a physical examination and a personal interview at the 3-year follow-up. Multivariate analysis was performed to identify the predictors for MACEs. In total, 138 patients (mean age 78.8±3.8years) with ACS were included in the study. Mean follow-up was 1196±296days. In all, 42% of the patients had MACEs and 25% had post-ACS heart failure. The mortality rate was 11%. After adjusting for significant cardiovascular risk factors, the following factors were significantly associated with MACEs: Age, high-sensitive troponin T (hsTNT), use of diuretics and reduced left ventricular ejection fraction (LVEF). Furthermore, the QoL evaluated with SF-36 in survivors from ACS at the end of study was similar to the QoL in an age-matched healthy Swedish population. In this prospective study on elderly ACS patients MACEs still occurred in 42% of the cases (despite low mortality and good QoL), with post-ACS heart failure as the most important event. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Inherited protein S deficiency due to a novel nonsense mutation in the PROS1 gene in the patient with recurrent vascular access thrombosis: A case report

    Directory of Open Access Journals (Sweden)

    Eun Jin Cho

    2012-03-01

    Full Text Available Vascular access thrombosis is one of the major causes of morbidity in patients maintained on chronic hemodialysis. Thrombophilia has been recognized as a risk factor of vascular access thrombosis. The authors report a case of inherited protein S deficiency associated with vascular access thrombotic events. DNA sequence analysis of the PROS1 gene identified a novel heterozygous nonsense mutation in exon 10 by transition of AAG (lysine to TAG (stop codon at codon 473 (c.1417A>T, p.K473X. Results from the study suggest that the inherited protein S deficiency due to a PROS1 gene mutation may cause vascular access thrombosis in hemodialysis patients.

  15. In-hospital mortality risk factors for patients with cerebral vascular events in infectious endocarditis. A correlative study of clinical, echocardiographic, microbiologic and neuroimaging findings.

    Science.gov (United States)

    González-Melchor, Laila; Kimura-Hayama, Eric; Díaz-Zamudio, Mariana; Higuera-Calleja, Jesús; Choque, Cinthia; Soto-Nieto, Gabriel I

    2015-01-01

    Cardiac complications in infectious endocarditis (IE) are seen in nearly 50% of cases, and systemic complications may occur. The aim of the present study was to determine the characteristics of inpatients with IE who suffered acute neurologic complications and the factors associated with early mortality. From January 2004 to May 2010, we reviewed clinical and imaging charts of all of the patients diagnosed with IE who presented a deficit suggesting a neurologic complication evaluated with Computed Tomography or Magnetic Resonance within the first week. This was a descriptive and retrolective study. Among 325 cases with IE, we included 35 patients (10.7%) [19 males (54%), mean age 44-years-old]. The most common underlying cardiac disease was rheumatic valvulopathy (n=8, 22.8%). Twenty patients survived (57.2%, group A) and 15 patients died (42.8%, group B) during hospitalization. The main cause of death was septic shock (n=7, 20%). There was no statistical difference among groups concerning clinical presentation, vegetation size, infectious agent and vascular territory. The overall number of lesions was significantly higher in group B (3.1 vs. 1.6, p=0.005) and moderate to severe cerebral edema were more frequent (p=0.09). Sixteen patients (45.7%) (12 in group A and 4 in group B, p=0.05) were treated by cardiac surgery. Only two patients had a favorable outcome with conservative treatment (5.7%). In patients with IE complicated with stroke, the number of lesions observed in neuroimaging examinations and conservative treatment were associated with higher in-hospital mortality. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  16. Aspirin effect on the incidence of major adverse cardiovascular events in patients with diabetes mellitus: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Ghali William A

    2011-04-01

    Full Text Available Abstract Background Aspirin has been recommended for the prevention of major adverse cardiovascular events (MACE, composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death in diabetic patients without previous cardiovascular disease. However, recent meta-analyses have prompted re-evaluation of this practice. The study objective was to evaluate the relative and absolute benefits and harms of aspirin for the prevention of incident MACE in patients with diabetes. Methods We performed a systematic review and meta-analysis on seven studies (N = 11,618 reporting on the use of aspirin for the primary prevention of MACE in patients with diabetes. Two reviewers conducted a systematic search of electronic databases (MEDLINE, EMBASE, the Cochrane Library, and BIOSIS and hand searched bibliographies and clinical trial registries. Reviewers extracted data in duplicate, evaluated the quality of the trials, and calculated pooled estimates. Results A total of 11,618 participants were included in the analysis. The overall risk ratio (RR for MACE was 0.91 (95% confidence intervals, CI, 0.82-1.00 with little heterogeneity among trials (I2 0.0%. Secondary outcomes of interest included myocardial infarction (RR, 0.85; 95% CI, 0.66-1.10, stroke (RR, 0.84; 95% CI, 0.64-1.11, cardiovascular death (RR, 0.95; 95% CI, 0.71-1.27, and all-cause mortality (RR, 0.95; 95% CI, 0.85-1.06. There were higher rates of hemorrhagic and gastrointestinal events. In absolute terms, these relative risks indicate that for every 10,000 diabetic patients treated with aspirin, 109 MACE may be prevented at the expense of 19 major bleeding events (with the caveat that the relative risk for the latter is not statistically significant. Conclusions The studies reviewed suggest that aspirin reduces the risk of MACE in patients with diabetes without cardiovascular disease, while also causing a trend toward higher rates of bleeding and gastrointestinal complications

  17. A population-based longitudinal study of recent stressful life events as risk factors for suicidal behavior in major depressive disorder.

    Science.gov (United States)

    Wang, Yunqiao; Sareen, Jitender; Afifi, Tracie O; Bolton, Shay-Lee; Johnson, Edward A; Bolton, James M

    2015-01-01

    The purpose of this study is to investigate whether the type and number of stressful life events (SLEs) will be associated with suicidal behavior in a 3-year follow-up period in persons with major depressive disorder (MDD). Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative longitudinal survey of mental health in non-institutionalized adults in the United States. The survey consisted of two waves: Wave 1 (2001--2002) and Wave 2 (2004-2005), n = 34,653. Twelve past-year SLEs were assessed at baseline. These SLEs were categorized into the following groups based on previous research: Loss or victimization; Relationship, friendship, or interpersonal stress; Financial stress; and Legal problems. Only respondents with MDD at Wave 1 were included (n = 6,004). Several SLEs were strongly associated with suicide attempts, among which, "serious problems with neighbor, friend, or relative" (adjusted odds ratio [AOR] = 2.21; 95% confidence interval [95% CI]: 1.41, 3.45) and "major financial crisis, bankruptcy, or unable to pay bills" (AOR = 2.31; 95% CI: 1.45, 3.66) were the most robust predictors of suicide attempts even after adjusting for sociodemographic variables and any anxiety, substance use, or personality disorder. People with MDD who had been exposed to certain SLEs are at elevated risk for future suicide attempts, even after accounting for the demographic factors and psychiatric comorbidity.

  18. Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

    International Nuclear Information System (INIS)

    Ribeiro, Rodrigo Antonini; Duncan, Bruce Bartholow; Ziegelmann, Patricia Klarmann; Stella, Steffan Frosi; Vieira, Jose Luiz da Costa; Restelatto, Luciane Maria Fabian; Polanczyk, Carisi Anne

    2015-01-01

    Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil

  19. Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    Rodrigo Antonini Ribeiro

    2015-01-01

    Full Text Available Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS perspective. Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg, intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg, high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$. A willingness-to-pay (WTP threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770 was applied. Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

  20. Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Rodrigo Antonini, E-mail: rodrigo.ribeiro@htanalyze.com [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Duncan, Bruce Bartholow [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Ziegelmann, Patricia Klarmann [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Departamento de Estatística da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Stella, Steffan Frosi [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Vieira, Jose Luiz da Costa [Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil); Restelatto, Luciane Maria Fabian [Serviço de Medicina Interna do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS (Brazil); Polanczyk, Carisi Anne [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil)

    2015-01-15

    Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

  1. Hemorrhage Control for Major Traumatic Vascular Injuries

    Science.gov (United States)

    2017-10-01

    TJ, Eastridge BJ, Gilani R, Chung KK, DeSantis SM, DuBose JJ , Tomasek TS, Fortuna GR, Sames VG, Todd SR, Podbielski JM, Wade CE, Holcomb JB and the...Eastridge BJ, Gilani R, Chung KK, DeSantis SM, DuBose JJ , Tomasek JS, Fortuna GR, Sams VG, Todd SR, Podbielski JM, Wade CE, Holcomb JB. Multicenter...Kisat M, Morrison JJ , Hashmi ZG, Efron DT, Rasmussen TE, Haider AH. Epidemiology and outcomes of non-compressible torso hemorrhage. J Surg Res. 2013;184

  2. Hemorrhage Control for Major Traumatic Vascular Injuries

    Science.gov (United States)

    2016-10-01

    Crystalloids Codes 1 Prehospital 1 Red Blood Cells (RBC) 6 Platelets – (Plt) 1 Albumin (Alb) 7 Hypertonic Solution ( Ht ) 2 Emergency Room 2 Plasma...Annual Report TEMPLATE Clinical Site: Contractor : Principal Investigator: Dates: Budgetary: Changes to Personnel since the previous annual

  3. Characterization of major ripening events during softening in grape: turgor, sugar accumulation, abscisic acid metabolism, colour development, and their relationship with growth.

    Science.gov (United States)

    Castellarin, Simone D; Gambetta, Gregory A; Wada, Hiroshi; Krasnow, Mark N; Cramer, Grant R; Peterlunger, Enrico; Shackel, Kenneth A; Matthews, Mark A

    2016-02-01

    Along with sugar accumulation and colour development, softening is an important physiological change during the onset of ripening in fruits. In this work, we investigated the relationships among major events during softening in grape (Vitis vinifera L.) by quantifying elasticity in individual berries. In addition, we delayed softening and inhibited sugar accumulation using a mechanical growth-preventing treatment in order to identify processes that are sugar and/or growth dependent. Ripening processes commenced on various days after anthesis, but always at similarly low elasticity and turgor. Much of the softening occurred in the absence of other changes in berry physiology investigated here. Several genes encoding key cell wall-modifying enzymes were not up-regulated until softening was largely completed, suggesting softening may result primarily from decreases in turgor. Similarly, there was no decrease in solute potential, increase in sugar concentration, or colour development until elasticity and turgor were near minimum values, and these processes were inhibited when berry growth was prevented. Increases in abscisic acid occurred early during softening and in the absence of significant expression of the V. vinifera 9-cis-epoxycarotenoid dioxygenases. However, these increases were coincident with decreases in the abscisic acid catabolite diphasic acid, indicating that initial increases in abscisic acid may result from decreases in catabolism and/or exogenous import. These data suggest that softening, decreases in turgor, and increases in abscisic acid represent some of the earliest events during the onset of ripening. Later, physical growth, further increases in abscisic acid, and the accumulation of sugar are integral for colour development. © The Author 2015. Published by Oxford University Press on behalf of the Society for Experimental Biology.

  4. Stent parameters predict major adverse clinical events and the response to platelet glycoprotein IIb/IIIa blockade: findings of the ESPRIT trial.

    Science.gov (United States)

    Tcheng, James E; Lim, Ing Haan; Srinivasan, Shankar; Jozic, Joseph; Gibson, C Michael; O'Shea, J Conor; Puma, Joseph A; Simon, Daniel I

    2009-02-01

    Only limited data describe relationships between stent parameters (length and diameter), adverse events after percutaneous coronary intervention, and effects of platelet glycoprotein IIb/IIIa blockade by stent parameters. In this post hoc analysis of the 1983 patients receiving a stent in the Enhanced Suppression of the Platelet Glycoprotein IIb/IIIa Receptor with Integrilin Therapy randomized percutaneous coronary intervention trial of eptifibatide versus placebo, rates of the major adverse cardiac event (MACE) end point (death, myocardial infarction, urgent target-vessel revascularization, or thrombotic bailout) at 48 hours and 1 year were correlated with stent parameters and then analyzed by randomization to eptifibatide versus placebo. In the placebo group, MACE increased with number of stents implanted, total stent length (by quartiles of or=30 mm), and total stented vessel area (by quartiles of area or=292 mm(2)). By stent parameters, MACE at 48 hours was reduced in the eptifibatide group at stent lengths of 18 to or=30 mm (OR, 0.43; 95% CI, 0.25 to 0.75; P=0.003), stent diameters of >2.5 to <3.5 mm (OR, 0.56; 95% CI, 0.39 to 0.82; P=0.002), and with 2 stents implanted (OR, 0.39; 95% CI, 0.22 to 0.69; P=0.001). In the placebo group, near-linear relationships were observed between both increasing stent length and increasing stented vessel area and MACE at 48 hours and 1 year (all, P<0.001); these gradients were flattened in the eptifibatide group (P=0.005 for stent length). Stent parameters predict MACE after percutaneous coronary intervention. Glycoprotein IIb/IIIa blockade mitigates much of the hazard of increasing procedural complexity.

  5. Tephra and cryptotephra in a 60,000-year-old lacustrine sequence from the Fucino Basin: new insights into the major explosive events in Italy

    Science.gov (United States)

    Di Roberto, Alessio; Smedile, Alessandra; Del Carlo, Paola; De Martini, Paolo Marco; Iorio, Marina; Petrelli, Maurizio; Pantosti, Daniela; Pinzi, Stefania; Todrani, Alessandro

    2018-03-01

    provide insights into the most recent volcanic activity of Albano maar, allowing us to date the onset of activity at the maar system at ca. 40 ka and to estimate the ages of all four eruptions that made up this eruptive sequence at ca. 37.5 ka (Albano 5), ca. 36.5 ka (Albano 6) and ca. 36 ka (Albano 7), respectively. Our work extends the known dispersal of several major explosive events, suggesting the intensity and magnitude appraisals, and attended risk scenario's need to be revised using improved records of distal fall out.

  6. I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: insights from a retrospective European multicenter study

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, Denis [CHU Cote de Nacre, Caen (France); Verberne, Hein J. [Academic Medical Centre, Amsterdam (Netherlands); Burchert, Wolfgang [Ruhr University Bochum, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeyenhausen (Germany); Knuuti, Juhani [Turku University Central Hospital, Turku (Finland); Povinec, Pavol [Comenius University School of Medicine, Bratislava (Slovakia); Sambuceti, Gianmario [University of Genova, Genova (Italy); Unlu, Mustafa [Gazi University, Ankara (Turkey); Estorch, Montserrat [Hospital Sant Pau, Barcelona (Spain); Banerjee, Gopa; Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States)

    2008-03-15

    Single-center experiences have shown that myocardial meta-iodobenzylguanidine (mIBG) uptake has prognostic value in heart failure (HF) patients. To verify these observations using a rigorous clinical trial methodology, a retrospective review and prospective quantitative reanalysis was performed on a series of cardiac {sup 123}I-mIBG scans acquired during a 10-year period at six centers in Europe. {sup 123}I-mIBG scans obtained on 290 HF patients [(262 with left ventricular ejection fraction (LVEF) < 50%)] from 1993 to 2002 were reanalyzed using a standardized methodology to determine the heart-to-mediastinum ratio (H/M) on delayed planar images. All image results were verified by three independent reviewers. Major cardiac events [MCEs; cardiac death, cardiac transplant, potentially fatal arrhythmia (including implantable cardioverter-defibrillator discharge)] during 24-month follow-up were confirmed by an adjudication committee. MCEs occurred in 67 patients (26%): mean H/M ratio was 1.51 {+-} 0.30 for the MCE group and 1.97 {+-} 0.54 for the non-MCE group (p < 0.001). Two-year event-free survival using an optimum H/M ratio threshold of 1.75 was 62% for H/M ratio less than 1.75, 95% for H/M ratio greater than or equal to 1.75 (p < 0.0001). Logistic regression showed H/M ratio and LVEF as the only significant predictors of MCE. Using the lower and upper H/M quartiles of 1.45 and 2.17 as high- and very low-risk thresholds, 2-year event-free survival rates were 52% and 98%, respectively. Among patients with LVEF {<=} 35% and H/M {>=} 1.75 (n = 73), there were nine MCEs because of progressive HF and only one because of an arrhythmia. Application of a clinical trial methodology via the retrospective reanalysis of {sup 123}I-mIBG images confirms the previously reported prognostic value of this method in HF patients, including potential identification of a quantitative threshold for low risk for cardiac mortality and potentially fatal ventricular arrhythmias. (orig.)

  7. Urinary Vitamin D Binding Protein and KIM-1 Are Potent New Biomarkers of Major Adverse Renal Events in Patients Undergoing Coronary Angiography.

    Directory of Open Access Journals (Sweden)

    Lyubov Chaykovska

    Full Text Available Vitamin-D-binding protein (VDBP is a low molecular weight protein that is filtered through the glomerulus as a 25-(OH vitamin D 3/VDBP complex. In the normal kidney VDBP is reabsorbed and catabolized by proximal tubule epithelial cells reducing the urinary excretion to trace amounts. Acute tubular injury is expected to result in urinary VDBP loss. The purpose of our study was to explore the potential role of urinary VDBP as a biomarker of an acute renal damage.We included 314 patients with diabetes mellitus or mild renal impairment undergoing coronary angiography and collected blood and urine before and 24 hours after the CM application. Patients were followed for 90 days for the composite endpoint major adverse renal events (MARE: need for dialysis, doubling of serum creatinine after 90 days, unplanned emergency rehospitalization or death.Increased urine VDBP concentration 24 hours after contrast media exposure was predictive for dialysis need (no dialysis: 113.06 ± 299.61 ng/ml, n = 303; need for dialysis: 613.07 ± 700.45 ng/ml, n = 11, Mean ± SD, p<0.001, death (no death during follow-up: 121.41 ± 324.45 ng/ml, n = 306; death during follow-up: 522.01 ± 521.86 ng/ml, n = 8; Mean ± SD, p<0.003 and MARE (no MARE: 112.08 ± 302.00 ng/ml, n = 298; MARE: 506.16 ± 624.61 ng/ml, n = 16, Mean ± SD, p<0.001 during the follow-up of 90 days after contrast media exposure. Correction of urine VDBP concentrations for creatinine excretion confirmed its predictive value and was consistent with increased levels of urinary Kidney Injury Molecule-1 (KIM-1 and baseline plasma creatinine in patients with above mentioned complications. The impact of urinary VDBP and KIM-1 on MARE was independent of known CIN risk factors such as anemia, preexisting renal failure, preexisting heart failure, and diabetes.Urinary VDBP is a promising novel biomarker of major contrast induced nephropathy-associated events 90 days after contrast media exposure.

  8. Vascular disease in cocaine addiction.

    Science.gov (United States)

    Bachi, Keren; Mani, Venkatesh; Jeyachandran, Devi; Fayad, Zahi A; Goldstein, Rita Z; Alia-Klein, Nelly

    2017-07-01

    Cocaine, a powerful vasoconstrictor, induces immune responses including cytokine elevations. Chronic cocaine use is associated with functional brain impairments potentially mediated by vascular pathology. Although the Crack-Cocaine epidemic has declined, its vascular consequences are increasingly becoming evident among individuals with cocaine use disorder of that period, now aging. Paradoxically, during the period when prevention efforts could make a difference, this population receives psychosocial treatment at best. We review major postmortem and in vitro studies documenting cocaine-induced vascular toxicity. PubMed and Academic Search Complete were used with relevant terms. Findings consist of the major mechanisms of cocaine-induced vasoconstriction, endothelial dysfunction, and accelerated atherosclerosis, emphasizing acute, chronic, and secondary effects of cocaine. The etiology underlying cocaine's acute and chronic vascular effects is multifactorial, spanning hypertension, impaired homeostasis and platelet function, thrombosis, thromboembolism, and alterations in blood flow. Early detection of vascular disease in cocaine addiction by multimodality imaging is discussed. Treatment may be similar to indications in patients with traditional risk-factors, with few exceptions such as enhanced supportive care and use of benzodiazepines and phentolamine for sedation, and avoiding β-blockers. Given the vascular toxicity cocaine induces, further compounded by smoking and alcohol comorbidity, and interacting with aging of the crack generation, there is a public health imperative to identify pre-symptomatic markers of vascular impairments in cocaine addiction and employ preventive treatment to reduce silent disease progression. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Contemporary vascular smartphone medical applications.

    Science.gov (United States)

    Carter, Thomas; O'Neill, Stephen; Johns, Neil; Brady, Richard R W

    2013-08-01

    Use of smartphones and medical mHealth applications (apps) within the clinical environment provides a potential means for delivering elements of vascular care. This article reviews the contemporary availability of apps specifically themed to major vascular diseases and the opportunities and concerns regarding their integration into practice. Smartphone apps relating to major vascular diseases were identified from the app stores for the 6 most popular smartphone platforms, including iPhone, Android, Blackberry, Nokia, Windows, and Samsung. Search terms included peripheral artery (arterial) disease, varicose veins, aortic aneurysm, carotid artery disease, amputation, ulcers, hyperhydrosis, thoracic outlet syndrome, vascular malformation, and lymphatic disorders. Forty-nine vascular-themed apps were identified. Sixteen (33%) were free of charge. Fifteen apps (31%) had customer satisfaction ratings, but only 3 (6%) had greater than 100. Only 13 apps (27%) had documented medical professional involvement in their design or content. The integration of apps into the delivery of care has the potential to benefit vascular health care workers and patients. However, high-quality apps designed by clinicians with vascular expertise are currently lacking and represent an area of concern in the mHealth market. Improvement in the quality and reliability of these apps will require the development of robust regulation. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Coding of adverse events of suicidality in clinical study reports of duloxetine for the treatment of major depressive disorder: descriptive study

    OpenAIRE

    Maund, Emma; Tendal, Britta; Hróbjartsson, Asbjørn; Lundh, Andreas; Gøtzsche, Peter C

    2014-01-01

    Objective To assess the effects of coding and coding conventions on summaries and tabulations of adverse events data on suicidality within clinical study reports. Design Systematic electronic search for adverse events of suicidality in tables, narratives, and listings of adverse events in individual patients within clinical study reports. Where possible, for each event we extracted the original term reported by the investigator, the term as coded by the medical coding dictionary, medical codi...

  11. Resting heart rate associates with one-year risk of major adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary intervention.

    Science.gov (United States)

    Wang, Shao-Li; Wang, Cheng-Long; Wang, Pei-Li; Xu, Hao; Du, Jian-Peng; Zhang, Da-Wu; Gao, Zhu-Ye; Zhang, Lei; Fu, Chang-Geng; Chen, Ke-Ji; Shi, Da-Zhuo

    2016-03-01

    The study was to access the association between resting heart rate (RHR) and one-year risk of major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). Patients with ACS after PCI (n = 808) were prospectively followed-up for MACE. RHR was obtained from electrocardiogram. MACE was defined as a composite of cardiac death, nonfatal recurrent myocardial infarction, ischemic-driven revascularization, and ischemic stroke. The association between RHR and one-year risk of MACE was assessed using Cox proportional hazards regression model. Compared with patients with RHR >76 bpm, the adjusted hazard ratio (AHR) was 0.51 (95% confidence intervals [CI]: 0.23-1.14; P = 0.100) for patients with RHR 76 bpm were at higher risk of MACE during one-year follow-up compared with patients with RHR 61-76 bpm. An elevated RHR ≥ 61 bpm was associated with increased risk of one-year MACE in ACS patients. © 2015 by the Society for Experimental Biology and Medicine.

  12. Increased long-term risk of major adverse cardiovascular events in patients with carbon monoxide poisoning: A population-based study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chung-Shun Wong

    Full Text Available Carbon monoxide (CO poisoning may cause toxicity to the cardiovascular system. However, the association between CO poisoning and the risk of major adverse cardiovascular events (MACE remains unestablished. We investigated the incidence of MACE after CO poisoning in Taiwan and evaluated whether CO-poisoned individuals had a higher risk of MACE than did the general population.Using Taiwan's National Health Insurance Research Database (NHIRD during 2005-2013, a nationwide population-based cohort study was conducted among patients who experienced CO poisoning between 2005 and 2013. CO poisoning was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study cohort comprised patients with CO poisoning between 2005 and 2010 (N = 13,939. Each patient was matched according to age, sex and index date with four randomly selected controls from the comparison cohort (N = 55,756. All patients were followed from the study date until MACE development, death, or the end of 2013. The hazard ratios for MACE were compared between the two cohorts by using Cox proportional hazards regressions analyses.Incident cases of MACE were identified from the NHIRD. After adjustment for potential confounders, the study cohort was independently associated with a higher MACE risk (adjusted hazard ratio, 2.00; 95% confidence interval, 1.83-2.18.This population-based cohort study indicated that patients with CO poisoning have a higher risk of MACE than do individuals without CO poisoning.

  13. Facial vascular malformations in children

    International Nuclear Information System (INIS)

    Brunelle, F.O.; Lallemand, D.; Chaumont, P.; Teillac, D.; Manach, Y.

    1988-01-01

    The authors present their experience with conventional and digital angiography of vascular malformations of the head and neck in children. 22 hemangioendotheliomas, 8 venous angiomas, and 3 arteriovenous fistula were studied. 22 patients were embolised. DSA offers many advantages during the diagnostic as well as during the therapeutic phase of angiography. Embolization appears to have a major role in treatment of such vascular malformations. (orig.)

  14. Vascular ultrasound.

    Science.gov (United States)

    Pilcher, D B; Ricci, M A

    1998-04-01

    Surgeon-interpreted diagnostic ultrasound has become the preferred screening test and often the definitive test for the diagnosis of arterial stenosis, aneurysm, and venous thrombosis. As a modality for surveillance, its noninvasive quality makes it particularly appealing as the test of choice to screen patients for abdominal aortic aneurysms or to perform follow-up examinations on those patients with a carotid endartectomy or in situ bypass grafts. The increasing reliance on intraoperative duplex imaging of vascular procedures demands that the surgeon learn the skills to perform the studies without a technologist or radiologist to interpret the examination.

  15. Adverse outcomes of anticoagulant use among hospitalized patients with chronic kidney disease: a comparison of the rates of major bleeding events between unfractionated heparin and enoxaparin.

    Directory of Open Access Journals (Sweden)

    Fatemeh Saheb Sharif-Askari

    Full Text Available BACKGROUND: Anticoagulation therapy is usually required in patients with chronic kidney disease (CKD for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of bleeding. OBJECTIVES: To determine the incidence of adverse outcomes of anticoagulants in hospitalized patients with CKD, and to compare the rates of major bleeding events between the unfractionated heparin (UFH and enoxaparin users. METHODS: One year prospective observational study was conducted in patients with CKD stages 3 to 5 (estimated GFR, 10-59 ml/min/1.73 m(2 who were admitted to the renal unit of Dubai Hospital. Propensity scores for the use of anticoagulants, estimated for each of the 488 patients, were used to identify a cohort of 117 pairs of patients. Cox regression method was used to estimate association between anticoagulant use and adverse outcomes. RESULTS: Major bleeding occurred in 1 in 3 patients who received anticoagulation during hospitalization (hazard ratio [HR], 4.61 [95% confidence interval [CI], 2.05-10.35]. Compared with enoxaparin users, patients who received anticoagulation with unfractionated heparin had a lower mean [SD] serum level of platelet counts (139.95 [113] × 10(3/µL vs 205.56 [123] × 10(3/µL; P<0.001, and had a higher risk of major bleeding (HR, 4.79 [95% CI, 1.85-12.36]. Furthermore, compared with those who did not receive anticoagulants, patients who did had a higher in-hospital mortality (HR, 2.54 [95% CI, 1.03-6.25]; longer length of hospitalization (HR, 1.04 [95% CI, 1.01-1.06]; and higher hospital readmission at 30 days (HR, 1.79 [95% CI, 1.10-2.91]. CONCLUSIONS: Anticoagulation among hospitalized patients with CKD was significantly associated with an increased risk of bleeding and in-hospital mortality. Hence, intensive monitoring and preventive measures such as laboratory monitoring and/or dose adjustment are warranted.

  16. Vascular complications of prosthetic inter-vertebral discs.

    Science.gov (United States)

    Daly, Kevin J; Ross, E Raymond S; Norris, Heather; McCollum, Charles N

    2006-10-01

    Five consecutive cases of prosthetic inter-vertebral disc displacement with severe vascular complications on revisional surgery are described. The objective of this case report is to warn spinal surgeons that major vascular complications are likely with anterior displacement of inter-vertebral discs. We have not been able to find a previous report on vascular complications associated with anterior displacement of prosthetic inter-vertebral discs. In all five patients the prosthetic disc had eroded into the bifurcation of the inferior vena cava and the left common iliac vein. In three cases the aortic bifurcation was also involved. The fibrosis was so severe that dissecting out the arteries and veins to provide access to the relevant disc proved impossible. Formal division of the left common iliac vein and artery with subsequent repair was our solution. Anterior inter-vertebral disc displacement was associated with severe vascular injury. Preventing anterior disc displacement is essential in disc design. In the event of anterior displacement, disc removal should be planned with a Vascular Surgeon.

  17. Renal posttransplant's vascular complications

    Directory of Open Access Journals (Sweden)

    Bašić Dragoslav

    2003-01-01

    Full Text Available INTRODUCTION Despite high graft and recipient survival figures worldwide today, a variety of technical complications can threaten the transplant in the postoperative period. Vascular complications are commonly related to technical problems in establishing vascular continuity or to damage that occurs during donor nephrectomy or preservation [13]. AIM The aim of the presenting study is to evaluate counts and rates of vascular complications after renal transplantation and to compare the outcome by donor type. MATERIAL AND METHODS A total of 463 kidneys (319 from living related donor LD and 144 from cadaveric donor - CD were transplanted during the period between June 1975 and December 1998 at the Urology & Nephrology Institute of Clinical Centre of Serbia in Belgrade. Average recipients' age was 33.7 years (15-54 in LD group and 39.8 (19-62 in CD group. Retrospectively, we analyzed medical records of all recipients. Statistical analysis is estimated using Hi-squared test and Fischer's test of exact probability. RESULTS Major vascular complications including vascular anastomosis thrombosis, internal iliac artery stenosis, internal iliac artery rupture obliterant vasculitis and external iliac vein rupture were analyzed. In 25 recipients (5.4% some of major vascular complications were detected. Among these cases, 22 of them were from CD group vs. three from LD group. Relative rate of these complications was higher in CD group vs. LD group (p<0.0001. Among these complications dominant one was vascular anastomosis thrombosis which occurred in 18 recipients (17 from CD vs. one from LD. Of these recipients 16 from CD lost the graft, while the rest of two (one from each group had lethal outcome. DISCUSSION Thrombosis of renal allograft vascular anastomosis site is the most severe complication following renal transplantation. In the literature, renal allograft thrombosis is reported with different incidence rates, from 0.5-4% [14, 15, 16]. Data from the

  18. Cerebral Vascular Disease and Neurovascular Injury in Ischemic Stroke

    Science.gov (United States)

    Hu, Xiaoming; De Silva, T. Michael; Chen, Jun; Faraci, Frank M.

    2017-01-01

    The consequences of cerebrovascular disease are among the leading health issues worldwide. Large and small cerebral vessel disease can trigger stroke and contribute to the vascular component of other forms of neurological dysfunction and degeneration. Both forms of vascular disease are driven by diverse risk factors, with hypertension as the leading contributor. Despite the importance of neurovascular disease and subsequent injury following ischemic events, fundamental knowledge in these areas lag behind our current understanding of neuroprotection and vascular biology in general. The goal of this review is to address select key structural and functional changes in the vasculature that promote hypoperfusion and ischemia, while also affecting the extent of injury and effectiveness of therapy. In addition, as damage to the blood-brain barrier (BBB) is one of the major consequences of ischemia, we discuss cellular and molecular mechanisms underlying ischemia-induced changes in BBB integrity and function, including alterations in endothelial cells and the contribution of pericytes, immune cells, and matrix metalloproteinases. Identification of cell types, pathways, and molecules that control vascular changes before and after ischemia may result in novel approaches to slow the progression of cerebrovascular disease and lessen both the frequency and impact of ischemic events. PMID:28154097

  19. Syntax Score and Major Adverse Cardiac Events in Patients with Suspected Coronary Artery Disease: Results from a Cohort Study in a University-Affiliated Hospital in Southern Brazil.

    Science.gov (United States)

    Fuchs, Felipe C; Ribeiro, Jorge P; Fuchs, Flávio D; Wainstein, Marco V; Bergoli, Luis C; Wainstein, Rodrigo V; Zen, Vanessa; Kerkhoff, Alessandra C; Moreira, Leila B; Fuchs, Sandra C

    2016-09-01

    The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. O SXescore prediz independentemente MACE em pacientes submetidos a

  20. Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study.

    Science.gov (United States)

    Stone, Peter H; Maehara, Akiko; Coskun, Ahmet Umit; Maynard, Charles C; Zaromytidou, Marina; Siasos, Gerasimos; Andreou, Ioannis; Fotiadis, Dimitris; Stefanou, Kostas; Papafaklis, Michail; Michalis, Lampros; Lansky, Alexandra J; Mintz, Gary S; Serruys, Patrick W; Feldman, Charles L; Stone, Gregg W

    2018-03-01

    This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe. Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients. In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined. A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (<1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p < 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mm 2 , or TCFA), high anatomic risk, and low ESS were prognostically synergistic: 3-year nc-MACE rates were 52.1% versus 14.4% versus 0.0% in high

  1. Enhancing the 'real world' prediction of cardiovascular events and major bleeding with the CHA2DS2-VASc and HAS-BLED scores using multiple biomarkers.

    Science.gov (United States)

    Roldán, Vanessa; Rivera-Caravaca, José Miguel; Shantsila, Alena; García-Fernández, Amaya; Esteve-Pastor, María Asunción; Vilchez, Juan Antonio; Romera, Marta; Valdés, Mariano; Vicente, Vicente; Marín, Francisco; Lip, Gregory Y H

    2018-02-01

    Atrial fibrillation (AF)-European guidelines suggest the use of biomarkers to stratify patients for stroke and bleeding risks. We investigated if a multibiomarker strategy improved the predictive performance of CHA 2 DS 2 -VASc and HAS-BLED in anticoagulated AF patients. We included consecutive patients stabilized for six months on vitamin K antagonists (INRs 2.0-3.0). High sensitivity troponin T, NT-proBNP, interleukin-6, von Willebrand factor concentrations and glomerular filtration rate (eGFR; using MDRD-4 formula) were quantified at baseline. Time in therapeutic range (TTR) was recorded at six months after inclusion. Patients were follow-up during a median of 2375 (IQR 1564-2887) days and all adverse events were recorded. In 1361 patients, adding four blood biomarkers, TTR and MDRD-eGFR, the predictive value of CHA 2 DS 2 -VASc increased significantly by c-index (0.63 vs. 0.65; p = .030) and IDI (0.85%; p originals scores. Addition of biomarkers enhanced the predictive value of CHA 2 DS 2 -VASc and HAS-BLED, although the overall improvement was modest and the added predictive advantage over original scores was marginal. Key Messages Recent atrial fibrillation (AF)-European guidelines for the first time suggest the use of biomarkers to stratify patients for stroke and bleeding risks, but their usefulness in real world for risk stratification is still questionable. In this cohort study involving 1361 AF patients optimally anticoagulated with vitamin K antagonists, adding high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, interleukin 6, von Willebrand factor, glomerular filtration rate (by the MDRD-4 formula) and time in therapeutic range, increased the predictive value of CHA 2 DS 2 -VASc for cardiovascular events, but not the predictive value of HAS-BLED for major bleeding. Reclassification analyses did not show improvement adding multiple biomarkers. Despite the improvement observed, the added predictive advantage is marginal and

  2. Vascular cognitive impairment

    Directory of Open Access Journals (Sweden)

    N.V. Vakhnina

    2014-01-01

    Full Text Available Vascular pathology of the brain is the second most common cause of cognitive impairment after Alzheimer's disease. The article describes the modern concepts of etiology, pathogenetic mechanisms, clinical features and approaches to diagnosis and therapy of vascular cognitive impairment (VCI. Cerebrovascular accident, chronic cerebral circulatory insufficiency and their combination, sometimes in combination with a concomitant neurodegenerative process, are shown to be the major types of brain lesions leading to VCI. The clinical presentation of VCI is characterized by the neuropsychological status dominated by impairment of the executive frontal functions (planning, control, attention in combination with focal neurological symptoms. The diagnosis is based on comparing of the revealed neuropsychological and neurological features with neuroimaging data. Neurometabolic, acetylcholinergic, glutamatergic, and other vasoactive drugs and non-pharmacological methods are widely used to treat VCI. 

  3. 5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department.

    Science.gov (United States)

    Morris, Niall; Body, Rick

    2017-12-01

    This study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome. This is a secondary analysis of a prospective, multi-centre, observational cohort at 14 centres: the Bedside Evaluation of Sensitive Troponin study. All fourteen Emergency Departments were based in the United Kingdom. Emergency physicians' assessments of the ECG were collected using a standardised form. Clinicians were asked to judge whether the ECG demonstrated ischaemia, the presence of ST depression (STD) and if there was abnormal T wave inversion (ATWI). Patients provided written informed consent and underwent serial high sensitivity troponin testing. 30 day follow-up was performed by research nurses using a standardised form via telephone. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, any cause of death and coronary revascularisation. In total, 756 patients were included in the analysis. Clinicians' ECG diagnosis of ischaemia for 30-day MACE: ECG ischaemia produces a sensitivity (Sn) of 19.54% (95% CI:11.81% to 29.43%), specificity (Sp) of 93.27% (95% CI:91.10% to 95.05%), positive predictive value (PPV) of 27.42% (95% CI:18.47% to 38.65%) and negative predictive value (NPV) of 89.91% (95%CI 88.92% to 90.83%). ECG ST depression produces Sn of 16.09% (9.09% to 25.52%), Sp of 89.69% (87.13% to 91.89%), PPV 16.87 (10.68% to 25.62%), and NPV 89.15% (88.19% to 90.04%). ECG ATWI produces Sn of 4.60% (1.27% to 11.36%), Sp of 91.63% (89.27% to 93.62%), PPV of 6.67% (2.59% to 16.12%) and NPV of 88.07% (87.52% to 88.6). This is the first prospective, multi-centre cohort study, that assess the diagnostic performance of EM clinician's ECG interpretation, with 30-day MACE as the primary outcome. The findings are highly relevant to EM as they represent the ECG terms used by popular acute coronary syndrome clinical decision rules

  4. Trial design: Rivaroxaban for the prevention of major cardiovascular events after transcatheter aortic valve replacement: Rationale and design of the GALILEO study.

    Science.gov (United States)

    Windecker, Stephan; Tijssen, Jan; Giustino, Gennaro; Guimarães, Ana H C; Mehran, Roxana; Valgimigli, Marco; Vranckx, Pascal; Welsh, Robert C; Baber, Usman; van Es, Gerrit-Anne; Wildgoose, Peter; Volkl, Albert A; Zazula, Ana; Thomitzek, Karen; Hemmrich, Melanie; Dangas, George D

    2017-02-01

    Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials.govNCT02556203). Patients are randomized (1:1 ratio), 1 to 7days after a successful TAVR, to either a rivaroxaban-based strategy or an antiplatelet-based strategy. In the experimental arm, subjects receive rivaroxaban (10mg once daily [OD]) plus acetylsalicylic acid (ASA, 75-100mg OD) for 90days followed by rivaroxaban alone. In the control arm, subjects receive clopidogrel (75mg OD) plus ASA (as above) for 90days followed by ASA alone. In case new-onset atrial fibrillation occurs after randomization, full oral anticoagulation will be implemented with maintenance of the original treatment assignment. The primary efficacy end point is the composite of all-cause death, stroke, myocardial infarction, symptomatic valve thrombosis, pulmonary embolism, deep venous thrombosis, and systemic embolism. The primary safety end point is the composite of life-threatening, disabling, and major bleeding, according to the Valve Academic Research Consortium definitions. GALILEO will test the hypothesis that a rivaroxaban-based antithrombotic strategy reduces the risk of thromboembolic complications post-TAVR with an acceptable risk of bleeding compared with the currently recommended antiplatelet therapy-based strategy in subjects without need of chronic oral anticoagulation. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Public Participation in Environmental Impact Assessment (EIA and Major Sports Events: A Comparative Analysis of the London 2012 Olympic Games and the Rio 2007 Pan American Games

    Directory of Open Access Journals (Sweden)

    Gisele Silva Pereira

    2015-01-01

    Full Text Available This paper explores public participation in environmental impact assessment (EIA and the decision making in the context of major sports events and their associated infrastructure in Brazil and England. The methodology is based on detailed case study analysis involving document analysis and interviews with key stakeholders. The results demonstrated that there is evidence that public participation within the EIA process informed the decision making and planning process for London 2012 and for the Pan American Village of the Rio 2007 Games. Finally, a practical recommendation for the Brazilian context and recommendations for further research are made. Participação pública na Avaliação de Impacto Ambiental (AIA e megaeventos esportivos: uma análise comparativa dos Jogos Olímpicos de Londres 2012 e dos Jogos Pan Americanos do Rio 2007 - Este artigo explora a participação pública na Avaliação de Impacto Ambiental (AIA e a tomada de decisão no contexto de megaeventos esportivos e a infraestrutura associada no Brasil e na Inglaterra. A metodologia baseia-se em estudo de caso envolvendo análise de documentos e entrevistas com atores-chave. Os resultados demonstraram que há evidência de que a participação pública integrante do processo de AIA informou a tomada de decisão e o processo de planejamento para Londres 2012 e para a Vila Pan Americana dos Jogos do Rio 2007. Finalmente, uma recomendação prática para o contexto brasileiro e recomendações para pesquisas futuras são destacadas.

  6. Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

    Directory of Open Access Journals (Sweden)

    Mattos Luiz Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2% patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001. Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001. Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001. Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001 as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01. In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53. Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94, and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08. CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

  7. Injuries to the vascular endothelium: vascular wall and endothelial dysfunction.

    Science.gov (United States)

    Fisher, Mark

    2008-01-01

    Vascular endothelial injury has multiple elements, and this article focuses on ischemia-related processes that have particular relevance to ischemic stroke. Distinctions between necrotic and apoptotic cell death provide a basic science context in which to better understand the significance of classical core and penumbra concepts of acute stroke, with apoptotic processes particularly prominent in the penumbra. The mitochondria are understood to serve as a reservoir of proteins that mediate apoptosis. Oxidative stress pathways generating reactive oxygen species (ROS) are prominent in endothelial injury, both ischemic and nonischemic, with prominent roles of enzyme- and nonenzymemediated pathways; mitochondria once again have a critical role, particularly in the nonenzymatic pathways generating ROS. Inflammation also contributes to vascular endothelial injury, and endothelial cells have the capacity to rapidly increase expression of inflammatory mediators following ischemic challenge; this leads to enhanced leukocyte-endothelial interactions mediated by selectins and adhesion molecules. Preconditioning consists of a minor version of an injurious event, which in turn may protect vascular endothelium from injury following a more substantial event. Presence of the blood-brain barrier creates unique responses to endothelial injury, with permeability changes due to impairment of endothelial-matrix interactions compounding altered vasomotor tone and tissue perfusion mediated by nitric oxide. Pharmacological protection against vascular endothelial injury can be provided by several of the phosphodiesterases (cilostazol and dipyridamole), along with statins. Optimal clinical responses for protection of brain vascular endothelium may use preconditioning as a model, and will likely require combined protection against apoptosis, ROS, and inflammation.

  8. Prevalence of blood type A and risk of vascular complications following transcatheter aortic valve implantation.

    Science.gov (United States)

    Rofe, M-T; Shacham, Y; Steinvi, A; Barak, L; Hareuveni, M; Banai, S; Keren, G; Finkelstein, A; Shmilovich, H

    2016-05-01

    To assess the prevalence of blood type A among patients referred for transcatheter aortic valve implantation (TAVI) and whether it is related to vascular complications. Vascular complications following TAVI are associated with adverse outcomes. Various blood types, particularly type A, have been shown to be more prevalent in cardiovascular diseases and to be related to prognosis. The prevalence of various blood types in a cohort of 491 consecutive patients who underwent TAVI was compared with a control group of 6500 consecutive hospitalised patients. The prevalence and predictors of vascular complications and bleeding events were evaluated in the blood type A group and were compared with non-type A patients. The mean age of TAVI patients was 83 ± 6 years, and 40 % were males. Patients were divided into two groups: blood type A (n = 220) and non-type A (n = 271). Type A was significantly more prevalent in the TAVI group than in the control group (45 vs. 38 %, p = 0.023). Compared with the non-type A group, patients with blood type A had more major and fatal bleeding (14.5 vs. 8.1 %, p = 0.027) and more vascular complications (any vascular complication: 24.5 vs. 15.9 % p = 0.016; major vascular complications: 12.3 vs. 7 % p = 0.047). In a multivariable analysis, blood type A emerged as a significant and independent predictor for vascular complications and bleeding events. Blood type A is significantly more prevalent in TAVI patients than in the general population and is related to higher rates of vascular and bleeding complications.

  9. Long-range pollution transport during the MILAGRO-2006 campaign: a case study of a major Mexico City outflow event using free-floating altitude-controlled balloons

    Directory of Open Access Journals (Sweden)

    P. B. Voss

    2010-08-01

    Full Text Available One of the major objectives of the Megacities Initiative: Local And Global Research Observations (MILAGRO-2006 campaign was to investigate the long-range transport of polluted Mexico City Metropolitan Area (MCMA outflow and determine its downwind impacts on air quality and climate. Six research aircraft, including the National Center for Atmospheric Research (NCAR C-130, made extensive chemical, aerosol, and radiation measurements above MCMA and more than 1000 km downwind in order to characterize the evolution of the outflow as it aged and dispersed over the Mesa Alta, Sierra Madre Oriental, Coastal Plain, and Gulf of Mexico. As part of this effort, free-floating Controlled-Meteorological (CMET balloons, commanded to change altitude via satellite, made repeated profile measurements of winds and state variables within the advecting outflow. In this paper, we present an analysis of the data from two CMET balloons that were launched near Mexico City on the afternoon of 18 March 2006 and floated downwind with the MCMA pollution for nearly 30 h. The repeating profile measurements show the evolving structure of the outflow in considerable detail: its stability and stratification, interaction with other air masses, mixing episodes, and dispersion into the regional background. Air parcel trajectories, computed directly from the balloon wind profiles, show three transport pathways on 18–19 March: (a high-altitude advection of the top of the MCMA mixed layer, (b mid-level outflow over the Sierra Madre Oriental followed by decoupling and isolated transport over the Gulf of Mexico, and (c low-level outflow with entrainment into a cleaner northwesterly jet above the Coastal Plain. The C-130 aircraft intercepted the balloon-based trajectories three times on 19 March, once along each of these pathways; in all three cases, peaks in urban tracer concentrations and LIDAR backscatter are consistent with MCMA pollution. In comparison with the transport models

  10. Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial.

    Science.gov (United States)

    Berwanger, Otavio; Santucci, Eliana Vieira; de Barros E Silva, Pedro Gabriel Melo; Jesuíno, Isabella de Andrade; Damiani, Lucas Petri; Barbosa, Lilian Mazza; Santos, Renato Hideo Nakagawa; Laranjeira, Ligia Nasi; Egydio, Flávia de Mattos; Borges de Oliveira, Juliana Aparecida; Dall Orto, Frederico Toledo Campo; Beraldo de Andrade, Pedro; Bienert, Igor Ribeiro de Castro; Bosso, Carlos Eduardo; Mangione, José Armando; Polanczyk, Carisi Anne; Sousa, Amanda Guerra de Moraes Rego; Kalil, Renato Abdala Karam; Santos, Luciano de Moura; Sposito, Andrei Carvalho; Rech, Rafael Luiz; Sousa, Antônio Carlos Sobral; Baldissera, Felipe; Nascimento, Bruno Ramos; Giraldez, Roberto Rocha Corrêa Veiga; Cavalcanti, Alexandre Biasi; Pereira, Sabrina Bernardez; Mattos, Luiz Alberto; Armaganijan, Luciana Vidal; Guimarães, Hélio Penna; Sousa, José Eduardo Moraes Rego; Alexander, John Hunter; Granger, Christopher Bull; Lopes, Renato Delascio

    2018-04-03

    The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management. Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017. Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days. Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group. Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use

  11. Headache and Vascular Events with Brain Tumors

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2013-05-01

    Full Text Available Investigators at the Children's Hospital of Philadelphia, PA, performed a retrospective study of 265 children with brain tumors who received cranial irradiation and developed severe recurrent headache.

  12. Short-term effects of air pollution, markers of endothelial activation, and coagulation to predict major adverse cardiovascular events in patients with acute coronary syndrome: insights from AIRACOS study.

    Science.gov (United States)

    Dominguez-Rodriguez, Alberto; Abreu-Gonzalez, Pedro; Rodríguez, Sergio; Avanzas, Pablo; Juarez-Prera, Ruben A

    2017-07-01

    The aim of this study was to determine whether markers of inflammation and coagulation are associated with short-term particulate matter exposure and predict major adverse cardiovascular events at 360 d in patients with acute coronary syndrome (ACS). We included 307 consecutive patients, and assessed the average concentrations of data on atmospheric pollution in ambient air and meteorological variables from 1 d up to 7 d prior to admission. In patients with ACS, the markers of endothelial activation and coagulation, but not black carbon exposure, are associated with major adverse cardiovascular events at one-year follow-up.

  13. Fetal origin of vascular aging

    Directory of Open Access Journals (Sweden)

    Shailesh Pitale

    2011-01-01

    Full Text Available Aging is increasingly regarded as an independent risk factor for development of cardiovascular diseases such as atherosclerosis and hypertension and their complications (e.g. MI and Stroke. It is well known that vascular disease evolve over decades with progressive accumulation of cellular and extracellular materials and many inflammatory processes. Metabolic syndrome, obesity and diabetes are conventionally recognized as risk factors for development of coronary vascular disease (CVD. These conditions are known to accelerate ageing process in general and vascular ageing in particular. Adverse events during intrauterine life may programme organ growth and favour disease later in life, popularly known as, ′Barker′s Hypothesis′. The notion of fetal programming implies that during critical periods of prenatal growth, changes in the hormonal and nutritional milieu of the conceptus may alter the full expression of the fetal genome, leading to permanent effects on a range of physiological.

  14. Beach-ridge series in northern Peru: chronology, correlation, and relationship with major Late Holocene El Niño events

    Directory of Open Access Journals (Sweden)

    1993-01-01

    íos de la costa norte del Perú (Santa, Chira, Piura podrían reflejar los mayores eventos El Niño de la segunda mitad del Holoceno. Con el objetivo de averiguar esta interpretación, se reexamina aquí las principales características de las dos secuencias de cordones observadas en ambos lados de la desembocadura del río Chira, y en particular el conjunto de datos radiocronológicos obtenidos sobre estos cordones. Se confirma que los cordones de las dos secuencias difieren entre sí tanto por el tipo de sedimento como por su morfología, pero que en los dos casos su formación implicó condiciones meteorológicas y procesos oceanográficos que caracterizan eventos El Niño muy fuertes. Los fechamientos por radiocarbono de conchas marinas y carbón muestreados dentro y sobre los cordones sugieren que las dos series se fueron formando paralelamente en los últimos 4500 años. Los cordones se habrían formado a intervalos de tiempo de 100-600 años. La comparación geomorfológica de las dos series de cordones, su disposición geométrica y el conjunto de datos geocronológicos llevan a establecer una correlación cronológica entre las dos secuencias. Esta correlación tiende a confirmar que la formación de estas construcciones litorales fue ligada a los más violentos trastornos océano climáticos de tipo El Niño que ocurrieron en los últimos milenios. It has previously been hypothesized that the sequences of beach ridges observed at the mouth of the major rivers of the northern coast of Peru (Santa, Chira and Piura Rivers might record the most intense events of the El Niño phenomenon that occurred in the second half of the Holocene. The purpose of this paper is to reexamine this interpretation through a comparative study of the two sequences preserved north and south of the Chira River mouth. The beach ridges of the two sequences are different sedimentologically and geomorphologically but in both cases required, for their formation, particular meteorologic and

  15. A Tool for Empirical Forecasting of Major Flares, Coronal Mass Ejections, and Solar Particle Events from a Proxy of Active-Region Free Magnetic Energy

    Science.gov (United States)

    Barghouty, A. F.; Falconer, D. A.; Adams, J. H., Jr.

    2010-01-01

    This presentation describes a new forecasting tool developed for and is currently being tested by NASA s Space Radiation Analysis Group (SRAG) at JSC, which is responsible for the monitoring and forecasting of radiation exposure levels of astronauts. The new software tool is designed for the empirical forecasting of M and X-class flares, coronal mass ejections, as well as solar energetic particle events. Its algorithm is based on an empirical relationship between the various types of events rates and a proxy of the active region s free magnetic energy, determined from a data set of approx.40,000 active-region magnetograms from approx.1,300 active regions observed by SOHO/MDI that have known histories of flare, coronal mass ejection, and solar energetic particle event production. The new tool automatically extracts each strong-field magnetic areas from an MDI full-disk magnetogram, identifies each as an NOAA active region, and measures a proxy of the active region s free magnetic energy from the extracted magnetogram. For each active region, the empirical relationship is then used to convert the free magnetic energy proxy into an expected event rate. The expected event rate in turn can be readily converted into the probability that the active region will produce such an event in a given forward time window. Descriptions of the datasets, algorithm, and software in addition to sample applications and a validation test are presented. Further development and transition of the new tool in anticipation of SDO/HMI is briefly discussed.

  16. Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes.

    Science.gov (United States)

    Hylek, Elaine M; Held, Claes; Alexander, John H; Lopes, Renato D; De Caterina, Raffaele; Wojdyla, Daniel M; Huber, Kurt; Jansky, Petr; Steg, Philippe Gabriel; Hanna, Michael; Thomas, Laine; Wallentin, Lars; Granger, Christopher B

    2014-05-27

    This study sought to characterize major bleeding on the basis of the components of the major bleeding definition, to explore major bleeding by location, to define 30-day mortality after a major bleeding event, and to identify factors associated with major bleeding. Apixaban was shown to reduce the risk of major hemorrhage among patients with atrial fibrillation in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. All patients who received at least 1 dose of a study drug were included. Major bleeding was defined according to the criteria of the International Society on Thrombosis and Haemostasis. Factors associated with major hemorrhage were identified using a multivariable Cox model. The on-treatment safety population included 18,140 patients. The rate of major hemorrhage among patients in the apixaban group was 2.13% per year compared with 3.09% per year in the warfarin group (hazard ratio [HR] 0.69, 95% confidence interval [CI]: 0.60 to 0.80; p < 0.001). Compared with warfarin, major extracranial hemorrhage associated with apixaban led to reduced hospitalization, medical or surgical intervention, transfusion, or change in antithrombotic therapy. Major hemorrhage followed by mortality within 30 days occurred half as often in apixaban-treated patients than in those receiving warfarin (HR 0.50, 95% CI: 0.33 to 0.74; p < 0.001). Older age, prior hemorrhage, prior stroke or transient ischemic attack, diabetes, lower creatinine clearance, decreased hematocrit, aspirin therapy, and nonsteroidal anti-inflammatory drugs were independently associated with an increased risk. Apixaban, compared with warfarin, was associated with fewer intracranial hemorrhages, less adverse consequences following extracranial hemorrhage, and a 50% reduction in fatal consequences at 30 days in cases of major hemorrhage. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Risk factors and prevention of vascular complications in polycythemia vera.

    Science.gov (United States)

    Barbui, T; Finazzi, G

    1997-01-01

    Risk factors for vascular complications in polycythemia vera (PV) include laboratory and clinical findings. Among laboratory values, the hematocrit has been clearly associated with thrombosis, particularly in the cerebral circulation. Platelet count is a possible but not yet clearly established predictor of vascular complications. Platelet function tests are of little help in prognostic evaluation because most attempts to correlate these abnormalities with clinical events have been disappointing. Clinical predictors of thrombosis include increasing age and a previous history of vascular events. Identifying risk factors for thrombosis is important to initiate therapy. Phlebotomy is associated with an increased incidence of thrombosis in the first 3 to 5 years, whereas chemotherapy may induce a higher risk of secondary malignancies after 7 to 10 years of follow-up. New cytoreductive drugs virtually devoid of mutagenic risk include interferon-alpha and anagrelide, but their role in reducing thrombotic complications remains to be demonstrated. Antithrombotic drugs, such as aspirin, are frequently used in PV, despite doubts regarding safety and efficacy. Two recent studies from the Gruppo Italiano Studio Policitemia Vera (GISP) assessed the rate of major thrombosis as well as the tolerability of low-dose aspirin in PV patients. These investigations created a favorable scenario for launching a European collaborative clinical trial (ECLAP study) aimed at testing the efficacy of low-dose aspirin in preventing thrombosis and prolonging survival in patients with PV.

  18. Genome-wide association analysis accounting for environmental factors through propensity-score matching: application to stressful live events in major depressive disorder.

    Science.gov (United States)

    Power, Robert A; Cohen-Woods, Sarah; Ng, Mandy Y; Butler, Amy W; Craddock, Nick; Korszun, Ania; Jones, Lisa; Jones, Ian; Gill, Michael; Rice, John P; Maier, Wolfgang; Zobel, Astrid; Mors, Ole; Placentino, Anna; Rietschel, Marcella; Aitchison, Katherine J; Tozzi, Federica; Muglia, Pierandrea; Breen, Gerome; Farmer, Anne E; McGuffin, Peter; Lewis, Cathryn M; Uher, Rudolf

    2013-09-01

    Stressful life events are an established trigger for depression and may contribute to the heterogeneity within genome-wide association analyses. With depression cases showing an excess of exposure to stressful events compared to controls, there is difficulty in distinguishing between "true" cases and a "normal" response to a stressful environment. This potential contamination of cases, and that from genetically at risk controls that have not yet experienced environmental triggers for onset, may reduce the power of studies to detect causal variants. In the RADIANT sample of 3,690 European individuals, we used propensity score matching to pair cases and controls on exposure to stressful life events. In 805 case-control pairs matched on stressful life event, we tested the influence of 457,670 common genetic variants on the propensity to depression under comparable level of adversity with a sign test. While this analysis produced no significant findings after genome-wide correction for multiple testing, we outline a novel methodology and perspective for providing environmental context in genetic studies. We recommend contextualizing depression by incorporating environmental exposure into genome-wide analyses as a complementary approach to testing gene-environment interactions. Possible explanations for negative findings include a lack of statistical power due to small sample size and conditional effects, resulting from the low rate of adequate matching. Our findings underscore the importance of collecting information on environmental risk factors in studies of depression and other complex phenotypes, so that sufficient sample sizes are available to investigate their effect in genome-wide association analysis. Copyright © 2013 Wiley Periodicals, Inc.

  19. Beta-blocker use and clinical outcomes after primary vascular surgery

    DEFF Research Database (Denmark)

    Høgh, A.; Lindholt, J.S.; Nielsen, Henrik

    2013-01-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

  20. Management of bleeding in vascular surgery.

    Science.gov (United States)

    Chee, Y E; Liu, S E; Irwin, M G

    2016-09-01

    Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. The interaction of miR-34b/c polymorphisms and negative life events increases susceptibility to major depressive disorder in Han Chinese population.

    Science.gov (United States)

    Xu, Cheng; Yang, Chunxia; Zhang, Aixia; Xu, Yong; Li, Xinrong; Liu, Zhifen; Liu, Sha; Sun, Ning; Zhang, Kerang

    2017-06-09

    Previous studies have shown that microRNAs(miRNAs) are involved in the pathogenesis of MDD; in particular, miR-34b/c has been implicated in MDD risk and found to exert antidepressant effects. However, the effects of miR-34b/c polymorphisms on MDD risk have not been investigated. In this study, we evaluated the effect of miR-34b/c gene polymorphisms and their interaction with negative life events in relation to MDD, using data from 381 Han Chinese patients with MDD and 291 healthy volunteers. Allelic, genotypic, haplotypic, and gene-environment associations were analyzed using UNPHASED and SPSS software. After discarding data with extremely severe negative life events in our study population, we found an association between rs4938723, rs2187473 polymorphisms and MDD in the dominant models (TC/CC vs. TT, OR=1.45, P=0.027; TC/CC vs. TT, OR=3.32, P=0.030). In haplotype analysis, the C-G haplotype (rs4938723/rs28757623) showed the strongest association with MDD (OR=1.95, P=0.026). Additionally, we found significant gene-environment combination rs4938723 C allele, rs28757623 G allele and high level of negative life events (C-G-HN) was significantly associated with MDD (OR, 3.85; 95% CI, 1.62-9.13). In addition, the combination of (C-C-HN) is of significance (OR, 2.99; 95% CI, 1.36-6.60), indicating that the rs28757623 C allele may contribute to the risk of MDD as well. The sample size was small and the role of miR-34b/c polymorphisms for MDD should be assessed using independent samples from other ethnic populations. Our results suggest that miR-34b/c is a susceptibility factor for MDD stratified by negative life events and that rs4938723 is a significant association locus for gene-environment interaction in relation to MDD risk. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Major Sport Venues

    Data.gov (United States)

    Department of Homeland Security — The Major Public Venues dataset is composed of facilities that host events for the National Association for Stock Car Auto Racing, Indy Racing League, Major League...

  3. SENTINEL EVENTS

    Directory of Open Access Journals (Sweden)

    Andrej Robida

    2004-09-01

    Full Text Available Background. The Objective of the article is a two year statistics on sentinel events in hospitals. Results of a survey on sentinel events and the attitude of hospital leaders and staff are also included. Some recommendations regarding patient safety and the handling of sentinel events are given.Methods. In March 2002 the Ministry of Health introduce a voluntary reporting system on sentinel events in Slovenian hospitals. Sentinel events were analyzed according to the place the event, its content, and root causes. To show results of the first year, a conference for hospital directors and medical directors was organized. A survey was conducted among the participants with the purpose of gathering information about their view on sentinel events. One hundred questionnaires were distributed.Results. Sentinel events. There were 14 reports of sentinel events in the first year and 7 in the second. In 4 cases reports were received only after written reminders were sent to the responsible persons, in one case no reports were obtained. There were 14 deaths, 5 of these were in-hospital suicides, 6 were due to an adverse event, 3 were unexplained. Events not leading to death were a suicide attempt, a wrong side surgery, a paraplegia after spinal anaesthesia, a fall with a femoral neck fracture, a damage of the spleen in the event of pleural space drainage, inadvertent embolization with absolute alcohol into a femoral artery and a physical attack on a physician by a patient. Analysis of root causes of sentinel events showed that in most cases processes were inadequate.Survey. One quarter of those surveyed did not know about the sentinel events reporting system. 16% were having actual problems when reporting events and 47% beleived that there was an attempt to blame individuals. Obstacles in reporting events openly were fear of consequences, moral shame, fear of public disclosure of names of participants in the event and exposure in mass media. The majority of

  4. A comparison of the physical properties of desert dust retrieved from the sunphotometer observation of major events in the Sahara, Sahel, and Arabian Peninsula

    KAUST Repository

    Masmoudi, Mohamed

    2015-05-01

    © 2015 Elsevier B.V. The objective of this work is to assess the variability of the size-distribution, real (n) and imaginary (k) parts of the refractive index, asymmetry parameter (g), and single scattering albedo (SSA) of desert dust events observed in the Sahara, Sahel, and Arabian Peninsula areas. For this we use the level-2 inversions of 14 AERONET sunphotometers representative of the area of study. In the dataset, the dust-dominated events are discriminated on the basis of their large optical depth and low (<. 0.3) Ångström exponent (α) calculated between 440. nm and 870. nm. In all the volume size-distributions a coarse mode (CM) of particles is observed but a fine mode (FM) of particles with radii. <. 0.2. μm is also present. The volume fraction represented by the FM is lower (3%) during the most intense dust storms than during moderate ones (12%). The inter-site variability of the characteristics of the CM-dominated situations is found to be non-significant and at 440, 675, 870, and 1020. nm a common set of values can be adopted for n (1.54 ± 0.03, 1.53 ± 0.02, 1.50 ± 0.02, 1.48 ± 0.02), k (0.0037 ± 0.0007, 0.0012 ± 0.0002, 0.0011 ± 0.0002, 0.0012 ± 0.0002), g (0.77 ± 0.01, 0.74 ± 0.01, 0.73 ± 0.01, 0.74 ± 0.01), and the SSA (0.90 ± 0.02, 0.97 ± 0.01, 0.98 ± 0.01, 0.98 ± 0.01). However; during the less intense dust-events the growing influence of the FM leads to regional differentiation of the dust properties and 2 main areas can be distinguished: 1) the relatively clean central Sahara/Sahel, and 2) the more polluted continuum constituted by the Mediterranean coast and the Arabian Peninsula.

  5. A comparison of the physical properties of desert dust retrieved from the sunphotometer observation of major events in the Sahara, Sahel, and Arabian Peninsula

    KAUST Repository

    Masmoudi, Mohamed; Alfaro, Sté phane C.; El Metwally, Mossad

    2015-01-01

    © 2015 Elsevier B.V. The objective of this work is to assess the variability of the size-distribution, real (n) and imaginary (k) parts of the refractive index, asymmetry parameter (g), and single scattering albedo (SSA) of desert dust events observed in the Sahara, Sahel, and Arabian Peninsula areas. For this we use the level-2 inversions of 14 AERONET sunphotometers representative of the area of study. In the dataset, the dust-dominated events are discriminated on the basis of their large optical depth and low (<. 0.3) Ångström exponent (α) calculated between 440. nm and 870. nm. In all the volume size-distributions a coarse mode (CM) of particles is observed but a fine mode (FM) of particles with radii. <. 0.2. μm is also present. The volume fraction represented by the FM is lower (3%) during the most intense dust storms than during moderate ones (12%). The inter-site variability of the characteristics of the CM-dominated situations is found to be non-significant and at 440, 675, 870, and 1020. nm a common set of values can be adopted for n (1.54 ± 0.03, 1.53 ± 0.02, 1.50 ± 0.02, 1.48 ± 0.02), k (0.0037 ± 0.0007, 0.0012 ± 0.0002, 0.0011 ± 0.0002, 0.0012 ± 0.0002), g (0.77 ± 0.01, 0.74 ± 0.01, 0.73 ± 0.01, 0.74 ± 0.01), and the SSA (0.90 ± 0.02, 0.97 ± 0.01, 0.98 ± 0.01, 0.98 ± 0.01). However; during the less intense dust-events the growing influence of the FM leads to regional differentiation of the dust properties and 2 main areas can be distinguished: 1) the relatively clean central Sahara/Sahel, and 2) the more polluted continuum constituted by the Mediterranean coast and the Arabian Peninsula.

  6. Radioecological impact of Saharan dusts fallout. Case study of a major event on the 21. of february 2004 in south part of France

    International Nuclear Information System (INIS)

    Masson, O.; Pourcelot, L.; Gurriaran, R.; Paulat, P.

    2005-01-01

    Lithometeors, Sirocco or more commonly 'red mud' are all in fact related to a single phenomenon which affects France every year: the wind transport and deposit of desert particles from the Sahara. On the 21. of February 2004, the southern part of France is swept by a weather event of wind transport of Saharan particles. The recordings of atmospheric dust contamination and the deposit of dust, which results from it, make an episode of exceptional width. In a few hours, the thickness of the deposit exceeds 1 mm (up to 4 mm in Corsica) with a maximum density of surface charge of 50 g.m -2 (50 tons per km 2 ). The loads of the PM 10 type particles in the air, recorded by associations of monitoring of the quality of the air, indicate concentrations multiplied to the maximum by 10 and an influence on the ground of the plume ranging between 300 000 and 350 000 km 2 . To the end, 2 million tons are deposited on a portion of the territory located at the south of a line from Nantes to Besancon. This event also had a significant radio-ecological impact, leading to significant 137 Cs, (239+240) Pu, 241 Am, activity levels of 38 Bq. kg -1 sec, 1 Bq. kg -1 sec and 0,46 Bq. kg -1 sec, respectively. Quality of air monitoring organisations recorded 10-fold increases in the concentration of charged PM 10 2 type particles within the cloud; ground coverage stretched over a 300 000 km 2 surface area. Across this whole area, the artificial radioactivity deposits are estimated to 37.10 10 Bq. In term of flow of deposit, this episode represents, with him only, i.e. in a few hours, a 137 Cs deposition equivalent to that recorded on average in a cumulated time of one year. Data from this study show that these weather-climatic episodes generate today, environmental samples which on average, present the highest levels and flux of artificial radioactivities, more than those in the sediments of the Rhone river deposited by flood events, for example. Changes in artificial radionuclide activity

  7. Prognostic value, clinical effectiveness and cost-effectiveness of high sensitivity C-reactive protein as a marker in primary prevention of major cardiac events.

    Science.gov (United States)

    Schnell-Inderst, Petra; Schwarzer, Ruth; Göhler, Alexander; Grandi, Norma; Grabein, Kristin; Stollenwerk, Björn; Klauß, Volker; Wasem, Jürgen; Siebert, Uwe

    2009-05-12

    In a substantial portion of patients (= 25%) with coronary heart disease (CHD), a myocardial infarction or sudden cardiac death without prior symptoms is the first manifestation of disease. The use of new risk predictors for CHD such as the high-sensitivity C-reactive Protein (hs-CRP) in addition to established risk factors could improve prediction of CHD. As a consequence of the altered risk assessment, modified preventive actions could reduce the number of cardiac death and non-fatal myocardial infarction. Does the additional information gained through the measurement of hs-CRP in asymptomatic patients lead to a clinically relevant improvement in risk prediction as compared to risk prediction based on traditional risk factors and is this cost-effective? A literature search of the electronic databases of the German Institute of Medical Documentation and Information (DIMDI) was conducted. Selection, data extraction, assessment of the study-quality and synthesis of information was conducted according to the methods of evidence-based medicine. Eight publications about predictive value, one publication on the clinical efficacy and three health-economic evaluations were included. In the seven study populations of the prediction studies, elevated CRP-levels were almost always associated with a higher risk of cardiovascular events and non-fatal myocardial infarctions or cardiac death and severe cardiovascular events. The effect estimates (odds ratio (OR), relative risk (RR), hazard ratio (HR)), once adjusted for traditional risk factors, demonstrated a moderate, independent association between hs-CRP and cardiac and cardiovascular events that fell in the range of 0.7 to 2.47. In six of the seven studies, a moderate increase in the area under the curve (AUC) could be detected by adding hs-CRP as a predictor to regression models in addition to established risk factors though in three cases this was not statistically significant. The difference [in the AUC] between the

  8. Prognostic value, clinical effectiveness and cost-effectiveness of high sensitivity C-reactive protein as a marker in primary prevention of major cardiac events

    Directory of Open Access Journals (Sweden)

    Klauß, Volker

    2009-05-01

    Full Text Available Background: In a substantial portion of patients (= 25% with coronary heart disease (CHD, a myocardial infarction or sudden cardiac death without prior symptoms is the first manifestation of disease. The use of new risk predictors for CHD such as the high-sensitivity C-reactive Protein (hs-CRP in addition to established risk factors could improve prediction of CHD. As a consequence of the altered risk assessment, modified preventive actions could reduce the number of cardiac death and non-fatal myocardial infarction. Research question: Does the additional information gained through the measurement of hs-CRP in asymptomatic patients lead to a clinically relevant improvement in risk prediction as compared to risk prediction based on traditional risk factors and is this cost-effective? Methods: A literature search of the electronic databases of the German Institute of Medical Documentation and Information (DIMDI was conducted. Selection, data extraction, assessment of the study-quality and synthesis of information was conducted according to the methods of evidence-based medicine. Results: Eight publications about predictive value, one publication on the clinical efficacy and three health-economic evaluations were included. In the seven study populations of the prediction studies, elevated CRP-levels were almost always associated with a higher risk of cardiovascular events and non-fatal myocardial infarctions or cardiac death and severe cardiovascular events. The effect estimates (odds ratio (OR, relative risk (RR, hazard ratio (HR, once adjusted for traditional risk factors, demonstrated a moderate, independent association between hs-CRP and cardiac and cardiovascular events that fell in the range of 0.7 to 2.47. In six of the seven studies, a moderate increase in the area under the curve (AUC could be detected by adding hs-CRP as a predictor to regression models in addition to established risk factors though in three cases this was not

  9. [Vascular Calcification - Pathological Mechanism and Clinical Application - . Role of vascular smooth muscle cells in vascular calcification].

    Science.gov (United States)

    Kurabayashi, Masahiko

    2015-05-01

    Vascular calcification is commonly seen with aging, chronic kidney disese (CKD), diabetes, and atherosclerosis, and is closely associated with cardiovascular morbidity and mortality. Vascular calcification has long been regarded as the final stage of degeneration and necrosis of arterial wall and a passive, unregulated process. However, it is now known to be an active and tightly regulated process involved with phenotypic transition of vascular smooth muscle cells (VSMC) that resembles bone mineralization. Briefly, calcium deposits of atherosclerotic plaque consist of hydroxyapatite and may appear identical to fully formed lamellar bone. By using a genetic fate mapping strategy, VSMC of the vascular media give rise to the majority of the osteochondrogenic precursor- and chondrocyte-like cells observed in the calcified arterial media of MGP (- / -) mice. Osteogenic differentiation of VSMC is characterized by the expression of bone-related molecules including bone morphogenetic protein (BMP) -2, Msx2 and osteopontin, which are produced by osteoblasts and chondrocytes. Our recent findings are that (i) Runx2 and Notch1 induce osteogenic differentiation, and (ii) advanced glycation end-product (AGE) /receptor for AGE (RAGE) and palmitic acid promote osteogenic differentiation of VSMC. To understand of the molecular mechanisms of vascular calcification is now under intensive research area.

  10. The vascular surgery workforce: a survey of consultant vascular surgeons in the UK, 2014.

    Science.gov (United States)

    Harkin, D W; Beard, J D; Shearman, C P; Wyatt, M G

    2015-04-01

    The purpose of this study was to describe the demographics, training, and practice characteristics of consultant vascular surgeons across the UK to provide an assessment of current, and inform future prediction of workforce needs. A questionnaire was developed using a modified Delphi process to generate questionnaire items. The questionnaire was emailed to all consultant vascular surgeons (n = 450) in the UK who were members of the Vascular Society of Great Britain & Ireland. 352 consultant vascular surgeons from 95 hospital trusts across the UK completed the survey (78% response rate). The mean age was 50.6 years old, the majority (62%) were mid-career, but 24% were above the age of 55. Currently, 92% are men and only 8% women. 93% work full-time, with 60% working >50 hours, and 21% working >60 hours per week. The average team was 5 to 6 (range 2-10) vascular surgeons, with 23% working in a large team of ≥8. 17% still work in small teams of ≤3. Over 90% of consultant vascular surgeons perform the major index vascular surgery procedures (aneurysm repair, carotid endarterectomy, infra-inguinal bypass, amputation). While 84% perform standard endovascular abdominal aortic aneurysm repair (EVAR), <50% perform more complex endovascular aortic therapy. The majority of vascular surgeons "like their job" (85%) and are "satisfied" (69%) with their job. 34% of consultant vascular surgeons indicated they were "extremely likely" to retire within the next 10 years. This study provides the first detailed analysis of the new specialty of vascular surgery as practiced in the UK. There is a need to plan for a significant expansion in the consultant vascular surgeon workforce in the UK over the next 10 years to maintain the status quo. Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial.

    Science.gov (United States)

    Zarzaur, Ben L; Dunn, Julie A; Leininger, Brian; Lauerman, Margaret; Shanmuganathan, Kathirkamanthan; Kaups, Krista; Zamary, Kirellos; Hartwell, Jennifer L; Bhakta, Ankur; Myers, John; Gordy, Stephanie; Todd, Samuel R; Claridge, Jeffrey A; Teicher, Erik; Sperry, Jason; Privette, Alicia; Allawi, Ahmed; Burlew, Clay Cothren; Maung, Adrian A; Davis, Kimberly A; Cogbill, Thomas; Bonne, Stephanie; Livingston, David H; Coimbra, Raul; Kozar, Rosemary A

    2017-12-01

    Following blunt splenic injury, there is conflicting evidence regarding the natural history and appropriate management of patients with vascular injuries of the spleen such as pseudoaneurysms or blushes. The purpose of this study was to describe the current management and outcomes of patients with pseudoaneurysm or blush. Data were collected on adult (aged ≥18 years) patients with blunt splenic injury and a splenic vascular injury from 17 trauma centers. Demographic, physiologic, radiographic, and injury characteristics were gathered. Management and outcomes were collected. Univariate and multivariable analyses were used to determine factors associated with splenectomy. Two hundred patients with a vascular abnormality on computed tomography scan were enrolled. Of those, 14.5% were managed with early splenectomy. Of the remaining patients, 59% underwent angiography and embolization (ANGIO), and 26.5% were observed. Of those who underwent ANGIO, 5.9% had a repeat ANGIO, and 6.8% had splenectomy. Of those observed, 9.4% had a delayed ANGIO, and 7.6% underwent splenectomy. There were no statistically significant differences between those observed and those who underwent ANGIO. There were 111 computed tomography scans with splenic vascular injuries available for review by an expert trauma radiologist. The concordance between the original classification of the type of vascular abnormality and the expert radiologist's interpretation was 56.3%. Based on expert review, the presence of an actively bleeding vascular injury was associated with a 40.9% risk of splenectomy. This was significantly higher than those with a nonbleeding vascular injury. In this series, the vast majority of patients are managed with ANGIO and usually embolization, whereas splenectomy remains a rare event. However, patients with a bleeding vascular injury of the spleen are at high risk of nonoperative failure, no matter the strategy used for management. This group may warrant closer observation or

  12. Using ACE Observations of Interplanetary Particles and Magnetic Fields as Possible Contributors to Variations Observed at Van Allen Probes during Major events in 2013

    Science.gov (United States)

    Armstrong, T. P.; Manweiler, J. W.; Gerrard, A. J.; Gkioulidou, M.; Lanzerotti, L. J.; Patterson, J. D.

    2013-12-01

    Observations from ACE EPAM including energy spectra of protons, helium, and oxygen will be prepared for coordinated use in estimating the direct and indirect access of energetic particles to inner and outer geomagnetic trapping zones. Complete temporal coverage from ACE at 12 seconds, 5 minutes, 17 minutes, hourly and daily cadences will be used to catalog interplanetary events arriving at Earth including interplanetary magnetic field sector boundaries, interplanetary shocks, and interplanetary coronal mass ejections, ICMEs. The first 6 months of 2013 have included both highly disturbed times, March 17 and May 22, and extended quiet periods of little or no variations. Among the specific questions that ACE and Van Allen Probes coordinated observations may aid in resolving are: 1. How much, if any, direct capture of interplanetary energetic particles occurs and what conditions account for it? 2. How much influence do interplanetary field and particle variations have on energization and/or loss of geomagnetically trapped populations? The poster will also present important links and describe methods and important details of access to numerically expressed ACE EPAM and Van Allen Probes RBSPICE observations that can be flexibly and easily accessed via the internet for student and senior researcher use.

  13. Development of intervention levels for the protection of the public in the event of a major nuclear accident. Past, present and future

    International Nuclear Information System (INIS)

    Emmerson, B.W.

    1989-01-01

    Since the mid-1950's nuclear energy has played an increasing role in meeting the world demand for electricity production. Although during this period incidents and accidents have occurred, in most cases their effect was confined to the plant. Three accidents, however, were sufficienty serious as to involve off-site consequences for the public. The experience from each contributed significantly in the development of current emergency response criteria and planning arrangements at the national and international level. This paper summarizes these contributions as they relate to the development of intervention levels for the protection of the public in the event of an accidental release of radioactive materials to the environment. It indicates the various measures taken by those countries that were affected by the release from the Chernobyl accident and reviews the subsequent actions by relevant international organizations to provide more comprehensive guidance on applying the principles of intervention and developing derived levels, particularly those aimed at controlling the consumption of contamined foodstuffs, or their movement in international trade. Finally, it considers the prospects for developing a more harmonized intervention approach based on the guidance now being completed at the international level [fr

  14. The IMIA History Working Group: Inception through the IMIA History Taskforce, and Major Events Leading Up to the 50th Anniversary of IMIA.

    Science.gov (United States)

    Kulikowski, C A; Mihalas, G; Greenes, R A; Yacubsohn, V; Park, H-A

    2017-08-01

    Background: The 50th Anniversary of IMIA will be celebrated in 2017 at the World Congress of Medical Informatics in China. This takes place 50 years after the International Federation of Information Processing (IFIP) Societies approved the formation of a new Technical Committee (TC) 4 on Medical Information Processing, which was the predecessor of IMIA, under the leadership of Dr. Francois Grémy. The IMIA History Working Group (WG) was approved in 2014 to document and write about the history of the field and its organizations. Objectives: The goals of this paper are to describe how the IMIA History WG arose and developed, including its meetings and projects, leading to the forthcoming 50th Anniversary of IMIA. Methods: We give a chronology of major developments leading up to the current work of the IMIA History WG and how it has stimulated writing on the international history of biomedical and health informatics, sponsoring the systematic compilation and writing of articles and stories from pioneers and leaders in the field, and the organization of workshops and panels over the past six years, leading towards the publication of the contributed volume on the 50th IMIA Anniversary History as an eBook by IOS Press. Conclusions: This article leads up to the IMIA History eBook which will contain original autobiographical retrospectives by pioneers and leaders in the field, together with professional organizational histories of the national and regional societies and working groups of IMIA, with commentary on the main themes and topics which have evolved as scientific and clinical practices have changed under the influence of new insights, technologies, and the changing socio-economic, cultural and professional circumstances around the globe over the past 50 years. Georg Thieme Verlag KG Stuttgart.

  15. Changes in Eocene-Miocene shallow marine carbonate factories along the tropical SE Circum-Caribbean responded to major regional and global environmental and tectonic events

    Science.gov (United States)

    Silva-Tamayo, Juan Carlos

    2015-04-01

    Changes in the factory of Cenozoic tropical marine carbonates have been for long attributed to major variations on climatic and environmental conditions. Although important changes on the factories of Cenozoic Caribbean carbonates seem to have followed global climatic and environmental changes, the regional impact of such changes on the factories of shallow marine carbonate along the Caribbean is not well established. Moreover, the influence of transpressional tectonics on the occurrence, distribution and stratigraphy of shallow marine carbonate factories along this area is far from being well understood. Here we report detailed stratigraphic, petrographic and Sr-isotope chemostratigraphic information of several Eocene-Miocene carbonate successions deposited along the equatorial/tropical SE Circum-Caribbean (Colombia and Panama) from which we further assess the influence of changing environmental conditions, transtentional tectonics and sea level change on the development of the shallow marine carbonate factories. Our results suggest that during the Eocene-early Oligocene interval, a period of predominant high atmospheric pCO2, coralline algae constitute the principal carbonate builders of shallow marine carbonate successions along the SE Circum-Caribbean. Detailed stratigraphic and paragenetic analyses suggest the developed of laterally continuous red algae calcareous build-ups along outer-rimmed carbonate platforms. The predominance of coralline red algae over corals on the shallow marine carbonate factories was likely related to high sea surface temperatures and high turbidity. The occurrence of such build-ups was likely controlled by pronounce changes in the basin paleotopography, i.e. the occurrence of basement highs and lows, resulting from local transpressional tectonics. The occurrence of these calcareous red algae dominated factories was also controlled by diachronic opening of different sedimentary basins along the SE Circum Caribbean resulting from

  16. Conodont succession and reassessment of major events around the Permian-Triassic boundary at the Selong Xishan section, southern Tibet, China

    Science.gov (United States)

    Yuan, Dong-Xun; Zhang, Yi-Chun; Shen, Shu-Zhong

    2018-02-01

    A major discrepancy for the age of the Selong Group from middle Cisuralian (Early Permian) to Changhsingian resulted from previous reports of Sakmarian, Kungurian and Guadalupian (Middle Permian) conodonts and Lopingian (Late Permian) brachiopods. Recently, Cisuralian and Guadalupian conodonts were reported again from the Selong Group and the basal part of the Kangshare Formation at the Selong section, but the age discrepancy remains. We present our conodont materials based on large samples collected from the Selong Group and our interpretation based on identifications using a sample population approach. Three conodont zones are recognized in our re-investigation of the upper part of the Selong Group. They include the Vjalovognathus sp., the Mesogondolella hendersoni, and the M. sheni zones, in ascending order. These zones are overlain by the basal Triassic Hindeodus parvus Zone and the Otoceras woodwardi Zone. Our reassessment of conodonts reported by previous studies from Selong and nearby sections suggest that all specimens consistently point to a Lopingian age; the upper part of the Selong Group is latest Changhsingian in age based on the presence of Clarkina orchardi and Mesogondolella sheni. Previously reported early Cisuralian and Guadalupian conodonts are misidentified using a form species concept. A hiatus may be present at the erosional surface between the Selong Group and the Waagenites Bed of the basal part of the Kangshare Formation. However, the hiatus is minimal because conodont and brachiopod assemblages above and below this surface are very similar, and it results from a latest Changhsingian transgression just before the extinction that follows a global latest Changhsingian regression. There is a distinct rapid end-Permian mass extinction at Selong within the Waagenites Bed, as indicated by the disappearances of all benthic brachiopods, rugose corals and Permian bryozoans. The burst of Clarkina species in the Waagenites Bed and throughout the

  17. Obstetric and vascular APS: same autoantibodies but different diseases?

    Science.gov (United States)

    Meroni, P L; Raschi, E; Grossi, C; Pregnolato, F; Trespidi, L; Acaia, B; Borghi, M O

    2012-06-01

    Beta2 glycoprotein I (β2GPI)-dependent antiphospholipid antibodies (aPLs) are the main pathogenic autoantibody population and at the same time the laboratory diagnostic tool for the antiphospholipid syndrome (APS). These antibodies are responsible for both the vascular and the obstetric manifestations of the syndrome but the pathogenic mechanisms behind these manifestations are not the same. For example, thrombotic events do not appear to play a major role in APS miscarriages and a direct reactivity of β2GPI-dependent aPLs on decidual and trophoblast cells was reported. A local expression of β2GPI on these tissues was reported both in physiological conditions and in APS women, thus explaining the local tropism of the autoantibodies. The two hit hypothesis was suggested to explain why the vascular manifestations of APS may occur only occasionally in spite of the persistent presence of aPLs. This is not apparently the case for the obstetric variant of the syndrome, making the difference even more striking. A different pathogenesis may also provide the rationale for the well-known fact that the vascular and the obstetric manifestations may occur independently although in a minority of cases.

  18. Linking vascular disorders and Alzheimer’s disease: Potential involvement of BACE1

    Science.gov (United States)

    Cole, Sarah L.; Vassar, Robert

    2012-01-01

    The etiology of Alzheimer’s disease (AD) remains unknown. However, specific risk factors have been identified, and aging is the strongest AD risk factor. The majority of cardiovascular events occur in older people and a close relationship between vascular disorders and AD exists. Amyloid plaques, composed of the beta amyloid peptide (Aβ), are hallmark lesions in AD and evidence indicates that Aβ plays a central role in AD pathophysiology. The BACE1 enzyme is essential for Aβ generation, and BACE1 levels are elevated in AD brain. The cause(s) of this BACE1 elevation remains undetermined. Here we review the potential contribution of vascular disease to AD pathogenesis. We examine the putative vasoactive properties of Aβ and how the cellular changes associated with vascular disease may elevate BACE1 levels. Despite increasing evidence, the exact role(s) vascular disorders play in AD remains to be determined. However, given that vascular diseases can be addressed by lifestyle and pharmacologic interventions, the potential benefits of these therapies in delaying the clinical appearance and progression of AD may warrant investigation. PMID:18289733

  19. Individualized Vascular Disease Prevention in High-Risk Patients

    NARCIS (Netherlands)

    Kaasenbrood, L

    2016-01-01

    In the pharmacologic prevention of vascular events, clinicians need to translate average effects from a clinical trial to the individual patient. Prediction models can contribute to individualized vascular disease prevention by selecting patients for treatment based on estimated risk or expected

  20. Vascular Function and Structure in Veteran Athletes after Myocardial Infarction.

    NARCIS (Netherlands)

    Maessen, M.F.H.; Eijsvogels, T.M.H.; Hijmans-Kersten, B.T.P.; Grotens, A.; Schreuder, T.H.A.; Hopman, M.T.E.; Thijssen, D.H.J.

    2017-01-01

    PURPOSE: Although athletes demonstrate lower cardiovascular risk and superior vascular function compared with sedentary peers, they are not exempted from cardiac events (i.e., myocardial infarction [MI]). The presence of an MI is associated with increased cardiovascular risk and impaired vascular

  1. Major events in Neogene oxygen isotopic records

    International Nuclear Information System (INIS)

    Kennett, J.P.; Hodell, D.A.

    1986-01-01

    Changes in oxygen isotopic ratios of foraminiferal calcite during the cainozoic have been one of the primary tools for investigating the history of Arctic and Antarctic glaciation, although interpretations of the oxygen isotopic record differ markedly. The ambiguity in interpretation results mainly from the partitioning of temperature from ice volume effects in delta 18 O changes. Oxygen isotopic records for the Cainozoic show an increase in delta 18 O values towards the present, reflecting gradual cooling and increased glaciation of the Earth's climate since the late Cretaceous. A variety of core material from the South Atlantic and South-west Pacific oceans are investigated. This composite data represents one of the most complete available with which to evaluate the evolution of glaciation during the Neogene. Expansion of ice shelves in Antarctica undoubtedly accompanied the increased glaciation of the northern hemisphere, since eustatic sea-level lowering would positively reinforce ice growth on Antarctica

  2. OR Challenges in Major Sport Events

    NARCIS (Netherlands)

    Barros, A.I.

    2012-01-01

    Although the origins of Operations Research are usually linked to the military, nowadays successful applications in different areas of the society (business, industrial, health sector and sports) can be found. In particular, applications in sports like sport tactics and strategy, scheduling and

  3. Outcome of endovascular treatment in symptomatic intracranial vascular stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Dae Chul; Kim, Sang Joon; Lee, Duk Hee; Kim, Won; Choi, Choong Gon; Lee, Jeong Hyun; Kwon, Sun Uck; Kim, Jong Sung [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Jeong [Daejeon Catholic Hospital, Daejeon (Korea, Republic of)

    2005-03-15

    The outcome evaluation for the revascularization of intracranial vascular stenoses has not been fully described due to the highly technical nature of the procedure. We report here on the early and late clinical outcome of angioplasty and/or stenting of symptomatic severe intracranial vascular stenoses at a single institute. Since 1995, we have treated 35 patients with symptomatic intracranial vascular stenosis (more than 70% stenosis, mean stenosis: 78.6% {+-} 6.2%). Angioplasty (n = 19) was performed for the horizontal segment of the middle cerebral artery (M1) (n = 16) and the basilar artery (BA) (n = 1), the intradural vertebral artery (VA) (n = 1), and the cavernous internal carotid artery (ICA) (n = 1). Stenting (n = 16) was performed for the cavernous or petrous ICAs (n = 9), the intradural VA (n = 3), BA (n = 2), and M1 (n = 2) artery. We assessed the angiographic success (defined as residual stenosis < 50%) rate, the periprocedural complications during the 30-day periprocedural period, the symptomatic recurrence and restenosis during a mean 22-month follow-up (FU) period. The Kaplan-Meier estimate of the cumulative even-free rate of the major cerebrovascular events, i.e. death, stroke or restenosis, was also done. Angiographic success was achieved in 97% of our patients (34/35). There were four procedure-related complications (11%) including a death and a minor stroke. During the mean 22-month FU, the asymptomatic restenosis rate was 9% and the symptomatic restenosis rate was 6% in the target lesion and 9% in all the vascular territories. The Kaplan-Meier estimate was 70.6% (95% confidence interval = 46.5-94.7) after 33 month of FU. In addition to a high angiographic success rate and an acceptable periprocedural complication rate, intracranial angioplasty and/or stenting revealed a relatively low symptomatic recurrence rate. Hemorrhage is a rare, but the physician must aware that potentially fatal periprocedural complications can occur.

  4. Open and endovascular aneurysm repair in the Society for Vascular Surgery Vascular Quality Initiative.

    Science.gov (United States)

    Spangler, Emily L; Beck, Adam W

    2017-12-01

    The Society for Vascular Surgery Vascular Quality Initiative is a patient safety organization and a collection of procedure-based registries that can be utilized for quality improvement initiatives and clinical outcomes research. The Vascular Quality Initiative consists of voluntary participation by centers to collect data prospectively on all consecutive cases within specific registries which physicians and centers elect to participate. The data capture extends from preoperative demographics and risk factors (including indications for operation), through the perioperative period, to outcomes data at up to 1-year of follow-up. Additionally, longer-term follow-up can be achieved by matching with Medicare claims data, providing long-term longitudinal follow-up for a majority of patients within the Vascular Quality Initiative registries. We present the unique characteristics of the Vascular Quality Initiative registries and highlight important insights gained specific to open and endovascular abdominal aortic aneurysm repair. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Perindopril for improving cardiovascular events

    Directory of Open Access Journals (Sweden)

    DiNicolantonio JJ

    2014-08-01

    Full Text Available James J DiNicolantonio, James H O'Keefe Department of Preventive Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USAIn a recent review in Vascular Health and Risk Management Wang et al state that “In mainly placebo-controlled cardiovascular (CV-outcome studies in patients with hypertension, CV benefits with perindopril were associated with large reductions in BP.”1 However, perindopril in the European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA study significantly reduced major cardiovascular events despite a small reduction (approximately 4 mmHg in systolic blood pressure from baseline.2,3 Additionally, the average baseline blood pressure in the EUROPA was just 137/82 mmHg, and in those without hypertension, perindopril still provided a 20% reduction in the combined endpoint of cardiovascular death, myocardial infarction, and cardiac arrest.4,5 In fact, patients receiving perindopril with a baseline systolic blood pressure of <120 mmHg had the greatest reduction in the primary event.6 View original paper by Wang and colleagues. 

  6. Vascular grading of angiogenesis

    DEFF Research Database (Denmark)

    Hansen, S; Grabau, D A; Sørensen, Flemming Brandt

    2000-01-01

    The study aimed to evaluate the prognostic value of angiogenesis by vascular grading of primary breast tumours, and to evaluate the prognostic impact of adding the vascular grade to the Nottingham Prognostic Index (NPI). The investigation included 836 patients. The median follow-up time was 11...... years and 4 months. The microvessels were immunohistochemically stained by antibodies against CD34. Angiogenesis was graded semiquantitatively by subjective scoring into three groups according to the expected number of microvessels in the most vascular tumour area. The vascular grading between observers...... for 24% of the patients, who had a shift in prognostic group, as compared to NPI, and implied a better prognostic dissemination. We concluded that the angiogenesis determined by vascular grading has independent prognostic value of clinical relevance for patients with breast cancer....

  7. Vascular grading of angiogenesis

    DEFF Research Database (Denmark)

    Hansen, S; Grabau, D A; Sørensen, Flemming Brandt

    2000-01-01

    The study aimed to evaluate the prognostic value of angiogenesis by vascular grading of primary breast tumours, and to evaluate the prognostic impact of adding the vascular grade to the Nottingham Prognostic Index (NPI). The investigation included 836 patients. The median follow-up time was 11...... years and 4 months. The microvessels were immunohistochemically stained by antibodies against CD34. Angiogenesis was graded semiquantitatively by subjective scoring into three groups according to the expected number of microvessels in the most vascular tumour area. The vascular grading between observers...... impact for 24% of the patients, who had a shift in prognostic group, as compared to NPI, and implied a better prognostic dissemination. We concluded that the angiogenesis determined by vascular grading has independent prognostic value of clinical relevance for patients with breast cancer....

  8. Increased risk for vascular complications due to GP IIb/IIIa-antagonists in patients with cardiogenic shock supported by intraaortic balloon pump (IABP

    Directory of Open Access Journals (Sweden)

    Jens Röther

    2015-08-01

    Conclusion: Vascular events with the use of IABP are common but in our study, not significantly associated with a higher mortality. Treatment with GP IIb/IIIa-antagonists is associated with a higher risk of vascular events.

  9. Risk Factor Analysis for Mastectomy Skin Flap Necrosis: Implications for Intraoperative Vascular Analysis.

    Science.gov (United States)

    Reintgen, Christian; Leavitt, Adam; Pace, Elizabeth; Molas-Pierson, Justine; Mast, Bruce A

    2016-06-01

    Skin flap necrosis after mastectomy can be a devastating complication significantly affecting patient outcomes. Routine vascular analysis (fluorescein or laser angiography) of mastectomy skin flaps in all patients has been advocated but is of questionable cost-effectiveness. The purpose of this study was to identify the incidence and causative risk factors for mastectomy skin flap necrosis and thereby calculate the fiscal reality of intraoperative vascular screening. This is an institutional review board-approved retrospective study of all patients from 2007 to 2013 who underwent mastectomy related to breast cancer. Skin flap necrosis was defined as major if it necessitated return to the operating room. Data analysis was done for determination of causative factors of necrosis, including age, body mass index, smoking, previous irradiation, coronary artery disease, chronic obstructive pulmonary disorder, hypertension, gastroesophageal reflux disease, hyperlipidemia, obstructive sleep apnea, asthma, diabetes, thyroid disease, history of lumpectomy, and breast reduction or augmentation. During this time, intraoperative vascular screening was not done. Five hundred eighty-one patients underwent 616 mastectomies with a total of 34 necrotic events (5.5%)-16 major and 18 minor. Analyses via Student t tests, univariate analyses, χ testing, and logistic regression showed that history of smoking was the only patient factor associated with postoperative necrosis (P = 0.008). More frequently represented in the necrosis group, but without statistical significance, are previous lumpectomy (P = 0.069) and immediate reconstruction (P = 0.078).For the entire study period, the actual cost to the hospital for major necrotic events was $7,123.10 or $445.19 for each of the 16 major necrotic events and $209.50 for all 34 necrotic events. Per-patient cost-effective screening would need to be less than $11.54 for all patients, $100.33 for highest risk patients (smokers), and $21.65 for

  10. Lipidomics in vascular health: current perspectives.

    Science.gov (United States)

    Kolovou, Genovefa; Kolovou, Vana; Mavrogeni, Sophie

    2015-01-01

    Identifying the mechanisms that convert a healthy vascular wall to an atherosclerotic wall is of major importance since the consequences may lead to a shortened lifespan. Classical risk factors (age, smoking, obesity, diabetes mellitus, hypertension, and dyslipidemia) may result in the progression of atherosclerotic lesions by processes including inflammation and lipid accumulation. Thus, the evaluation of blood lipids and the full lipid complement produced by cells, organisms, or tissues (lipidomics) is an issue of importance. In this review, we shall describe the recent progress in vascular health research using lipidomic advances. We will begin with an overview of vascular wall biology and lipids, followed by a short analysis of lipidomics. Finally, we shall focus on the clinical implications of lipidomics and studies that have examined lipidomic approaches and vascular health.

  11. Vascular retraction driven by matrix softening

    Science.gov (United States)

    Valentine, Megan

    We recently discovered we can directly apply physical forces and monitor the downstream responses in a living organism in real time through manipulation of the blood vessels of a marine organism called, Botryllus schlosseri. The extracellular matrix (ECM) plays a key role in regulating vascular growth and homeostasis in Botryllus,a basal chordate which has a large, transparent extracorporeal vascular network that can encompass areas >100 cm2. We have determined that lysyl oxidase 1 (LOX1), which is responsible for cross-linking collagen, is expressed in all vascular cells and is critically important for vascular maintenance. Inhibition of LOX1 activity in vivo by the addition of a specific inhibitor, ß-aminopropionitrile (BAPN), caused a rapid, global regression of the entire vascular bed, with some vessels regressing >10 mm within 16 hrs. In this talk, I will discuss the molecular and cellular origins of this systemic remodeling event, which hinges upon the ability of the vascular cells to sense and respond to mechanical signals, while introducing this exciting new model system for studies of biological physics and mechanobiology. Collaborators: Anthony DeTomaso, Delany Rodriguez, Aimal Khankhel (UCSB).

  12. Vascular Access in Children

    International Nuclear Information System (INIS)

    Krishnamurthy, Ganesh; Keller, Marc S.

    2011-01-01

    Establishment of stable vascular access is one of the essential and most challenging procedures in a pediatric hospital. Many clinical specialties provide vascular service in a pediatric hospital. At the top of the “expert procedural pyramid” is the pediatric interventional radiologist, who is best suited and trained to deliver this service. Growing awareness regarding the safety and high success rate of vascular access using image guidance has led to increased demand from clinicians to provide around-the-clock vascular access service by pediatric interventional radiologists. Hence, the success of a vascular access program, with the pediatric interventional radiologist as the key provider, is challenging, and a coordinated multidisciplinary team effort is essential for success. However, there are few dedicated pediatric interventional radiologists across the globe, and also only a couple of training programs exist for pediatric interventions. This article gives an overview of the technical aspects of pediatric vascular access and provides useful tips for obtaining vascular access in children safely and successfully using image guidance.

  13. Pediatric vascular access

    International Nuclear Information System (INIS)

    Donaldson, James S.

    2006-01-01

    Pediatric interventional radiologists are ideally suited to provide vascular access services to children because of inherent safety advantages and higher success from using image-guided techniques. The performance of vascular access procedures has become routine at many adult interventional radiology practices, but this service is not as widely developed at pediatric institutions. Although interventional radiologists at some children's hospitals offer full-service vascular access, there is little or none at others. Developing and maintaining a pediatric vascular access service is a challenge. Interventionalists skilled in performing such procedures are limited at pediatric institutions, and institutional support from clerical staff, nursing staff, and technologists might not be sufficiently available to fulfill the needs of such a service. There must also be a strong commitment by all members of the team to support such a demanding service. There is a slippery slope of expected services that becomes steeper and steeper as the vascular access service grows. This review is intended primarily as general education for pediatric radiologists learning vascular access techniques. Additionally, the pediatric or adult interventional radiologist seeking to expand services might find helpful tips. The article also provides education for the diagnostic radiologist who routinely interprets radiographs containing vascular access devices. (orig.)

  14. Vascular complications of prosthetic inter-vertebral discs

    OpenAIRE

    Daly, Kevin J.; Ross, E. Raymond S.; Norris, Heather; McCollum, Charles N.

    2006-01-01

    Five consecutive cases of prosthetic inter-vertebral disc displacement with severe vascular complications on revisional surgery are described. The objective of this case report is to warn spinal surgeons that major vascular complications are likely with anterior displacement of inter-vertebral discs. We have not been able to find a previous report on vascular complications associated with anterior displacement of prosthetic inter-vertebral discs. In all five patients the prosthetic disc had e...

  15. Pathophysiology of Headaches with a Prominent Vascular Component

    Directory of Open Access Journals (Sweden)

    Juan A Pareja

    1996-01-01

    Full Text Available Vascular changes, whether preliminary or secondary, seem to accompany most headaches. The literature concerning pathophysiological mechanisms in headaches where vascular phenomena are a major, integral part, ie, migraine and cluster headache syndrome, is reviewed and the most common forms of headache associated with cerebrovascular disease are discussed. Emphasis is placed on the vascular phenomena and on the abundant hypotheses and theories regarding headache mechanisms. This review also presents alternative explanatory models, and compares the available anatomical, physiological and biochemical results.

  16. Major depression

    Science.gov (United States)

    Depression - major; Depression - clinical; Clinical depression; Unipolar depression; Major depressive disorder ... providers do not know the exact causes of depression. It is believed that chemical changes in the ...

  17. Fusion events

    International Nuclear Information System (INIS)

    Aboufirassi, M; Angelique, J.C.; Bizard, G.; Bougault, R.; Brou, R.; Buta, A.; Colin, J.; Cussol, D.; Durand, D.; Genoux-Lubain, A.; Horn, D.; Kerambrun, A.; Laville, J.L.; Le Brun, C.; Lecolley, J.F.; Lefebvres, F.; Lopez, O.; Louvel, M.; Meslin, C.; Metivier, V.; Nakagawa, T.; Peter, J.; Popescu, R.; Regimbart, R.; Steckmeyer, J.C.; Tamain, B.; Vient, E.; Wieloch, A.; Yuasa-Nakagawa, K.

    1998-01-01

    The fusion reactions between low energy heavy ions have a very high cross section. First measurements at energies around 30-40 MeV/nucleon indicated no residue of either complete or incomplete fusion, thus demonstrating the disappearance of this process. This is explained as being due to the high amount o energies transferred to the nucleus, what leads to its total dislocation in light fragments and particles. Exclusive analyses have permitted to mark clearly the presence of fusion processes in heavy systems at energies above 30-40 MeV/nucleon. Among the complete events of the Kr + Au reaction at 60 MeV/nucleon the majority correspond to binary collisions. Nevertheless, for the most considerable energy losses, a class of events do occur for which the detected fragments appears to be emitted from a unique source. These events correspond to an incomplete projectile-target fusion followed by a multifragmentation. Such events were singled out also in the reaction Xe + Sn at 50 MeV/nucleon. For the events in which the energy dissipation was maximal it was possible to isolate an isotropic group of events showing all the characteristics of fusion nuclei. The fusion is said to be incomplete as pre-equilibrium Z = 1 and Z = 2 particles are emitted. The cross section is of the order of 25 mb. Similar conclusions were drown for the systems 36 Ar + 27 Al and 64 Zn + nat Ti. A cross section value of ∼ 20 mb was determined at 55 MeV/nucleon in the first case, while the measurement of evaporation light residues in the last system gave an upper limit of 20-30 mb for the cross section at 50 MeV/nucleon

  18. The drone as an additional risk factor due to conditions not provided for in radiological safety at major events; O drone como fator adicional de risco decorrente de condicoes nao previstas na seguranca radiologica em grandes eventos

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Gilberto de Jesus

    2015-07-01

    Major international events are potential targets of terrorist actions, seeking instant publicity that events of this magnitude provide, with the intention of causing terror and disseminate its power to a large number of people worldwide. In this context, the critical analysis of additional risk factor linked to procedures and protocols adopted on radiation safety is important. The possibility of unforeseen situations of risk, especially those resulting from the current global technological development, is a fact. Radioactive material can be used in this type of terrorism in a wide range of devices and illicit trafficking of this material is a reality that worries the International Atomic Energy Agency. In the current technological development scenario of the world, the potential occurrence of terrorist acts using drones combined with radioactive material dispersal devices, is real. The recent history of drones incidents presents cases where, despite not having been necessarily terrorist motivation, their circumstances and characteristics favor the occurrence of malicious acts. This paper proposes to alert the need of updating the current security protocols, considering the potential association of this technology with radioactive dispersal devices. (author)

  19. Uterine Vascular Lesions

    Science.gov (United States)

    Vijayakumar, Abhishek; Srinivas, Amruthashree; Chandrashekar, Babitha Moogali; Vijayakumar, Avinash

    2013-01-01

    Vascular lesions of the uterus are rare; most reported in the literature are arteriovenous malformations (AVMs). Uterine AVMs can be congenital or acquired. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, cesarean delivery, and curettage. It can be seen from these reports that there is confusion concerning the terminology of uterine vascular lesions. There is also a lack of diagnostic criteria and management guidelines, which has led to an increased number of unnecessary invasive procedures (eg, angiography, uterine artery embolization, hysterectomy for abnormal vaginal bleeding). This article familiarizes readers with various vascular lesions of the uterus and their management. PMID:24340126

  20. Magnetic resonance vascular imaging

    International Nuclear Information System (INIS)

    Axel, L

    1989-01-01

    The basis principles of MRI are reviewed in order to understand how blood flow effects arise in conventional imaging. Then some of the ways these effects have ben used in MRI techniques specifically designed for vascular imaging, are considered. (author)

  1. Diffuse corpus callosum infarction - Rare vascular entity with differing etiology.

    Science.gov (United States)

    Mahale, Rohan; Mehta, Anish; Buddaraju, Kiran; John, Aju Abraham; Javali, Mahendra; Srinivasa, Rangasetty

    2016-01-15

    Infarctions of the corpus callosum are rare vascular events. It is relatively immune to vascular insult because of its rich vascular supply from anterior and posterior circulations of brain. Report of 3 patients with largely diffuse acute corpus callosum infarction. 3 patients with largely diffuse acute corpus callosum infarction were studied and each of these 3 patients had 3 different aetiologies. The 3 different aetiologies of largely diffuse acute corpus callosum infarction were cardioembolism, tuberculous arteritis and takayasu arteritis. Diffuse corpus callosum infarcts are rare events. This case series narrates the three different aetiologies of diffuse acute corpus callosum infarction which is a rare vascular event. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. 3D bioprinting for vascularized tissue fabrication

    Science.gov (United States)

    Richards, Dylan; Jia, Jia; Yost, Michael; Markwald, Roger; Mei, Ying

    2016-01-01

    3D bioprinting holds remarkable promise for rapid fabrication of 3D tissue engineering constructs. Given its scalability, reproducibility, and precise multi-dimensional control that traditional fabrication methods do not provide, 3D bioprinting provides a powerful means to address one of the major challenges in tissue engineering: vascularization. Moderate success of current tissue engineering strategies have been attributed to the current inability to fabricate thick tissue engineering constructs that contain endogenous, engineered vasculature or nutrient channels that can integrate with the host tissue. Successful fabrication of a vascularized tissue construct requires synergy between high throughput, high-resolution bioprinting of larger perfusable channels and instructive bioink that promotes angiogenic sprouting and neovascularization. This review aims to cover the recent progress in the field of 3D bioprinting of vascularized tissues. It will cover the methods of bioprinting vascularized constructs, bioink for vascularization, and perspectives on recent innovations in 3D printing and biomaterials for the next generation of 3D bioprinting for vascularized tissue fabrication. PMID:27230253

  3. Retinal artery occlusion and associated recurrent vascular risk with underlying etiologies.

    Directory of Open Access Journals (Sweden)

    Jeong-Ho Hong

    Full Text Available RAO is caused by various etiologies and subsequent vascular events may be associated with underlying etiologies. Our aim is to investigate the etiologies of RAO, the occurrence of subsequent vascular events and their association in patients with RAO.We analyzed data from 151 consecutive patients presenting with acute non-arteritic RAO between 2003 and 2013 in a single tertiary-care hospital. The primary outcome was the occurrence of a vascular event defined as stroke, myocardial infarction, and vascular death within 365 days of the RAO onset. The Kaplan-Meier survival analysis and Cox proportional hazard model were used to estimate the hazard ratio of the vascular events.Large artery atherosclerosis (LAA was the etiology more frequently associated with of RAO (41.1%, 62/151. During the one year follow-up, ischemic stroke and vascular events occurred in 8.6% and 9.9% of patients, respectively. Ten vascular events occurred in RAO patients attributed to LAA and 4 occurred in undetermined etiology. RAO patients with LAA had a nearly four times higher risk of vascular events compared to those without LAA (hazard ratio 3.94, 95% confidence interval 1.21-12.81. More than a half of all events occurred within one month and over three fourths of ischemic strokes occurred ipsilateral to the RAO.After occurrence of RAO, there is a high risk of a subsequent vascular event, particularly ipsilateral stroke, within one month. LAA is an independent factor for the occurrence of a subsequent vascular event. Management for the prevention of secondary vascular events is necessary in patients with RAO especially with LAA. Large clinical trials are needed to confirm these findings.

  4. Human genetics of diabetic vascular complications

    Indian Academy of Sciences (India)

    Diabetic vascular complications (DVC) affecting several important organ systems of human body such as the cardiovascular system constitute a major public health problem. There is evidence demonstrating that genetic factors contribute to the risk of DVC genetic variants, structural variants, and epigenetic changes play ...

  5. Association between Fluorescent Advanced Glycation End-Products and Vascular Complications in Type 2 Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Alexis Guerin-Dubourg

    2017-01-01

    Full Text Available Objectives. Diabetes is a major health problem associated with hyperglycemia and chronically increased oxidative stress and enhanced formation of advanced glycation end-products (AGEs. The aim of this study was to determine whether oxidative plasma biomarkers in diabetic patients could be evidenced and associated with vascular complications. Methods. Oxidative stress biomarkers such as thiols, ischemia-modified albumin (IMA, glycated albumin (GA, fructosamine, and AGEs were measured in 75 patients with poorly controlled type 2 diabetes (HbA1c > 7.5% with (44 or without (31 vascular disease and in 31 nondiabetic controls. Results. Most biomarkers of oxidation and glycation were significantly increased in diabetic patients in comparison with nondiabetics. Fructosamines, GA, IMA, and AGEs were positively correlated and levels of fluorescent AGEs were significantly increased in the plasma from patients presenting vascular complication. Conclusions. These results bring new evidence for the potential interest of glycated albumin, oxidative stress, and glycoxidation parameters in the monitoring of type 2 diabetic patients. Furthermore, it emphasizes fluorescent AGEs as a putative indicator for vascular event prediction in diabetic patients.

  6. Vascular trauma: selected historical reflections from the

    Directory of Open Access Journals (Sweden)

    Rich Norman M

    2011-04-01

    Full Text Available 【Abstract】In the spirit of international exchanges of knowledge with colleagues from all over the world, who are interested in the care and treatment of vascular trauma, we offer selected historical reflections from the western world on vascular trauma. Whereas there are a number of key individuals and a variety of events that are important to us in our writing, we know essentially nothing about what is written by other cultures and, particularly, the Chinese. It is well recognized around the world that Chinese surgeons are among the first to be highly successful in re-plantation of severed extremities, repairing both injured arteries and veins. Also, we recognize that there are contributions in other parts of the world, which are not well known to us collectively. Contributions from the Arabic speaking part of the world come to mind because there is periodic brief reference. We offer our perspective hoping that there will be one or more Chinese surgeons who will offer us the benefit of sharing their perspective on important historical contributions to the managing of vascular trauma outside of the western world, and, particularly, the English speaking literature. Once again, we encourage our colleagues in the Arabic speaking world to provide us with their perspective of the development and management of vascular trauma. Key words: Vascular system injuries; History; Western world; International educational exchange

  7. Future Trends in Vascular Access Creation.

    Science.gov (United States)

    Shenoy, Surendra

    2017-01-01

    Delivery of a prescribed dialysis dose, which is critical for longevity on hemodialysis, is directly dependent on vascular access (VA). However, VA is fraught with high failure rates and has room for innovation. Arteriovenous fistula (AVF), considered the 'best choice', has a high 'failure to mature' rate. Arteriovenous grafts (AVGs) are considered when patients are poor candidates for or have failed AVF, but have a high incidence of infections and thrombosis. Due to associated morbidity and mortality from complications, central venous catheters are considered only as 'bridging short-term access' when there is an urgent need for dialysis. The observation from current data that there is a significant center effect in the rate of AVF maturation supports investigation to identify factors that contribute to success in high-performing centers that create AVF and establish 'best practice' approaches to improve outcomes. Biocompatible AVG constructs that promote rapid tissue incorporation withstand needle punctures due to better integrity and can improve current AVG outcomes. Stenosis in the 'access circuit' is a major cause for short- and long-term permanent access failure. While the pathology of stenosis development is well understood, factors responsible for this problem are poorly studied. Increased flow in the access circuit likely plays a major role in the development of such stenosis. Investigation into understanding the hemodynamics of this flow may help identify etiology and stenosis sites perhaps even prior to the event, thus providing potential targets to mitigate the stenotic response. In summary, this chapter reflects on the shortcomings of current access modalities and discusses potential avenues to improve VA outcomes in the future. © 2017 S. Karger AG, Basel.

  8. Age-specific association between blood pressure and vascular and non-vascular chronic diseases in 0·5 million adults in China: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Ben Lacey, FFPH

    2018-06-01

    Full Text Available Summary: Background: The age-specific association between blood pressure and vascular disease has been studied mostly in high-income countries, and before the widespread use of brain imaging for diagnosis of the main stroke types (ischaemic stroke and intracerebral haemorrhage. We aimed to investigate this relationship among adults in China. Methods: 512 891 adults (59% women aged 30–79 years were recruited into a prospective study from ten areas of China between June 25, 2004, and July 15, 2008. Participants attended assessment centres where they were interviewed about demographic and lifestyle characteristics, and their blood pressure, height, and weight were measured. Incident disease was identified through linkage to local mortality records, chronic disease registries, and claims to the national health insurance system. We used Cox regression analysis to produce adjusted hazard ratios (HRs relating systolic blood pressure to disease incidence. HRs were corrected for regression dilution to estimate associations with long-term average (usual systolic blood pressure. Findings: During a median follow-up of 9 years (IQR 8–10, there were 88 105 incident vascular and non-vascular chronic disease events (about 90% of strokes events were diagnosed using brain imaging. At ages 40–79 years (mean age at event 64 years [SD 9], usual systolic blood pressure was continuously and positively associated with incident major vascular disease throughout the range 120–180 mm Hg: each 10 mm Hg higher usual systolic blood pressure was associated with an approximately 30% higher risk of ischaemic heart disease (HR 1·31 [95% CI 1·28–1·34] and ischaemic stroke (1·30 [1·29–1·31], but the association with intracerebral haemorrhage was about twice as steep (1·68 [1·65–1·71]. HRs for vascular disease were twice as steep at ages 40–49 years than at ages 70–79 years. Usual systolic blood pressure was also positively associated with incident

  9. Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study

    Energy Technology Data Exchange (ETDEWEB)

    Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji [Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi (Japan); Sato, Makito [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Tatebayashi Kosei Hospital, Department of Internal Medicine, Gunma (Japan); Sano, Hirokazu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Isesaki Municipal Hospital, Department of Cardiovascular Medicine, Isesaki (Japan); Ueda, Tetsuya [Fujioka General Hospital, Division of Cardiology, Fujioka (Japan); Sasaki, Toyoshi [Takasaki General Medical Center, Division of Cardiology, Takasaki (Japan); Nakahara, Takehiro; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Higuchi, Tetsuya; Tsushima, Yoshito [Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Maebashi (Japan)

    2016-02-15

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m{sup 2}] undergoing stress {sup 99m}Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD. (orig.)

  10. Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study

    International Nuclear Information System (INIS)

    Kasama, Shu; Toyama, Takuji; Sato, Makito; Sano, Hirokazu; Ueda, Tetsuya; Sasaki, Toyoshi; Nakahara, Takehiro; Kurabayashi, Masahiko; Higuchi, Tetsuya; Tsushima, Yoshito

    2016-01-01

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m 2 ] undergoing stress 99m Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD. (orig.)

  11. Angiogenesis and vascular targeting: Relevance for hyperthermia

    DEFF Research Database (Denmark)

    Horsman, Michael R

    2008-01-01

    The creation of a functional blood supply from the normal tissue vasculature via the process of angiogenesis is critical for the continued growth and development of solid tumours. This importance has led to the concept of targeting the tumour vasculature as a therapeutic strategy, and two major...... types of vascular targeting agents (VTAs) have developed; those that inhibit the angiogenic process-angiogenesis inhibiting agents (AIAs)-and those that specifically damage the already established neovasculature-vascular disrupting agents (VDAs). The tumour vasculature also plays a critical role...

  12. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    International Nuclear Information System (INIS)

    Eagle, K.A.; Singer, D.E.; Brewster, D.C.; Darling, R.C.; Mulley, A.G.; Boucher, C.A.

    1987-01-01

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning

  13. Overview of vascular disease

    International Nuclear Information System (INIS)

    Bisset, G.S. III

    1998-01-01

    Vascular disease in the pediatric population is a poorly understood process which is often underestimated in its incidence. The common beginnings of such ubiquitous diseases as atherosclerosis manifest themselves at a cellular level shortly after birth. Other common systemic disorders, including congestive heart failure and sepsis, are also intricately associated with dysfunctional vasculature. Progress in the understanding of normal and pathophysiologic processes within the vascular system begins with the 'control center' - the endothelial cell. The purpose of this review is to consolidate a body of knowledge on the processes that occur at the cellular level within the blood vessel wall, and to simplify the understanding of how imbalances in these physiologic parameters result in vascular disease. (orig.)

  14. Changes in the quality of river water before, during and after a major flood event associated with a La Niña cycle and treatment for drinking purposes.

    Science.gov (United States)

    Murshed, Mohamad Fared; Aslam, Zeeshan; Lewis, Rosmala; Chow, Christopher; Wang, Dongsheng; Drikas, Mary; van Leeuwen, John

    2014-10-01

    The treatment of organics present in the lower reaches of a major river system (the Murray-Darling Basin, Australia) before (March-July 2010), during (December 2010-May 2011) and after (April-December 2012) a major flood period was investigated. The flood period (over 6months) occurred during an intense La Niña cycle, leading to rapid and high increases in river flows and organic loads in the river water. Dissolved organic carbon (DOC) increased (2-3 times) to high concentrations (up to 16mg/L) and was found to correlate with river flow rates. The treatability of organics was studied using conventional jar tests with alum and an enhanced coagulation model (mEnCo©). Predicted mean alum dose rates (per mg DOC) were higher before (9.1mg alum/mg DOC) and after (8.5mg alum/mg DOC) than during the flood event (8.0mg alum/mg DOC), indicating differences in the character of the organics in raw waters. To assess the character of natural organic matter present in raw and treated waters, high performance size exclusion chromatography with UV and fluorescence detectors were used. During the flood period, high molecular weight UV absorbing compounds (>2kDa) were mostly detected in waters collected, but were not evident in waters collected before and afterwards. The relative abundances of humic-like and protein-like compounds during and following the flood period were also investigated and found to be of a higher molecular weight during the flood period. The treatability of the organics was found to vary over the three climate conditions investigated. Copyright © 2014. Published by Elsevier B.V.

  15. New molecular probes of vascular inflammation

    International Nuclear Information System (INIS)

    Molecular Cardiovascular Imaging, Westfälische Wilhelms University Münster, Münster, (Germany))" data-affiliation=" (Department of Nuclear Medicine, University Hospital Münster, Münster, and DFG CRC 656 Molecular Cardiovascular Imaging, Westfälische Wilhelms University Münster, Münster, (Germany))" >VRACHIMIS, Alexis; HONOLD, Lisa; Cells in Motion Cluster of Excellence, Westfälische Wilhelms University Münster, Münster, (Germany))" data-affiliation=" (European Institute of Molecular Imaging, Westfälische Wilhelms University Münster, Münster, and DFG EXC 1003 Cells in Motion Cluster of Excellence, Westfälische Wilhelms University Münster, Münster, (Germany))" >FAUST, Andreas; Cells in Motion Cluster of Excellence, Westfälische Wilhelms University Münster, Münster, (Germany))" data-affiliation=" (European Institute of Molecular Imaging, Westfälische Wilhelms University Münster, Münster, and DFG EXC 1003 Cells in Motion Cluster of Excellence, Westfälische Wilhelms University Münster, Münster, (Germany))" >HERMANN, Sven; SCHÄFERS, Michael

    2016-01-01

    New molecular imaging approaches featuring the assessment of inflammatory processes in the vascular wall on top of existing anatomic and functional vessel imaging procedures could emerge as decisive tools for the understanding and prevention of cardiovascular events. In this respect imaging approaches addressing specific molecular and cellular targets in atherosclerosis are of high interest. This review summarizes the rationale and current status of nuclear imaging probes which possess high translational potential.

  16. Endothelial dysfunction, vascular disease and stroke: the ARTICO study.

    Science.gov (United States)

    Roquer, J; Segura, T; Serena, J; Castillo, J

    2009-01-01

    Endothelial dysfunction is a fundamental step in the atherosclerotic disease process. Its presence is a risk factor for the development of clinical events, and may represent a marker of atherothrombotic burden. Also, endothelial dysfunction contributes to enhanced plaque vulnerability, may trigger plaque rupture, and favors thrombus formation. The assessment of endothelial vasomotion is a useful marker of atherosclerotic vascular disease. There are different methods to assess endothelial function: endothelium-dependent vasodilatation brachial flow-mediated dilation, cerebrovascular reactivity to L-arginine, and the determination of some biomarkers such as microalbuminuria, platelet function, and C-reactive protein. Endothelial dysfunction has been observed in stroke patients and has been related to stroke physiopathology, stroke subtypes, clinical severity and outcome. Resting ankle-brachial index (ABI) is also considered an indicator of generalized atherosclerosis, and a low ABI is associated with an increase in stroke incidence in the elderly. Despite all these data, there are no studies analyzing the predictive value of ABI for new cardiovascular events in patients after suffering an acute ischemic stroke. ARTICO is an ongoing prospective, observational, multicenter study being performed in 50 Spanish hospitals. The aim of the ARTICO study is to evaluate the prognostic value of a pathological ABI (ARTICO study will increase the knowledge of patient outcome after ischemic stroke and may help to improve our ability to detect patients at high risk of stroke recurrence or major cardiovascular events. (c) 2009 S. Karger AG, Basel.

  17. Transcatheter aortic valve replacement and vascular complications definitions.

    Science.gov (United States)

    Van Mieghem, Nicolas M; Généreux, Philippe; van der Boon, Robert M A; Kodali, Susheel; Head, Stuart; Williams, Matthew; Daneault, Benoit; Kappetein, Arie-Pieter; de Jaegere, Peter P; Leon, Martin B; Serruys, Patrick W

    2014-03-20

    Transcatheter aortic valve replacement (TAVR) requires large calibre catheters and is therefore associated with increased vascular complications. The aim of this study was to illustrate the impact of the different definitions of major vascular complications on their incidence and to underscore the importance of uniform reporting. We pooled dedicated databases of consecutive patients undergoing TAVR from two tertiary care facilities and looked for the incidence of major vascular complications using various previously reported definitions. The level of agreement (Kappa statistic) between the respective definitions and the Valve Academic Research Consortium (VARC) consensus definition of vascular complications was assessed. A total of 345 consecutive patients underwent transfemoral TAVR and were included in this analysis. A completely percutaneous access and closure technique was applied in 96% of cases. Arterial sheath size ranged between 18 and 24 Fr, the majority being 18 Fr (60%). Procedural success was reached in 94.5%. Depending on the definition used, major vascular complications occurred in 5.2-15.9% of patients. According to the VARC definitions, the rate of major and minor vascular complications was 9.0% and 9.6%, respectively. Major vascular complications according to VARC criteria demonstrated at least a substantial level of agreement with the SOURCE registry (k 0.80), the UK registry (k 0.82) the Italian registry (k 0.72) and "FRANCE" registry (k 0.70) definitions, compared to a moderate level of agreement with the definitions used in the German registry ( 0.47) and the 18 Fr Safety and Efficacy study (k 0.42). Minor complications according to VARC demonstrated a moderate agreement only with vascular complications using the German registry definition (k 0.54). Non-uniformity in how vascular complications are defined precludes any reliable comparison between previously reported TAVR registries. The VARC consensus document offers standardised endpoint

  18. Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6months follow-up.

    Science.gov (United States)

    Xia, Jinggang; Xu, Ji; Hu, Shaodong; Hao, Hengjian; Yin, Chunlin; Xu, Dong

    2017-08-01

    We explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. From May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. The occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85-5.38; P=0.01). The trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up. Copyright © 2017. Published by Elsevier B.V.

  19. Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease.

    Science.gov (United States)

    Khalil, Raouf A

    2013-12-15

    Cardiovascular disease (CVD) is less common in premenopausal women than men of the same age or postmenopausal women, suggesting vascular benefits of estrogen. Estrogen activates estrogen receptors ERα, ERβ and GPR30 in endothelium and vascular smooth muscle (VSM), which trigger downstream signaling pathways and lead to genomic and non-genomic vascular effects such as vasodilation, decreased VSM contraction and growth and reduced vascular remodeling. However, randomized clinical trials (RCTs), such as the Women's Health Initiative (WHI) and Heart and Estrogen/progestin Replacement Study (HERS), have shown little vascular benefits and even adverse events with menopausal hormone therapy (MHT), likely due to factors related to the MHT used, ER profile, and RCT design. Some MHT forms, dose, combinations or route of administration may have inadequate vascular effects. Age-related changes in ER amount, distribution, integrity and post-ER signaling could alter the vascular response to MHT. The subject's age, preexisting CVD, and hormone environment could also reduce the effects of MHT. Further evaluation of natural and synthetic estrogens, phytoestrogens, and selective estrogen-receptor modulators (SERMs), and the design of appropriate MHT combinations, dose, route and 'timing' could improve the effectiveness of conventional MHT and provide alternative therapies in the peri-menopausal period. Targeting ER using specific ER agonists, localized MHT delivery, and activation of specific post-ER signaling pathways could counter age-related changes in ER. Examination of the hormone environment and conditions associated with hormone imbalance such as polycystic ovary syndrome may reveal the causes of abnormal hormone-receptor interactions. Consideration of these factors in new RCTs such as the Kronos Early Estrogen Prevention Study (KEEPS) could enhance the vascular benefits of estrogen in postmenopausal CVD. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Progenitor cells in pulmonary vascular remodeling

    Science.gov (United States)

    Yeager, Michael E.; Frid, Maria G.; Stenmark, Kurt R.

    2011-01-01

    Pulmonary hypertension is characterized by cellular and structural changes in the walls of pulmonary arteries. Intimal thickening and fibrosis, medial hypertrophy and fibroproliferative changes in the adventitia are commonly observed, as is the extension of smooth muscle into the previously non-muscularized vessels. A majority of these changes are associated with the enhanced presence of α-SM-actin+ cells and inflammatory cells. Atypical abundances of functionally distinct endothelial cells, particularly in the intima (plexiform lesions), and also in the perivascular regions, are also described. At present, neither the origin(s) of these cells nor the molecular mechanisms responsible for their accumulation, in any of the three compartments of the vessel wall, have been fully elucidated. The possibility that they arise from either resident vascular progenitors or bone marrow–derived progenitor cells is now well established. Resident vascular progenitor cells have been demonstrated to exist within the vessel wall, and in response to certain stimuli, to expand and express myofibroblastic, endothelial or even hematopoietic markers. Bone marrow–derived or circulating progenitor cells have also been shown to be recruited to sites of vascular injury and to assume both endothelial and SM-like phenotypes. Here, we review the data supporting the contributory role of vascular progenitors (including endothelial progenitor cells, smooth muscle progenitor cells, pericytes, and fibrocytes) in vascular remodeling. A more complete understanding of the processes by which progenitor cells modulate pulmonary vascular remodeling will undoubtedly herald a renaissance of therapies extending beyond the control of vascular tonicity and reduction of pulmonary artery pressure. PMID:22034593

  1. Gene transfer therapy in vascular diseases.

    Science.gov (United States)

    McKay, M J; Gaballa, M A

    2001-01-01

    Somatic gene therapy of vascular diseases is a promising new field in modern medicine. Recent advancements in gene transfer technology have greatly evolved our understanding of the pathophysiologic role of candidate disease genes. With this knowledge, the expression of selective gene products provides the means to test the therapeutic use of gene therapy in a multitude of medical conditions. In addition, with the completion of genome sequencing programs, gene transfer can be used also to study the biologic function of novel genes in vivo. Novel genes are delivered to targeted tissue via several different vehicles. These vectors include adenoviruses, retroviruses, plasmids, plasmid/liposomes, and oligonucleotides. However, each one of these vectors has inherent limitations. Further investigations into developing delivery systems that not only allow for efficient, targeted gene transfer, but also are stable and nonimmunogenic, will optimize the clinical application of gene therapy in vascular diseases. This review further discusses the available mode of gene delivery and examines six major areas in vascular gene therapy, namely prevention of restenosis, thrombosis, hypertension, atherosclerosis, peripheral vascular disease in congestive heart failure, and ischemia. Although we highlight some of the recent advances in the use of gene therapy in treating vascular disease discovered primarily during the past two years, many excellent studies published during that period are not included in this review due to space limitations. The following is a selective review of practical uses of gene transfer therapy in vascular diseases. This review primarily covers work performed in the last 2 years. For earlier work, the reader may refer to several excellent review articles. For instance, Belalcazer et al. (6) reviewed general aspects of somatic gene therapy and the different vehicles used for the delivery of therapeutic genes. Gene therapy in restenosis and stimulation of

  2. Experimental results and clinical impact of using autologous rectus fascia sheath for vascular replacement

    NARCIS (Netherlands)

    Kobori, Laszlo; Nemeth, Tibor; Nagy, Peter; Dallos, Gabor; Sotonyi, Peter; Fehervari, Imre; Nemes, Balazs; Gorog, Denes; Patonai, Attila; Monostory, Katalin; Doros, Attila; Sarvary, Enikoe; Fazakas, Janos; Gerlei, Zsuzsanna; Benkoe, Tamas; Piros, Laszlo; Jaray, Jeno; De Jong, Koert P.

    Vascular complications are major causes of graft failure in liver transplantation. The use of different vascular grafts is common but the results are controversial. The aim of this study was to create an 'ideal' arterial interponate for vascular replacements in the clinical field. An autologous,

  3. Arteriographic evaluation, in the perispheric vascular trauma

    International Nuclear Information System (INIS)

    Patino, Jairo Hernando; Granados, Ana Maria; Lopera B, Jorge; Prada W, Angela Maria

    1993-01-01

    136 patients were angiographically studied under the suspicion of perispheric vascular lesion submitted to the radiology department of the San Vicente de Paul University Hospital (H.U.S.VP.) Medellin Colombia. The majority of the patients were young with wounds caused by gunshots (79.4%). the must frequent angiographic indication was the proximity of the wound to a vascular path (44.5%). 63% of the patients with angiography indicative of abnormality needed surgery from which 21% were because of the proximity of the wound to a vascular path and 76% because of the mayor findings when admitted to the hospital. the possible complications as a result of the angiographic procedure were revised only find inc two mayor reactions to the contrast media. there were no late complications. Angiography is highlighting sensitive (100%) specific (98.5%) and secure in the evaluation of patients with perispheric vascular trauma. Due to the high number of false negatives when the physical examination is performed, every patient with a wound near a vascular path must be evaluated angiographically

  4. Nanomedicine approaches in vascular disease: a review.

    Science.gov (United States)

    Gupta, Anirban Sen

    2011-12-01

    Nanomedicine approaches have revolutionized the treatment of cancer and vascular diseases, where the limitations of rapid nonspecific clearance, poor biodistribution and harmful side effects associated with direct systemic drug administration can be overcome by packaging the agents within sterically stabilized, long-circulating nanovehicles that can be further surface-modified with ligands to actively target cellular/molecular components of the disease. With significant advancements in genetics, proteomics, cellular and molecular biology and biomaterials engineering, the nanomedicine strategies have become progressively refined regarding the modulation of surface and bulk chemistry of the nanovehicles, control of drug release kinetics, manipulation of nanoconstruct geometry and integration of multiple functionalities on single nanoplatforms. The current review aims to capture the various nanomedicine approaches directed specifically toward vascular diseases during the past two decades. Analysis of the promises and limitations of these approaches will help identify and optimize vascular nanomedicine systems to enhance their efficacy and clinical translation in the future. Nanomedicine-based approaches have had a major impact on the treatment and diagnosis of malignancies and vascular diseases. This review discusses various nanomedicine approaches directed specifically toward vascular diseases during the past two decades, highlighting their advantages, limitations and offering new perspectives on future applications. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. LRP1 in brain vascular smooth muscle cells mediates local clearance of Alzheimer's amyloid-β.

    Science.gov (United States)

    Kanekiyo, Takahisa; Liu, Chia-Chen; Shinohara, Mitsuru; Li, Jie; Bu, Guojun

    2012-11-14

    Impaired clearance of amyloid-β (Aβ) is a major pathogenic event for Alzheimer's disease (AD). Aβ depositions in brain parenchyma as senile plaques and along cerebrovasculature as cerebral amyloid angiopathy (CAA) are hallmarks of AD. A major pathway that mediates brain Aβ clearance is the cerebrovascular system where Aβ is eliminated through the blood-brain barrier (BBB) and/or degraded by cerebrovascular cells along the interstitial fluid drainage pathway. An Aβ clearance receptor, the low-density lipoprotein receptor-related protein 1 (LRP1), is abundantly expressed in cerebrovasculature, in particular in vascular smooth muscle cells. Previous studies have indicated a role of LRP1 in endothelial cells in transcytosing Aβ out of the brain across the BBB; however, whether this represents a significant pathway for brain Aβ clearance remains controversial. Here, we demonstrate that Aβ can be cleared locally in the cerebrovasculature by an LRP1-dependent endocytic pathway in smooth muscle cells. The uptake and degradation of both endogenous and exogenous Aβ were significantly reduced in LRP1-suppressed human brain vascular smooth muscle cells. Conditional deletion of Lrp1 in vascular smooth muscle cell in amyloid model APP/PS1 mice accelerated brain Aβ accumulation and exacerbated Aβ deposition as amyloid plaques and CAA without affecting Aβ production. Our results demonstrate that LRP1 is a major Aβ clearance receptor in cerebral vascular smooth muscle cell and a disturbance of this pathway contributes to Aβ accumulation. These studies establish critical functions of the cerebrovasculature system in Aβ metabolism and identify a new pathway involved in the pathogenesis of both AD and CAA.

  6. CIRSE Vascular Closure Device Registry

    International Nuclear Information System (INIS)

    Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2011-01-01

    Purpose: Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods: The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results: Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion: The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.

  7. CIRSE Vascular Closure Device Registry

    Science.gov (United States)

    Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

    2010-01-01

    Purpose Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters. PMID:20981425

  8. Enhanced Recovery after Vascular Surgery

    Directory of Open Access Journals (Sweden)

    Milena D. Stojanovic

    2018-01-01

    Full Text Available The beginnings of the enhanced recovery after surgery (ERAS program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients.

  9. The vascular basement membrane in the healthy and pathological brain.

    Science.gov (United States)

    Thomsen, Maj S; Routhe, Lisa J; Moos, Torben

    2017-10-01

    The vascular basement membrane contributes to the integrity of the blood-brain barrier (BBB), which is formed by brain capillary endothelial cells (BCECs). The BCECs receive support from pericytes embedded in the vascular basement membrane and from astrocyte endfeet. The vascular basement membrane forms a three-dimensional protein network predominantly composed of laminin, collagen IV, nidogen, and heparan sulfate proteoglycans that mutually support interactions between BCECs, pericytes, and astrocytes. Major changes in the molecular composition of the vascular basement membrane are observed in acute and chronic neuropathological settings. In the present review, we cover the significance of the vascular basement membrane in the healthy and pathological brain. In stroke, loss of BBB integrity is accompanied by upregulation of proteolytic enzymes and degradation of vascular basement membrane proteins. There is yet no causal relationship between expression or activity of matrix proteases and the degradation of vascular matrix proteins in vivo. In Alzheimer's disease, changes in the vascular basement membrane include accumulation of Aβ, composite changes, and thickening. The physical properties of the vascular basement membrane carry the potential of obstructing drug delivery to the brain, e.g. thickening of the basement membrane can affect drug delivery to the brain, especially the delivery of nanoparticles.

  10. VASCULAR INJURIES IN TEHRAN: A REVIEW OF 123 CASES

    Directory of Open Access Journals (Sweden)

    M. Karbakhsh M. R. Zarei

    2006-09-01

    Full Text Available Abstract- Studies of the epidemiology of civilian vascular trauma in developing countries are rather few. This is a prospective study of our experience with vascular trauma in a referral university hospital in Tehran, Iran. The aim was to study the etiology, pattern of injuries and the mortality and morbidity rates due to vascular trauma in our population. In this cross-sectional study, all trauma patients suspicious of having vascular injuries who were admitted to Sina Hospital between March 2002 and May 2003 were included. Among 123 studied cases, there were 109 males and 14 females.Blunt injuries were more common than penetrating ones (56.1% vs. 43.9%. The most common anatomical site of vascular injuries had been knee and lower leg. In fact, cases with lower extremities vascular trauma were twice as common as those with vascular trauma in upper limbs (59.1% vs. 27.3%. The commonest injured vessels were popliteal artery followed by femoral artery. Arterial repair with graft interposition was done in 23 cases and bypass graft in 13 cases. Procedures on veins were performed in 24 cases. Five patients (4.06% died and in 3 cases the patients died because of non-vascular reasons. The present study allows an understanding of the epidemiology of vascular trauma in the one of the major trauma centers in the metropolitan city of Tehran. The majority of our cases were young males sustaining vascular injuries due to road traffic accidents or being stabbed with knives. It also has important implications for vascular injury prevention in our community.

  11. Major Links.

    Science.gov (United States)

    Henderson, Tona

    1995-01-01

    Provides electronic mail addresses for resources and discussion groups related to the following academic majors: art, biology, business, chemistry, computer science, economics, health sciences, history, literature, math, music, philosophy, political science, psychology, sociology, and theater. (AEF)

  12. Major Roads

    Data.gov (United States)

    Minnesota Department of Natural Resources — This data set contains roadway centerlines for major roads (interstates and trunk highways) found on the USGS 1:24,000 mapping series. These roadways are current...

  13. Initiating events frequency determination

    International Nuclear Information System (INIS)

    Simic, Z.; Mikulicic, V.; Vukovic, I.

    2004-01-01

    The paper describes work performed for the Nuclear Power Station (NPS). Work is related to the periodic initiating events frequency update for the Probabilistic Safety Assessment (PSA). Data for all relevant NPS initiating events (IE) were reviewed. The main focus was on events occurring during most recent operating history (i.e., last four years). The final IE frequencies were estimated by incorporating both NPS experience and nuclear industry experience. Each event was categorized according to NPS individual plant examination (IPE) initiating events grouping approach. For the majority of the IE groups, few, or no events have occurred at the NPS. For those IE groups with few or no NPS events, the final estimate was made by means of a Bayesian update with general nuclear industry values. Exceptions are rare loss-of-coolant-accidents (LOCA) events, where evaluation of engineering aspects is used in order to determine frequency.(author)

  14. Protein Kinase C Inhibitors as Modulators of Vascular Function and Their Application in Vascular Disease

    Directory of Open Access Journals (Sweden)

    Raouf A. Khalil

    2013-03-01

    Full Text Available Blood pressure (BP is regulated by multiple neuronal, hormonal, renal and vascular control mechanisms. Changes in signaling mechanisms in the endothelium, vascular smooth muscle (VSM and extracellular matrix cause alterations in vascular tone and blood vessel remodeling and may lead to persistent increases in vascular resistance and hypertension (HTN. In VSM, activation of surface receptors by vasoconstrictor stimuli causes an increase in intracellular free Ca2+ concentration ([Ca2+]i, which forms a complex with calmodulin, activates myosin light chain (MLC kinase and leads to MLC phosphorylation, actin-myosin interaction and VSM contraction. Vasoconstrictor agonists could also increase the production of diacylglycerol which activates protein kinase C (PKC. PKC is a family of Ca2+-dependent and Ca2+-independent isozymes that have different distributions in various blood vessels, and undergo translocation from the cytosol to the plasma membrane, cytoskeleton or the nucleus during cell activation. In VSM, PKC translocation to the cell surface may trigger a cascade of biochemical events leading to activation of mitogen-activated protein kinase (MAPK and MAPK kinase (MEK, a pathway that ultimately increases the myofilament force sensitivity to [Ca2+]i, and enhances actin-myosin interaction and VSM contraction. PKC translocation to the nucleus may induce transactivation of various genes and promote VSM growth and proliferation. PKC could also affect endothelium-derived relaxing and contracting factors as well as matrix metalloproteinases (MMPs in the extracellular matrix further affecting vascular reactivity and remodeling. In addition to vasoactive factors, reactive oxygen species, inflammatory cytokines and other metabolic factors could affect PKC activity. Increased PKC expression and activity have been observed in vascular disease and in certain forms of experimental and human HTN. Targeting of vascular PKC using PKC inhibitors may function in

  15. Plant Vascular Biology 2010

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Biao

    2014-11-17

    This grant supported the Second International Conference on Plant Vascular Biology (PVB 2010) held July 24-28, 2010 on the campus of Ohio State University, Columbus, Ohio. Biao Ding (Ohio State University; OSU) and David Hannapel (Iowa State University; ISU) served as co-chairs of this conference. Biao Ding served as the local organizer. PVB is defined broadly here to include studies on the biogenesis, structure and function of transport systems in plants, under conditions of normal plant growth and development as well as of plant interactions with pathogens. The transport systems cover broadly the xylem, phloem, plasmodesmata and vascular cell membranes. The PVB concept has emerged in recent years to emphasize the integrative nature of the transport systems and approaches to investigate them.

  16. Vascular Surgery and Robotics

    Directory of Open Access Journals (Sweden)

    Indrani Sen

    2016-01-01

    Full Text Available The application of robotics to Vascular surgery has not progressed as rapidly as of endovascular technology, but this is changing with the amalgamation of these two fields. The advent of Endovascular robotics is an exciting field which overcomes many of the limitations of endovascular therapy like vessel tortuosity and operator fatigue. This has much clinical appeal for the surgeon and hold significant promise of better patient outcomes. As with most newer technological advances, it is still limited by cost and availability. However, this field has seen some rapid progress in the last decade with the technology moving into the clinical realm. This review details the development of robotics, applications, outcomes, advantages, disadvantages and current advances focussing on Vascular and Endovascular robotics

  17. Diverse Imaging characteristics of a mandibular intraosseous vascular lesion

    International Nuclear Information System (INIS)

    Handa, Hina; Naidu, Giridhar S.; Dara, Balaji Gandhi Babu; Deshpande, Ashwini; Raghavendra, Raju

    2014-01-01

    Intraosseous vascular lesions of the maxillofacial region are rare, and the differential diagnosis of intraosseous vascular malformations from other jaw lesions can be challenging. In the present case, magnetic resonance imaging and three-dimensional computed tomographic angiography (CTA) was used for diagnosis, and the lesion was treated with surgical excision. Diverse characteristics such as the 'honeycomb' and 'sunburst' radiographic appearances and the absence of major peripheral feeder vessels in the CTA were noted. Intraosseous vascular malformations have a varied radiographic appearance, and the nomenclature of these lesions is equally diverse, with several overlapping terms. Pathologists do not generally differentiate among intraosseous vascular lesions on the basis of histopathology, although these lesions may present with contrasting immunohistochemical and clinical behaviors requiring varied treatment strategies. This case report highlights the need for multiple imaging modalities to differentiate among vascular lesions, as well as to better understand the behaviors of these unique lesions.

  18. [Vascular depression in the elderly. Does inflammation play a role?].

    Science.gov (United States)

    Viscogliosi, Giovanni; Andreozzi, Paola; Chiriac, Iulia Maria; Ettorre, Evaristo; Vulcano, Achiropita; Servello, Adriana; Marigliano, Benedetta; Marigliano, Vincenzo

    2011-06-01

    Vascular depression in the elderly. Does inflammation play a role?Depression is the most common comorbidity in the elderly, and it is a major determinant of disability. The late-onset depression in highly associated to cardiovascular disease. Depressive symptoms may follow vascular brain damage, especially when mood regulating areas are affected. However depression is strongly associated to vascular disease even when there is no manifest brain damage. Recently great attention has been given to chronic inflammation, both related to depression and vascular disease. Both experimental and clinical evidence shows that a rise in the concentrations of proinflammatory cytokines and glucocorticoids in depressed patients is associated with defect in serotonergic function. Chronic inflammation may underlie many forms of depression associated with vascular disease and metabolic syndrome. The importance of the inflammation hypothesis of depression lies is that psychotropic drugs may have central anti-inflammatory action, and that new generation of central anti-inflammatory drugs may be useful in depression treatment.

  19. Vascular lesions following radiation

    International Nuclear Information System (INIS)

    Fajardo, L.F.; Berthrong, M.

    1988-01-01

    The special radiation sensitivity of the vascular system is mainly linked to that of endothelial cells, which are perhaps the most radiation-vulnerable elements of mesenchymal tissues. Within the vascular tree, radiation injures most often capillaries, sinusoids, and small arteries, in that order. Lesions of veins are observed less often, but in certain tissues the veins are regularly damaged (e.g., intestine) or are the most affected structures (i.e., liver). Large arteries do suffer the least; however, when significant damage does occur in an elastic artery (e.g., thrombosis or rupture), it tends to be clinically significant and even fatal. Although not always demonstrable in human tissues, radiation vasculopathy generally is dose and time dependent. Like other radiation-induced lesions, the morphology in the vessels is not specific, but it is characteristic enough to be often recognizable. Vascular injury, especially by therapeutic radiation is not just a morphologic marker. It is a mediator of tissue damage; perhaps the most consistent pathogenetic mechanism in delayed radiation injury

  20. Vascular lumen formation.

    Science.gov (United States)

    Lammert, Eckhard; Axnick, Jennifer

    2012-04-01

    The vascular system developed early in evolution. It is required in large multicellular organisms for the transport of nutrients, oxygen, and waste products to and from tissues. The vascular system is composed of hollow tubes, which have a high level of complexity in vertebrates. Vasculogenesis describes the de novo formation of blood vessels, e.g., aorta formation in vertebrate embryogenesis. In contrast, angiogenesis is the formation of blood vessels from preexisting ones, e.g., sprouting of intersomitic blood vessels from the aorta. Importantly, the lumen of all blood vessels in vertebrates is lined and formed by endothelial cells. In both vasculogenesis and angiogenesis, lumen formation takes place in a cord of endothelial cells. It involves a complex molecular mechanism composed of endothelial cell repulsion at the cell-cell contacts within the endothelial cell cords, junctional rearrangement, and endothelial cell shape change. As the vascular system also participates in the course of many diseases, such as cancer, stroke, and myocardial infarction, it is important to understand and make use of the molecular mechanisms of blood vessel formation to better understand and manipulate the pathomechanisms involved.

  1. Pulmonary vascular imaging

    International Nuclear Information System (INIS)

    Fedullo, P.F.; Shure, D.

    1987-01-01

    A wide range of pulmonary vascular imaging techniques are available for the diagnostic evaluation of patients with suspected pulmonary vascular disease. The characteristics of any ideal technique would include high sensitivity and specificity, safety, simplicity, and sequential applicability. To date, no single technique meets these ideal characteristics. Conventional pulmonary angiography remains the gold standard for the diagnosis of acute thromboembolic disease despite the introduction of newer techniques such as digital subtraction angiography and magnetic resonance imaging. Improved noninvasive lower extremity venous testing methods, particularly impedance plethysmography, and ventilation-perfusion scanning can play significant roles in the noninvasive diagnosis of acute pulmonary emboli when properly applied. Ventilation-perfusion scanning may also be useful as a screening test to differentiate possible primary pulmonary hypertension from chronic thromboembolic pulmonary hypertension. And, finally, angioscopy may be a useful adjunctive technique to detect chronic thromboembolic disease and determine operability. Optimal clinical decision-making, however, will continue to require the proper interpretation of adjunctive information obtained from the less-invasive techniques, applied with an understanding of the natural history of the various forms of pulmonary vascular disease and with a knowledge of the capabilities and shortcomings of the individual techniques

  2. The making of indigenous vascular prosthesis

    Directory of Open Access Journals (Sweden)

    Madathipat Unnikrishnan

    2016-01-01

    Full Text Available Background & objectives: Vascular illnesses are on the rise in India, due to increase in lifestyle diseases and demographic transition, requiring intervention to save life, organ or limbs using vascular prosthesis. The aim of this study was to develop indigenous large diameter vascular graft for treatment of patients with vascular pathologies. Methods: The South India Textile Research Association, at Coimbatore, Tamil Nadu, India, developed seamless woven polyester (Polyethylene terephthalate graft at its research wing. Further characterization and testing followed by clinical trials were conducted at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Fifteen in vivo experiments were carried out in 1992-1994 in pigs as animal model. Controlled (phase I clinical trial in ten patients was performed along with control graft. Thereafter, phase II trial involved 22 patients who underwent multi-centre clinical trial in four centres across India. Results: Laboratory testing showed that polyester graft was non-toxic, non-leeching and non-haemolytic with preserved long-term quality, further confirming in pigs by implanting in thoracic aorta, comparable to control Dacron grafts. Perigraft incorporation and smooth neointima formation which are prime features of excellent healing characteristics, were noted at explantation at planned intervals. Subsequently in the phase I and II clinical trials, all patients had excellent recovery without mortality or device-related adverse events. Patients receiving the test graft were followed up for 10 and 5 years, respectively. Serial clinical, duplex scans and CT angiograms performed periodically confirmed excellent graft performance. Interpretation & conclusions: Indigenously developed Chitra vascular graft was comparable to commercially available Dacron graft, ready for clinical use at affordable cost to patients as against costly imported grafts.

  3. The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke.

    Science.gov (United States)

    Serena, Joaquín; Segura, Tomás; Roquer, Jaume; García-Gil, María; Castillo, José

    2015-03-11

    About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers. The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events. Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI 50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. In the final Cox regression analysis, body mass index (BMI), systolic blood pressure, history of diabetes mellitus, symptomatic PAD (HR, 2.76; 95% CI, 1.10-6.95; p=0.03), and particularly patients with both ICA stenosis >50% and PAD (HR 4.52; 95% CI, 2.14-9.53; p50% nor isolated abnormal ABI remained associated with an increased risk of recurrence in comparison with the whole population. Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either

  4. Vascular risk factors, cognitve decline, and dementia

    Directory of Open Access Journals (Sweden)

    E Duron

    2008-04-01

    Full Text Available E Duron, Olivier HanonBroca Hospital, Paris, FranceAbstract: Dementia is one of the most important neurological disorders in the elderly. Aging is associated with a large increase in the prevalence and incidence of degenerative (Alzheimer’s disease and vascular dementia, leading to a devastating loss of autonomy. In view of the increasing longevity of populations worldwide, prevention of dementia has turned into a major public health challenge. In the past decade, several vascular risk factors have been found to be associated with vascular dementia but also Alzheimer’s disease. Some longitudinal studies, have found significant associations between hypertension, diabetus mellitus, and metabolic syndrome, assessed at middle age, and dementia. Studies assessing the link between hypercholesterolemia, atrial fibrillation, smoking, and dementia have given more conflicting results. Furthermore, some studies have highlighted the possible protective effect of antihypertensive therapy on cognition and some trials are evaluating the effects of statins and treatments for insulin resistance. Vascular risk factors and their treatments are a promising avenue of research for prevention of dementia, and further long-term, placebo-controlled, randomized studies, need to be performed.Keywords: dementia, hypertension, diabetus mellitus, hypercholesterolemia, metabolic syndrome

  5. Vascular Complications of Pancreatitis: Role of Interventional Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Barge, Jaideep U.; Lopera, Jorge E. [University of Texas Health Science Center, San Antonio (United States)

    2012-02-15

    Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.

  6. Role of renal vascular potassium channels in physiology and pathophysiology

    DEFF Research Database (Denmark)

    Salomonsson, Max; Brasen, Jens Christian; Sorensen, Charlotte Mehlin

    2017-01-01

    The control of renal vascular tone is important for the regulation of salt and water balance, blood pressure and the protection against damaging elevated glomerular pressure. The K+ conductance is a major factor in the regulation of the membrane potential (Vm ) in vascular smooth muscle (VSMC...... the ambiguous in vitro and in vivo results. We discuss the role of single types of K+ channels and the integrated function of several classes. We also deal with the possible role of renal vascular K+ channels in the pathophysiology of hypertension, diabetes mellitus and sepsis. This article is protected...

  7. Treatment of the diabetic foot from a vascular surgeon's viewpoint.

    Science.gov (United States)

    Chang, B B; Shah, D M; Darling, R C; Leather, R P

    1993-11-01

    Diabetic foot lesions are caused by neurologic, orthopaedic, immunologic, and vascular derangements. Whereas some lesions may be initially caused by trauma and others directly caused by vascular disease, improvement of arterial perfusion often plays an important role in the successful salvage of these limbs. Fortunately, in the last several years, there has been a major improvement in the identification and treatment of those patients in whom correction of arterial occlusive disease is necessary for healing.

  8. Vascular remodeling and mineralocorticoids.

    Science.gov (United States)

    Weber, K T; Sun, Y; Campbell, S E; Slight, S H; Ganjam, V K

    1995-01-01

    Circulating mineralocorticoid hormones are so named because of their important homeostatic properties that regulate salt and water balance via their action on epithelial cells. A broader range of functions in nonclassic target cellular sites has been proposed for these steroids and includes their contribution to wound healing following injury. A chronic, inappropriate (relative to intravascular volume and dietary sodium intake) elevation of these circulating hormones evokes a wound healing response in the absence of tissue injury--a wound healing response gone awry. The adverse remodeling of vascularized tissues seen in association with chronic mineralocorticoid excess is the focus of this review.

  9. Atrial fibrillation and vascular disease-a bad combination

    DEFF Research Database (Denmark)

    Bjerring Olesen, Jonas; Gislason, Gunnar Hilmar; Torp-Pedersen, Christian

    2012-01-01

    This article provides an overview of (i) the risk of stroke associated with vascular disease (acute coronary syndromes and peripheral artery disease) in patients with atrial fibrillation, (ii) the frequent coexistence of vascular disease in patients with atrial fibrillation and, (iii...... fibrillation. Indeed, patients with atrial fibrillation often had coexisting vascular disease (around 18%), and the combination of the two diseases substantially increases the risk of future cardiovascular events. The increased risk associated with peripheral artery disease in atrial fibrillation is even more...... pronounced. Patients with atrial fibrillation and stable vascular disease should be treated with oral anticoagulation only, although when these patients present with acute coronary syndrome and/or undergo coronary stenting, concomitant treatment with antiplatelet drugs is indicated. To guide antithrombotic...

  10. VEGF signaling inside vascular endothelial cells and beyond.

    Science.gov (United States)

    Eichmann, Anne; Simons, Michael

    2012-04-01

    Vascular endothelial growth factor-A (VEGF-A) has long been recognized as the key regulator of vascular development and function in health and disease. VEGF is a secreted polypeptide that binds to transmembrane tyrosine kinase VEGF receptors on the plasma membrane, inducing their dimerization, activation and assembly of a membrane-proximal signaling complex. Recent studies have revealed that many key events of VEGFR signaling occur inside the endothelial cell and are regulated by endosomal receptor trafficking. Plasma membrane VEGFR interacting molecules, including vascular guidance receptors Neuropilins and Ephrins also regulate VEGFR endocytosis and trafficking. VEGF signaling is increasingly recognized for its roles outside of the vascular system, notably during neural development, and blood vessels regulate epithelial branching morphogenesis. We review here recent advances in our understanding of VEGF signaling and its biological roles. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Major international sport profiles.

    Science.gov (United States)

    Patel, Dilip R; Stier, Bernhard; Luckstead, Eugene F

    2002-08-01

    Sports are part of the sociocultural fabric of all countries. Although different sports have their origins in different countries, many sports are now played worldwide. International sporting events bring athletes of many cultures together and provide the opportunity not only for athletic competition but also for sociocultural exchange and understanding among people. This article reviews five major sports with international appeal and participation: cricket, martial arts, field hockey, soccer, and tennis. For each sport, the major aspects of physiological and biomechanical demands, injuries, and prevention strategies are reviewed.

  12. Event Investigation

    International Nuclear Information System (INIS)

    Korosec, D.

    2000-01-01

    The events in the nuclear industry are investigated from the license point of view and from the regulatory side too. It is well known the importance of the event investigation. One of the main goals of such investigation is to prevent the circumstances leading to the event and the consequences of the event. The protection of the nuclear workers against nuclear hazard, and the protection of general public against dangerous effects of an event could be achieved by systematic approach to the event investigation. Both, the nuclear safety regulatory body and the licensee shall ensure that operational significant events are investigated in a systematic and technically sound manner to gather information pertaining to the probable causes of the event. One of the results should be appropriate feedback regarding the lessons of the experience to the regulatory body, nuclear industry and general public. In the present paper a general description of systematic approach to the event investigation is presented. The systematic approach to the event investigation works best where cooperation is present among the different divisions of the nuclear facility or regulatory body. By involving management and supervisors the safety office can usually improve their efforts in the whole process. The end result shall be a program which serves to prevent events and reduce the time and efforts solving the root cause which initiated each event. Selection of the proper method for the investigation and an adequate review of the findings and conclusions lead to the higher level of the overall nuclear safety. (author)

  13. Interventional vascular radiology

    International Nuclear Information System (INIS)

    Yune, H.Y.

    1984-01-01

    The papers published during this past year in the area of interventional vascular radiology presented some useful modifications and further experiences both in the area of thromboembolic therapy and in dilation and thrombolysis, but no new techniques. As an introductory subject, an excellent monograph reviewing the current spectrum of pharmacoangiography was presented in Radiographics. Although the presented material is primarily in diagnostic application of various pharmacologic agents used today to facilitate demonstration of certain diagnostic criteria of various disease processes, both vasodilatory and vasoconstrictive reaction to these agents are widely used in various therapeutic vascular procedures. This monograph should be reviewed by every angiographer whether or not he or she performs interventional procedures, and it would be very convenient to have this table available in the angiography suite. In a related subject, Bookstein and co-workers have written an excellent review concerning pharmacologic manipulations of various blood coagulative parameters during angiography. Understanding the proper method of manipulation of the bloodclotting factors during angiography, and especially during interventional angiography, is extremely important. Particularly, the method of manipulating the coagulation with the use of heparin and protamine and modification of the platelet activity by using aspirin and dipyridamole are succinctly reviewed. The systemic and selective thrombolytic activities of streptokianse are also discussed

  14. Vascular dysfunction in preeclampsia.

    Science.gov (United States)

    Brennan, Lesley J; Morton, Jude S; Davidge, Sandra T

    2014-01-01

    Preeclampsia is a complex disorder which affects an estimated 5% of all pregnancies worldwide. It is diagnosed by hypertension in the presence of proteinuria after the 20th week of pregnancy and is a prominent cause of maternal morbidity and mortality. As delivery is currently the only known treatment, preeclampsia is also a leading cause of preterm delivery. Preeclampsia is associated with maternal vascular dysfunction, leading to serious cardiovascular risk both during and following pregnancy. Endothelial dysfunction, resulting in increased peripheral resistance, is an integral part of the maternal syndrome. While the cause of preeclampsia remains unknown, placental ischemia resulting from aberrant placentation is a fundamental characteristic of the disorder. Poor placentation is believed to stimulate the release of a number of factors including pro- and antiangiogenic factors and inflammatory activators into the maternal systemic circulation. These factors are critical mediators of vascular function and impact the endothelium in distinctive ways, including enhanced endothelial oxidative stress. The mechanisms of action and the consequences on the maternal vasculature will be discussed in this review. © 2013 John Wiley & Sons Ltd.

  15. effects of tranexamic acid on death, vascular occlusive events

    African Journals Online (AJOL)

    the effects of early administration of a short course of tranexamic acid on death, ... study staff (site investigators and trial coordinating centre staff ) were masked to .... supply company (Bilcare, Crickhowell, UK). ..... establishing the presence or absence of haemorrhage, ... would have reduced the power of the trial to show an.

  16. Severe hypoglycemia and risks of vascular events and death.

    NARCIS (Netherlands)

    Zoungas, S.; Patel, A.; Chalmers, J.; Galan, B.E. de; Li, Q.; Billot, L.; Woodward, M.; Ninomiya, T.; Neal, B.; MacMahon, S; Grobbee, D.E.; Kengne, A.P.; Marre, M.; Heller, S.

    2010-01-01

    BACKGROUND: Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention. We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse

  17. Vascular Remodeling in Experimental Hypertension

    Directory of Open Access Journals (Sweden)

    Norma R. Risler

    2005-01-01

    Full Text Available The basic hemodynamic abnormality in hypertension is an increased peripheral resistance that is due mainly to a decreased vascular lumen derived from structural changes in the small arteries wall, named (as a whole vascular remodeling. The vascular wall is an active, flexible, and integrated organ made up of cellular (endothelial cells, smooth muscle cells, adventitia cells, and fibroblasts and noncellular (extracellular matrix components, which in a dynamic way change shape or number, or reorganize in response to physiological and pathological stimuli, maintaining the integrity of the vessel wall in physiological conditions or participating in the vascular changes in cardiovascular diseases such as hypertension. Research focused on new signaling pathways and molecules that can participate in the mechanisms of vascular remodeling has provided evidence showing that vascular structure is not only affected by blood pressure, but also by mechanisms that are independent of the increased pressure. This review will provide an overview of the evidence, explaining some of the pathophysiologic mechanisms participating in the development of the vascular remodeling, in experimental models of hypertension, with special reference to the findings in spontaneously hypertensive rats as a model of essential hypertension, and in fructose-fed rats as a model of secondary hypertension, in the context of the metabolic syndrome. The understanding of the mechanisms producing the vascular alterations will allow the development of novel pharmacological tools for vascular protection in hypertensive disease.

  18. Vascular pattern formation in plants.

    Science.gov (United States)

    Scarpella, Enrico; Helariutta, Ykä

    2010-01-01

    Reticulate tissue systems exist in most multicellular organisms, and the principles underlying the formation of cellular networks have fascinated philosophers, mathematicians, and biologists for centuries. In particular, the beautiful and varied arrangements of vascular tissues in plants have intrigued mankind since antiquity, yet the organizing signals have remained elusive. Plant vascular tissues form systems of interconnected cell files throughout the plant body. Vascular cells are aligned with one another along continuous lines, and vascular tissues differentiate at reproducible positions within organ environments. However, neither the precise path of vascular differentiation nor the exact geometry of vascular networks is fixed or immutable. Several recent advances converge to reconcile the seemingly conflicting predictability and plasticity of vascular tissue patterns. A control mechanism in which an apical-basal flow of signal establishes a basic coordinate system for body axis formation and vascular strand differentiation, and in which a superimposed level of radial organizing cues elaborates cell patterns, would generate a reproducible tissue configuration in the context of an underlying robust, self-organizing structure, and account for the simultaneous regularity and flexibility of vascular tissue patterns. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Early Detection System of Vascular Disease and Its Application Prospect

    Directory of Open Access Journals (Sweden)

    Huan Liu

    2016-01-01

    Full Text Available Markers of imaging, structure, and function reflecting vascular damage, integrating a long time accumulation effect of traditional and unrecognized cardiovascular risk factors, can be regarded as surrogate endpoints of target organ damage before the occurrence of clinical events. Prevention of cardiovascular disease requires risk stratification and treatment of traditional risk factors, such as smoking, hypertension, hyperlipidemia, and diabetes. However, traditional risk stratification is not sufficient to provide accurate assessment of future cardiovascular events. Therefore, vascular injury related parameters obtained by ultrasound or other noninvasive devices, as a surrogate parameter of subclinical cardiovascular disease, can improve cardiovascular risk assessment and optimize the preventive treatment strategy. Thus, we will summarize the research progress and clinical application of early assessment technology of vascular diseases in the present review.

  20. Metabolic syndrome and incidence of type 2 diabetes in patients with manifest vascular disease

    NARCIS (Netherlands)

    Wassink, A.M.J.; Graaf, van der Y.; Soedamah-Muthu, S.S.; Spiering, W.; Visseren, F.L.J.

    2008-01-01

    Risk reduction in patients with clinically manifest vascular disease focuses on preventing new vascular events and not on prevention of type 2 diabetes. However, given the common pathophysiological pathways involved in the development of atherosclerosis and type 2 diabetes, it is probable that

  1. Additive Manufacturing of Vascular Grafts and Vascularized Tissue Constructs.

    Science.gov (United States)

    Elomaa, Laura; Yang, Yunzhi Peter

    2017-10-01

    There is a great need for engineered vascular grafts among patients with cardiovascular diseases who are in need of bypass therapy and lack autologous healthy blood vessels. In addition, because of the severe worldwide shortage of organ donors, there is an increasing need for engineered vascularized tissue constructs as an alternative to organ transplants. Additive manufacturing (AM) offers great advantages and flexibility of fabrication of cell-laden, multimaterial, and anatomically shaped vascular grafts and vascularized tissue constructs. Various inkjet-, extrusion-, and photocrosslinking-based AM techniques have been applied to the fabrication of both self-standing vascular grafts and porous, vascularized tissue constructs. This review discusses the state-of-the-art research on the use of AM for vascular applications and the key criteria for biomaterials in the AM of both acellular and cellular constructs. We envision that new smart printing materials that can adapt to their environment and encourage rapid endothelialization and remodeling will be the key factor in the future for the successful AM of personalized and dynamic vascular tissue applications.

  2. Early Vascular Ageing - A Concept in Development.

    Science.gov (United States)

    M Nilsson, Peter

    2015-04-01

    Cardiovascular disease (CVD) is a prevalent condition in the elderly, often associated with metabolic disturbance and type 2 diabetes. For a number of years, research dedicated to understand atherosclerosis dominated, and for many good reasons, this pathophysiological process being proximal to the CVD events. In recent years, research has been devoted to an earlier stage of vascular pathology named arteriosclerosis (arterial stiffness) and the new concept of early vascular ageing (EVA), developed by a group of mostly European researchers. This overview describes recent developments in research dedicated to EVA and new emerging aspects found in studies of families at high cardiovascular risk. There are new aspects related to genetics, telomere biology and the role of gut microbiota. However, there is still no unifying definition available of EVA and no direct treatment, but rather only recommendations for conventional cardiovascular risk factor control. New interventions are being developed - not only new antihypertensive drugs, but also new drugs for vascular protection - the selective angiotensin-II (AT2) agonist Compound 21 (C21). Human studies are eagerly awaited. Even new functional food products could have the potential to positively influence cardiometabolic regulation, to be confirmed.

  3. Ample spectrum of vascular hepatic disease

    International Nuclear Information System (INIS)

    Camacho, Juan C; Marquez Adriana; Romero, Javier; Aguirre Diego

    2010-01-01

    Hepatic vascular diseases (HVD) are a broad spectrum of entities of low prevalence but with different clinical manifestations that may even lead to death. Its early detection and timely treatment may change the prognosis. Diagnostic imaging plays a key role and imaging findings may be typical. However, in most cases, radiologists must take into account a wide range of differential diagnosis. Computed tomography (CT) of the abdomen is one of the most useful tools for the diagnosis of HVD taking also into account the value of other imaging methods such as Doppler Ultrasound and Magnetic Resonance Imaging (MRI). HVD can be classified according to the compromised vascular structure and can be divided into venous, portal, arterial, sinusoidal and others disorders. The objective of this review is to describe the most common presentation HVD. The major imaging findings and differential diagnosis recognizing its correlation with the pathophysiological mechanisms.

  4. Vascular lesions of the vocal fold.

    Science.gov (United States)

    Gökcan, Kürşat Mustafa; Dursun, Gürsel

    2009-04-01

    The aim of the study was to present symptoms, laryngological findings, clinical course, management modalities, and consequences of vascular lesions of vocal fold. This study examined 162 patients, the majority professional voice users, with vascular lesions regarding their presenting symptoms, laryngological findings, clinical courses and treatment results. The most common complaint was sudden hoarseness with hemorrhagic polyp. Microlaryngoscopic surgery was performed in 108 cases and the main indication of surgery was the presence of vocal fold mass or development of vocal polyp during clinical course. Cold microsurgery was utilized for removal of vocal fold masses and feeding vessels cauterized using low power, pulsed CO(2) laser. Acoustic analysis of patients revealed a significant improvement of jitter, shimmer and harmonics/noise ratio values after treatment. Depending on our clinical findings, we propose treatment algorithm where voice rest and behavioral therapy is the integral part and indications of surgery are individualized for each patient.

  5. Cardiac and vascular malformations

    International Nuclear Information System (INIS)

    Ley, S.; Ley-Zaporozhan, J.

    2015-01-01

    Malformations of the heart and great vessels show a high degree of variation. There are numerous variants and defects with only few clinical manifestations and are only detected by chance, such as a persistent left superior vena cava or a partial anomalous pulmonary venous connection. Other cardiovascular malformations are manifested directly after birth and need prompt mostly surgical interventions. At this point in time echocardiography is the diagnostic modality of choice for morphological and functional characterization of malformations. Additional imaging using computed tomography (CT) or magnetic resonance imaging (MRI) is only required in a minority of cases. If so, the small anatomical structures, the physiological tachycardia and tachypnea are a challenge for imaging modalities and strategies. This review article presents the most frequent vascular, cardiac and complex cardiovascular malformations independent of the first line diagnostic imaging modality. (orig.) [de

  6. Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

    LENUS (Irish Health Repository)

    Dover, Mary

    2013-09-17

    Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI\\'s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to

  7. Disruptive technological advances in vascular access for dialysis: an overview.

    Science.gov (United States)

    Yeo, Wee-Song; Ng, Qin Xiang

    2017-11-29

    End-stage kidney disease (ESKD), one of the most prevalent diseases in the world and with increasing incidence, is associated with significant morbidity and mortality. Current available modes of renal replacement therapy (RRT) include dialysis and renal transplantation. Though renal transplantation is the preferred and ideal mode of RRT, this modality may not be available to all patients with ESKD. Moreover, renal transplant recipients are constantly at risk of complications associated with immunosuppression and immunosuppressant use, and posttransplant lymphoproliferative disorder. Dialysis may be the only available modality in certain patients. However, dialysis has its limitations, which include issues associated with lack of vascular access, risks of infections and vascular thrombosis, decreased quality of life, and absence of biosynthetic functions of the kidney. In particular, the creation and maintenance of hemodialysis vascular access in children poses a unique set of challenges to the pediatric nephrologist owing to the smaller vessel diameters and vascular hyperreactivity compared with adult patients. Vascular access issues continue to be one of the major limiting factors prohibiting the delivery of adequate dialysis in ESKD patients and is the Achilles' heel of hemodialysis. This review aims to provide a critical overview of disruptive technological advances and innovations for vascular access. Novel strategies in preventing neointimal hyperplasia, novel bioengineered products, grafts and devices for vascular access will be discussed. The potential impact of these solutions on improving the morbidity encountered by dialysis patients will also be examined.

  8. Vascular endothelial growth factor signaling regulates the segregation of artery and vein via ERK activity during vascular development

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Se-Hee [McAllister Heart Institute, Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 (United States); Schmitt, Christopher E.; Woolls, Melissa J. [McAllister Heart Institute, Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 (United States); Yale Cardiovascular Research Center and Section of Cardiovascular Medicine, Dept. of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511 (United States); Holland, Melinda B. [McAllister Heart Institute, Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 (United States); Kim, Jun-Dae [Yale Cardiovascular Research Center and Section of Cardiovascular Medicine, Dept. of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511 (United States); Jin, Suk-Won, E-mail: suk-won.jin@yale.edu [Yale Cardiovascular Research Center and Section of Cardiovascular Medicine, Dept. of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511 (United States)

    2013-01-25

    Highlights: ► VEGF-A signaling regulates the segregation of axial vessels. ► VEGF-A signaling is mediated by PKC and ERK in this process. ► Ectopic activation of ERK is sufficient to rescue defects in vessel segregation. -- Abstract: Segregation of two axial vessels, the dorsal aorta and caudal vein, is one of the earliest patterning events occur during development of vasculature. Despite the importance of this process and recent advances in our understanding on vascular patterning during development, molecular mechanisms that coordinate the segregation of axial vessels remain largely elusive. In this report, we find that vascular endothelial growth factor-A (Vegf-A) signaling regulates the segregation of dorsal aorta and axial vein during development. Inhibition of Vegf-A pathway components including ligand Vegf-A and its cognate receptor Kdrl, caused failure in segregation of axial vessels in zebrafish embryos. Similarly, chemical inhibition of Mitogen-activated protein kinase kinase (Map2k1)/Extracellular-signal-regulated kinases (Erk) and phosphatidylinositol 3-kinases (PI3 K), which are downstream effectors of Vegf-A signaling pathway, led to the fusion of two axial vessels. Moreover, we find that restoring Erk activity by over-expression of constitutively active MEK in embryos with a reduced level of Vegf-A signaling can rescue the defects in axial vessel segregation. Taken together, our data show that segregation of axial vessels requires the function of Vegf-A signaling, and Erk may function as the major downstream effector in this process.

  9. Vascular endothelial growth factor signaling regulates the segregation of artery and vein via ERK activity during vascular development

    International Nuclear Information System (INIS)

    Kim, Se-Hee; Schmitt, Christopher E.; Woolls, Melissa J.; Holland, Melinda B.; Kim, Jun-Dae; Jin, Suk-Won

    2013-01-01

    Highlights: ► VEGF-A signaling regulates the segregation of axial vessels. ► VEGF-A signaling is mediated by PKC and ERK in this process. ► Ectopic activation of ERK is sufficient to rescue defects in vessel segregation. -- Abstract: Segregation of two axial vessels, the dorsal aorta and caudal vein, is one of the earliest patterning events occur during development of vasculature. Despite the importance of this process and recent advances in our understanding on vascular patterning during development, molecular mechanisms that coordinate the segregation of axial vessels remain largely elusive. In this report, we find that vascular endothelial growth factor-A (Vegf-A) signaling regulates the segregation of dorsal aorta and axial vein during development. Inhibition of Vegf-A pathway components including ligand Vegf-A and its cognate receptor Kdrl, caused failure in segregation of axial vessels in zebrafish embryos. Similarly, chemical inhibition of Mitogen-activated protein kinase kinase (Map2k1)/Extracellular-signal-regulated kinases (Erk) and phosphatidylinositol 3-kinases (PI3 K), which are downstream effectors of Vegf-A signaling pathway, led to the fusion of two axial vessels. Moreover, we find that restoring Erk activity by over-expression of constitutively active MEK in embryos with a reduced level of Vegf-A signaling can rescue the defects in axial vessel segregation. Taken together, our data show that segregation of axial vessels requires the function of Vegf-A signaling, and Erk may function as the major downstream effector in this process

  10. Purchase decision involvement: Event management segments and related event behavior

    Science.gov (United States)

    Rodney B. Warnick; David C. Bojanic

    2012-01-01

    The goal of this research was to examine the relationships between different levels of event purchase decision involvement (PDI) segments and their respective event behaviors (e.g., expenditures, travel behavior, event consumption and satisfaction). The specific purpose was to answer two major research questions: 1) Can PDI identify different levels or segments of...

  11. Dynamic adaption of vascular morphology

    DEFF Research Database (Denmark)

    Okkels, Fridolin; Jacobsen, Jens Christian Brings

    2012-01-01

    The structure of vascular networks adapts continuously to meet changes in demand of the surrounding tissue. Most of the known vascular adaptation mechanisms are based on local reactions to local stimuli such as pressure and flow, which in turn reflects influence from the surrounding tissue. Here ...

  12. Diagnostic criteria for vascular dementia

    NARCIS (Netherlands)

    Scheltens, P.; Hijdra, A. H.

    1998-01-01

    The term vascular dementia implies the presence of a clinical syndrome (dementia) caused by, or at least assumed to be caused by, a specific disorder (cerebrovascular disease). In this review, the various sets of criteria used to define vascular dementia are outlined. The various sets of criteria

  13. The vascular secret of Klotho

    DEFF Research Database (Denmark)

    Lewin, Ewa; Olgaard, Klaus

    2015-01-01

    Klotho is an evolutionarily highly conserved protein related to longevity. Increasing evidence of a vascular protecting effect of the Klotho protein has emerged and might be important for future treatments of uremic vascular calcification. It is still disputed whether Klotho is locally expressed ...

  14. Matrix ageing and vascular impacts: focus on elastin fragmentation.

    Science.gov (United States)

    Duca, Laurent; Blaise, Sébastien; Romier, Béatrice; Laffargue, Muriel; Gayral, Stéphanie; El Btaouri, Hassan; Kawecki, Charlotte; Guillot, Alexandre; Martiny, Laurent; Debelle, Laurent; Maurice, Pascal

    2016-06-01

    Cardiovascular diseases (CVDs) are the leading cause of death worldwide and represent a major problem of public health. Over the years, life expectancy has considerably increased throughout the world, and the prevalence of CVD is inevitably rising with the growing ageing of the population. The normal process of ageing is associated with progressive deterioration in structure and function of the vasculature, commonly called vascular ageing. At the vascular level, extracellular matrix (ECM) ageing leads to molecular alterations in long half-life proteins, such as elastin and collagen, and have critical effects on vascular diseases. This review highlights ECM alterations occurring during vascular ageing with a specific focus on elastin fragmentation and also the contribution of elastin-derived peptides (EDP) in age-related vascular complications. Moreover, current and new pharmacological strategies aiming at minimizing elastin degradation, EDP generation, and associated biological effects are discussed. These strategies may be of major relevance for preventing and/or delaying vascular ageing and its complications. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  15. Social media in vascular surgery.

    Science.gov (United States)

    Indes, Jeffrey E; Gates, Lindsay; Mitchell, Erica L; Muhs, Bart E

    2013-04-01

    There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  16. Event Modeling

    DEFF Research Database (Denmark)

    Bækgaard, Lars

    2001-01-01

    The purpose of this chapter is to discuss conceptual event modeling within a context of information modeling. Traditionally, information modeling has been concerned with the modeling of a universe of discourse in terms of information structures. However, most interesting universes of discourse...... are dynamic and we present a modeling approach that can be used to model such dynamics.We characterize events as both information objects and change agents (Bækgaard 1997). When viewed as information objects events are phenomena that can be observed and described. For example, borrow events in a library can...

  17. Evaluation of the tropospheric flows to a major Southern Hemisphere stratospheric warming event using NCEP/NCAR Reanalysis data with a PSU/NCAR nudging MM5V3 model

    Science.gov (United States)

    Wang, K.

    2008-04-01

    Previous studies of the exceptional 2002 Southern Hemisphere (SH) stratospheric warming event lead to some uncertainty, namely the question of whether excessive heat fluxes in the upper troposphere and lower stratosphere are a symptom or cause of the 2002 SH warming event. In this work, we use a hemispheric version of the MM5 model with nudging capability and we devised a novel approach to separately test the significance of the stratosphere and troposphere for this year. We paired the flow conditions from 2002 in the stratosphere and troposphere, respectively, against the conditions in 1998 (a year with displaced polar vortex) and in 1948 (a year with strong polar vortex that coincided with the geographical South Pole). Our experiments show that the flow conditions from below determine the stratospheric flow features over the polar region. Regardless of the initial stratospheric conditions in 1998 or 1948, when we simulated these past stratospheres with the troposphere/lower stratosphere conditions constrained to 2002 levels, the simulated middle stratospheres resemble those observed in 2002 stratosphere over the polar region. On the other hand, when the 2002 stratosphere was integrated with the troposphere/lower stratosphere conductions constrained to 1948 and 1998, respectively, the simulated middle stratospheric conditions over the polar region shift toward those of 1948 and 1998. Thus, our experiments further support the wave-forcing theory as the cause of the 2002 SH warming event.

  18. Diagnosis and treatment of vascular damage in dementia.

    Science.gov (United States)

    Biessels, Geert Jan

    2016-05-01

    This paper provides an overview of cognitive impairment due to vascular brain damage, which is referred to as vascular cognitive impairment (VCI). Over the past decades, we have seen marked progress in detecting VCI, both through maturation of diagnostic concepts and through advances in brain imaging, especially MRI. Yet in daily practice, it is often challenging to establish the diagnosis, particularly in patients where there is no evident temporal relation between a cerebrovascular event and cognitive dysfunction. Because vascular damage is such a common cause of cognitive dysfunction, it provides an obvious target for treatment. In patients whose cognitive dysfunction follows directly after a stroke, the etiological classification of this stroke will direct treatment. In many patients however, VCI develops due to so-called "silent vascular damage," without evident cerebrovascular events. In these patients, small vessel diseases (SVDs) are the most common cause. Yet no SVD-specific treatments currently exist, which is due to incomplete understanding of the pathophysiology. This review addresses developments in this field. It offers a framework to translate diagnostic criteria to daily practice, addresses treatment, and highlights some future perspectives. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia, edited by M. Paul Murphy, Roderick A. Corriveau, and Donna M. Wilcock. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Vascular access site complication in transfemoral coronary angiography between uninterrupted warfarin and heparin bridging.

    Science.gov (United States)

    Wongcharoen, Wanwarang; Pinyosamosorn, Kittipong; Gunaparn, Siriluck; Boonnayhun, Suchada; Thonghong, Tasalak; Suwannasom, Pannipa; Phrommintikul, Arintaya

    2017-08-01

    Warfarin discontinuation with heparin bridging is a common practice in patients receiving warfarin prior to elective coronary angiography (CAG). The uninterrupted warfarin strategy has been suggested to be alternative option for patients with high thromboembolic risk. Therefore, we aimed to assess the safety of elective transfemoral CAG during uninterrupted warfarin therapy compared to heparin bridging. This study was a randomized open-label design with blinded event evaluation. The 110 consecutive patients (age ≥ 18 years) receiving warfarin before the planned transfemoral CAG were randomly assigned to either heparin bridging or uninterrupted warfarin with targeted INR (2.0-3.0). The primary outcome was the incidence of major vascular access site complications. The baseline characteristics were comparable between two groups (mean age was 60.1 ± 7.8 years, 49 males). The mean INR on the day of CAG of heparin bridging and uninterrupted warfarin groups was 1.2 ± 0.3 and 2.2 ± 0.5 (P warfarin patients (P = 0.243). The total vascular access site complications occurred in 6 (10.9%) heparin-bridging and one (1.8%) uninterrupted warfarin patients (P = 0.113). No patient developed either other bleeding or thromboembolic events during 7 days after CAG. We demonstrated that an uninterrupted warfarin strategy did not increase vascular access site complications in patients undergoing transfemoral CAG compared to heparin bridging therapy. Due to the safety and the ease of uninterrupted warfarin strategy, this approach should be encouraged in patients receiving long-term warfarin who undergo elective transfemoral CAG. © 2017, Wiley Periodicals, Inc.

  20. Acceleration of vascularized bone tissue-engineered constructs in a large animal model combining intrinsic and extrinsic vascularization.

    Science.gov (United States)

    Weigand, Annika; Beier, Justus P; Hess, Andreas; Gerber, Thomas; Arkudas, Andreas; Horch, Raymund E; Boos, Anja M

    2015-05-01

    During the last decades, a range of excellent and promising strategies in Bone Tissue Engineering have been developed. However, the remaining major problem is the lack of vascularization. In this study, extrinsic and intrinsic vascularization strategies were combined for acceleration of vascularization. For optimal biomechanical stability of the defect site and simplifying future transition into clinical application, a primary stable and approved nanostructured bone substitute in clinically relevant size was used. An arteriovenous (AV) loop was microsurgically created in sheep and implanted, together with the bone substitute, in either perforated titanium chambers (intrinsic/extrinsic) for different time intervals of up to 18 weeks or isolated Teflon(®) chambers (intrinsic) for 18 weeks. Over time, magnetic resonance imaging and micro-computed tomography (CT) analyses illustrate the dense vascularization arising from the AV loop. The bone substitute was completely interspersed with newly formed tissue after 12 weeks of intrinsic/extrinsic vascularization and after 18 weeks of intrinsic/extrinsic and intrinsic vascularization. Successful matrix change from an inorganic to an organic scaffold could be demonstrated in vascularized areas with scanning electron microscopy and energy dispersive X-ray spectroscopy. Using the intrinsic vascularization method only, the degradation of the scaffold and osteoclastic activity was significantly lower after 18 weeks, compared with 12 and 18 weeks in the combined intrinsic-extrinsic model. Immunohistochemical staining revealed an increase in bone tissue formation over time, without a difference between intrinsic/extrinsic and intrinsic vascularization after 18 weeks. This study presents the combination of extrinsic and intrinsic vascularization strategies for the generation of an axially vascularized bone substitute in clinically relevant size using a large animal model. The additional extrinsic vascularization promotes tissue

  1. Lifestyle and metabolic approaches to maximizing erectile and vascular health.

    Science.gov (United States)

    Meldrum, D R; Gambone, J C; Morris, M A; Esposito, K; Giugliano, D; Ignarro, L J

    2012-01-01

    Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient

  2. Amplatzer vascular plugs in congenital cardiovascular malformations

    International Nuclear Information System (INIS)

    Barwad, Parag; Ramakrishnan, Sivasubramanian; Kothari, Shyam S; Saxena, Anita; Gupta, Saurabh K; Juneja, Rajnish; Gulati, Gurpreet Singh; Jagia, Priya; Sharma, Sanjiv

    2013-01-01

    Amplatzer vascular plugs (AVPs) are devices ideally suited to close medium-to-large vascular communications. There is limited published literature regarding the utility of AVPs in congenital cardiovascular malformations (CCVMs). To describe the use of AVPs in different CCVMs and to evaluate their safety and efficacy. All patients who required an AVP for the closure of CCVM were included in this retrospective review of our catheterization laboratory data. The efficacy and safety of AVPs are reported. A total of 39 AVPs were implanted in 31 patients. Thirteen (33%) were AVP type I and 23 (59%) were AVP type II. AVP type III were implanted in two patients and type IV in one patient. The major indications for their use included closure of pulmonary arteriovenous malformation (AVM) (n = 7), aortopulmonary collaterals (n = 7), closure of a patent Blalock-Taussig shunt (n = 5), systemic AVM (n = 5), coronary AVM (n = 4), patent ductus arteriosus (PDA) (n = 3), pulmonary artery aneurysms (n = 3), and venovenous collaterals (n = 2). Deployment of the AVP was done predominantly via the 5 – 7F Judkin's right coronary guide catheter. Overall 92% of the AVPs could be successfully deployed and resulted in occlusion of the target vessel in all cases, within 10 minutes. No procedure-related or access site complication occurred. AVPs are versatile, easy to use, and effective devices to occlude the vascular communications in a variety of settings. AVP II is especially useful in the closure of tubular structures with a high flow

  3. Events and Effects

    DEFF Research Database (Denmark)

    Rytter, Mikkel

    2010-01-01

    Analyzing the period of ‘intensive transnationalism’ among Pakistani migrants in Denmark precipitated by the 2005 earthquake in Kashmir, this article explores the relationship between events and effects on a global scale. One significant initiative after the disaster was the founding of an ad hoc......, and national identity politics in Denmark. Despite the medical doctors’ efforts and intentions, the out- come was framed by 9/11, which has become the major critical event of the decade—one that has supported a developing cleavage between the Danish majority and Denmark’s Muslim immigrant minority....

  4. [The future of vascular medicine].

    Science.gov (United States)

    Kroeger, K; Luther, B

    2014-10-01

    In the future vascular medicine will still have a great impact on health of people. It should be noted that the aging of the population does not lead to a dramatic increase in patient numbers, but will be associated with a changing spectrum of co-morbidities. In addition, vascular medical research has to include the intensive care special features of vascular patients, the involvement of vascular medicine in a holistic concept of fast-track surgery, a geriatric-oriented intensive monitoring and early geriatric rehabilitation. For the future acceptance of vascular medicine as a separate subject area under delimitation of cardiology and radiology is important. On the other hand, the subject is so complex and will become more complex in future specialisations that mixing of surgery and angiology is desirable, with the aim to preserve the vascular surgical knowledge and skills on par with the medical and interventional measures and further develop them. Only large, interdisciplinary guided vascular centres will be able to provide timely diagnosis and therapy, to deal with the growing multi-morbidity of the patient, to perform complex therapies even in an acute emergency and due to sufficient number of cases to present with well-trained and experienced teams. These requirements are mandatory to decrease patients' mortality step by step. Georg Thieme Verlag KG Stuttgart · New York.

  5. Constructal vascularized structures

    Science.gov (United States)

    Cetkin, Erdal

    2015-06-01

    Smart features such as self-healing and selfcooling require bathing the entire volume with a coolant or/and healing agent. Bathing the entire volume is an example of point to area (or volume) flows. Point to area flows cover all the distributing and collecting kinds of flows, i.e. inhaling and exhaling, mining, river deltas, energy distribution, distribution of products on the landscape and so on. The flow resistances of a point to area flow can be decreased by changing the design with the guidance of the constructal law, which is the law of the design evolution in time. In this paper, how the flow resistances (heat, fluid and stress) can be decreased by using the constructal law is shown with examples. First, the validity of two assumptions is surveyed: using temperature independent Hess-Murray rule and using constant diameter ducts where the duct discharges fluid along its edge. Then, point to area types of flows are explained by illustrating the results of two examples: fluid networks and heating an area. Last, how the structures should be vascularized for cooling and mechanical strength is documented. This paper shows that flow resistances can be decreased by morphing the shape freely without any restrictions or generic algorithms.

  6. Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study

    DEFF Research Database (Denmark)

    Worm, Signe Westring; Sabin, Caroline; Weber, Rainer

    2010-01-01

    BACKGROUND. The risk of myocardial infarction (MI) in patients with human immunodeficiency virus (HIV) infection has been assessed in 13 anti-HIV drugs in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. METHODS. Poisson regression models were adjusted for cardiovascular risk...... factors, cohort, calendar year, and use of other antiretroviral drugs and assessed the association between MI risk and cumulative (per year) or recent (current or in the past 6 months) use of antiretroviral drugs, with >30,000 person-years of exposure. RESULTS. Over 178,835 person-years, 580 patients......% CI, 1.01-1.17], respectively) after adjustment for lipids but were not altered further after adjustment for other metabolic parameters. CONCLUSIONS. Of the drugs considered, only indinavir, lopinavir-ritonavir, didanosine, and abacavir were associated with a significantly increased risk of MI...

  7. Nitrogen accumulation and partitioning in a High Arctic tundra ecosystem from extreme atmospheric N deposition events

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Sonal, E-mail: S.Choudhary@sheffield.ac.uk [Department of Animal and Plant Sciences, University of Sheffield, Western Bank, Sheffield S10 2TN (United Kingdom); Management School, University of Sheffield, Conduit Road, Sheffield S10 1FL (United Kingdom); Blaud, Aimeric [Department of Animal and Plant Sciences, University of Sheffield, Western Bank, Sheffield S10 2TN (United Kingdom); Osborn, A. Mark [Department of Animal and Plant Sciences, University of Sheffield, Western Bank, Sheffield S10 2TN (United Kingdom); School of Applied Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083 (Australia); Press, Malcolm C. [School of Biosciences, University of Birmingham, Edgbaston, Birmingham B15 2TT (United Kingdom); Manchester Metropolitan University, Manchester, M15 6BH (United Kingdom); Phoenix, Gareth K. [Department of Animal and Plant Sciences, University of Sheffield, Western Bank, Sheffield S10 2TN (United Kingdom)

    2016-06-01

    Arctic ecosystems are threatened by pollution from recently detected extreme atmospheric nitrogen (N) deposition events in which up to 90% of the annual N deposition can occur in just a few days. We undertook the first assessment of the fate of N from extreme deposition in High Arctic tundra and are presenting the results from the whole ecosystem {sup 15}N labelling experiment. In 2010, we simulated N depositions at rates of 0, 0.04, 0.4 and 1.2 g N m{sup −2} yr{sup −1}, applied as {sup 15}NH{sub 4}{sup 15}NO{sub 3} in Svalbard (79{sup °}N), during the summer. Separate applications of {sup 15}NO{sub 3}{sup −} and {sup 15}NH{sub 4}{sup +} were also made to determine the importance of N form in their retention. More than 95% of the total {sup 15}N applied was recovered after one growing season (~ 90% after two), demonstrating a considerable capacity of Arctic tundra to retain N from these deposition events. Important sinks for the deposited N, regardless of its application rate or form, were non-vascular plants > vascular plants > organic soil > litter > mineral soil, suggesting that non-vascular plants could be the primary component of this ecosystem to undergo measurable changes due to N enrichment from extreme deposition events. Substantial retention of N by soil microbial biomass (70% and 39% of {sup 15}N in organic and mineral horizon, respectively) during the initial partitioning demonstrated their capacity to act as effective buffers for N leaching. Between the two N forms, vascular plants (Salix polaris) in particular showed difference in their N recovery, incorporating four times greater {sup 15}NO{sub 3}{sup −} than {sup 15}NH{sub 4}{sup +}, suggesting deposition rich in nitrate will impact them more. Overall, these findings show that despite the deposition rates being extreme in statistical terms, biologically they do not exceed the capacity of tundra to sequester pollutant N during the growing season. Therefore, current and future extreme events

  8. Nitrogen accumulation and partitioning in a High Arctic tundra ecosystem from extreme atmospheric N deposition events

    International Nuclear Information System (INIS)

    Choudhary, Sonal; Blaud, Aimeric; Osborn, A. Mark; Press, Malcolm C.; Phoenix, Gareth K.

    2016-01-01

    Arctic ecosystems are threatened by pollution from recently detected extreme atmospheric nitrogen (N) deposition events in which up to 90% of the annual N deposition can occur in just a few days. We undertook the first assessment of the fate of N from extreme deposition in High Arctic tundra and are presenting the results from the whole ecosystem "1"5N labelling experiment. In 2010, we simulated N depositions at rates of 0, 0.04, 0.4 and 1.2 g N m"−"2 yr"−"1, applied as "1"5NH_4"1"5NO_3 in Svalbard (79"°N), during the summer. Separate applications of "1"5NO_3"− and "1"5NH_4"+ were also made to determine the importance of N form in their retention. More than 95% of the total "1"5N applied was recovered after one growing season (~ 90% after two), demonstrating a considerable capacity of Arctic tundra to retain N from these deposition events. Important sinks for the deposited N, regardless of its application rate or form, were non-vascular plants > vascular plants > organic soil > litter > mineral soil, suggesting that non-vascular plants could be the primary component of this ecosystem to undergo measurable changes due to N enrichment from extreme deposition events. Substantial retention of N by soil microbial biomass (70% and 39% of "1"5N in organic and mineral horizon, respectively) during the initial partitioning demonstrated their capacity to act as effective buffers for N leaching. Between the two N forms, vascular plants (Salix polaris) in particular showed difference in their N recovery, incorporating four times greater "1"5NO_3"− than "1"5NH_4"+, suggesting deposition rich in nitrate will impact them more. Overall, these findings show that despite the deposition rates being extreme in statistical terms, biologically they do not exceed the capacity of tundra to sequester pollutant N during the growing season. Therefore, current and future extreme events may represent a major source of eutrophication. - Highlights: • High Arctic tundra demonstrated a

  9. Diabetes and Retinal Vascular Dysfunction

    Directory of Open Access Journals (Sweden)

    Eui Seok Shin

    2014-01-01

    Full Text Available Diabetes predominantly affects the microvascular circulation of the retina resulting in a range of structural changes unique to this tissue. These changes ultimately lead to altered permeability, hyperproliferation of endothelial cells and edema, and abnormal vascularization of the retina with resulting loss of vision. Enhanced production of inflammatory mediators and oxidative stress are primary insults with significant contribution to the pathogenesis of diabetic retinopathy (DR. We have determined the identity of the retinal vascular cells affected by hyperglycemia, and have delineated the cell autonomous impact of high glucose on function of these cells. We discuss some of the high glucose specific changes in retinal vascular cells and their contribution to retinal vascular dysfunction. This knowledge provides novel insight into the molecular and cellular defects contributing to the development and progression of diabetic retinopathy, and will aid in the development of innovative, as well as target specific therapeutic approaches for prevention and treatment of DR.

  10. Vascular graft infections with Mycoplasma

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Skov Jensen, J; Prag, J

    1995-01-01

    laboratory techniques, the percentage of culture-negative yet grossly infected vascular grafts seems to be increasing and is not adequately explained by the prior use of antibiotics. We have recently reported the first case of aortic graft infection with Mycoplasma. We therefore suggest the hypothesis...... that the large number of culture-negative yet grossly infected vascular grafts may be due to Mycoplasma infection not detected with conventional laboratory technique....

  11. Limb vascular function in women

    DEFF Research Database (Denmark)

    Hellsten, Ylva; Gliemann, Lasse

    2018-01-01

    Throughout life, women are subjected to both acute fluctuations in sex hormones, associated with the menstrual cycle, and chronic changes following the onset of menopause. Female sex hormones, and in particular estrogen, strongly influence cardiovascular function such as the regulation of vascular...... studies. Physical activity should be recommended for women of all ages, but the most essential timing for maintenance of vascular health may be from menopause and onwards....

  12. Angiogenesis, Cancer, and Vascular Aging

    Directory of Open Access Journals (Sweden)

    Junji Moriya

    2017-10-01

    Full Text Available Several lines of evidence have revealed that the angiogenic response to ischemic injury declines with age, which might account for the increased morbidity and mortality of cardiovascular disease (CVD among the elderly. While impairment of angiogenesis with aging leads to delayed wound healing or exacerbation of atherosclerotic ischemic diseases, it also inhibits the progression of cancer. Age-related changes of angiogenesis have been considered to at least partly result from vascular aging or endothelial cell senescence. There is considerable evidence supporting the hypothesis that vascular cell senescence contributes to the pathogenesis of age-related CVD, suggesting that vascular aging could be an important therapeutic target. Since therapeutic angiogenesis is now regarded as a promising concept for patients with ischemic CVD, it has become even more important to understand the detailed molecular mechanisms underlying impairment of angiogenesis in older patients. To improve the usefulness of therapeutic angiogenesis, approaches are needed that can compensate for impaired angiogenic capacity in the elderly while not promoting the development or progression of malignancy. In this review, we briefly outline the mechanisms of angiogenesis and vascular aging, followed by a description of how vascular aging leads to impairment of angiogenesis. We also examine potential therapeutic approaches that could enhance angiogenesis and/or vascular function in the elderly, as well as discussing the possibility of anti-senescence therapy or reversal of endothelial cell senescence.

  13. Selective cyclooxygenase-1 inhibition improves collateral vascular reactivity in biliary cirrhotic rats

    Directory of Open Access Journals (Sweden)

    Ching-Chih Chang

    2013-10-01

    Conclusion: There was no significant hemodynamic change and renal toxicity after acute administration of COX inhibitor in the FBDL-induced cirrhotic rats. Preincubation of selective COX-1, but not COX-2, inhibitor could enhance collateral vascular response to AVP, indicating that COX-1 plays a major role in the collateral vascular reactivity.

  14. Clinical application of the amplatzer vascular plug in the embolization of vascular malformations associated with congenital heart diseasee

    International Nuclear Information System (INIS)

    Pan Xin; Wang Cheng; Lu Jing; Wu Weihua; Fang Weiyi

    2009-01-01

    Objective: To evaluate the clinical efficacy of percutaneous transcatheter embolization by using Amplatzer vascular plug (AVP) for the treatment of vascular malformations associated with congenital heart diseases. Methods: During the period of June 2006-June 2008, 12 patients with congenital heart disease accompanied by vascular malformations received transcatheter occlusion of the anomalous vessels with AVP. The vascular malformations included solitary or multiple saccular pulmonary arteriovenous malformation (n = 7), coronary artery fistula (n = 2) and major aortopulmonary collaterals concomitant with severe Fallot' s tetralogy (n = 3). All patients were screened with transthoracic echocardiography (TTE) and thoracic CT angiography (CTA), and all the diagnoses were confirmed by routine cardioangiography. Results: Transcatheter occlusion of vascular malformations with AVP was successfully accomplished in all 12 patients. An angiographic check immediately after the procedure showed that complete occlusion was obtained in all patients and no embolism,migration or residual shunt were seen. Sixteen anomalous vessels were occluded. The mean internal diameter of these vessels was (5.2 ± 1.9) mm,while the mean diameter of AVP used was (9.2 ± 2.4) mm. After the operation (mean 3 months), the follow-up echocardiography and/or thoracic CT angiography showed that in all patients the occlusion remained in satisfactory condition and no residual shunt was found. Conclusions: Percutaneous transcatheter closure of congenital vascular malformations with AVP is technically feasible and clinically effective, this treatment can markedly improve patient's living quality and it is well worth extending its clinical application. (authors)

  15. Upcoming Events

    Science.gov (United States)

    Electrical Engineering Instructional Laboratories Student Resources Industrial & Manufacturing Engineering Industrial & Manufacturing Engineering Academic Programs Industrial & Manufacturing Engineering Major Industrial & Manufacturing Engineering Minor Industrial & Manufacturing Engineering

  16. Rotationplasty with vascular reconstruction for prosthetic knee joint infection.

    Science.gov (United States)

    Fujiki, Masahide; Miyamoto, Shimpei; Nakatani, Fumihiko; Kawai, Akira; Sakuraba, Minoru

    2015-01-01

    Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.

  17. The plant vascular system: Evolution, development and functions

    Science.gov (United States)

    William J. Lucas; Andrew Groover; Raffael Lichtenberger; Kaori Furuta; Shri-Ram Yadav; Yka Helariutta; Xin-Qiang He; Hiroo Fukuda; Julie Kang; Siobhan M. Brady; John W. Patrick; John Sperry; Akiko Yoshida; Ana-Flor Lopez-Millan; Michael A. Grusak; Pradeep Kachroo

    2013-01-01

    The emergence of the tracheophyte-based vascular system of land plants had major impacts on the evolution of terrestrial biology, in general, through its role in facilitating the development of plants with increased stature, photosynthetic output, and ability to colonize a greatly expanded range of environmental habitats. Recently, considerable progress has been made...

  18. Response of local vasc