1,210 research outputs found
Rapid accelerations of Antarctic Peninsula outlet glaciers driven by surface melt
Atmospheric warming is increasing surface melting across the Antarctic Peninsula, with unknown impacts upon glacier dynamics at the ice-bed interface. Using high-resolution satellite-derived ice velocity data, optical satellite imagery and regional climate modelling, we show that drainage of surface meltwater to the bed of outlet glaciers on the Antarctic Peninsula occurs and triggers rapid ice flow accelerations (up to 100% greater than the annual mean). This provides a mechanism for this sector of the Antarctic Ice Sheet to respond rapidly to atmospheric warming. We infer that delivery of water to the bed transiently increases basal water pressure, enhancing basal motion, but efficient evacuation subsequently reduces water pressure causing ice deceleration. Currently, melt events are sporadic, so efficient subglacial drainage cannot be maintained, resulting in multiple short-lived (< 6 day) ice flow perturbations. Future increases in meltwater could induce a shift in glacier dynamic regime, characterised by seasonal-scale ice flow variations
Rolofylline, an adenosine A1−receptor antagonist, in acute heart failure
Background:
Worsening renal function, which is associated with adverse outcomes, often develops
in patients with acute heart failure. Experimental and clinical studies suggest that
counterregulatory responses mediated by adenosine may be involved. We tested the
hypothesis that the use of rolofylline, an adenosine A1−receptor antagonist, would
improve dyspnea, reduce the risk of worsening renal function, and lead to a more
favorable clinical course in patients with acute heart failure.
Methods:
We conducted a multicenter, double-blind, placebo-controlled trial involving patients
hospitalized for acute heart failure with impaired renal function. Within 24 hours
after presentation, 2033 patients were randomly assigned, in a 2:1 ratio, to receive
daily intravenous rolofylline (30 mg) or placebo for up to 3 days. The primary end
point was treatment success, treatment failure, or no change in the patient’s clinical
condition; this end point was defined according to survival, heart-failure status,
and changes in renal function. Secondary end points were the post-treatment development
of persistent renal impairment and the 60-day rate of death or readmission
for cardiovascular or renal causes.
Results:
Rolofylline, as compared with placebo, did not provide a benefit with respect to the
primary end point (odds ratio, 0.92; 95% confidence interval, 0.78 to 1.09; P=0.35).
Persistent renal impairment developed in 15.0% of patients in the rolofylline group
and in 13.7% of patients in the placebo group (P=0.44). By 60 days, death or readmission
for cardiovascular or renal causes had occurred in similar proportions of patients
assigned to rolofylline and placebo (30.7% and 31.9%, respectively; P=0.86).
Adverse-event rates were similar overall; however, only patients in the rolofylline
group had seizures, a known potential adverse effect of A1-receptor antagonists.
Conclusions:
Rolofylline did not have a favorable effect with respect to the primary clinical composite
end point, nor did it improve renal function or 60-day outcomes. It does not
show promise in the treatment of acute heart failure with renal dysfunction. (Funded
by NovaCardia, a subsidiary of Merck; ClinicalTrials.gov numbers, NCT00328692
and NCT00354458.
A combined clinical and biomarker approach to predict diuretic response in acute heart failure
Background:
Poor diuretic response in acute heart failure is related to poor clinical outcome. The underlying mechanisms and pathophysiology behind diuretic resistance are incompletely understood. We evaluated a combined approach using clinical characteristics and biomarkers to predict diuretic response in acute heart failure (AHF).
Methods and results:
We investigated explanatory and predictive models for diuretic response—weight loss at day 4 per 40 mg of furosemide—in 974 patients with AHF included in the PROTECT trial. Biomarkers, addressing multiple pathophysiological pathways, were determined at baseline and after 24 h. An explanatory baseline biomarker model of a poor diuretic response included low potassium, chloride, hemoglobin, myeloperoxidase, and high blood urea nitrogen, albumin, triglycerides, ST2 and neutrophil gelatinase-associated lipocalin (r2 = 0.086). Diuretic response after 24 h (early diuretic response) was a strong predictor of diuretic response (β = 0.467, P < 0.001; r2 = 0.523). Addition of diuretic response after 24 h to biomarkers and clinical characteristics significantly improved the predictive model (r2 = 0.586, P < 0.001).
Conclusions:
Biomarkers indicate that diuretic unresponsiveness is associated with an atherosclerotic profile with abnormal renal function and electrolytes. However, predicting diuretic response is difficult and biomarkers have limited additive value. Patients at risk of poor diuretic response can be identified by measuring early diuretic response after 24 h
A network analysis to compare biomarker profiles in patients with and without diabetes mellitus in acute heart failure
Aims:
It is unclear whether distinct pathophysiological processes are present among patients with acute heart failure (AHF), with and without diabetes. Network analysis of biomarkers may identify correlative associations that reflect different pathophysiological pathways.
Methods and results:
We analysed a panel of 48 circulating biomarkers measured within 24 h of admission for AHF in a subset of patients enrolled in the PROTECT trial. In patients with and without diabetes, we performed a network analysis to identify correlations between measured biomarkers. Compared with patients without diabetes (n = 1111), those with diabetes (n = 922) had a higher prevalence of ischaemic heart disease and traditional coronary risk factors. After multivariable adjustment, patients with and without diabetes had significantly different levels of biomarkers across a spectrum of pathophysiological domains, including inflammation (TNFR-1a, periostin), cardiomyocyte stretch (BNP), angiogenesis (VEGFR, angiogenin), and renal function (NGAL, KIM-1) (adjusted P-value <0.05). Among patients with diabetes, network analysis revealed that periostin strongly clustered with C-reactive protein and interleukin-6. Furthermore, renal markers (creatinine and NGAL) closely associated with potassium and glucose. These findings were not seen among patients without diabetes.
Conclusion:
Patients with AHF and diabetes, compared with those without diabetes, have distinct biomarker profiles. Network analysis suggests that cardiac remodelling, inflammation, and fibrosis are closely associated with each other in patients with diabetes. Furthermore, potassium levels may be sensitive to changes in renal function as reflected by the strong renal–potassium–glucose correlation. These findings were not seen among patients without diabetes and may suggest distinct pathophysiological processes among AHF patients with diabetes
Biomarker profiles of acute heart failure patients with a mid-range ejection fraction
OBJECTIVES:
In this study, the authors used biomarker profiles to characterize differences between patients with acute heart failure with a midrange ejection fraction (HFmrEF) and compare them with patients with a reduced (heart failure with a reduced ejection fraction [HFrEF]) and preserved (heart failure with a preserved ejection fraction [HFpEF]) ejection fraction.
BACKGROUND:
Limited data are available on biomarker profiles in acute HFmrEF.
METHODS:
A panel of 37 biomarkers from different pathophysiological domains (e.g., myocardial stretch, inflammation, angiogenesis, oxidative stress, hematopoiesis) were measured at admission and after 24 h in 843 acute heart failure patients from the PROTECT trial. HFpEF was defined as left ventricular ejection fraction (LVEF) of ≥50% (n = 108), HFrEF as LVEF of <40% (n = 607), and HFmrEF as LVEF of 40% to 49% (n = 128).
RESULTS:
Hemoglobin and brain natriuretic peptide levels (300 pg/ml [HFpEF]; 397 pg/ml [HFmrEF]; 521 pg/ml [HFrEF]; ptrend <0.001) showed an upward trend with decreasing LVEF. Network analysis showed that in HFrEF interactions between biomarkers were mostly related to cardiac stretch, whereas in HFpEF, biomarker interactions were mostly related to inflammation. In HFmrEF, biomarker interactions were both related to inflammation and cardiac stretch. In HFpEF and HFmrEF (but not in HFrEF), remodeling markers at admission and changes in levels of inflammatory markers across the first 24 h were predictive for all-cause mortality and rehospitalization at 60 days (pinteraction <0.05).
CONCLUSIONS:
Biomarker profiles in patients with acute HFrEF were mainly related to cardiac stretch and in HFpEF related to inflammation. Patients with HFmrEF showed an intermediate biomarker profile with biomarker interactions between both cardiac stretch and inflammation markers. (PROTECT-1: A Study of the Selective A1 Adenosine Receptor Antagonist KW-3902 for Patients Hospitalized With Acute HF and Volume Overload to Assess Treatment Effect on Congestion and Renal Function; NCT00328692)
Serum potassium levels and outcome in acute heart failure (data from the PROTECT and COACH trials)
Serum potassium is routinely measured at admission for acute heart failure (AHF), but
information on association with clinical variables and prognosis is limited. Potassium
measurements at admission were available in 1,867 patients with AHF in the original cohort
of 2,033 patients included in the Patients Hospitalized with acute heart failure and Volume
Overload to Assess Treatment Effect on Congestion and Renal FuncTion trial. Patients
were grouped according to low potassium (<3.5 mEq/l), normal potassium (3.5 to 5.0 mEq/l),
and high potassium (>5.0 mEq/l) levels. Results were verified in a validation cohort of 1,023
patients. Mean age of patients was 71 – 11 years, and 66% were men. Low potassium was
present in 115 patients (6%), normal potassium in 1,576 (84%), and high potassium in 176
(9%). Potassium levels increased during hospitalization (0.18 – 0.69 mEq/l). Patients with
high potassium more often used angiotensin-converting enzyme inhibitors and mineralocorticoid
receptor antagonists before admission, had impaired baseline renal function and a
better diuretic response (p [ 0.005), independent of mineralocorticoid receptor antagonist
usage. During 180-day follow-up, a total of 330 patients (18%) died. Potassium levels at
admission showed a univariate linear association with mortality (hazard ratio [log] 2.36,
95% confidence interval 1.07 to 5.23; p [ 0.034) but not after multivariate adjustment.
Changes of potassium levels during hospitalization or potassium levels at discharge were
not associated with outcome after multivariate analysis. Results in the validation cohort
were similar to the index cohort. In conclusion, high potassium levels at admission are
associated with an impaired renal function but a better diuretic response. Changes in potassium
levels are common, and overall levels increase during hospitalization. In conclusion,
potassium levels at admission or its change during hospitalization are not associated
with mortality after multivariate adjustment
Genome-Wide Fitness Test and Mechanism-of-Action Studies of Inhibitory Compounds in Candida albicans
Candida albicans is a prevalent fungal pathogen amongst the immunocompromised population, causing both superficial and life-threatening infections. Since C. albicans is diploid, classical transmission genetics can not be performed to study specific aspects of its biology and pathogenesis. Here, we exploit the diploid status of C. albicans by constructing a library of 2,868 heterozygous deletion mutants and screening this collection using 35 known or novel compounds to survey chemically induced haploinsufficiency in the pathogen. In this reverse genetic assay termed the fitness test, genes related to the mechanism of action of the probe compounds are clearly identified, supporting their functional roles and genetic interactions. In this report, chemical–genetic relationships are provided for multiple FDA-approved antifungal drugs (fluconazole, voriconazole, caspofungin, 5-fluorocytosine, and amphotericin B) as well as additional compounds targeting ergosterol, fatty acid and sphingolipid biosynthesis, microtubules, actin, secretion, rRNA processing, translation, glycosylation, and protein folding mechanisms. We also demonstrate how chemically induced haploinsufficiency profiles can be used to identify the mechanism of action of novel antifungal agents, thereby illustrating the potential utility of this approach to antifungal drug discovery
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ECONOMIC EVALUATION OF CO2 STORAGE AND SINK ENHANCEMENT OPTIONS
This project developed life-cycle costs for the major technologies and practices under development for CO{sub 2} storage and sink enhancement. The technologies evaluated included options for storing captured CO{sub 2} in active oil reservoirs, depleted oil and gas reservoirs, deep aquifers, coal beds, and oceans, as well as the enhancement of carbon sequestration in forests and croplands. The capture costs for a nominal 500 MW{sub e} integrated gasification combined cycle plant from an earlier study were combined with the storage costs from this study to allow comparison among capture and storage approaches as well as sink enhancements
Diagnosis of Historical and Future Flow Regimes of the Bow River at Calgary Using a Dynamically Downscaled Climate Model and a Physically Based Land Surface Hydrological Model : Final Report
Final Report developed under Agreement #AP744 for the Natural Resources Canada Climate Change Adaptation Program.Developed under Agreement #AP744 for the Natural Resources Canada Climate Change Adaptation Program, with financial and in-kind assistance from Natural
Resources Canada, Alberta Environment and Parks, the City of Calgary, Environment and
Climate Change Canada and the Global Water Futures program.Non-Peer ReviewedThis report assesses the impacts of projected climate change on the hydrology, including the
flood frequencies, of the Bow and Elbow Rivers above Calgary, Alberta. It reports on
investigations of the effects of projected climate change on the runoff mechanisms for the Bow
and Elbow River basins, which are important mountain headwaters in Alberta, Canada. The study developed a methodology and applied a case study for incorporating climate change into flood frequency estimates that can be applied to a variety of river basins across Canada
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