2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

Ambition Giveth and Ambition Taketh Away: The Life of Napoleon

In this ambitious essay, Clayton Cardinal cogently argues that ambition helps explain both the rise and fall of a man who gave his name to an entire age: Napoleon. Having himself at an early age derided ambition, Napoleon soon came to self-consciously embody it, comparing himself favorably to, as Cardinal shows, “an Olympic athlete,” “a shooting star,” and “the envoy of the Grand Nation,” France. Napoleon’s desire to create what he called an “empire of the world,” however, ultimately to led to his ruin. Throughout the essay, Cardinal demonstrates strong command of the sources, which are interpreted with sophistication and nuance and seamlessly incorporated into the prose. Thanks to its clarity and concision, the writing is a pleasure to read

Recent advances in isotopes as palaeolimnological proxies

Isotope geochemistry is an essential part of environmental and climate change research and over the last few decades has contributed significantly to our understanding of a huge array of environmental problems, not least in palaeolimnology and limnogeology. Here we describe some of the recent developments in the use of stable isotopes in palaeo-lake research. These are: better preparation, analysis, and interpretation of biogenic silica oxygen and silicon isotopes; extraction and characterisation of specific compounds such as leaf waxes and algal lipids for isotope analysis; determining the excess of 13C–18O bonds in clumped isotopes; and the measurement of multiple isotope ratios in chironomid chitin. These advances have exciting prospects and it will be interesting to see how these techniques develop further and consequently offer a real advancement in our science over the next decade

Angiotensin II Type 1 receptor antibodies are associated with inflammatory cytokines and poor clinical outcomes in pediatric kidney transplantation

Angiotensin II type 1 receptor (AT1R) antibody has been linked to poor allograft outcomes in adult kidney transplantation. However, its clinical consequences in children are unknown. To study this, we examined the relationship of AT1R antibody with clinical outcomes, biopsy findings, inflammatory cytokines, and HLA donor-specific antibodies (DSA) in a cohort of pediatric renal transplant recipients. Sixty-five patients were longitudinally monitored for AT1R antibody, HLA DSA, IL-8, TNF-α, IL-1β, IFN-γ, IL-17, and IL-6, renal dysfunction, hypertension, rejection, and allograft loss during the first two years post transplantation. AT1R antibody was positive in 38 of the 65 of children but was not associated with HLA DSA. AT1R antibody was associated with renal allograft loss (odds ratio of 13.1 [95% confidence interval 1.48-1728]), the presence of glomerulitis or arteritis, and significantly higher TNF-α, IL-1β, and IL-8 levels, but not rejection or hypertension. AT1R antibody was associated with significantly greater declines in eGFR in patients both with and without rejection. Furthermore, in patients without rejection, AT1R antibody was a significant risk factor for worsening eGFR over the two-year follow-up period. Thus, AT1R antibody is associated with vascular inflammation in the allograft, progressive decline in eGFR, and allograft loss. AT1R antibody and inflammatory cytokines may identify those at risk for renal vascular inflammation and lead to early biopsy and intervention in pediatric kidney transplantation

Necrotizing fasciitis: a surgical emergency

none5Accurate assessment and timely interventions are critical in the treatment of patients affected with necrotizing fasciitis, a rare, fulminating, potentially life-threatening, infectious process of the soft tissues. Understanding the natural history and unique characteristics of this disease is crucial to achieve early recognition, effective management and a favorable patient outcome. Classic symptoms include severe pain, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, bullous formations and edema in the affected area and fever. This article aims at reviewing the information known about this disease, collected from various sources. Radical surgical debridement, broad-spectrum antibiotics, negative pressure wound therapy and hyperbaric oxygen therapy are considered to be the cornerstones of treatment.mixedD. de Tullio; C. Rossi; S. Bolzon; L. Scagliarini; S. OcchionorelliDE TULLIO, Damiano; Rossi, Camilla; Bolzon, Stefano; Scagliarini, Lucia; Occhionorelli, Savin