The impact of type 2 diabetes and Microalbuminuria on future cardiovascular events in patients with clinically manifest vascular disease from the Second Manifestations of ARTerial Disease (SMART) study

Aims Type 2 diabetes mellitus and microalbuminuria are important risk factors for cardiovascular disease (CVD). Whether these two complications are important and independent risk factors for future CVD events in a high-risk population with clinically manifest vascular disease is unknown. The objectives of this study were to examine the impact of Type 2 diabetes and microalbuminuria on future CVD events. Methods Patients with clinically manifest vascular disease (coronary, cerebral and peripheral vascular disease) from the Second Manifestation of Arterial disease study were followed up for 4 years. Data obtained from 1996–2006 were analysed. At baseline, there were 804 patients with Type 2 diabetes mellitus (mean age 60 years) and 2983 patients without. Incident CVD (n = 458) was defined as hospital-verified myocardial infarction, stroke, vascular death and the composite of these vascular events. Results Both Type 2 diabetes [hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.16, 1.75] and microalbuminuria (HR 1.86, 95% CI 1.49, 2.33) increased the risk of new cardiovascular events in univariate analyses. From multivariable models, presence of diabetes remained significantly and independently related to incident CVD (HR 1.42, 95% CI 1.11, 1.80). Presence of microalbuminuria also remained significantly independently related to incident CVD (HR 1.38, 95% CI 1.07, 1.77). In diabetes-stratified analyses, the effect of microalbuminuria on CVD risk was observed only in patients with diabetes. In microalbuminuria-stratified analyses, the significant and independent effect of diabetes on CVD risk was shown only in the non-microalbuminuric group. Conclusions In this high-risk population, both microalbuminuria and Type 2 diabetes are important and independent risk factors for future CV

L-Band MMICs for Space-based SAR system

The design and performance of an L-Band GaAs chip-set is presented.The chip-set consists of a 6-bit attenuator circuit,a Low-Noise Amplifier (LNA)and a Multi Function Chip that is the combination of a 6-bit attenuator and 6-bit Phase shifter circuit.The chip-set is developed for the pre-flight engineering T/R (Transmit and Receive)modules currently in development with Astrium in a space-based SAR (Synthetic Aperture Radar)system.The MMICs are realised in the 0.25 µm PHEMT (PH25)technology of UMS.Only one iteration was needed for the MMICs in order to be fully compliant with the specifications

Are Dutch Skylarks partial migrants? Ring recovery data and radio-telemetry suggest local coexistence of contrasting migration strategies

In recent years, Skylarks Alauda arvensis have undergone dramatic population declines in many European countries. Evidence exists for deteriorating conditions during the breeding season, but little is known about the situation during the rest of the annual cycle. Here we use two approaches to test if the Dutch breeding population of Skylarks consists of resident and/or migratory individuals. First, we present an analysis of ring recoveries from the Dutch Ringing Centre "Vogeltrekstation". Out of 25 recoveries, 12 Skylarks were resident in winter, 10 migrated and three were classified as probable migrants. Resident birds were accompanied during winter by birds from northern and eastern Europe. Very limited natal and breeding dispersal recorded in the same dataset suggests that our results were not influenced by long dispersal distances. Next, we compared these results to a local radio-telemetry study in the northern Netherlands. During two different years we equipped a total of 27 Skylarks from a breeding population with radio-transmitters and followed them during the subsequent winter. Four birds were found to winter locally. Out of 23 individuals that we did not find in winter, 14 returned in the following breeding season to the study area, all with a working transmitter, suggesting that they wintered outside our study area. Two ring recoveries of birds from the same study population indeed showed migration to south-west Europe. Based on these two lines of evidence, we conclude local coexistence of a resident and a migrant strategy in Dutch Skylarks. The findings of our study are important for the planning of conservation efforts, as we can only protect this rapidly declining species when we know their behaviour and whereabouts throughout the entire annual cycle

Proton radiography to improve proton radiotherapy: Simulation study at different proton beam energies

To improve the quality of cancer treatment with protons, a translation of X-ray Computed Tomography (CT) images into a map of the proton stopping powers needs to be more accurate. Proton stopping powers determined from CT images have systematic uncertainties in the calculated proton range in a patient of typically 3-4\% and even up to 10\% in region containing bone~\cite{USchneider1995,USchneider1996,WSchneider2000,GCirrone2007,HPaganetti2012,TPlautz2014,GLandry2013,JSchuemann2014}. As a consequence, part of a tumor may receive no dose, or a very high dose can be delivered in healthy ti\-ssues and organs at risks~(e.g. brain stem)~\cite{ACKnopf2013}. A transmission radiograph of high-energy protons measuring proton stopping powers directly will allow to reduce these uncertainties, and thus improve the quality of treatment. The best way to obtain a sufficiently accurate radiograph is by tracking individual protons traversing the phantom (patient)~\cite{GCirrone2007,TPlautz2014,VSipala2013}. In our simulations we have used an ideal position sensitive detectors measuring a single proton before and after a phantom, while the residual energy of a proton was detected by a BaF$_{2}$ crystal. To obtain transmission radiographs, diffe\-rent phantom materials have been irradiated with a 3x3~cm$^{2}$ scattered proton beam, with various beam energies. The simulations were done using the Geant4 simulation package~\cite{SAgostinelli2003}. In this study we focus on the simulations of the energy loss radiographs for various proton beam energies that are clinically available in proton radiotherapy.Comment: 6 pages, 6 figures, Presented at Jagiellonian Symposium on Fundamental and Applied Subatomic Physics, 7-12 June, 2015, Krak\'ow, Polan

Whole genome sequence analysis indicates recent diversification of mammal-associated Campylobacter fetus and implicates a genetic factor associated with H2S production

cknowledgements We like to thank Emma Yee (U.S. Department of Agriculture) for the generation of sequence data, we thank James Bono (U.S. Department of Agriculture) for the generation of PacBio RS reads and thank Dr. Brian Brooks and Dr. John Devenish (Canadian Food Inspection Agency) for providing C. fetus strains and for critical review of this manuscript. Funding Publication charges for this article have been funded by Utrecht University, the Netherlands.Peer reviewedPublisher PD

How Should the Precautionary Principle Apply to Pregnant Women in Clinical Research?

The precautionary principle is often invoked in relation to pregnant women and may be one of the underlying reasons for their continuous underrepresentation in clinical research. The principle is appealing, because potential fetal harm as a result of research participation is considered to be serious and irreversible. In our paper, we explore through conceptual analysis whether and if so how the precautionary principle should apply to pregnant women. We argue that the principle is a decision-making strategy underlying risk-benefit decisions in clinical research, which can be applied to pregnant women. However, the current application is a strong one, leading to the promotion of absolute exclusion or, less often, absolute inclusion of pregnant women. In order to change this paralyzing situation, a shift toward weak precautionary thinking is necessary. Instead of automatic extreme precaution, a balance will be found between harms and potential benefits of including pregnant women in clinical research

Clinical trials in desmoid-type fibromatosis in children and adults:A systematic review

Desmoid-type fibromatosis (DTF) is a rare locally aggressive soft tissue neoplasm, which occurs in children and adults, with a peak incidence in young adults. For the majority of the patients, DTF is a chronic and symptomatic disease, which affects health-related quality of life. Systemic treatment regimens tend to differ for patients treated by pediatric oncologists compared to medical oncologists. This systematic review identified 14 clinical trials in children and adults with DTF. Tumor response and progression-free survival rates varied widely between studies and study populations. Treatment choices for patients with DTF are based on a paucity of (randomized) trials. Treatment principles of DTF are similar in pediatric and adult oncology, but the treatment itself is different. This seems mostly driven by a lack of tyrosine kinase inhibitor (TKI) accessibility in pediatric oncology. An insufficient number of studies examined patient-reported outcomes, which are extremely important for patients with a chronic disease like DTF.</p

Campylobacter fetus Subspecies Contain Conserved Type IV Secretion Systems on Multiple Genomic Islands and Plasmids

Acknowledgments We like to thank Dr. John Devenish and Dr. Brian Brooks (Canadian Food Inspection Agency) for providing strains. We thank Nathaniel Simon and Mary Chapman for the generation of Illumina MiSeq reads and we thank James Bono for the generation of PacBio RS reads. Funding: The authors have no support or funding to report.Peer reviewedPublisher PD