Atrial fibrillation in a primary care practice: prevalence and management

BACKGROUND: Atrial fibrillation is a common serious cardiac arrhythmia. Knowing the prevalence of atrial fibrillation and documentation of medical management are important in the provision of primary care. This study sought to determine the prevalence of atrial fibrillation in a primary care population and to identify and quantify the treatments being used for stroke prevention in this group of patients. METHODS: A prevalence study through chart audit was conducted in the family medicine practice at the Sunnybrook campus of the Sunnybrook and Women's College Health Sciences Centre. The main outcome measures were the prevalence of atrial fibrillation in our primary care practice and the use of warfarin for stroke prevention in this population. RESULTS: 261 patients in our practice have atrial fibrillation. The overall prevalence in our family practice unit is 3.9%. When considering patients aged 60 and over, the prevalence rises to 12.2%. 204 of our patients with atrial fibrillation (78.2%) are currently being treated with warfarin. Another 21 patients were previously treated and discontinued for a number of reasons. Of the 57 patients not currently treated with warfarin, 44 are treated with ASA, 2 with ticlopidine, and 11 are receiving no preventative treatment. CONCLUSIONS: The prevalence of atrial fibrillation in our practice is higher than the range of prevalence reported in the general literature. However, our coverage with warfarin treatment exceeds previous reports in the literature

Nonthermal Emission from Star-Forming Galaxies

The detections of high-energy gamma-ray emission from the nearby starburst galaxies M82 & NGC253, and other local group galaxies, broaden our knowledge of star-driven nonthermal processes and phenomena in non-AGN star-forming galaxies. We review basic aspects of the related processes and their modeling in starburst galaxies. Since these processes involve both energetic electrons and protons accelerated by SN shocks, their respective radiative yields can be used to explore the SN-particle-radiation connection. Specifically, the relation between SN activity, energetic particles, and their radiative yields, is assessed through respective measures of the particle energy density in several star-forming galaxies. The deduced energy densities range from O(0.1) eV/cm^3 in very quiet environments to O(100) eV/cm^3 in regions with very high star-formation rates.Comment: 17 pages, 5 figures, to be published in Astrophysics and Space Science Proceeding

Assessment of a fragment of e-cadherin as a serum biomarker with predictive value for prostate cancer

In prostate cancer, biomarkers may provide additional value above standard clinical and pathology parameters to predict outcome after specific therapy. The purpose of this study is to evaluate an 80 kDa fragment of the cell adhesion molecule e-cadherin as a serum biomarker. A broad spectrum of prostate cancer serum samples, representing different stages of prostate cancer disease, including benign prostatic hyperplasia (BPH), localised (Loc PCA) and metastatic prostate cancer (Met PCA), was examined for the cleaved product. There is a significant difference in the expression level of the 80 kDa fragment in the serum of healthy individuals vs patients with BPH and between BPH vs Loc PCA and Met PCA (P<0.001). Highest expression levels are observed in advanced metastatic disease. In the cohort of Loc PCA cases, there was no association between the 80 kDa serum concentration and clinical parameters. Interestingly, patients with an 80 kDa level of >7.9 μg l−1 at the time of diagnosis have a 55-fold higher risk of biochemical failure after surgery compared to those with lower levels. This is the first report of the application of an 80 kDa fragment of e-cadherin as a serum biomarker in a broad spectrum of prostate cancer cases. At an optimised cutoff, high expression at the time of diagnosis is associated with a significantly increased risk of biochemical failure, potentially supporting its use for a tailored follow-up protocol for those patients

Cosmic Rays and the Search for a Lorentz Invariance Violation

This is an introductory review about the on-going search for a signal of Lorentz Invariance Violation (LIV) in cosmic rays. We first summarise basic aspects of cosmic rays, focusing on rays of ultra high energy (UHECRs). We discuss the Greisen-Zatsepin-Kuz'min (GZK) energy cutoff for cosmic protons, which is predicted due to photopion production in the Cosmic Microwave Background (CMB). This is a process of modest energy in the proton rest frame. It can be investigated to a high precision in the laboratory, if Lorentz transformations apply even at factors $\gamma \sim O(10^{11})$. For heavier nuclei the energy attenuation is even faster due to photo-disintegration, again if this process is Lorentz invariant. Hence the viability of Lorentz symmetry up to tremendous gamma-factors - far beyond accelerator tests - is a central issue. Next we comment on conceptual aspects of Lorentz Invariance and the possibility of its spontaneous breaking. This could lead to slightly particle dependent ``Maximal Attainable Velocities''. We discuss their effect in decays, Cerenkov radiation, the GZK cutoff and neutrino oscillation in cosmic rays. We also review the search for LIV in cosmic gamma-rays. For multi TeV gamma-rays we possibly encounter another puzzle related to the transparency of the CMB, similar to the GZK cutoff. The photons emitted in a Gamma Ray Burst occur at lower energies, but their very long path provides access to information not far from the Planck scale. No LIV has been observed so far. However, even extremely tiny LIV effects could change the predictions for cosmic ray physics drastically. An Appendix is devoted to the recent hypothesis by the Pierre Auger Collaboration, which identifies nearby Active Galactic Nuclei - or objects next to them - as probable UHECR sources.Comment: 81 pages, 15 figures, some points extended and improved, references adde

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Malignant monotypic epithelioid angiomyolipoma of the kidney.

In summary, this case highlights the importance of considering epithelioid AML in the differential diagnosis of renal tumours, particularly in patients with associated conventional AMLs and/or other evidence of TS. In a patient with TS, a non-cystic renal mass is most likely to be an AML, even in the absence of radiological detection of fat due to haemorrhage or minimal fat content in an AML composed predominantly of smooth muscle. It may, however, represent a RCC or potentially a malignant epithelioid AML. Definitive demonstration of the benign nature of this patient's liver lesions was crucial for further management. © 2004 The Royal College of Radiologist. Published by Elsevier Ltd. All rights reserved