Outcome of carotid stent-assisted angioplasty versus open surgical repair of recurrent carotid stenosis

AbstractPurposeWe compared outcome and durability of carotid stent-assisted angioplasty (CAS) with open surgical repair (ie, repeat carotid endarterectomy [CEA]) to treat recurrent carotid stenosis (RCS).MethodsA retrospective review of anatomic and neurologic outcomes was carried out after 27 repeat CEA procedures (1993-2002) and 52 CAS procedures (1997-2002) performed to treat high-grade internal carotid artery (ICA) RCS after CEA. The incidence of intervention because of symptomatic RCS was similar (repeat CEA, 63%; CAS, 60%), but the interval from primary CEA to repeat intervention was greater (P < .05) in the repeat CEA group (83 ± 15 months) compared with the CAS group (50 ± 8 months). In the CAS group, 17 of 52 arteries (33%) were judged not to be surgical candidates because of surgically inaccessible high lesions (n = 8), medical comorbid conditions (n = 4), neck irradiation (n = 3), or previous surgery with cranial nerve deficit or stroke (n = 2). Three patients who underwent repeat CEA had lesions not appropriate for treatment with CAS.ResultsOverall 30-day morbidity was similar after CAS (12%; death due to ipsilateral intracranial hemorrhage, 1; nondisabling stroke, 1; reversible neurologic deficits or transient ischemic attack, 2; access site complication, 2) and repeat CEA (11%; no death; nondisabling stroke, 1; reversible cranial nerve injury, 1; cervical hematoma, 1). Combined stroke and death rate was 3.7% for repeat CEA and 5.7% for CAS (P > .1). All duplex ultrasound scans obtained within 3 months after CEA and CAS demonstrated patent ICA and velocity spectra of less than 50% stenosis. During follow-up, no repeat CEA (mean, 39 months) or CAS (mean, 26 months) repair demonstrated ICA occlusion, but two patients (8%) who underwent repeat CEA and 4 patients (8%) who underwent CAS required balloon or stent angioplasty because of 80% RCS. At last follow-up, no patient had ipsilateral stroke and all ICA remain patent. At duplex scanning, stenosis-free (<50% diameter reduction) ICA patency at 36 months was 75% after repeat CEA and 57% after CAS (P = .26, log-rank test).ConclusionsCarotid angioplasty for treatment of high-grade stenotic ICA after CEA resulted in similar anatomic and neurologic outcomes compared with open surgical repair. Most lesions are amenable to endovascular therapy, and CAS enabled treatment in patients judged not to be suitable surgical candidates. Duplex scanning surveillance after repeat CEA or CAS is recommended, because stenosis can recur after either secondary procedure

The Sloan Digital Sky Survey: The Cosmic Spectrum and Star-Formation History

We present a determination of the `Cosmic Optical Spectrum' of the Universe, i.e. the ensemble emission from galaxies, as determined from the red-selected Sloan Digital Sky Survey main galaxy sample and compare with previous results of the blue-selected 2dF Galaxy Redshift Survey. Broadly we find good agreement in both the spectrum and the derived star-formation histories. If we use a power-law star-formation history model where star-formation rate $\propto (1+z)^\beta$ out to z=1, then we find that $\beta$ of 2 to 3 is still the most likely model and there is no evidence for current surveys missing large amounts of star formation at high redshift. In particular `Fossil Cosmology' of the local universe gives measures of star-formation history which are consistent with direct observations at high redshift. Using the photometry of SDSS we are able to derive the cosmic spectrum in absolute units (i.e.$W \AA$^{-1}$Mpc$^{-3}$) at 2--5\AA resolution and find good agreement with published broad-band luminosity densities. For a Salpeter IMF the best fit stellar mass/light ratio is 3.7--7.5$\Msun/\Lsun$in the r-band (corresponding to$\omstars h = 0.0025$--0.0055) and from both the stellar emission history and the H$\alpha$luminosity density independently we find a cosmological star-formation rate of 0.03--0.04 h$\Msun$yr$^{-1}$Mpc$^{-3}$ today.Comment: 17 pages, 11 figures, ApJ in press (April 10th 2003

The View from the Top: CALIOP Ice Water Content in the Uppermost Layer of Tropical Cyclones

NASA's CALIPSO satellite carries both the Cloud and Aerosol Lidar with Orthogonal Polarization (CALIOP) and the Imaging Infrared Radiometer (IIR). The lidar is ideally suited to viewing the very top of tropical cyclones, and the IIR provides critical optical and microphysical information. The lidar and the IIR data work together to understand storm clouds since they are perfectly co-located, and big tropical cyclones provide an excellent complex target for comparing the observations. There is a lot of information from these case studies for understanding both the observations and the tropical cyclones, and we are just beginning to scratch the surface of what can be learned. Many tropical cyclone cloud particle measurements are focused on the middle and lower regions of storms, but characterization of cyclone interaction with the lowermost stratosphere at the upper storm boundary may be important for determining the total momentum and moisture transport budget, and perhaps for predicting storm intensity as well. A surprising amount of cloud ice is to be found at the very top of these big storms

The Galaxy Luminosity Function and Luminosity Density at Redshift z=0.1

Using a catalog of 147,986 galaxy redshifts and fluxes from the Sloan Digital Sky Survey (SDSS), we measure the galaxy luminosity density at z = 0.1 in five optical bandpasses corresponding to the SDSS bandpasses shifted to match their rest-frame shape at z = 0.1. We denote the bands (0.1)u, (0.1)g, (0.1)r, (0.1)i, (0.1)z with lambda(eff) = (3216; 4240; 5595; 6792; 8111 Angstrom), respectively. To estimate the luminosity function, we use a maximum likelihood method that allows for a general form for the shape of the luminosity function,fits for simple luminosity and number evolution, incorporates the flux uncertainties, and accounts for the flux limits of the survey. We find luminosity densities at z = 0.1 expressed in absolute AB magnitudes in a Mpc(3) to be (-14.10 +/- 0.15, -15.18 +/- 0.03, - 15.90 +/- 0.03, -16.24 +/- 0.03, -16.56 +/- 0.02) in ((0.1)u, (0.1)g, (0.1)r, (0.1)i, (0.1)z), respectively, for a cosmological model with Omega(0) = 0.3, Omega(Lambda) = 0.7, and h = 1 and using SDSS Petrosian magnitudes. Similar results are obtained using Sersic model magnitudes, suggesting that flux from outside the Petrosian apertures is not a major correction. In the (0.1)r band, the best-fit Schechter function to our results has phi* = (1.49 +/- 0.04) x 10(-2) h(3) Mpc(-3), M-* - 5 log(10) h = - 20.44 +/- 0.01, and alpha = - 1.05 +/- 0.01. In solar luminosities, the luminosity density in (0.1)r is (1.84 +/- 0.04) x 10(8) h L-0.1r,L-. Mpc(-3). Our results in the (0.1)g band are consistent with other estimates of the luminosity density, from the Two-Degree Field Galaxy Redshift Survey and the Millennium Galaxy Catalog. They represent a substantial change ( similar to 0.5 mag) from earlier SDSS luminosity density results based on commissioning data, almost entirely because of the inclusion of evolution in the luminosity function model

Quantifying the Amount of Ice in Cold Tropical Cirrus Clouds

How much ice is there in the Tropical Tropopause layer, globally? How does one begin to answer that question? Clouds are currently the largest source of uncertainty in climate models, and the ice water content (IWC) of cold cirrus clouds is needed to understand the total water and radiation budgets of the upper troposphere and lower stratosphere (UT/LS). The Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellite, originally a "pathfinder" mission only expected to last for three years, has now been operational for more than eight years. Lidar data from CALIPSO can provide information about how IWC is vertically distributed in the UT/LS, and about inter-annual variability and seasonal changes in cloud ice. However, cloud IWC is difficult to measure accurately with either remote or in situ instruments because IWC from cold cirrus clouds is derived from the particle cross-sectional area or visible extinction coefficient. Assumptions must be made about the relationship between the area, volume and density of ice particles with various crystal habits. Recently there have been numerous aircraft field campaigns providing detailed information about cirrus ice water content from cloud probes. This presentation evaluates the assumptions made when creating the Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) global IWC data set, using recently reanalyzed aircraft particle probe measurements of very cold, thin TTL cirrus from the 2006 CR-AVE

Discovery of (meth)acrylate polymers that resist colonization by fungi associated with pathogenesis and biodeterioration

© 2020 The Authors. Fungi have major, negative socioeconomic impacts, but control with bioactive agents is increasingly restricted, while resistance is growing. Here, we describe an alternative fungal control strategy via materials operating passively (i.e., no killing effect). We screened hundreds of (meth)acrylate polymers in high throughput, identifying several that reduce attachment of the human pathogen Candida albicans, the crop pathogen Botrytis cinerea, and other fungi. Specific polymer functional groups were associated with weak attachment. Low fungal colonization materials were not toxic, supporting their passive, anti-attachment utility. We developed a candidate monomer formulation for inkjet-based 3D printing. Printed voice prosthesis components showed up to 100% reduction in C. albicans biofilm versus commercial materials. Furthermore, spray-coated leaf surfaces resisted fungal infection, with no plant toxicity. This is the first high-throughput study of polymer chemistries resisting fungal attachment. These materials are ready for incorporation in products to counteract fungal deterioration of goods, food security, and health

British Lung Foundation/United Kingdom primary immunodeficiency network consensus statement on the definition, diagnosis, and management of granulomatous-lymphocytic interstitial lung disease in common variable immunodeficiency disorders

A proportion of people living with common variable immunodeficiency disorders develop granulomatous-lymphocytic interstitial lung disease (GLILD). We aimed to develop a consensus statement on the definition, diagnosis, and management of GLILD. All UK specialist centers were contacted and relevant physicians were invited to take part in a 3-round online Delphi process. Responses were graded as Strongly Agree, Tend to Agree, Neither Agree nor Disagree, Tend to Disagree, and Strongly Disagree, scored +1, +0.5, 0, −0.5, and −1, respectively. Agreement was defined as greater than or equal to 80% consensus. Scores are reported as mean ± SD. There was 100% agreement (score, 0.92 ± 0.19) for the following definition: “GLILD is a distinct clinico-radio-pathological ILD occurring in patients with [common variable immunodeficiency disorders], associated with a lymphocytic infiltrate and/or granuloma in the lung, and in whom other conditions have been considered and where possible excluded.” There was consensus that the workup of suspected GLILD requires chest computed tomography (CT) (0.98 ± 0.01), lung function tests (eg, gas transfer, 0.94 ± 0.17), bronchoscopy to exclude infection (0.63 ± 0.50), and lung biopsy (0.58 ± 0.40). There was no consensus on whether expectant management following optimization of immunoglobulin therapy was acceptable: 67% agreed, 25% disagreed, score 0.38 ± 0.59; 90% agreed that when treatment was required, first-line treatment should be with corticosteroids alone (score, 0.55 ± 0.51)

Re-evaluating pretomanid analogues for Chagas disease:Hit-to-lead studies reveal both in vitro and in vivo trypanocidal efficacy

Phenotypic screening of a 900 compound library of antitubercular nitroimidazole derivatives related to pretomanid against the protozoan parasite Trypanosoma cruzi (the causative agent for Chagas disease) identified several structurally diverse hits with an unknown mode of action. Following initial profiling, a first proof-of-concept in vivo study was undertaken, in which once daily oral dosing of a 7-substituted 2-nitroimidazooxazine analogue suppressed blood parasitemia to low or undetectable levels, although sterile cure was not achieved. Limited hit expansion studies alongside counter-screening of new compounds targeted at visceral leishmaniasis laid the foundation for a more in-depth assessment of the best leads, focusing on both drug-like attributes (solubility, metabolic stability and safety) and maximal killing of the parasite in a shorter timeframe. Comparative appraisal of one preferred lead (58) in a chronic infection mouse model, monitored by highly sensitive bioluminescence imaging, provided the first definitive evidence of (partial) curative efficacy with this promising nitroimidazooxazine class

Drug Adverse Event Detection in Health Plan Data Using the Gamma Poisson Shrinker and Comparison to the Tree-based Scan Statistic

Background: Drug adverse event (AE) signal detection using the Gamma Poisson Shrinker (GPS) is commonly applied in spontaneous reporting. AE signal detection using large observational health plan databases can expand medication safety surveillance. Methods: Using data from nine health plans, we conducted a pilot study to evaluate the implementation and findings of the GPS approach for two antifungal drugs, terbinafine and itraconazole, and two diabetes drugs, pioglitazone and rosiglitazone. We evaluated 1676 diagnosis codes grouped into 183 different clinical concepts and four levels of granularity. Several signaling thresholds were assessed. GPS results were compared to findings from a companion study using the identical analytic dataset but an alternative statistical method—the tree-based scan statistic (TreeScan). Results: We identified 71 statistical signals across two signaling thresholds and two methods, including closely-related signals of overlapping diagnosis definitions. Initial review found that most signals represented known adverse drug reactions or confounding. About 31% of signals met the highest signaling threshold. Conclusions: The GPS method was successfully applied to observational health plan data in a distributed data environment as a drug safety data mining method. There was substantial concordance between the GPS and TreeScan approaches. Key method implementation decisions relate to defining exposures and outcomes and informed choice of signaling thresholds

Do Genetic Variants Modify the Effect of Smoking on Risk of Preeclampsia in Pregnancy?

Under embargo until: 2022-11-28Objective Maternal smoking is associated with as much as a 50% reduced risk of preeclampsia, despite increasing risk of other poor pregnancy outcomes that often co-occur with preeclampsia, such as preterm birth and fetal growth restriction. Researchers have long sought to understand whether this perplexing association is biologically based, or a result of noncausal mechanisms. We examined whether smoking-response genes modify the smoking-preeclampsia association to investigate potential biological explanations. Study Design We conducted a nested case–control study within the Norwegian Mother, Father and Child Birth Cohort (1999–2008) of 2,596 mother–child dyads. We used family-based log-linear Poisson regression to examine modification of the maternal smoking-preeclampsia relationship by maternal and fetal single nucleotide polymorphisms involved in cellular processes related to components of cigarette smoke (n = 1,915 with minor allele frequency ≥10%). We further investigated the influence of smoking cessation during pregnancy. Results Three polymorphisms showed overall (p < 0.001) multiplicative interaction between smoking and maternal genotype. For rs3765692 (TP73) and rs10770343 (PIK3C2G), protection associated with smoking was reduced with two maternal copies of the risk allele and was stronger in continuers than quitters (interaction p = 0.02 for both loci, based on testing 3-level smoking by 3-level genotype). For rs2278361 (APAF1) the inverse smoking-preeclampsia association was eliminated by the presence of a single risk allele, and again the trend was stronger in continuers than in quitters (interaction p = 0.01). Conclusion Evidence for gene–smoking interaction was limited, but differences by smoking cessation warrant further investigation. We demonstrate the potential utility of expanded dyad methods and gene–environment interaction analyses for outcomes with complex relationships between maternal and fetal genotypes and exposures.acceptedVersio