Small bound for birational automorphism groups of algebraic varieties (with an Appendix by Yujiro Kawamata)

We give an effective upper bound of |Bir(X)| for the birational automorphism group of an irregular n-fold (with n = 3) of general type in terms of the volume V = V(X) under an ''albanese smoothness and simplicity'' condition. To be precise, |Bir(X)| < d_3 V^{10}. An optimum linear bound |Bir(X)|-1 < (1/3)(42)^3 V is obtained for those 3-folds with non-maximal albanese dimension. For all n > 2, a bound |Bir(X)| < d_n V^{10} is obtained when alb_X is generically finite, alb(X) is smooth and Alb(X) is simple.Comment: Mathematische Annalen, to appea

Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: one-year results of the randomized TIME trial

CONTEXT: The risk-benefit ratio of invasive vs medical management of elderly patients with symptomatic chronic coronary artery disease (CAD) is unclear. The Trial of Invasive versus Medical therapy in Elderly patients (TIME) recently showed early benefits in quality of life from invasive therapy in patients aged 75 years or older, although with a certain excess in mortality. OBJECTIVE: To assess the long-term value of invasive vs medical management of chronic CAD in elderly adults in terms of quality of life and prevention of major adverse cardiac events. DESIGN: One-year follow-up analysis of TIME, a prospective randomized trial with enrollment between February 1996 and November 2000. SETTING AND PARTICIPANTS: A total of 282 patients with Canadian Cardiac Society class 2 or higher angina despite treatment with 2 or more anti-anginal drugs who survived for the first 6 months after enrollment in TIME (mean age, 80 years [range, 75-91 years]; 42% women), enrolled at 14 centers in Switzerland. INTERVENTIONS: Participants were randomly assigned to undergo coronary angiography followed by revascularization (if feasible) (n = 140 surviving 6 months) or to receive optimized medical therapy (n = 142 surviving 6 months). MAIN OUTCOME MEASURES: Quality of life, assessed by standardized questionnaire; major adverse cardiac events (death, nonfatal myocardial infarction, or hospitalization for acute coronary syndrome) after 1 year. RESULTS: After 1 year, improvements in angina and quality of life persisted for both therapies compared with baseline, but the early difference favoring invasive therapy disappeared. Among invasive therapy patients, later hospitalization with revascularization was much less likely (10% vs 46%; hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.11-0.32; P&lt;.001). However, 1-year mortality (11.1% for invasive; 8.1% for medical; HR, 1.51; 95% CI, 0.72-3.16; P =.28) and death or nonfatal myocardial infarction rates (17.0% for invasive; 19.6% for medical; HR, 0.90; 95% CI, 0.53-1.53; P =.71) were not significantly different. Overall major adverse cardiac event rates were higher for medical patients after 6 months (49.3% vs 19.0% for invasive; P&lt;.001), a difference which increased to 64.2% vs 25.5% after 12 months (P&lt;.001). CONCLUSIONS: In contrast with differences in early results, 1-year outcomes in elderly patients with chronic angina are similar with regard to symptoms, quality of life, and death or nonfatal infarction with invasive vs optimized medical strategies based on this intention-to-treat analysis. The invasive approach carries an early intervention risk, while medical management poses an almost 50% chance of later hospitalization and revascularization

Der akute Myokardinfarkt in der Schweiz: Resultate aus dem PIMICS-Herzinfarkt-Register. PIMICS-Projekt (Prospective Ischemia Myocardial Infarction Captopril Survey). [Acute myocardial infarct in Switzerland: results from the PIMICS Heart Infarct Register. PIMICS Project (Prospective Ischemia Myocardial Infarction Captopril Survey)]

The aim of the PIMICS project was to create, for the first time in Switzerland, a registry of data concerning epidemiology and therapy in patients hospitalised for acute myocardial infarction covering all regions of the country. During 1995/96 73 Swiss hospitals of all categories took part in the PIMICS project. The ratio between males and females in the 3877 registered patients was 2.6:1 (2791 men vs. 1086 women). Female patients were significantly older than males (70.4 +/- 12.0 years vs. 63.4 +/- 12.6 years; p &lt; 0.0001). The prevalence of risk factors differed between men and women: significantly more women had hypertension or diabetes, whereas smoking was more prevalent in males. The median delay between onset of symptoms and arrival at the hospital was 5.5 hours. Thrombolysis and primary angioplasty were more frequently performed in men (40.4% vs. 31.2% in women, p &lt; 0.0001, and 5.7% in men vs. 3.5% in women, p = 0.005 respectively). During the acute phase males were treated more frequently with betablockers. The overall in-hospital mortality was 9.1%. It was significantly higher in female patients (13.5% vs. 7.4% in men; p &lt; 0.0001) and in patients with reinfarction (14.5% vs. 7.1%; p &lt; 0.0001). The mean hospital stay was 12.6 +/- 5.3 days. Only 7.7% of all patients with acute myocardial infarction were discharged within 6 days. At discharge, 51.7% were treated with betablockers and 69.3% with aspirin; 44.8% received ACE-inhibitors and only 13.8% lipid-lowering drugs. Follow-up measures such as coronary angiography and/or angioplasty or bypass surgery were performed significantly more often in males (45.0% vs. 32.9%; p &lt; 0.0001). Likewise, men were more frequently assigned to a rehabilitation program than women (38.2% vs. 32.9%; p = 0.0004). The pre-hospital delay in patients with acute myocardial infarction remains too long. Primary and secondary prevention should be intensified in high risk groups, particularly in females. Thrombolysis and primary angioplasty as mainstays of treatment in acute myocardial infarction are generally used too sparingly, especially in women. With such measures the hospital stay could be shortened further