Motor Vehicle Accidents: The Most Common Cause of Traumatic Vertebrobasilar Ischemia

Background: Recent media exposure of strokes from chiropractic manipulation have focused attention on traumatic vertebrobasilar ischemia. However, chiropractic manipulation, while the easiest cause to recognize, is probably not the most common cause of this condition. Methods: We reviewed all consecutive cases of traumatic vertebrobasilar ischemia referred to a single neurovascular practice over 20 years, from the office files and hospital records. Results: There were 80 patients whose vertebrobasilar ischemia was attributed to neck trauma. Five were diagnosed as due to chiropractic manipulation, but the commonest attributed cause was motor vehicle accidents (MVAs), which accounted for 70 cases; one was a sports injury, and five were industrial accidents. In some cases neck pain from an MVA led to chiropractic manipulation, so the cause may have been compounded. In most vehicular cases the diagnosis had been missed, even denied, by the neurologists and neurosurgeons initially involved. The longest delay between the injury and the onset of delayed symptoms was five years. Conclusions: Traumatic vertebrobasilar ischemia is most often due to MVAs; the diagnosis is often missed, in part because of the delay between injury and onset of symptoms and, in part, we hypothesize, because of reluctance of doctors to be involved in medicolegal cases

Le rôle du collatéral dans le report des investissements en présence d’asymétries d’information

Cet article étudie les liens potentiels qui peuvent exister entre la disponibilité du collatéral pour les firmes et leurs décisions d’investissement. Nous identifions d’abord sous quelles conditions le collatéral apparaît de façon optimale dans les contrats financiers. Puis, sous ces conditions, nous considérons comment le collatéral, lorsque soumis à des chocs exogènes, peut être la source du report des investissements à une période ultérieure. En particulier, nous démontrons que des chocs permanents au collatéral peuvent causer des changements temporaires dans les décisions d’investissement. Un lien est ainsi créé entre le fonctionnement des marchés financiers et les décisions d’investissement des entreprises.This article studies the potential links between the value of collateral and the investment decisions made by firms. We show that the use of collateral is an endogenous response to the presence of asymmetric information in financial markets. We then show that permanent shocks to the value of collateral can cause firms to temporarily postpone their investments. This creates a link between imperfections in financial markets and investment decisions made by firms

Le rôle du collatéral dans le report des investissements en présence d’asymétries d’information

Cet article étudie les liens potentiels qui peuvent exister entre la disponibilité du collatéral pour les firmes et leurs décisions d’investissement. Nous identifions d’abord sous quelles conditions le collatéral apparaît de façon optimale dans les contrats financiers. Puis, sous ces conditions, nous considérons comment le collatéral, lorsque soumis à des chocs exogènes, peut être la source du report des investissements à une période ultérieure. En particulier, nous démontrons que des chocs permanents au collatéral peuvent causer des changements temporaires dans les décisions d’investissement. Un lien est ainsi créé entre le fonctionnement des marchés financiers et les décisions d’investissement des entreprises.This article studies the potential links between the value of collateral and the investment decisions made by firms. We show that the use of collateral is an endogenous response to the presence of asymmetric information in financial markets. We then show that permanent shocks to the value of collateral can cause firms to temporarily postpone their investments. This creates a link between imperfections in financial markets and investment decisions made by firms

Répartition géographique de la maladie d’Alzheimer au Saguenay-Lac-Saint-Jean, Québec (Projet IMAGE) : résultats préliminaires

La maladie d'Alzheimer (MA) est une affection neurodégénérative du cerveau dont l'étiologie demeure encore inconnue. Il s'agit de la forme de démence la plus commune chez la personne âgée car environ 60 % des cas de démence sénile présentent des lésions anatomo-pathologiques caractéristiques de la MA. Le taux de prévalence de la MA serait d'environ 5 % chez les individus âgés de 65 ans et plus. Les premiers symptômes apparaissent généralement après 60 ans et le risque d'être atteint augmente avec l'âge. En raison du phénomène de vieillissement de nos populations, le nombre de cas de MA devrait augmenter de façon significative dans l'avenir.Notre article a pour objectif de présenter les premières données du Projet IMAGE sur la répartition géographique de la MA, selon le lieu résidentiel des cas, au sein d'une région spécifique de la province de Québec. Nous faisons également état de nos premières mesures sur les variations entre les milieux urbain et rural. Le registre IMAGE de cas Alzheimer est en édification depuis 1986 sur l'ensemble du territoire du Saguenay—Lac-Saint-Jean; 221 cas « définitifs », « probables » et « possibles » sont répertoriés actuellement. En travaillant sur la base de six sphères géographiques de recensement prédéfinies, la variation des taux de prévalence standardisés n'apparaît pas statistiquement significative. Seules les sphères d'Alma et de La Baie, avec un indice comparatif de prévalence supérieur à l'unité, présentent une tendance au surnombre de cas, sans pour autant être statistiquement significative. Par ailleurs, la proportion de cas recensés dans la sphère d'Alma est en grande partie rurale.Alzheimer's disease (AD) is a neurodegenerative disorder of the brain; its etiology remains unknown. It represents the most common form of dementia among the elderly, since over 60 % of the cases of senile dementia show the characteristic anatomo-pathological features of AD. The prevalence rate of AD is approximately 5 % amongst individuals aged 65 and over. The disease onset is generally after 60 and the risk of developing AD increases with age. In view of the phenomenon of ageing of our populations, the number of cases of AD should increase significantly in the future.The objective of this paper is to present the preliminary findings of the IMAGE Project on the geographical distribution of AD cases, based on their place of residence in one specific region of the province of Québec. We also present our initial measurements on the variations in prevalence rates between urban and rural areas. The establishment of the IMAGE registry of AD cases has been in progress since 1986 over the entire Saguenay—Lac-Saint-Jean territory; 221 possible, probable and definite cases have actually been screened. Working on the basis of six predefined geographical spheres of screening, the variation of standardized prevalence rates does not appear to be statistically significant. Only the spheres of Alma and of La Baie, with a comparative prevalence index greater than 1,0, show a trend for more cases, albeit not statistically significant. Moreover, the proportion of cases found in the sphere of Alma is largely rural

Surveillance de l’exposition à l’amiante dans les métiers de la construction

Cette recherche découle du mandat de surveillance des travailleurs confié au Ministère de la santé et des services sociaux dans la foulée de la politique québécoise d’utilisation accrue et sécuritaire de l’amiante chrysotile. Elle portait sur l’élaboration et la recension d’outils de surveillance de l’exposition professionnelle à l’amiante dans l’industrie de la construction. Le système de codification des matériaux contenant de l’amiante (MCA) élaboré par l’Association nationale de défense des victimes de l’amiante (ANDEVA) en France, légèrement bonifié, est celui qui est le plus complet pour classer les MCA dans l’industrie de la construction. Une base de données relationnelle a été élaborée concernant les MCA et leurs fournisseurs. Elle comporte 1461 MCA et 576 fournisseurs. La majorité des données provient de sources juridiques. Un registre de MCA en place dans des édifices québécois a été constitué à partir de données fournies par neuf organismes publics ou parapublics. Il comprend 23 099 MCA répertoriés dans 1 550 bâtiments provenant de toutes les régions du Québec. Une recension de la littérature concernant les outils de surveillance de l’exposition à l’amiante dans l’industrie de la construction a permis de dresser les constats suivants : 1- Il existe d’autres matrices emploi-exposition (MEE) à part celle d’ÉV@LUTIL, notamment une MEE néerlandaise. 2- Des registres nationaux de travailleurs exposés à l’amiante ont été créés par réglementation dans d’autres juridictions, notamment celui de l’Ontario où il est constitué de l’ensemble des travailleurs de la construction exposés à l’amiante. 3- Les banques de données d’exposition professionnelle se sont considérablement développées au cours des dernières années. Certaines banques sont disponibles en ligne, p.ex. Fibrex, et permettent d’établir des profils d’exposition par branche industrielle, enclenchant une rétroaction préventive dans les milieux de travail. 4- Les données québécoises d’exposition professionnelle à l’amiante dans la construction sont inadéquates (en postes fixes) ou indisponibles

L'Abbittibbi et le Témiskaming hier et aujourd'hui

Ouvrage contenant les études suivantes: Benoît-Beaudry Gourd, «La colonisation et le peuplement du Témiscamingue et de l'Abitibi 1880-1950. Aperçu historique». Jean Laflamme, «Un camp de concentration en Abitibi durant la grande guerre». Roger Barrette, «Le plan Vautrin et l'Abitibi-Témiscamingue 1934-1936». Gilbert Saint-Laurent, «Prémices du transport d'écoliers du Québec. L'exemple de la Commission scolaire de Guérin, Comté de Témiscamingue, 1909-1950». Yves Côté, «L'évolution et la régression d'une ville minière: Duparquet». Jacques Meunier, «Réflexion en marge de la marginalité». Laurent Deshaies, «Le développement économique de l'Abitibi-Témiscamingue. Essai de prospective ou esquisse d'une géographie du futur de la région. Première partie». Bibiane Plourde-Savard et Noël Savard, «L'industrie manufacturière du Nord-Ouest québécois». Jean De Denus, «Le conseil régional de développement de l'Abitibi-Témiscamingue. Un organisme-tampon?». Michel Poudrier, «Classes sociales des étudiants du CEGEP du Nord-Ouest.

One RNA plays three roles to provide catalytic activity to a group I intron lacking an endogenous internal guide sequence

Catalytic RNA molecules possess simultaneously a genotype and a phenotype. However, a single RNA genotype has the potential to adopt two or perhaps more distinct phenotypes as a result of differential folding and/or catalytic activity. Such multifunctionality would be particularly significant if the phenotypes were functionally inter-related in a common biochemical pathway. Here, this phenomenon is demonstrated by the ability of the Azoarcus group I ribozyme to function when its canonical internal guide sequence (GUG) has been removed from the 5′ end of the molecule, and added back exogenously in trans. The presence of GUG triplets in non-covalent fragments of the ribozyme allow trans-splicing to occur in both a reverse splicing assay and a covalent self-assembly assay in which the internal guide sequence (IGS)-less ribozyme can put itself together from two of its component pieces. Analysis of these reactions indicates that a single RNA fragment can perform up to three distinct roles in a reaction: behaving as a portion of a catalyst, behaving as a substrate, and providing an exogenous IGS. This property of RNA to be multifunctional in a single reaction pathway bolsters the probability that a system of self-replicating molecules could have existed in an RNA world during the origins of life on the Earth

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362