A Comparison of Rando Phantom Lung Dose From Proton and Electron Therapy of the Chest Wall

This research was sponsored by the National Science Foundation Grant NSF PHY-931478

Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients

The risk of death in hemodialysis patients treated with calcium-containing phosphate binders or sevelamer is not known. We assessed all-cause mortality in 127 patients new to hemodialysis assigned to calcium-containing binders or sevelamer after a median follow-up of 44 months from randomization. This was a predetermined secondary end point of a randomized clinical trial designed to assess progression of coronary artery calcium (CAC) scores in the two treatment arms. Thirty-four deaths occurred during the follow-up period: 23 in subjects randomized to calcium-containing phosphate binders and 11 in subjects randomized to sevelamer. Baseline CAC score was a significant predictor of mortality after adjustment for age, race, gender, and diabetes with increased mortality proportional to baseline score (P=0.002). Mortality was borderline significantly lower in subjects randomized to sevelamer (5.3/100 patient years, confidence interval (CI) (2.2–8.5) compared to those randomized to calcium-containing binders (10.6/100 patient years, CI 6.3–14.9) (P=0.05). The greater risk of death for patients treated with calcium-containing phosphate binders persisted after full multivariable adjustment (P=0.016, hazard ratio 3.1, CI 1.23–7.61). In subjects new to hemodialysis baseline CAC score was a significant predictor of all-cause mortality. Treatment with sevelamer was associated with a significant survival benefit as compared to the use of calcium-containing phosphate binders

Therapeutic Effect of Iron Citrate in Blocking Calcium Deposition in High Pi-Calcified VSMC: Role of Autophagy and Apoptosis

In chronic kidney disease (CKD), the first cause of mortality is cardiovascular disease induced mainly by vascular calcification (VC). Recently, iron-based phosphate binders have been proposed in advanced CKD to treat hyperphosphatemia. We studied the effect of iron citrate (iron) on the progression of calcification in high-phosphate (Pi) calcified VSMC. Iron arrested further calcification when added on days 7\u201315 in the presence of high Pi (1.30 \ub1 0.03 vs 0.61 \ub1 0.02; OD/mg protein; day 15; Pi vs Pi + Fe, p < 0.01). We next investigated apoptosis and autophagy. Adding iron to high-Pi-treated VSMC, on days 7\u201311, decreased apoptotic cell number (17.3 \ub1 2.6 vs 11.6 \ub1 1.6; Annexin V; % positive cells; day 11; Pi vs Pi + Fe; p < 0.05). The result was confirmed thorough analysis of apoptotic nuclei both in VSMCs and aortic rings treated on days 7\u201315 (3.8 \ub1 0.2 vs 2.3 \ub1 0.3 and 4.0 \ub1 0.3 vs 2.2 \ub1 0.2; apoptotic nuclei; arbitrary score; day 15; Pi vs Pi + Fe; VSMCs and aortic rings; p < 0.05). Studying the prosurvival axis GAS6/AXL, we found that iron treatment on days 9\u201314 counteracted protein high-Pi-stimulated down-regulation and induced its de novo synthesis. Moreover, iron added on days 9\u201315 potentiated autophagy, as detected by an increased number of autophagosomes with damaged mitochondria and an increase in autophagic flux. Highlighting the effect of iron on apoptosis, we demonstrated its action in blocking the H2O2-induced increase in calcification added both before high Pi treatment and when the calcification was already exacerbated. In conclusion, we demonstrate that iron arrests further high Pi-induced calcium deposition through an anti-apoptotic action and the induction of autophagy on established calcified VSMC

Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators

Background: Dying at home and dying at the preferred place of death are advocated to be desirable outcomes of palliative care. More insight is needed in their usefulness as quality indicators. Our objective is to describe whether " the percentage of patients dying at home'' and "the percentage of patients who died in their place of preference'' are feasible and informative quality indicators. Methods and Findings: A mortality follow-back study was conducted, based on data recorded by representative GP networks regarding home-dwelling patients who died non-suddenly in Belgium (n = 1036), the Netherlands (n = 512), Italy (n = 1639) or Spain (n = 565). "The percentage of patients dying at home'' ranged between 35.3% (Belgium) and 50.6% (the Netherlands) in the four countries, while "the percentage of patients dying at their preferred place of death'' ranged between 67.8% (Italy) and 86.0% (Spain). Both indicators were strongly associated with palliative care provision by the GP (odds ratios of 1.55-13.23 and 2.30-6.63, respectively). The quality indicator concerning the preferred place of death offers a broader view than the indicator concerning home deaths, as it takes into account all preferences met in all locations. However, GPs did not know the preferences for place of death in 39.6% (the Netherlands) to 70.3% (Italy), whereas the actual place of death was known in almost all cases. Conclusion: GPs know their patients' actual place of death, making the percentage of home deaths a feasible indicator for collection by GPs. However, patients' preferred place of death was often unknown to the GP. We therefore recommend using information from relatives as long as information from GPs on the preferred place of death is lacking. Timely communication about the place where patients want to be cared for at the end of life remains a challenge for GPs

Hard diffractive quarkonium hadroproduction at high energies

We present a study of heavy quarkonium production in hard diffractive process by the Pomeron exchange for Tevatron and LHC energies. The numerical results are computed using recent experimental determination of the diffractive parton density functions in Pomeron and are corrected by unitarity corrections through gap survival probability factor. We give predictions for single as well as central diffractive ratios. These processes are sensitive to the gluon content of the Pomeron at small Bjorken-x and may be particularly useful in studying the small-x physics. They may also be a good place to test the different available mechanisms for quarkonium production at hadron colliders.Comment: 7 pages, 3 figures, 1 table. Final version to be published in European Physical Journal

Dissipation of vibration in rough contact

The relationship which links the normal vibration occurring during the sliding of rough surfaces and the nominal contact area is investigated. Two regimes are found. In the first one, the vibrational level does not depend on the contact area, while in the second one, it is propor- tional to the contact area. A theoretical model is proposed. It is based on the assumption that the vibrational level results from a competition between two processes of vibration damping, the internal damping of the material and the contact damping occurring at the interface

Estimates of hadron azimuthal anisotropy from multiparton interactions in proton-proton collisions at sqrt(s) = 14 TeV

We estimate the amount of collective "elliptic flow" expected at mid-rapidity in proton-proton (p-p) collisions at the CERN Large Hadron Collider (LHC), assuming that any possible azimuthal anisotropy of the produced hadrons with respect to the plane of the reaction follows the same overlap-eccentricity and particle-density scalings as found in high-energy heavy ion collisions. Using a Glauber eikonal model, we compute the p-p eccentricities, transverse areas and particle-multiplicities for various phenomenological parametrisations of the proton spatial density. For realistic proton transverse profiles, we find integrated elliptic flow v2 parameters below 3% in p-p collisions at sqrt(s) = 14 TeV.Comment: 17 pages, 9 figures. Very minor mods. Version to appear in EPJ-

Multiple Interactions and the Structure of Beam Remnants

Recent experimental data have established some of the basic features of multiple interactions in hadron-hadron collisions. The emphasis is therefore now shifting, to one of exploring more detailed aspects. Starting from a brief review of the current situation, a next-generation model is developed, wherein a detailed account is given of correlated flavour, colour, longitudinal and transverse momentum distributions, encompassing both the partons initiating perturbative interactions and the partons left in the beam remnants. Some of the main features are illustrated for the Tevatron and the LHC.Comment: 69pp, 33 figure

Study Design and Baseline Characteristics of the CARDINAL Trial: A Phase 3 Study of Bardoxolone Methyl in Patients with Alport Syndrome

Introduction: Alport syndrome is a rare genetic disorder that affects as many as 60,000 persons in the USA and a total of 103,000 persons (200 pg/mL at baseline or with significant cardiovascular histories were excluded. Patients were randomized 1:1 to bardoxolone methyl or placebo, with stratification by baseline UACR. Results: A total of 371 patients were screened, and 157 patients were randomly assigned to receive bardoxolone methyl (n = 77) or placebo (n = 80). The average age at screening was 39.2 years, and 23 (15%) were <18 years of age. Of the randomized population, 146 (93%) had confirmed genetic diagnosis of Alport syndrome, and 62% of patients had X-linked mode of inheritance. Mean baseline eGFR was 62.7 mL/min/1.73 m2, and the geometric mean UACR was 141.0 mg/g. The average annual rate of eGFR decline prior to enrollment in the study was -4.9 mL/min/1.73 m2 despite 78% of the patient population receiving ACE inhibitor (ACEi) or ARB therapy. Discussion/Conclusion: CARDINAL is one of the largest interventional, randomized controlled trials in Alport syndrome conducted to date. Despite the use of ACEi or ARB, patients were experiencing significant loss of kidney function prior to study entry