155 research outputs found

    Percutaneous angioplasty for infrainguinal graft-related stenoses

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    Objective:To assess the success of percutaneous transluminal angioplasty (PTA) in treating infrainguinal graft-related stenoses.Design:Retrospective analysis of stenoses undergoing PTA over 6 years.Materials:Fifty-seven stenoses in 42 grafts.Methods:Site, length and type of stenoses recorded. Follow-up till discharge, graft occlusion or death.Results:PTA was successful in 48/57 stenoses in 36 grafts (G), with a poor result in seven. Further PTA was required in seven stenoses (7 G). One graft occluded at PTA and one stenosis was inaccessible. Overall graft (G) patency (median 13 months) was 82% (1 year patency 84%). Of 48 successful PTAs (37 G), 36 remained patent (28 G), eight (4 G) occluded and four were lost to follow-up (4 G). Fourteen of thirty-six stenoses which remained patent required further intervention (seven PTA, six jump grafts, one vein patch). The four occlusions were associated with small veins (two), multiple stenoses (one) and a PTFE graft which occluded 10 days following PTA. Of the seven PTAs with a poor angiographic result, five remained patent, three after further intervention.Conclusion:PTA is the best treatment for localised stenoses. Stenoses >2 cm or multiple (three or more) stenoses are best treated surgically. Follow-up is essential, as 20% require further intervention

    Impact of metabolic syndrome and its components on cardiovascular disease event rates in 4900 patients with type 2 diabetes assigned to placebo in the field randomised trial

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    <p>Abstract</p> <p>Background</p> <p>Patients with the metabolic syndrome are more likely to develop type 2 diabetes and may have an increased risk of cardiovascular disease (CVD) events.We aimed to establish whether CVD event rates were influenced by the metabolic syndrome as defined by the World Health Organisation (WHO), the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) and to determine which component(s) of the metabolic syndrome (MS) conferred the highest cardiovascular risk in in 4900 patients with type 2 diabetes allocated to placebo in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial.</p> <p>Research design and methods</p> <p>We determined the influence of MS variables, as defined by NCEP ATPIII, IDF and WHO, on CVD risk over 5 years, after adjustment for CVD, sex, HbA<sub>1c</sub>, creatinine, and age, and interactions between the MS variables in a Cox proportional-hazards model.</p> <p>Results</p> <p>About 80% had hypertension, and about half had other features of the metabolic syndrome (IDF, ATPIII). There was no difference in the prevalence of metabolic syndrome variables between those with and without CVD at study entry. The WHO definition identified those at higher CVD risk across both sexes, all ages, and in those without prior CVD, while the ATPIII definition predicted risk only in those aged over 65 years and in men but not in women. Patients meeting the IDF definition did not have higher risk than those without IDF MS.</p> <p>CVD risk was strongly influenced by prior CVD, sex, age (particularly in women), baseline HbA1<sub>c</sub>, renal dysfunction, hypertension, and dyslipidemia (low HDL-c, triglycerides > 1.7 mmol/L). The combination of low HDL-c and marked hypertriglyceridemia (> 2.3 mmol/L) increased CVD risk by 41%. Baseline systolic blood pressure increased risk by 16% per 10 mmHg in those with no prior CVD, but had no effect in those with CVD. In those without prior CVD, increasing numbers of metabolic syndrome variables (excluding waist) escalated risk.</p> <p>Conclusion</p> <p>Absence of the metabolic syndrome (by the WHO definition) identifies diabetes patients without prior CVD, who have a lower risk of future CVD events. Hypertension and dyslipidemia increase risk.</p

    Effects of Fenofibrate Treatment on Cardiovascular Disease Risk in 9,795 Individuals With Type 2 Diabetes and Various Components of the Metabolic Syndrome: The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

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    OBJECTIVE—We explored whether cardiovascular disease (CVD) risk and the effects of fenofibrate differed in subjects with and without metabolic syndrome and according to various features of metabolic syndrome defined by the Adult Treatment Panel III (ATP III) in subjects with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

    Satellites of satellites: The case for Carina and Fornax

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    We use the Auriga cosmological simulations of Milky Way (MW)-mass galaxies and their surroundings to study the satellite populations of dwarf galaxies in lambda-cold dark matter. As expected from prior work, the number of satellites above a fixed stellar mass is a strong function of the mass of the primary dwarf. For galaxies as luminous as the Large Magellanic Cloud (LMC), and for haloes as massive as expected for the LMC (from its rotation speed), the simulations predict about ∼3 satellites with stellar masses exceeding M∗ > 105 M⊙. If the LMC is on its first pericentric passage, then these satellites should be near the LMC and should have orbital angular momenta roughly coincident with that of the LMC. We use 3D positions and velocities from the 2nd data release of the Gaia mission to revisit which of the 'classical' MW dwarf spheroidals could plausibly be LMC satellites. The new proper motions of the Fornax and Carina dwarf spheroidals place them on orbits closely aligned with the orbital plane of the Magellanic Clouds, hinting at a potential Magellanic association. Together with the Small Magellanic Cloud (SMC), this result raises to 3, the number of LMC satellites with M∗ > 105 M⊙, as expected from simulations. This also fills the 12 mag luminosity gap between the SMC and the ultrafaints Hyi1, Car2, Hor1, and Car3, the few ultrafaint satellites confirmed to have orbits consistent with a Magellanic origin

    A UK wide cohort study describing management and outcomes for infants with surgical Necrotising Enterocolitis

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    The Royal College of Surgeons have proposed using outcomes from necrotising enterocolitis (NEC) surgery for revalidation of neonatal surgeons. The aim of this study was therefore to calculate the number of infants in the UK/Ireland with surgical NEC and describe outcomes that could be used for national benchmarking and counselling of parents. A prospective nationwide cohort study of every infant requiring surgical intervention for NEC in the UK was conducted between 01/03/13 and 28/02/14. Primary outcome was mortality at 28-days. Secondary outcomes included discharge, post-operative complication, and TPN requirement. 236 infants were included, 43(18%) of whom died, and eight(3%) of whom were discharged prior to 28-days post decision to intervene surgically. Sixty infants who underwent laparotomy (27%) experienced a complication, and 67(35%) of those who were alive at 28 days were parenteral nutrition free. Following multi-variable modelling, presence of a non-cardiac congenital anomaly (aOR 5.17, 95% CI 1.9-14.1), abdominal wall erythema or discolouration at presentation (aOR 2.51, 95% CI 1.23-5.1), diagnosis of single intestinal perforation at laparotomy (aOR 3.1 95% CI 1.05-9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9-237) were associated with increased 28-day mortality. These results can be used for national benchmarking and counselling of parents

    Urban markets and diversity: towards a research agenda

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    In this paper we advocate the study of local street markets to explore fundamental issues about the relationship between economy and society. This relationship evolves over time and we believe that it has been recast in an age of increasing cultural diversity and neo-liberal state regulatory structures. In street markets we can see how diversity and the nature of economic transactions become mutually constitutive. We argue that cultural diversity propels local markets, while everyday interactions in markets influence intercultural relationships. These complex processes are affected by the spatiality of markets and the regulatory environments within which they operate. We conclude by framing a research programme on street markets and discuss a number of methodological complications that would need to be addressed in this endeavour
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