Oral diabetes medication monotherapy and short-term mortality in individuals with type 2 diabetes and coronary artery disease

Objective To determine whether sulfonylurea use, compared with non-sulfonylurea oral diabetes medication use, was associated with 2-year mortality in individuals with well-controlled diabetes and coronary artery disease (CAD). Research design and methods We studied 5352 US veterans with type 2 diabetes, obstructive CAD on coronary angiography, hemoglobin A1c ≤7.5% at the time of catheterization, and taking zero or one oral diabetes medication (categorized as no medications, non-sulfonylurea medication, or sulfonylurea). We estimated the association between medication category and 2-year mortality using inverse probability of treatment-weighted (IPW) standardized mortality differences and IPW multivariable Cox proportional hazards regression. Results 49%, 35%, and 16% of the participants were on no diabetes medications, non-sulfonylurea medications, and sulfonylureas, respectively. In individuals on no medications, non-sulfonylurea medications, and sulfonylureas, the unadjusted mortality rates were 6.6%, 5.2%, and 11.9%, respectively, and the IPW-standardized mortality rates were 5.9%, 6.5%, and 9.7%, respectively. The standardized absolute 2-year mortality difference between non-sulfonylurea and sulfonylurea groups was 3.2% (95% CI 0.7 to 5.7) (p=0.01). In Cox proportional hazards models, the point estimate suggested that sulfonylurea use might be associated with greater hazard of mortality than non-sulfonylurea medication use, but this finding was not statistically significant (HR 1.38 (95% CI 1.00 to 1.93), p=0.05). We did not observe significant mortality differences between individuals on no diabetes medications and non-sulfonylurea users. Conclusions Sulfonylurea use was common (nearly one-third of those taking medications) and was associated with increased 2-year mortality in individuals with obstructive CAD. The significance of the association between sulfonylurea use and mortality was attenuated in fully adjusted survival models. Caution with sulfonylurea use may be warranted for patients with well-controlled diabetes and CAD, and metformin or newer diabetes medications with cardiovascular safety data could be considered as alternatives when individualizing therapy

A systematic review of the overlap of fluid biomarkers in delirium and advanced cancer-related syndromes.

BACKGROUND:Delirium is a serious and distressing neurocognitive disorder of physiological aetiology that is common in advanced cancer. Understanding of delirium pathophysiology is largely hypothetical, with some evidence for involvement of inflammatory systems, neurotransmitter alterations and glucose metabolism. To date, there has been limited empirical consideration of the distinction between delirium pathophysiology and that of the underlying disease, for example, cancer where these mechanisms are also common in advanced cancer syndromes such as pain and fatigue. This systematic review explores biomarker overlap in delirium, specific advanced cancer-related syndromes and prediction of cancer prognosis. METHODS:A systematic review (PROSPERO CRD42017068662) was conducted, using MEDLINE, PubMed, Embase, CINAHL, CENTRAL and Web of Science, to identify body fluid biomarkers in delirium, cancer prognosis and advanced cancer-related syndromes of interest. Studies were excluded if they reported delirium tremens only; did not measure delirium using a validated tool; the sample had less than 75% of participants with advanced cancer; measured tissue, genetic or animal biomarkers, or were conducted post-mortem. Articles were screened for inclusion independently by two authors, and data extraction and an in-depth quality assessment conducted by one author, and checked by two others. RESULTS:The 151 included studies were conducted in diverse settings in 32 countries between 1985 and 2017, involving 28130 participants with a mean age of 69.3 years. Seventy-one studies investigated delirium biomarkers, and 80 studies investigated biomarkers of an advanced cancer-related syndrome or cancer prognosis. Overall, 41 biomarkers were studied in relation to both delirium and either an advanced cancer-related syndrome or prognosis; and of these, 24 biomarkers were positively associated with either delirium or advanced cancer syndromes/prognosis in at least one study. The quality assessment showed large inconsistency in reporting. CONCLUSION:There is considerable overlap in the biomarkers in delirium and advanced cancer-related syndromes. Improving the design of delirium biomarker studies and considering appropriate comparator/controls will help to better understanding the discrete pathophysiology of delirium in the context of co-existing illness

Hydroacoustic Detection of Submarine Landslides on Kilauea Volcano

Landslides produced at the site where lava flows into the ocean at Kilauea volcano have been detected hydroacoustically. Up to 10 landslides per day were detected by a hydrophone on the Hawaii Undersea Geo-Observatory (HUGO), located 50 km south of the entry site. The largest of these landslides, partly subaerial events known as bench collapses, were detected by a network of hydrophones in the eastern Pacific, 5000–7000 km away from the source. The landslides display a characteristic spectral signature easily recognizable among other signals such as earthquake T-phases and anthropogenic noises. The fact that signals are detected at great distances suggests that hydroacoustic detection of landslides could be a powerful tool in tsunami monitoring and modeling efforts

Current Concepts of Cerebrovascular Disease - Stroke: Stroke and Drug Abuse

This Review Summarizes Available Information Concerning Cerebral Vascular Complications of the Most Commonly Abused Substances and Discusses Possible Mechanisms of Vascular Injury and Cerebral Damage. Although Alcohol is Frequently Abused and May Have Important Cerebrovascular Effects, its Consideration is Beyond the Scope of This Review

Optical Spectral Signatures of Dusty Starburst Galaxies

We analyse the optical spectral properties of the complete sample of Very Luminous Infrared Galaxies presented by Wu et al. (1998a,b) and we find a high fraction (~50 %) of spectra showing both a strong H_delta line in absorption and relatively modest [OII] emission (e(a) spectra). The e(a) signature has been proposed as an efficient method to identify dusty starburst galaxies and we study the star formation activity and the nature of these galaxies, as well as the effects of dust on their observed properties. We examine their emission line characteristics, in particular their [OII]/H_alpha ratio, and we find this to be greatly affected by reddening. A search for AGN spectral signatures reveals that the e(a)'s are typically HII/LINER galaxies. We compare the star formation rates derived from the FIR luminosities with the estimates based on the H_alpha line and find that the values obtained from the optical emission lines are a factor of 10-70 (H_alpha) and 20-140 ([OII]) lower than the FIR estimates (50-300 M_sun yr^-1). We then study the morphological properties of the e(a) galaxies, looking for a near companion or signs of a merger/interaction. In order to explore the evolution of the e(a) population, we present an overview of the available observations of e(a)'s in different environments both at low and high redshift. Finally, we discuss the role of dust in determining the e(a) spectral properties and we propose a scenario of selective obscuration in which the extinction decreases with the stellar age.Comment: 26 pages, Latex, including 7 postscript figures, accepted for publication in the Astrophysical Journa

Validation of an electrogoniometry system as a measure of knee kinematics during activities of daily living

Purpose: The increasing use of electrogoniometry (ELG) in clinical research requires the validation of different instrumentation. The purpose of this investigation was to examine the concurrent validity of an ELG system during activities of daily living. Methods: Ten asymptomatic participants gave informed consent to participate. A Biometrics SG150 electrogoniometer was directly compared to a 12 camera three dimensional motion analysis system during walking, stair ascent, stair descent, sit to stand, and stand to sit activities for the measurement of the right knee angle. Analysis of validity was undertaken by linear regression. Standard error of estimate (SEE), standardised SEE (SSEE), and Pearson’s correlation coefficient r were computed for paired trials between systems for each functional activity. Results: The 95% confidence interval of SEE was reasonable between systems across walking (LCI = 2.43 °; UCI = 2.91 °), stair ascent (LCI = 2.09 °; UCI = 2.42 °), stair descent (LCI = 1.79 °; UCI = 2.10 °), sit to stand (LCI = 1.22 °; UCI = 1.41 °), and stand to sit (LCI = 1.17 °; UCI = 1.34 °). Pearson’s correlation coefficient r across walking (LCI = 0.983; UCI = 0.990), stair ascent (LCI = 0.995; UCI = 0.997), stair descent (LCI = 0.995; UCI = 0.997), sit to stand (LCI = 0.998; UCI = 0.999), and stand to sit (LCI = 0.996; UCI = 0.997) was indicative of a strong linear relationship between systems. Conclusion: ELG is a valid method of measuring the knee angle during activities representative of daily living. The range is within that suggested to be acceptable for the clinical evaluation of patients with musculoskeletal conditions

A comparison between Pa alpha and H alpha emission: The relation between HII region mean reddening, local gas density and metallicity

We measure reddenings to HII regions in NGC 2903, NGC 1512, M51, NGC 4449 and NGC 6946 from Hubble Space Telescope Pa alpha and H alpha images. Extinctions range from A_V ~ 5 - 0 depending upon the galaxy. For the galaxies with HST images in both lines, NGC 2903, NGC 1512 and M51, the Pa alpha and H alpha emission are almost identical in morphology which implies that little emission from bright HII regions is hidden from view by regions of comparatively high extinction. The scatter in the measured extinctions is only +- 0.5 mag. We compare the reddenings we measure in five galaxies using the Pa alpha to H alpha ratios to those measured previously from the Balmer decrement in the LMC and as a function of radius in M101 and M51. We find that luminosity weighted mean extinctions of these ensembles of HI regions are correlated with gas surface density and metallicity. The correlation is consistent with the mean extinction depending on dust density where the dust to gas mass ratio scales with the metallicity. This trend is expected if HII regions tend to be located near the mid-plane of a gas disk and emerge from their parent molecular clouds soon after birth. In environments with gas densities below a few hundred Msol/pc^2 star formation rates estimated from integrated line fluxes and mean extinctions are likely to be fairly accurate.Comment: accepted for publication in A