Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein

Background: Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment.Methods: We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes.Results: the trial was stopped after a median follow-up of 1.9 years (maximum, 5.0). Rosuvastatin reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein levels by 37%. the rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001), with corresponding rates of 0.17 and 0.37 for myocardial infarction (hazard ratio, 0.46; 95% CI, 0.30 to 0.70; P=0.0002), 0.18 and 0.34 for stroke (hazard ratio, 0.52; 95% CI, 0.34 to 0.79; P=0.002), 0.41 and 0.77 for revascularization or unstable angina (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.00001), 0.45 and 0.85 for the combined end point of myocardial infarction, stroke, or death from cardiovascular causes (hazard ratio, 0.53; 95% CI, 0.40 to 0.69; P<0.00001), and 1.00 and 1.25 for death from any cause (hazard ratio, 0.80; 95% CI, 0.67 to 0.97; P=0.02). Consistent effects were observed in all subgroups evaluated. the rosuvastatin group did not have a significant increase in myopathy or cancer but did have a higher incidence of physician-reported diabetes.Conclusions: in this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681.).AstraZenecaNovartisMerckAbbottRocheSanofi-AventisMerck-Schering-PloughIsisDade BehringVascular BiogenicsPfizerMerck FrosstResverlogixDupontAegerionArisaphKowaGenentechMartekReliantGenzymeGlaxoSmithKlineBoehringer IngelheimDiaDexusMedlogixAntheraBristol-Myers SquibbVIA PharmaceuticalsInterleukin GeneticsKowa Research InstituteTakedaBG MedicineOxford BiosciencesHarvard Univ, Sch Med, Brigham & Womens Hosp, Ctr Cardiovasc Dis Prevent, Boston, MA 02215 USAHarvard Univ, Sch Med, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02215 USAUniversidade Federal de São Paulo, São Paulo, BrazilMcGill Univ, Ctr Hlth, Montreal, PQ, CanadaCornell Univ, Weill Cornell Med Coll, New York, NY 10021 USAUniv Amsterdam, Acad Med Ctr, Dept Vasc Med, NL-1105 AZ Amsterdam, NetherlandsUniv Ulm, Med Ctr, Ulm, GermanyHosp Cordoba, Cordoba, ArgentinaCopenhagen Univ Hosp, Herlev Hosp, Herlev, DenmarkUniv Glasgow, Glasgow, Lanark, ScotlandSt Lukes Episcopal Hosp, Texas Heart Inst, Houston, TX 77030 USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Analysis and implementation of fractional-order chaotic system with standard components

This paper is devoted to the problem of uncertainty in fractional-order Chaotic systems implemented by means of standard electronic components. The fractional order element (FOE) is typically substituted by one complex impedance network containing a huge number of discrete resistors and capacitors. In order to balance the complexity and accuracy of the circuit, a sparse optimization based parameter selection method is proposed. The random error and the uncertainty of system implementation are analyzed through numerical simulations. The effectiveness of the method is verified by numerical and circuit simulations, tested experimentally with electronic circuit implementations. The simulations and experiments show that the proposed method reduces the order of circuit systems and finds a minimum number for the combination of commercially available standard components.This work was supported in part by the National Natural Science Foundation of China under Grant 61501385, in part by the National Nuclear Energy Development Project of State Administration for Science, Technology and Industry for National Defense, PRC under Grant 18zg6103, and in part by Sichuan Science and Technology Program under Grant 2018JY0522. We would like to thank Xinghua Feng for meaningful discussion.info:eu-repo/semantics/publishedVersio

Asylum at an impasse: refugee protest and the politics of asylum governance in Cairo

This thesis explores the relationship between refugee protest and the politics of asylum governance through the case of a 2005 protest in Egypt. It challenges prevalent views of refugees as victims, of the bodies that host and assist as benevolent, and of the relationships between them as apolitical. In a 2005 sit-in in Cairo, Sudanese demonstrators took collective political action as refugees â but found their action countered and undone by host states and humanitarian institutions. Drawing from this case, the thesis develops existing understandings of the politics of asylum governance, and political activism concerned with it, along three lines. First, it takes an inductive approach to understanding the politics at play, developing concepts that allow for comparison across contexts. Second, it integrates analysis of both protester and institutional accounts of a refugee protest. Third, it explores three hitherto understudied aspects of the politics of asylum governance: the political activity of asylees regarding the rules of asylum within host countries; the effects of political struggles within asylum governance on refugee political participation; and the interactions between refugees and asylum governance in an urban, southern context. This thesis argues that refugee protest and the politics of asylum governance are related in causal, discursive, and epistemological ways: that the politics of asylum governance play a causal role in refugee protest; that protest and governance concerned with asylum share a discursive repertoire, which may be mobilised agonistically; and that the study of refugee protest is a compelling approach through which to gain insight into the politics of asylum governance. Through this study, the thesis opens new dimensions within existing scholarship on the depoliticisation of refugees, and of humanitarianism as a dominating force.</p

A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism

BACKGROUNDControversy persists regarding the extent of shared pathways between arterial and venous thrombosis and whether treatments of known efficacy for one disease process have consistent benefits for the other. Observational studies have yielded variable estimates of the effect of statin therapy on the risk of venous thromboembolism, and evidence from randomized trials is lacking.METHODSWe randomly assigned 17,802 apparently healthy men and women with both low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to receive rosuvastatin, 20 mg per day, or placebo. We followed participants for the first occurrence of pulmonary embolism or deep-vein thrombosis and performed analyses of the data on an intention-to-treat basis.RESULTSDuring a median follow-up period of 1.9 years (maximum, 5.0), symptomatic venous thromboembolism occurred in 94 participants: 34 in the rosuvastatin group and 60 in the placebo group. the rates of venous thromboembolism were 0.18 and 0.32 event per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio with rosuvastatin, 0.57; 95% confidence interval [CI], 0.37 to 0.86; P = 0.007); the corresponding rates for unprovoked venous thromboembolism (i.e., occurring in the absence of a known malignant condition, trauma, hospitalization, or surgery) were 0.10 and 0.17 (hazard ratio, 0.61; 95% CI, 0.35 to 1.09; P = 0.09) and for provoked venous thromboembolism (i.e., occurring in patients with cancer or during or shortly after trauma, hospitalization, or surgery), 0.08 and 0.16 (hazard ratio, 0.52; 95% CI, 0.28 to 0.96; P = 0.03). the rates of pulmonary embolism were 0.09 in the rosuvastatin group and 0.12 in the placebo group (hazard ratio, 0.77; 95% CI, 0.41 to 1.45; P = 0.42), whereas the rates of deep-vein thrombosis only were 0.09 and 0.20, respectively (hazard ratio, 0.45; 95% CI, 0.25 to 0.79; P = 0.004). Consistent effects were observed in all the subgroups examined. No significant differences were seen between treatment groups in the rates of bleeding episodes.CONCLUSIONSIn this trial of apparently healthy persons, rosuvastatin significantly reduced the occurrence of symptomatic venous thromboembolism. (ClinicalTrials.gov number, NCT00239681.)AstraZenecaNational Institute on AgingHarvard Univ, Sch Med, Brigham & Womens Hosp, Div Prevent Med, Boston, MA 02215 USAHarvard Univ, Sch Med, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02215 USAUniversidade Federal de São Paulo, São Paulo, BrazilMcGill Univ, Ctr Hlth, Montreal, PQ, CanadaCornell Univ, Weill Med Coll, New York, NY 10021 USAUniv Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, NetherlandsUniv Ulm, Ulm, GermanyHosp Cordoba, Cordoba, ArgentinaUniv Copenhagen, Herlev Hosp, Copenhagen Univ Hosp, DK-2730 Herlev, DenmarkUniv Glasgow, Glasgow, Lanark, ScotlandSt Lukes Episcopal Hosp, Texas Heart Inst, Houston, TX USAUniversidade Federal de São Paulo, São Paulo, BrazilNational Institute on Aging: AG031061Web of Scienc