Impacto de la modalidad de carga de fluidos en el diagnóstico de la capacidad de respuesta a volumen

The purpose of this study was to describe the ‘charge of volume’ and evaluate the difference in proper proportion for ‘responders’ (PR) according the type of liquid, volume, the timing of infusion and the moment of evaluation. Methods: Medline and Embase searches were made for studies using charge of volumen as a cardiac precharge test among a technique description, fluid  response capacities reported definition and PR. Primary results were average PR, according liquid volumen, liquid type, infusion ratio and time for evaluation. Results: A total of 85 studies (3,601 patients) for the analysis. PR were 54.4% (IC 95% 46.9-62.7) where <500 ml was administrated 57.2% (IC 95% 52.9-61.0) where 500 ml was administrated and 60.5% (IC 95% 35.9-79.2) where >500 ml was administrated (p=0.71). PR was not influenced by the type of fluid. RP was similar among patients given a charge of volumen during <15 minutes  (59.2%, IC 95% 54.2-64.1) and during 15-30 minutes (57.7%, IC 95% 52.4-62.4, p = 1). In time of infusion ≥30 minutes, a lesser 49.9% (IC 95% 45.6-54, p = 0.04) PR happened. Response was evaluated at the end of fluid exposure between 1 and 10 minutes, and <10 minutes after fluid exposure. Responder´s proportion was 53.9%, 57.7% y 52.3% (p=0.47). Findings: PR decreases in a long infusion time.  Standardise charge of volumen is desirable.El objetivo de este estudio fue describir la “carga de volumen” y evaluar la diferencia en la proporción de "respondedores" (PR) según el tipo de fluido, el volumen, la duración de la infusión y el momento de la evaluación. Métodos: Se realizaron búsquedas en MEDLINE y Embase para estudios que utilizan la carga de volumen como una prueba de precarga cardíaca con una descripción de la técnica, una definición reportada de capacidad de respuesta de fluidos y PR. El resultado primario fue la PR media, según el volumen de líquido, el tipo de líquidos, la tasa de infusión y el tiempo de evaluación. Resultados: se incluyeron un total de 85 estudios (3601 pacientes) en el análisis. Las PR fueron 54.4% (IC 95% 46.9-62.7) donde se administró <500 ml, 57.2% (IC 95% 52.9-61.0) donde se administraron 500 ml y 60.5% (IC 95% 35.9-79.2) donde> 500 ml fue administrado (p = 0.71). El PR no se vio afectado por el tipo de fluido. La RP fue similar entre los pacientes a los que se administró una carga de volumen durante <15 minutos (59.2%, IC 95% 54.2-64.1) y durante 15-30 minutos (57.7%, IC 95% 52.4-62.4, p = 1). Cuando el tiempo de infusión fue ≥30 minutos, hubo una PR menor de 49.9% (IC 95% 45.6-54, p = 0.04). La respuesta se evaluó al final de la exposición a los fluidos, entre 1 y 10 minutos, y > 10 minutos después de la exposición a los fluidos. Las proporciones de respondedores fueron 53.9%, 57.7% y 52.3%, respectivamente (p = 0.47). Conclusiones: el PR disminuye con un tiempo de infusión largo. Es deseable estandarizar la carga de volumen

Impacto de la modalidad de carga de fluidos en el diagnóstico de la capacidad de respuesta a volumen

El objetivo de este estudio fue describir la “carga de volumen” y evaluar la diferencia en la proporción de "respondedores" (PR) según el tipo de fluido, el volumen, la duración de la infusión y el momento de la evaluación. Métodos: Se realizaron búsquedas en MEDLINE y Embase para estudios que utilizan la carga de volumen como una prueba de precarga cardíaca con una descripción de la técnica, una definición reportada de capacidad de respuesta de fluidos y PR. El resultado primario fue la PR media, según el volumen de líquido, el tipo de líquidos, la tasa de infusión y el tiempo de evaluación. Resultados: se incluyeron un total de 85 estudios (3601 pacientes) en el análisis. Las PR fueron 54.4% (IC 95% 46.9-62.7) donde se administró 500 ml fue administrado (p = 0.71). El PR no se vio afectado por el tipo de fluido. La RP fue similar entre los pacientes a los que se administró una carga de volumen durante 10 minutos después de la exposición a los fluidos. Las proporciones de respondedores fueron 53.9%, 57.7% y 52.3%, respectivamente (p = 0.47). Conclusiones: el PR disminuye con un tiempo de infusión largo. Es deseable estandarizar la carga de volumen. Abstract The purpose of this study was to describe the ‘charge of volume’ and evaluate the difference in proper proportion for ‘responders’ (PR) according the type of liquid, volume, the timing of infusion and the moment of evaluation. Methods: Medline and Embase searches were made for studies using charge of volumen as a cardiac precharge test among a technique description, fluid  response capacities reported definition and PR. Primary results were average PR, according liquid volumen, liquid type, infusion ratio and time for evaluation. Results: A total of 85 studies (3,601 patients) for the analysis. PR were 54.4% (IC 95% 46.9-62.7) where 500 ml was administrated (p=0.71). PR was not influenced by the type of fluid. RP was similar among patients given a charge of volumen during <15 minutes  (59.2%, IC 95% 54.2-64.1) and during 15-30 minutes (57.7%, IC 95% 52.4-62.4, p = 1). In time of infusion ≥30 minutes, a lesser 49.9% (IC 95% 45.6-54, p = 0.04) PR happened. Response was evaluated at the end of fluid exposure between 1 and 10 minutes, and <10 minutes after fluid exposure. Responder´s proportion was 53.9%, 57.7% y 52.3% (p=0.47). Findings: PR decreases in a long infusion time.  Standardise charge of volumen is desirable

A polymorphism at the 3'-UTR region of the aromatase gene defines a subgroup of postmenopausal breast cancer patients with poor response to neoadjuvant letrozole

<p>Abstract</p> <p>Background</p> <p>Aromatase (<it>CYP19A1</it>) regulates estrogen biosynthesis. Polymorphisms in <it>CYP19A1 </it>have been related to the pathogenesis of breast cancer (BC). Inhibition of aromatase with letrozole constitutes the best option for treating estrogen-dependent BC in postmenopausal women. We evaluate a series of polymorphisms of <it>CYP19A1 </it>and their effect on response to neoadjuvant letrozole in early BC.</p> <p>Methods</p> <p>We analyzed 95 consecutive postmenopausal women with stage II-III ER/PgR [+] BC treated with neoadjuvant letrozole. Response to treatment was measured by radiology at 4^thmonth by World Health Organization (WHO) criteria. Three polymorphisms of <it>CYP19A1</it>, one in exon 7 (rs700519) and two in the 3'-UTR region (rs10046 and rs4646) were evaluated on DNA obtained from peripheral blood.</p> <p>Results</p> <p>Thirty-five women (36.8%) achieved a radiological response to letrozole. The histopathological and immunohistochemical parameters, including hormonal receptor status, were not associated with the response to letrozole. Only the genetic variants (AC/AA) of the rs4646 polymorphism were associated with poor response to letrozole (p = 0.03). Eighteen patients (18.9%) reported a progression of the disease. Those patients carrying the genetic variants (AC/AA) of rs4646 presented a lower progression-free survival than the patients homozygous for the reference variant (p = 0.0686). This effect was especially significant in the group of elderly patients not operated after letrozole induction (p = 0.009).</p> <p>Conclusions</p> <p>Our study reveals that the rs4646 polymorphism identifies a subgroup of stage II-III ER/PgR [+] BC patients with poor response to neoadjuvant letrozole and poor prognosis. Testing for the rs4646 polymorphism could be a useful tool in order to orientate the treatment in elderly BC patients.</p

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Development and validation of HERWIG 7 tunes from CMS underlying-event measurements

This paper presents new sets of parameters (“tunes”) for the underlying-event model of the HERWIG7 event generator. These parameters control the description of multiple-parton interactions (MPI) and colour reconnection in HERWIG7, and are obtained from a fit to minimum-bias data collected by the CMS experiment at s=0.9, 7, and 13Te. The tunes are based on the NNPDF 3.1 next-to-next-to-leading-order parton distribution function (PDF) set for the parton shower, and either a leading-order or next-to-next-to-leading-order PDF set for the simulation of MPI and the beam remnants. Predictions utilizing the tunes are produced for event shape observables in electron-positron collisions, and for minimum-bias, inclusive jet, top quark pair, and Z and W boson events in proton-proton collisions, and are compared with data. Each of the new tunes describes the data at a reasonable level, and the tunes using a leading-order PDF for the simulation of MPI provide the best description of the dat

Measurement of the top quark forward-backward production asymmetry and the anomalous chromoelectric and chromomagnetic moments in pp collisions at √s = 13 TeV

Abstract The parton-level top quark (t) forward-backward asymmetry and the anomalous chromoelectric (d̂ t) and chromomagnetic (μ̂ t) moments have been measured using LHC pp collisions at a center-of-mass energy of 13 TeV, collected in the CMS detector in a data sample corresponding to an integrated luminosity of 35.9 fb−1. The linearized variable AFB(1) is used to approximate the asymmetry. Candidate t t ¯ events decaying to a muon or electron and jets in final states with low and high Lorentz boosts are selected and reconstructed using a fit of the kinematic distributions of the decay products to those expected for t t ¯ final states. The values found for the parameters are AFB(1)=0.048−0.087+0.095(stat)−0.029+0.020(syst),μ̂t=−0.024−0.009+0.013(stat)−0.011+0.016(syst), and a limit is placed on the magnitude of | d̂ t| &lt; 0.03 at 95% confidence level. [Figure not available: see fulltext.

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe