569 research outputs found
Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation
Background: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is
able to identify those at high perioperative risk requiring admission to critical care unit (CCU). We sought to determine if
functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO2AT) could identify these patients.
Methods: Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed
CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET), echocardiography and arterial
applanation tonometry were performed.
Results: There were 70 participants (age 41.7614.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were
desensitized). 14 patients (20%) required escalation of care from the ward to CCU following transplantation. Reduced
anaerobic threshold (VO2AT) was the most significant predictor, independently (OR = 0.43; 95% CI 0.27–0.68; p,0.001) and
in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12–0.59; p = 0.001). The area under the receiveroperating-
characteristic curve was 0.93, based on a risk prediction model that incorporated VO2AT, body mass index and
desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU
admission.
Conclusions: To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a
preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO2AT has the
potential to predict perioperative morbidity in kidney transplant recipients
The impact of capital structure on the decision to outsource with long term contracts
This paper analyzes how capital structure affects the firms’ strategic choice between outsourcing with long term contracts and outsourcing to the spot market. When outsourcing to the spot market firms are exposed to price uncertainty, whereas a long term contract allows them to set in advance the outsourcing price. We show that, to the extent that leverage and uncertainty can lead to financial distress costs in bad states of nature, firms may use long term contracts as a risk management device to hedge input price uncertainty.N/
The Relation Between the Surface Brightness and the Diameter for Galactic Supernova Remnants
In this work, we have constructed a relation between the surface brightness
() and diameter (D) of Galactic C- and S-type supernova remnants
(SNRs). In order to calibrate the -D dependence, we have carefully
examined some intrinsic (e.g. explosion energy) and extrinsic (e.g. density of
the ambient medium) properties of the remnants and, taking into account also
the distance values given in the literature, we have adopted distances for some
of the SNRs which have relatively more reliable distance values. These
calibrator SNRs are all C- and S-type SNRs, i.e. F-type SNRs (and S-type SNR
Cas A which has an exceptionally high surface brightness) are excluded. The
Sigma-D relation has 2 slopes with a turning point at D=36.5 pc: (at 1
GHz)=8.4 D
WmHzster (for
WmHzster and D36.5 pc) and (at 1
GHz)=2.7 10 D
WmHzster (for
WmHzster and D36.5 pc). We discussed the theoretical
basis for the -D dependence and particularly the reasons for the change
in slope of the relation were stated. Added to this, we have shown the
dependence between the radio luminosity and the diameter which seems to have a
slope close to zero up to about D=36.5 pc. We have also adopted distance and
diameter values for all of the observed Galactic SNRs by examining all the
available distance values presented in the literature together with the
distances found from our -D relation.Comment: 45 pages, 2 figures, accepted for publication in Astronomical and
Astrophysical Transaction
Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy
Objectives: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)– and fractional flow reserve (FFR)–guided revascularization strategies. Background: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes. Methods: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization. Results: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919). Conclusions: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (Functional Lesion Assessment of Intermediate Stenosis to guide Revascularization [DEFINE-FLAIR]; NCT02053038
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Investigation of recast and crack formation in laser trepanning drilling of CMSX-4 angled holes
This paper presents an experimental investigation on the influences of laser trepanning drilling process parameters on the recast layer thickness and surface crack formation in CMSX-4 nickel-based superalloy angled holes. The effects of peak power, pulse frequency and the trepanning speed as input parameters were investigated in details by varying the laser drilling conditions using Taguchi orthogonal array-based design of experiment approach. Analysis of variance identifies the significant parameters affecting the output responses. It is found that the output responses are affected mainly by the peak power and trepanning speed. The experimental results reveal that the recast layer thickness increases with the increase of peak power and trepanning speed whereas the crack number density decreases with the increase of peak power only. Pulse frequency has no significant effect on both output responses within the range of values investigated. The knowledge gained in this parametric study could be used to improve the metallurgical characteristics of laser-drilled nickel-based acute angled holes
Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group
This Policy Review presents the International Myeloma Working Group's clinical practice recommendations for the treatment of relapsed and refractory multiple myeloma. Based on the results of phase 2 and phase 3 trials, these recommendations are proposed for the treatment of patients with relapsed and refractory disease who have received one previous line of therapy, and for patients with relapsed and refractory multiple myeloma who have received two or more previous lines of therapy. These recommendations integrate the issue of drug access in both low-income and middle-income countries and in high-income countries to help guide real-world practice and thus improve patient outcomes
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