342 research outputs found

    Influence of coronary artery disease on morbidity and mortality after abdominal aortic aneurysmectomy: A population-based study, 1971–1987

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    AbstractThe prognostic importance of coronary artery disease at the time of elective abdominal aortic aneurysmectomy was evaluated among 131 residents of Olmsted County, Minnesota who underwent elective aneurysmectomy from 1971 to 1987 and were followed up to 1988 for death and cardiac events (cardiac death, myocardial infarction, coronary bypass surgery and angioplasty). Before aneurysmectomy, 75 patients (Group 1) had no clinically recognized coronary disease, 47 patients (Group 2) had suspected or overt uncorrected coronary artery disease (history of prior myocardial infarction, angina or a positive stress test) and 9 patients (Group 3) had undergone coronary artery bypass grafting or coronary angioplasty.The 30 day operative mortality rate was 3% (2 of 75) in Group 1 and 9% (4 of 47) in Group 2 (p = 0.15). According to Kaplan-Meier analysis, estimated survival 8 years after aneurysmectomy was 59% (expected rate 68%, p = 0.29) in Group 1 versus 34% (expected rate 61%, p = 0.01) in Group 2. The cumulative incidence rate of cardiac events at 8 years was 15% and 61%, respectively, for patients without and with suspected/overt coronary artery disease (p < 0.01). Using multivariable proportional hazards analysis, uncorrected coronary artery disease was associated with a nearly twofold increased risk of death (hazard ratio 1.79, 95% confidence interval 1.06 to 3.00) and a fourfold increased risk of cardiac events (hazard ratio 3.71, 95% confidence interval 1.79 to 7.69).These population-based data support an aggressive lifelong approach to the management of coronary artery disease in patients undergoing abdominal aortic aneurysmectomy

    Prevalent inhibitors in haemophilia B subjects enrolled in the Universal Data Collection database

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    Several risk factors for inhibitors have recently been described for hemophilia A. It has been assumed that similar risk factors are also relevant for hemophilia B, but there is limited data to confirm this notion

    Effects of chronic exercise on feelings of energy and fatigue: A quantitative synthesis

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    The authors investigated the effect of chronic exercise on feelings of energy and fatigue using metaanalytic techniques. Chronic exercise increased feelings of energy and lessened feelings of fatigue compared with control conditions by a mean effect delta of 0.37. The effect varied according to the presence or absence of a placebo control or whether chronic exercise was completed alone or in combination with an additional therapy. Investigations that used a placebo control and examined chronic exercise alone found no effect of chronic exercise on feelings of energy and fatigue. Certain placebo controls may increase feelings of energy and lessen feelings of fatigue when used with older adults or people with psychological distress. The results highlight the need for research identifying the most useful control conditions for accurately interpreting mental health outcome data obtained in chronic exercise investigations

    Enhanced U-Pb detrital zircon, Lu-Hf zircon, δ18O zircon, and Sm-Nd whole rock global databases

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    High-quality global isotopic databases provide Earth scientists with robust means for developing and testing a variety of geological hypotheses. Database design establishes the range of questions that can be addressed, and validation techniques can enhance data quality. Here, six validated global isotopic databases provide extensive records of analyses from U-Pb in detrital zircon, Lu-Hf in zircon, Sm-Nd from whole rocks, and δ18O in zircon. The U-Pb detrital zircon records are segregated into three independently sampled databases. Independent samples are critical for testing the replicability of results, a key requisite for gaining confidence in the validity of a hypothesis. An advantage of our updated databases is that a hypothesis developed from one of the global detrital zircon databases can be immediately tested with the other two independent detrital zircon databases to assess the replicability of results. The independent εHf(t) and εNd(t) values provide similar means of testing for replicable results. This contribution discusses database design, data limitations, and validation techniques used to ensure the data are optimal for subsequent geological investigations

    Extent of hypoattenuation on CT angiography source images in Basilar Artery occlusion: prognostic value in the Basilar Artery International Cooperation Study

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    &lt;p&gt;&lt;b&gt;Background and Purpose:&lt;/b&gt; The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at &#8805;8 versus &#60;8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS &#60;8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS &#8805;8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at &#8805;6 versus &#60;6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.&lt;/p&gt

    Regional trends and petrologic factors inhibit global interpretations of zircon trace element compositions

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    The trace element composition of zircon reveals information about the melt that they are derived from, as such, detrital zircon trace element compositions can be used to interrogate melt compositions, and thus the evolution of the continental crust in time and space. Here, we present a global database of detrital zircon compositions and use it to test whether average global trends for five common petrogenetic proxies truly represent secular changes in continental evolution. We demonstrate that the secular trend is broadly comparable across continental regions for Ti-in-zircon temperatures, but for other trace element ratios interrogated, secular trends are highly variable between continental regions. Because trace element ratios result from multiple petrologic variables, we argue that these petrogenetic proxies can be overinterpreted if projected to global geologic processes. In particular, we caution against the interpretation of crustal thickness from trace elements in zircon, and we argue that our results negate current hypotheses concerning secular changes in crustal thickness

    Using polymorphisms in FKBP5 to define biologically distinct subtypes of posttraumatic stress disorder: Evidence from endocrine and gene expression studies

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    Context: Polymorphisms in the gene encoding the glucocorticoid receptor (GR) regulating co-chaperone FKBP5 have been shown to alter GR sensitivity and are associated with an increased risk to develop posttraumatic stress disorder (PTSD). Objective: To investigate interactions of the FKBP5 single-nucleotide polymorphism rs9296158 and PTSD symptoms on baseline cortisol level, low-dose dexamethasone suppression, and whole-blood gene expression. Design: Association of FKBP5 genotypes and PTSD symptoms with endocrine measures and genome-wide expression profiles. Setting: Waiting rooms of general medical and gynecological clinics of an urban hospital at Emory University. Participants: The 211 participants were primarily African American (90.05%) and of low socioeconomic status and had high rates of trauma and PTSD. Main Outcome Measures: Baseline and post-dexamethasone suppression cortisol measures and gene expression levels. Results: In our endocrine study, we found that only risk allele A carriers of rs9296158 showed GR supersensitivity with PTSD; in contrast, baseline cortisol levels were decreased in PTSD only in patients with the GG genotype. Expression of 183 transcripts was significantly correlated with PTSD symptoms after multiple testing corrections. When adding FKBP5 genotype and its interaction with PTSD symptoms, expression levels of an additional 32 genes were significantly regulated by the interaction term. Within these 32 genes, previously reported PTSD candidates were identified, including FKBP5 and the IL18 and STAT pathways. Significant overrepresentation of steroid hormone transcription factor binding sites within these 32 transcripts was observed, highlighting the fact that the earlier-described genotype and PTSDdependent differences in GR sensitivity could drive the observed gene expression pattern. Results were validated by reverse transcriptase-polymerase chain reaction and replicated in an independent sample (N=98). Conclusions: These data suggest that the inheritance of GR sensitivity-moderating FKBP5 polymorphisms can determine specific types of hypothalamic-pituitaryadrenal axis dysfunction within PTSD, which are also reflected in gene-expression changes of a subset of GRresponsive genes. Thus, these findings indicate that functional variants in FKBP5 are associated with biologically distinct subtypes of PTSD

    Early Intubation in Endovascular Therapy for Basilar Artery Occlusion:A Post Hoc Analysis of the BASICS Trial

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    BACKGROUND: The optimal anesthetic management for endovascular therapy (EVT) in patients with posterior circulation stroke remains unclear. Our objective was to investigate the impact of early intubation in patients enrolled in the BASICS trial (Basilar Artery International Cooperation Study). METHODS: BASICS was a multicenter, randomized, controlled trial that compared the efficacy of EVT compared with the best medical care alone in patients with basilar artery occlusion. In this post hoc analysis, early intubation within the first 24 hours of the estimated time of basilar artery occlusion was examined as an additional covariate using regression modeling. We estimated the adjusted relative risks (RRs) for favorable outcomes, defined as modified Rankin Scale scores of 0 to 3 at 90 days. An adjusted common odds ratio was estimated for a shift in the distribution of modified Rankin Scale scores at 90 days. RESULTS: Of 300 patients in BASICS, 289 patients were eligible for analysis (151 in the EVT group and 138 in the best medical care group). compared with medical care alone, EVT was related to a higher risk of early intubation (RR, 1.29 [95% CI, 1.09–1.53]; P&lt;0.01), and early intubation was negatively associated with favorable outcome (RR, 0.61 [95% CI, 0.45–0.84]; P=0.002). Whereas there was no overall treatment effect of EVT on favorable outcome (RR, 1.22 [95% CI, 0.95–1.55]; P=0.121), EVT was associated with favorable outcome (RR, 1.34 [95% CI, 1.05–1.71]; P=0.018) and a shift toward lower modified Rankin Scale scores (adjusted common odds ratio, 1.63 [95% CI, 1.04–2.57]; P=0.033) if adjusted for early intubation. CONCLUSIONS: In this post hoc analysis of the neutral BASICS trial, early intubation was linked to unfavorable outcomes, which might mitigate a potential benefit from EVT by indirect effects due to an increased risk of early intubation. This relationship may be considered when assessing the efficacy of EVT in patients with basilar artery occlusion in future trials.</p

    The replication crisis and its relevance to Earth Science studies: Case studies and recommendations

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    Numerous scientific fields are facing a replication crisis, where the results of a study often cannot be replicated when a new study uses independent data. This issue has been particularly emphasized in psychology, health, and medicine, as incorrect results in these fields could have serious consequences, where lives might be at stake. While other fields have also highlighted significant replication problems, the Earth Sciences seem to be an exception. The paucity of Earth Science research aimed at understanding the replication crisis prompted this study. Specifically, this work aims to fill that gap by seeking to replicate geological results involving various types of time-series. We identify and discuss 11 key variables for replicating U-Pb age distributions: independent data, global sampling, proxy data, data quality, disproportionate non-random sampling, stratigraphic bias, potential filtering bias, accuracy and precision, correlating time-series segments, testing assumptions and divergent analytical methods, and analytical transparency. Even while this work primarily focuses on U-Pb age distributions, most of these factors (or variations of them) also apply to other geoscience disciplines. Thus, some of the discussions involve time-series consisting of εHf, δ18O-zircon, 14C, 10Be, marine δ13C, and marine δ18O. We then provide specific recommendations for minimizing adverse effects related to these factors, and in the process enhancing prospects for replicating geological results
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