EVALUATION OF TREATMENTS FOR CORONARY ARTERY DISEASE UTILIZING CONTEMPORARY STATISTICAL METHODS

Cardiovascular disease is the leading cause of mortality worldwide, and approximately half of all cardiovascular deaths are attributed specifically to coronary artery disease (CAD). Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures play a prominent role in managing the heavy burden of CAD. The purpose of this dissertation was to evaluate revascularization treatment in patients with multivessel coronary disease. Specifically, predictors of long-term prognosis and factors related to selection of revascularization strategy were investigated in the BARI and BARI 2D cohorts, respectively.In BARI, treatment with CABG was associated with a significantly lower risk of sudden cardiac death, but did not impact any other causes of mortality. Moreover, protection conferred by CABG was observed in patients regardless of diabetes status. Following successful initial PCI in BARI, male gender, proximal LAD disease, and incomplete revascularization were associated with an increased risk of a first subsequent revascularization event but not latter events. Diabetes and extensive CAD, on the other hand, demonstrated an incremental impact on the number of repeat procedures over 10 years of follow-up.Among patients with diabetes and stable CAD in BARI 2D, angiographic features associated with the extent and location of coronary disease greatly influenced the decision to perform CABG over PCI. Geographic region, independent of patient characteristics, was also a driving factor in treatment selection, with a greater propensity to recommend PCI in the US. In all countries of origin, we observed substantial variation across individual clinical sites in this decision-making process. Results in the BARI cohort may have clinical implications on guiding initial revascularization strategy and underscore the importance of intensive management of atherosclerotic risk factors in order to limit disease progression. Our investigation of BARI 2D demonstrate the need for rigorous evaluation of optimal CAD treatment approaches in diabetic patients and factors that guide this decision-making process in current practice. Overall, these findings may be useful for devising long-term treatment strategies that address the chronic, progressive, and systemic nature of coronary disease, which will be of great public health importance as medical advances continue to extend the lives of individuals with CAD

Damage Assessment Method of Reinforcement Concrete Building By Fuzzy Theory

 As reinforcement concrete building is composition material which reinforcement    bar and concrete work together, effect factors concerned with its damage are countlessly much and interrelationship between them is also very complex and indefiniteness. Until now many researches about the damage assessment of a building   has been performed but the problem accounting correctly damage of the reinforcement concrete building by connecting several of damage factors has not yet been solved.  In research a method accounting damage of reinforcement concrete building in the fuzzy integral way in consideration of fuzzy property existing in the damage assessment system of it has been newly suggested

Impact of Pneumocystis jirovecii pneumonia on kidney transplant outcome

Backgrounds Pneumocystis jirovecii pneumonia (PCP) remains an important cause of morbidity and mortality in kidney transplant recipients. While the acute phase toxicity in patients with PCP is well-characterized, there is a lack of data on the effects of PCP on long-term graft outcome. Method This retrospective observational study analyzed 1502 adult patients who underwent kidney transplantation at Seoul National University Hospital between 2000 and 2017. After a propensity score matching was performed, the graft and survival outcomes were compared between PCP-negative and PCP-positive groups. Results A total of 68 patients (4.5%) developed PCP after transplantation. The multivariable Cox analysis showed that positivity for cytomegalovirus and lack of initial oral antibiotic prophylaxis were risk factors of post-transplant PCP. The PCP-positive group had higher hazard ratios of graft failure [adjusted hazard ratio (HR), 3.1 (1.14–8.26); P = 0.027] and mortality [adjusted HR, 11.0 (3.68–32.80); P < 0.001] than the PCP-negative group. However, the PCP event was not related with subsequent development of de novo donor-specific antibodies or pathologic findings, such as T-cell or antibody mediated rejection and interstitial fibrosis and tubular atrophy. Conclusions PCP is a risk factor of long-term graft failure and mortality, irrespective of rejection. Accordingly, appropriate prophylaxis and treatment is needed to avoid adverse transplant outcomes of PCP.This study was supported by the Young Investigator Research Grant from the Korean Society Nephrology (Kyowa Hakko Kirin 2017) and a grant from the Basic Science Research Program through the National Research Foundation of Korea (NRF), which is funded by the Ministry of Education (NRF-2017R1D1A1B03031642). The grants had neither role in the study design, nor in data collection, analysis, interpretation and nor in manuscript writing

Reduction of circulating innate lymphoid cell progenitors results in impaired cytokine production by innate lymphoid cells in patients with lupus nephritis

Abstract Background Innate lymphoid cells (ILCs) play an essential role in maintaining homeostasis; however, they can also cause chronic inflammation and autoimmune disease. This study aimed to identify the role of ILCs in the pathogenesis of lupus nephritis (LN). Methods The percentage of ILCs within the peripheral blood mononuclear cell (PBMC) population and urine of patients with LN (n = 16), healthy controls (HC; n = 8), and disease controls (ANCA-associated vasculitis (AAV; n = 6), IgA nephropathy (IgAN; n = 9), and other glomerular diseases (n = 5)) was determined by flow cytometry analysis. In addition, ILCs were sorted and cultured with plasma from LN patients or HC to elucidate whether the reduced population of CD117+ ILCs observed in LN was due to changes in the ILC progenitor population. Results The percentage of total ILCs and CD117+ ILCs in LN was significantly lower than that in HC. The percentage of cytokine-secreting ILCs was also lower in LN; however, when the disease stabilized, cytokine production was restored to levels similar to those in HC. The increase in the number of exhausted ILCs (cells unable to secrete cytokines) correlated positively with disease activity. When CD117+ ILCs were cultured with LN plasma, the number of CD117+ ILCs fell, but that of other ILC subsets increased. Conclusions The percentage of CD117+ ILCs and the capacity of ILCs to secrete cytokines fell as LN severity increased, suggesting that an inflammatory environment of LN induces persistent differentiation and exhaustion of ILCs