The role of early contrast-enhanced chest computed tomography in the aetiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion

AIMS: The role of chest computed tomography (CT) is not well defined for either diagnosis or management of pericardial disease. The aim of this study was to evaluate the added value of early chest CT in the diagnostic workup for patients presenting with cardiac tamponade or large pericardial effusion of unknown aetiology as the first manifestation of disease. METHODS AND RESULTS: We performed CT scan on 55 patients with pericardial effusion as defined above, undergoing echo-guided pericardiocentesis. We compared the success rate in making diagnosis and/or staging the underlying disorder of three sequential workups, including, respectively, (i) clinical presentation, inflammatory markers, chest X-ray imaging, (ii) all of the above and pericardial fluid analysis, and (iii) all of the above and chest CT. We were able to make diagnosis in 53 patients (96%): the major cause of effusion was malignancy (38%). Clinical and biochemical data were not able to differentiate non-tumour from tumour patients. CT revealed pathological findings in all patients with malignancy: tumour mass in 15/21 (71%) and pathological lymphadenopathy in the remaining 6 cases. The workup including CT provided a significantly higher diagnostic yield than the other two workups (P < 0.0001), both in the overall population and in the two subgroups of neoplastic (Npl) and non-Npl patients. CONCLUSION: In all patients with cardiac tamponade or large pericardial effusion, CT was useful either in identifying the underlying disease or in excluding other potential causes of pericardial effusion. We conclude that chest CT is a very useful non-invasive diagnostic tool to identify and stage pericardial diseases

HUBUNGAN DUKUNGAN KELUARGA DENGAN TINGKAT DEPRESI PADA NARAPIDANA NAPZA DI RUTAN KELAS IIB KAJHU ACEH BESAR

Banda Ace

Capturing and communicating impact of citizen science for policy: A storytelling approach

In response to the need for approaches to understand how citizen science is currently influencing environmental policy and associated decision making, we devised the Citizen Science Impact StoryTelling Approach (CSISTA). We iteratively designed instruments to be used as tools primarily for citizen science practitioners seeking to understand or communicate policy impacts. We then trialled the CSISTA and associated instruments on four exemplary citizen science initiatives, using different forms of inquiry and collaboration with respective initiative leaders. In this paper, we present CSISTA, with details of the steps for implementing inquiry and storytelling instruments. Additionally, we reflect on insights gained and challenges encountered implementing the approach. Overall, we found the versatility and structure of CSISTA as a process with multiple guiding instruments useful. We envision the approach being helpful, particularly with regards to: 1) gaining an understanding of a citizen science initiative's policy and decision-making impacts; 2) creating short policy impact stories to communicate such impacts to broader audiences; or 3) fulfilling both goals to understand and communicate policy impacts with a unified approach. We encourage others to explore, adapt, and improve the approach. Additionally, we hope that explorations of CSISTA will foster broader discussions on how to understand and strengthen interactions between citizen science practitioners, policy makers, and decision makers at large, whether at local, national, or international scales

Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Introduction: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. Methods: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. Results: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P <.001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). Conclusions: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention

Control of Mitochondrial Membrane Permeabilization by Adenine Nucleotide Translocator Interacting with HIV-1 Viral Protein R and Bcl-2

Viral protein R (Vpr), an apoptogenic accessory protein encoded by HIV-1, induces mitochondrial membrane permeabilization (MMP) via a specific interaction with the permeability transition pore complex, which comprises the voltage-dependent anion channel (VDAC) in the outer membrane (OM) and the adenine nucleotide translocator (ANT) in the inner membrane. Here, we demonstrate that a synthetic Vpr-derived peptide (Vpr52-96) specifically binds to the intermembrane face of the ANT with an affinity in the nanomolar range. Taking advantage of this specific interaction, we determined the role of ANT in the control of MMP. In planar lipid bilayers, Vpr52-96 and purified ANT cooperatively form large conductance channels. This cooperative channel formation relies on a direct protein–protein interaction since it is abolished by the addition of a peptide corresponding to the Vpr binding site of ANT. When added to isolated mitochondria, Vpr52-96 uncouples the respiratory chain and induces a rapid inner MMP to protons and NADH. This inner MMP precedes outer MMP to cytochrome c. Vpr52-96–induced matrix swelling and inner MMP both are prevented by preincubation of purified mitochondria with recombinant Bcl-2 protein. In contrast to König's polyanion (PA10), a specific inhibitor of the VDAC, Bcl-2 fails to prevent Vpr52-96 from crossing the mitochondrial OM. Rather, Bcl-2 reduces the ANT–Vpr interaction, as determined by affinity purification and plasmon resonance studies. Concomitantly, Bcl-2 suppresses channel formation by the ANT–Vpr complex in synthetic membranes. In conclusion, both Vpr and Bcl-2 modulate MMP through a direct interaction with ANT

Time Course of Ischemic and Bleeding Burden in Elderly Patients&#160;With&#160;Acute Coronary Syndromes Randomized to Low-Dose Prasugrel or Clopidogrel

Background Elderly patients have high ischemic and bleeding rates after acute coronary syndrome; however, the occurrence of these complications over time has never been studied. This study sought to characterize average daily ischemic rates ( ADIRs ) and average daily bleeding rates ( ADBRs ) over 1\ua0year in patients aged >74\ua0years with acute coronary syndrome undergoing percutaneous coronary intervention who were randomized in the Elderly ACS 2 trial, comparing low-dose prasugrel (5\ua0mg daily) with clopidogrel (75\ua0mg daily). Methods and Results ADIRs and ADBRs were calculated as the total number of events, including recurrent events, divided by the number of patient-days of follow-up and assessed within different clinical phases: acute (0-3\ua0days), subacute (4-30\ua0days), and late (31-365\ua0days). Generalized estimating equations were used to test the least squares mean differences for the pairwise comparisons of ADIRs and ADBRs and the pairwise comparison of clopidogrel versus prasugrel effects. Globally, ADIRs were 2.6 times (95% CI, 2.4-2.9) higher than ADBRs . ADIRs were significantly higher in the clopidogrel arm than in the low-dose prasugrel arm in the subacute phase ( Padj<0.001) without a difference in ADBRs ( Padj=0.35). In the late phase, ADIRs remained significantly higher with clopidogrel ( Padj<0.001), whereas ADBRs were significantly higher with low-dose prasugrel ( Padj<0.001). Conclusions Ischemic burden was greater than bleeding burden in all clinical phases of 1-year follow-up of elderly patients with acute coronary syndrome treated with percutaneous coronary intervention. Low-dose prasugrel reduced ischemic events in the subacute and chronic phases compared with clopidogrel, whereas bleeding burden was lower with clopidogrel in the late phase. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01777503

Diverse consequences of algorithmic probability

We reminisce and discuss applications of algorithmic probability to a wide range of problems in artificial intelligence, philosophy and technological society. We propose that Solomonoff has effectively axiomatized the field of artificial intelligence, therefore establishing it as a rigorous scientific discipline. We also relate to our own work in incremental machine learning and philosophy of complexity. © 2013 Springer-Verlag Berlin Heidelberg

CUORE: The first bolometric experiment at the ton scale for the search for neutrino-less double beta decay

The Cryogenic Underground Observatory for Rare Events (CUORE) is the most massive bolometric experiment searching for neutrino-less double beta (0νββ) decay. The detector consists of an array of 988 TeO crystals (742 kg) arranged in a compact cylindrical structure of 19 towers. This paper will describe the CUORE experiment, including the cryostat, and present the detector performance during the first year of running. Additional detail will describe the effort made in improving the energy resolution in the Te 0νββ decay region of interest (ROI) and the suppression of backgrounds. A description of work to lower the energy threshold in order to give CUORE the sensitivity to search for other rare events, such as dark matter, will also be provided. 2 13

Perspectives of lowering CUORE thresholds with Optimum Trigger

CUORE is a cryogenic experiment that focuses on the search of neutrinoless double beta decay in 130Te and it is located at the Gran Sasso National Laboratories. Its detector consists of 988 TeO2 crystals operating at a base temperature of ~10 mK. It is the first ton-scale bolometric experiment ever realized for this purpose. Thanks to its large target mass and ultra-low background, the CUORE detector is also suitable for the search of other rare phenomena. In particular the low energy part of the spectra is interesting for the detection of WIMP-nuclei scattering reactions. One of the most important requirements to perform these studies is represented by the achievement of a stable energy threshold lower than 10 keV. Here, the CUORE capability to accomplish this purpose using a low energy software trigger will be presented and described

Results from the CUORE-0 experiment

The CUORE-0 experiment searched for neutrinoless double beta decay in 130Te using an array of 52 tellurium dioxide crystals, operated as bolometers at a temperature of 10 mK. It took data in the Gran Sasso National Laboratory (Italy) since March 2013 to March 2015. We present the results of a search for neutrinoless double beta decay in 9.8 kg-years 130Te exposure that allowed us to set the most stringent limit to date on this half-life. The performance of the detector in terms of background and energy resolution is also reported