BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD.

BACKGROUND AND OBJECTIVES: In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic BP treatment (target <120 mm Hg) was associated with fewer cardiovascular events and higher incidence of kidney function decline compared with standard treatment (target <140 mm Hg). We evaluated the association between mean arterial pressure reduction, kidney function decline, and cardiovascular events in patients without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We categorized patients in the intensive treatment group of the SPRINT according to mean arterial pressure reduction throughout follow-up: <20, 20 to <40, and ≥40 mm Hg. We defined the primary outcome as kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals), and we defined the secondary outcome as cardiovascular events. In a propensity score analysis, patients in each mean arterial pressure reduction category from the intensive treatment group were matched with patients from the standard treatment group to calculate the number needed to treat regarding cardiovascular events and the number needed to harm regarding kidney function decline. RESULTS: In the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg. Adjusted hazard ratios for kidney function decline were 2.10 (95% confidence interval, 1.22 to 3.59) for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 (95% confidence interval, 2.75 to 14.08) for mean arterial pressure reduction ≥40 mm Hg. In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16. CONCLUSIONS: In the intensive treatment group of SPRINT, larger declines in mean arterial pressure were associated with higher incidence of kidney function decline. Intensive treatment seemed to be less favorable when a larger reduction in mean arterial pressure was needed to attain the BP target.info:eu-repo/semantics/publishedVersio

Comment on Bress et al. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial. Diabetes Care 2017;40:1401-1408.

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Taming chaos to sample rare events: The effect of weak chaos

Rare events in nonlinear dynamical systems are difficult to sample because of the sensitivity to perturbations of initial conditions and of complex landscapes in phase space. Here, we discuss strategies to control these difficulties and succeed in obtaining an efficient sampling within a Metropolis-Hastings Monte Carlo framework. After reviewing previous successes in the case of strongly chaotic systems, we discuss the case of weakly chaotic systems. We show how different types of nonhyperbolicities limit the efficiency of previously designed sampling methods, and we discuss strategies on how to account for them. We focus on paradigmatic low-dimensional chaotic systems such as the logistic map, the Pomeau-Maneville map, and area-preserving maps with mixed phase space. Published under license by AIP Publishing

High resolution tsunami modelling for the evaluation of potential risk areas in Setúbal (Portugal)

The use of high resolution hydrodynamic modelling to simulate the potential effects of tsunami events can provide relevant information about the most probable inundation areas. Moreover, the consideration of complementary data such as the type of buildings, location of priority equipment, type of roads, enables mapping of the most vulnerable zones, computing of the expected damage on man-made structures, constrain of the definition of rescue areas and escape routes, adaptation of emergency plans and proper evaluation of the vulnerability associated with different areas and/or equipment. &lt;br&gt;&lt;br&gt; Such an approach was used to evaluate the specific risks associated with a potential occurrence of a tsunami event in the region of Setúbal (Portugal), which was one of the areas most seriously affected by the 1755 tsunami. &lt;br&gt;&lt;br&gt; In order to perform an evaluation of the hazard associated with the occurrence of a similar event, high resolution wave propagation simulations were performed considering different potential earthquake sources with different magnitudes. Based on these simulations, detailed inundation maps associated with the different events were produced. These results were combined with the available information on the vulnerability of the local infrastructures (building types, roads and streets characteristics, priority buildings) in order to impose restrictions in the production of high-scale potential damage maps, escape routes and emergency routes maps

Analgesic interpatient variability of remifentanil assessed through pupillary dilation reflex

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Structural insights into carboxylic polyester-degrading enzymes and their functional depolymerizing neighbors

Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Esters are organic compounds widely represented in cellular structures and metabolism, originated by the condensation of organic acids and alcohols. Esterification reactions are also used by chemical industries for the production of synthetic plastic polymers. Polyester plastics are an increasing source of environmental pollution due to their intrinsic stability and limited recycling efforts. Bioremediation of polyesters based on the use of specific microbial enzymes is an interesting alternative to the current methods for the valorization of used plastics. Microbial esterases are promising catalysts for the biodegradation of polyesters that can be engineered to improve their biochemical properties. In this work, we analyzed the structure-activity relationships in microbial esterases, with special focus on the recently described plastic-degrading enzymes isolated from marine microorganisms and their structural homologs. Our analysis, based on structure-alignment, molecular docking, coevolution of amino acids and surface electrostatics determined the specific characteristics of some polyester hydrolases that could be related with their efficiency in the degradation of aromatic polyesters, such as phthalates.This work is supported by the Portuguese Foundation for Science and Technology (FCT) under the framework of the research grant PTDC-MED-GEN-29389-2017.info:eu-repo/semantics/publishedVersio

Pupillary pain index correlates with postoperative pain scores in neurosurgical patients

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