106 research outputs found
Intracoronary gamma-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis
BACKGROUND: Treatment of in-stent restenosis presents a critical
limitation of intracoronary stent implantation. Ionizing radiation has
been shown to decrease neointimal formation within stents in animal models
and in initial clinical trials. We studied the effects of intracoronary
gamma-radiation therapy versus placebo on the clinical and angiographic
outcomes of patients with in-stent restenosis. METHODS AND RESULTS: One
hundred thirty patients with in-stent restenosis underwent successful
coronary intervention and were then blindly randomized to receive either
intracoronary gamma-radiation with (192)Ir (15 Gy) or placebo. Four
independent core laboratories blinded to the treatment protocol analyzed
the angiographic and intravascular ultrasound end points of restenosis.
Procedural success and in-hospital and 30-day complications were similar
among the groups. At 6 months, patients assigned to radiation therapy
required less target lesion revascularization and target vessel
revascularization (9 [13.8%] and 17 [26.2%], respectively) compared with
patients assigned to placebo (41 [63.1%, P=0.0001] and 44 [67.7%,
P=0.0001], respectively). Binary angiographic restenosis was lower in the
irradiated group (19% versus 58% for placebo, P=0.001). Freedom from major
cardiac events was lower in the radiation group (29.2% versus 67.7% for
placebo, P<0.001). CONCLUSIONS: Intracoronary gamma-radiation used as
adjunct therapy for patients with in-stent restenosis significantly
reduces both angiographic and clinical restenosis
Crises and collective socio-economic phenomena: simple models and challenges
Financial and economic history is strewn with bubbles and crashes, booms and
busts, crises and upheavals of all sorts. Understanding the origin of these
events is arguably one of the most important problems in economic theory. In
this paper, we review recent efforts to include heterogeneities and
interactions in models of decision. We argue that the Random Field Ising model
(RFIM) indeed provides a unifying framework to account for many collective
socio-economic phenomena that lead to sudden ruptures and crises. We discuss
different models that can capture potentially destabilising self-referential
feedback loops, induced either by herding, i.e. reference to peers, or
trending, i.e. reference to the past, and account for some of the phenomenology
missing in the standard models. We discuss some empirically testable
predictions of these models, for example robust signatures of RFIM-like herding
effects, or the logarithmic decay of spatial correlations of voting patterns.
One of the most striking result, inspired by statistical physics methods, is
that Adam Smith's invisible hand can badly fail at solving simple coordination
problems. We also insist on the issue of time-scales, that can be extremely
long in some cases, and prevent socially optimal equilibria to be reached. As a
theoretical challenge, the study of so-called "detailed-balance" violating
decision rules is needed to decide whether conclusions based on current models
(that all assume detailed-balance) are indeed robust and generic.Comment: Review paper accepted for a special issue of J Stat Phys; several
minor improvements along reviewers' comment
Spallation reactions. A successful interplay between modeling and applications
The spallation reactions are a type of nuclear reaction which occur in space
by interaction of the cosmic rays with interstellar bodies. The first
spallation reactions induced with an accelerator took place in 1947 at the
Berkeley cyclotron (University of California) with 200 MeV deuterons and 400
MeV alpha beams. They highlighted the multiple emission of neutrons and charged
particles and the production of a large number of residual nuclei far different
from the target nuclei. The same year R. Serber describes the reaction in two
steps: a first and fast one with high-energy particle emission leading to an
excited remnant nucleus, and a second one, much slower, the de-excitation of
the remnant. In 2010 IAEA organized a worskhop to present the results of the
most widely used spallation codes within a benchmark of spallation models. If
one of the goals was to understand the deficiencies, if any, in each code, one
remarkable outcome points out the overall high-quality level of some models and
so the great improvements achieved since Serber. Particle transport codes can
then rely on such spallation models to treat the reactions between a light
particle and an atomic nucleus with energies spanning from few tens of MeV up
to some GeV. An overview of the spallation reactions modeling is presented in
order to point out the incomparable contribution of models based on basic
physics to numerous applications where such reactions occur. Validations or
benchmarks, which are necessary steps in the improvement process, are also
addressed, as well as the potential future domains of development. Spallation
reactions modeling is a representative case of continuous studies aiming at
understanding a reaction mechanism and which end up in a powerful tool.Comment: 59 pages, 54 figures, Revie
Phi meson production in Au+Au and p+p collisions at sqrt (s)=200 GeV
We report the STAR measurement of Phi meson production in Au+Au and p+p
collisions at sqrt (s)=200 GeV. Using the event mixing technique, the Phi
spectra and yields are obtained at mid-rapidity for five centrality bins in
Au+Au collisions and for non-singly-diffractive p+p collisions. It is found
that the Phi transverse momentum distributions from Au+Au collisions are better
fitted with a single-exponential while the p+p spectrum is better described by
a double-exponential distribution. The measured nuclear modification factors
indicate that Phi production in central Au+Au collisions is suppressed relative
to peripheral collisions when scaled by the number of binary collisions. The
systematics of versus centrality and the constant Phi/K- ratio versus beam
species, centrality, and collision energy rule out kaon coalescence as the
dominant mechanism for Phi production.Comment: 6 pages, 3 figures, submitted to Phys. Rev. Let
Human toxocariasis: contribution by Brazilian researchers
In the present paper the main aspects of the natural history of human infection by Toxocara larvae that occasionally result in the occurrence of visceral and/or ocular larva migrans syndrome were reviewed. The contribution by Brazilian researchers was emphasized, especially the staff of the Tropical Medicine Institute of São Paulo (IMT)
Predicting the Need for Biopsy to Detect Clinically Significant Prostate Cancer in Patients with a Magnetic Resonance Imaging–detected Prostate Imaging Reporting and Data System/Likert ≥3 Lesion: Development and Multinational External Validation of the Imperial Rapid Access to Prostate Imaging and Diagnosis Risk Score
Background: Although multiparametric magnetic resonance imaging (MRI) has highsensitivity, its lower specificity leads to a high prevalence of false-positive lesions requir-ing biopsy.Objective: To develop and externally validate a scoring system for MRI-detected ProstateImaging Reporting and Data System (PIRADS)/Likert 3 lesions containing clinically sig-nificant prostate cancer (csPCa).Design, setting, and participants: The multicentre Rapid Access to Prostate Imaging andDiagnosis (RAPID) pathway included 1189 patients referred to urology due to elevatedage-specific prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE); April 27, 2017 to October 25, 2019.</p
New insights into the genetic etiology of Alzheimer's disease and related dementias
Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
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