14 research outputs found

    Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

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    Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged >= 65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1,-2, and-3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and Z85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

    The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

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    The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure

    The NOMAD experiment at the CERN SPS

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    The NOMAD experiment is a short base-line search for νμντ\nu_{\mu}\rightarrow \nu_{\tau} oscillations in the CERN neutrino beam. The ντ\nu_{\tau}'s are searched for through their charged-current interactions followed by the observation of the resulting τ\tau^{-} through its electronic, muonic or hadronic decays. These decays are recognized using kinematical criteria necessitating the use of a light target which enables the reconstruction of individual particles produced in the neutrino interactions. This paper describes the various components of the NOMAD detector: the target and muon drift chambers, the electromagnetic and hadronic calorimeters, the preshower and transition radiation detectors, and the veto and trigger scintillation counters. The beam and data acquisition system are also described. The quality of the reconstruction of individual particles is demonstrated through the ability of NOMAD to observe Ks0^0_{\rm s}'s, Λ0\Lambda^0's and π0\pi^0's. Finally, the observation of τ\tau^{-} through its electronic decay being one of the most promising channels in the search, the identification of electrons in NOMAD is discussed

    Variable Intrafamilial Expression of ABCB4 Disease

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    Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease with autosomal recessive inheritance caused by mutations in theABCB4gene. The clinical presentation of PFIC3 varies significantly, displaying incomplete penetrance without clear genotype-phenotype correlations. As such, the suitability of living-related liver donation for children with advanced disease has been questioned. We report here the long-term follow-up of a patient with PFIC3 resulting in decompensated cirrhosis at 11 years who successfully underwent living donor liver transplantation from his father, who carried the sameABCB4homozygous mutation

    Huntington's Disease with Small CAG Repeat Expansions

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    International audienceAbstract Background Carriers of small cytosine‐adenine‐guanine (CAG) repeats below 39 in the HTT gene are traditionally associated with milder Huntington's disease, but their clinical profile has not been extensively studied. Objective To study the phenotype of CAG 36‐38 repeat carriers. Methods We included 35 patients and premanifest carriers of CAG 36‐38 repeats. We compared clinical and neuropsychological profiles of 11 CAG 36‐38 patients with 11 matched CAG 40‐42 patients. In addition, we analyzed 243 CAG 36‐38 individuals from the ENROLL study to complete the phenotype description. Results Global cognitive efficiency and performance in different cognitive subdomains were similar in small CAG 36‐38 and typically CAG 40‐42 expanded individuals. Chorea as the first symptom was significantly less frequent for CAG 36‐38 patients ( P = 0.04) despite similar total motor scores at first visit. Total motor score at last visit was significantly lower in CAG 36‐38 carriers ( P = 0.003). The similar cognitive and different motor profile of CAG 36‐38 (n = 243) and CAG 40‐42 (n = 4675) carriers was confirmed in the ENROLL database. Additionally, clinicians were significantly less confident in diagnosing Huntington's disease ( P = 2.4e−8) and diagnosis happened significantly later in CAG 36‐38 ( P = 2.2e−6) despite a similar age at symptom onset ( P = 0.29). Conclusions We showed that small CAG 36‐38 expansion carriers had a similar cognitive profile to those with the more common CAG 40‐42 expansions. These individuals may evade molecular diagnosis because of the absence of chorea rather than because of a low penetrance of symptoms. This finding should encourage neurologists to consider Huntington's disease in cognitively impaired elderly patients without typical chorea and anticipate consequences for genetic counseling in their offspring. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

    Scritture nascoste, scritture invisibili. Quando il medium non fa "passare" il messaggio.

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    In all writing traditions there are cases in which the written message cannot or must not intentionally be read, in the past and in the present. Artists’ signatures, texts written with invisible ink, encryptions, inscriptions for the gods, texts reserved to confidential readers, invented writings are all examples of an eccentric relation between the medium and its message. They do not match with the general theory of communication, which distinguishes source, message, medium and target among the essential constituent of a communication act. Moreover, in the constant dialectic between medium and message, code-switching and cultural interferences can be observed, both at a graphic and a linguistic level, which can totally or partially hide the code.The environment in which the message is conceived, made up of physical, cultural, religious, pragmatic aspects, defines and clarifies the use of this peculiar communication strategy, which finds an extreme case in the subliminal advertising
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