53 research outputs found

    Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

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    Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

    Circumglobal wave train and the summer monsoon over northwestern India and Pakistan: The explicit role of the surface heat low

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    This study examines the influence of the mid-latitude circulation on the surface heat low (HL) and associated monsoon rainfall over northwestern India and Pakistan using the ERA40 data and high resolution (T106L31) climate model ECHAM5 simulation. Special emphasis is given to the surface HL which forms over Pakistan and adjoining areas of India, Iran and Afghanistan during the summer season. A heat low index (HLI) is defined to depict the surface HL. The HLI displays significant correlations with the upper level mid-latitude circulation over western central Asia and low level monsoon circulation over Arabian Sea and acts as a bridge connecting the mid-latitude wave train to the Indian summer monsoon. A time-lagged singular value decomposition analysis reveals that the eastward propagation of the mid-latitude circumglobal wave train (CGT) influences the surface pressure anomalies over the Indian domain. The largest low (negative) pressure anomalies over the western parts of the HL region (i.e., Iran and Afghanistan) occur in conjunction with the upper level anomalous high that develops over western-central Asia during the positive phase of the CGT. The composite analysis also reveals a significant increase in the low pressure anomalies over Iran and Afghanistan during the positive phase of CGT. The westward increasing low pressure anomalies with its north–south orientation provokes enormous north–south pressure gradient (lower pressure over land than over sea). This in turn enables the moist southerly flow from the Arabian Sea to penetrate farther northward over northwestern India and Pakistan. A monsoon trough like conditions develops over northwestern India and Pakistan where the moist southwesterly flow from the Arabian Sea and the Persian Gulf converge. The convergence in association with the orographic uplifting expedites convection and associated precipitation over northwestern India and Pakistan. The high resolution climate model ECHAM5 simulation also underlines the proposed findings and mechanism

    Precipitation variability over the South Asian monsoon heat flow and associated teleconnections

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    The present study examines the precipitation variability over the South Asian monsoon heat low region and associated teleconnections using high resolution (T106L31) climate simulations performed with the ECHAM5 model. It is found that an intensification of the heat low in response to enhanced precipitation/convection over northwestern India-Pakistan (NWIP) can induce large-scale circulation anomalies that resemble the northern summer circumglobal teleconnection (CGT) wave-like pattern extending well into the Asian monsoon region. Accordingly the wave-like response to rainfall increase over the heat low region is associated with anomalous ascent over northern China and descent over the South China Sea. Additionally, small but statistically significant lead-lag correlations between the heat low and precipitation over northern China further suggest that the detected signal pertains to the true features of the process. On the other hand, suppressed convection and rainfall over the heat low region do not reveal any significant large-scale circulation anomalies. Copyright 2011 by the American Geophysical Union

    Sulfur isotopes, trace element, and textural analyses of pyrite, arsenopyrite and base metal sulfides associated with gold mineralization in the Pataz-Parcoy district, Peru: implication for paragenesis, fluid source, and gold deposition mechanisms

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    In the Pataz-Parcoy district, current mining activity is focused on the mesothermal quartz-carbonate-sulfide veins hosted by the Pataz batholith. Total gold production yielded approximately 8 Moz with grades in the mined ore shoots varying between 7 and 15 g/t Au, and locally reaching up to 120 g/t Au. High-grade ore shoots are extraordinarily enriched in sulfides, representing 10 to 20 modal vol% of the vein. Ore mineralogy is characterized by a complex paragenesis of pyrite, arsenopyrite, galena, sphalerite, chalcopyrite, and gold. Gold occurs mostly as electrum in equilibrium with base metals sulfides filling fractures of pyrite and arsenopyrite. A novel combination of secondary ion mass spectrometry, laser ablation inductively coupled plasma mass spectrometry, and electron probe microanalysis is used to track the compositional evolution of ore fluid(s) and to investigate the mineralization processes occurring in the Pataz-Parcoy district. Contrasting with the classical two-stage ore sequence previously proposed for the Pataz-Parcoy district, we suggest a revised paragenetic sequence, i.e., (1) deposition of pyrite core (PyI) with homogeneously distributed base metal sulfide inclusions, (2) progressive replacement of PyI by arsenian pyrite (PyII) and arsenopyrite associated with invisible gold deposition, and (3) deposition of sphalerite – galena ± chalcopyrite - electrum in fractured pyrite and arsenopyrite. We propose two models for the formation of base metal sulfide inclusions in PyI, i.e., (1) co-precipitation of base metal sulfide with PyI and later redistribution in cracks driven by partial As replacement of PyI to PyII and arsenopyrite and (2) preferential replacement of the PyI along crystallographic planes by percolation of the fluid responsible for base metal sulfide deposition in fractured pyrite and arsenopyrite
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