Leczenie dużymi dawkami statyn: korzyści i bezpieczeństwo intensywnej terapii hipolipemizującej

Cholesterol frakcji LDL (LDL-C) jest biomarkerem miażdżycy. Zmniejszenie stężenia LDL-C wiąże się ze zmniejszeniem ryzyka niepożądanych punktów końcowych o etiologii sercowo-naczyniowej. W ostatnich badaniach wykazano korzyści z obniżenia stężenia LDL-C poniżej 100 mg/dl, a nawet poniżej 70 mg/dl. Na ich podstawie dokonano aktualizacji zaleceń, sugerując niższe docelowe stężenia LDL-C u niektórych pacjentów należących do grupy wysokiego ryzyka. U pacjentów bez potwierdzonej choroby wieńcowej lub ekwiwalentu choroby wieńcowej z co najmniej 2 czynnikami ryzyka, należy obliczyć 10-letnie ryzyko według skali Framingham w celu ustalenia docelowej wartości LDL-C. Wydaje się, że optymalne stężenie LDL-C u wszystkich pacjentów z chorobą sercowo-naczyniową wynosi poniżej 70 mg/dl. U pacjentów bez choroby sercowo-naczyniowej celowe jest zmniejszenie stężenia LDL-C o co najmniej 50% w stosunku do stężenia wyjściowego. Stężenie LDL-C poniżej 70 mg/dl można osiągnąć w bezpieczny sposób u większości pacjentów z chorobą sercowo-naczyniową, o ile stosuje się wysoce skuteczne leki hipolipemizujące. W ciągu ponad 20 lat stosowania statyn przez miliony pacjentów udowodniono, że taka terapia jest bezpieczna i dobrze tolerowana. Lekarze powinni wybrać lek, który pozwoli osiągnąć odpowiednie stężenie LDL-C, na podstawie danych dotyczących klinicznych punktów końcowych, wybrać odpowiednio dużą dawkę początkową oraz modyfikować dawkę tak, aby osiągnąć docelowe stężenie

Beginning of Viniculture in France

Chemical analyses of ancient organic compounds absorbed into the pottery fabrics of imported Etruscan amphoras (ca. 500-475 B.C.) and into a limestone pressing platform (ca. 425-400 B.C.) at the ancient coastal port site of Lattara in southern France provide the earliest biomolecular archaeological evidence for grape wine and viniculture from this country, which is crucial to the later history of wine in Europe and the rest of the world. The data support the hypothesis that export of wine by ship from Etruria in central Italy to southern Mediterranean France fueled an ever-growing market and interest in wine there, which, in turn, as evidenced by the winepress, led to transplantation of the Eurasian grapevine and the beginning of a Celtic industry in France. Herbal and pine resin additives to the Etruscan wine point to the medicinal role of wine in antiquity, as well as a means of preserving it during marine transport

Uniqueness in the Freedericksz transition with weak anchoring

In this paper we consider a boundary value problem for a quasilinear pendulum equation with nonlinear boundary conditions that arises in a classical liquid crystals setup, the Freedericksz transition, which is the simplest opto-electronic switch, the result of competition between reorienting effects of an applied electric field and the anchoring to the bounding surfaces. A change of variables transforms the problem into the equation x = −f(x) for ∈ (−T, T), with boundary conditions x = ± T f(x) at = ∓T, for a convex nonlinearity f. By analyzing an associated inviscid Burgers' equation, we prove uniqueness of monotone solutions in the original nonlinear boundary value problem. This result has been for many years conjectured in the liquid crystals literature, e. g. in E. G. Virga, Variational Theories for Liquid Crystals,Chapman and Hall, London, 1994 and in I. W. Stewart, The Static and Dynamic Continuum Theory of Liquid Crystals: A Mathematical Introduction, Taylor and Francis, London, 2003

The XMM Cluster Survey: The Dynamical State of XMMXCS J2215.9-1738 at z=1.457

We present new spectroscopic observations of the most distant X-ray selected galaxy cluster currently known, XMMXCS J2215.9-1738 at z=1.457, obtained with the DEIMOS instrument at the W. M. Keck Observatory, and the FORS2 instrument on the ESO Very Large Telescope. Within the cluster virial radius, as estimated from the cluster X-ray properties, we increase the number of known spectroscopic cluster members to 17 objects, and calculate the line of sight velocity dispersion of the cluster to be 580+/-140 km/s. We find mild evidence that the velocity distribution of galaxies within the virial radius deviates from a single Gaussian. We show that the properties of J2215.9-1738 are inconsistent with self-similar evolution of local X-ray scaling relations, finding that the cluster is underluminous given its X-ray temperature, and that the intracluster medium contains ~2-3 times the kinetic energy per unit mass of the cluster galaxies. These results can perhaps be explained if the cluster is observed in the aftermath of an off-axis merger. Alternatively, heating of the intracluster medium through supernovae and/or Active Galactic Nuclei activity, as is required to explain the observed slope of the local X-ray luminosity-temperature relation, may be responsible.Comment: 13 pages, 6 figures, accepted for publication in Ap

Epidermal Mosaicism and Blaschko\u27s Lines

To test the hypothesis that epidermal rather than dermal mosaicism determines Blaschko\u27s lines in hypomelanosis of Ito (HI), we studied the distribution of chromosomal mosaicism in four patients. In two, mosaicism had not been detected in lymphocytes or dermal fibroblasts, but was clearly shown in epidermal keratinocytes; furthermore, the abnormal cell line was confirmed to the hypopigmented epidermis and the normal epidermis contained only normal cells. Negative findings in the other two patients might be because of mosaicism which was undetected either because it was submicroscopic or because it was present in melanocytes, which have not yet been studied. These preliminary results support the ideas that (1) Blaschko\u27s lines represent single clones of epidermal cells; (2) in patients with HI and severe neurological involvement mosaicism, if detectable, is best shown in keratinocytes; and (3) the cytogenetic defect in epidermal cells may be directly responsible for the failure of pigmentation in HI

Seasonal variability of the warm Atlantic Water layer in the vicinity of the Greenland shelf break

The warmest water reaching the east and west coast of Greenland is found between 200?m and 600?m. Whilst important for melting Greenland's outlet glaciers, limited winter observations of this layer prohibit determination of its seasonality. To address this, temperature data from Argo profiling floats, a range of sources within the World Ocean Database and unprecedented coverage from marine-mammal borne sensors have been analysed for the period 2002-2011. A significant seasonal range in temperature (~1-2?°C) is found in the warm layer, in contrast to most of the surrounding ocean. The phase of the seasonal cycle exhibits considerable spatial variability, with the warmest water found near the eastern and southwestern shelf-break towards the end of the calendar year. High-resolution ocean model trajectory analysis suggest the timing of the arrival of the year's warmest water is a function of advection time from the subduction site in the Irminger Basin

The XMM Cluster Survey: a massive galaxy cluster at z = 1.45

We report the discovery of XMMXCS J2215.9-1738, a massive galaxy cluster at z=1.45, which was found in the XMM Cluster Survey. The cluster candidate was initially identified as an extended X-ray source in archival XMM data. Optical spectroscopy shows that six galaxies within a ~60" diameter region lie at z=1.45+/-0.01. Model fits to the X-ray spectra of the extended emission yield kT=7.4+2.7-1.8 keV (90% confidence); if there is an undetected central X-ray point source, then kT=6.5+2.6-1.8 keV. The bolometric X-ray luminosity is LX=4.4+0.8-0.6C 1044 ergs s-1 over a 2 Mpc radial region. The measured TX, which is the highest for any known cluster at z>1, suggests that this cluster is relatively massive for such a high redshift. The redshift of XMMXCS J2215.9-1738 is the highest currently known for a spectroscopically confirmed cluster of galaxies

The XMM Cluster Survey: Evidence for energy injection at high redshift from evolution of the X-ray luminosity-temperature relation

We measure the evolution of the X-ray luminosity-temperature (L_X-T) relation since z~1.5 using a sample of 211 serendipitously detected galaxy clusters with spectroscopic redshifts drawn from the XMM Cluster Survey first data release (XCS-DR1). This is the first study spanning this redshift range using a single, large, homogeneous cluster sample. Using an orthogonal regression technique, we find no evidence for evolution in the slope or intrinsic scatter of the relation since z~1.5, finding both to be consistent with previous measurements at z~0.1. However, the normalisation is seen to evolve negatively with respect to the self-similar expectation: we find E(z)^{-1} L_X = 10^{44.67 +/- 0.09} (T/5)^{3.04 +/- 0.16} (1+z)^{-1.5 +/- 0.5}, which is within 2 sigma of the zero evolution case. We see milder, but still negative, evolution with respect to self-similar when using a bisector regression technique. We compare our results to numerical simulations, where we fit simulated cluster samples using the same methods used on the XCS data. Our data favour models in which the majority of the excess entropy required to explain the slope of the L_X-T relation is injected at high redshift. Simulations in which AGN feedback is implemented using prescriptions from current semi-analytic galaxy formation models predict positive evolution of the normalisation, and differ from our data at more than 5 sigma. This suggests that more efficient feedback at high redshift may be needed in these models.Comment: Accepted for publication in MNRAS; 12 pages, 6 figures; added references to match published versio