Fibromuscular Arterial Disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75604/1/j.1440-1673.1970.tb01633.x.pd

Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

In situ synchrotron tomographic investigation of the solidification of an AlMg4.7Si8 alloy.

International audienceThe solidification sequence of an AlMg4.7Si8 alloy is imaged in situ by synchrotron microtomography. Tomograms with (1.4 mu m)(3)/voxel have been recorded every minute while cooling the melt from 600 degrees C at a cooling rate of 5 K min(-1) to 540 degrees C in the solid state. The solidification process starts with the three-dimensional evolution of the alpha-Al dendritic structure at 590 degrees C. The growth of the a-Al dendrites is described by curvature parameters that represent the coarsening quantitatively, and ends in droplet-like shapes of the secondary dendrite arms at 577 degrees C. There, the eutectic valley of alpha-Al/Mg2Si is reached, forming initially octahedral Mg2Si particles preferentially at the bases of the secondary dendrite arms. The eutectic grows with seaweed-like Mg2Si structures, with increasing connectivity. During this solidification stage Fe-aluminides form and expand as thin objects within the interdendritic liquid. Finally, the remaining liquid freezes as ternary alpha-Al/Mg2Si/Si eutectic at 558 degrees C, increasing further the connectivity of the intermetallic phases. The frozen alloy consists of four phases exhibiting morphologies characteristic of their mode of solidification: alpha-Al dendrites, eutectic alpha-Al/Mg2Si "Chinese script" with Fe-aluminides, and interpenetrating alpha-Al/Mg2Si/Si ternary eutectic. (C) 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved

In situ synchrotron diffraction of the solidification of Mg4Y3Nd

In situ synchrotron diffraction experiments were performed during the solidification of a Mg4Y3Nd alloy. The material was melted and solidified inside a sealed stainless steel crucible in the chamber of a Bähr 805 A/D dilatometer. The sample was heated up to 680 °C and kept at this temperature for 5 min to ensure it is molten. Afterwards it was cooled down to the fully solidified state with a cooling rate of 10 K/min. During the T(t) program diffraction patterns were acquired continuously in every 25 s (∼5 K). The forming phases were identified as α-Mg at 625 °C, Mg$_{12}$Nd and Mg$_{14}$Y$_{4}$Nd at 545 °C, and Mg$_{24}$Y$_{5}$ at 320 °C. The experimental results were correlated with simulations based on thermodynamic databases