Emergency Portacaval Shunt Versus Rescue Portacaval Shunt in a Randomized Controlled Trial of Emergency Treatment of Acutely Bleeding Esophageal Varices in Cirrhosis—Part 3

Emergency treatment of bleeding esophageal varices in cirrhosis is of singular importance because of the high mortality rate. Emergency portacaval shunt is rarely used today because of the belief, unsubstantiated by long-term randomized trials, that it causes frequent portal-systemic encephalopathy and liver failure. Consequently, portacaval shunt has been relegated solely to salvage therapy when endoscopic and pharmacologic therapies have failed. Question: Is the regimen of endoscopic sclerotherapy with rescue portacaval shunt for failure to control bleeding varices superior to emergency portacaval shunt? A unique opportunity to answer this question was provided by a randomized controlled trial of endoscopic sclerotherapy versus emergency portacaval shunt conducted from 1988 to 2005. Unselected consecutive cirrhotic patients with acute bleeding esophageal varices were randomized to endoscopic sclerotherapy (n = 106) or emergency portacaval shunt (n = 105). Diagnostic workup was completed and treatment was initiated within 8 h. Failure of endoscopic sclerotherapy was defined by strict criteria and treated by rescue portacaval shunt (n = 50) whenever possible. Ninety-six percent of patients had more than 10 years of follow-up or until death. Comparison of emergency portacaval shunt and endoscopic sclerotherapy followed by rescue portacaval shunt showed the following differences in measurements of outcomes: (1) survival after 5 years (72% versus 22%), 10 years (46% versus 16%), and 15 years (46% versus 0%); (2) median post-shunt survival (6.18 versus 1.99 years); (3) mean requirements of packed red blood cell units (17.85 versus 27.80); (4) incidence of recurrent portal-systemic encephalopathy (15% versus 43%); (5) 5-year change in Child’s class showing improvement (59% versus 19%) or worsening (8% versus 44%); (6) mean quality of life points in which lower is better (13.89 versus 27.89); and (7) mean cost of care per year ($39,200 versus$216,700). These differences were highly significant in favor of emergency portacaval shunt (all p < 0.001). Emergency portacaval shunt was strikingly superior to endoscopic sclerotherapy as well as to the combination of endoscopic sclerotherapy and rescue portacaval shunt in regard to all outcome measures, specifically bleeding control, survival, incidence of portal-systemic encephalopathy, improvement in liver function, quality of life, and cost of care. These results strongly support the use of emergency portacaval shunt as the first line of emergency treatment of bleeding esophageal varices in cirrhosis

Search for the rare decay B-0 ->tau(+)tau(-) at BABAR

We present the results of a search for the decay B-0 ->tau(+)tau(-) in a data sample of (232 +/- 3)x10(6) Upsilon(4S)-> BB decays using the BABAR detector. Certain extensions of the standard model predict measurable levels of this otherwise rare decay. We reconstruct fully one neutral B meson and seek evidence for the signal decay in the rest of the event. We find no evidence for signal events and obtain B(B-0 ->tau(+)tau(-))< 4.1x10(-3) at the 90% confidence level

Measurement of the D+->pi(+) pi(0) and D+-> K+ pi(0) branching fractions

Contains fulltext : 128229.pdf (publisher's version ) (Open Access

Branching fraction limits for B-0 decays to eta ' eta, eta 'pi(0) and eta pi(0)

Contains fulltext : 128244.pdf (publisher's version ) (Open Access

Search for B meson decays to eta(')eta K-'

Contains fulltext : 128253.pdf (publisher's version ) (Open Access

Search for the decay B+ -> tau(+)nu(tau)

Contains fulltext : 128262.pdf (publisher's version ) (Open Access

Colonización en las tierras áridas de Norteamérica: El viaje de Agarito (Berberis trifoliolata) revelado por datos moleculares multilocus y restos fósiles de Packrat Midden

Here we conduct research to understand the evolutionary history of a shrubby species known as Agarito (Berberis trifoliolata), an endemic species to the Chihuahuan Desert. We identify genetic signatures based on plastid DNA and AFLP markers and perform niche modelling and spatial connectivity analyses as well as niche modelling based on records in packrats to elucidate whether orogenic events such as mountain range uplift in the Miocene or the contraction/expansion dynamics of vegetation in response to climate oscillations in the Pliocene/Pleistocene had an effect on evolutionary processes in Agarito. Our results of current niche modelling and palaeomodelling showed that the area currently occupied by Berberis trifoliolata is substantially larger than it was during the Last Interglacial period and the Last Glacial Maximum. Agarito was probably confined to small areas in the Northeastern and gradually expanded its distribution just after the Last Glacial Maximum when the weather in the Chihuahuan Desert and adjacent regions became progressively warmer and drier. The most contracted range was predicted for the Interglacial period. Populations remained in stable areas during the Last Glacial Maximum and expanded at the beginning of the Holocene. Most genetic variation occured in populations from the Sierra Madre Oriental. Two groups of haplotypes were identified: the Mexican Plateau populations and certain Northeastern populations. Haplogroups were spatially connected during the Last Glacial Maximum and separated during interglacial periods. The most important prediction of packrat middens palaeomodelling lies in the Mexican Plateau, a finding congruent with current and past niche modelling predictions for agarito and genetic results. Our results corroborate that these climate changes in the Pliocene/Pleistocene affected the evolutionary history of agarito. The journey of agarito in the Chihuahuan Desert has been dynamic, expanding and contracting its distribution range and currently occupying the largest area in its history.Aquí realizamos una investigación para comprender la historia evolutiva de una especie arbustiva conocida como Agarito (Berberis trifoliolata), una especie endémica del desierto de Chihuahua. Identificamos firmas genéticas basadas en marcadores de ADN plastidial y AFLP y realizamos análisis de modelado de nicho y de conectividad espacial, así como de modelado de nicho basado en registros en packrats para dilucidar si los eventos orogénicos como el levantamiento de la cordillera en el Mioceno o la dinámica de contracción/expansión de la vegetación en respuesta a las oscilaciones climáticas en el Plioceno/Pleistoceno tuvieron un efecto en los procesos evolutivos de Agarito. Nuestros resultados de la modelización del nicho actual y de la paleomodelización mostraron que el área ocupada actualmente por Berberis trifoliolata es sustancialmente mayor de lo que era durante el último período interglacial y el último máximo glacial. El agarito estaba probablemente confinado en pequeñas zonas del noreste y amplió gradualmente su distribución justo después del Último Máximo Glacial, cuando el clima en el desierto de Chihuahua y las regiones adyacentes se volvió progresivamente más cálido y seco. El área de distribución más contraída se predijo para el periodo interglaciar. Las poblaciones permanecieron en zonas estables durante el Último Máximo Glacial y se expandieron a principios del Holoceno. La mayor variación genética se produjo en las poblaciones de la Sierra Madre Oriental. Se identificaron dos grupos de haplotipos: las poblaciones de la Meseta Mexicana y ciertas poblaciones del Noreste. Los haplogrupos estuvieron conectados espacialmente durante el Último Máximo Glacial y se separaron durante los periodos interglaciares. La predicción más importante de la paleomodelación de los muladares de las ratas de carga se sitúa en la Meseta Mexicana, un hallazgo congruente con las predicciones actuales y pasadas de la modelización del nicho del agarito y los resultados genéticos. Nuestros resultados corroboran que estos cambios climáticos en el Plioceno/Pleistoceno afectaron a la historia evolutiva del agarito. El recorrido del agarito en el Desierto Chihuahuense ha sido dinámico, expandiendo y contrayendo su rango de distribución y ocupando actualmente la mayor área de su historia.Fil: Angulo, Diego F. Universidad Autónoma de Yucatán; México.Fil: Amarilla, Leonardo D. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; Argentina.Fil: Amarilla, Leonardo D. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto Multidisciplinario de Biología Vegetal; Argentina.Fil: Anton, Ana M. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; Argentina.Fil: Anton, Ana M. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto Multidisciplinario de Biología Vegetal; Argentina.Fil: Sosa, Victoria. Instituto de Ecología. Departamento de Biología Evolutiva; México