Renal hyperfiltration defined by high estimated glomerular filtration rate:A risk factor for cardiovascular disease and mortality

Renal hyperfiltration, defined as an increased glomerular filtration rate above normal values, is associated with early phases of kidney disease in the setting of various conditions such as obesity and diabetes. Although it is recognized that glomerular hyperfiltration, that is, increased filtration per nephron unit (usually studied at low glomerular filtration levels and often referred to as single nephron hyperfiltration), is a risk factor for the progression of chronic kidney disease, the implications of having renal hyperfiltration for cardiovascular disease and mortality risk are incompletely understood. Recent evidence from diverse populations, including healthy individuals and patients with diabetes or established cardiovascular disease, suggests that renal hyperfiltration is associated with a higher risk of cardiovascular disease and all-cause mortality. In this review, we critically summarize the existing studies, discuss possible mechanisms, and describe the remaining gaps in our knowledge regarding the association of renal hyperfiltration with cardiovascular disease and mortality risk

NASA Making Earth System Data Records for Use in Research Environments (MEaSUREs) Global Food Security Support Analysis Data (GFSAD) Crop Dominance 2010 Global 1 km V001

The NASA Making Earth System Data Records for Use in Research Environments (MEaSUREs) Global Food Security Support Analysis Data (GFSAD) Crop Dominance Global 1 kilometer (km) dataset was created using multiple input data including: Advanced Very High Resolution Radiometer (AVHRR), Satellite Probatoire d'Observation de la Terre (SPOT) vegetation, and Moderate Resolution Imaging Spectrometer (MODIS) remote sensing data; crop type data, secondary elevation data; 50-year precipitation and 20-year temperature data; reference sub-meter to 5-meter resolution ground data; and country statistic data. The GFSAD1KCD data were produced for nominal 2010 by overlaying the five dominant crops of the world produced by Ramankutty et al. (2008), Monfreda et al. (2008), and Portman et al. (2009) over the remote sensing derived global irrigated and rainfed cropland area map of the International Water Management Institute (IWMI; Thenkabail et al., 2009a, 2009b, 2011, Biradar et al., 2009) to ultimately create eight classes of crop dominance. The GFSAD1KCD nominal 2010 product is based on data ranging from years 2007 through 2012

Pelvic organ prolapse and collagen-associated disorders

Contains fulltext : 109010.pdf (publisher's version ) (Open Access)INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) and other disorders, such as varicose veins and joint hypermobility, have been associated with changes in collagen strength and metabolism. We hypothesized that these various disorders were more prevalent in both POP patients and their family members. METHODS: In this study, the prevalence of various collagen-associated disorders, including POP, was compared between POP patients (n = 110) and control patients (n = 100) and their first and second degree family members. RESULTS: POP patients reported a higher prevalence of varicose veins, joint hypermobility and rectal prolapse and were more likely to have family members with POP as compared to the control group (p < 0.01). In contrast, the family members of the POP group did not report a higher prevalence of collagen-associated disorders compared to the family members of the control group (p = 0.82). CONCLUSIONS: POP and other collagen-associated disorders may have a common aetiology, originating at the molecular level of the collagens.1 maart 201

An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

Purpose: To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR). Methods: This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11&nbsp;months but was extended in a minority of cases up to 7&nbsp;years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement. Results: One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1&nbsp;month) was favoured by age &lt;60&nbsp;years (p&nbsp;&lt;&nbsp;0.005), no previous observation (p&nbsp;&lt;&nbsp;0.0002), duration less than 3&nbsp;months (p&nbsp;&lt;&nbsp;0.0001), absence of CSCR in the fellow eye (p&nbsp;=&nbsp;0.04), leakage outside of the arcade (p&nbsp;=&nbsp;0.05) and fluid height &gt;500&nbsp;\u3bcm (p&nbsp;=&nbsp;0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1&nbsp;month was favoured by first episode (p&nbsp;=&nbsp;0.04), height of subretinal fluid &gt;500&nbsp;\u3bcm (p&nbsp;&lt;&nbsp;0.0001) and short duration of observation (p&nbsp;=&nbsp;0.02). Finally, there was no statistically significant difference among the treatments at 12&nbsp;months. Conclusion: Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Background &amp; Aims: Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. Methods: A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Results: Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Conclusions: Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death – termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD – patients in this group rarely require hospital admission and have a much lower 1-year mortality risk

Flipped classroom model for learning evidence-based medicine

Sydney Y Rucker,1 Zulfukar Ozdogan,1 Morhaf Al Achkar2 1School of Education, Indiana University, Bloomington, IN, 2Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA Abstract: Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice. Keywords: evidence-based medicine, flipped classroom, residency educatio

Efeito de diferentes agentes de clareamento na rugosidade superficial e estabilidade de cor da porcelana feldspática

Objective: The aim of this study was to evaluate the effect of different bleaching agents on the surface roughness and color stability of feldspathic porcelain. Material and Methods: In this study, totally 40 disc-shaped Noritake and Ceramco 3 feldspathic porcelain and two bleaching agents (Opalescence Boost and Opalescence Pf) were used. Bleaching agents were exposed to specimens according to their protocol. Then, the surface roughness of the specimens was evaluated with profilometer and the color of the specimens was recorded by colorimeter. Statistical analysis of the data was performed with IBM SPSS Statistics 20. Results: The results showed that that there were statistically significant differences between the bleaching agents on the surface roughness of feldspathic porcelain (p0.05). Conclusion: The obtained data presented that the bleaching agents increased the surface roughness and not affect the color stability of the feldspathic porcelain. © 2019, Universidade Estadual Paulista, Institute of Science and Technology of Sao Jose dos Campos. All rights reserved

APPLICATION OF FISSION-TRACK DATING TO ARCHAEOMETRY - PROVENANCE STUDIES OF PREHISTORIC OBSIDIAN ARTIFACTS

Several obsidian artifacts from Anatolian (Turkey) Neolithic sites have been analysed by the FT dating method and the results have been compared with data referring to obsidian natural sources located in the Mediterranean and adjacent regions. The conclusions can be summarized as follows: (1) some of the artifacts are very probably from Central Anatolian sources, others from Northern Anatolian sources, (2) the remaining artifacts are from unidentified sources, probably located or in Eastern Anatolian or in Western Anatolia and (3) the Carpathian and Aegean sources are not represented in the studied sample set. Comparison between the FT dating method and the trace elements composition by Instrumental Neutron Activation Analysis (INAA) shows that the combination of these two approaches is a powerful tool for provenance studies of prehistoric obsidian artifacts

APPLICATION OF FISSION-TRACK DATING TO ARCHAEOMETRY - PROVENANCE STUDIES OF PREHISTORIC OBSIDIAN ARTIFACTS

16th International Conference on Nuclear Tracks in Solids -- SEP 07-11, 1992 -- BEIJING, PEOPLES R CHINAWOS: A1993NY99100169Several obsidian artifacts from Anatolian (Turkey) Neolithic sites have been analysed by the FT dating method and the results have been compared with data referring to obsidian natural sources located in the Mediterranean and adjacent regions. The conclusions can be summarized as follows: (1) some of the artifacts are very probably from Central Anatolian sources, others from Northern Anatolian sources, (2) the remaining artifacts are from unidentified sources, probably located or in Eastern Anatolian or in Western Anatolia and (3) the Carpathian and Aegean sources are not represented in the studied sample set. Comparison between the FT dating method and the trace elements composition by Instrumental Neutron Activation Analysis (INAA) shows that the combination of these two approaches is a powerful tool for provenance studies of prehistoric obsidian artifacts.CHINA INST ATOM ENERGY, INT NUCL TRACK SO