Determinants of carotid microembolization

AbstractPurpose: Earlier studies have highlighted risk factors for perioperative stroke after carotid endarterectomy, such as female sex, preoperative symptoms, and cerebral infarction. In this study, we investigated the relationship between these factors and perioperative microembolization. Methods: A total of 235 patients were entered in the study at two centers. Transcranial Doppler ultrasound scanning was possible in 190 patients (81%) and was performed for 1 hour preoperatively and continuously intraoperatively as a means of detecting microemboli and monitoring mean middle cerebral artery velocity. The findings of transcranial Doppler ultrasound scanning were related to perioperative risk factors by means of univariate analysis. Results: Microemboli were detected in 28 (15%), 79 (42%), and 98 (52%) patients preoperatively, during carotid artery dissection, and after closure of the artery, respectively. Having 10 or more emboli after carotid artery closure was more common in women (P =.04) and in patients with symptomatic carotid artery disease (P =.04) and was demonstrated in three of the six patients who had a perioperative stroke. These three patients also had preoperative evidence of cerebral infarction and an intraoperative middle cerebral artery velocity less than 40 cm/s. Conclusion: In this study, perioperative microembolization was more common in women and patients with symptomatic carotid artery disease. These findings may explain the increased risk of carotid surgery in these patients. (J Vasc Surg 2001;34:1060-4.

Pharmacogenomics of statin-related myopathy:Meta-analysis of rare variants from whole-exome sequencing

AIMS:Statin-related myopathy (SRM), which includes rhabdomyolysis, is an uncommon but important adverse drug reaction because the number of people prescribed statins world-wide is large. Previous association studies of common genetic variants have had limited success in identifying a genetic basis for this adverse drug reaction. We conducted a multi-site whole-exome sequencing study to investigate whether rare coding variants confer an increased risk of SRM. METHODS AND RESULTS:SRM 3-5 cases (N = 505) and statin treatment-tolerant controls (N = 2047) were recruited from multiple sites in North America and Europe. SRM 3-5 was defined as symptoms consistent with muscle injury and an elevated creatine phosphokinase level >4 times upper limit of normal without another likely cause of muscle injury. Whole-exome sequencing and variant calling was coordinated from two analysis centres, and results of single-variant and gene-based burden tests were meta-analysed. No genome-wide significant associations were identified. Given the large number of cases, we had 80% power to identify a variant with minor allele frequency of 0.01 that increases the risk of SRM 6-fold at genome-wide significance. CONCLUSIONS:In this large whole-exome sequencing study of severe statin-related muscle injury conducted to date, we did not find evidence that rare coding variants are responsible for this adverse drug reaction. Larger sample sizes would be required to identify rare variants with small effects, but it is unclear whether such findings would be clinically actionable

The role of idioms in sentiment analysis

In this paper we investigate the role of idioms in automated approaches to sentiment analysis. To estimate the degree to which the inclusion of idioms as features may potentially improve the results of traditional sentiment analysis, we compared our results to two such methods. First, to support idioms as features we collected a set of 580 idioms that are relevant to sentiment analysis, i.e. the ones that can be mapped to an emotion. These mappings were then obtained using a web-based crowdsourcing approach. The quality of the crowdsourced information is demonstrated with high agreement among five independent annotators calculated using Krippendorff's alpha coefficient (α = 0.662). Second, to evaluate the results of sentiment analysis, we assembled a corpus of sentences in which idioms are used in context. Each sentence was annotated with an emotion, which formed the basis for the gold standard used for the comparison against two baseline methods. The performance was evaluated in terms of three measures - precision, recall and F-measure. Overall, our approach achieved 64% and 61% for these three measures in two experiments improving the baseline results by 20 and 15 percent points respectively. F-measure was significantly improved over all three sentiment polarity classes: Positive, Negative and Other. Most notable improvement was recorded in classification of positive sentiments, where recall was improved by 45 percent points in both experiments without compromising the precision. The statistical significance of these improvements was confirmed by McNemar's test

The horizons of the constitution: Politeia, the political regime and the good

How do we think about the word politeia when this involves a reaching back to the past? The response, pursued in this paper, is that in the classical understanding of politeia there is a significant connection between the question of the ‘good’ and the constitution; a connection which has become occluded or obscured by modern constitutional thought. In support of this understanding of politeia it must be acknowledged that what is meant, in this paper, by ‘good’ is very different from that conventionally found in contemporary constitutional, legal or political theory. In an effort to disclose how politeia unravels this novel sense of ‘the good’ the paper will closely consider the philosophical work of Hans-Georg Gadamer on Plato. The paper claims that this largely neglected work is of importance to contemporary constitutional philosophy, particularly in so far as it focuses, as in this paper, on classical traditions or origins within constitutional thought

End of the conversation or recasting constitutional dialogue

Constitutional dialogue has become an influential concept to understand the relationship between courts and other the institutional branches of the state, with the primary focus being on legislatures. More recently, the place of dialogue within the constitutional literature has been challenged as vague; providing a potential to over-reach or overstate the judicial role and distorting the reality of practices which in fact shape the relationship between courts and other institutions. Critics have placed into focus the question: should constitutional scholarship abandon ‘constitutional dialogue’ as a way of understanding the relationship between courts and other institutions within the constitutional order? This article seeks to respond to this question by arguing that constitutional dialogue remains an important aspect of understanding the development of constitutional understanding about inter-institutional roles but does so by acknowledging the criticisms levelled against constitutional dialogue. Developing this approach, the argument made in this article seeks to recast the theoretical foundations of dialogue in constitutional theory by shifting the understanding of dialogue away from its normative and descriptive tethers. In its place, constitutional dialogue should be considered in the context of a philosophical understanding of language and the role that it plays to create constitutional meanings and experiences. Dialogue has a deeper and more significant register than a metaphor conveying a ‘conversation’, ‘communication’ or a ‘deliberative rationality’ between the institutions of the constitutional order—dialogue must be understood through the perspective of language as disclosing a world of common meaning and experience

The economic crisis and the rule of law in Europe

As a critical lens to assess the rule of law the article confronts the often used term of criticism levelled at it: that it is inherently elusive or uncertain. Taking this as a starting point the article considers whether there is something productive in this apparent uncertainty which renders this challenge both misleading and also apt to neglect key aspects of the concept in favour of adopting a version of rule of law based on predictability. The article develops an account of what can be termed ‘the constitutive’ dimension of the rule of law which it is argued here has been neglected due to an emphasis on predictability and also ‘regulatory’ dimension which concentrates on the rule of law as the control or restraint of political power. The constitutive dimension of the rule of law explores the meaning of the foundational moment of the constitutional community and the language used to express this as a basis for solidarity and as a point of orientation during points of considerable change or crisis. In this regard the article establishes that there is an important theoretical relationship between the rule of law and ideas about the constituent power which require development and further reflection. The second part of the article, in Sects. 3 and 4, takes the theoretical investigation of the constitutive dimension to the rule of law and considers how this concept can provide a basis for critical reflection regarding the economic crisis of the EU. The focus on the economic crisis in the EU is two-fold: in the first instance the economic crisis is a moment of stress on the political and legal understanding of the EU and shows up the complexity of the commitment to the rule of law in this context. Secondly, given the aspect of the EU as a ‘polity’ under construction the economic crisis and its response underscores the problematic aspect of the constituent power in the EU. The article primarily focuses on the contributions made by Jurgen Habermas in respect of the crisis and its response in terms of the rule of law. Habermas argues for a reciprocal understanding of political solidarity and justice to be made part of the solution and response to the EU economic crisis and a rejection of the executive federalism dominated approach which is characterised by a technocratic approach to political question. Habermas’ approach is noteworthy for the manner that it focuses on a response which articulates how the crisis can become a basis not only for an appreciation of the importance of political solidarity but equally to allow Europe to confront the constitutive meanings of the EU as a legal and political project