High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low ...diastolic HSLD) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events.
The purpose of this study was to determine the relationship between pre-procedural blood pressure and long-term outcome following percutaneous coronary intervention (PCI).
The study included 10,876 consecutive patients between August 2009 and December 2016 from the Melbourne Interventional Group registry undergoing PCI with pre-procedural blood pressure recorded. Patients with ST-segment elevation myocardial infarction, cardiogenic shock, and out-of-hospital cardiac arrest were excluded. Patients were divided into 4 groups according to SBP (high ≥120 mm Hg, low <120 mm Hg) and DBP (high >70 mm Hg, low ≤70 mm Hg).
Mean pulse pressure was 60 ± 21 mm Hg. Patients with HSLD were older and more frequently women, with higher rates of hypercholesterolemia, renal impairment, diabetes, and multivessel and left main disease (all p ≤ 0.0001). There was no difference in 30-day major adverse cardiac events, but at 12 months the HSLD group had a greater incidence of myocardial infarction (p = 0.018) and stroke (p = 0.013). Long-term mortality was highest for HSLD (7.9%) and lowest for low systolic, high diastolic (narrow pulse pressure) at 2.1% (p = 0.0002). Cox regression analysis demonstrated significantly lower long-term mortality in the low systolic, high diastolic cohort (hazard ratio: 0.50; 99% confidence interval: 0.25 to 0.98; p = 0.04).
Pulse pressure at the time of index PCI is associated with long-term outcomes following PCI. A wide pulse pressure may serve as a surrogate marker for risk following PCI and represents a potential target for future therapies.
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In recent years, the discovery of many regulatory elements within introns, the recognition of the regulatory potential of intronic and other non-protein coding RNAs, and the concept of a cellular ...'ribotype' resulting from differences in RNA processing in different cells and tissues have led to increasing interest in the role of introns' in enhancing eukaryotic genetic complexity, via alternative splicing and as both the recipient and donor of cis-acting and trans-acting elements. To explore the evolution and function of introns in eukaryotes, we have developed an intron sequence information system (ISIS; http://isis.bit.uq.edu.au/) which contains information on over 170,000 spliceosomal introns. Data in ISIS version 1 is based on intron-containing sequences from GenBank release 111. ISIS contains phylogenetic and protein homology categories, information about individual sequences and various bioinformatic analyses of taxonomical groupings of sequences using non-redundant subsets of the data. The database is searchable by Blast, GenBank attributes and elements that we have annotated within introns, and gives graphical views of gene structure and elements such as alternative coding regions, EST matches and repetitive sequences. During analysis of this database, we found many EST matches within sequences annotated as introns, indicating that there are many previously unrecognized alternatively spliced exons, especially as many of these exons are conserved between species. Alternative splicing was first predicted by Walter Gilbert, and subsequently verified by the discovery of cDNA isoforms exhibiting the addition or exclusion of whole or partial exons, although identification of such splice variants has largely occurred on an ad hoc basis. The development of large human EST (partial cDNA) sequence libraries over recent years, however, provides an opportunity to examine the incidence of alternative splicing globally by searching these libraries for exon skipping, exon truncation or inclusion of sequences currently described as intronic.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Repeat hospitalizations for recurrent acute coronary syndrome (ACS) or unplanned revascularization after acute myocardial infarction (MI) are common, costly and potentially preventable. We aim to ...describe 10-year trends and identify independent risk factors of these repeat hospitalizations.
We analyzed data from 9615 patients from the Melbourne Interventional Group registry (2005–2014) who underwent percutaneous coronary intervention (PCI) for their index MI and survived to discharge. Patients with ≥1 hospitalization for recurrent ACS events and/or unplanned revascularization in the year after discharge were included in the recurrent coronary hospitalization group. We assessed yearly trends of recurrent coronary events and identified independent predictors using multivariate analysis.
Recurrent coronary hospitalization occurred in 1175 (12.2%) patients. There was a significant decrease in the rate of recurrent ACS hospitalization (15.3%-7.6%, P for trend <.001) and unplanned revascularization (4.2%-2.1%, P for trend = .01), but not in all-cause re-hospitalizations (P for trend = .28). On multivariate analysis, female gender, diabetes mellitus, previous coronary bypass surgery, previous PCI, reduced ejection fraction, heart failure, multi-vessel coronary disease and obstructive sleep apnea were independent predictors of recurrent coronary hospitalizations (all P < .05).
Recurrent hospitalization for ACS or unplanned revascularization has decreased significantly over the past decade. Risk factors for such events are numerous and largely non-modifiable, however they identify a cohort of patients in whom non-culprit vessel PCI in multi-vessel disease, optimization of left ventricular dysfunction and diabetes management may improve outcomes.
Annexin II mRNA coding for a calcium binding protein was found to be absent in prostate cancer by subtractive hybridization and Northern analysis. In contrast to high expression in normal and benign ...hyperplastic glandular and basal epithelium, Annexin II heavy (p36) and light (p11) chains in 31/31 prostate cancer specimens were lost immunohistochemically. In glands involved by prostate intraepithelial neoplasia, 65% lost both chains in glandular epithelial cells, whereas basal cells were all positively stained. Southern analysis of cancer DNA showed no noticeable deletion in p36 gene. LNCaP cells treated with 5-azacytidine re-expressed p36, suggesting methylation could be responsible for the silencing.
HUMAN immunodeficiency virus type 1 (HIV-1) causes the acquired immunodeficiency syndrome (AIDS),
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a chronic illness characterized by progressive immune and neurologic dysfunction. HIV-1 also ...causes an acute viral syndrome
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with variable manifestations, most frequently fever, lymphadenopathy, pharyngitis, and rash. HIV-1 has been cultured during primary infection from peripheral-blood lymphocytes, plasma, and cerebrospinal fluid,
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and HIV-1 p24 antigen has been detected transiently in plasma,
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but no studies have systematically quantified infectious virus in plasma or characterized temporal changes in the level of viremia during this period of transition from acute to chronic disease. The genotypic and biologic characteristics of the strains . . .
Ductile cast irons (DCIs) are of increasing importance in the renewable energy and transportation sectors. The distribution and morphology of the graphite nodules, in particular the formation of ...degenerate features during solidification, dictate the mechanical performance of DCIs. In situ high-speed synchrotron X-ray tomography was used to capture the evolution of graphite nodules during solidification of DCI, including degenerate features and the effect of the carbon concentration field. The degeneration of nodules is observed to increase with re-melting cycles, which is attributed to Mg-loss. The dendritic primary austenite and carbon concentration gradients in the surrounding liquid phase were found to control nodule morphology by locally restricting and promoting growth.
A coupled diffusion-mechanical model was developed, confirming the experimentally informed hypothesis that protrusions form through liquation cracking of the austenite shell and subsequent localised growth. These results provide valuable insights into the solidification kinetics of cast irons, supporting the design of advanced alloys.
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High biodiversity of forests is not predicted by traditional models, and evidence for trade-offs those models require is limited. High-dimensional regulation (e.g.,
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factors to regulate
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species) ...has long been recognized as a possible alternative explanation, but it has not be been seriously pursued, because only a few limiting resources are evident for trees, and analysis of multiple interactions is challenging. We develop a hierarchical model that allows us to synthesize data from long-term, experimental, data sets with processes that control growth, maturation, fecundity, and survival. We allow for uncertainty at all stages and variation among 26 000 individuals and over time, including 268 000 tree years, for dozens of tree species. We estimate population-level parameters that apply at the species level and the interactions among latent states, i.e., the demographic rates for each individual, every year. The former show that the traditional trade-offs used to explain diversity are not present. Demographic rates overlap among species, and they do not show trends consistent with maintenance of diversity by simple mechanisms (negative correlations and limiting similarity). However, estimates of latent states at the level of individuals and years demonstrate that species partition environmental variation. Correlations between responses to variation in time are high for individuals of the same species, but not for individuals of different species. We demonstrate that these relationships are pervasive, providing strong evidence that high-dimensional regulation is critical for biodiversity regulation.
Images obtained by the Voyager spacecraft revealed dark, wedge-shaped bands
on Europa that were interpreted as evidence that surface plates, 50-100 km
across, moved and rotated relative to each ...other. This implied
that they may be mechanically decoupled from the interior by a layer of warm
ice or liquid water,. Here we report similar
features seen in higher resolution images (420 metres per pixel) obtained
by the Galileo spacecraft that reveal new details of wedge-band formation.
In particular, the interior of one dark band shows bilateral symmetry of parallel
lineaments and pit complexes which indicates that plate separation occurred
in discrete episodes from a central axis. The images also show that this style
of tectonic activity involved plates < 10 km across. Although this
tectonic style superficially resembles aspects of similar activity on Earth,
such as sea-floor spreading and the formation of ice leads in polar seas,
there are significant differences in the underlying physical mechanisms: thewedge-shaped
bands on Europa most probably formed when lower material (ice or water) rose
to fill the fractures that widened in response to regional surface stresses.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective--Previous reports have demonstrated that physician counseling can improve rates of breast-feeding initiation and duration but suggest that physitians are ill-prepared for this role. It is ...unclear whether residency training for pediatricians, obstetrician/gynecologists, and family physicians provides the knowledge and skills necessary for effective breast-feeding promotion. Design--Survey. Participants--A national random sample of 3115 residents and 1920 practicing physicians in pediatrics, obstetrics/gynecology, and family medicine. Outcomes--Assessment of breast-feeding knowledge, attitudes, training, and experience. Results--Overall response rate was 68%. All groups demonstrated significant deficits in knowledge of breast-feeding benefits and clinical management; for example, less than 50% of residents chose appropriate clinical management for a breast-fed jaundiced infant or a breast abscess. Practicing physicians perfommed slightly better, but still more than 30% chose incorrect advice for mothers with low milk supply. Residents reported that their breast-feeding instruction consisted mainly of didactic lecture, not patient experience. Only 55% of senior residents recalled even one instance of precepting related to breast-feeding, and less than 20% had demonstrated breast-feeding techniques at least five times during residency. Regarding preparation for breast-feeding counseling, more than 50% of all practicing physicians rated their residency training as inadequate. Overall, physician involvement in breast-feeding promotion was endorsed by 90% of respondents, yet only half rated themselves as effective in counseling breast-feeding patients. The greatest predictor of physician self-confidence was previous personal or spousal breast-feeding experience. Conclusions--In this national sample of residents and practicing physicians in three specialties, physicians were ill-prepared to counsel breast-feeding mothers
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