To investigate whether simple and non-invasive measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) and/or C-reactive protein (CRP) can predict perioperative major cardiovascular event ...(PMCE).
Prospective, single-centre, cohort study.
A 1900-bed tertiary-care university hospital in Seoul, Korea Design and
The predictive power of NT-proBNP, CRP and Revised Cardiac Risk Index (RCRI) for the risk of PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) were evaluated from a prospective cohort of 2054 elective major non-cardiac surgery patients. Optimal cut-off values were derived from receiver operating characteristic curve (ROC) analysis.
PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) within postoperative 30 days.
PMCE developed in a total of 290 patients (14.1%). Each increasing quartile of NT-proBNP or CRP level was associated with a greater risk of PMCE after adjustment for traditional clinical risk factors. The relative risk (RR) of highest versus lowest quartile was 5.2 for NT-proBNP (p<0.001) and 3.7 for CRP (p<0.001). Both NT-proBNP (cut-off = 301 ng/l) and CRP (cut-off = 3.4 mg/l) predicted PMCE better than RCRI (cut-off = 2) by ROC analysis (p<0.001). Moreover, the predictive power of RCRI (adjusted RR = 1.5) could be improved significantly by addition of CRP and NT-proBNP to RCRI (adjusted RR 4.6) (p<0.001).
High preoperative NT-proBNP or CRP is a strong and independent predictor of perioperative major cardiovascular event in non-cardiac surgery. The predictive power of current clinical risk evaluation system would be strengthened by these biomarkers.
Here, we present precise phase-connected pulse timing solutions for 16 γ-ray-selected pulsars recently discovered using the Large Area Telescope (LAT) on the Fermi Gamma-ray Space Telescope plus one ...very faint radio pulsar (PSR J1124–5916) that is more effectively timed with the LAT. We describe the analysis techniques including a maximum likelihood method for determining pulse times of arrival from unbinned photon data. A major result of this work is improved position determinations, which are crucial for multiwavelength follow-up. For most of the pulsars, we overlay the timing localizations on X-ray images from Swift and describe the status of X-ray counterpart associations. We report glitches measured in PSRs J0007+7303, J1124–5916, and J1813–1246. We analyze a new 20 ks Chandra ACIS observation of PSR J0633+0632 that reveals an arcminute-scale X-ray nebula extending to the south of the pulsar. We were also able to precisely localize the X-ray point source counterpart to the pulsar and find a spectrum that can be described by an absorbed blackbody or neutron star atmosphere with a hard power-law component. Another Chandra ACIS image of PSR J1732–3131 reveals a faint X-ray point source at a location consistent with the timing position of the pulsar. Finally, we present a compilation of new and archival searches for radio pulsations from each of the γ-ray-selected pulsars as well as a new Parkes radio observation of PSR J1124–5916 to establish the γ-ray to radio phase offset.
Reports detailing the response of hypertensive patients to renal denervation (RDN) in Asian patients are limited. We evaluated 6- and 12-month outcomes after RDN in an Asian population and compared ...outcomes to a primarily Caucasian population. The Global SYMPLICITY Registry (GSR) is a prospective, all-comer, worldwide registry that evaluates the safety and effectiveness of RDN and includes the Korean registry substudy (GSR Korea) and a Caucasian subset (GSR Caucasian). Given differences in baseline characteristics among GSR Korea (n=93) as compared with GSR Caucasian (n=169) patients, including lower baseline office systolic blood pressure (SBP), lower body mass index and differences in medications, propensity score adjustment was performed when comparing the change in SBP between subsets. The 6- and 12-month change in SBP in GSR Korea was -19.4±17.2 and -27.2±18.1 mm Hg, respectively (P<0.001 for both vs baseline). GSR Caucasian had a SBP change similar to GSR Korea at 6 months (-20.9±21.4 mm Hg, unadjusted P=0.547, adjusted P=0.998), whereas at 12 months the change was significantly less pronounced (-20.1±23.9 mm Hg, unadjusted P=0.004, adjusted P=0.002). There were no protocol-defined procedure-related adverse events and no chronic adverse events associated with the device in an Asian population. RDN provided a significant reduction in 6- and 12-month office SBP among Asian patients, with a favorable safety profile. The 12-month SBP reduction was larger than that observed in Caucasian patients.
We report the discovery of eight gamma-ray pulsars in blind frequency searches using the LAT, onboard the Fermi Gamma-ray Space Telescope. Five of the eight pulsars are young (tau_c<100 kyr), ...energetic (Edot>10^36 erg/s), and located within the Galactic plane (|b|<3 deg). The remaining three are older, less energetic, and located off the plane. Five pulsars are associated with sources included in the LAT bright gamma-ray source list, but only one, PSR J1413-6205, is clearly associated with an EGRET source. PSR J1023-5746 has the smallest characteristic age (tau_c=4.6 kyr) and is the most energetic (Edot=1.1E37 erg/s) of all gamma-ray pulsars discovered so far in blind searches. PSRs J1957+5033 and J2055+25 have the largest characteristic ages (tau_c~1 Myr) and are the least energetic (Edot~5E33 erg/s) of the newly-discovered pulsars. We present the timing models, light curves, and detailed spectral parameters of the new pulsars. We used recent XMM observations to identify the counterpart of PSR J2055+25 as XMMU J205549.4+253959. In addition, publicly available archival Chandra X-ray data allowed us to identify the likely counterpart of PSR J1023-5746 as a faint, highly absorbed source, CXOU J102302.8-574606. The large X-ray absorption indicates that this could be among the most distant gamma-ray pulsars detected so far. PSR J1023-5746 is positionally coincident with the TeV source HESS J1023-575, located near the young stellar cluster Westerlund 2, while PSR J1954+2836 is coincident with a 4.3 sigma excess reported by Milagro at a median energy of 35 TeV. Deep radio follow-up observations of the eight pulsars resulted in no detections of pulsations and upper limits comparable to the faintest known radio pulsars, indicating that these can be included among the growing population of radio-quiet pulsars in our Galaxy being uncovered by the LAT, and currently numbering more than 20.
We searched for radio pulsars in 25 of the non-variable, unassociated sources in the Fermi LAT Bright Source List with the Green Bank Telescope at 820 MHz. We report the discovery of three radio and ...Delta *g-ray millisecond pulsars (MSPs) from a high Galactic latitude subset of these sources. All of the pulsars are in binary systems, which would have made them virtually impossible to detect in blind Delta *g-ray pulsation searches. They seem to be relatively normal, nearby (<=2 kpc) MSPs. These observations, in combination with the Fermi detection of Delta *g-rays from other known radio MSPs, imply that most, if not all, radio MSPs are efficient Delta *g-ray producers. The Delta *g-ray spectra of the pulsars are power law in nature with exponential cutoffs at a few GeV, as has been found with most other pulsars. The MSPs have all been detected as X-ray point sources. Their soft X-ray luminosities of ~1030-1031 erg s--1 are typical of the rare radio MSPs seen in X-rays.
We investigated the therapeutic potential of ex vivo expanded endothelial progenitor cells (EPCs) for myocardial neovascularization.
Peripheral blood mononuclear cells obtained from healthy human ...adults were cultured in EPC medium and harvested 7 days later. Myocardial ischemia was induced by ligating the left anterior descending coronary artery in male Hsd:RH-rnu (athymic nude) rats. A total of 10(6) EPCs labeled with 1,1'-dioctadecyl-1 to 3,3,3',3'-tetramethylindocarbocyanine perchlorate were injected intravenously 3 hours after the induction of myocardial ischemia. Seven days later, fluorescence-conjugated Bandeiraea simplicifolia lectin I was administered intravenously, and the rats were immediately killed. Fluorescence microscopy revealed that transplanted EPCs accumulated in the ischemic area and incorporated into foci of myocardial neovascularization. To determine the impact on left ventricular function, 5 rats (EPC group) were injected intravenously with 10(6) EPCs 3 hours after ischemia; 5 other rats (control group) received culture media. Echocardiography, performed just before and 28 days after ischemia, disclosed ventricular dimensions that were significantly smaller and fractional shortening that was significantly greater in the EPC group than in the control group by day 28. Regional wall motion was better preserved in the EPC group. After euthanization on day 28, necropsy examination disclosed that capillary density was significantly greater in the EPC group than in the control group. Moreover, the extent of left ventricular scarring was significantly less in rats receiving EPCs than in controls. Immunohistochemistry revealed capillaries that were positive for human-specific endothelial cells.
Ex vivo expanded EPCs incorporate into foci of myocardial neovascularization and have a favorable impact on the preservation of left ventricular function.
Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarctions or may lead to insidious progressive brain ...damage resulting in vascular dementia. This study was designed to evaluate the prevalence and risk factors of SCI in an apparently normal adult population. Nine hundred ninety-four consecutive symptom-free adults (mean age 49.0±7.7; men:women 830:164) who underwent brain magnetic resonance imaging at the Center for Health Promotion at Samsung Medical Center were assessed. All were neurologically normal in history and physical examination. A total of 121 SCI lesions was observed in 58 subjects. The lesion prevalence adjusted for patient age was 5.1%. There was no gender difference in prevalence. Ninety-nine lesions were <1 cm in diameter, 15 were between 1 and 2 cm, 3 were between 2 and 3 cm, and 4 were >3 cm in diameter. The most frequent site of the SCI lesion was basal ganglia, after which the periventricular white matter, cerebral cortex, and thalamus were the most frequent sites. Old age, hypertension, a history of coronary artery disease, evidence of cardiomegaly in chest radiographs, and high fasting glucose/hemoglobin A1c levels were associated with SCI on univariate analysis. Multivariate analysis demonstrated old age and hypertension to be independent risk factors for SCI, and mild alcohol consumption was revealed as an independent protective factor against SCI.
Although the production of X‐rays from natural and rocket‐triggered lightning leaders have been studied in detail over the last 10 years, the energy spectrum of the X‐rays has never been well ...measured because the X‐rays are emitted in very short but intense bursts that result in pulse pileup in the detectors. The energy spectrum is important because it provides information about the source mechanism for producing the energetic runaway electrons and about the electric fields that they traverse. We have recently developed and operated the first spectrometer for the energetic radiation from lightning. The instrument is part of the Atmospheric Radiation Imagery and Spectroscopy (ARIS) project and will be referred to as ARIS‐S (ARIS Spectrometer). It consists of seven
3′′ NaI(Tl)/photomultiplier tube scintillation detectors with different thicknesses of attenuators, ranging from no attenuator to more than
1′′ of lead placed over the detector (all the detectors are in a
1/8′′ thick aluminum box). Using X‐ray pulses preceding 48 return strokes in 8 rocket‐triggered lightnings, we found that the spectrum of X‐rays from leaders is too soft to be consistent with Relativistic Runaway Electron Avalanche. It has a power law dependence on the energies of the photons, and the power index, λ, is between 2.5 and 3.5. We present the details of the design of the instrument and the results of the analysis of the lightning data acquired during the summer of 2012.
Key Points
Energy spectrum of X‐rays from lightning leaders is investigated using a new high‐energy spectrometer
The spectrum has no characteristic energy and too soft to be consistent with the RREA theory
The spectrum of X‐rays from dart‐stepped leaders is harder than the other types of leaders
In this study, push-out tests were conducted to investigate shear behaviour of FRP perfobond shear connector. The parameters influencing shear capacity of FRP perfobond shear connector are concrete ...dowel effect, shear resistance effect of the laterally reinforced FRP re- bar, and frictional effect between shear connector and concrete. The specimens were designed to consider these parameters. The specimens coated with sand to increase frictional resistance between the FRP re-bar and concrete. Based on the test results and the parameters, new equation was suggested to predict shear strength of FRP perfobond shear connectors. The predicted results and the experimental results were compared to check the feasibility of prediction.
The deletion (D) allele of the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene is strongly associated with an increased level of circulating ACE. The ACE gene ...polymorphism may influence the production of angiotensin II (Ang II). It has been shown that Ang II modulates fibrinolysis, that is, Ang II increases plasminogen activator inhibitor-1 (PAI-1) mRNA and plasma PAI-1 levels in vitro and in vivo. Considered together, we tested the hypothesis that the deletion allele of the ACE gene might be associated with increased levels of PAI-1. We related the ACE genotype to PAI-1 antigen levels in 603 men and 221 women attending a routine health screening. As a whole, the plasma PAI-1 level was not strongly associated with ACE genotype. Since the PAI-1 level was significantly influenced by well-known risk factors for coronary artery disease (CAD), we further analyzed the data after excluding subjects with major cardiovascular risk factors. In low-risk male subjects, the DD genotype had significantly higher levels of plasma PAI-1 (DD20.3 +/- 2.2; DI13.9 +/- 1.1; II13.6 +/- 1.3 ng/mL, P = .010 by ANOVA). In low-risk female subjects, the DD genotype showed a tendency to a high level of plasma PAI-1 without statistical significance. When analysis was restricted to postmenopausal women (age >or= to 55 or FSH >or= to 35 ng/mL), the DD genotype showed a significantly higher level of PAI-1 than subjects with the DI and II genotypes (27.7 +/- 6.2 versus 15.6 +/- 1.8 ng/mL, P = .028). The DD polymorphism of the ACE gene is associated with high PAI-1 levels in male and possibly in postmenopausal female subjects who have lower conventional cardiovascular risk factors. These results suggest that the increased ACE activity caused by DD polymorphism may play an important role in elevating the level of plasma PAI-1. Our data support the notion that the genetic variation of ACE contributes to the balance of the fibrinolytic pathway. (Arterioscler Thromb Vasc Biol. 1997;17:3242-3247.)
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