A two-step process, in which circulating levels of amyloid P are reduced and then anti–serum amyloid P antibody is given to activate macrophage clearance mechanisms of tissue deposits, appears to ...reduce amyloid deposits in liver and some other organs.
In systemic amyloidosis, the extracellular deposition of normally soluble plasma proteins as insoluble amyloid fibrils damages the structure and function of tissues and organs.
1
Current treatment consists of support or replacement of failing organs and measures to reduce the abundance of the amyloid fibril precursor protein.
1
,
2
A sufficient reduction of precursor supply arrests the accumulation of amyloid and can reduce morbidity and mortality. However, amyloid regression is very slow and often does not occur at all, in contrast to the usually swift clearance of other extracellular debris and efficient tissue remodeling — for example, after trauma. At least 65% . . .
SNAPSHOT USA 2019 Cove, Michael V.; Bontrager, Helen; Bresnan, Claire ...
Ecology (Durham),
June 2021, Letnik:
102, Številka:
6
Journal Article
Recenzirano
Odprti dostop
With the accelerating pace of global change, it is imperative that we obtain rapid inventories of the status and distribution of wildlife for ecological inferences and conservation planning. To ...address this challenge, we launched the SNAPSHOT USA project, a collaborative survey of terrestrial wildlife populations using camera traps across the United States. For our first annual survey, we compiled data across all 50 states during a 14‐week period (17 August–24 November of 2019). We sampled wildlife at 1,509 camera trap sites from 110 camera trap arrays covering 12 different ecoregions across four development zones. This effort resulted in 166,036 unique detections of 83 species of mammals and 17 species of birds. All images were processed through the Smithsonian’s eMammal camera trap data repository and included an expert review phase to ensure taxonomic accuracy of data, resulting in each picture being reviewed at least twice. The results represent a timely and standardized camera trap survey of the United States. All of the 2019 survey data are made available herein. We are currently repeating surveys in fall 2020, opening up the opportunity to other institutions and cooperators to expand coverage of all the urban–wild gradients and ecophysiographic regions of the country. Future data will be available as the database is updated at eMammal.si.edu/snapshot‐usa, as will future data paper submissions. These data will be useful for local and macroecological research including the examination of community assembly, effects of environmental and anthropogenic landscape variables, effects of fragmentation and extinction debt dynamics, as well as species‐specific population dynamics and conservation action plans. There are no copyright restrictions; please cite this paper when using the data for publication.
Saving freshwater from salts Cañedo-Argüelles, M.; Hawkins, C. P.; Kefford, B. J. ...
Science (American Association for the Advancement of Science),
02/2016, Letnik:
351, Številka:
6276
Journal Article
Recenzirano
Ion-specific standards are needed to protect biodiversity
Many human activities—like agriculture and resource extraction—are increasing the total concentration of dissolved inorganic salts (i.e., ...salinity) in freshwaters. Increasing salinity can have adverse effects on human health (
1
); increase the costs of water treatment for human consumption; and damage infrastructure e.g., amounting to $700 million per year in the Border Rivers catchment, Australia (
2
). It can also reduce freshwater biodiversity (
3
); alter ecosystem functions (
4
); and affect economic well-being by altering ecosystem goods and services (e.g., fisheries collapse). Yet water-quality legislation and regulations that target salinity typically focus on drinking water and irrigation water, which does not automatically protect biodiversity. For example, specific electrical conductivities (a proxy for salinity) of 2 mS/cm can be acceptable for drinking and irrigation but could extirpate many freshwater insect species (
3
). We argue that salinity standards for specific ions and ion mixtures, not just for total salinity, should be developed and legally enforced to protect freshwater life and ecosystem services. We identify barriers to setting such standards and recommend management guidelines.
Aims
Heart failure (HF) and chronic obstructive pulmonary disease are common partners. Bronchodilators are associated with adverse cardiovascular outcomes in patients with pulmonary disease. The ...outcome of patients with HF prescribed bronchodilators is poorly defined.
Methods and results
The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme randomized 7599 patients with symptomatic HF to receive candesartan or placebo. The relative risk conveyed by bronchodilator therapy was examined using a multivariable Cox proportional hazards model. The prevalence of bronchodilator therapy was similar in patients with reduced and preserved systolic function (respectively, 8.7 vs. 9.2%, P = 0.46). Beta‐blocker utilization was markedly lower in patients receiving bronchodilators compared with those without (overall 31.9 vs. 57.6%, P < 0.0001). Bronchodilator use was associated with increased all‐cause mortality HR 1.26 (1.09–1.45), P = 0.0015, cardiovascular death HR 1.21 (1.03–1.42), P = 0.0216, HF hospitalization HR 1.49 (1.29–1.72), P < 0.0001, and major adverse cardiovascular events HR 1.32 (1.17–1.76), P < 0.0001. The adverse outcomes were consistent in patients with reduced and preserved systolic function. No significant interaction was observed between bronchodilators and beta‐blockade with respect to outcomes.
Conclusion
Bronchodilator use is a powerful independent predictor of worsening HF and increased mortality in a broad spectrum of patients with HF. Whether this relates to a toxic effect of bronchodilators, underlying pulmonary disease, or both is unclear and warrants further investigation.
Many studies have examined short-term changes in understory vegetation following prescribed burning. However, knowledge concerning longer term effects on both forest understory and overstory ...vegetation is lacking. This investigation was initiated to examine changes in understory (herbaceous and shrub) and overstory species composition almost four decades after logging and prescribed burning at the Pike Bay Experimental Forest in Minnesota. The experiment was established in 1964 with a randomized block design with four treatments: control (c); burned in spring 1967 (S0); burned in spring 1967 + repeat burn spring 1969 (S2); and burned in spring 1967 + repeat burn fall 1970 (F4). Overstory and understory species diversity indices and richness varied within and among treatments but were not strongly or consistently affected by the treatments. Multivariate analyses (multi-response block permutation procedures and non-metric multidimensional scaling) reveal some lingering effects of burning intensity and seasonal variation as well as some compositional differentiation among treatments, but only in the herb layer. In this environment, the effects of two repeated burnings (fire) have essentially disappeared for overstory and understory species diversity and community composition and have failed to convert an aspen-dominated stand to a coniferous stand (an original goal of the study).
This authoritative guide for the nursing management of common gynaecological conditions is updated with cutting-edge topics and new evidence-based guidelines and patient teaching materials to enhance ...excellence in clinical practice. The outline format provides easy-to-access information in a formatted presentation style for a wide variety of commonly-occurring clinical conditions unique to women.
Imaging plays an essential role in the evaluation of malignant pleural mesothelioma (MPM). Computed tomography is the primary imaging modality used for the diagnosis and staging of MPM. Magnetic ...resonance (MR) imaging and, more recently, positron emission tomography (PET) have emerged as modalities that can provide additional important diagnostic and prognostic information to help further delineate the extent of disease, especially in surgical candidates. Use of MR imaging performed with different pulse sequences and gadolinium-based contrast material can improve the detection of tumor extension, especially to the chest wall and diaphragm. PET can provide both anatomic and metabolic information, especially in cases of extrathoracic and mediastinal nodal metastasis. Each imaging modality has its advantages and limitations, but their combined use is crucial in determining the most appropriate treatment options for patients with MPM.
Understanding how species' thermal limits have evolved across the tree of life is central to predicting species' responses to climate change. Here, using experimentally-derived estimates of thermal ...tolerance limits for over 2000 terrestrial and aquatic species, we show that most of the variation in thermal tolerance can be attributed to a combination of adaptation to current climatic extremes, and the existence of evolutionary 'attractors' that reflect either boundaries or optima in thermal tolerance limits. Our results also reveal deep-time climate legacies in ectotherms, whereby orders that originated in cold paleoclimates have presently lower cold tolerance limits than those with warm thermal ancestry. Conversely, heat tolerance appears unrelated to climate ancestry. Cold tolerance has evolved more quickly than heat tolerance in endotherms and ectotherms. If the past tempo of evolution for upper thermal limits continues, adaptive responses in thermal limits will have limited potential to rescue the large majority of species given the unprecedented rate of contemporary climate change.
Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis Gillmore, Julian D; Maurer, Mathew S; Falk, Rodney H ...
Circulation (New York, N.Y.),
2016-June-14, 2016-Jun-14, 2016-06-14, 20160614, Letnik:
133, Številka:
24
Journal Article
Recenzirano
Odprti dostop
BACKGROUND—Cardiac transthyretin (ATTR) amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed ...because of the limited specificity of echocardiography and the traditional requirement for histological confirmation. It has long been recognized that technetium-labeled bone scintigraphy tracers can localize to myocardial amyloid deposits, and use of this imaging modality for the diagnosis of cardiac ATTR amyloidosis has lately been revisited. We conducted a multicenter study to ascertain the diagnostic value of bone scintigraphy in this disease.
METHODS AND RESULTS—Results of bone scintigraphy and biochemical investigations were analyzed from 1217 patients with suspected cardiac amyloidosis referred for evaluation in specialist centers. Of 857 patients with histologically proven amyloid (374 with endomyocardial biopsies) and 360 patients subsequently confirmed to have nonamyloid cardiomyopathies, myocardial radiotracer uptake on bone scintigraphy was >99% sensitive and 86% specific for cardiac ATTR amyloid, with false positives almost exclusively from uptake in patients with cardiac AL amyloidosis. Importantly, the combined findings of grade 2 or 3 myocardial radiotracer uptake on bone scintigraphy and the absence of a monoclonal protein in serum or urine had a specificity and positive predictive value for cardiac ATTR amyloidosis of 100% (positive predictive value confidence interval, 98.0–100).
CONCLUSIONS—Bone scintigraphy enables the diagnosis of cardiac ATTR amyloidosis to be made reliably without the need for histology in patients who do not have a monoclonal gammopathy. We propose noninvasive diagnostic criteria for cardiac ATTR amyloidosis that are applicable to the majority of patients with this disease.
A 'one-stop' comprehensive guide to women's health, updated with new evidence- based guidelines and timely topics The 11th edition of this classic guide for management of common gynecological ...conditions by advanced practice nurses is updated with cutting-edge topics, new evidence-based guidelines, and current patient teaching materials to enhance excellence in clinical practice. It features a completely updated chapter on the well woman annual exam including issues about the care of older women, and extensive revisions throughout the new edition regarding contraceptive methods, CAMs, medical abortion, HIV-AIDs, HPV screening and vaccine recommendations, and much more. Appendices containing abundant clinical resources and valuable patient teaching information, and comprehensive bibliographies, are also extensively revised and rewritten. Concise and well organized, this authoritative resource features an outline format that provides speedy access to critical information across womenís age span. Guidelines reflect ìbest-practiceî standards of care that are culled from literature on evidence-based practice and help to ensure improved patient outcomes. Expert contributors include prominent specialists from all arenas of gynecological health. Complete guidelines are presented in a template that includes definition, etiology, history, physical exam, lab exam, differential diagnosis, treatment, complications, consultation/referral, and follow-up. The guide addresses common gynecologic concerns including infections and sexually transmitted diseases, navigating life transitions, and menopause and incontinence. It encompasses issues of weight management, osteoporosis, smoking cessation, stress management, changes in sexuality, and health risks. New to the 11 th Edition: * Enhanced mental health chapter detailing the discontinuation of SSRI/SNRIs * A bibliography for each guideline including additional websites * Revisions to guidelines for STDs, vaginitis and vaginosis * Guidelines for management of cytological abnormalities and cervical intraepithelial neoplasia * New information on hormone therapy, menopause, and osteoporosis * Updated information on contraception based on patientsí individual profiles and clinical data * Revised information on natural family planning from an expert NFP educator * New data on long term effects of HRT * New data on HPV, HIV treatment and survival * Expanded section on screening for updating of laboratory tests * Additional data-based evidence on over-the-counter remedies and non-prescription supplements * New data on screenings for breast cancer * New Pap smear guidelines across the lifespan * Physical assessment of pelvic floor integrity and dysfunction * Helpful techniques for difficult examinations * Updated information on vulvar dermatology * Information on lesbian, bisexual, and transgender health concerns Key Features: * Reflects best-practice standards of care empirically demonstrated to improve patient outcomes * Updated to include cutting-edge topics and new evidence-based guidelines * Presents guidelines in concise, consistent outline format to ensure quick and easy access to clinical information * Written by a highly respected and experienced team of authors * Provides valuable patient teaching information
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