Objectives: To examine trends in the prevalence of diagnosed atrial fibrillation (AF), its treatment with oral anticoagulants between 1994 and 2003, and predictors of anticoagulant treatment in 2003. ...Methods: Analysis of electronic data from 131 general practices (about one million registered patients annually) contributing to the DIN-LINK database. Results: From 1994 to 2003 the prevalence of “active” AF rose from 0.78% to 1.31% in men and from 0.79% to 1.15% in women. The proportion of patients with AF taking anticoagulants rose from 25% to 53% in men and from 21% to 40% in women. Most others received antiplatelets. The likelihood of receiving anticoagulants was greater for men and with increasing stroke risk. It decreased sharply with age after 75 years. Socioeconomic status, urbanisation and region had no influence. Non-steroidal anti-inflammatory drugs, antiplatelet drugs and ulcer healing drugs were associated with reduced likelihood of receiving anticoagulants, as were peptic ulcers, chronic gut disorders, anaemias, psychoses and poor compliance. Anticoagulant treatment was associated with several cardiovascular co-morbidities and drugs, possibly due to secondary care treatment. Nevertheless, only 56.5% of patients at very high risk of stroke were taking anticoagulants in 2003, whereas 38.2% of patients at low risk of stroke received anticoagulants. Conclusions: This study confirms previously observed trends of increasing AF prevalence and warfarin treatment. Many patients who may benefit from anticoagulation still do not receive it, whereas others at lower risk of stroke do. The lower likelihood of women receiving anticoagulants is of particular concern.
Summary Background Patients with psoriasis may experience significant psychological and social disabilities. Stress or distress are proposed aggravators of the disease process in psoriasis. ...Preliminary studies to date have suggested that adjunctive psychological therapies may be effective in the clinical management of psoriasis.
Objectives To examine whether a 6‐week multidisciplinary management approach, the Psoriasis Symptom Management Programme (PSMP) for patients with psoriasis improves clinical severity of psoriasis and its associated psychological distress and disability.
Methods In a case–control study, patients with psoriasis attending an out‐patient psoriasis speciality clinic chose to receive standard psoriasis treatment alone (n = 53) or to enter the PSMP as an adjunct to standard therapy (n = 40). They were assessed at baseline, at the end of the 6‐week PSMP and after 6 months follow‐up.
Results As compared with standard treatment alone, analysis of covariance indicated that participation in the PSMP resulted in a greater reduction in clinical severity of psoriasis (P = 0·001), anxiety (P = 0·001), depression (P = 0·001), psoriasis‐related stress (P = 0·001) and disability (P = 0·04) at 6 weeks and 6 months follow‐up.
Conclusions The management of the physical aspects of psoriasis and its psychological effects are significantly improved for patients who opt for a 6‐week integrated multidisciplinary approach. Furthermore, the techniques learnt by participation in the PSMP facilitate continued control of psoriasis for at least 6 months.
Objective
Supplementing pregnant women at high risk of developing pre‐eclampsia with calcium may reduce the incidence of the disease. This study examines differences in serum and hair concentrations ...of calcium and magnesium between women with pre‐eclamptic and normotensive pregnancies.
Design
Observational case–control study.
Setting
Two teaching hospitals in Cape Town, South Africa.
Population
Women with pre‐eclamptic (N = 96) or normotensive (N = 96) pregnancies, who delivered a single, live infant.
Methods
Demographic and current pregnancy details were retrieved from clinical notes. Each participant completed a dietary questionnaire. Venous blood samples were taken from each participant to assess serum calcium and magnesium concentrations. Hair samples were obtained from all participants and calcium and magnesium levels were measured by inductively coupled plasma optical emission spectrometry (ICPOES).
Main outcome measure
Hair and serum calcium and magnesium concentrations were compared between women with pre‐eclamptic and normotensive pregnancies.
Results
Diet and socio‐economic status in the two groups were similar. There was no significant difference in the hair calcium level between women with pre‐eclamptic 1241 parts per million (ppm); range, 331–4654 ppm and normotensive (1146 ppm; range, 480–4136 ppm) pregnancies (P = 0.5). Hair calcium levels in both groups were not affected by HIV infection.
Conclusion
Woman with pre‐eclampsia showed no difference in chronic calcium status relative to normotensive women. This finding does not support the current belief that the mechanism by which calcium supplementation reduces the risk of developing pre‐eclampsia is by correcting a nutritional deficiency.
Inherited mutations in the E-cadherin gene (CDH1) were described recently in three Maori kindreds with familial gastric cancer. Familial gastric cancer is genetically heterogeneous and it is not ...clear what proportion of gastric cancer susceptibility in non-Maori populations is due to germline CDH1 mutations. Therefore, we screened eight familial gastric cancer kindreds of British and Irish origin for germline CDH1 mutations, by SSCP analysis of all 16 exons and flanking sequences. Each family contained: (i) two cases of gastric cancer in first degree relatives with one affected before age 50 years; or (ii) three or more cases of gastric cancer. Novel germline CDH1 mutations (a nonsense and a splice site) were detected in two families (25%). Both mutations were predicted to truncate the E-cadherin protein in the signal peptide domain. In one family there was evidence of non-penetrance and susceptibility to both gastric and colorectal cancer; thus, in addition to six cases of gastric cancer, a CDH1 mutation carrier developed colorectal cancer at age 30 years. We have confirmed that germline mutations in the CDH1 gene cause familial gastric cancer in non-Maori populations. However, only a minority of familial gastric cancers can be accounted for by CDH1 mutations. Loss of E-cadherin function has been implicated in the pathogenesis of sporadic colorectal and other cancers, and our findings provide evidence that germline CDH1 mutations predispose to early onset colorectal cancer. Thus, CDH1 should be investigated as a cause of inherited susceptibility to both gastric and colorectal cancers.
This paper describes the design and demonstration of a novel, easily fabricated micro-Coulter counter utilizing liquid metal electrodes. Fluid and electrode channels were fabricated simultaneously in ...a single lithographic patterning step. Eutectic gallium-indium (EGaIn) was injected into the device to form functional electrodes in a cross-channel parallel configuration. Functionality of the device was demonstrated at an ac excitation frequency of 5 kHz using a polymer microsphere suspension and simple post-processing techniques. The device successfully detected particles, exhibiting an output response proportional to particle size. EGaIn was demonstrated to be an effective micro-fluidic electrode material and provided a novel approach for the fabrication of a functional micro-Coulter counter.
Distinguishing surgically remedial forms from other causes of primary aldosteronism (PA) may be difficult, and it is made more challenging by the earlier detection of milder disease. The technical ...demands of bilateral adrenal vein sampling (AVS)—increasingly advocated for localizing a unilateral autonomous lesion (UAL)— and lack of agreed criteria for establishing unilateral autonomy, add further to the diagnostic challenge. This retrospective review of 49 hypokalemic patients with unequivocal PA (41 with surgically proven and remedial UAL, eight patients with bilateral adrenal hyperplasia) analyzes the value of computerized tomography adrenal scanning (n = 32), 4 h erect posture testing (n = 42), and AVS (n = 27) in predicting and lateralizing a surgically remedial lesion. A fall in plasma aldosterone during 4 h erect posture (positive test) occurred in 63% of patients with UAL and in none with bilateral adrenal hyperplasia. A positive posture test or computerized tomography adrenal scan (single focal macroadenoma) both had high positive predictive value (100% and 89% respectively), but low sensitivity for diagnosis of UAL. AVS, undertaken during low dose ACTH stimulation, localized the UAL in all cases (positive predictive value 100%) where the aldosterone/cortisol ratio of blood drawn from the uninvolved gland was less than that of peripheral blood (contralateral ratio <1). Biochemical severity, reflected by overnight supine plasma aldosterone, was strongly correlated with the degree of contralateral gland suppression (n = 16, r = 0.79, P < 0.001). Importantly, the AVS findings show that when bilateral access is not possible, UAL can be successfully lateralized when only one adrenal vein (the contralateral) is accessed, or the ipsilateral vein is sampled in subjects whose posture test was positive. In this series of patients with overt (hypokalemic) PA, preoperative testing successfully identified a surgically remedial lesion in 39 of 41 cases. Confirmation of the recommended diagnostic approach must now await larger prospective studies.
Helicoverpa armigera and Helicoverpa zea are major caterpillar pests of Old and New World agriculture, respectively. Both, particularly H. armigera, are extremely polyphagous, and H. armigera has ...developed resistance to many insecticides. Here we use comparative genomics, transcriptomics and resequencing to elucidate the genetic basis for their properties as pests.
We find that, prior to their divergence about 1.5 Mya, the H. armigera/H. zea lineage had accumulated up to more than 100 more members of specific detoxification and digestion gene families and more than 100 extra gustatory receptor genes, compared to other lepidopterans with narrower host ranges. The two genomes remain very similar in gene content and order, but H. armigera is more polymorphic overall, and H. zea has lost several detoxification genes, as well as about 50 gustatory receptor genes. It also lacks certain genes and alleles conferring insecticide resistance found in H. armigera. Non-synonymous sites in the expanded gene families above are rapidly diverging, both between paralogues and between orthologues in the two species. Whole genome transcriptomic analyses of H. armigera larvae show widely divergent responses to different host plants, including responses among many of the duplicated detoxification and digestion genes.
The extreme polyphagy of the two heliothines is associated with extensive amplification and neofunctionalisation of genes involved in host finding and use, coupled with versatile transcriptional responses on different hosts. H. armigera's invasion of the Americas in recent years means that hybridisation could generate populations that are both locally adapted and insecticide resistant.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This paper presents a new solar Extreme Ultraviolet (EUV) flux model for aeronomic calulations (EUVAC), which is based on the measured F74113 solar EUV reference spectrum. The model provides fluxes ...in the 37 wavelength bins that are in widespread use. This paper also presents cross sections to be used with the EUVAC flux model to calculate photoionization rates. The flux scaling for solar activity is accomplished using a proxy-based on the F10.7 index and its 81-day average together with the measured solar flux variation from the EUVS instrument on the Atmosphere Explorer E satellite. This new model produces 50-575 A integrated EUV fluxes in good agreement with rocket observations. The solar cycle variation of the chromospheric fluxes agrees well with the measured variation of the Lyman alpha flux between 1982 and 1988. In addition, the theoretical photoelectron fluxes, calculated using the new EUV flux model, are in good agreement with the solar minimum photoelectron fluxes from the Atmosphere Explorer E satellite and also with the solar maximum photoelectron fluxes from the Dynamics Explorer satellite. Its relative simplicity coupled with its ability to reproduce the 50-575 A solar EUV flux as well as the measured photoelectron spectrum makes the model well suited for aeronomic applications. However, EUVAC is not designed to accurately predict the solar flux variability for numerous individual lines.
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