Cardiovascular disease accounts for about one-third of all premature deaths (ie, age < 70) in Cuba. Yet, the relevance of major risk factors, including systolic blood pressure (SBP), diabetes, and ...body-mass index (BMI), to cardiovascular mortality in this population remains unclear.
In 1996-2002, 146,556 adults were recruited from the general population in five areas of Cuba. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to national death registries until Jan 1, 2017; in 2006-08, 24,345 participants were resurveyed. After excluding all with missing data, cardiovascular disease at recruitment, and those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate cardiovascular mortality rate ratios (RRs) at ages 35-79 years to SBP, diabetes and BMI; RR were corrected for regression dilution to give associations with long-term average (ie, 'usual') levels of SBP and BMI.
After exclusions, there were 125,939 participants (mean age 53 SD12; 55% women). Mean SBP was 124 mmHg (SD15), 5% had diabetes, and mean BMI was 24.2 kg/m
(SD3.6); mean SBP and diabetes prevalence at recruitment were both strongly related to BMI. During follow-up, there were 4112 cardiovascular deaths (2032 ischaemic heart disease, 832 stroke, and 1248 other). Cardiovascular mortality was positively associated with SBP (>=120 mmHg), diabetes, and BMI (>=22.5 kg/m
): 20 mmHg higher usual SBP about doubled cardiovascular mortality (RR 2.02, 95%CI 1.88-2.18), as did diabetes (2.15, 1.95-2.37), and 10 kg/m
higher usual BMI (1.92, 1.64-2.25). RR were similar in men and in women. The association with BMI and cardiovascular mortality was almost completely attenuated following adjustment for the mediating effect of SBP. Elevated SBP (>=120 mmHg), diabetes and raised BMI (>=22.5 kg/m
) accounted for 27%, 14%, and 16% of cardiovascular deaths, respectively.
This large prospective study provides direct evidence for the effects of these major risk factors on cardiovascular mortality in Cuba. Despite comparatively low levels of these risk factors by international standards, the strength of their association with cardiovascular death means they nevertheless exert a substantial impact on premature mortality in Cuba.
Within the first 72 hours after stroke, active finger extension is a strong predictor of long-term dexterity. Transcranial magnetic stimulation may add prognostic value to clinical assessment, which ...is especially relevant for patients unable to follow instructions.
The current prospective cohort study aims at determining whether amplitude of motor evoked potentials of the extensor digitorum communis (EDC) can improve clinical prediction after stroke when added to clinical tests.
the amplitude of motor evoked potentials of the affected EDC muscle at rest was measured in 18 participants within 4 weeks after stroke, as were the ability to perform finger extension and the Fugl-Meyer Motor Assessment of the upper extremity (FMA_UE). These three determinants were related to the FMA_UE at 26 weeks after stroke (FMA_UE26), both directly, and via the proportional recovery prediction model. The relation between amplitude of the motor evoked potentials and FMA_UE26 was evaluated for EDC. For comparison, also the MEP amplitudes of biceps brachii and adductor digiti minimi muscles were recorded.
Patients' ability to voluntarily extend the fingers was strongly related to FMA_UE26, in our cohort there were no false negative results for this predictor. Our data revealed that the relation between amplitude of motor evoked potential of EDC and FMA_UE26 was significant, but moderate (rs = 0.58) without added clinical value. The other tested muscles did not correlate significantly to FMA_UE26.
Our study demonstrates no additional value of motor evoked potential amplitude of the affected EDC muscle to the clinical test of finger extension, the latter being more strongly related to FMA_UE26.
We present a methodology for the selection of accelerometric time histories as input for dynamic response analyses over vast areas. The method is primarily intended for seismic microzonation studies ...and regional probabilistic seismic hazard assessments that account for site effects. It is also suitable for structural response analyses if one would like to use a fixed set of ground motion records for analyzing multiple structures with different (or unknown) periods. The proposed procedure takes advantage of unsupervised machine learning techniques to identify zones (i.e., groups of sites) with homogeneous seismic hazard, for which the same set of earthquake recordings can be reasonably used in the numerical simulations. The procedure consists of three steps: (1) data-driven cluster analysis to identify groups of sites with comparable seismic hazard levels for a specified mean return period (MRP); (2) for each zone, definition of a single, reference uniform hazard spectrum (UHS) corresponding to the MRP of interest; (3) selection of a set of accelerometric recordings that are consistent with the magnitude-distance scenarios contributing to the hazard of each zone, and meet the spectrum-compatibility requirement with respect to the reference UHS. An application of the procedure in the Po Plain (Northern Italy) is described in detail.
Otitis media (OM) is one of the most common infections in young children, arising from bacterial and/or viral infection of the middle ear. Globally,
and non-typeable
(NTHi) are the predominant ...bacterial otopathogens. Importantly, common upper respiratory viruses are increasingly recognized contributors to the polymicrobial pathogenesis of OM. This study aimed to identify predominant bacteria and viruses in the nasopharynx, adenoids and middle ears of peri-urban/urban South-East Queensland Australian children, with and without clinical history of chronic otitis media with effusion (COME) and/or recurrent acute otitis media (RAOM).
Sixty children, 43 diagnosed with OM and 17 controls with no clinical history of OM from peri-urban/urban South-East Queensland community were recruited to the study. Respiratory tract bacterial and viral presence were examined within nasopharyngeal swabs (NPS), middle ear effusions (MEE) and adenoids, using real-time polymerase chain reaction (RT-PCR) and bacterial culture.
At least one otopathogen present was observed in all adenoid samples, 86.1% and 82.4% of NPS for children with and without OM, respectively, and 47.1% of the MEE from the children with OM. NTHi was the most commonly detected bacteria in both the OM and control cohorts within the adenoids (90.0% vs 93.8%), nasopharynx (67.4% vs 58.8%) respectively, and in the MEE (OM cohort 25.9%). Viruses were detected in all adenoid samples, 67.4% vs 47.1% of the NPS from the OM and control cohorts, respectively, and 37% of the MEE. Rhinovirus was the predominant virus identified in the adenoids (85.0% vs 68.8%) and nasopharynx (37.2% vs 41.2%) from the OM and control cohorts, respectively, and the MEE (19.8%).
NTHi and rhinovirus are predominant otopathogens within the upper respiratory tract of children with and without OM from peri-urban and urban South-East Queensland, Australia. The presence of bacterial otopathogens within the middle ear is more predictive of concurrent URT infection than was observed for viruses, and the high otopathogen carriage within adenoid tissues confirms the complex polymicrobial environment in children, regardless of OM history.
This paper reports the development of dosimeters based on plastic scintillating fibers imaged by a charge-coupled device camera, and their performance evaluation through irradiations with the ...electron Flash research accelerator located at the Centro Pisano Flash Radiotherapy. The dosimeter prototypes were composed of a piece of plastic scintillating fiber optically coupled to a clear optical fiber which transported the scintillation signal to the readout systems (an imaging system and a photodiode). The following properties were tested: linearity, capability to reconstruct the percentage depth dose curve in solid water and to sample in time the single beam pulse. The stem effect contribution was evaluated with three methods, and a proof-of-concept one-dimensional array was developed and tested for online beam profiling. Results show linearity up to 10 Gy per pulse, and good capability to reconstruct both the timing and spatial profiles of the beam, thus suggesting that plastic scintillating fibers may be good candidates for low-energy electron Flash dosimetry.
•Flash radiotherapy may be groundbreaking for improving cancer treatment.•Conventional dosimeters do not function properly in the Flash regime.•Dosimeters based on plastic scintillating fibers were developed and characterized.•No quenching or energy dependence was observed in the Flash regime.•The beam time structure could be properly sampled.
In this study, we apply an empirical scoring method to evaluate the feasibility of probabilistic seismic hazard analyses at regional scale in Italy accounting for site amplification, which is taken ...into account through the application of a set of ground motion prediction equations (GMPEs) defined for specific ground types. Precisely, this method calculates the agreement (in terms of likelihood) between the hazard results computed using a specific hazard model and the number of ground-motion exceedances at a set of reference sites. Such a procedure is applied to quantify the likelihood of the outcomes of different hazard models, each based on a specific GMPE, with respect to the observations at 56 accelerometric sites operating in Italy for at least 25 years. Indirectly, this allows evaluating the influence of the selected GMPE in providing reliable hazard estimates. Seven possible GMPEs, applicable in active shallow crustal regions like Italy, have been examined taking into account the correlation among the hazard estimates provided by each computational model at the reference sites. Our results indicate that, although using GMPEs for pre-defined soil categories provides only a broad assessment of the hazard (since it ignores specific site response), large-scale hazard maps of Italy that are compatible with observations can be provided when suitable GMPEs are considered. A restricted number of GMPEs was found appropriate to this scope.
Heat-shock protein protection Sharp, Frank R; Massa, Stephen M; Swanson, Raymond A
Trends in neurosciences (Regular ed.),
03/1999, Letnik:
22, Številka:
3
Journal Article
Recenzirano
Heat-shock proteins (HSPs) are induced, in part, by denatured proteins produced during heat shock, ischemia and other stresses. They are found in all plant, yeast, bacterial and mammalian cells. ...However, they are still relatively little studied in medically relevant fields, which includes the neurosciences. The HSP70 heat-shock protein, along with other chaperones, aids the restoration of the structure and function of the denatured proteins. Recent studies suggest that heat shock and viral overproduction of HSP70 protects brain cells in vitro against injuries that produce necrosis and some types of apoptosis. Overproduction of HSP70 in vivo protects the brain against injury produced by ischemia and prolonged seizures. Heat-shock proteins and glucose-regulated proteins (GRPs) provide molecular markers of specific types of cell stress. A particular HSP or GRP could protect against very specific types of injury or against a variety of pathological processes.
Cognitive problems following stroke are typically analysed using either short but relatively uninformative general tests or through detailed but time consuming tests of domain specific deficits ...(e.g., in language, memory, praxis). Here we present an analysis of neuropsychological deficits detected using a screen designed to fall between other screens by being ‘broad’ (testing multiple cognitive abilities) but ‘shallow’ (sampling the abilities briefly, to be time efficient) – the BCoS. Assessment using the Birmingham Cognitive Screen (BCoS) enables the relations between ‘domain specific’ and ‘domain general’ cognitive deficits to be evaluated as the test generates an overall cognitive profile for individual patients. We analysed data from 287 patients tested at a sub-acute stage of stroke (<3 months). Graphical modelling techniques were used to investigate the associative structure and conditional independence between deficits within and across the domains sampled by BCoS (attention and executive functions, language, memory, praxis and number processing). The patterns of deficit within each domain conformed to existing cognitive models. However, these within-domain patterns underwent substantial change when the whole dataset was modelled, indicating that domain-specific deficits can only be understood in relation to linked changes in domain-general processes. The data point to the importance of using over-arching cognitive screens, measuring domain-general as well as domain-specific processes, in order to account for neuropsychological deficits after stroke. The paper also highlights the utility of using graphical modelling to understand the relations between cognitive components in complex datasets.
Purpose
To evaluate if a web-based telemedicine system (the Glucoonline
®
system) is effective to improve glucose control in insulin-treated patients with type 1 and type 2 diabetes, as compared to ...standard of care.
Methods
This was a prospective, randomized, controlled trial, carried out at three tertiary referral centers for diabetes in Italy. Adults with insulin-treated type 1 and type 2 diabetes, inadequate glycemic control, and no severe diabetes-related complications and/or comorbidities were eligible for this study. Patients were randomized to either perform telemedicine-assisted (Group A) or standard (Group B) self-monitoring blood glucose (SMBG) for 6 months. In Group A, patients received prompt feedback about their blood glucose levels and therapy suggestions from the study staff via phone/SMS, when appropriate. In Group B, patients had no remote assistance from the study staff between planned visits.
Results
123 patients were included in the final analysis. After 6 months, patients achieved a significant reduction in HbA1c in Group A (−0.38%,
p
< 0.05) but not in Group B (+ 0.08%,
p
= 0.53). A significant difference in the percentage of patients with HbA1c < 7% between Group A and Group B was found after 3 months (28.6% vs 11.1%,
p
= 0.02). Also, fewer patients (
p
< 0.05) with HbA1c > 8.5% were found in Group A vs Group B, respectively, after both 3 months (14.3% vs 35.2%) and 6 months (21.8% vs 42.9%).
Conclusions
The use of the Glucoonline™ system resulted in improved metabolic control. Telemedicine services have potential to support diabetes self-management and provide the patients with remote, prompt assistance using affordable technological equipment.
Trial registration
This study was registered at clinicaltrials.gov (NCT01804803) on March 5, 2013.
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