The Society of Thoracic Surgeons Predicted Risk of Mortality (PROM) score is a well-validated predictor of 30-day mortality after cardiac procedures. This study investigated the ability of PROM to ...predict longer-term survival.
From January 1, 1996, to December 31, 2009, 24,222 patients with PROM scores underwent cardiac procedures at an academic center. Long-term all-cause mortality was determined from the Social Security Death Index. Logistic and Cox survival regression analyses evaluated the long-term predictive utility of the PROM. Area under the receiver operator characteristic curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for the whole sample and for 30-day survivors.
The overall 30-day mortality was 2.78% (674 of 24,222). PROM predicted 30-day mortality extremely well (area under the receiver operator characteristic, 0.794) and predicted longer-term survival almost as well. Among all patients and 30-day survivors, area under the receiver operator characteristic values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated. PROM was highly predictive of Kaplan-Meier survival for patients surviving beyond 30 days. Among 30-day survivors, each percent increase in PROM score was associated with a 9.6% increase (95% confidence interval, 9.3% to 10.0%) in instantaneous hazard of death (p<0.001).
The PROM algorithm accurately predicts death at 30-days and during 14 years of follow-up with almost equally strong discriminatory power. This may have profound implications for informed consent and for longitudinal comparative effectiveness studies.
It is not known which patient subgroups may benefit most from off-pump coronary artery bypass grafting (OPCAB) rather than coronary artery bypass grafting on cardiopulmonary bypass (CPB).
The Society ...of Thoracic Surgeons database was queried for all isolated, primary coronary artery bypass graft cases between January 1, 1997, and December 31, 2007, at a US academic center. The Society of Thoracic Surgeons Predicted Risk of Mortality (PROM) was calculated by a formula based on 30 preoperative risk factors. It was used in three ways to compare 30-day operative mortality between patients treated with OPCAB versus CPB. First, patients were divided into quartiles based on their PROM, and mortality rates were compared between OPCAB and CPB patients within each PROM quartile. Second, a logistic regression model tested for an interaction between surgery type and PROM; a significant interaction would indicate that the relative mortality risk of OPCAB versus CPB varied with different PROM levels. Finally, locally smoothed kernel regression curves were used to visually estimate a threshold PROM point at which mortality rates diverge for the surgery types.
There were 14,766 consecutive patients, 7,083 OPCAB (48.0%) and 7,683 CPB (52.0%). There was no difference in operative mortality between OPCAB and CPB for patients in the lower two risk quartiles. In the higher risk quartiles there was a mortality benefit for OPCAB (odds ratio, 0.62 and 0.45 for OPCAB in the third and fourth risk quartiles). Logistic regression analysis confirmed a significant interaction between surgery type and PROM (p = 0.005) meaning that OPCAB is especially beneficial to patients with higher PROM. This benefit is most significant for patients with PROM values above 2.5% to 3%, where mortality curves sharply diverge.
Off-pump coronary artery bypass grafting is associated with lower operative mortality than coronary artery bypass grafting on CPB for higher risk patients. This mortality benefit increases with increasing PROM.
The dynamics of genome evolution caused by whole genome duplications and other processes are hypothesized to shape the diversification of plants and thus contribute to the astonishing variation in ...species richness among the main lineages of land plants. Ferns, the second most species-rich lineage of land plants, are highly suitable to test this hypothesis because of several unique features that distinguish fern genomes from those of seed plants. In this study, we tested the hypothesis that genome diversity and disparity shape fern species diversity by recording several parameters related to genome size and chromosome number.
We conducted de novo measurement of DNA C-values across the fern phylogeny to reconstruct the phylogenetic history of the genome space occupation in ferns by integrating genomic parameters such as genome size, chromosome number and average DNA amount per chromosome into a time-scaled phylogenetic framework. Using phylogenetic generalized least square methods, we determined correlations between chromosome number and genome size, species diversity and evolutionary rates of their transformation.
The measurements of DNA C-values for 233 species more than doubled the taxon coverage from ~2.2 % in previous studies to 5.3 % of extant diversity. The dataset not only documented substantial differences in the accumulation of genomic diversity and disparity among the major lineages of ferns but also supported the predicted correlation between species diversity and the dynamics of genome evolution.
Our results demonstrated substantial genome disparity among different groups of ferns and supported the prediction that alterations of reproductive modes alter trends of genome evolution. Finally, we recovered evidence for a close link between the dynamics of genome evolution and species diversity in ferns for the first time.
Our objective was to determine the standardized ileal digestibility (SID) of CP and AA in soybean meal (SBM) and canola, cotton, and sunflower products fed to finishing pigs. Each of 8 barrows ...(average initial BW = 106.6 ± 5.5 kg) were surgically fitted with a T-cannula in the distal ileum. Pigs were allotted to an 8 × 8 Latin square design with 8 diets and 8 periods. The 7 protein ingredients were canola seeds (CS), canola meal (CM), cottonseed meal (CSM), sunflower seeds (SFS), sunflower meal (SFM), dehulled sunflower meal (SFM-DH), and SBM, with each ingredient included as the sole source of AA in the diet. A N-free diet was used to estimate basal endogenous losses of AA. Among tested ingredients, SBM had the greatest (P < 0.05) SID of Lys, and CS had the least (P < 0.05) SID of Phe, Thr, and Tyr. The SID of all indispensable AA except Trp was less (P < 0.05) in CS than SBM, and CM had a greater (P < 0.05) SID of all indispensable AA except Arg, His, Lys, and Trp than CS. However, the SID of all indispensable AA except Arg and Trp were less (P < 0.05) in CM than in SBM. The SID of all indispensable AA except Arg and Trp also were less (P < 0.05) in CSM than in SBM, and the SID of Met was less (P < 0.05) in CSM than in all other ingredients. Among sunflower products, the SID of His, Leu, Phe, and Thr were less (P < 0.05) in SFM-DH than in SFS and SFM, and the SID of Ile, Met, and Val were less (P < 0.05) in SFM-DH than in SFS; however, for CP, Arg, Lys, and Trp, no differences among SFS, SFM, and SFM-DH were observed. The SID of all indispensable AA except Trp were less (P < 0.05) in SFM-DH than SBM, and the SID of His, Ile, Lys, Thr, and Val in SFM were also less (P < 0.05) than in SBM. Except for Lys, no differences between SBM and SFS were observed. In conclusion, the SID of most AA in CS, CM, CSM, SFM, and SFM-DH are less than in SBM.
Hidradenitis suppurativa (HS) is a chronic debilitating autoinflammatory skin disease. Adalimumab is the only biologic agent available to treat HS, but lack of response is observed in some patients. ...Ustekinumab may be useful to treat patients with HS who do not respond to adalimumab.
The objectives of this study were: (1) to retrospectively evaluate the therapeutic outcomes of ustekinumab in a multicenter series of patients with HS and (2) to assess all published scientific evidence on its utilization in patients with HS.
We evaluated the therapeutic outcomes of 10 patients with HS treated with ustekinumab and conducted a systematic review of published epidemiological studies on ustekinumab-treated patients with HS.
In the case series, an improvement in the Physician Global Assessment score was observed in 70% (7/10) patients and an improvement in the Numerical Pain Rating Scale in 80% (8/10). In the systematic review, clinical improvement in disease severity was reported in 76% (34/45) patients and symptomatic improvement in 84% (38/45). No severe ustekinumab-related adverse event was recorded.
These findings suggest that ustekinumab may be an effective and safe option for patients with HS who fail to respond to first-line therapies.
In depending on the sulfation method, important effects on the acidity, textural properties as well as on the activity for the esterification of fatty acids with ethanol. Conversions up to 82.2% of ...the oleic acid and selectivity to ester of 100% were reached after 3
h of reaction at 80
°C in sulfated titania: (▾) titania impregnated with ammonium sulfate; (♦) titania sol–gel sulfated with ammonium sulfate; (▴) titania sol–gel sulfate with sulfuric acid; (●) titania sol–gel; (■) without catalyst.
Sulfated titanias were prepared by using ammonium sulfate and sulfuric acid as sulfate precursors. Depending on the sulfation method, important effects on the acidity, textural properties as well as on activity were found. After ammonium sulfate was used, a large amount of S
O linked to the titania surface was observed by FTIR spectroscopy. The acidity strength determined with Hammett indicators showed strong acidity in the sulfated samples. The FTIR-pyridine adsorption spectra evidenced the presence of Lewis and Brönsted acid sites in the catalysts sulfated with ammonium sulfate, while in the titania sulfated with sulfuric acid, only Lewis-type sites were observed. The sulfated titanias showed very high activity for the esterification of fatty acids with ethanol in a mixture of oleic acid (79%). Conversions up to 82.2% of the oleic acid and selectivity to ester of 100% were reached after 3
h of reaction at 80
°C. The results showed that sulfated titanias are promising solid acid catalysts to be used in the esterification of free fatty acids with ethanol.
A new carbon-nitrogen organic semiconductor has been synthesized by pyrolysis of uric acid. This layered carbon-nitrogen material contains imidazole-, pyridine (naphthyridine)- and graphitic-like ...nitrogen, as evinced by infrared and X-ray photoelectron spectroscopies. Quantum chemistry calculations support that it would consist of a 2D polymeric material held together by hydrogen bonds. Layers are stacked with an interplanar distance between 3.30 and 3.36 Å, as in graphite and coke. Terahertz spectroscopy shows a behavior similar to that of amorphous carbons, such as coke, with non-interacting layers. This material features substantial differences from polymeric carbon nitride, with some characteristics closer to those of nitrogen-doped graphene, in spite of its higher nitrogen content. The direct optical band gap, dependent on the polycondensation temperature, ranges from 2.10 to 2.32 eV. Although in general the degree of crystallinity is low, in the material synthesized at 600 °C some spots with a certain degree of crystallinity can be found.
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The oral agent miltefosine has demonstrated a >95% cure rate in Indian visceral leishmaniasis. We performed a large, placebo-controlled study of miltefosine therapy (2.5 mg/kg per day orally for 28 ...days) against cutaneous leishmaniasis in Colombia and Guatemala. In regions in Colombia where Leishmania vianna panamensis is common, the per-protocol cure rates for miltefosine and placebo were 91% (40 of 44 patients) and 38% (9 of 24). These values are similar to historic values for the antimony standard of care and placebo. In regions in Guatemala where L. v. braziliensis and L. mexicana mexicana are common, the per-protocol cure rates were 53% (20 of 38) for miltefosine and 21% (4 of 19) for placebo. The miltefosine rate was lower than historic antimony cure rates of >90%. Miltefosine was well tolerated. Miltefosine is a useful oral agent against cutaneous leishmaniasis due to L. v. panamensis in Colombia but not against leishmaniasis due to L. v. braziliensis in Guatemala.
Red clover (Trifolium pratense L.) is a globally significant forage legume in pastoral livestock farming systems. It is an attractive component of grassland farming, because of its high yield and ...protein content, nutritional value and ability to fix atmospheric nitrogen. Enhancing its role further in sustainable agriculture requires genetic improvement of persistency, disease resistance, and tolerance to grazing. To help address these challenges, we have assembled a chromosome-scale reference genome for red clover. We observed large blocks of conserved synteny with Medicago truncatula and estimated that the two species diverged ~23 million years ago. Among the 40,868 annotated genes, we identified gene clusters involved in biochemical pathways of importance for forage quality and livestock nutrition. Genotyping by sequencing of a synthetic population of 86 genotypes show that the number of markers required for genomics-based breeding approaches is tractable, making red clover a suitable candidate for association studies and genomic selection.
Abstract
High dietary protein may increase susceptibility of weaned pigs to enteric pathogens. Dietary supplementation with functional amino acids (FAA) may improve growth performance of pigs during ...disease challenge. The objective of this study was to evaluate the interactive effects of dietary protein content and FAA supplementation above requirements for growth on performance and immune response of weaned pigs challenged with Salmonella. Sixty-four mixed-sex weanling pigs (13.9 ± 0.82 kg) were randomly assigned to dietary treatments in a 2 × 2 factorial arrangement with low (LP) or high protein (HP) content and basal (AA–) or FAA profile (AA+; Thr, Met, and Trp at 120% of requirements) as factors. After a 7-d adaptation period, pigs were inoculated with either a sterile saline solution (CT) or saline solution containing Salmonella Typhimurium (ST; 3.3 × 109 CFU/mL). Growth performance, body temperature, fecal score, acute-phase proteins, oxidant/antioxidant balance, ST shedding score in feces and intestinal colonization, fecal and digesta myeloperoxidase (MPO), and plasma urea nitrogen (PUN) were measured pre- and postinoculation. There were no dietary effects on any measures pre-inoculation or post-CT inoculation (P > 0.05). Inoculation with ST increased body temperature and fecal score (P < 0.05), serum haptoglobin, plasma superoxide dismutase (SOD), malondialdehyde (MDA), PUN, and fecal MPO, and decreased serum albumin and plasma reduced glutathione (GSH):oxidized glutathione (GSSG) compared with CT pigs (P < 0.05). ST-inoculation reduced average daily gain (ADG) and feed intake (ADFI) vs. CT pigs (P < 0.05) but was increased by AA+ vs. AA– in ST pigs (P < 0.05). Serum albumin and GSH:GSSG were increased while haptoglobin and SOD were decreased in ST-inoculated pigs fed AA+ vs. AA– (P < 0.05). PUN was higher in HP vs. LP-fed pigs postinoculation (P < 0.05). Fecal ST score was increased in ST-inoculated pigs on days 1 and 2 postinoculation and declined by day 6 (P < 0.05) in all pigs while the overall score was reduced in AA+ vs. AA– pigs (P < 0.05). Cecal digesta ST score was higher in HP vs. LP-fed pigs and were lower in AA+ compared with AA– fed pigs in the colon (P < 0.05). Fecal and digesta MPO were reduced in ST pigs fed AA+ vs. AA– (P < 0.05). These results demonstrate a positive effect of FAA supplementation, with minimal effects of dietary protein, on performance and immune status in weaned pigs challenged with Salmonella.
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