Objective: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).Design:Prospective, single-centre, cohort study.Setting:A 1900-bed tertiary-care university hospital in Seoul, KoreaDesign and patients: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.Main outcome measurement:PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) within postoperative 30 days.Results: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).Conclusions: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.
Background
Chronic rhinosinusitis (CRS) is an inflammatory process in the nasal cavity and paranasal sinuses, and bacteria have been considered to be a cause. Indeed, recent evidence indicates that ...bacteria‐derived extracellular vesicles (EV) appear to be an important causative agent of inflammatory diseases. Here, we aimed to evaluate the diversity of nasal microbiota and their secreted EV in patients with CRS.
Methods
Nasal lavage (NAL) fluid samples were obtained from five patients with CRS with polyposis, three patients with CRS without polyposis, and three non‐CRS controls. After preparation of bacteria and EV from samples using differential centrifugation, genomic DNA was extracted and 16S‐rDNA amplicons were subjected to high‐throughput pyrosequencing on a Roche 454 GS‐FLX platform.
Results
Metagenomics showed that bacteria composition was positively correlated with EV composition. Samples from patients with CRS had greater bacterial abundance and lower diversity, both from bacteria and the EV portion of samples, compared with non‐CRS samples. At each phylogenetic level, Bacteroidetes decreased while Proteobacteria increased in the CRS group at the phylum level. At the genus level, Prevotella spp. decreased in the CRS group, while Staphylococcus spp. increased from both bacteria and EV. Moreover, Staphylococcus aureus and its secreting EV compositions were higher in samples from CRS with polyps compared with CRS without polyps.
Conclusions
These results suggest that patients with CRS have altered nasal microbiota and decreased diversity in bacterial compositions as well as increased S. aureus abundance in those patients with polyps.
Magnetospheric compression due to impact of enhanced solar wind dynamic pressure Pdyn has long been considered as one of the generation mechanisms of electromagnetic ion cyclotron (EMIC) waves. With ...the Van Allen Probe‐A observations, we identify three EMIC wave events that are triggered by Pdyn enhancements under prolonged northward interplanetary magnetic field (IMF) quiet time preconditions. They are in contrast to one another in a few aspects. Event 1 occurs in the middle of continuously increasing Pdyn while Van Allen Probe‐A is located outside the plasmapause at postmidnight and near the equator (magnetic latitude (MLAT) ~ −3°). Event 2 occurs by a sharp Pdyn pulse impact while Van Allen Probe‐A is located inside the plasmapause in the dawn sector and rather away from the equator (MLAT ~ 12°). Event 3 is characterized by amplification of a preexisting EMIC wave by a sharp Pdyn pulse impact while Van Allen Probe‐A is located outside the plasmapause at noon and rather away from the equator (MLAT ~ −15°). These three events represent various situations where EMIC waves can be triggered by Pdyn increases. Several common features are also found among the three events. (i) The strongest wave is found just above the He+ gyrofrequency. (ii) The waves are nearly linearly polarized with a rather oblique propagation direction (~28° to ~39° on average). (iii) The proton fluxes increase in immediate response to the Pdyn impact, most significantly in tens of keV energy, corresponding to the proton resonant energy. (iv) The temperature anisotropy with T⊥ > T|| is seen in the resonant energy for all the events, although its increase by the Pdyn impact is not necessarily always significant. The last two points (iii) and (iv) may imply that in addition to the temperature anisotropy, the increase of the resonant protons must have played a critical role in triggering the EMIC waves by the enhanced Pdyn impact.
Key Points
Three EMIC wave events triggered by various dynamic pressure conditions
Exhibit proton flux increases in expected resonant energy
Exhibit temperature anisotropy with T⊥ > T|| in the resonant energy
BACKGROUND: An excess of intra‐abdominal fat is observed frequently in dogs with hyperadrenocorticism (HAC). Adipokine dysregulation is a possible cause of complications related to visceral obesity, ...but little information is available on adipokine in dogs with naturally occurring HAC. OBJECTIVES: To examine the differences in the circulating adipokines concentrations in overweight dogs with and without pituitary‐dependent HAC (PDH). ANIMALS: Thirty healthy dogs and 15 client‐owned dogs with PDH. METHODS: Case–controlled observational study, which enrolled 15 overweight dogs diagnosed with PDH and 30 otherwise healthy dogs of similar body condition score. Nine of 15 dogs with PDH were treated with low‐dose trilostane twice daily and reassessed after treatment. RESULTS: The serum leptin (P < .0001) and insulin (P < .0001) concentrations were significantly higher in the PDH group (leptin, 22.8 ± 8.8 mean ± SD; insulin, 9.1 ± 6.1) than the healthy group (leptin, 4.9 ± 3.7; insulin, 1.9 ± 0.9). However, there were no significant differences in the adiponectin, resistin, tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐6, IL‐10, and IL‐18 levels between the 2 groups. In the PDH group, the serum cortisol concentrations had a linear association with the leptin concentrations, and there were significant decreases in the leptin (P = .0039) and insulin (P = .0039) levels after trilostane treatment. However, the leptin and insulin levels remained higher after trilostane treatment than in healthy control dogs with similar body condition score. CONCLUSIONS AND CLINICAL IMPORTANCE: Hypercortisolemia in dogs with PDH might upregulate the circulating leptin levels. However, a large population‐based study will be necessary to determine whether the upregulation of leptin is involved directly with the complications caused by HAC.
Introduction
La vaccination annuelle contre la grippe est recommandée aux personnes ayant des antécédents de maladie cardiovasculaire. Nous avons étudié 1) l’évolution de la vaccination antigrippale ...entre 2009 et 2018 chez les Canadiens ayant été victimes d’une maladie cardiovasculaire et 2) les déterminants de la vaccination dans cette population au cours de la période.
Methods
Nous avons utilisé des données de l’Enquête sur la santé dans les collectivités canadiennes (ESCC). L’échantillon à l’étude était constitué de répondants de 2009 à 2018, âgés de 30 ans et plus, ayant été victimes d’une maladie cardiovasculaire (infarctus du myocarde ou accident vasculaire cérébral) et ayant fourni leur statut vaccinal contre la grippe. Une analyse pondérée a été effectuée pour déterminer l’évolution du taux de vaccination. Nous avons utilisé une analyse de régression linéaire pour l’évolution et une analyse de régression logistique à plusieurs variables pour les déterminants de la vaccination antigrippale. Les variables choisies étaient des facteurs sociodémographiques, des caractéristiques cliniques, des comportements liés à la santé et les interactions avec le système de santé.
Results
Durant la période à l’étude, le taux de vaccination a été généralement stable dans notre échantillon de 42 000 sujets, se situant aux alentours de 58,9 %. Plusieurs déterminants de la vaccination ont été établis : un âge avancé (rapport de cotes ajusté RCA = 4,28; intervalle de confiance à 95 % IC à 95 % : 4,24 à 4,32, un accès régulier à un professionnel de la santé (RCA = 2,39; IC à 95 % : 2,37 à 2,41) et le fait de ne pas fumer (RCA = 1,48; IC à 95 % : 1,47 à 1,49). Le seul facteur associé à une diminution de la probabilité de vaccination était le travail à temps plein (RCA = 0,72; IC à 95 % : 0,72 à 0,72).
Conclusion
Le taux de vaccination antigrippale reste inférieur au niveau recommandé pour les patients ayant des antécédents de maladie cardiovasculaire. D’autres recherches sont à mener sur l’efficacité des interventions pour augmenter la vaccination dans cette population.
Images from the Optical Navigation Camera system (ONC) onboard the Hayabusa2 spacecraft show the MASCOT lander during its descent to the surface of asteroid (162173) Ryugu. We used results from a ...previous stereo-photogrammetric analysis that provided precise ONC image orientation data (camera position and pointing), ONC orthoimages, and an ONC-based 3D surface model to combine them with the visibilities of MASCOT itself and its shadow on-ground within the ONC images. We integrated additional information from instruments onboard MASCOT (MASMag, MARA, MASCam) and derived MASCOT’s release position and modeled its free-fall descent path and its velocity over 350 s from its release at ∼41 m altitude above ground until its first contact with the surface of Ryugu. After first contact, MASCOT bounced over the surface of Ryugu for 663 s and came to rest at its first settlement point after four intermediate surface contacts. We again used ONC images that show MASCOT and partly its shadow and reconstructed the bouncing path and the respective velocities of MASCOT. The achieved accuracy for the entire descent and bouncing path is ∼0.1 m (1σ).
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