BACKGROUND AND AIMS: Vitamin K insufficiency is common and linked to an increased risk of cardiovascular disease and osteoporotic fractures. The aim of this study was to examine whether daily ...supplementation with oral vitamin K could improve vascular health and physical function in older people with established vascular disease. METHODS AND RESULTS: A double blind, randomised, placebo-controlled trial. Participants aged ≤ 70 years with a history of vascular disease were randomised to receive 6 months of daily oral 100mcg vitamin K2 (MK7 subtype) or matching placebo with outcomes measured at 0, 3 and 6 months. The primary outcome was between-group difference in endothelial function assessed using flow-mediated dilatation of the brachial artery at 6 months. Secondary outcomes included carotid-radial pulse wave velocity, augmentation index, blood pressure, carotid intima-media thickness, C-reactive protein, B-type natriuretic peptide, cholesterol and desphospho-uncarboxylated matrix Gla protein levels. Handgrip strength and the Short Physical Performance Battery assessed physical function, while postural sway was measured using a 3-dimensional force platform. RESULTS: 80 participants were randomised, mean age 77 (SD 5) years; 44/80 were male. Vitamin K levels rose in the intervention arm compared to placebo (+48 pg/ml vs −6 pg/ml, p=0.03) at 6 months. Desphospho-uncarboxylated Matrix Gla protein levels fell in the intervention group compared to placebo at 6 months (−130 SD 117 pmol/L vs +13 SD 180 pmol/L, p<0.001). No change was seen in endothelial function (between group difference −0.3% 95%CI −1.3 to 0.8, p=0.62). A modest, non-significant improvement in pulse wave velocity was seen in the vitamin K group (−0.8m/s 95%CI −1.8 to 0.3, p=0.15) while all other vascular and physical function outcomes unchanged. CONCLUSIONS: Six months of vitamin K2 supplementation did not improve markers of vascular health or physical function in older patients with vascular disease.
Hemarthrosis secondary to heparin use is a scarce event, especially in patients with no underlying thrombophilia or platelet disorders. Although previously associated with thrombophilia, platelet ...disorders, or secondary to fibrinolytic therapy, to date, there are very few reported cases in contemporary literature for heparin-induced hemarthrosis. In this article, we report a case of left shoulder joint inferior subluxation secondary to heparin-induced hemarthrosis in an 81-year-old male with an extensive cardiac history and multiple comorbidities. This case report depicts a rare event and discusses its clinical implications aiding healthcare professionals in an early diagnosis and timely management.
Abstract Fast X-ray Transients (FXTs) are extragalactic bursts of soft X-rays first identified ≳10 yr ago. Since then, nearly 40 events have been discovered, although almost all of these have been ...recovered from archival Chandra and XMM-Newton data. To date, optical sky surveys and follow-up searches have not revealed any multiwavelength counterparts. The Einstein Probe, launched in 2024 January, has started surveying the sky in the soft X-ray regime (0.5–4 keV) and will rapidly increase the sample of FXTs discovered in real time. Here we report the first discovery of both an optical and radio counterpart to a distant FXT, the fourth source publicly released by the Einstein Probe. We discovered a fast-fading optical transient within the 3′ localization radius of EP 240315a with the all-sky optical survey ATLAS, and our follow-up Gemini spectrum provides a redshift, z = 4.859 ± 0.002. Furthermore, we uncovered a radio counterpart in the S band (3.0 GHz) with the MeerKAT radio interferometer. The optical (rest-frame UV) and radio luminosities indicate that the FXT most likely originates from either a long gamma-ray burst or a relativistic tidal disruption event. This may be a fortuitous early mission detection by the Einstein Probe or may signpost a mode of discovery for high-redshift, high-energy transients through soft X-ray surveys, combined with locating multiwavelength counterparts.
A systematic programme of calibration observations was carried out to monitor the performance of the Spectral and Photometric Imaging REceiver (SPIRE) Fourier Transform Spectrometer (FTS) instrument ...on board the Herschel Space Observatory. Observations of planets (including the prime point-source calibrator, Uranus), asteroids, line sources, dark sky and cross-calibration sources were made in order to monitor repeatability and sensitivity, and to improve FTS calibration. We present a complete analysis of the full set of calibration observations and use them to assess the performance of the FTS. Particular care is taken to understand and separate out the effect of pointing uncertainties, including the position of the internal beam steering mirror for sparse observations in the early part of the mission. The repeatability of spectral-line centre positions is <5 km s−1, for lines with signal-to-noise ratios >40, corresponding to <0.5–2.0 per cent of a resolution element. For spectral-line flux, the repeatability is better than 6 per cent, which improves to 1–2 per cent for spectra corrected for pointing offsets. The continuum repeatability is 4.4 per cent for the SPIRE Long Wavelength spectrometer (SLW) band and 13.6 per cent for the SPIRE Short Wavelength spectrometer (SSW) band, which reduces to ∼1 per cent once the data have been corrected for pointing offsets. Observations of dark sky were used to assess the sensitivity and the systematic offset in the continuum, both of which were found to be consistent across the FTS-detector arrays. The average point-source calibrated sensitivity for the centre detectors is 0.20 and 0.21 Jy 1σ; 1 h, for SLW and SSW. The average continuum offset is 0.40 Jy for the SLW band and 0.28 Jy for the SSW band.
Background:The chromosome 17q21.31 microdeletion syndrome is a novel genomic disorder that has originally been identified using high resolution genome analyses in patients with unexplained mental ...retardation.Aim:We report the molecular and/or clinical characterisation of 22 individuals with the 17q21.31 microdeletion syndrome.Results:We estimate the prevalence of the syndrome to be 1 in 16 000 and show that it is highly underdiagnosed. Extensive clinical examination reveals that developmental delay, hypotonia, facial dysmorphisms including a long face, a tubular or pear-shaped nose and a bulbous nasal tip, and a friendly/amiable behaviour are the most characteristic features. Other clinically important features include epilepsy, heart defects and kidney/urologic anomalies. Using high resolution oligonucleotide arrays we narrow the 17q21.31 critical region to a 424 kb genomic segment (chr17: 41046729–41470954, hg17) encompassing at least six genes, among which is the gene encoding microtubule associated protein tau (MAPT). Mutation screening of MAPT in 122 individuals with a phenotype suggestive of 17q21.31 deletion carriers, but who do not carry the recurrent deletion, failed to identify any disease associated variants. In five deletion carriers we identify a <500 bp rearrangement hotspot at the proximal breakpoint contained within an L2 LINE motif and show that in every case examined the parent originating the deletion carries a common 900 kb 17q21.31 inversion polymorphism, indicating that this inversion is a necessary factor for deletion to occur (p<10−5).Conclusion:Our data establish the 17q21.31 microdeletion syndrome as a clinically and molecularly well recognisable genomic disorder.
Bullous emphysema is a chronic obstructive pulmonary disease (COPD) that results from chronic inflammation of the lung parenchyma leading to alveolar destruction. Etiology includes tobacco smoking ...and alpha-1 antitrypsin deficiency. In this article, we present a rare case of bullous emphysema in a nonsmoker with no genetic predisposition or social risk factors presenting with productive cough, fatigue, and shortness of breath. The patient was diagnosed with bullous emphysema with superimposed pneumonia based on clinical and radiological findings. The patients acute complaints were treated successfully with antibiotics, supplemental oxygen, systemic steroids, and, nebulizer treatments. With this case report the authors highlight an unusual presentation of pneumonia in a patient with underlying bullous emphysema. Environmental exposure is often overlooked and the outcomes cannot be turned to favor without a comprehensive approach in patient management from history and physical to deciding the right treatment and follow-up protocols.
Neurocysticercosis (NCC) is the most common parasitic infection of the nervous system and acquired epilepsy in low-resource settings due to the pork tapeworm, Taenia solium. Humans contract the ...intestinal infection of the adult tapeworm (taeniasis) through the fecal-oral route after consuming undercooked food, particularly pork or water, contaminated with tapeworm eggs. When the larvae invades the central nervous system (CNS), the infection causes NCC, which often manifests as late-onset seizures, chronic headaches, and intracranial hypertension. We describe a 31-year-old Hispanic multigravida woman from Guatemala, at 33 weeks of gestation, who presented with multiple syncopal and hypotensive episodes prompting a Computed tomography (CT) image of the head revealing multiple small cerebral calcifications indicating NCC. In this article, we highlight the significance of early symptom recognition and diagnostic workup for NCC in areas with diverse immigrant populations. We also discuss the epidemiology, clinical manifestations, and current treatment modalities available for NCC.
Models are key tools for integrating a wide range of system information in a common framework. Attempts to model exploited marine ecosystems can increase understanding of system dynamics; identify ...major processes, drivers and responses; highlight major gaps in knowledge; and provide a mechanism to ‘road test’ management strategies before implementing them in reality. The Atlantis modelling framework has been used in these roles for a decade and is regularly being modified and applied to new questions (e.g. it is being coupled to climate, biophysical and economic models to help consider climate change impacts, monitoring schemes and multiple use management). This study describes some common lessons learned from its implementation, particularly in regard to when these tools are most effective and the likely form of best practices for ecosystem‐based management (EBM). Most importantly, it highlighted that no single management lever is sufficient to address the many trade‐offs associated with EBM and that the mix of measures needed to successfully implement EBM will differ between systems and will change through time. Although it is doubtful that any single management action will be based solely on Atlantis, this modelling approach continues to provide important insights for managers when making natural resource management decisions.
Modelling marine protected areas: insights and hurdles Fulton, Elizabeth A.; Bax, Nicholas J.; Bustamante, Rodrigo H. ...
Philosophical transactions of the Royal Society of London. Series B. Biological sciences,
11/2015, Letnik:
370, Številka:
1681
Journal Article
Recenzirano
Odprti dostop
Models provide useful insights into conservation and resource management issues and solutions. Their use to date has highlighted conditions under which no-take marine protected areas (MPAs) may help ...us to achieve the goals of ecosystem-based management by reducing pressures, and where they might fail to achieve desired goals. For example, static reserve designs are unlikely to achieve desired objectives when applied to mobile species or when compromised by climate-related ecosystem restructuring and range shifts. Modelling tools allow planners to explore a range of options, such as basing MPAs on the presence of dynamic oceanic features, and to evaluate the potential future impacts of alternative interventions compared with 'no-action' counterfactuals, under a range of environmental and development scenarios. The modelling environment allows the analyst to test if indicators and management strategies are robust to uncertainties in how the ecosystem (and the broader human–ecosystem combination) operates, including the direct and indirect ecological effects of protection. Moreover, modelling results can be presented at multiple spatial and temporal scales, and relative to ecological, economic and social objectives. This helps to reveal potential 'surprises', such as regime shifts, trophic cascades and bottlenecks in human responses. Using illustrative examples, this paper briefly covers the history of the use of simulation models for evaluating MPA options, and discusses their utility and limitations for informing protected area management in the marine realm.
Background It is unclear to what extent factors affecting energy balance contribute to the development of body fatness in youth. The objective of the current study was to describe the relationship of ...physical activity, energy intake, and sedentary behavior to BMI, fat free–mass index (FFMI), and fat mass index (FMI) in children aged 10–18 years. Methods In the subsample studied, participants were 245 girls and 227 boys (aged ≥10 years at entry or during follow-up assessments, or aged 11–14 years at entry) followed for 4 years from entry at ages 8, 11, or 14 years. At baseline and anniversary examinations, trained interviewers used a questionnaire to assess time spent daily in moderate-to-vigorous physical activity (MVPA), sedentary behavior, and energy intake (kcal/day). Sexual maturation was assessed by direct observation of pubic-hair development (Tanner Stages 1–5). Triplicate recordings of height and weight were used to estimate BMI by the standard formula (kg/m2 ); bioelectric impedance was used to estimate percent body fat for calculating FFMI and FMI (kg/m2 ). Multilevel models were used to examine the association of MVPA, energy intake, and sedentary behavior with BMI, FFMI, and FMI. Data were analyzed in 2007–2008. Results Energy intake was unrelated to FMI or FFMI in models adjusted for age or sexual maturation or in any model to BMI. Sedentary behavior was unrelated to FMI in any model or to FFMI or BMI in models adjusted for age or sexual maturation. MVPA was inversely related to FMI. Conclusions In children aged 10–18 years, MVPA was inversely associated with fat mass and with BMI. Investigations in youth of dietary intake and physical activity, including interventions to prevent or reverse overweight as represented by BMI, should address its fat and lean components and not BMI alone.
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