Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the ...usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain.
We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy).
Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval CI, 0.76 to 1.17; P=0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (-2.3 mm Hg; 95% CI, -4.4 to -0.2; P=0.03).
Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; ClinicalTrials.gov number, NCT00081731.).
The postinjury period of glucose metabolic depression is accompanied by adenosine triphosphate decreases, increased flux of glucose through the pentose phosphate pathway, free radical production, ...activation of poly-ADP ribose polymerase via DNA damage, and inhibition of glyceraldehyde dehydrogenase (a key glycolytic enzyme) via depletion of the cytosolic NAD pool. Under these post-brain injury conditions of impaired glycolytic metabolism, glucose becomes a less favorable energy substrate. Ketone bodies are the only known natural alternative substrate to glucose for cerebral energy metabolism. While it has been demonstrated that other fuels (pyruvate, lactate, and acetyl-L-carnitine) can be metabolized by the brain, ketones are the only endogenous fuel that can contribute significantly to cerebral metabolism. Preclinical studies employing both pre- and postinjury implementation of the ketogenic diet have demonstrated improved structural and functional outcome in traumatic brain injury (TBI) models, mild TBI/concussion models, and spinal cord injury. Further clinical studies are required to determine the optimal method to induce cerebral ketone metabolism in the postinjury brain, and to validate the neuroprotective benefits of ketogenic therapy in humans.
Observations of the X‐ray sky after the next decade will most likely be dominated by Athena (Advanced Telescope for High ENergy Astrophysics), the second large mission of ESA's Cosmic Vision ...2015–2035 programme. Athena has been conceived to address the “Hot and Energetic Universe” science theme, which focuses on the assembly and evolution of hot baryons in cosmic structures as well as the physics and energetic output generated by accreting super‐massive black holes, along with the relationship between the two processes, dubbed cosmic feedback. Thanks to its transformational capabilities, Athena will enable bringing all of today's XMM‐Newton's hot science topics to a new stage. In this paper, we summarize the Athena science case, science requirements, as well as the expected mission performance, mission concept, and its status.
Room temperature ionic liquids (RTILs) were applied to a lithium (Li) metal battery system, and the behavior of Li electrodeposition on nickel electrodes in RTILs was investigated using
in situ ...optical microscopy with/without an organic additive, vinylene carbonate (VC), in the RTILs. Two RTILs, PP13TFSA (
N-methyl-
N-propylpiperidinium bis(trifluoromethanesulfonyl)amide) and EMIFSA (1-ethyl-3-methylimidazolium bis(fluorosulfonyl)amide), were chosen as the base electrolytes. Dendritic particles were obtained in the case of EMIFSA with and without VC, and PP13TFSA without VC, while non-dendritic fine particles were obtained in the case of PP13TFSA with VC.
Ti–6Al–4V alloy is widely used in superplastic forming process. The conventional conditions require high forming temperatures (T≥900°C) and low strain rates (ε̇≤10−3s−1). In order to reduce the costs ...of the industrial process, recent investigations focus on the micro-structural refinement of the material. It allows an improvement of the forming conditions which makes lower forming temperatures and higher strain rates eligible whereas low strain rates (ε̇≤10−3s−1) and high temperatures (T≥800°C) are particularly suitable for conventional superplastic forming conditions. However, the mechanical response of the Titanium alloy strongly depends on the starting micro-structure considered and on its evolution with the temperature and the deformation. The objective of the present investigation is to observe the micro-structural evolutions of Ti–6Al–4V alloy under thermal and mechanical loadings from different starting micro-structures. Hence, an internal grain growth variable is identified by the use of these observations. Then, it is introduced into the behavior model and its influence on the mechanical response of the material is analyzed. The final constitutive equations are able to take into account viscosity, strain hardening and grain size evolution for a wide range of strain rates and forming temperatures (10−4s−1≤ε̇≤10−2s−1;650°C≤T≤870°C). Moreover, the model is able to consider several starting microstructures (different initial grain sizes) and to predict their influence on the viscous flow and the strain hardening. At last, some model verifications are conducted to check the validity of the non-isothermal model formulation. Some predictions are also performed by considering several starting microstructures.
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•Mechanical behavior of Ti–6Al–4V alloy with different starting microstructures.•High temperature tensile testing under hot and superplastic forming conditions.•Grain growth evolution regarding the test conditions (temperature and de-formation).•Model formulation (grain growth effect, viscous flow and strain hardening).•Model verification and prediction (nonisothermal formulation, several grain sizes).
Fast ripples (FR, 250-500 Hz) detected with chronic intracranial electrodes are proposed biomarkers of epileptogenesis. This study determined whether resection of FR-containing neocortex recorded ...during intraoperative electrocorticography (ECoG) was associated with postoperative seizure freedom in pediatric patients with mostly extratemporal lesions.
FRs were retrospectively reviewed in 30 consecutive pediatric cases. ECoGs were recorded at 2,000 Hz sampling rate and visually inspected for FR, with reviewer blinded to the resection and outcome.
Average age at surgery was 9.1 ± 6.7 years, ECoG duration was 11.8 ± 8.1 minutes, and postoperative follow-up was 27 ± 4 months. FRs were undetected in 6 ECoGs with remote or extensive lesions. FR episodes (n = 273) were identified in ECoGs from 24 patients, and in 64% FRs were independent of spikes, sharp waves, voltage attenuation, and paroxysmal fast activity. Of these 24 children, FR-containing cortex was removed in 19 and all became seizure-free, including 1 child after a second surgery. The remaining 5 children had incomplete FR resection and all continued with seizures postoperatively. In 2 ECoGs, the location of electrographic seizures matched FR location. FR-containing cortex was found outside of MRI and FDG-PET abnormalities in 6 children.
FRs were detected during intraoperative ECoG in 80% of pediatric epilepsy cases, and complete resection of FR cortex correlated with postoperative seizure freedom. These findings support the view that interictal FRs are excellent surrogate markers of epileptogenesis, can be recorded during brief ECoG, and could be used to guide future surgical resections in children.
Highlights • This review is an up-date document on basic aspects of non-invasive stimulation of brain, spinal cord and nerve roots. • The main physiological, theoretical and methodological features ...of transcranial magnetic stimulation (TMS) are described. • Instructions for practical use of non-invasive stimulation in clinical applications and research are provided.
Summary
We hypothesized that the baseline FRAX score and previous falls would predict the incidence of sarcopenia in community-dwelling older adults who received medical check-ups. The FRAX score ...(hazard ratio HR = 1.087, 95% CI 1.014–1.167) and previous falls (HR = 5.181, 95% CI 1.002–26.777) were determined to be independent risk factors for the incidence of sarcopenia.
Purpose
This prospective study was performed to elucidate the prevalence and incidence of sarcopenia in community-dwelling older adults who received medical check-ups, and to determine whether FRAX score and fall history predict the incidence of sarcopenia.
Methods
Participants were recruited from a group of individuals who had registered for an annual town-sponsored medical check-up. Study inclusion criteria were aged older than 60 years, living independently, and ability to walk without assistance. Individuals who received nursing care were excluded from the study. A total of 426 residential participants were analyzed. Demographic information, fall history of the previous year, and FRAX score without bone mineral density were assessed. The assessment for sarcopenia was based on the recommendations of the Asian Working Group for Sarcopenia.
Results
The final sample for the assessment of sarcopenia incidence comprised 258 participants. The mean follow-up time was 2.92 years. The rate of sarcopenia was 1.06 cases per 100 person-years at risk. The Cox multivariate logistic regression model in our analysis was adjusted for age, gender, muscle mass, and covariates and showed that the FRAX score (HR = 1.087, 95% CI 1.014–1.167) and recent history of falls (HR = 5.181, 95% CI 1.002–26.777) were independent risk factors for the incidence of sarcopenia.
Conclusion
FRAX and history of falling can be a simple screening tool to raise awareness of the prevention of osteoporosis and sarcopenia in clinical settings.
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