Treatment of acute myocardial infarction (AMI) has changed considerably in recent years. The objective of this study was to investigate differences in in-hospital mortality and 6-month outcomes after ...a first AMI between patients who participated in two trials, in 1992-1994 and 2001-2003, respectively.
The study involved 1440 consecutive patients with a first AMI who were admitted to four university hospitals during 1992-1994 (the RESCATE-I trial) and 1288 with a first AMI who met the same diagnostic criteria and who were admitted to the same hospitals during 2001-2003 (the RESCATE-II trial). Patient management, in-hospital mortality and 6-month prognosis and outcomes were compared between the two trials.
Reperfusion therapy was carried out in 60.7% of patients in the first trial and in 72.6% in the second (P< .001). In the RESCATE-II trial, the median door-to-needle time was shorter (41 min vs. 93 min; P< .001) and patients more frequently underwent coronary angiography (65.2% vs. 28.1%; P< .001) and revascularization (34.9% vs. 8.1%; P< .001). In addition, in-hospital mortality was lower in RESCATE-II (7.5% vs. 10.9%; P< .001). After adjustment for age, sex, comorbidity, AMI severity and reperfusion therapy, the odds ratio for in-hospital mortality in RESCATE-II compared with the first trial was 0.52 (95% confidence interval, 0.31-0.86). In addition, mortality (1.4% vs. 3.6%; P=.001) and readmissions at 6 months were also lower in RESCATE-II.
Both in-hospital and 6-month mortality in patients with a first AMI decreased during the last decade, probably due to more frequent reperfusion and revascularization therapy and better medical treatment.
The purpose of this study was to assess whether joint hypermobility syndrome is more frequent in patients with panic disorder, agoraphobia, or both than in control subjects and, if so, to determine ...whether mitral valve prolapse modifies or accounts in part for the association.
A case-control study was conducted in a general teaching hospital outpatient clinic. Subjects were 99 patients, newly diagnosed and untreated, with panic disorder, agoraphobia, or both and two groups of age- and sex-matched control subjects: 99 psychiatric patients and 64 medical patients who had never suffered from any anxiety disorder. Measures consisted of the Structured Clinical Interview for DSM-III-R, Beighton's criteria for joint hypermobility syndrome, and two-dimensional and M-mode echocardiogram. The presence of mitral valve prolapse and joint hypermobility syndrome was explored by raters who were blind to subjects' psychiatric status.
Joint hypermobility syndrome was found in 67.7% of patients with anxiety disorder but in only 10.1% of psychiatric and 12.5% of medical control subjects. On the basis of statistical analysis, patients with anxiety disorder were over 16 times more likely than control subjects to have joint laxity. These findings were not altered after the presence of mitral valve prolapse was taken into account. Of the patients with anxiety disorder, those who had joint hypermobility syndrome were younger and more often women and had an earlier onset of the disorder than those without joint hypermobility syndrome.
Joint laxity is highly prevalent in patients with panic disorder, agoraphobia, or both and may reflect a constitutional disposition to suffer from anxiety. Mitral valve prolapse plays a secondary role in the association between joint hypermobility and anxiety.
Using instrumental neutron activation analysis (INAA) of prehistoric pottery, daub, and modern clay samples from Valencia, Spain, we tested expectations on changes in raw material use with ...socio-economic shifts during the Neolithic (ca. 5600–2800 BC). Elemental analysis identified three distinctive clay source groups used by Neolithic potters. Contrary to expectations, a shift in raw material use was identified between the Early and Middle Neolithic despite general similarities in technological practices. In the Late Neolithic, pottery production became more specialized, but potters used the same range of clay sources documented earlier. This study illustrates the utility of INAA for testing hypotheses of prehistoric craft production.
La reflexión sobre la dinámica de las relaciones sociales en la Prehistoria reciente encuentra un apoyo clave en el análisis de las prácticas funerarias. La presencia y significación de los ...enterramientos individuales y colectivos en las sociedades del Neolítico final/ Calcolítico en el sureste de la Península Ibérica proporciona una nueva evidencia al debate sobre la aparición de las desigualdades sociales en la región. Nuestra contribución se basa en el reciente descubrimiento y excavación de varias tumbas individuales en fosa, localizadas en contextos domésticos, en el yacimiento de La Vital (Gandía, Valencia). Las peculiaridades del continente (detección de episodios rituales particulares en las distintas tumbas) y del contenido (vasos campaniformes, objetos metálicos, ofrendas animales), unido a una ajustada cronometría, permiten plantear diversas alternativas relativas a la dinámica poblacional, las redes de circulación de información y las formas de reproducción social entre finales del IV y el desarrollo del III milenio cal BC en el área central del Mediterráneo en la Península Ibérica.
To determine the prevalence of acute myocardial infarction (AMI) without classical risk factors, and to ascertain whether affected patients exhibit a higher prevalence of emergent risk factors and ...whether the presence of specific emergent risk factors influence prognosis at 6 months.
The FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) study is a multicenter cohort study that includes 1371 AMI patients who were admitted within 24 hours of symptom onset. Strict definitions were used for classical risk factors and the concentrations of the following markers were determined: lipoprotein (a) Lp(a), oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, fibrinogen, homocysteine and antibody to Chlamydia. The end-points observed during the 6-month follow-up were death, angina and re-infarction.
The prevalence of AMI without classical risk factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut-points were determined using smoothing splines: 60 mg/ dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively.
The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors.
Long-Term Socioecology and Contingent Landscapes Barton, C. Michael; Bernabeu, Joan; Aura, J. Emili ...
Journal of archaeological method and theory,
09/2004, Letnik:
11, Številka:
3
Journal Article
Recenzirano
Long-term social and natural processes reciprocally interact in spatially and temporally dynamic socioecosystems. We describe an integrated program of patch-based survey and subsurface testing aimed ...at studying long-term socioecology, focusing especially on the transition from foraging to farming in Mediterranean Spain. Measures of landuse ubiquity, intensity, dispersion, and persistence trace late-Pleistocene through mid-Holocene socioecological trajectories in four upland valleys. Although farming replaced foraging in all four valleys, the timing and nature of this transition varied because of cumulative interactions between social and natural processes. These processes continue to structure modern landscapes and landuse in these valleys.
Introduction: High blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), a sensitive indicator of cardiac abnormalities, have been associated with poor outcome in patients with ...amyloidosis. However, its clinical value in lymphoma is unknown.
Aim: To assess the value of NT-proBNP as a prognostic variable for survival in patients with lymphoma treated with chemotherapy with curative intent.
Patients and methods: Clinical heart examination, evaluation of cardiovascular risk factors, determination of NT-proBNP (ECLIA; Roche) blood levels and high resolution ultrasound echocardiography were done at diagnosis. Clinical variables related with patient characteristics, lymphoma risk and cardiovascular risk were analyzed.
Results: 117 consecutive pts have been analyzed: median age: 63 years (range: 18–88); male: 56%; NHL: 80%; HL: 20%; ECOG/PS ≥2: 29%; III–IV: 56%; B-symptoms: 16%; LDH >1 nv: 34%; b2-microglobulin >1 nv: 57%; albumin <35 g/L: 32%; haemoglobin <105 g/L: 25%; extranodal ≥2: 20%; number of comorbidities ≥2: 51%; previous cardiac disease: 10%; median NT-proBNP: 107 pg/mL (4–9102); median left ventricular ejection fraction (LVEF): 66% (41–83). High blood levels of NT-proBNP were associated with previous cardiologic history but not with LVEF. With a median follow-up of 15.8 moths (0.2–48.9), 16 patients died. Overall survival (OS) at 24 months was 84% (95% CI: 77– 91%). In the univariate analysis, factors associated with worse OS were: NT-proBNP >900, ECOG/PS ≥2, LDH >1 nv, b2-microglobulin >1 nv, albumin < 35 g/L, haemoglobin <105 g/L, comorbidities ≥2, previous cardiologic history, extranodal sites ≥2, age >60. In multivariate analysis, factors predicting for survival were NT-proBNP >900 (HR 15, 95%CI: 3.9–57.8) (p<0.0001) and ECOG/PS ≥2.(HR 4.1, 95%CI: 1.1–16.3) (p=0.04).
Conclusions:
NT-proBNP >900 pg/mL is the strongest prognostic factor for survival in patients with lymphoma following treatment with curative intent.NT-proBNP is an easy, fast, widely available and well-standardized parameter that could be useful in addition to other well-established prognostic indexes.
Resum: Estudiem els exvots pintats sobre taulells dels segles XVIII i XIX. A partir de les presentalles conservades al santuari del castell de Cullera i d’alguns plafons de la via pública o ...d’interior d’habitatges analitzem aquesta tipologia ceràmica. També identifiquem la mà d’alguns dels pintors que treballaren a les fàbriques de la ciutat de València: Mestre de Noguera, Valentí Garcés, Vicent Camarlenc, Joan Ortiz, Mestre de Santa Anna i Miquel Mollà. Paraules clau: exvots, taulells, pintura ceràmica, devoció popular, València Abstract: We study the votive offerings painted on tiles from the 18th and 19th centuries. This ceramic typology is analyzed based on the works preserved in the sanctuary of castle of Cullera and some panels on public roads or inside homes. We also identify the authorship of some the painters who worked in the factories of the city of València: Mestre de Noguera, Valentí Garcés, Vicent Camarlenc, Joan Ortiz, Mestre de Santa Anna and Miquel Mollà. Keywords: votive offering, glazed tiles, ceramic painting, popular devotion, València
An early decrease in systemic vascular resistance (SVR) after total paracentesis has been observed in ascitic patients who developed paracentesis-induced circulatory dysfunction.
To investigate the ...mechanisms of early changes in SVR after total paracentesis and the influence of intra-abdominal pressure and the flow rate of ascites extraction on the development of an early decrease in SVR.
Twenty-two cirrhotic patients with tense ascites were treated by total paracentesis (7 +/- 0.4 l). Measurements of intra-abdominal pressure and the volume of ascites removed were recorded every 10 min. Hormonal and haemodynamic measurements were performed at baseline and 3 h after total paracentesis.
SVR decreased 3 h after paracentesis in 17 patients and remained stable in five patients. Patients with a decrease in SVR showed a significant increase in nitrite/nitrate serum values (4.4 +/- 0.9 to 7.4 +/- 1 nmol/ml; P < 0.05). A significant correlation was observed between the decrease in SVR and nitrite/nitrate serum values (r = 0.566; P < 0.05). The volume of ascites removed was similar in patients with and without a decrease in SVR. Patients with a decrease in SVR showed higher baseline intra-abdominal pressure, shorter duration of paracentesis (60 +/- 4.9 vs 88 +/- 0.4 min; P < 0.01) and higher flow rate of ascites extraction (1.18 +/- 0.08 vs 0.81 +/- 0.12 l/min; P < 0.05).
Our results confirm that an early decrease in SVR after total paracentesis is due to an increase in arterial vasodilation that may be related to an abrupt decrease in intra-abdominal pressure after fast paracentesis. Haemodynamic disturbances after total paracentesis could be prevented by reducing the flow rate of ascites extraction.
PDF
