RESUMEN
Hypertension (HTN) is a significant risk factor for cardiovascular morbidity and mortality. Metabolic abnormalities, including adverse cholesterol and triglycerides (TG) profiles, are frequent comorbid findings with HTN and contribute to cardiovascular disease. Diuretics, which are used to treat HTN and heart failure, have been associated with worsening of fasting lipid concentrations. Genome-wide meta-analyses with 39,710 European-ancestry (EA) individuals and 9925 African-ancestry (AA) individuals were performed to identify genetic variants that modify the effect of loop or thiazide diuretic use on blood lipid concentrations. Both longitudinal and cross sectional data were used to compute cohort-specific interaction results, which were then combined through meta-analysis in each ancestry. These ancestry-specific results were further combined through trans-ancestry meta-analysis. Analysis of EA data identified two genome-wide significant (p < 5 × 10-8) loci with single nucleotide variant (SNV)-loop diuretic interaction on TG concentrations (including COL11A1). Analysis of AA data identified one genome-wide significant locus adjacent to BMP2 with SNV-loop diuretic interaction on TG concentrations. Trans-ancestry analysis strengthened evidence of association for SNV-loop diuretic interaction at two loci (KIAA1217 and BAALC). There were few significant SNV-thiazide diuretic interaction associations on TG concentrations and for either diuretic on cholesterol concentrations. Several promising loci were identified that may implicate biologic pathways that contribute to adverse metabolic side effects from diuretic therapy.
Asunto(s)
Negro o Afroamericano/genética , Diuréticos/sangre , Variación Genética/genética , Hipertensión/sangre , Hipertensión/genética , Población Blanca/genética , Diuréticos/efectos adversos , Estudio de Asociación del Genoma Completo , Humanos , Hipertensión/tratamiento farmacológico , Lípidos/sangreRESUMEN
The lack of reliable measures of alcohol intake is a major obstacle to the diagnosis and treatment of alcohol-related diseases. Epigenetic modifications such as DNA methylation may provide novel biomarkers of alcohol use. To examine this possibility, we performed an epigenome-wide association study of methylation of cytosine-phosphate-guanine dinucleotide (CpG) sites in relation to alcohol intake in 13 population-based cohorts (ntotal=13 317; 54% women; mean age across cohorts 42-76 years) using whole blood (9643 European and 2423 African ancestries) or monocyte-derived DNA (588 European, 263 African and 400 Hispanic ancestry) samples. We performed meta-analysis and variable selection in whole-blood samples of people of European ancestry (n=6926) and identified 144 CpGs that provided substantial discrimination (area under the curve=0.90-0.99) for current heavy alcohol intake (⩾42 g per day in men and ⩾28 g per day in women) in four replication cohorts. The ancestry-stratified meta-analysis in whole blood identified 328 (9643 European ancestry samples) and 165 (2423 African ancestry samples) alcohol-related CpGs at Bonferroni-adjusted P<1 × 10-7. Analysis of the monocyte-derived DNA (n=1251) identified 62 alcohol-related CpGs at P<1 × 10-7. In whole-blood samples of people of European ancestry, we detected differential methylation in two neurotransmitter receptor genes, the γ-Aminobutyric acid-A receptor delta and γ-aminobutyric acid B receptor subunit 1; their differential methylation was associated with expression levels of a number of genes involved in immune function. In conclusion, we have identified a robust alcohol-related DNA methylation signature and shown the potential utility of DNA methylation as a clinically useful diagnostic test to detect current heavy alcohol consumption.
Asunto(s)
Consumo de Bebidas Alcohólicas/genética , Trastornos Relacionados con Alcohol/genética , Metilación de ADN/efectos de los fármacos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/metabolismo , Trastornos Relacionados con Alcohol/metabolismo , Biomarcadores/sangre , Población Negra/genética , Islas de CpG/genética , Epigénesis Genética , Etanol/sangre , Etanol/metabolismo , Femenino , Estudio de Asociación del Genoma Completo , Humanos , Masculino , Persona de Mediana Edad , Población Blanca/genéticaRESUMEN
Sulfonylureas, a commonly used class of medication used to treat type 2 diabetes, have been associated with an increased risk of cardiovascular disease. Their effects on QT interval duration and related electrocardiographic phenotypes are potential mechanisms for this adverse effect. In 11 ethnically diverse cohorts that included 71 857 European, African-American and Hispanic/Latino ancestry individuals with repeated measures of medication use and electrocardiogram (ECG) measurements, we conducted a pharmacogenomic genome-wide association study of sulfonylurea use and three ECG phenotypes: QT, JT and QRS intervals. In ancestry-specific meta-analyses, eight novel pharmacogenomic loci met the threshold for genome-wide significance (P<5 × 10-8), and a pharmacokinetic variant in CYP2C9 (rs1057910) that has been associated with sulfonylurea-related treatment effects and other adverse drug reactions in previous studies was replicated. Additional research is needed to replicate the novel findings and to understand their biological basis.
Asunto(s)
Electrocardiografía/efectos de los fármacos , Etnicidad/genética , Compuestos de Sulfonilurea/efectos adversos , Anciano , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/genética , Citocromo P-450 CYP2C9/genética , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/genética , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/genética , Femenino , Variación Genética/efectos de los fármacos , Variación Genética/genética , Estudio de Asociación del Genoma Completo/métodos , Humanos , Masculino , Persona de Mediana Edad , Farmacogenética/métodos , Pruebas de Farmacogenómica/métodos , Compuestos de Sulfonilurea/uso terapéuticoRESUMEN
Mayaro virus (MAYV) is an emerging mosquito-borne arbovirus present in Central and South America that causes arthralgia and febrile illness. Domestic mosquitoes Aedes aegypti (Diptera: Culicidae) and Aedes albopictus are potential vectors of MAYV that may allow for transmission to humans in urban settings. The present paper assesses susceptibility to infection, disseminated infection and transmission potential in Florida Ae. aegypti and Ae. albopictus for MAYV. Oral infection was significantly higher in Ae. albopictus (85-100%) than in Ae. aegypti (67-82%). Viral dissemination to the haemocoel in Ae. aegypti and Ae. albopictus mosquitoes was rapid and co-occurred with infection of the salivary glands. Rates of disseminated infection were generally higher in Ae. aegypti (45-85%) than in Ae. albopictus (38-76%), although the difference was significant only at 9 days after feeding on MAYV-infected blood. Both mosquito species exhibited low rates of MAYV infection in saliva expectorates. Viral titres in the bodies of mosquitoes increased in line with the number of days post-blood feeding and were higher in Ae. aegypti than in Ae. albopictus. Although Florida mosquito vectors have the potential to transmit MAYV and thus to initiate an urban cycle after having fed on higher titres of MAYV-infected blood, lower viraemia in infected humans is likely to limit transmission potential.
Asunto(s)
Aedes/virología , Infecciones por Alphavirus/transmisión , Alphavirus/fisiología , Mosquitos Vectores/virología , Aedes/clasificación , Alphavirus/genética , Infecciones por Alphavirus/virología , Animales , Bovinos , Chlorocebus aethiops , Femenino , Florida , Humanos , Mosquitos Vectores/clasificación , ARN Viral/química , ARN Viral/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Salud Urbana , Células VeroRESUMEN
We conducted a population-based case-control study to assess the myocardial infarction (MI) and stroke risks associated with sulphonylureas and insulin when used in combination with metformin. Cases had type 2 diabetes and used metformin + insulin or metformin + sulphonylureas at the time of a first MI or first stroke between 1995 and 2010; controls used the same treatment combinations and were randomly sampled from the same population. MI and stroke diagnoses and potential confounders were validated by medical record reviews. Compared with metformin + sulphonylurea, metformin + insulin was associated with similar risks of MI or stroke [odds ratio 0.98 (95% confidence interval 0.63-1.52)]. Meta-analysis with another observational study improved the precision of the risk estimate [relative risk 0.92 (95% confidence interval 0.69-1.24)]. Current evidence suggests that there may not be large differences in cardiovascular risk associated with the use of insulin or sulphonylureas when used in combination with metformin.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Metformina/uso terapéutico , Infarto del Miocardio/prevención & control , Accidente Cerebrovascular/prevención & control , Compuestos de Sulfonilurea/uso terapéutico , Anciano , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/inducido químicamente , Angiopatías Diabéticas/complicaciones , Angiopatías Diabéticas/epidemiología , Angiopatías Diabéticas/prevención & control , Cardiomiopatías Diabéticas/inducido químicamente , Cardiomiopatías Diabéticas/complicaciones , Cardiomiopatías Diabéticas/epidemiología , Cardiomiopatías Diabéticas/prevención & control , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Hipoglucemiantes/efectos adversos , Incidencia , Insulina/efectos adversos , Masculino , Registros Médicos , Metformina/efectos adversos , Persona de Mediana Edad , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/complicaciones , Infarto del Miocardio/epidemiología , Guías de Práctica Clínica como Asunto , Modelos de Riesgos Proporcionales , Factores de Riesgo , Accidente Cerebrovascular/inducido químicamente , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología , Compuestos de Sulfonilurea/efectos adversos , Washingtón/epidemiologíaRESUMEN
Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/V(urea), a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome.
Asunto(s)
Hemodiálisis en el Domicilio , Fallo Renal Crónico/terapia , Adulto , Anciano , Diseño de Equipo , Femenino , Hemodiálisis en el Domicilio/efectos adversos , Hemodiálisis en el Domicilio/instrumentación , Hemodiálisis en el Domicilio/mortalidad , Humanos , Hiperfosfatemia/etiología , Hiperfosfatemia/terapia , Hipertensión/etiología , Hipertensión/terapia , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/terapia , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , América del Norte , Cooperación del Paciente , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
A total of 10 ciprofloxacin-sensitive (ciprofloxacin minimum inhibitory concentration, MIC < 0.5 micro g/ml) and 10 ciprofloxacin-resistant (MIC 16 to 32 micro g/ml) presumptive C. jejuni were further characterized and evaluated for their inhibition by natural orange oil fractions. Partial species identification was performed by using a hippuricase gene-based polymerase chain reaction (PCR) assay. One of the isolates appeared to be atypical and failed to hydrolyze hippurate. Of the ciprofloxacin-resistant C. jejuni isolates tested, six were found to have their quinolone resistance determined by a C --> T mutation in codon 86 of gyrA. Both groups of ciprofloxacin-sensitive and -resistant C. jejuni isolates were most susceptible to cold-pressed terpeneless Valencia orange oil (C4) which yielded inhibition zones from 44.0 +/- 1.4 to 80 +/- 0.0 mm. Less inhibitory responses were recorded for 5-fold concentrated Valencia orange oil (C3) and distilled d-limonene (C7) which exerted similar effects on both ciprofloxacin-sensitive and -resistant C. jejuni isolates. In general, ciprofloxacin-resistant and -sensitive C. jejuni isolates were equally susceptible to the respective orange oil fractions.
Asunto(s)
Antiinfecciosos/farmacología , Campylobacter jejuni/efectos de los fármacos , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana , Aceites de Plantas/farmacología , Animales , Campylobacter jejuni/genética , Campylobacter jejuni/metabolismo , Cromatografía de Gases , Ciclohexenos/farmacología , Limoneno , Espectrometría de Masas , Pruebas de Sensibilidad Microbiana , Aceites de Plantas/química , Reacción en Cadena de la Polimerasa , Quinolonas/farmacología , Terpenos/farmacologíaRESUMEN
BACKGROUND: Arterial thrombosis involves platelet aggregation and clot formation, yet little is known about the contribution of genetic variation in fibrin-based hemostatic factors to arterial clotting risk. We hypothesized that common variation in 24 coagulation-fibrinolysis genes would contribute to risk of incident myocardial infarction (MI) or ischemic stroke (IS). METHODS: We conducted a population-based, case-control study. Subjects were hypertensive adults and postmenopausal women 30-79 years of age, who sustained a first MI (n = 856) or IS (n = 368) between 1995 and 2002, and controls matched on age, hypertension status, and calendar year (n = 2,689). We investigated the risk of MI and IS associated with (i) global variation within each gene as measured by common haplotypes and (ii) individual haplotypes and single nucleotide polymorphisms (SNPs). Significance was assessed using a 0.2 threshold of the false discovery rate q-value, which accounts for multiple testing. RESULTS: After accounting for multiple testing, global genetic variation in factor (F) VIII was associated with IS risk. Two haplotypes in FVIII and one in FXIIIa1 were significantly associated with increased IS risk (all q-values < 0.2). A plasminogen gene SNP was associated with MI risk. All are new discoveries not previously reported. Another 24 tests had P-values < 0.05 and q-values > 0.2 in MI and IS analyses, 23 of which are new and hypothesis generating. CONCLUSIONS: Apart from the association of FVIII variation with IS, we found little evidence that common variation in the 24 candidate fibrin-based hemostasis genes strongly influences arterial thrombotic risk, but our results cannot rule out small effects.
Asunto(s)
Factor VIII/genética , Factor XIIIa/genética , Variación Genética , Hemostasis/genética , Infarto del Miocardio/genética , Plasminógeno/genética , Accidente Cerebrovascular/genética , Anciano , Estudios de Casos y Controles , Haplotipos , Humanos , Hipertensión , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , PosmenopausiaRESUMEN
BACKGROUND: Peritonitis is a common complication of peritoneal dialysis (PD) and is associated with significant morbidity. Adequate treatment is essential to reduce morbidity and recurrence. OBJECTIVES: To evaluate the benefits and harms of treatments for PD-associated peritonitis. SEARCH STRATEGY: We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library), MEDLINE, EMBASE and reference lists without language restriction. Date of search: February 2005 SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTs assessing the treatment of peritonitis in peritoneal dialysis patients (adults and children) evaluating: administration of an antibiotic(s) by different routes (e.g. oral, intraperitoneal, intravenous); dose of an antibiotic agent(s); different schedules of administration of antimicrobial agents; comparisons of different regimens of antimicrobial agents; any other intervention including fibrinolytic agents, peritoneal lavage and early catheter removal were included. DATA COLLECTION AND ANALYSIS: Two authors extracted data on study quality and outcomes. Statistical analyses were performed using the random effects model and the dichotomous results were expressed as relative risk (RR) with 95% confidence intervals (CI) and continuous outcomes as mean difference (WMD) with 95% CI. MAIN RESULTS: We identified 36 studies (2089 patients): antimicrobial agents (30); urokinase (4), peritoneal lavage (1) intraperitoneal (IP) immunoglobulin (1). No superior antibiotic agent or combination of agents were identified. Primary response and relapse rates did not differ between IP glycopeptide-based regimens compared to first generation cephalosporin regimens, although glycopeptide regimens were more likely to achieve a complete cure (3 studies, 370 episodes: RR 1.66, 95% CI 1.01 to 3.58). For relapsing or persistent peritonitis, simultaneous catheter removal/replacement was superior to urokinase at reducing treatment failure rates (1 study, 37 patients: RR 2.35, 95% CI 1.13 to 4.91). Continuous IP and intermittent IP antibiotic dosing had similar treatment failure and relapse rates. IP antibiotics were superior to IV antibiotics in reducing treatment failure (1 study, 75 patients: RR 3.52, 95% CI 1.26 to 9.81). The methodological quality of most included studies was suboptimal and outcome definitions were often inconsistent. There were no RCTs regarding duration of antibiotics or timing of catheter removal. AUTHORS' CONCLUSIONS: Based on one study, IP administration of antibiotics is superior to IV dosing for treating PD peritonitis. Intermittent and continuous dosing of antibiotics are equally efficacious. There is no role shown for routine peritoneal lavage or use of urokinase. No interventions were found to be associated with significant harm.
Asunto(s)
Diálisis Peritoneal/efectos adversos , Peritonitis/terapia , Administración Oral , Antibacterianos/administración & dosificación , Fibrinolíticos/uso terapéutico , Humanos , Inmunoglobulinas/uso terapéutico , Infusiones Parenterales , Inyecciones Intravenosas , Lavado Peritoneal , Peritonitis/tratamiento farmacológico , Peritonitis/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéuticoRESUMEN
As the result of a previous study many laboratories have used XAM neutral medium-improved white mounting medium in textile fibre examination for more than 20 years. Due to European Directive 98/79/EC, XAM is no longer available and an alternative needed to be found. A list of desirable properties was formulated and a number of mounting media were tested against this. Entellan New was identified as the best mounting medium, and performed similarly to XAM in all aspects.
Asunto(s)
Ciencias Forenses/métodos , Resinas Sintéticas , TextilesRESUMEN
A range of fibre samples was measured using J&M MSP400 and J&M MSP800 microspectrophotometers across the visible and UV/visible wavelength ranges respectively. The first derivative of the absorbance spectra was then calculated and studied. When the absorbance spectra produced for some samples were broad and featureless, the first derivative spectra provided more points of comparison that facilitated discrimination. For many of the samples, calculating the first derivative did not result in any additional discrimination due to the high number of points of comparison present in the absorbance spectra. However, for the samples that exhibited a high level of intra-sample colour variation (e.g. through uneven dye uptake common in cotton and wool, etc.), which was evident in the absorbance spectra, the associated first derivative spectra highlighted this variation between the fibres and could potentially have resulted in false exclusions. The results show that whilst calculating first derivative can be a useful aid in the comparison of spectra, a high degree of caution is required when applying this method to fibres which exhibit a large intra-sample variation in colour.
Asunto(s)
Ciencias Forenses/métodos , Microespectrofotometría/métodos , Análisis Espectral/métodos , Textiles , Sensibilidad y EspecificidadRESUMEN
Essentials Endogenous hormone levels' influence on hemostatic factor levels is not fully characterized. We tested for associations of endogenous hormone with hemostatic factor levels in postmenopause. Estrone levels were inversely associated with the natural anticoagulant, protein S antigen. Dehydroepiandrosterone sulfate levels were inversely associated with thrombin generation. SUMMARY: Background Oral use of exogenous estrogen/progestin alters hemostatic factor levels. The influence of endogenous hormones on these levels is incompletely characterized. Objectives Our study aimed to test whether, among postmenopausal women, high levels of estradiol (E2), estrone (E1), testosterone (T), dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), and androstenedione, and low levels of sex hormone-binding globulin (SHBG), are positively associated with measures of thrombin generation (TG), a normalized activated protein C sensitivity ratio (nAPCsr), and factor VII activity (FVIIc), and negatively associated with antithrombin activity (ATc) and total protein S antigen (PSAg). Methods This Heart and Vascular Health study cross-sectional analysis included 131 postmenopausal women without a prior venous thrombosis who were not currently using hormone therapy. Adjusted mean differences in TG, nAPCsr, FVIIc, ATc and PSAg levels associated with differences in hormone levels were estimated using multiple linear regression. We measured E2, E1, total T, DHEAS, DHEA and androstenedione levels by mass spectrometry, SHBG levels by immunoassay, and calculated the level of free T. Results One picogram per milliliter higher E1 levels were associated with 0.24% lower PSAg levels (95% Confidence Interval [CI]: -0.35, -0.12) and 1 µg mL-1 higher DHEAS levels were associated with 40.8 nm lower TG peak values (95% CI: -59.5, -22.2) and 140.7 nm×min lower TG endogenous thrombin potential (ETP) (95% CI: -212.1, -69.4). After multiple comparisons correction, there was no evidence for other associations. Conclusions As hypothesized, higher E1 levels were associated with lower levels of the natural anticoagulant PSAg. Contrary to hypotheses, higher DHEAS levels were associated with differences in TG peak and ETP that suggest less generation of thrombin.
Asunto(s)
Hemostasis , Posmenopausia/sangre , Globulina de Unión a Hormona Sexual/metabolismo , Esteroides/sangre , Trombosis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Androstenodiona/sangre , Antitrombinas/metabolismo , Estudios Transversales , Deshidroepiandrosterona/sangre , Sulfato de Deshidroepiandrosterona/sangre , Estradiol/sangre , Estrona/sangre , Factor VII/metabolismo , Femenino , Humanos , Persona de Mediana Edad , Proteína C/metabolismo , Proteína S/metabolismo , Testosterona/sangre , Trombina/metabolismo , Adulto JovenRESUMEN
UNLABELLED: Essentials A lowered risk of recurrent venous thrombosis (VT) with statin treatment is controversial. Among observational inception cohort of 2,798 adults with incident VT, 457 had recurrent VT. Time-to-event models with time-varying statin use and adjustment for potential confounders was used for analysis. Compared to nonuse, current statin use was associated with 26% lower risk of recurrent VT. Click to hear Prof. Büller's perspective on Anticoagulant Therapy in the Treatment of Venous Thromboembolism SUMMARY: Background Meta-analyses of randomized controlled trials suggest that treatment with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) lowers the risk of incident venous thrombosis (VT), particularly among those without prevalent clinical cardiovascular disease (CVD). Whether this is true for the prevention of recurrent VT is debated. We used an observational inception cohort to estimate the association of current statin use with the risk of recurrent VT. Methods and Results The study setting was a large healthcare organization with detailed medical record and pharmacy information at cohort entry and throughout follow-up. We followed 2798 subjects 18-89 years of age who experienced a validated incident VT between January 1, 2002, and December 31, 2010, for a first recurrent VT, validated by medical record review. During follow-up, 457 (16%) developed a first recurrent VT. In time-to-event models incorporating time-varying statin use and adjusting for potential confounders, current statin use was associated with a 26% lower risk of recurrent VT: hazard ratio 0.74, 95% confidence interval 0.59-0.94. Among cohort members free of CVD (n = 2134), current statin use was also associated with a lower risk (38%) of recurrent VT: hazard ratio 0.62, 95% confidence interval 0.45-0.85. We found similar results when restricting to new users of statins and in subgroups of different statin types and doses. Conclusions In a population-based cohort of subjects who had experienced an incident VT, statin use, compared with nonuse, was associated with a clinically relevant lower risk of recurrent VT. These findings suggest a potential secondary benefit of statins among patients who have experienced an incident VT.
Asunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/prevención & control , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Enfermedades Cardiovasculares/terapia , Anticonceptivos Orales/uso terapéutico , Estrógenos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Modelos de Riesgos Proporcionales , Embolia Pulmonar/tratamiento farmacológico , Recurrencia , Factores de Riesgo , Trombosis/tratamiento farmacológico , Trombosis de la Vena/metabolismo , Adulto JovenRESUMEN
Fifty-eight garments were taped and searched for mid to dark blue wool fibres. These were then removed from the tapings, mounted on slides and examined using a high-power microscope (400x). A total of 2,740 blue wool fibres were identified and visible range microspectrophotometry (MSP) was performed on them. Three hundred independent blue wool populations were identified on 56 of the 58 garments searched. The lack of control fibres meant the spectral range of each population was unknown. The number of populations may have been underestimated by grouping together the fibres that had broad single peaks and a lack of distinguishing features in the spectra. Although blue wool is considered to be a common fibre type, 300 unique spectral shapes were identified by the use of microspectrophotometry alone. This demonstrates that the dyes used in the dyeing of blue wool are variable. Showing that many different populations of blue wool occur on a range of garments should ensure that the forensic scientist does not underestimate or understate the strength of evidence in cases where blue wool is found. Hopefully this work will enlighten scientists and enable them to also assess the true value of their findings when other commonly occurring fibres are encountered.
RESUMEN
Four sets of acrylic fibre samples were obtained from a company that dyes fabrics for the fashion industry. Between seven and ten different batches of fibres constituted each set. Comparison microscopy, visible and UV range microspectrophotometry and thin layer chromatography (TLC) were used to compare the dyes on each batch of fibres within the sets. Only one of the four sets exhibited variation within the batches. The differences were seen when both microscopical and analytical techniques were used. In addition, two further sets of samples had been obtained from a company that produces carpets for the car industry. The first set consisted of 26 batches of acid dyed orange nylon fibres. The second consisted of 21 batches of acid dyed mustard coloured nylon and direct dyed brown viscose fibres blended together. When the first set was viewed under UV light one batch had more pale orange fibres present and they fluoresced more brightly than the other fibres. This could be due to the blending with a different dye batch of fibre or due to poor dye uptake--the latter being more likely. When tested using visible and UV range microspectrophotometry and TLC, further dye batch variation was not detected. The second set was examined after separating the nylon and viscose fibres from each other. The nylon fibres were indistinguishable when a range of microscopical and analytical techniques were employed; however, the viscose fibres showed dye batch variation when TLC was used.
RESUMEN
This case study examined the outcomes of persons with spinal cord injury (SCI) who had a single kidney. A Urologic Database, including 1655 persons with SCI between 1969 and 1997, was examined and 22 persons were identified with single kidneys. Twenty persons had adequate follow-up. Renal function was measured by total and individual kidney effective renal plasma flow (ERPF). Of 11 persons who had a single kidney prior to injury or as a result of an associated injury, all maintained a normal ERPF for an average of 8.6 years. Of 9 persons who had removal of a kidney following their injury for other diseases or urinary complications, 3 were deceased, but 2 had a normal ERPF in the remaining kidney prior to death. One with vesicoureteral reflux had decreased renal function in the remaining kidney. Recurrent renal calculi in a single kidney carries risks for decreasing renal function, urosepsis, and death.
Asunto(s)
Pruebas de Función Renal , Riñón/anomalías , Nefrectomía , Complicaciones Posoperatorias/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Vejiga Urinaria Neurogénica/fisiopatología , Adolescente , Adulto , Causas de Muerte , Estudios de Seguimiento , Humanos , Riñón/irrigación sanguínea , Riñón/fisiopatología , Cálculos Renales/mortalidad , Cálculos Renales/fisiopatología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Flujo Sanguíneo Regional/fisiología , Traumatismos de la Médula Espinal/mortalidad , Tasa de Supervivencia , Vejiga Urinaria Neurogénica/mortalidad , Urodinámica/fisiologíaRESUMEN
Crime laboratories in the USA, who undertake fiber examinations, together with members of the European Fibres Group (plus representatives from Israel, Japan, Canada, and Australia) were surveyed in 1994 and 1995, respectively, and asked to provide subject-specific information relating to personnel, equipment, training, quality control, and techniques available. The information obtained showed that generally more fiber casework is carried out in Europe than in the USA. Most laboratories are quite well equipped but those in Europe seem to be able to obtain more state-of-the-art instrumentation. Proficiency testing and peer review is accepted practice worldwide. Americans appear to update fiber collections on a more regular basis than Europeans but both keep literature up to date. Contamination is a major issue, as with all areas of trace evidence. The results from the survey suggest that minimum standards are clearly not always being observed. Careful consideration also needs to be given as to whether legitimate contact could have occurred prior to an offense being committed. The standard of forensic fiber examination worldwide is generally high. With laboratory management continuing to support the work of the Scientific Working Group for Materials and the European Fibres Group and by instigating "best practice" as set out in their guidelines, standards should continue to improve.
RESUMEN
The current emphasis on DNA technology in forensic science has led many to believe that trace evidence examinations, including fibers, may be of little value. Reasons are given here to show that this is an erroneous assumption. In the face of this situation, fibers examiners have been challenged to consider ways in which they can improve the services they offer to the Criminal Justice System not only by increasing the efficiency of the examinations, but also by expressing the evidential value of the findings in a clearer way. The separate stages within fibers casework from evidence collection to report writing are critically examined. Suggestions are made on how improvements may be achieved. Areas where particular progress can be made include improving communication and exchange of information between the investigator and the scientist and streamlining analysis by using the latest equipment in conjunction with effective case management. In addition, ways of making better use of existing data pertaining to fiber frequencies, accumulating new data by using the resources of working groups, and improving training procedures with respect to evidence interpretation are discussed.
Asunto(s)
Vestuario , Medicina Legal , Criminología/tendencias , Dermatoglifia del ADN , Testimonio de Experto , Humanos , Espectroscopía Infrarroja por Transformada de FourierRESUMEN
A study was conducted in 4 Canadian processing plants in 1995-96 to determine the prevalence of quality defects in Canadian cattle. One percent of the annual number of cattle processed in Canada were evaluated on the processing floor and 0.1% were graded in the cooler. Brands were observed on 37% and multiple brands on 6% of the cattle. Forty percent of the cattle had horns, 20% of which were scurs, 33% were stubs, 10% were tipped, and 37% were full length. Tag (mud and manure on the hide) was observed on 34% of the cattle. Bruises were found on 78% of the carcasses, 81% of which were minor in severity. Fifteen percent of the bruises were located on the round, 29% on the loin, 40% on the rib, 16% on the chuck, and 0.02% on the brisket. Grubs were observed in 0.02% of the steers, and injection sites were observed in 1.3% of whole hanging carcasses. Seventy percent of the livers were passed for human food and 14% for pet food; 16% were condemned. Approximately 71% of the liver condemnations were due to liver abscesses. Four percent of the heads, 6% of the tongues, and 0.2% of whole carcasses were condemned. The pregnancy rate in female cattle was approximately 6.7%. The average hot carcass weight was 357 kg (s = 40) in steers, 325 kg (s = 41) in heifers, 305 kg (s = 53) in cows, 388 kg (s = 62) in virgin bulls and 340 kg (s = 39) in mature bulls. The average ribeye area in all cattle was 84 cm2 (s = 12); range 29 cm2 to 128 cm2. Grade fat was highly variable and averaged 9 mm (s = 4) for steers and heifers, 6 mm (s = 6) for cows, 5 mm (s = 1) for virgin bulls, and 4 mm (s = 0.5) for mature bulls. The average lean meat yield was 59.7% in cattle (s = 3.4); range 39% to 67%. One percent of the carcasses were devoid of marbling, 1% were dark cutters, and 0.05% of the steer carcasses were staggy. Six percent of the carcasses had poor conformation, 3.7% were underfinished, and 0.7% were overfinished. Yellow fat was observed in 4% of the carcasses; 10% of carcasses were aged. Based on January 1996 prices, the economic analysis showed that the Canadian beef industry lost $70.52 per head or $189.6 million annually from quality nonconformities. Methods identified to reduce these nonconformities included improvements in management, animal identification, handling, genetic selection, marketing, grading, and information transfer.
Asunto(s)
Mataderos/normas , Bovinos/fisiología , Auditoría Financiera , Auditoría Administrativa , Carne/normas , Mataderos/economía , Crianza de Animales Domésticos/economía , Crianza de Animales Domésticos/organización & administración , Animales , Composición Corporal/fisiología , Peso Corporal/fisiología , Canadá , Femenino , Industria de Procesamiento de Alimentos/economía , Industria de Procesamiento de Alimentos/organización & administración , Humanos , Masculino , Carne/economía , Embarazo , Índice de Embarazo , Control de CalidadRESUMEN
People must relate to time and the manner in which they relate to time is often a reflection of their object relationships and level of development. A patient's relationship to time throughout a therapy session can be a particular perspective from which object relationships and transference issues can be viewed. The patient's relationship to time during the final minutes of psychotherapy sessions provides a particularly revealing opportunity for observing a patient's desires, affect, and level of functioning. Clinical examples of patients' behaviors during the final minutes of psychotherapy sessions have demonstrated a variety of levels of object relationships. A number of affects have been described in these examples.