RESUMO
Presentation with severe acute kidney injury due to cast nephropathy (CN) is a medical emergency in multiple myeloma (MM), with high risk of dialysis-dependent renal failure and death. Accrual of patients with CN into interventional studies is difficult, while phase III trials exclude patients with severe renal insufficiency. Real-world data are warranted. We assessed 2252 patients from the population-based Danish Multiple Myeloma Registry (DMMR) who were diagnosed between 2013 and 2017. We identified 204 patients with clinically-suspected CN, defined as serum creatinine concentration >177 µmol/L and serum free light chain (sFLC) concentration >1000 mg/L at the time of diagnosis. The median age was 72 years. Thirty-one percent of patients presented with dialysis-dependent renal failure. Kidney biopsies were performed in 19% of patients and showed CN in 74% of cases. Despite prompt initiation of bortezomib-based therapy in 94% of patients, 33% of patients died in the first year after diagnosis. Compared with the rest of the patients in the DMMR with symptomatic MM, patients with clinically-suspected CN had worse overall survival (OS) irrespective of transplant eligibility. Achievement of renal recovery was associated with deep reductions of involved sFLC. Achievement of very good partial response or better in the first line of therapy and/or deep reduction of involved sFLC at 3 months after initiation of therapy were associated with superior OS. In conclusion, MM patients presenting with clinically-suspected CN have an alarmingly high one-year mortality when treated with current standards of care. Early and deep hematologic response is crucial for survival.
Assuntos
Injúria Renal Aguda , Creatinina/sangue , Cadeias Leves de Imunoglobulina/sangue , Mieloma Múltiplo , Sistema de Registros , Diálise Renal , Injúria Renal Aguda/sangue , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Idoso , Dinamarca/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/sangue , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
The acoustic environment of swift foxes Vulpes velox vocalizing close to the ground and the effect of propagation on individual identity information in vocalizations were quantified in a transmission experiment in prairie habitat. Sounds were propagated (0.45 m above the ground) at distances up to 400 m. Effects of transmission were measured on three sound types: synthesized sweeps with 1.3 kHz bandwidths spanning in the range of 0.3-8.0 kHz; single elements of swift fox barking sequences (frequency range of 0.3-4.0 kHz) and complete barking sequences. Synthesized sweeps spanning 0.3-1.6 and 1.2-2.5 kHz propagated the furthest and the latter sweeps exhibited the best transmission properties for long-range propagation. Swift fox barking sequence elements are centered toward the lower end of this frequency range. Nevertheless, measurable individual spectral characteristics of the barking sequence seem to persist to at least 400 m. Individual temporal features were very consistent to at least 400 m. The communication range of the barking sequences is likely to be farther than 400 m and it should be considered a long-ranging vocalization. However, relative to the large home ranges of swift foxes (up to 16 km(2) in the experimental area) the barking sequence probably functions at intermediate distances.
Assuntos
Raposas/fisiologia , Localização de Som , Vocalização Animal , Estimulação Acústica , Acústica , Animais , Ecossistema , Modelos Estatísticos , Movimento (Física) , Som , Espectrografia do Som , Fatores de TempoRESUMO
IMPORTANCE: Severe hypertriglyceridemia is associated with increased risk of acute pancreatitis. However, the threshold above which triglycerides are associated with acute pancreatitis is unclear. OBJECTIVE: To test the hypothesis that nonfasting mild-to-moderate hypertriglyceridemia (177-885 mg/dL; 2-10 mmol/L) is also associated with acute pancreatitis. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study examines individuals from the Copenhagen General Population Study in 2003 to 2015 and the Copenhagen City Heart Study initiated in 1976 to 1978 with follow-up examinations in 1981 to1983, 1991 to 1994, and in 2001 to 2003. Median follow-up was 6.7 years (interquartile range, 4.0-9.4 years); and includes 116â¯550 individuals with a triglyceride measurement from the Copenhagen General Population Study (n = 98â¯649) and the Copenhagen City Heart Study (n = 17â¯901). All individuals were followed until the occurrence of an event, death, emigration, or end of follow-up (November 2014), whichever came first. EXPOSURES: Plasma levels of nonfasting triglycerides. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for acute pancreatitis (n = 434) and myocardial infarction (n = 3942). RESULTS: Overall, 116â¯550 individuals were included in this study (median [interquartile range] age, 57 [47-66] years). Compared with individuals with plasma triglyceride levels less than 89 mg/dL (<1 mmol/L), the multivariable adjusted HRs for acute pancreatitis were 1.6 (95% CI, 1.0-2.6; 4.3 events/10â¯000 person-years) for individuals with triglyceride levels of 89 mg/dL to 176 mg/dL (1.00 mmol/L-1.99 mmol/L), 2.3 (95% CI, 1.3-4.0; 5.5 events/10â¯000 person-years) for 177 mg/dL to 265 mg/dL (2.00 mmol/L-2.99 mmol/L), 2.9 (95% CI, 1.4-5.9; 6.3 events/10â¯000 person-years) for 366 mg/dL to 353 mg/dL (3.00 mmol/L-3.99 mmol/L), 3.9 (95% CI, 1.5-10.0; 7.5 events/10â¯000 person-years) for 354 mg/dL-442 mg/dL (4.00 mmol/L-4.99 mmol/L), and 8.7 (95% CI, 3.7-20.0; 12 events/10â¯000 person-years) for individuals with triglyceride levels greater than or equal to 443 mg/dL (≥5.00 mmol/L) (trend, P = 6 × 10-8). Corresponding HRs for myocardial infarction were 1.6 (95% CI, 1.4-1.9; 41 events/10â¯000 person-years), 2.2 (95% CI, 1.9-2.7; 57 events/10â¯000 person-years), 3.2 (95% CI, 2.6-4.1; 72 events/10â¯000 person-years), 2.8 (95% CI, 2.0-3.9; 68 events/10â¯000 person-years), and 3.4 (95% CI, 2.4-4.7; 78 events/10â¯000 person-years) (trend, P = 6 × 10-31), respectively. The multivariable adjusted HR for acute pancreatitis was 1.17 (95% CI, 1.10-1.24) per 89 mg/dL (1 mmol/L) higher triglycerides. When stratified by sex, age, education, smoking, hypertension, statin use, study cohort, diabetes, body mass index (calculated as weight in kilograms divided by height in meters squared), alcohol intake, and gallstone disease, these results were similar with no statistical evidence of interaction. CONCLUSIONS AND RELEVANCE: Nonfasting mild-to-moderate hypertriglyceridemia from 177 mg/dL (2 mmol/L) and above is associated with high risk of acute pancreatitis, with HR estimates higher than for myocardial infarction.
Assuntos
Hipertrigliceridemia/epidemiologia , Pancreatite/epidemiologia , Triglicerídeos/sangue , Adulto , Idoso , Amilases/metabolismo , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Lipase/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Pâncreas/metabolismo , Risco , Índice de Gravidade de DoençaRESUMO
The habitat, but also the nest hole of a hole-nesting species, will degrade the song during transmission. We investigated how the sounds degrade in a sound transmission experiment with the song of the Pied Flycatcher Ficedula hypoleuca (Muscicapidae). Ten different song elements were transmitted to microphones placed inside and outside a nest box. On average, song degradation was much greater inside than outside the nest boxes, especially with respect to excess attenuation and blurring of the song elements. Being inside a nest box therefore strongly reduces a Pied Flycatcher's possibility of detecting and recognizing songs or eavesdropping on singing interactions.
Assuntos
Acústica , Percepção Auditiva/fisiologia , Aves/fisiologia , Comportamento de Nidação , Vocalização Animal/fisiologia , Animais , Feminino , MasculinoRESUMO
O habitat, mas também a cavidade do ninho de uma espécie nidificando em ocos, provoca uma degradação do som durante sua transmissão. Pesquisamos como os sons são degradados num experimento de transmissão sonora usando o canto do pássaro Ficedula hypoleuca (Muscicapidae). Dez elementos diferentes do canto foram enviados para microfones colocados dentro e fora de uma caixa de nidificação. Em média, a degradação do canto foi muito maior dentro do que fora do ninho, particularmente no que diz respeito ao excesso de atenuação e à borrada dos elementos do canto. Estar dentro de uma cavidade de nidificação, portanto, reduz fortemente a capacidade da espécie de detectar e reconhecer cantos ou de interceptar interaçäes vocais.