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First 30 Days (first 30 + days)
Selected AbstractsPerioperative Outcome and Long-Term Mortality for Heart Failure Patients Undergoing Intermediate- and High-Risk Noncardiac Surgery: Impact of Left Ventricular Ejection FractionCONGESTIVE HEART FAILURE, Issue 2 2010Kirsten O. Healy MD The impact of left ventricular ejection fraction (LVEF) on outcome in patients with heart failure (HF) undergoing noncardiac surgery has not been extensively evaluated. In this study, 174 patients (mean age, 75±12 years, 47% male, mean LVEF (47%±18%) underwent intermediate- or high-risk noncardiac surgery. Patients were stratified by LVEF, and adverse perioperative complications were identified and compared. Adverse perioperative events occurred in 53 patients (30.5%), including 14 (8.1%) deaths within 30 days, 26 (14.9%) myocardial infarctions, and 44 (25.3%) HF exacerbations. Among the factors associated with adverse perioperative outcomes in the first 30 days were advanced age (>80 years), diabetes, and a severely decreased LVEF (<30%). Long-term mortality was high, and Cox proportional hazards analysis demonstrated that LVEF was an independent risk factor for long-term mortality. Congest Heart Fail. 2010;16:45,49. © 2009 Wiley Periodicals, Inc. [source] Initial cultivation of a temperate-region soil immediately accelerates aggregate turnover and CO2 and N2O fluxesGLOBAL CHANGE BIOLOGY, Issue 8 2006A. STUART GRANDY Abstract The immediate effects of tillage on protected soil C and N pools and on trace gas emissions from soils at precultivation levels of native C remain largely unknown. We measured the response to cultivation of CO2 and N2O emissions and associated environmental factors in a previously uncultivated U.S. Midwest Alfisol with C concentrations that were indistinguishable from those in adjacent late successional forests on the same soil type (3.2%). Within 2 days of initial cultivation in 2002, tillage significantly (P=0.001, n=4) increased CO2 fluxes from 91 to 196 mg CO2 -C m,2 h,1 and within the first 30 days higher fluxes because of cultivation were responsible for losses of 85 g CO2 -C m,2. Additional daily C losses were sustained during a second and third year of cultivation of the same plots at rates of 1.9 and 1.0 g C m,2 day,1, respectively. Associated with the CO2 responses were increased soil temperature, substantially reduced soil aggregate size (mean weight diameter decreased 35% within 60 days), and a reduction in the proportion of intraaggregate, physically protected light fraction organic matter. Nitrous oxide fluxes in cultivated plots increased 7.7-fold in 2002, 3.1-fold in 2003, and 6.7-fold in 2004 and were associated with increased soil NO3, concentrations, which approached 15 ,g N g,1. Decreased plant N uptake immediately after tillage, plus increased mineralization rates and fivefold greater nitrifier enzyme activity, likely contributed to increased NO3, concentrations. Our results demonstrate that initial cultivation of a soil at precultivation levels of native soil C immediately destabilizes physical and microbial processes related to C and N retention in soils and accelerates trace gas fluxes. Policies designed to promote long-term C sequestration may thus need to protect soils from even occasional cultivation in order to preserve sequestered C. [source] Winter streamflow variability, Yukon Territory, CanadaHYDROLOGICAL PROCESSES, Issue 4 2002R. D. Moore Abstract Knowledge of winter streamflow regimes is required in northern catchments to evaluate water supply and to assess the vulnerability of aquatic habitat. The objective of this study was to explore the nature and causes of winter streamflow variability in northern rivers through examination of a limited number of case studies involving intensive field measurements, as well as a synoptic analysis of winter streamflow measurements archived by Water Survey of Canada for rivers in Yukon Territory, Canada. Evidence was found for an abrupt decrease in discharge at freeze-up in one of the case studies and for 10 of the 25 stations in the synoptic analysis that had measurements within 30 days of freeze-up (an additional 12 stations had no measurements within 30 days of freeze-up). However, given the paucity of measurements in the early winter, the magnitude, duration and frequency of these events cannot be specified. The case studies indicate that, even where a coherent depression does not occur, discharge can fluctuate around a smooth recession trend for about the first 30 days after the onset of ice effects, probably as a result of transient storage and release of water behind ice jams. A storage-depletion model that represents streamflow as outflow from two parallel linear reservoirs provided a reasonable fit to most of the observed measurements (excluding those in the first 30 days following freeze-up), with model fit deteriorating with increasing latitude and decreasing catchment size. The effect of latitude could relate to abstraction of flow by ice production, which would cause deviations from a storage-depletion trend. Northern catchments also tended to have steeper late-winter recessions, which could reflect a lack of extensive, deep aquifers to maintain late-winter discharge. The tendency to poorer model fit in smaller catchments could reflect a problem with data reliability, since it is more difficult to find good winter gauging sections in smaller streams. Some evidence for temperature-related discharge fluctuations was found in both the case studies and synoptic analyses. However, the magnitude of these effects appears to be about ±10 to 15%, at most, and not to be consistent between winters. Further advances in understanding winter streamflow variability will require frequent measurements on a range of streams over a number of winters. Copyright © 2002 John Wiley & Sons, Ltd. [source] Are All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Rebecca C. Rossom MD OBJECTIVES: To estimate mortality risk associated with individual commonly prescribed antipsychotics. DESIGN: Five-year retrospective study. SETTING: Veterans national healthcare data. PARTICIPANTS: Predominantly male, aged 65 and older, with a diagnosis of dementia and no other indication for an antipsychotic. Subjects who received an antipsychotic were compared with randomly selected controls who did not. Exposed and control cohorts were matched according to their date of dementia diagnosis and time elapsed from diagnosis to the start of antipsychotic therapy. MEASUREMENTS: Mortality during incident antipsychotic use. RESULTS: Cohorts who were exposed to haloperidol (n=2,217), olanzapine (n=3,384), quetiapine (n=4,277), or risperidone (n=8,249) had more comorbidities than their control cohorts. During the first 30 days, there was a significant increase in mortality in subgroups prescribed a daily dose of haloperidol greater than 1 mg (hazard ratio (HR)=3.2, 95% confidence interval (CI)=2.2,4.5, P<.001), olanzapine greater than 2.5 mg (HR=1.5, 95% CI=1.1,2.0, P=.01), or risperidone greater than 1 mg (HR=1.6, 95% CI=1.1,2.2, P=.01) adjusted for demographic characteristics, comorbidities, and medication history using Cox regression analyses. Greater mortality was not seen when a daily dose of quetiapine greater than 50 mg (HR=1.2, 95% CI=0.7,1.8, P=.50) was prescribed, and there was no greater mortality associated with a dose less than 50 mg (HR=0.7, 95% CI=0.5,1.0, P=.03). No antipsychotic was associated with greater mortality after the first 30 days. CONCLUSION: Commonly prescribed doses of haloperidol, olanzapine, and risperidone, but not quetiapine, were associated with a short-term increase in mortality. Further investigations are warranted to identify patient characteristics and antipsychotic dosage regimens that are not associated with a greater risk of mortality in elderly patients with dementia. [source] A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department,The DEED II StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004FRACP, Gideon A. Caplan MBBS Objectives: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED). Design: Prospective, randomized, controlled trial with 18 months of follow-up. Setting: Large medical school,affiliated public hospital in an urban setting in Sydney, Australia. Participants: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups. Intervention: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care. Measurements: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)). Results: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: ,0.25 vs ,0.75; P<.001; mental status questionnaire change from baseline at 12 months: ,0.21 vs ,0.64; P<.001). Conclusion: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit. [source] Catheter Ablation of Recurrent Scar-Related Ventricular Tachycardia Using Electroanatomical Mapping and Irrigated Ablation Technology: Results of the Prospective Multicenter Euro-VT-StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010HILDEGARD TANNER M.D. Catheter Ablation of Ventricular Tachycardia.,Introduction: Ventricular tachycardia (VT) late after myocardial infarction is an important contributor to morbidity and mortality. This prospective multicenter study assessed the efficacy and safety of electroanatomical mapping in combination with open-saline irrigated ablation technology for ablation of chronic recurrent mappable and unmappable VT in remote myocardial infarction. Methods and Results: In 8 European institutions, 63 patients (89% males) were enrolled in the study. All patients had remote myocardial infarction and presented with a median number of 17 (range 1,380) VTs in the preceding 6 months. Incessant VT was present in 14 patients (22%). Left ventricular ejection fraction measured 30 ± 13%. A mean of 3 VTs were targeted per patient and 22% of all patients had only unmappable VT. The mean follow-up period was 12 ± 3 months. A total of 164 VTs were targeted during catheter ablation. Ablation was acutely successful in 51 patients (81%). One patient (1.5%) experienced a major complication with degeneration of VT into ventricular fibrillation necessitating cardiopulmonary resuscitation maneuvers. However, no death occurred acutely or within the first 30 days after catheter ablation. During the follow-up, 19 of the initially successful ablated patients (37%) and 31 of all ablated patients (49%) developed some type of VT recurrence. Conclusions: The results of this multicenter study demonstrate the high acute success rate and a low complication rate of irrigated tip catheter ablation of all clinical relevant VTs in remote myocardial infarction. However, during the follow-up a relevant number of recurrences occurred. (J Cardiovasc Electrophysiol, Vol. 21, pp. 47,53, January 2010) [source] Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention with Drug-Eluting Stent Implantation in Patients with Multivessel Coronary DiseaseJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2007ZHEN KUN YANG M.D. Background: Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world. Methods: From January 2003 to December 2004, 466 consecutive patients with MVD underwent revascularization, 235 by PCI with DES and 231 by CABG. The study end-point was the incidence of major adverse cardiovascular events (MACEs) at the first 30 days after procedure and during follow-up. Results: Most preoperative characteristics were similar in the two groups, but left main disease (24.7% vs 2.6%, P<0.001) and three-vessel disease (65% vs 54%, P = 0.02) were more prevalent in CABG group. The number of coronary lesions was also greater in CABG group (3.7 ± 1.1 vs 3.3 ± 1.1, P<0.001). Despite higher early morbidity (3.9% vs 0.8%, P = 0.03) associated with CABG, there were no significant differences in composite MACEs at the first 30 days between the two groups. During follow-up (mean 25±8 months), the incidence of death, myocardial infarction, or cerebrovascular event was similar in both groups (PCI 6.3% vs CABG 5.6%, P = 0.84). However, bypass surgery still afforded a lower need for repeat revascularization (2.8% vs 10.4%, p = 0.001). Consequently, overall MACE rate (14.5% vs 7.9%, P = 0.03) remained higher after PCI. Conclusion: PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis. [source] Living donor liver transplantation for hepatocellular carcinoma: A single-center preliminary reportLIVER TRANSPLANTATION, Issue 6 2006Massimo Malagó Liver transplantation (LT) is the treatment of choice for early hepatocellular carcinoma (HCC) in patients with end-stage liver disease but is limited by the availability of donor organs. Living donor liver transplantation (LDLT) represents an alternative therapeutic option for patients with disease confined to the liver. Between April 1998 and December 2003, 537 patients underwent liver transplantation in our center. Thirty patients with HCC and associated terminal cirrhosis and 4 patients with tumor recurrence after liver resection who underwent LDLT were reviewed. Nineteen patients (55.8%) met the Milan criteria for LT, whereas 15 patients (44.2%) "exceeded" them. The overall survival rates at 1 and 2 years were 68% and 62%, respectively, with a median follow-up of 41 months (range, 17-64 months). Five patients (14.7%) died in the first 30 days after LDLT. Hospital mortality was significantly correlated with age >60 years. Four patients developed recurrence between 6 and 35 months after LDLT. Recurrence was significantly related to the presence of more than 3 tumor lesions in our series. In conclusion, LDLT is a promising treatment option for patients with HCC. Even longer follow-up and bigger patients' series are needed to fully assess the benefits of LDLT for HCC patients exceeding the Milan criteria. Liver Transpl 12:934,940, 2006. © 2006 AASLD. [source] Growth and digestive enzymes of Macrobrachium rosenbergii juveniles: effect of different stocktypes and dietary protein levels under a similar culture environmentAQUACULTURE RESEARCH, Issue 12 2009Vidya Sagar Abstract A feeding trial was conducted to study the effect of dietary protein (DP) levels on the growth and digestive enzyme activities of different wild stocks of Macrobrachium rosenbergii juveniles. Wild juveniles of M. rosenbergii were collected from the west coast of India, Gujarat (G), Maharashtra (M) and from the east coast of India, Andhra Pradesh (A), and raised in culture ponds of 200 m2 at 1 juvenile m,2. All the animals were tagged individually with Elastomer tags of a particular colour assigned to their respective stock and acclimatized for 7 days before being released into the pond at a ratio of 70:65:65 (A:M:G). Each of the two feeds, the first with 27% DP, termed the suboptimum level (S), and the second 32% DP, termed the optimum level (O), was fed in duplicate ponds at 6% of the body mass for the first 30 days and 4% for the last 30 days. The average weight of stocked prawn, respectively, in O DP and S DP fed ponds was 0.90 ± 0.04 and 1.06 ± 0.08 g for the G stock, 0.80 ± 0.07 and 1.01 ± 0.1 g for the M stock and 3.06 ± 0.13 and 3.10 ± 0.23 g for the A stock. Both the protein level and the stock type had a significant (P<0.05) effect on the weight gain% of the prawn. There was an approximate 95% change in weight gain with a DP change. Similarly, G and M stocks exhibited significantly higher (P<0.05) growth rates of approximately 90% than the A stock, although no difference was noted between the G and the M stocks. However, for protein × stock (interaction) levels, there was no significant difference (P>0.05) among the groups. Although insignificant, the survival rates among the different stocks varied from 56% to 77%. Optimum protein level showed a significant increase (P<0.05) in the specific growth rate (SGR). Feed conversion ratio, feed efficiency ratio, protein efficiency ratio and net protein utilization were not affected either due to DP, stock type or their interaction. The O × A group exhibited the maximum variation in body weight. Digestive enzyme activities were similar in all the groups, but enzymes for phospho-monoesterase were significantly higher (P<0.05) at O DP. Both the G and the M stock showed a significantly higher (P<0.05) alkaline phosphatase activity while acid phosphatase activity was significantly higher (P<0.05) in the M stock only. Overall, the G and M stocks showed higher growth responses compared with the A stock. [source] High-frequency vibration for the recanalization of guidewire refractory chronic total coronary occlusions,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2008Klaus Tiroch MD Abstract Background: Recanalization of coronary chronic total occlusions (CTOs) remains a clinical challenge, particularly when standard guidewire attempts fail. Objectives: We sought to determine the safety and efficacy of a novel method that used high-frequency (20 kHz) vibration to fragment occlusive fibrous tissue and facilitate guidewire crossing into the distal vessel. Methods: A total of 125 patients with CTO, who failed at attempts of conventional guidewire recanalization after more than 5 min of fluoroscopy time, were enrolled in the study. The primary efficacy endpoint was the advancement of the CROSSERÔ catheter through the occlusion and attainment of coronary guidewire positioning in the distal coronary lumen. The primary safety endpoint was the occurrence of death, myocardial infarction, clinical perforation, or target vessel revascularization within the first 30 days. Results: The average fluoroscopy time while delivering the CROSSER catheter was 12.4 min. CROSSER-assisted guidewire recanalization was achieved in 76 (60.8%) procedures and a final diameter stenosis <50% was obtained in 68 (54.4%) of cases. Major adverse events occurred in 11 (8.8%) patients, lower than the predefined objective performance criteria. Angina frequency and quality of life were improved in patients with successful guidewire recanalization. Conclusions: We conclude that high-frequency vibration using the CROSSER catheter is a safe and effective therapy for patients with CTO, which are refractory to standard guidewire recanalization. © 2008 Wiley-Liss, Inc. [source] Grafting CVD of Poly(vinyl pyrrolidone) for Durable Scleral Lens Coatings,CHEMICAL VAPOR DEPOSITION, Issue 1-3 2010Kyra L. Sedransk Abstract Grafting (g)CVD from the monomer 1-vinyl-2-pyrrolidone (VP) and the Type II initiator benzophenone (BP) under 254,nm UV irradiation yields durable hydrophilic coatings on substrates of poly(methacrylic acid) (PMA) derivatives, desirable for scleral lens applications. The gCVD polymerization of the VP monomer is essentially complete, and little excess BP remains in the film. Process optimization, through single variable and two fractional factorial experiments, result in retention of >90% of the as-deposited film thickness after rinsing. Increasing the initiator dosing time beyond 10,min, or the UV exposure time beyond 5,min, has little effect on the as-deposited thickness, or percentage of film retained after rinsing. This suggests that UV irradiation rapidly transforms most of the BP absorbed on the surface to initiating radicals. Once sufficient initiator dosage and UV exposure have been achieved, the initial deposition thickness is controlled primarily by the total flux of monomer to the surface, which is consistent with previous studies. For all samples, thickness loss occurs primarily during the first 30 days of saline soak-testing with no statistically significant loss (p,>,0.25) during the next 90 days of soak testing. While the additional UV exposure time has a limited effect on initial film thickness, it does increase long term thickness retention, most likely by forming crosslinked and branched structures within the film. All samples tested retain sufficient gCVD coating thickness to impart improved hydrophilicity at the surface throughout the entire 120 day saline soak-testing period. The fractional factorial experiments correlate improved hydrophilicity with an interaction between initiator dosage time and UV exposure time. Indeed, decreasing these two process variables in tandem provides the greatest reduction in contact angle. While the uncoated PMA displayed 92.3°,±,2.1° advancing and 86.7°,±,3.0° receding contact angles with water, the most hydrophilic gCVD coating lowers the advancing and receding contact angles to 39.5°,±,2.6° and 36.2°,±,1.6°, respectively. [source] | ||||||||||