86,667 research outputs found
Electrocardiographic Minnesota Code findings predicting short term mortality in asymptomatic subjects. The Italian RIFLE Pooling Project
No full textRole of body mass index in the prediction of all cause mortality in over 62,000 men and women. The Italian RIFLE Pooling Project. Risk Factor and Life Expectancy.
No full textSTUDY OBJECTIVE: To evaluate the relation of body mass index (BMI) to short-term mortality in a large Italian population sample.DESIGN: Within the Italian RIFLE pooling project, BMI was measured in 47 population samples made of 32,741 men and 30,305 women ages 20-69 years (young 20-44, mature 45-69). Data on mortality were collected for the next six years.MAIN OUTCOME MEASURES: Age adjusted death rates in quintile classes of BMI and Cox proportional hazards models with six year all causes mortality as end point, BMI as covariate and age, smoking, systolic blood pressure as possible confounders were computed. Multivariate analysis was tested in all subjects and after the exclusion of smokers, early (first two years) deaths, and both categories.RESULTS: The univariate analysis failed to demonstrate in all cases a U or inverse J shaped relation. The Cox coefficients for the linear and quadratic terms of BMI proved significant for both young and mature women. The minimum of the curve was located at 27.0 (24.0, 30.0, 95% confidence limits, CL) and 31.8 (25.5, 38.2, 95% CL) units of BMI, for young and mature women respectively. Similar findings were obtained even when exclusion were performed. No relation was found for young men while for mature adult men only the model for all subjects retained significant curvilinear relation (minimum 29.3; 22.4, 36.2, 95% CL).CONCLUSION: These uncommon high values of BMI carrying the minimum risk of death seems to be in contrast with weight guidelines. A confirmation of these findings in other population groups might induce the consideration of changes in the suggested healthy values of BMI
Normotensive middle-aged men after 5-10 years: normal blood pressure or hypertension?
No full textWe evaluated the incidence of hypertension over 5-10 years of follow-up in middle-aged men, 40-59 years at entry, selected from the Italian section of the Seven Countries Study. Out of the 2480 subjects, 852 were normotensive at entry [systolic blood pressure (SBP) less than 140 mmHg and diastolic blood pressure (DBP) less than 90 mmHg)], alive after 10 years and had been evaluated repeatedly after 5 and 10 years. After 5 years, 31.3\% had developed borderline hypertension (140 less than or equal to SBP less than 160 and 90 less than or equal to DBP less than or equal to 95 mmHg) and 14.6\% had developed definite hypertension (SBP greater than or equal to 160 mmHg or DBP greater than or equal to 95 mmHg). During the next 5 years, out of the 267 borderline hypertensives, 28.5\% became definite hypertensives, while 29.6\% reverted to normal blood pressure. Out of the 124 definite hypertensives, 46\% remained in this category, while 34.7\% became borderline hypertensives and 19.4\% became normotensive. In men aged 60-69 years, less than 2\% of hypertensives were being effectively treated and changes in body weight were closely related to blood pressure. In addition, out of 461 normotensive subjects who remained normotensive at the 5-year examination, 63.6\% remained normotensive in the next 5 years also, while 28\% developed borderline hypertension and only 8.4\% moved into the definite hypertensive class. These data suggest that a normotensive subject aged 40-59 years has a 34.4\% probability of remaining normotensive in the next 10 years.(ABSTRACT TRUNCATED AT 250 WORDS
[Outcome of the normotensive subject in a 5-to-10 year follow-up: normal arterial pressure or hypertension?].
No full textCan the intraprostatic concentration of epidermal growth factor influence the variance of serum prostate specific antigen levels in patients with benign prostatic hyperplasia?
No full textPurpose: Except for prostate volume, little is known about the factors influencing serum prostate specific antigen (PSA) levels. Considering that dihydrotestosterone and epidermal growth factor are regulators of the proliferation and differentiation in the epithelial component of human prostate tissue and that PSA is produced only by the epithelial cells of the gland, studies were performed on patients with a histological diagnosis of benign prostatic hyperplasia (BPH) to establish whether a significant association exists between the intraprostatic concentration of dihydrotestosterone or epidermal growth factor and serum PSA levels.
Materials and Methods: A total of 20 patients with BPH who had not been previously treated were part of a larger study on the correlation among PSA, prostate volume and age, and were evaluated according to the algorithm in the guidelines of the international consultation on BPH. All men underwent open suprapubic prostatectomy to enucleate the entire adenoma and in each case sections were made in the periurethral, subcapsular and intermediate zones of the BPH tissue. Dihydrotestosterone and epidermal growth factor concentrations were evaluated by radioimmunoassay in the periurethral zone and in total BPH tissue.
Results: In these 20 patients with BPH serum PSA levels were significantly associated with epidermal growth factor but not with dihydrotestosterone concentrations in total BPH tissue (r = 0.7762, p = 0.00002836 and r = 0.3923, p = 0.0956307, respectively). A stronger association was found between PSA levels and the periurethral concentration of epidermal growth factor and dihydrotestosterone (r = 0.8117, p = 0.000005 and r = 0.5656, p = 0.0098326, respectively). On the contrary, epidermal growth factor and dihydrotestosterone were not significantly associated with prostate volume (p = 0.957415 and p = 0.531439, respectively).
Conclusions: To our knowledge this study is the first report in the literature to demonstrate an association between serum PSA, and dihydrotestosterone and epidermal growth factor levels, particularly in the periurethral zone of human BPH tissue. These data suggest the importance of epidermal growth factor and dihydrotestosterone in influencing serum PSA levels
The role of some risk factors in the prediction of stone recurrence after lithotripsy
No full textThe incidence of kidney stone recurrence after extracorporeal shock waves lithotripsy (ESWL) has to be re-valuated and the identification of potential risk factors, able to predict the recurrence, is under discussion. This prospective study, carried out on a homogeneous group of 520 patients (275 males, 245 females; aged 14-79 years), previously treated with ESWL for idiopathic calcium nephrolithiasis, allowed to estimate the incidence of recurrence (101 relapses; mean incidence of about 10% per year) with a long enough follow-up (23 months on average; median =24 months, range = 12-48 months). Multivariate statistical analysis performed to predict the recurrence by some possible risk factors, showed that age was inversely related to occurrence of the event (Relative Risk (RR) =0.9837; 95% CL=0.9689-0.9987) whereas urinary calcium (UC) (RR=1.0013; 95% CL=1.0003- 1.0022), alkaline phosphatase (AP), (RR=1.0048; 95% CL=1.0021-1.0074) and history of previous relapses (RR=1.5239; 95% CL=1.0226-2.2710) were directly related to the recurrence. The levels of UC were not correlated to those of AP (linear correlation coefficient r=0.0032), but the combination of their high levels increased the risk of recurrences
Bilateral Internal Thoracic Arteries Improve 10-Year Outcomes of Coronary Artery Bypass Grafting
No full textBackground: This observational cohort study was designed by the PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery) steering committee to evaluate the 10-year follow-up outcome of bilateral internal thoracic arteries (BITA) versus single internal thoracic artery. Methods: The PRIORITY project was designed to evaluate long-term outcome of 2 large prospective multicenter cohort studies of coronary artery bypass grafting. Clinical data on isolated coronary artery bypass grafting were merged with administrative data to collect follow-up information. The primary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events at 10-year follow-up. Secondary endpoints were individual components of major adverse cardiac and cerebrovascular events at 10 years and surgical site complications or infections. A propensity score–based inverse probability treatment weighting (IPTW) was used to overcome the selection bias related to the observational nature of the study. Results: The study population consisted of 10,988 patients who underwent isolated coronary artery bypass grafting. BITA was used in 23.5%. The use of BITA is related to lower incidence of major adverse cardiac and cerebrovascular events at 10 years (adjusted hazard ratio [HR] 0.88, 95% CI 0.79-0.98, P < .001). BITA correlated with better 10-year survival (IPTW adjusted HR 0.87, 95% CI 0.78-1.00, P = .05), re-revascularization (IPTW adjusted HR 0.83, 95% CI 0.74-0.92, P < .001), and myocardial infarction (IPTW adjusted HR 0.86, 95% CI 0.77-0.95, P = .005) but to increased incidence of surgical site complications or infections (HR 2.12, 95% CI 1.39-3.24, P < .001). Conclusions: In propensity-matched patients, use of BITA was associated with improved 10-year survival, freedom from repeat revascularization, and myocardial infarction but also higher incidence of surgical site complications
Variations on the Author
No full text“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Impact of off-pump coronary artery bypass grafting on long-term percutaneous coronary interventions
No full textObjectives The debate regarding the advantages and limitations of off-pump versus on-pump coronary artery bypass grafting (CABG) has yet to be resolved. This study was designed to compare the impact of surgical technique on long-term mortality and subsequent revascularization. Methods The Predicting Long-Term Outcomes After Isolated Coronary Artery Bypass Surgery (PRIORITY) project was designed to evaluate the long-term outcomes of 2 large, prospective multicenter cohort studies on CABG conducted in Italy between 2002 and 2004 and in 2007 and 2008. Clinical data on isolated CABG were compiled from 2 administrative databases. Results The study population consisted of 11,021 patients who underwent isolated CABG (27.2% off-pump CABG). Surgical strategy did not affect in-hospital mortality. Multivariate logistic regression demonstrated that on-pump CABG was the only factor that protected from in-hospital percutaneous coronary intervention after surgery (odds ratio, 0.61). Although unadjusted long-term survival was significantly worse for off-pump CABG, adjustment did not confirm off-pump CABG as a risk factor for mortality (hazard ratio, 0.96; 95% confidence interval, 0.87-1.06). The on-pump CABG group had a significantly lower hospitalization for subsequent percutaneous coronary intervention, a finding confirmed even with adjustment for confounding factors (hazard ratio, 0.70; 95% confidence interval, 0.62-0.80; P <.001). Off-pump CABG thus carried a 42% higher risk for subsequent percutaneous coronary intervention than on-pump CABG. The incidence of repeat CABG was similar between groups. Conclusions This study demonstrated that off-pump OPCAB did not affect short- and long-term mortality, but it was a significant risk factor for rehospitalization for percutaneous coronary intervention
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