Fractional hepatic de novo lipogenesis in healthy subjects during near-continuous oral nutrition and bed rest: a comparison with published data in artificially fed, critically ill patients.

BACKGROUND AND AIMS: In critically ill patients, fractional hepatic de novo lipogenesis increases in proportion to carbohydrate administration during isoenergetic nutrition. In this study, we sought to determine whether this increase may be the consequence of continuous enteral nutrition and bed rest. We, therefore, measured fractional hepatic de novo lipogenesis in a group of 12 healthy subjects during near-continuous oral feeding (hourly isoenergetic meals with a liquid formula containing 55% carbohydrate). In eight subjects, near-continuous enteral nutrition and bed rest were applied over a 10 h period. In the other four subjects, it was extended to 34 h. Fractional hepatic de novo lipogenesis was measured by infusing(13) C-labeled acetate and monitoring VLDL-(13)C palmitate enrichment with mass isotopomer distribution analysis. Fractional hepatic de novo lipogenesis was 3.2% (range 1.5-7.5%) in the eight subjects after 10 h of near continuous nutrition and 1.6% (range 1.3-2.0%) in the four subjects after 34 h of near-continuous nutrition and bed rest. This indicates that continuous nutrition and physical inactivity do not increase hepatic de novo lipogenesis. Fractional hepatic de novo lipogenesis previously reported in critically ill patients under similar nutritional conditions (9.3%) (range 5.3-15.8%) was markedly higher than in healthy subjects (P<0.001). These data from healthy subjects indicate that fractional hepatic de novo lipogenesis is increased in critically ill patients.

Comparative cost-effectiveness analyses of cardiovascular magnetic resonance and coronary angiography combined with fractional flow reserve for the diagnosis of coronary artery disease.

BACKGROUND: According to recent guidelines, patients with coronary artery disease (CAD) should undergo revascularization if significant myocardial ischemia is present. Both, cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) allow for a reliable ischemia assessment and in combination with anatomical information provided by invasive coronary angiography (CXA), such a work-up sets the basis for a decision to revascularize or not. The cost-effectiveness ratio of these two strategies is compared. METHODS: Strategy 1) CMR to assess ischemia followed by CXA in ischemia-positive patients (CMR + CXA), Strategy 2) CXA followed by FFR in angiographically positive stenoses (CXA + FFR). The costs, evaluated from the third party payer perspective in Switzerland, Germany, the United Kingdom (UK), and the United States (US), included public prices of the different outpatient procedures and costs induced by procedural complications and by diagnostic errors. The effectiveness criterion was the correct identification of hemodynamically significant coronary lesion(s) (= significant CAD) complemented by full anatomical information. Test performances were derived from the published literature. Cost-effectiveness ratios for both strategies were compared for hypothetical cohorts with different pretest likelihood of significant CAD. RESULTS: CMR + CXA and CXA + FFR were equally cost-effective at a pretest likelihood of CAD of 62% in Switzerland, 65% in Germany, 83% in the UK, and 82% in the US with costs of CHF 5'794, euro 1'517, £ 2'680, and $ 2'179 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR. CONCLUSIONS: The CMR + CXA strategy is more cost-effective than CXA + FFR below a CAD prevalence of 62%, 65%, 83%, and 82% for the Swiss, the German, the UK, and the US health care systems, respectively. These findings may help to optimize resource utilization in the diagnosis of CAD.

Enriched basaltic andesites from mid-crustal fractional crystallization, recharge, and assimilation (Pilavo Volcano, Western Cordillera of Ecuador)

The origin of andesite is an important issue in petrology because andesite is the main eruptive product at convergent margins, corresponds to the average crustal composition and is often associated with major Cu-Au mineralization. In this study we present petrographic, mineralogical, geochemical and isotopic data for basaltic andesites of the latest Pleistocene Pilavo volcano, one of the most frontal volcanoes of the Ecuadorian Quaternary arc, situated upon thick (30-50 km) mafic crust composed of accreted Cretaceous oceanic plateau rocks and overlying mafic to intermediate Late Cretaceous-Late Tertiary magmatic arcs. The Pilavo rocks are basaltic andesites (54-57 center dot 5 wt % SiO(2)) with a tholeiitic affinity as opposed to the typical calc-alkaline high-silica andesites and dacites (SiO(2) 59-66 wt %) of other frontal arc volcanoes of Ecuador (e.g. Pichincha, Pululahua). They have much higher incompatible element contents (e.g. Sr 650-1350 ppm, Ba 650-1800 ppm, Zr 100-225 ppm, Th 5-25 ppm, La 15-65 ppm) and Th/La ratios (0 center dot 28-0 center dot 36) than Pichincha and Pululahua, and more primitive Sr ((87)Sr/(86)Sr similar to 0 center dot 7038-0 center dot 7039) and Nd (epsilon(Nd) similar to +5 center dot 5 to +6 center dot 1) isotopic signatures. Pilavo andesites have geochemical affinities with modern and recent high-MgO andesites (e.g. low-silica adakites, Setouchi sanukites) and, especially, with Archean sanukitoids, for both of which incompatible element enrichments are believed to result from interactions of slab melts with peridotitic mantle. Petrographic, mineral chemistry, bulk-rock geochemical and isotopic data indicate that the Pilavo magmatic rocks have evolved through three main stages: (1) generation of a basaltic magma in the mantle wedge region by flux melting induced by slab-derived fluids (aqueous, supercritical or melts); (2) high-pressure differentiation of the basaltic melt (at the mantle-crust boundary or at lower crustal levels) through sustained fractionation of olivine and clinopyroxene, leading to hydrous, high-alumina basaltic andesite melts with a tholeiitic affinity, enriched in incompatible elements and strongly impoverished in Ni and Cr; (3) establishment of one or more mid-crustal magma storage reservoirs in which the magmas evolved through dominant amphibole and clinopyroxene (but no plagioclase) fractionation accompanied by assimilation of the modified plutonic roots of the arc and recharge by incoming batches of more primitive magma from depth. The latter process has resulted in strongly increasing incompatible element concentrations in the Pilavo basaltic andesites, coupled with slightly increasing crustal isotopic signatures and a shift towards a more calc-alkaline affinity. Our data show that, although ultimately originating from the slab, incompatible element abundances in arc andesites with primitive isotopic signatures can be significantly enhanced by intra-crustal processes within a thick juvenile mafic crust, thus providing an additional process for the generation of enriched andesites.

Comparativecost-effectivenessanalyses of cardiacmagneticresonanceimaging versus invasive coronary angiography combined with fractional flow reserve testing to diagnose ischemia in coronary artery disease

Introduction: According to guidelines, patients with coronary artery disease (CAD) should undergo revascularization if myocardial ischemia is present. While coronary angiography (CXA) allows the morphological assessment of CAD, the fractional flow reserve (FFR) has proved to be a complementary invasive test to assess the functional significance of CAD, i.e. to detect ischemia. Perfusion Cardiac Magnetic Resonance (CMR) has turned out to be a robust non-invasive technique to assess myocardial ischemia. The objective: is to compare the cost-effectiveness ratio - defined as the costs per patient correctly diagnosed - of two algorithms used to diagnose hemodynamically significant CAD in relation to the pretest likelihood of CAD: 1) aCMRto assess ischemia before referring positive patients to CXA (CMR + CXA), 2) a CXA in all patients combined with a FFR test in patients with angiographically positive stenoses (CXA + FFR). Methods: The costs, evaluated from the health care system perspective in the Swiss, German, the United Kingdom (UK) and the United States (US) contexts, included public prices of the different tests considered as outpatient procedures, complications' costs and costs induced by diagnosis errors (false negative). The effectiveness criterion wasthe ability to accurately identify apatient with significantCAD.Test performancesused in the model were based on the clinical literature. Using a mathematical model, we compared the cost-effectiveness ratio for both algorithms for hypothetical patient cohorts with different pretest likelihood of CAD. Results: The cost-effectiveness ratio decreased hyperbolically with increasing pretest likelihood of CAD for both strategies. CMR + CXA and CXA + FFR were equally costeffective at a pretest likelihood of CAD of 62% in Switzerland, 67% in Germany, 83% in the UK and 84% in the US with costs of CHF 5'794, Euros 1'472, £ 2'685 and $ 2'126 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR. Implications for the health care system/professionals/patients/society These results facilitate decision making for the clinical use of new generations of imaging procedures to detect ischemia. They show to what extent the cost-effectiveness to diagnose CAD depends on the prevalence of the disease.

Igneous layering, fractional crystallization and growth of granitic plutons: The Dolbel batholith in SW Niger

This study reassesses the development of compositional layering during the growth of granitic plutons, with emphasis on fractional crystallization and its interaction with both injection and inflation-related deformation. The Dolbel batholith (SW Niger) consists of 14, kilometre-sized plutons emplaced by pulsed magma inputs. Each pluton has a coarse-grained core and a peripheral layered series. Rocks consist of albite (An(<= 11)), K-feldspar (Or(96 99), Ab(1) (4)), quartz, edenite (X(Mg)=0337-0.55), augite (X(Mg)=0.65-0.72) and accessories (apatite, titanite and Fe-Ti-oxides). Whole-rock compositions are metaluminous, sodic (K(2)O/Na(2)O=0.49-0.62) and iron-rich [FeO(tot)/(FeO(tot)+MgO)=0.65-0.82]. The layering is present as size-graded and modally graded, sub-vertical, rhythmic units. Each unit is composed of three layers, which are, towards the interior: edenite +/- plagioclase (C(a/p)), edenite+plagioclase+augite+quartz (C(q)), and edenite+plagioclase+augite+quartz+K-feldspar (C(k)). All phases except quartz show zoned microstructures consisting of external intercumulus overgrowths, a central section showing oscillatory zoning and, in the case of amphibole and titanite, complexly zoned cores. Ba and Sr contents of feldspars decrease towards the rims. Plagioclase crystal size distributions are similar in all units, suggesting that each unit experienced a similar thermal history. Edenite, characteristic of the basal C(a/p) layer, is the earliest phase to crystallize. Microtextures and phase diagrams suggest that edenite cores may have been brought up with magma batches at the site of emplacement and mechanically segregated along the crystallized wall, whereas outer zones of the same crystals formed in situ. The subsequent C(q) layers correspond to cotectic compositions in the Qz-Ab-Or phase diagram at P(H2O)=5 kbar. Each rhythmic unit may therefore correspond to a magma batch and their repetition to crystallization of recurrent magma recharges. Microtextures and chemical variations in major phases allow four main crystallization stages to be distinguished: (1) open-system crystallization in a stirred magma during magma emplacement, involving dissolution and overgrowth (core of edenite and titanite crystals); (2) in situ fractional crystallization in boundary layers (C(a/p) and C(q) layers); (3) equilibrium `en masse' eutectic crystallization (C(k) layers); (4) compaction and crystallization of the interstitial liquid in a highly crystallized mush (e. g. feldspar intercumulus overgrowths). It is concluded that the formation of the layered series in the Dolbel plutons corresponds principally to in situ differentiation of successive magma batches. The variable thickness of the Ck layers and the microtextures show that crystallization of a rhythmic unit stops and it is compacted when a new magma batch is injected into the chamber. Therefore, assembly of pulsed magma injections and fractional crystallization are independent, but complementary, processes during pluton construction.

Integral cohomology of finite postnikov towers

Depuis le séminaire H. Cartan de 1954-55, il est bien connu que l'on peut trouver des éléments de torsion arbitrairement grande dans l'homologie entière des espaces d'Eilenberg-MacLane K(G,n) où G est un groupe abélien non trivial et n>1. L'objectif majeur de ce travail est d'étendre ce résultat à des H-espaces possédant plus d'un groupe d'homotopie non trivial. Dans le but de contrôler précisément le résultat de H. Cartan, on commence par étudier la dualité entre l'homologie et la cohomologie des espaces d'Eilenberg-MacLane 2-locaux de type fini. On parvient ainsi à raffiner quelques résultats qui découlent des calculs de H. Cartan. Le résultat principal de ce travail peut être formulé comme suit. Soit X un H-espace ne possédant que deux groupes d'homotopie non triviaux, tous deux finis et de 2-torsion. Alors X n'admet pas d'exposant pour son groupe gradué d'homologie entière réduite. On construit une large classe d'espaces pour laquelle ce résultat n'est qu'une conséquence d'une caractéristique topologique, à savoir l'existence d'un rétract faible X K(G,n) pour un certain groupe abélien G et n>1. On généralise également notre résultat principal à des espaces plus compliqués en utilisant la suite spectrale d'Eilenberg-Moore ainsi que des méthodes analytiques faisant apparaître les nombres de Betti et leur comportement asymptotique. Finalement, on conjecture que les espaces qui ne possédent qu'un nombre fini de groupes d'homotopie non triviaux n'admettent pas d'exposant homologique. Ce travail contient par ailleurs la présentation de la « machine d'Eilenberg-MacLane », un programme C++ conçu pour calculer explicitement les groupes d'homologie entière des espaces d'Eilenberg-MacLane. <br/><br/>By the work of H. Cartan, it is well known that one can find elements of arbitrarilly high torsion in the integral (co)homology groups of an Eilenberg-MacLane space K(G,n), where G is a non-trivial abelian group and n>1. The main goal of this work is to extend this result to H-spaces having more than one non-trivial homotopy groups. In order to have an accurate hold on H. Cartan's result, we start by studying the duality between homology and cohomology of 2-local Eilenberg-MacLane spaces of finite type. This leads us to some improvements of H. Cartan's methods in this particular case. Our main result can be stated as follows. Let X be an H-space with two non-vanishing finite 2-torsion homotopy groups. Then X does not admit any exponent for its reduced integral graded (co)homology group. We construct a wide class of examples for which this result is a simple consequence of a topological feature, namely the existence of a weak retract X K(G,n) for some abelian group G and n>1. We also generalize our main result to more complicated stable two stage Postnikov systems, using the Eilenberg-Moore spectral sequence and analytic methods involving Betti numbers and their asymptotic behaviour. Finally, we investigate some guesses on the non-existence of homology exponents for finite Postnikov towers. We conjecture that Postnikov pieces do not admit any (co)homology exponent. This work also includes the presentation of the "Eilenberg-MacLane machine", a C++ program designed to compute explicitely all integral homology groups of Eilenberg-MacLane spaces. <br/><br/>Il est toujours difficile pour un mathématicien de parler de son travail. La difficulté réside dans le fait que les objets qu'il étudie sont abstraits. On rencontre assez rarement un espace vectoriel, une catégorie abélienne ou une transformée de Laplace au coin de la rue ! Cependant, même si les objets mathématiques sont difficiles à cerner pour un non-mathématicien, les méthodes pour les étudier sont essentiellement les mêmes que celles utilisées dans les autres disciplines scientifiques. On décortique les objets complexes en composantes plus simples à étudier. On dresse la liste des propriétés des objets mathématiques, puis on les classe en formant des familles d'objets partageant un caractère commun. On cherche des façons différentes, mais équivalentes, de formuler un problème. Etc. Mon travail concerne le domaine mathématique de la topologie algébrique. Le but ultime de cette discipline est de parvenir à classifier tous les espaces topologiques en faisant usage de l'algèbre. Cette activité est comparable à celle d'un ornithologue (topologue) qui étudierait les oiseaux (les espaces topologiques) par exemple à l'aide de jumelles (l'algèbre). S'il voit un oiseau de petite taille, arboricole, chanteur et bâtisseur de nids, pourvu de pattes à quatre doigts, dont trois en avant et un, muni d'une forte griffe, en arrière, alors il en déduira à coup sûr que c'est un passereau. Il lui restera encore à déterminer si c'est un moineau, un merle ou un rossignol. Considérons ci-dessous quelques exemples d'espaces topologiques: a) un cube creux, b) une sphère et c) un tore creux (c.-à-d. une chambre à air). a) b) c) Si toute personne normalement constituée perçoit ici trois figures différentes, le topologue, lui, n'en voit que deux ! De son point de vue, le cube et la sphère ne sont pas différents puisque ils sont homéomorphes: on peut transformer l'un en l'autre de façon continue (il suffirait de souffler dans le cube pour obtenir la sphère). Par contre, la sphère et le tore ne sont pas homéomorphes: triturez la sphère de toutes les façons (sans la déchirer), jamais vous n'obtiendrez le tore. Il existe un infinité d'espaces topologiques et, contrairement à ce que l'on serait naïvement tenté de croire, déterminer si deux d'entre eux sont homéomorphes est très difficile en général. Pour essayer de résoudre ce problème, les topologues ont eu l'idée de faire intervenir l'algèbre dans leurs raisonnements. Ce fut la naissance de la théorie de l'homotopie. Il s'agit, suivant une recette bien particulière, d'associer à tout espace topologique une infinité de ce que les algébristes appellent des groupes. Les groupes ainsi obtenus sont appelés groupes d'homotopie de l'espace topologique. Les mathématiciens ont commencé par montrer que deux espaces topologiques qui sont homéomorphes (par exemple le cube et la sphère) ont les même groupes d'homotopie. On parle alors d'invariants (les groupes d'homotopie sont bien invariants relativement à des espaces topologiques qui sont homéomorphes). Par conséquent, deux espaces topologiques qui n'ont pas les mêmes groupes d'homotopie ne peuvent en aucun cas être homéomorphes. C'est là un excellent moyen de classer les espaces topologiques (pensez à l'ornithologue qui observe les pattes des oiseaux pour déterminer s'il a affaire à un passereau ou non). Mon travail porte sur les espaces topologiques qui n'ont qu'un nombre fini de groupes d'homotopie non nuls. De tels espaces sont appelés des tours de Postnikov finies. On y étudie leurs groupes de cohomologie entière, une autre famille d'invariants, à l'instar des groupes d'homotopie. On mesure d'une certaine manière la taille d'un groupe de cohomologie à l'aide de la notion d'exposant; ainsi, un groupe de cohomologie possédant un exposant est relativement petit. L'un des résultats principaux de ce travail porte sur une étude de la taille des groupes de cohomologie des tours de Postnikov finies. Il s'agit du théorème suivant: un H-espace topologique 1-connexe 2-local et de type fini qui ne possède qu'un ou deux groupes d'homotopie non nuls n'a pas d'exposant pour son groupe gradué de cohomologie entière réduite. S'il fallait interpréter qualitativement ce résultat, on pourrait dire que plus un espace est petit du point de vue de la cohomologie (c.-à-d. s'il possède un exposant cohomologique), plus il est intéressant du point de vue de l'homotopie (c.-à-d. il aura plus de deux groupes d'homotopie non nuls). Il ressort de mon travail que de tels espaces sont très intéressants dans le sens où ils peuvent avoir une infinité de groupes d'homotopie non nuls. Jean-Pierre Serre, médaillé Fields en 1954, a montré que toutes les sphères de dimension >1 ont une infinité de groupes d'homotopie non nuls. Des espaces avec un exposant cohomologique aux sphères, il n'y a qu'un pas à franchir...

Evolution of T1 Relaxation, ADC, and Fractional Anisotropy during Early Brain Maturation: A Serial Imaging Study on Preterm Infants.

BACKGROUND AND PURPOSE: The alteration of brain maturation in preterm infants contributes to neurodevelopmental disabilities during childhood. Serial imaging allows understanding of the mechanisms leading to dysmaturation in the preterm brain. The purpose of the present study was to provide reference quantitative MR imaging measures across time in preterm infants, by using ADC, fractional anisotropy, and T1 maps obtained by using the magnetization-prepared dual rapid acquisition of gradient echo technique. MATERIALS AND METHODS: We included preterm neonates born at <30 weeks of gestational age without major brain lesions on early cranial sonography and performed 3 MRIs (3T) from birth to term-equivalent age. Multiple measurements (ADC, fractional anisotropy, and T1 relaxation) were performed on each examination in 12 defined white and gray matter ROIs. RESULTS: We acquired 107 MRIs (35 early, 33 intermediary, and 39 at term-equivalent age) in 39 cerebral low-risk preterm infants. Measures of T1 relaxation time showed a gradual and significant decrease with time in a region- and hemispheric-specific manner. ADC values showed a similar decline with time, but with more variability than T1 relaxation. An increase of fractional anisotropy values was observed in WM regions and inversely a decrease in the cortex. CONCLUSIONS: The gradual change with time reflects the progressive maturation of the cerebral microstructure in white and gray matter. Our study provides reference trajectories from 25 to 40 weeks of gestation of T1 relaxation, ADC, and fractional anisotropy values in low-risk preterm infants. We speculate that deviation thereof might reflect disturbed cerebral maturation; the correlation of this disturbed maturation with neurodevelopmental outcome remains to be addressed.