Association between parental history and genetic risk scores for coronary heart disease prediction: The population-based CoLaus study.

BACKGROUND AND AIMS: Parental history (PH) and genetic risk scores (GRSs) are separately associated with coronary heart disease (CHD), but evidence regarding their combined effects is lacking. We aimed to evaluate the joint associations and predictive ability of PH and GRSs for incident CHD. METHODS: Data for 4283 Caucasians were obtained from the population-based CoLaus Study, over median follow-up time of 5.6 years. CHD was defined as incident myocardial infarction, angina, percutaneous coronary revascularization or bypass grafting. Single nucleotide polymorphisms for CHD identified by genome-wide association studies were used to construct unweighted and weighted versions of three GRSs, comprising of 38, 53 and 153 SNPs respectively. RESULTS: PH was associated with higher values of all weighted GRSs. After adjustment for age, sex, smoking, diabetes, systolic blood pressure, low and high density lipoprotein cholesterol, PH was significantly associated with CHD [HR 2.61, 95% CI (1.47-4.66)] and further adjustment for GRSs did not change this estimate. Similarly, one standard deviation change of the weighted 153-SNPs GRS was significantly associated with CHD [HR 1.50, 95% CI (1.26-1.80)] and remained so, after further adjustment for PH. The weighted, 153-SNPs GRS, but not PH, modestly improved discrimination [(C-index improvement, 0.016), p = 0.048] and reclassification [(NRI improvement, 8.6%), p = 0.027] beyond cardiovascular risk factors. After including both the GRS and PH, model performance improved further [(C-index improvement, 0.022), p = 0.006]. CONCLUSION: After adjustment for cardiovascular risk factors, PH and a weighted, polygenic GRS were jointly associated with CHD and provided additive information for coronary events prediction.

Comparison of the prognostic value of pretreatment measurements of systemic inflammatory response in patients undergoing curative resection of clear cell renal cell carcinoma.

PURPOSE: Pretreatment measurements of systemic inflammatory response, including the Glasgow prognostic score (GPS), the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), the platelet-to-lymphocyte ratio (PLR) and the prognostic nutritional index (PNI) have been recognized as prognostic factors in clear cell renal cell carcinoma (CCRCC), but there is at present no study that compared these markers. METHODS: We evaluated the pretreatment GPS, NLR, MLR, PLR and PNI in 430 patients, who underwent surgery for clinically localized CCRCC (pT1-3N0M0). Associations with disease-free survival were assessed with Cox models. Discrimination was measured with the C-index, and a decision curve analysis was used to evaluate the clinical net benefit. RESULTS: On multivariable analyses, all measures of systemic inflammatory response were significant prognostic factors. The increase in discrimination compared with the stage, size, grade and necrosis (SSIGN) score alone was 5.8 % for the GPS, 1.1-1.4 % for the NLR, 2.9-3.4 % for the MLR, 2.0-3.3 % for the PLR and 1.4-3.0 % for the PNI. On the simultaneous multivariable analysis of all candidate measures, the final multivariable model contained the SSIGN score (HR 1.40, P < 0.001), the GPS (HR 2.32, P < 0.001) and the MLR (HR 5.78, P = 0.003) as significant variables. Adding both the GPS and the MLR increased the discrimination of the SSIGN score by 6.2 % and improved the clinical net benefit. CONCLUSIONS: In patients with clinically localized CCRCC, the GPS and the MLR appear to be the most relevant prognostic measures of systemic inflammatory response. They may be used as an adjunct for patient counseling, tailoring management and clinical trial design.

Factores asociados a que usuarias de un hospital público, no soliciten los resultados de citologia cervical

El cáncer de cuello uterino y su mortalidad en Colombia ha permanecido constantes pese a los esfuerzos institucionales, distritales y nacionales que han buscado fortalecer los programas de prevención; sin embargo las estrategias actuales hacen énfasis en la toma de citología y no en la solicitud oportuna del resultado y el tratamiento de la usuaria en caso de anormalidad. METODOLOGIA: Se realizó un estudio en dos fases, un análisis descriptivo se analizaron 12875 y una segunda que involucro 257 pacientes en un análisis de casos y controles de una muestra aleatoria. RESULTADOS: Se utiliza para análisis bivariado la prueba de Chi cuadrado y regresión logística que muestran diferencias significativas en los siguientes variables: la explicación sobre la importancia del examen (p= 0.0060), importancia de la solicitud de resultado (p= 0.003), explicación sobre cuando reclamarlo (p=0.030), distancia entre residencia y centro de salud (p=0.065) DISCUSIÓN: En nuestro estudio se identificó que los factores como el acceso de la paciente al centro de salud, el tiempo del cual dispone para solicitar el resultado, si el dinero con el que cuenta la paciente para desplazarse al hospital, si es la primera vez que se realiza la citología, si le explicaron la importancia de reclamar el resultado y en que lapso de tiempo debía hacerlo, la información que tiene acerca de la importancia de realizarse la citología contribuyen en el hecho de que una paciente de esta población de un hospital público reclame o no su resultado de su citología

Supervivencia cáncer específica posterior a nefrectomía radical frente a nefrectomía parcial en carcinoma renal t2: revisión sistemática

Introducción: El tratamiento estándar para los tumores renales localizados es la nefrectomía radical, sin embargo debido a la variación el tamaño del tumor renal en el momento del diagnóstico, se ha reemplazado en algunos casos por la nefrectomía parcial. Objetivo: Este estudio busca comparar el resultado oncológico de la nefrectomía parcial en términos de supervivencia cáncer específica, respecto a la nefrectomía radical, en pacientes mayores de 50 años con carcinoma renal estadio II (T2N0M0) Métodos: Se realizó una revisión sistemática de la literatura, con inclusión de estudios de casos y controles, cohortes y experimentos clínicos aleatorizados incluidos en las bases de datos de MEDLINE , EMBASE y CENTRAL Resultados: La búsqueda inicial emitió un total de 101 resultados, 11 artículos fueron preseleccionados y sólo un artículo cumplió con los criterios de selección; éste se clasificó como nivel de evidencia II. Conclusión: No fue posible concluir su equivalencia oncológica de la nefrectomía radical con la nefrectomía parcial, dado que no hay diseños de estudios que permitan llegar a esta conclusión.

Evolución de importaciones entre Corea del Sur y Colombia 2013

En los últimos años Colombia ha demostrado un cambio y apertura en su política comercial, aumentando su interés por expandir sus relaciones comerciales con otros países y otros continentes. Como resultado de estas políticas comerciales y la constante evolución y cambio en las tendencias comerciales en el mundo. Colombia le apuesta a diversificar sus exportaciones por medio de la realización de Tratados de Libre Comercio con países de continentes como el Asiático. Y su primera aproximación para establecer una relación comercial con el continente Asiático es la firma del TLC con la República de Corea. Como consecuencia de la firma del TLC, es necesario que tanto el Estado junto con sus instituciones, el sector real y la academia unan esfuerzos para que se le saque el mayor provecho y se identifiquen las mejores oportunidades a este tipo de tratados. Por lo tanto el objetivo del proyecto como parte de una contribución al Laboratorio de Tratados de Libre Comercio de la Universidad del Rosario es determinar la evolución de las relaciones comerciales entre Colombia y Corea por medio de herramientas cuantitativas y cualitativas, con el fin de a partir del entendimiento de la evolución en la relación comercial establecer un marco de oportunidades para los diferentes sectores y empresas colombianas. Esta relación se determinara estudiando la evolución en forma cuantitativa de las importaciones realizadas por Colombia y cada uno de sus departamentos desde Corea del Sur. Analizando la evolución en las importaciones de los diez principales productos importados por cada departamento desde Corea del Sur en los últimos años.

Estimation of visual motion parameters used for bio-inspired navigation

Visual motion cues play an important role in animal and humans locomotion without the need to extract actual ego-motion information. This paper demonstrates a method for estimating the visual motion parameters, namely the Time-To-Contact (TTC), Focus of Expansion (FOE), and image angular velocities, from a sparse optical flow estimation registered from a downward looking camera. The presented method is capable of estimating the visual motion parameters in a complicated 6 degrees of freedom motion and in real time with suitable accuracy for mobile robots visual navigation.

Exact arbitrage, well-diversified portfolios and asset pricing in large markets

: In a model of a nancial market with an atomless continuum of assets, we give a precise and rigorous meaning to the intuitive idea of a \well-diversi ed" portfolio and to a notion of \exact arbitrage". We show this notion to be necessary and su cient for an APT pricing formula to hold, to be strictly weaker than the more conventional notion of \asymptotic arbitrage", and to have novel implications for the continuity of the cost functional as well as for various versions of APT asset pricing. We further justify the idealized measure-theoretic setting in terms of a pricing formula based on \essential" risk, one of the three components of a tri-variate decomposition of an asset's rate of return, and based on a speci c index portfolio constructed from endogenously extracted factors and factor loadings. Our choice of factors is also shown to satisfy an optimality property that the rst m factors always provide the best approximation. We illustrate how the concepts and results translate to markets with a large but nite number of assets, and relate to previous work.

Bayesian binary regression model: an application to in-hospital death after AMI prediction

Um modelo bayesiano de regressão binária é desenvolvido para predizer óbito hospitalar em pacientes acometidos por infarto agudo do miocárdio. Métodos de Monte Carlo via Cadeias de Markov (MCMC) são usados para fazer inferência e validação. Uma estratégia para construção de modelos, baseada no uso do fator de Bayes, é proposta e aspectos de validação são extensivamente discutidos neste artigo, incluindo a distribuição a posteriori para o índice de concordância e análise de resíduos. A determinação de fatores de risco, baseados em variáveis disponíveis na chegada do paciente ao hospital, é muito importante para a tomada de decisão sobre o curso do tratamento. O modelo identificado se revela fortemente confiável e acurado, com uma taxa de classificação correta de 88% e um índice de concordância de 83%.

Experimental and numerical study of heat transfer in hot machined workpiece using infrared radiation

One of the greatest problems found in machining is related to the cutting tool wear. A way for increasing the tool life points out to the development of materials more resistant to wear, such as PCBN inserts. However, the unit cost of these tools is considerable high, around 10 to 20 times compared to coated carbide insert, besides its better performance occurs in high speeds requiring modern machine tools. Another way, less studied is the workpiece heating in order to diminish the shear stress material and thus reduce the machining forces allowing an increase of tool life. For understanding the heat transfer influences by conduction in this machining process, a mathematical model was developed to allow a simplified numerical simulation, using the finite element method, in order to determine the temperature profiles inside the workpiece.

Application of an auditory steady-state response test to evaluate the attenuation of hearing protection devices

This research aims to present a new method to get real attenuation of hearing protection devices, with good reproducibility and a small standard deviation, without relying on skills and cooperation individual. Thus the authors performed tests in 10 individuals without protection and after with two kinds of ear protections (ear plug and ear muffs), to get the threshold limit value in each of the 3 stages. For this, the research used an electrophysical exam, normally used in speech therapy, named ASSR (auditory steady-state response). The principle of this exam is put on individual’s head 3 electrodes, to capture electrical signs directly in auditory nerve. In summary, the authors presented the final results. The method proposed by ANSI (American National Standards Institute) indicated an attenuation of 27.6 dB for ear plugs, while the value found in this work was 16 dB; and for ear muffs, the ANSI method indicated 29.8 dB while the value found here was 28.5 dB.

Prediction of enzymatic infarct size in ST-segment elevation myocardial infarction

Objectives Predictors of adverse outcomes following myocardial infarction (MI) are well established; however, little is known about what predicts enzymatically estimated infarct size in patients with acute ST-elevation MI. The Complement And Reduction of INfarct size after Angioplasty or Lytics trials of pexelizumab used creatine kinase (CK)-MB area under the curve to determine infarct size in patients treated with primary percutaneous coronary intervention (PCI) or fibrinolysis. Methods Prediction of infarct size was carried out by measuring CK-MB area under the curve in patients with ST-segment elevation MI treated with reperfusion therapy from January 2000 to April 2002. Infarct size was calculated in 1622 patients (PCI=817; fibrinolysis=805). Logistic regression was used to examine the relationship between baseline demographics, total ST-segment elevation, index angiographic findings (PCI group), and binary outcome of CK-MB area under the curve greater than 3000 ng/ml. Results Large infarcts occurred in 63% (515) of the PCI group and 69% (554) of the fibrinolysis group. Independent predictors of large infarcts differed depending on mode of reperfusion. In PCI, male sex, no prior coronary revascularization and diabetes, decreased systolic blood pressure, sum of ST-segment elevation, total (angiographic) occlusion, and nonright coronary artery culprit artery were independent predictors of larger infarcts (C index=0.73). In fibrinolysis, younger age, decreased heart rate, white race, no history of arrhythmia, increased time to fibrinolytic therapy in patients treated up to 2 h after symptom onset, and sum of ST-segment elevation were independently associated with a larger infarct size (C index=0.68). Conclusion Clinical and patient data can be used to predict larger infarcts on the basis of CK-MB quantification. These models may be helpful in designing future trials and in guiding the use of novel pharmacotherapies aimed at limiting infarct size in clinical practice. Coron Artery Dis 23:118-125 (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Definição de metadados para registros de áudio em repositórios digitais de acesso aberto

A sociedade atual exige inovadores ambientes de trabalho para lidar efetivamente com uma carga cada vez maior de informações heterogêneas. A produção e divulgação dos dados e novos conhecimentos também ocorrem de forma rápida e ampla. No entanto, recuperar informação relevante torna-se cada vez mais difícil, uma vez que o conhecimento humano não está mais centralizado em unidades físicas de informação e sim distribuído, inclusive em repositórios digitais. Com a diversidade de suportes existentes uma informação pode estar num livro, num artigo, num filme ou num arquivo de áudio. O objetivo deste trabalho é definir os metadados para registros de áudio em repositórios digitais de acesso aberto, garantindo que essas informações tenham maior visibilidade no extenso universo da internet. Os metadados possuem importante contribuição no registro e na futura recuperação do recurso informacional, tornando acessíveis coleções que existem apenas em formato digital. Assim, o processo de recuperação depende da qualidade do tratamento dado ao documento e da escolha e uso dos tipos de metadados. O Dublin Core (DC) é um dos esquemas de metadados mais utilizado em repositórios digitais, sendo já um padrão ISO (ISO 15836:2009). Neste trabalho foi feita a identificação e comparação dos metadados disponíveis no formato MARC 21, na metodologia LILACS e também no esquema DC, definindo-se um escopo mínimo de metadados. Para melhorar e completar a descrição dos registros desse tipo de material, que possui uma complexidade específica, também foram acrescentados novos metadados com base em estudos feitos pela Library of Congress para o desenvolvimento de sua coleção digital. O resultado do trabalho é um formulário específico para os materiais de coleções de áudio, mantendo a compatibilidade e interoperabilidade com o esquema Dublin Core. Aos elementos existentes foram agregados refinamentos como entrevistador, editor de som, áudio bits, duração e identificação do arquivo, que abrangem e melhoram os aspectos de descrição e preservação digital. O mundo está rapidamente sendo transformado pela proliferação de recursos de informação disponíveis e distribuídos pela rede de computadores com um número cada vez maior de instituições que têm desenvolvido coleções digitais. Uma das vantagens das coleções em áudio é o fato de que a linguagem utilizada na expressão oral, especialmente em entrevistas, tende a ser mais coloquial e por isso torna a informação mais acessível aos ouvintes não especializados nas disciplinas em questão e faz a ponte entre universidade e sociedade. Dar visibilidade às coleções de áudio, “spots” de rádio acessíveis que podem ser veiculados por rádios comunitárias e educativas, vai ao encontro do papel de promoção de pesquisas das instituições. Esse compartilhamento da informação contribui para a construção da cidadania e capacitação da população para participar das políticas públicas

Framingham risk score and alternatives for prediction of coronary heart disease in older adults

Background Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS. Methods Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization. Results During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS. Conclusions The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.

Re-evaluating adjuvant breast cancer trials: assessing hormone receptor status by immunohistochemical versus extraction assays

BACKGROUND: Tumor levels of steroid hormone receptors, a factor used to select adjuvant treatment for early-stage breast cancer, are currently determined with immunohistochemical assays. These assays have a discordance of 10%-30% with previously used extraction assays. We assessed the concordance and predictive value of hormone receptor status as determined by immunohistochemical and extraction assays on specimens from International Breast Cancer Study Group Trials VIII and IX. These trials predominantly used extraction assays and compared adjuvant chemoendocrine therapy with endocrine therapy alone among pre- and postmenopausal patients with lymph node-negative breast cancer. Trial conclusions were that combination therapy provided a benefit to pre- and postmenopausal patients with estrogen receptor (ER)-negative tumors but not to ER-positive postmenopausal patients. ER-positive premenopausal patients required further study. METHODS: Tumor specimens from 571 premenopausal and 976 postmenopausal patients on which extraction assays had determined ER and progesterone receptor (PgR) levels before randomization from October 1, 1988, through October 1, 1999, were re-evaluated with an immunohistochemical assay in a central pathology laboratory. The endpoint was disease-free survival. Hazard ratios of recurrence or death for treatment comparisons were estimated with Cox proportional hazards regression models, and discriminatory ability was evaluated with the c index. All statistical tests were two-sided. RESULTS: Concordance of hormone receptor status determined by both assays ranged from 74% (kappa = 0.48) for PgR among postmenopausal patients to 88% (kappa = 0.66) for ER in postmenopausal patients. Hazard ratio estimates were similar for the association between disease-free survival and ER status (among all patients) or PgR status (among postmenopausal patients) as determined by the two methods. However, among premenopausal patients treated with endocrine therapy alone, the discriminatory ability of PgR status as determined by immunohistochemical assay was statistically significantly better (c index = 0.60 versus 0.51; P = .003) than that determined by extraction assay, and so immunohistochemically determined PgR status could predict disease-free survival. CONCLUSIONS: Trial conclusions in which ER status (for all patients) or PgR status (for postmenopausal patients) was determined by immunohistochemical assay supported those determined by extraction assays. However, among premenopausal patients, trial conclusions drawn from PgR status differed--immunohistochemically determined PgR status could predict response to endocrine therapy, unlike that determined by the extraction assay.

Concordance Probability and Discriminatory Power in Proportional Hazards Regression

The concordance probability is used to evaluate the discriminatory power and the predictive accuracy of nonlinear statistical models. We derive an analytic expression for the concordance probability in the Cox proportional hazards model. The proposed estimator is a function of the regression parameters and the covariate distribution only and does not use the observed event and censoring times. For this reason it is asymptotically unbiased, unlike Harrell's c-index based on informative pairs. The asymptotic distribution of the concordance probability estimate is derived using U-statistic theory and the methodology is applied to a predictive model in lung cancer.