Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. METHODS: We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia). RESULTS: Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67-0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74-0.88, p<0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70-0.89, p<0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66-0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76-0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74-0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71-0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77-0.88, p < 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74-0.87, p < 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced, while common adverse effects were significantly increased. CONCLUSION: Aldosterone antagonists appear to be effective in reducing SCD and other mortality events, compared with placebo or standard medication in patients with HF and/or after a MI.

An experimental/numerical study of the turbulent boundary layer development along a surface with a sudden change in roughness

A theory for the description of turbulent boundary layer flows over surfaces with a sudden change in roughness is considered. The theory resorts to the concept of displacement in origin to specify a wall function boundary condition for a kappa-epsilon model. An approximate algebraic expression for the displacement in origin is obtained from the experimental data by using the chart method of Perry and Joubert(J.F.M., vol. 17, pp. 193-122, 1963). This expression is subsequently included in the near wall logarithmic velocity profile, which is then adopted as a boundary condition for a kappa-epsilon modelling of the external flow. The results are compared with the lower atmospheric observations made by Bradley(Q. J. Roy. Meteo. Soc., vol. 94, pp. 361-379, 1968) as well as with velocity profiles extracted from a set of wind tunnel experiments carried out by Avelino et al.( 7th ENCIT, 1998). The measurements are found to be in good agreement with the theoretical computations. The skin-friction coefficient was calculated according to the chart method of Perry and Joubert(J.F.M., vol. 17, pp. 193-122, 1963) and to a balance of the integral momentum equation. In particular, the growth of the internal boundary layer thickness obtained from the numerical simulation is compared with predictions of the experimental data calculated by two methods, the "knee" point method and the "merge" point method.

Classification and hearing evolution of patients with sudden sensorineural hearing loss

The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference in thresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.

Neighbourhood Income and Neonatal, Postneonatal and Sudden Infant Death Syndrome (SIDS) Mortality in Canada, 1991-2005

CONTEXTE : La mortalité infantile a diminué au Canada depuis les années 1990 et 2000 mais nous ignorons si toutes les classes socioéconomiques ont bénéficié également de ce progrès. OBJECTIFS : La présente étude portait sur les différences entre les taux de mortalité néonatale et postnéonatale et de mort subite du nourrisson entre les différents quintiles de revenu des quartiers au Canada de 1991 à 2005. MÉTHODES : Le fichier couplé des naissances vivantes et des décès infantiles au Canada a été utilisé à l’exclusion des naissances survenues en Ontario, au Yukon, dans les Territoires du Nord-ouest et au Nunavut. Les taux de mortalité néonatale et postnéonatale et de mort subite du nourrisson ont été calculé par quintile de revenu des quartiers et par période (1991-1995, 1996-2000, 2001-2005). Les rapports de risque (RR) ont été calculés par quintile de revenu et période avec ajustement pour la province de résidence, l’âge de la mère, la parité, le sexe du nourrisson et les naissances multiples. RÉSULTATS : En zone urbaine, pour toute la période étudiée (1991- 2005), le quintile de revenu le plus pauvre avait un risque plus élevé de mortalité néonatale (RR ajusté 1,24; IC 95% 1,15-1,34), de mortalité postnéonatale (RR ajusté 1,58; IC 95% 1,41-1,76) et de mort subite du nourrisson (RR ajusté 1,83; IC 95% 1,49-2,26) par rapport au quintile le plus riche. Les taux de mortalité post néonatale et de mort subite du nourrisson ont décliné respectivement de 37 % et de 57 % de 1991- 1995 à 2001-2005 alors que le taux de mortalité néonatale n’a pas changé de façon significative. Cette diminution de la mortalité postnéonatale et de la mort subite du nourrisson a été observée dans tous les quintiles de revenu. CONCLUSION : Malgré une diminution de la mortalité postnéonatale et du syndrome de mort subite du nourrisson dans tous les quintiles de revenu, les inégalités subsistent au Canada. Ce résultat démontre le besoin de stratégies efficaces de promotion de la santé visant spécifiquement les populations vulnérables. MOTS CLÉS : mort subite du nourrisson; mortalité infantile; statut socioéconomique

‘Sudden Stratospheric Warming and its Influence on the Tropical Atmosphere'

The stratospheric warming events are categorized into major and minor warming depending on the temperature increase in the polar stratosphere. The warming is called a ‘major’, when the polar temperature increases poleward from 60 degree latitude and followed by a reversal in the zonal wind at 10 hPa (~32 Km). Usually major warming events are associated with the displacement of polar vortex from high to mid latitudes or the splitting of vortices in to two. The warming is called a "Minor", when the polar temperature increases more than 25 degree in a period of a week or less, at any stratospheric level with less intensified easterly wind anomalies. The stratospheric warmings generated during the transition period of winter to spring are called final warmings. The warming events observed in the early winter period (November to early December) over Canadian region are called Canadian warmings. There is strong interaction between stratosphere and troposphere during SSW period over high and low latitudes regions. The thesis consists of 7 chapters

The frequency and dynamics of stratospheric sudden warmings in the 21st century

Changes to stratospheric sudden warmings (SSWs) over the coming century, as predicted by the Geophysical Fluid Dynamics Laboratory (GFDL) chemistry climate model [Atmospheric Model With Transport and Chemistry (AMTRAC)], are investigated in detail. Two sets of integrations, each a three-member ensemble, are analyzed. The first set is driven with observed climate forcings between 1960 and 2004; the second is driven with climate forcings from a coupled model run, including trace gas concentrations representing a midrange estimate of future anthropogenic emissions between 1990 and 2099. A small positive trend in the frequency of SSWs is found. This trend, amounting to 1 event/decade over a century, is statistically significant at the 90% confidence level and is consistent over the two sets of model integrations. Comparison of the model SSW climatology between the late 20th and 21st centuries shows that the increase is largest toward the end of the winter season. In contrast, the dynamical properties are not significantly altered in the coming century, despite the increase in SSW frequency. Owing to the intrinsic complexity of our model, the direct cause of the predicted trend in SSW frequency remains an open question.

A new look at stratospheric sudden warmings. Part III. Polar vortex evolution and vertical structure

The evolution of the Arctic polar vortex during observed major mid-winter stratospheric sudden warmings (SSWs) is investigated for the period 1957-2002, using European Centre for Medium-Range Weather Forecasts (ECMWF) ERA-40 Ertel’s potential vorticity (PV) and temperature fields. Time-lag composites of vertically weighted PV, calculated relative to the SSW onset time, are derived for both vortex displacement SSWs and vortex splitting SSWs, by averaging over the 15 recorded displacement and 13 splitting events. The evolving vertical structure of the polar vortex during a typical SSW of each type is clearly illustrated by plotting an isosurface of the composite PV field, and is shown to be very close to that observed during representative individual events. Results are verified by comparison with an elliptical diagnostic vortex moment technique. For both types of SSW, little variation is found between individual events in the orientation of the developing vortex relative to the underlying topography, i.e. the location of the vortex during SSWs of each type is largely fixed in relation to the Earth’s surface. During each type of SSW, the vortex is found to have a distinctive vertical structure. Vortex splitting events are typically barotropic, with the vortex split occurring near-simultaneously over a large altitude range (20-40 km). In the majority of cases, of the two daughter vortices formed, it is the ‘Siberian’ vortex that dominates over its ‘Canadian’ counterpart. In contrast, displacement events are characterized by a very clear baroclinic structure; the vortex tilts significantly westward with height, so that the top and bottom of the vortex are separated by nearly 180◦ longitude before the upper vortex is sheared away and destroyed.

Sudden stratospheric warmings as noise-induced transitions

Sudden stratospheric warmings (SSWs) are usually considered to be initiated by planetary wave activity. Here it is asked whether small-scale variability (e.g., related to gravity waves) can lead to SSWs given a certain amount of planetary wave activity that is by itself not sufficient to cause a SSW. A highly vertically truncated version of the Holton–Mass model of stratospheric wave–mean flow interaction, recently proposed by Ruzmaikin et al., is extended to include stochastic forcing. In the deterministic setting, this low-order model exhibits multiple stable equilibria corresponding to the undisturbed vortex and SSW state, respectively. Momentum forcing due to quasi-random gravity wave activity is introduced as an additive noise term in the zonal momentum equation. Two distinct approaches are pursued to study the stochastic system. First, the system, initialized at the undisturbed state, is numerically integrated many times to derive statistics of first passage times of the system undergoing a transition to the SSW state. Second, the Fokker–Planck equation corresponding to the stochastic system is solved numerically to derive the stationary probability density function of the system. Both approaches show that even small to moderate strengths of the stochastic gravity wave forcing can be sufficient to cause a SSW for cases for which the deterministic system would not have predicted a SSW.

A Possible Influence of Equatorial Winds on the September 2002 Southern Hemisphere Sudden Warming Event

The stratospheric sudden warming in the Southern Hemisphere (SH) in September 2002 was unexpected for two reasons. First, planetary wave activity in the Southern Hemisphere is very weak, and midwinter warmings have never been observed, at least not since observations of the upper stratosphere became regularly available. Second, the warming occurred in a west phase of the quasi-biennial oscillation (QBO) in the lower stratosphere. This is unexpected because warmings are usually considered to be more likely in the east phase of the QBO, when a zero wind line is present in the winter subtropics and hence confines planetary wave propagation to higher latitudes closer to the polar vortex. At first, this evidence suggests that the sudden warming must therefore be simply a result of anomalously strong planetary wave forcing from the troposphere. However, recent model studies have suggested that the midwinter polar vortex may also be sensitive to the equatorial winds in the upper stratosphere, the region dominated by the semiannual oscillation. In this paper, the time series of equatorial zonal winds from two different data sources, the 40-yr ECMWF Re-Analysis (ERA) and the Met Office assimilated dataset, are reviewed. Both suggest that the equatorial winds in the upper stratosphere above 10 hPa were anomalously easterly in 2002. Idealized model experiments are described in which the modeled equatorial winds were relaxed toward these observations for various years to examine whether the anomalous easterlies in 2002 could influence the timing of a warming event. It is found that the 2002 equatorial winds speed up the evolution of a warming event in the model. Therefore, this study suggests that the anomalous easterlies in the 1–10-hPa region may have been a contributory factor in the development of the observed SH warming. However, it is concluded that it is unlikely that the anomalous equatorial winds alone can explain the 2002 warming event.