Revascularization versus medical therapy for renal-artery stenosis

Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited.

Tolvaptan in patients with autosomal dominant polycystic kidney disease

The course of autosomal dominant polycystic kidney disease (ADPKD) is often associated with pain, hypertension, and kidney failure. Preclinical studies indicated that vasopressin V(2)-receptor antagonists inhibit cyst growth and slow the decline of kidney function.

Simvastatin in the Acute Respiratory Distress Syndrome

Background

Studies in animals and in vitro and phase 2 studies in humans suggest that statins may be beneficial in the treatment of the acute respiratory distress syndrome (ARDS). This study tested the hypothesis that treatment with simvastatin would improve clinical outcomes in patients with ARDS.

Methods

In this multicenter, double-blind clinical trial, we randomly assigned (in a 1:1 ratio) patients with an onset of ARDS within the previous 48 hours to receive enteral simvastatin at a dose of 80 mg or placebo once daily for a maximum of 28 days. The primary outcome was the number of ventilator-free days to day 28. Secondary outcomes included the number of days free of nonpulmonary organ failure to day 28, mortality at 28 days, and safety.

Results

The study recruited 540 patients, with 259 patients assigned to simvastatin and 281 to placebo. The groups were well matched with respect to demographic and baseline physiological variables. There was no significant difference between the study groups in the mean (±SD) number of ventilator-free days (12.6±9.9 with simvastatin and 11.5±10.4 with placebo, P=0.21) or days free of nonpulmonary organ failure (19.4±11.1 and 17.8±11.7, respectively; P=0.11) or in mortality at 28 days (22.0% and 26.8%, respectively; P=0.23). There was no significant difference between the two groups in the incidence of serious adverse events related to the study drug.

Conclusions

Simvastatin therapy, although safe and associated with minimal adverse effects, did not improve clinical outcomes in patients with ARDS. (Funded by the U.K. National Institute for Health Research Efficacy and Mechanism Evaluation Programme and others; HARP-2 Current Controlled Trials number, ISRCTN88244364.)

Tiotropium Respimat inhaler and the risk of death in COPD

Tiotropium delivered at a dose of 5 μg with the Respimat inhaler showed efficacy similar to that of 18 μg of tiotropium delivered with the HandiHaler inhalation device in placebo-controlled trials involving patients with chronic obstructive pulmonary disease (COPD). Although tiotropium HandiHaler was associated with reduced mortality, as compared with placebo, more deaths were reported with tiotropium Respimat than with placebo.

An approach to determine the local boundary of small disturbance voltage stability region in a cut-set power space:基于微扰的割集电压稳定域局部边界求解方法

A new approach to determine the local boundary of voltage stability region in a cut-set power space (CVSR) is presented. Power flow tracing is first used to determine the generator-load pair most sensitive to each branch in the interface. The generator-load pairs are then used to realize accurate small disturbances by controlling the branch power flow in increasing and decreasing directions to obtain new equilibrium points around the initial equilibrium point. And, continuous power flow is used starting from such new points to get the corresponding critical points around the initial critical point on the CVSR boundary. Then a hyperplane cross the initial critical point can be calculated by solving a set of linear algebraic equations. Finally, the presented method is validated by some systems, including New England 39-bus system, IEEE 118-bus system, and EPRI-1000 bus system. It can be revealed that the method is computationally more efficient and has less approximation error. It provides a useful approach for power system online voltage stability monitoring and assessment. This work is supported by National Natural Science Foundation of China (No. 50707019), Special Fund of the National Basic Research Program of China (No. 2009CB219701), Foundation for the Author of National Excellent Doctoral Dissertation of PR China (No. 200439), Tianjin Municipal Science and Technology Development Program (No. 09JCZDJC25000), National Major Project of Scientific and Technical Supporting Programs of China During the 11th Five-year Plan Period (No. 2006BAJ03A06). ©2009 State Grid Electric Power Research Institute Press.

Genetically Determined Height and Coronary Artery Disease

Background: The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear. 
Methods: We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD (6.5 cm) with the risk of CAD in 65,066 cases and 128,383 controls. Using individual-level genotype data from 18,249 persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles. To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes. 
Results: We observed a relative increase of 13.5% (95% confidence interval [CI], 5.4 to 22.1; P<0.001) in the risk of CAD per 1-SD decrease in genetically determined height. There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD (odds ratio for height quartile 4 versus quartile 1, 0.74; 95% CI, 0.68 to 0.84; P<0.001). Of the 12 risk factors that we studied, we observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides (accounting for approximately 30% of the association). We identified several overlapping pathways involving genes associated with both development and atherosclerosis. 
Conclusions: There is a primary association between a genetically determined shorter height and an increased risk of CAD, a link that is partly explained by the association between shorter height and an adverse lipid profile. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association. (Funded by the British Heart Foundation and others.)

DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer

BACKGROUND: Prostate cancer is a heterogeneous disease, but current treatments are not based on molecular stratification. We hypothesized that metastatic, castration-resistant prostate cancers with DNA-repair defects would respond to poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibition with olaparib.

METHODS: We conducted a phase 2 trial in which patients with metastatic, castration-resistant prostate cancer were treated with olaparib tablets at a dose of 400 mg twice a day. The primary end point was the response rate, defined either as an objective response according to Response Evaluation Criteria in Solid Tumors, version 1.1, or as a reduction of at least 50% in the prostate-specific antigen level or a confirmed reduction in the circulating tumor-cell count from 5 or more cells per 7.5 ml of blood to less than 5 cells per 7.5 ml. Targeted next-generation sequencing, exome and transcriptome analysis, and digital polymerase-chain-reaction testing were performed on samples from mandated tumor biopsies.

RESULTS: Overall, 50 patients were enrolled; all had received prior treatment with docetaxel, 49 (98%) had received abiraterone or enzalutamide, and 29 (58%) had received cabazitaxel. Sixteen of 49 patients who could be evaluated had a response (33%; 95% confidence interval, 20 to 48), with 12 patients receiving the study treatment for more than 6 months. Next-generation sequencing identified homozygous deletions, deleterious mutations, or both in DNA-repair genes--including BRCA1/2, ATM, Fanconi's anemia genes, and CHEK2--in 16 of 49 patients who could be evaluated (33%). Of these 16 patients, 14 (88%) had a response to olaparib, including all 7 patients with BRCA2 loss (4 with biallelic somatic loss, and 3 with germline mutations) and 4 of 5 with ATM aberrations. The specificity of the biomarker suite was 94%. Anemia (in 10 of the 50 patients [20%]) and fatigue (in 6 [12%]) were the most common grade 3 or 4 adverse events, findings that are consistent with previous studies of olaparib.

CONCLUSIONS: Treatment with the PARP inhibitor olaparib in patients whose prostate cancers were no longer responding to standard treatments and who had defects in DNA-repair genes led to a high response rate. (Funded by Cancer Research UK and others; ClinicalTrials.gov number, NCT01682772; Cancer Research UK number, CRUK/11/029.).

Apropriação do português por adultos eslavófonos: o tempo e o aspeto

As alterações no panorama social português que ocorreram no virar do milénio, marcadas pela chegada massiva de imigrantes provenientes de países que não tinham laços históricos e linguísticos com Portugal – com destaque para as comunidades do Leste europeu –, vieram colocar novos desafios à sociedade e à escola portuguesas. Com o propósito de caracterizar o perfil de apropriação da Língua Portuguesa (LP) de aprendentes adultos eslavófonos residentes em Portugal, foram recolhidos 87 questionários e testes linguísticos junto de adultos falantes de línguas eslavas que frequentavam cursos de LP em contexto formal/ não formal. Complementarmente, foram realizadas 17 entrevistas a aprendentes e professores. A análise de dados, de carácter quantitativo e qualitativo, centrou-se em três eixos fundamentais: a) o perfil de apropriação da LP; b) a gestão dos repertórios linguísticos; e c) as dificuldades manifestadas na apropriação, compreensão e uso do sistema temporal-aspetual em LP. Para cada um destes eixos, salientamos as seguintes conclusões: a) o contexto formal/ não formal é aquele que é considerado o mais eficaz; a apropriação da LP decorre ainda em contexto de autoaprendizagem e em contexto informal. A expressão oral afigura-se como uma competência de intervenção prioritária para este público. b) os repertórios linguísticos dos informantes deste estudo são limitados em número e diversidade de línguas, estando quase circunscritos às línguas eslavas, com amplo destaque para o Russo. A influência das Línguas Maternas na apropriação da LP é percecionada, de uma forma geral, como negativa, e é reduzida a adoção de estratégias de rentabilização interlinguística. c) as principais dificuldades no que se refere ao Tempo e Aspeto prendem- -se com o modo conjuntivo, os tempos compostos, os valores secundários de alguns tempos verbais, o pretérito perfeito composto do indicativo, a distinção entre o pretérito perfeito simples e o pretérito imperfeito do indicativo e a distinção entre os verbos ‘ser’ e ‘estar’. De uma forma global, apontam-se como pistas de intervenção a criação de cursos de LP de nível mais avançado, uma maior rentabilização do capital linguístico presente em sala de aula e a frequência, por parte dos docentes, de formação em línguas eslavas. A nível de recursos didáticos, sugere-se a elaboração de materiais bilingues para autoaprendizagem e de materiais de apoio ao professor. Seria igualmente útil a promoção de mais oportunidades de interação entre imigrantes e nativos.

The sectionalism of the tariff bill. Speech of Hon. John L. McLaurin, of South Carolina, in the Senate of the United States

This document contains a speech by John L. McLaurin, representative of South Carolina. Sections of the speech include: sectionalism exposed, the bill might have been defeated, the south plundered of its rights, not a protectionist, fraudulent demands of New England, Hon. Randolph Tucker, Hon. W.R. Morrison, and Hon. R.Q. Mills strangers to the doctrine in 1882, a tariff for revenue against the doctrine of free raw material, don’t want Cleveland’s interpretation, contest of schedules, and my remedy.

LMP triggered real time demand response events

Recent changes in power systems mainly due to the substantial increase of distributed generation and to the operation in competitive environments has created new challenges to operation and planning. In this context, Virtual Power Players (VPP) can aggregate a diversity of players, namely generators and consumers, and a diversity of energy resources, including electricity generation based on several technologies, storage and demand response. Demand response market implementation has been done in recent years. Several implementation models have been considered. An important characteristic of a demand response program is the trigger criterion. A program for which the event trigger depends on the Locational Marginal Price (LMP) used by the New England Independent System operator (ISO-NE) inspired the present paper. This paper proposes a methodology to support VPP demand response programs management. The proposed method has been computationally implemented and its application is illustrated using a 32 bus network with intensive use of distributed generation. Results concerning the evaluation of the impact of using demand response events are also presented.

Sei whale (Balaenoptera borealis) ecology and management in the North Atlantic

Tese de Doutoramento em Ciências do Mar, especialidade em Ecologia Marinha.

Pro Bono Publico, poem, n.d.

The poem is unsigned and is not divided into stanzas. It mentions General Brock, General Dearborn, Sir Peregrine, Fort George and the militia men of Lincoln. General Isaac Brock was a British Army officer and administrator who was promoted to Major General. He was responsible for defending Upper Canada against the United States. He died at the Battle of Queenston Heights during the War of 1812. In 1812, Dearborn was in charge of the northeastern sector from Niagara to the New England coast in his role as senior Major General of the U.S. Army. Dearborn proved that he was neither psychologically nor physically fit enough to take control. He tried to persuade New England governors to allow their militia to be used to invade Canada. He was not successful in his quest and no major offensive was launched against Lower Canada. Sir Peregrine probably refers to Sir Peregrine Maitland who was appointed as the Lieutenant Governor of Upper Canada in 1818. Fort George is located in Niagara-on-the-Lake, Ontario. It was the site of several battles during the War of 1812. The Lincoln Militia fought in battles on the Niagara Peninsula and the eastern shores of the Niagara River in the War of 1812.