Hospitalization Rates and Post-Operative Mortality for Abdominal Aortic Aneurysm in Italy over the Period 2000–2011

Background

Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000–2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s.

Methods

This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs).

Results

Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001). The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001). No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs.

Conclusions

The incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008.     

Transfemoral Aortic Valve Implantation with the New Edwards Sapien 3 Valve for Treatment of Severe Aortic Stenosis—Impact of Valve Size in a Single Center Experience

Aims

The third generation Edwards Sapien 3 (Edwards Lifesciences Inc., Irvine, California) system was optimized to reduce residual aortic regurgitation and vascular complications.

Methods and Results

235 patients with severe symptomatic aortic stenosis were prospectively enrolled. Transcatheter aortic valve implantations (TAVI) were performed without general anesthesia by transfemoral approach. Patients were followed for 30 days. Patients received 23mm (N = 77), 26mm (N = 91) or 29mm (N = 67) valve based on pre-procedural 256 multislice computer tomography. Mean oversizing did not differ between the 3 valves. There was no residual moderate or severe aortic regurgitation. Rate of mild aortic regurgitation and regurgitation index did not differ between groups. There was no switch to general anesthesia or conversion to surgery. Rate of major vascular complication was 3.0% with no difference between valve and delivery sheath sizes. Within 30 days rates of all cause mortality (2.6%) and stroke (2.1%) were low.

Conclusions

In patients with severe aortic stenosis transfemoral TAVI with the Edwards Sapien 3 valve without general anesthesia was associated with a high rate of device success, no moderate or severe residual aortic regurgitation, low rates of major vascular complication, mortality and stroke within 30 days with no difference between the 3 valve sizes.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02162069","term_id":"NCT02162069"}}NCT02162069     

Geometric optimization for prey–predator strategies

This paper investigates several strategies for prey and predator in both bounded and unbounded domains, assuming they have the same speed. The work describes how the prey should move to escape from the predator and how predator should move to catch the prey. The approach is agent-based and explicitly tracks movement of individuals as prey and predator. We show that the prey escapes one or two competing predators, while might be caught in the case of three predators. The paper also describes a strategy for finding a well camouflaged static prey which emits signals.     

Scoring functions for protein–protein interactions

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Box–Cox transformation for QTL mapping

The maximum likelihood method of QTL mapping assumes that the phenotypic values of a quantitative trait follow a normal distribution. If the assumption is violated, some forms of transformation should be taken to make the assumption approximately true. The Box–Cox transformation is a general transformation method which can be applied to many different types of data. The flexibility of the Box–Cox transformation is due to a variable, called transformation factor, appearing in the Box–Cox formula. We developed a maximum likelihood method that treats the transformation factor as an unknown parameter, which is estimated from the data simultaneously along with the QTL parameters. The method makes an objective choice of data transformation and thus can be applied to QTL analysis for many different types of data. Simulation studies show that (1) Box–Cox transformation can substantially increase the power of QTL detection; (2) Box–Cox transformation can replace some specialized transformation methods that are commonly used in QTL mapping; and (3) applying the Box–Cox transformation to data already normally distributed does not harm the result.     

Exact Tests for Hardy–Weinberg Proportions

Exact conditional tests are often required to evaluate statistically whether a sample of diploids comes from a population with Hardy–Weinberg proportions or to confirm the accuracy of genotype assignments. This requirement is especially common when the sample includes multiple alleles and sparse data, thus rendering asymptotic methods, such as the common χ²-test, unreliable. Such an exact test can be performed using the likelihood ratio as its test statistic rather than the more commonly used probability test. Conceptual advantages in using the likelihood ratio are discussed. A substantially improved algorithm is described to permit the performance of a full-enumeration exact test on sample sizes that are too large for previous methods. An improved Monte Carlo algorithm is also proposed for samples that preclude full enumeration. These algorithms are about two orders of magnitude faster than those currently in use. Finally, methods are derived to compute the number of possible samples with a given set of allele counts, a useful quantity for evaluating the feasibility of the full enumeration procedure. Software implementing these methods, ExactoHW, is provided.WHEN studying the genetics of a population, one of the first questions to be asked is whether the genotype frequencies fit Hardy–Weinberg (HW) expectations. They will fit HW if the population is behaving like a single randomly mating unit without intense viability selection acting on the sampled loci. In addition, testing for HW proportions is often used for quality control in genotyping, as the test is sensitive to misclassifications or undetected null alleles. Traditionally, geneticists have relied on test statistics with asymptotic χ²-distributions to test for goodness-of-fit with respect to HW proportions. However, as pointed out by several authors (Elston and Forthofer 1977; Emigh 1980; Louis and Dempster 1987; Hernandez and Weir 1989; Guo and Thompson 1992; Chakraborty and Zhong 1994; Rousset and Raymond 1995; Aoki 2003; Maiste and Weir 2004; Wigginton et al. 2005; Kang 2008; Rohlfs and Weir 2008), these asymptotic tests quickly become unreliable when samples are small or when rare alleles are involved. The latter situation is increasingly common as techniques for detecting large numbers of alleles become widely used. Moreover, loci with large numbers of alleles are intentionally selected for use in DNA identification techniques (e.g., Weir 1992). The result is often sparse-matrix data for which the asymptotic methods cannot be trusted.A solution to this problem is to use an exact test (Levene 1949; Haldane 1954) analogous to Fisher''s exact test for independence in a 2 × 2 contingency table and its generalization to rectangular tables (Freeman and Halton 1951). In this approach, one considers only potential outcomes that have the same allele frequencies as observed, thus greatly reducing the number of outcomes that must be analyzed. One then identifies all such outcomes that deviate from the HW null hypothesis by at least as much the observed sample. The total probability of this subset of outcomes, conditioned on HW and the observed allele frequencies, is then the P-value of the test. When it is not possible to enumerate all outcomes, it is still feasible to approximate the P-value by generating a large random sample of tables.The exact HW test has been used extensively and eliminates the uncertainty inherent in the asymptotic methods (Emigh 1980; Hernandez and Weir 1989; Guo and Thompson 1992; Rousset and Raymond 1995). However, there are two difficulties with the application of this method and its interpretation, both of which are addressed in this report.The first issue is the question of how one decides which of the potential outcomes are assigned to the subset that deviates from HW proportions by as much as or more than the observed sample. If the alternative hypothesis is specifically an excess or a dearth of homozygotes, then the tables can be ordered by Rousset and Raymond''s (1995) U-score or, equivalently, by Robertson and Hill''s (1984) minimum-variance estimator of the inbreeding coefficient. However, when no specific direction of deviation from HW is suspected, then there are several possible test statistics that can be used (Emigh 1980). These include the χ²-statistic, the likelihood ratio (LR), and the conditional probability itself. The last option is by far the most widely used (Elston and Forthofer 1977; Louis and Dempster 1987; Chakraborty and Zhong 1994; Weir 1996; Wigginton et al. 2005) and implemented in the GENEPOP software package (Rousset 2008). The idea of using the null-hypothesis probability as the test statistic was originally suggested in the context of rectangular contingency tables (Freeman and Halton 1951), but this idea has been criticized for its lack of discrimination between the null hypothesis and alternatives (Gibbons and Pratt 1975; Radlow and Alf 1975; Cressie and Read 1989). For example, suppose a particular sample was found to have a very low probability under the null hypothesis of HW. Such a result would usually tend to argue against the population being in HW equilibrium. However, if this particular outcome also has a very low probability under even the best-fitting alternative hypothesis, then it merely implies that a rare event has occurred regardless of whether the population is in random-mating proportions. The first part of this report compares the use of probability vs. the likelihood ratio as the test statistic in HW exact tests. Reasons for preferring the likelihood ratio are presented.The second difficulty in performing HW exact tests is the extensive computation needed for large samples when multiple alleles are involved. In this report I present a new algorithm for carrying out these calculations. This method adapts some of the techniques originally developed for rectangular contingency tables in which each possible outcome is represented as a path through a lattice-like network (Mehta and Patel 1983). Unlike the loop-based method currently in use (Louis and Dempster 1987), the new algorithm uses recursion and can be applied to any number of alleles without modification. In addition, it improves the efficiency by about two orders of magnitude, thus allowing the full enumeration procedure to be applied to larger samples and with greater numbers of alleles.The recursion algorithm has been tested successfully on samples with as many as 20 alleles when most of those alleles are rare. However, there are still some samples for which a complete enumeration is not practical. For example, the data from the human Rh locus in Figure 1D would require examining 2 × 10⁵⁶ tables (see below). For such cases a Monte Carlo approach must be used (Guo and Thompson 1992). Several improvements to the method of independent random tables are suggested here to make that approach practical for even the largest of realistic samples, thus eliminating the need for the less-accurate Markov chain approach.Open in a separate windowFigure 1.—Sample data sets: examples that have been used in previous discussions of exact tests for HW proportions. For each data set, a triangular matrix of genotype counts is shown next to the vector of allele counts. (A) From Table 2, bottom row, of Louis and Dempster (1987). (B) From Figure 2 of Guo and Thompson (1992). (C) From the documentation included with the GENEPOP software package (Rousset 2008). (D) From Figure 5 of Guo and Thompson (1992).Finally, I address the problem of determining the number of tables of genotype counts corresponding to a given set of allele counts. This number is needed for determining whether the exact test can be performed by full enumeration. Previously, this number could not be obtained except by actually carrying out the complete enumeration.The methods described are implemented in a software package, ExactoHW, for MacOS X10.5 or later. It is available in compiled form (supporting information, File S1) or as source code for academic use on request from the author.     

Heuristics for the Hodgkin–Huxley system

Hodgkin and Huxley (HH) discovered that voltages control ionic currents in nerve membranes. This led them to describe electrical activity in a neuronal membrane patch in terms of an electronic circuit whose characteristics were determined using empirical data. Due to the complexity of this model, a variety of heuristics, including relaxation oscillator circuits and integrate-and-fire models, have been used to investigate activity in neurons, and these simpler models have been successful in suggesting experiments and explaining observations. Connections between most of the simpler models had not been made clear until recently. Shown here are connections between these heuristics and the full HH model. In particular, we study a new model (Type III circuit): It includes the van der Pol-based models; it can be approximated by a simple integrate-and-fire model; and it creates voltages and currents that correspond, respectively, to the h and V components of the HH system.     

BIA–MS–MS: biomolecular interaction analysis for functional proteomics

One of the experimental processes of functional proteomics is the analysis of protein interaction. Here, we review a new analytical platform, BIA–MS, for protein interaction analysis. BIA–MS is an integration of a surface plasmon resonance biosensor for real-time interaction analysis and mass spectrometry for the subsequent identification of interacting molecules.     

A new polyaniline–catalase–glutaraldehyde-modified biosensor for hydrogen peroxide detection

A new biosensor based on catalase enzyme immobilized on electrochemically constructed polyaniline (PANI) film modified with glutaraldehyde has been developed for the determination of hydrogen peroxide (H₂O₂) in milk samples. Assembly processes of polyaniline and immobilization of the enzyme were monitored with the help of electrochemical impedance spectroscopy. Amperometric measurements have been performed at cathodic peak (?0.3?V vs. Ag/AgCI) which was attributed to reduction of PANI. Hydrogen peroxide was determined by using amperometric method at ?0.3?V. The biosensor responses were correlated linearly with the hydrogen peroxide concentrations between 5.0?×?10^?6 and 1.0?×?10^?4?M by amperometric method. Detection limit of the biosensor is 2.18?×?10^?6?M for H₂O₂. In the optimization studies of the biosensor, some parameters such as optimum pH, temperature, concentration of aniline, amount of enzyme, and number of scans during electropolymerization were investigated.     

Carboxymethylcellulose–gelatin–superoxidase dismutase electrode for amperometric superoxide radical sensing

A novel, highly sensitive superoxide dismutase biosensor for the direct and simultaneous determination of superoxide radicals was developed by immobilization of superoxide dismutase within carboxymethylcellulose-gelatin on a Pt electrode surface. The parameters affecting the performance of the biosensor were investigated. The response of the CMC-G-SOD biosensor was proportional to O (2) (·-) concentration and the detection limit was 1.25 × 10(-3) mM with a correlation coefficient of 0.9994. The developed biosensor exhibited high analytical performance with wider linear range, high sensitivity and low response time. The biosensor retained 89.8% of its sensitivity after use for 80 days. The support system enhanced the immobilization of superoxide dismutase and promoted the electron transfer of superoxide dismutase minimizing its fouling effect. The biosensor was quite effective not only in detecting O (2) (·-) , but also in determining the antioxidant properties of acetylsalicylic acid-based drugs and the anti-radical activity of healthy and cancerous human brain tissues.     

BIA–MS–MS: biomolecular interaction analysis for functional proteomics

One of the experimental processes of functional proteomics is the analysis of protein interaction. Here, we review a new analytical platform, BIA–MS, for protein interaction analysis. BIA–MS is an integration of a surface plasmon resonance biosensor for real-time interaction analysis and mass spectrometry for the subsequent identification of interacting molecules.     

Partial uracil–DNA–glycosylase treatment for screening of ancient DNA

The challenge of sequencing ancient DNA has led to the development of specialized laboratory protocols that have focused on reducing contamination and maximizing the number of molecules that are extracted from ancient remains. Despite the fact that success in ancient DNA studies is typically obtained by screening many samples to identify a promising subset, ancient DNA protocols have not, in general, focused on reducing the time required to screen samples. We present an adaptation of a popular ancient library preparation method that makes screening more efficient. First, the DNA extract is treated using a protocol that causes characteristic ancient DNA damage to be restricted to the terminal nucleotides, while nearly eliminating it in the interior of the DNA molecules, allowing a single library to be used both to test for ancient DNA authenticity and to carry out population genetic analysis. Second, the DNA molecules are ligated to a unique pair of barcodes, which eliminates undetected cross-contamination from this step onwards. Third, the barcoded library molecules include incomplete adapters of short length that can increase the specificity of hybridization-based genomic target enrichment. The adapters are completed just before sequencing, so the same DNA library can be used in multiple experiments, and the sequences distinguished. We demonstrate this protocol on 60 ancient human samples.     

Utility of unipolar recordings for complex Wolff–Parkinson–White ablation

Radiofrequency ablation has been shown to be a safe and effective treatment strategy for the management of symptomatic patients with Wolff–Parkinson–White syndrome. It is supported by a success rate of 95% and a recurrence rate of less than 5%. However, ablation of accessory pathways can be challenging at times. The causes for failure can be grouped into three categories – unusual location of the pathway, technical difficulties in delivering the ablation and localization error [1]. In this case report we are reporting a case of a young male who presented to us with symptomatic Wolff–Parkinson–White syndrome with two failed prior ablations at another institution. This case illustrates the importance of knowing accurate localization and course of the accessory pathway by utilizing the unipolar and bipolar electrograms simultaneously during radiofrequency ablation.     

Polarization-Insensitive Metal–Semiconductor–Metal Nanoplasmonic Structures for Ultrafast Ultraviolet Detectors

We propose a theoretical design principle of polarization-insensitive metal–semiconductor–metal (MSM) structure for ultraviolet photodetectors based on one-dimensional nanogratings. Because the Fabry–Pérot cavity modes supported by a 100-nm-thick ZnO layer with nanostructures for transverse electric and transverse magnetic polarized incidence overlap with each other, a polarization-insensitive absorption enhancement for the ZnO layer at UV wavelengths is achieved, which can be implemented as a nano-interdigitated electrode to address a long-existing limitation between the speed and the responsivity for conventional MSM photodetectors.     

Extended Parker–Sochacki method for Michaelis–Menten enzymatic reaction model

In this article, a new approach—namely, the extended Parker–Sochacki method (EPSM)—is presented for solving the Michaelis–Menten nonlinear enzymatic reaction model. The Parker–Sochacki method (PSM) is combined with a new resummation method called the Sumudu–Padé resummation method to obtain approximate analytical solutions for the model. The obtained solutions by the proposed approach are compared with the solutions of PSM and the Runge–Kutta numerical method (RKM). The comparison proves the practicality, efficiency, and correctness of the presented approach. It serves as a basis for solving other nonlinear biochemical reaction models in the future.     

Abdominal Aortic Aneurysms—Unusual Clinical Manifestations

Misleading symptoms were responsible for failure to make the diagnosis of symptomatic abdominal aortic aneurysm in 15 patients. The presenting complaints appeared to be specific for other diseases, such as genitourinary disease, diverticulitis, intra-abdominal neoplasm and functional large intestinal disorders. A correct diagnosis was ultimately made in 12 patients and aneurysmectomy was performed. In three patients, who died of ruptured aneurysm, the diagnosis was not made until postmortem examination.An awareness of the atypical symptoms of aneurysms, careful physical examination and appropriate x-ray studies will lead to the diagnosis of symptomatic aortic aneurysms. Early resection will result in a lower mortality rate.     

OECD pressure–state–response indicators for managing biodiversity: a realistic perspective for a French biosphere reserve

Sustainability is said to be the science of integration, be it integration of scale, discipline or of stakeholders’ interests. One way to integrate such diverse elements is to develop sustainable development indicators. Numerous national and international organizations have attempted to develop such indicators, among which interaction indicators are of critical importance because they enable us to link up human activities, ecological dynamics, and social goals. Among the various ways to develop such indicators, the most common ones are the pressure–state–response (PSR) indicators, as well as others coming from this framework. With realistic methodology one shall observe how PSR indicators might appear as an operational tool to face rapid social and ecological changes within a French biosphere reserve in Brittany. Results suggest that such a framework is insufficient to describe, understand and manage social and ecological interactions.