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Mucinous adenocarcinoma in the lung delivering since pathological humeral break: in a situation report and fresh surgical treatment.
Since urine NGAL levels appear to be dependent on plasma levels, the renal handling of circulating NGAL was examined using recombinant human NGAL. After intravenous recombinant human NGAL administration to mice, human NGAL in mouse urine was detected by ELISA during proximal tubular dysfunction, but not in pre-renal azotemia. Thus, during AKI, IL-6 mediates hepatic NGAL production, hepatocytes are the primary source of plasma and urine NGAL, and plasma NGAL appears in the urine during proximal tubule dysfunction. Hence, our data change the paradigm by which NGAL should be interpreted as a biomarker of AKI. OBJECTIVES Aluminum-containing vaccine adjuvants stimulate an adequate immune response to vaccination. The safety and rapid elimination of these molecules, a guarantee of their safe use for several decades, have been challenged by a growing number of studies over the last 20 years. Evaluation of exposure to aluminum adjuvants of an individual is thus essential. The current review answers the following questions what is the exposure of aluminum adjuvants of an individual vaccinated in France? What are the factors of variation? METHODS To evaluate the immunization exposure to aluminum for a vaccinee in France, we used the 2018 vaccination schedule and the Social Security database for vaccines reimbursed that year. French mandatory and recommended vaccines for an individual who does not travel abroad and has no particular professional obligations have been taken into account. RESULTS Our results show that an individual following the vaccination requirements and recommendations of 2018 receives between 2545 and 7735μg of Al3+ during his lifetime, and at least 50% before the age of 1year. Exposure varies with age, weight, sex, and choice of administered vaccines. CONCLUSION Vaccines with higher doses of aluminum are mainly injected at the beginning of life. Women receive a proportionately larger dose than men. The most reimbursed vaccines are often those with the highest amount of aluminum salts. Determining the underlying etiology of chest pain remains a mainstay of modern cardiological practice and is focused on identifying coronary artery disease to improve both symptoms and prognosis. In the current age of multi-modality imaging, the expanding repertoire of tests has subjected clinicians to a tyranny of choices. In whom should we perform further investigations? What non-invasive modality should be used? Which test is the best gatekeeper for invasive coronary angiography? In this week's American Heart Journal, Houssany-Pissot and colleagues present real-world data from a large French cohort of patients who present with suspected stable coronary artery disease undergoing invasive coronary angiography. Their findings demonstrate that compared to functional testing, coronary computed tomography angiography is associated with fewer normal invasive coronary angiograms and more patients with actionable disease. Moreover, this was apparent irrespective of the pre-test probability of obstructive coronary artery disease. The consistency of this study with data from randomised trials and observational registries leads us to agree that computed tomography has primacy as gatekeeper for the cardiac catheter laboratory irrespective of the level of pre-test probability. This latest addition to the growing and large body of evidence does beg the question of why guidelines do not now recommend CCTA as the first line test of choice for the non-invasive investigation of all patients with stable coronary artery disease? Crown All rights reserved.BACKGROUND Although computer-aided design and computer-aided manufacturing has been successfully used in fabricating removable partial dentures (RPDs), making altered cast impressions is still a time-consuming and labor-intensive process for fabricating RPDs with a distal extension. An alternative digital technique has been developed to simplify this process. METHODS The authors present a case in which they sought to improve the efficiency and simplicity in obtaining altered cast impressions by means of digital technology. Initially, a primary plaster cast was scanned as a digital cast. Based on the digital cast, a novel custom tray was designed and fabricated using a 3-dimensional printing method. With the custom tray, the novel altered cast impression was fabricated and scanned, and the final virtual altered cast was reconstructed by a stitching method. RESULTS Based on the virtual altered cast, the authors designed the virtual RPD framework. Finally, the titanium alloy framework was fabricated using a 3-dimensional printing process, and the authors fit the final RPD to the patient. CONCLUSIONS This novel digital altered cast impression technique may eliminate interoperator variability and increase precision compared with the traditional technique. PRACTICAL IMPLICATIONS This technique showed the potential for reducing clinical appointments, chair time, and laboratory procedures. BACKGROUND Integrating preventive oral health services (POHS) into medical offices may ease access to care for children with intellectual and developmental disabilities (IDD). The authors examined the impact of state policies allowing delivery of POHS in medical offices on receipt of POHS among Medicaid enrollees with IDD. METHODS The authors used 2006 through 2014 Medicaid data for children with IDD aged 6 months through 5 years from 38 states. IDD were defined using 14 condition codes from Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. The length of the state's medical POHS policy (no policy, less then 1 year, 1 year, 2 years, 3 years, or ≥ 4 years) was interacted with an indicator that the child was younger than 3 years. The authors used logistic regression models to estimate the likelihood that a child received POHS in a medical office or in a medical or dental office in a given year. RESULTS Among 447,918 children with IDD, 1.6% received POHS in medical offices. Children younger than 3 years in states with longer-enacted policies had higher rates of receiving POHS. For example, the predicted probability of receiving POHS was 40.6% (95% confidence interval, 36.3% to 44.9%) for children younger than 3 years in states with a medical POHS policy for more than 4 years compared with 30.6% (95% confidence interval, 27.8% to 33.5%) for children in states without a policy. CONCLUSIONS State Medicaid policies allowing delivery of POHS in medical offices increased receipt of POHS among Medicaid-enrolled children with IDD who were younger than 3 years. PRACTICAL IMPLICATIONS Few children with IDD receive POHS in any setting. Efforts are needed to reduce barriers to POHS for publicly insured children with IDD. Each week, I record audio summaries for every paper in JACC, as well as an issue summary. Although this process is quite time-consuming, I have become familiar with every paper that we publish. Thus, I have personally selected the top 100 papers (both Original Investigations and Review Articles, and an occasional Editorial Comment) from the distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC, as well as most of the central illustrations, with the realization that a magnifying glass will be be needed for appropriate visualization. The highlights comprise the following sections Basic & Translational Research, Cardiac Failure & Myocarditis, Cardiomyopathies/Congenital & Genetics, Cardio-Oncology, Coronary Disease & Interventions, Hypertension, Imaging, Metabolic & Lipid Disorders, Neurovascular Disease & Dementia, Promoting Health & Prevention, Rhythm Disorders & Thromboembolism, Valvular Heart Disease, and Vascular Medicine (1-100). BACKGROUND A gut-microbial metabolite, trimethylamine N-oxide (TMAO), has been associated with coronary atherosclerotic burden. No previous prospective study has addressed associations of long-term changes in TMAO with coronary heart disease (CHD) incidence. OBJECTIVES The purpose of this study was to investigate whether 10-year changes in plasma TMAO levels were significantly associated with CHD incidence. METHODS This prospective nested case-control study included 760 healthy women at baseline. Plasma TMAO levels were measured both at the first (1989 to 1990) and the second (2000 to 2002) blood collections; 10-year changes (Δ) in TMAO were calculated. Incident cases of CHD (n = 380) were identified after the second blood collection through 2016 and were matched to controls (n = 380). RESULTS Regardless of the initial TMAO levels, 10-year increases in TMAO from the first to second blood collection were significantly associated with an increased risk of CHD (relative risk [RR] in the top tertile 1.58 [95% confidence interval (CI) 1.05 to 2.38]; RR per 1-SD increment 1.33 [95% CI 1.06 to 1.67]). Participants with elevated TMAO levels (the top tertile) at both time points showed the highest RR of 1.79 (95% CI 1.08 to 2.96) for CHD as compared with those with consistently low TMAO levels. Further, we found that the ΔTMAO-CHD relationship was strengthened by unhealthy dietary patterns (assessed by the Alternate Healthy Eating Index) and was attenuated by healthy dietary patterns (p interaction = 0.008). CONCLUSIONS Long-term increases in TMAO were associated with higher CHD risk, and repeated assessment of TMAO over 10 years improved the identification of people with a higher risk of CHD. Diet may modify the associations of ΔTMAO with CHD risk. BACKGROUND Left ventricular (LV) systolic function may be overestimated in patients with secondary mitral regurgitation (MR) when using LV ejection fraction (EF). LV global longitudinal strain (GLS) is a less load-dependent measure of LV function. However, the prognostic value of LV GLS in secondary MR has not been evaluated. OBJECTIVES This study sought to demonstrate the prognostic value of LV GLS over LVEF in patients with secondary MR. METHODS A total of 650 patients (mean 66 ± 11 years of age, 68% men) with significant secondary MR were included. The study population was subdivided based on the LV GLS value at which the hazard ratio (HR) for all-cause mortality was >1 using a spline curve analysis (LV GLS less then 7.0%, impaired LV systolic function vs. LV GLS ≥7.0%, preserved LV systolic function). The primary endpoint was all-cause mortality. RESULTS During a median follow-up of 56 (interquartile range 28 to 106 months) months, 334 (51%) patients died. Patients with a more impaired LV GLS showed significantly higher mortality rates at 1-, 2-, and 5-year follow-up (13%, 23%, and 44%, respectively) when compared with patients with more preserved LV systolic function (5%, 14%, and 31%, respectively). On multivariable analysis, LV GLS less then 7.0% was associated with increased mortality (HR 1.337; 95% confidence interval 1.038 to 1.722; p = 0.024), whereas LVEF ≤30% was not (HR 1.055; 95% confidence interval 0.794 to 1.403; p = 0.711). CONCLUSIONS In patients with secondary MR, impaired LV GLS was independently associated with an increased risk for all-cause mortality, whereas LVEF was not. LV GLS may therefore be useful in the risk stratification of patients with secondary MR.
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