Urinary Tubular Injury Biomarkers Are Associated With ESRD and Death in the REGARDS Study.

IntroductionUrinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary kidney injury molecule-1 (uKIM-1) are established markers of subclinical acute kidney injury. In persons with reduced estimated glomerular filtration rate (eGFR) and albuminuria who are at high risk for end-stage renal disease (ESRD) and death, the associations of these urinary markers with incident ESRD or death is an area of active investigation.MethodsAmong 1472 black and white participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study with eGFR ≤60 ml/min per 1.73 m2 (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] cystatin, 2012) and albumin-to-creatinine ratio (ACR) ≥30 mg/g, we evaluated the associations of baseline uNGAL and uKIM-1 with progression to ESRD and all-cause death. Cox models were sequentially adjusted for urinary creatinine, traditional risk factors, C-reactive protein, ACR, and eGFR.ResultsThere were 257 ESRD events and 819 deaths over a median follow-up of 5.7 and 6.5 years, respectively. In demographic adjusted models, higher levels of uNGAL were associated with increased risk of ESRD and death, but these associations were attenuated in fully adjusted models including baseline eGFR for both ESRD (hazard ratio [HR] = 1.06 per doubling, 95% confidence interval [CI] 0.98-1.14) and death (HR = 1.04, 95% CI = 1.00-1.08). Higher levels of uKIM-1 were associated with increased risk of ESRD and death in demographic-adjusted models, and although attenuated in fully adjusted models, remained statistically significant for both ESRD (HR = 1.24 per doubling, 95% CI = 1.08-1.42) and death (HR = 1.10, 95% CI =1.03-1.19).ConclusionIn this cohort of high-risk patients with baseline eGFR ≤60 ml/min per 1.73 m2 and albuminuria, renal tubular injury is associated with higher mortality and progression to ESRD. Further studies are necessary to investigate the mechanism underlying this increased risk

Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: A review of the National Cancer Database

For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson-Deyo comorbidity score ≥2 (OR 0.82), and high-volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non-Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high-volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival

Scalar ground-state observables in the random phase approximation

We calculate the ground-state expectation value of scalar observables in the matrix formulation of the random phase approximation (RPA). Our expression, derived using the quasiboson approximation, is a straightforward generalization of the RPA correlation energy. We test the reliability of our expression by comparing against full diagonalization in 0 h-bar omega shell-model spaces. In general the RPA values are an improvement over mean-field (Hartree-Fock) results, but are not always consistent with shell-model results. We also consider exact symmetries broken in the mean-field state and whether or not they are restored in RPA.Comment: 7 pages, 3 figure

Endoscopic Posterior Cricoid Split with Costal Cartilage Graft: A Fifteen‐Year Experience

Objective To evaluate outcomes of the endoscopic posterior cricoid split with rib graft (EPCS/RG) procedure in the treatment of subglottic stenosis (SGS), posterior glottic stenosis (PGS), and bilateral vocal fold immobility (BVFI). Study Design Retrospective chart review. Methods Chart review of all patients who underwent EPCS/RG at a single tertiary-care facility between 1999 and 2014. Patients were grouped based on the primary indication for the procedure. Decannulation was the primary endpoint. Secondary endpoints were the number of subsequent airway procedures and length of hospitalization. Results Thirty-three patients were identified; 32 had tracheotomy. Overall decannulation rate was 65.6%. Subgroup analysis demonstrated the following decannulation rates: 53.8% for SGS, 100% for PGS, and 28.6% for BVFI. Fisher exact test found a significant difference in overall decannulation rates between groups (P = 0.002). Operation-specific decannulation rates for patients who never required an open procedure were 23% for SGS, 91.6% for PGS, and 28.6% for BVFI. This difference was also statistically significant (P = 0.001). Multivariate logistic regression analysis found prematurity had a positive correlation with decannulation that approached statistical significance (P < 0.051; odds ratio 6.1; 95% confidence interval 0.99, 37.6). The percentage of patients who underwent repeat airway procedures for the groups was 61.5% for SGS, 16.6 % for PGS, and 14.3% for BVFI. The median length of hospitalization after EPCS/RG was 3 days. Conclusion This represents the largest series of patients who have undergone EPCS/RG and demonstrates that the majority of patients can be decannulated after this procedure. Patients with PGS had the highest operation-specific decannulation rates

Association of urinary uromodulin with kidney&nbsp;function decline and mortality: the&nbsp;health ABC study .

BackgroundUrine uromodulin (uUMOD) is a protein secreted by the kidney tubule. Recent studies have suggested that higher uUMOD may be associated with improved kidney and mortality outcomes.MethodsUsing a case-cohort design, we evaluated the association between baseline uUMOD levels and ≥&nbsp;30% estimated glomerular filtration rate (eGFR) decline, incident chronic kidney disease (CKD), rapid kidney function decline, and mortality using standard and modified Cox proportional hazards regression.ResultsThe median value of uUMOD was 25.8&nbsp;µg/mL, mean age of participants was 74 years, 48% were women, and 39% were black. Persons with higher uUMOD had lower prevalence of diabetes and coronary artery disease (CAD), and had lower systolic blood pressure. Persons with higher uUMOD also had higher eGFR, lower urinary albumin to creatinine ratio (ACR), and lower C-reactive protein (CRP). There was no association of uUMOD with &gt;&nbsp;30% eGFR decline. In comparison to those in the lowest quartile of uUMOD, those in the highest quartile had a significantly (53%) lower risk of incident CKD (CI 73%, 18%) and a 51% lower risk of rapid kidney function decline (CI 76%, 1%) after multivariable adjustment. Higher uUMOD was associated with lower risk of mortality in demographic adjusted models, but not after multivariable adjustment.ConclusionHigher levels of uUMOD are associated with lower risk of incident CKD and rapid kidney function decline. Additional studies are needed in the general population and in persons with advanced CKD to confirm these findings.


On the consistency of de Sitter vacua

In this paper the consistency of the de Sitter invariant $\alpha$-vacua, which have been introduced as simple tools to study the effects of transplanckian physics, is investigated. In particular possible non renormalization problems are discussed, as well as non standard properties of Greens functions. We also discuss the non thermal properties of the $\alpha$-vacua and the necessity of $\alpha$ to change. The conclusion is that non of these problems necessarily exclude an application of the $\alpha$-vacua to inflation.Comment: 12 pages, v2: minor clarifications and corrections to reference

Spectroscopy of 19^{19}Ne for the thermonuclear 15^{15}O(α,γ\alpha,\gamma)19^{19}Ne and 18^{18}F(p,αp,\alpha)15^{15}O reaction rates

Uncertainties in the thermonuclear rates of the $^{15}$O($\alpha,\gamma$)$^{19}$Ne and $^{18}$F($p,\alpha$)$^{15}$O reactions affect model predictions of light curves from type I X-ray bursts and the amount of the observable radioisotope $^{18}$F produced in classical novae, respectively. To address these uncertainties, we have studied the nuclear structure of $^{19}$Ne over $E_{x} = 4.0 - 5.1$ MeV and $6.1 - 7.3$ MeV using the $^{19}$F($^{3}$He,t)$^{19}$Ne reaction. We find the $J^{\pi}$ values of the 4.14 and 4.20 MeV levels to be consistent with $9/2^{-}$ and $7/2^{-}$ respectively, in contrast to previous assumptions. We confirm the recently observed triplet of states around 6.4 MeV, and find evidence that the state at 6.29 MeV, just below the proton threshold, is either broad or a doublet. Our data also suggest that predicted but yet unobserved levels may exist near the 6.86 MeV state. Higher resolution experiments are urgently needed to further clarify the structure of $^{19}$Ne around the proton threshold before a reliable $^{18}$F($p,\alpha$)$^{15}$O rate for nova models can be determined.Comment: 5 pages, 3 figures, Phys. Rev. C (in press

Quadratic Word Equations with Length Constraints, Counter Systems, and Presburger Arithmetic with Divisibility

Word equations are a crucial element in the theoretical foundation of constraint solving over strings, which have received a lot of attention in recent years. A word equation relates two words over string variables and constants. Its solution amounts to a function mapping variables to constant strings that equate the left and right hand sides of the equation. While the problem of solving word equations is decidable, the decidability of the problem of solving a word equation with a length constraint (i.e., a constraint relating the lengths of words in the word equation) has remained a long-standing open problem. In this paper, we focus on the subclass of quadratic word equations, i.e., in which each variable occurs at most twice. We first show that the length abstractions of solutions to quadratic word equations are in general not Presburger-definable. We then describe a class of counter systems with Presburger transition relations which capture the length abstraction of a quadratic word equation with regular constraints. We provide an encoding of the effect of a simple loop of the counter systems in the theory of existential Presburger Arithmetic with divisibility (PAD). Since PAD is decidable, we get a decision procedure for quadratic words equations with length constraints for which the associated counter system is \emph{flat} (i.e., all nodes belong to at most one cycle). We show a decidability result (in fact, also an NP algorithm with a PAD oracle) for a recently proposed NP-complete fragment of word equations called regular-oriented word equations, together with length constraints. Decidability holds when the constraints are additionally extended with regular constraints with a 1-weak control structure.Comment: 18 page