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  • 1
    Abstract: Background The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta-analytic approach. Methods We meta-analysed individual-level data for 637 315 individuals without a history of cardiovascular disease from 24 cohorts (median follow-up 4.2-19.0 years) included in the Chronic Kidney Disease Prognosis Consortium. We assessed C statistic difference and reclassification improvement for cardiovascular mortality and fatal and non-fatal cases of coronary heart disease, stroke, and heart failure in a 5 year timeframe, contrasting prediction models for traditional risk factors with and without creatinine-based eGFR, albuminuria (either albumin-to-creatinine ratio [ACR] or semi-quantitative dipstick proteinuria), or both. Findings The addition of eGFR and ACR significantly improved the discrimination of cardiovascular outcomes beyond traditional risk factors in general populations, but the improvement was greater with ACR than with eGFR, and more evident for cardiovascular mortality (C statistic difference 0.0139 [95% CI 0.0105- 0.0174] for ACR and 0.0065 [0.0042-0.0088] for eGFR) and heart failure (0.0196 [0.0108-0.0284] and 0.0109 [0.0059-0.0159]) than for coronary disease (0.0048 [0.0029-0.0067] and 0.0036 [0.0019-0.0054]) and stroke (0.0105 [0.0058-0.0151]and 0.0036 [0.0004-0.0069]). Dipstick proteinuria showed smaller improvement than ACR. The discrimination improvement with eGFR or ACR was especially evident in individuals with diabetes or hypertension, but remained significant with ACR for cardiovascular mortality and heart failure in those without either of these disorders. In individuals with chronic kidney disease, the combination of eGFR and ACR for risk discrimination outperformed most single traditional predictors; the C statistic for cardiovascular mortality fell by 0.0227 (0.0158-0.0296) after omission of eGFR and ACR compared with less than 0.007 for any single modifiable traditional predictor. Interpretation Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when these measures are already assessed for clinical purpose or if cardiovascular mortality and heart failure are outcomes of interest. ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved classification of cardiovascular risk, supporting current guidelines for chronic kidney disease. Our results lend some support to also incorporating eGFR and ACR into assessments of cardiovascular risk in the general population.
    Type of Publication: Journal article published
    PubMed ID: 26028594
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  • 2
    Electronic Resource
    Electronic Resource
    The European physical journal 26 (1993), S. 119-125 
    ISSN: 1434-6079
    Keywords: 36.40.+d ; 31.20.Sy ; 32.80.Dz ; 71.10.+x
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract Theoretical investigations of size evolutionary patterns for multiply charged anionic metal clusters and solvation of sodium in water clusters are discussed. For Na N Z- clusters, energetic stability and electron decay channels are determined. Formation of a “surface Rydberg-like state” in Na(H2O) N , correlating with calculated and measured ionization potentials, is analyzed.
    Type of Medium: Electronic Resource
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  • 3
    Publication Date: 2011-01-08
    Description: Ammonites are prominent in macroevolutionary studies because of their abundance and diversity in the fossil record, but their paleobiology and position in the marine food web are not well understood due to the lack of preserved soft tissue. We present three-dimensional reconstructions of the buccal apparatus in the Mesozoic ammonite Baculites with the use of synchrotron x-ray microtomography. Buccal mass morphology, combined with the coexistence of food remains found in the buccal mass, suggests that these ammonites fed on plankton. This diet may have extended to all aptychophoran ammonites, which share the same buccal mass morphology. Understanding the role of these ammonites in the Mesozoic food web provides insights into their radiation in the Early Jurassic, as well as their extinction at the end of the Cretaceous/early Paleogene.〈br /〉〈span class="detail_caption"〉Notes: 〈/span〉Kruta, Isabelle -- Landman, Neil -- Rouget, Isabelle -- Cecca, Fabrizio -- Tafforeau, Paul -- New York, N.Y. -- Science. 2011 Jan 7;331(6013):70-2. doi: 10.1126/science.1198793.〈br /〉〈span class="detail_caption"〉Author address: 〈/span〉UMR-CNRS 7207, Departement Histoire de la Terre, Museum National d'Histoire Naturelle, 47 rue Cuvier, 75231 Paris Cedex 05, France.〈br /〉〈span class="detail_caption"〉Record origin:〈/span〉 〈a href="" target="_blank"〉PubMed〈/a〉
    Keywords: Animals ; Biological Evolution ; Cephalopoda/*anatomy & histology/physiology ; Diet ; Digestive System ; Extinction, Biological ; Feeding Behavior ; *Food Chain ; *Fossils ; Gastropoda/anatomy & histology ; Isopoda/anatomy & histology ; Jaw/anatomy & histology ; Tooth/anatomy & histology ; X-Ray Microtomography ; *Zooplankton
    Print ISSN: 0036-8075
    Electronic ISSN: 1095-9203
    Topics: Biology , Chemistry and Pharmacology , Computer Science , Medicine , Natural Sciences in General , Physics
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