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- Kjekshus, John, et al.
(författare)
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Rosuvastatin in older patients with systolic heart failure.
- 2007
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Ingår i: The New England journal of medicine. - 1533-4406. ; 357:22, s. 2248-61
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with systolic heart failure have generally been excluded from statin trials. Acute coronary events are uncommon in this population, and statins have theoretical risks in these patients. METHODS: A total of 5011 patients at least 60 years of age with New York Heart Association class II, III, or IV ischemic, systolic heart failure were randomly assigned to receive 10 mg of rosuvastatin or placebo per day. The primary composite outcome was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included death from any cause, any coronary event, death from cardiovascular causes, and the number of hospitalizations. RESULTS: As compared with the placebo group, patients in the rosuvastatin group had decreased levels of low-density lipoprotein cholesterol (difference between groups, 45.0%; P<0.001) and of high-sensitivity C-reactive protein (difference between groups, 37.1%; P<0.001). During a median follow-up of 32.8 months, the primary outcome occurred in 692 patients in the rosuvastatin group and 732 in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.83 to 1.02; P=0.12), and 728 patients and 759 patients, respectively, died (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.31). There were no significant differences between the two groups in the coronary outcome or death from cardiovascular causes. In a prespecified secondary analysis, there were fewer hospitalizations for cardiovascular causes in the rosuvastatin group (2193) than in the placebo group (2564) (P<0.001). No excessive episodes of muscle-related or other adverse events occurred in the rosuvastatin group. CONCLUSIONS: Rosuvastatin did not reduce the primary outcome or the number of deaths from any cause in older patients with systolic heart failure, although the drug did reduce the number of cardiovascular hospitalizations. The drug did not cause safety problems. (ClinicalTrials.gov number, NCT00206310.)
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| 3. |
- Pallavicini, Nicola, 1983-
(författare)
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Method development for isotope analysis of trace and ultra-trace elements in environmental matrices
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The increasing load of toxic elements entering the ecosystems, as a consequence of anthropogenic processes, has grown public awareness in the last decades, resulting in a great number of studies focusing on pollution sources, transport, distribution, interactions with living organisms and remediation. Physical/chemical processes that drive the uptake, assimilation, compartmentation and translocation of heavy metals in biota has received a great deal of attention recently, since elemental concentrations and isotopic composition in biological matrices can be used as probes of both natural and anthropogenic sources. Further they can help to evaluate fate of contaminants and to assess bioavailability of such elements in nature. While poorly defined isotopic pools, multiple sources and fractionating processes add complexity to source identification studies, tracing is hindered mainly by poorly known or unidentified fractionating factors.High precision isotope ratio measurements have found increasing application in various branches of science, from classical isotope geochronology to complex multi-tracer experiments in environmental studies. Instrumental development and refining separation schemes have allowed higher quality data to be obtained and played a major role in the recent progress of the field. The use of modern techniques such as inductively coupled plasma sector field mass spectrometry (ICP-SFMS) and multi-collector inductively coupled plasma mass spectrometry (MC-ICP-MS) for trace and ultra-trace element concentrations and isotope ratio measurements have given new opportunities. However, sources of errors must be accurately evaluated and avoided at every procedural step. Moreover, even with the utilization of sound analytical measurement protocols, source and process tracing in natural systems can be complicated further by spatial and temporal variability.The work described in the present thesis has been focused primarily on analytical method development, optimization and evaluation (including sample preparation, matrix separation, instrumental analysis and data evaluation stages) for isotopic and multi-elemental analyses in environmental samples at trace and ultra-trace levels. Special attention was paid to evaluate strengths and limitations of the methods as applied to complex natural environments, aiming at correct interpretation of isotopic results in environmental forensics. The analytical protocols covered several isotope systems of both stable (Cd, B, Cr, Cu, Fe, Tl and Zn) and radiogenic (Os, Pb and Sr) elements.Paper I was dedicated to the optimization and testing of a rapid and high sample throughput method for Os concentrations and isotope measurements by ICP-SFMS. If microwave (MW) digestion followed by sample introduction to ICP-SFMS by traditional solution nebulization (SN) offered unparalleled throughput important for processing large number of samples, high-pressure ashing (HPA) combined with gas-phase introduction (GPI) proved to be advantageous for samples with low (below 500 pg) analyte content. The method was applied to a large scale bio-monitoring case, confirming accumulation of anthropogenic Os in animals from an area affected by emissions from a stainless steel foundry.The method for Cr concentrations and isotope ratios in different environmental matrices was optimized in Paper II. A coupling between a high pressure/temperature acid digestion and a one pass, single column matrix separation allowed the analysis of chromites, soils, and biological matrices (first Cr isotope study in lichens and mosses) by ICP-SFMS and MC-ICP-MS. With an overall reproducibility of 0.11‰ (2σ), the results suggested a uniform isotope composition in soil depth profiles. On the other hand a strong negative correlation found between δ53Cr and Cr concentrations in lichens and mosses indicates that airborne Cr from local anthropogenic source(s) is depleted in heavy isotopes, therefore highlighting the possibility of utilization of Cr isotopes to trace local airborne pollution source from steel foundries. Paper III describes development of high-precision Cd isotope ratio measurement by MC-ICP-MS in a variety of environmental matrices. Several digestion methods (HPA, MW, ultrawave and ashing) were tested for sample preparation, followed by analyte separation from matrix using ion-exchange chromatography. The reproducibility of the method (2σ for δ114Cd/110Cd) was found to be better than 0.1‰. The method was applied to a large number of birch leaves (n>80) collected at different locations and growth stages. Cd in birch leaves is enriched in heavier isotopes relative to the NIST SRM 3108 Cd standard with a mean δ114Cd/110Cd of 0.7‰. The fractionation is assumed to stem from sample uptake through the root system and element translocation in the plant and it exhibits profound between-tree as well as seasonal variations. The latter were compared with seasonal isotopic variations for other isotopic systems (Zn, Os, Pb) in the same trees to aid a better understanding of underlying processes.In Paper IV the number of isotope systems studied was extended to include B, Cd, Cu, Fe, Pb, Sr, Tl and Zn. The analytical procedure utilized a high pressure acid digestion (UltraCLAVE), which provides complete oxidation of the organic material in biological samples, and a two-column ion-exchange separation which represents further development of the separation scheme described in Paper III. Such sample preparation ensures low blank levels, efficient separation of matrix elements, sufficiently high analyte recoveries and reasonably high sample throughput. The method was applied to a large number of biological samples (n>240) and the data obtained represent the first combined characterization of variability in isotopic composition for eight elements in leaves, needles, lichens and mushrooms collected from a geographically confined area.To further explore the reason of variability observed, soil profiles from the same area were analyzed for both concentrations and isotopic compositions of B, Cd, Cr, Cu, Fe, Pb, Sr, Tl and Zn in Paper V. Results of this study suggest that the observed high variability can be dependent on operationally-defined fractions (assessed by applying a modified SEP to process soil samples) and on the typology of the individual matrix analyzed (assessed through the coupling of soil profile results to those obtained for other matrices: lysimetric waters, mushrooms, litter, needles, leaves and lichens).The method development conducted in this work highlights the importance of considering all possible sources of biases/errors as well as possibility to use overlapping sample preparation schemes for multi-isotope studies. The results obtained for different environmental matrices represent a starting point for discussing the role of natural isotopic variability in isotope applications and forensics, and the importance of in-depth knowledge of the multiple parameters affecting the variability observed.
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