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- Khosla, S., et al.
(författare)
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Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms
- 2014
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 101:11, s. 1350-1357
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Forskningsöversikt (refereegranskat)abstract
- Background: Abdominal aortic aneurysm (AAA) is an important cause of sudden death; however, there are currently incomplete means to predict the risk of AAA rupture. AAA peak wall stress (PWS) can be estimated using finite element analysis (FEA) methods from computed tomography (CT) scans. The question is whether AAA PWS can predict AAA rupture. The aim of this systematic review was to compare PWS in patients with ruptured and intact AAA. Methods: The MEDLINE database was searched on 25 May 2013. Case-control studies assessing PWS in asymptomatic intact, and acutely symptomatic or ruptured AAA from CT scans using FEA were included. Data were extracted independently. A random-effects model was used to calculate standard mean differences (SMDs) for PWS measurements. Results: Nine studies assessing 348 individuals were identified and used in the meta-analysis. Results from 204 asymptomatic intact and 144 symptomatic or ruptured AAAs showed that PWS was significantly greater in the symptomatic/ruptured AAAs compared with the asymptomatic intact AAAs (SMD 0.95, 95 per cent confidence interval 0. 71 to 1.18; P < 0. 001). The findings remained significant after adjustment for mean systolic blood pressure, standardized at 120 mmHg(SMD 0.68, 0.39 to 0.96; P < 0. 001). Minimal heterogeneity between studies was noted (I-2 = 0 per cent). Conclusion: This study suggests that PWS is greater in symptomatic or ruptured AAA than in asymptomatic intact AAA.
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| 2. |
- Martin, Maria A., et al.
(författare)
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Ten new insights in climate science 2021 : a horizon scan
- 2021
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Ingår i: Global Sustainability. - : Cambridge University Press (CUP). - 2059-4798. ; 4, s. 1-20
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Forskningsöversikt (refereegranskat)abstract
- Non-technical summary: We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding about the remaining options to achieve the Paris Agreement goals, through overcoming political barriers to carbon pricing, taking into account non-CO2 factors, a well-designed implementation of demand-side and nature-based solutions, resilience building of ecosystems and the recognition that climate change mitigation costs can be justified by benefits to the health of humans and nature alone. We consider new insights about what to expect if we fail to include a new dimension of fire extremes and the prospect of cascading climate tipping elements.Technical summary: A synthesis is made of 10 topics within climate research, where there have been significant advances since January 2020. The insights are based on input from an international open call with broad disciplinary scope. Findings include: (1) the options to still keep global warming below 1.5 °C; (2) the impact of non-CO2 factors in global warming; (3) a new dimension of fire extremes forced by climate change; (4) the increasing pressure on interconnected climate tipping elements; (5) the dimensions of climate justice; (6) political challenges impeding the effectiveness of carbon pricing; (7) demand-side solutions as vehicles of climate mitigation; (8) the potentials and caveats of nature-based solutions; (9) how building resilience of marine ecosystems is possible; and (10) that the costs of climate change mitigation policies can be more than justified by the benefits to the health of humans and nature.Social media summary: How do we limit global warming to 1.5 °C and why is it crucial? See highlights of latest climate science.
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| 3. |
- Singh, Tejas P., et al.
(författare)
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Systematic Review and Meta-Analysis of Peak Wall Stress and Peak Wall Rupture Index in Ruptured and Asymptomatic Intact Abdominal Aortic Aneurysms
- 2021
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Ingår i: Journal of the American Heart Association. - : WILEY. - 2047-9980 .- 2047-9980. ; 10:8
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Forskningsöversikt (refereegranskat)abstract
- Background Prior studies have suggested aortic peak wall stress (PWS) and peak wall rupture index (PWRI) can estimate the rupture risk of an abdominal aortic aneurysm (AAA), but whether these measurements have independent predictive ability over assessing AAA diameter alone is unclear. The aim of this systematic review was to compare PWS and PWRI in participants with ruptured and asymptomatic intact AAAs of similar diameter. Methods and Results Web of Science, Scopus, Medline, and The Cochrane Library were systematically searched to identify studies assessing PWS and PWRI in ruptured and asymptomatic intact AAAs of similar diameter. Random-effects meta-analyses were performed using inverse variance-weighted methods. Leave-one-out sensitivity analyses were conducted to assess the robustness of findings. Risk of bias was assessed using a modification of the Newcastle-Ottawa scale and standard quality assessment criteria for evaluating primary research papers. Seven case-control studies involving 309 participants were included. Meta-analyses suggested that PWRI (standardized mean difference, 0.42; 95% CI, 0.14-0.70; P=0.004) but not PWS (standardized mean difference, 0.13; 95% CI, -0.18 to 0.44; P=0.418) was greater in ruptured than intact AAAs. Sensitivity analyses suggested that the findings were not dependent on the inclusion of any single study. The included studies were assessed to have a medium to high risk of bias. Conclusions Based on limited evidence, this study suggested that PWRI, but not PWS, is greater in ruptured than asymptomatic intact AAAs of similar maximum aortic diameter.
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| 4. |
- Thanigaimani, Shivshankar, et al.
(författare)
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Association Between Metformin Prescription and Abdominal Aortic Aneurysm Growth and Clinical Events : a Systematic Review and Meta-Analysis.
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 62:5, s. 747-756
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: A meta-analysis of the association between metformin prescription and abdominal aortic aneurysm (AAA) growth and events (rupture or surgical repair) was performed.METHODS: Open source databases were searched for observational studies reporting the association between metformin prescription and AAA growth or events. Meta-analyses were performed using random effects models. The risk of bias of included studies was assessed using a quality assessment tool developed in a previous systematic review. Sensitivity analyses restricted to people with diabetes, leave one out analyses, and an individual patient risk factor adjusted sub-analysis were performed. Funnel plots assessed reporting bias.RESULTS: Eight studies comprising 153 553 patients were included, of whom 35 240 were and 118 313 were not prescribed metformin. Pooled weighted mean (± standard deviation) AAA growth was significantly reduced in patients prescribed metformin (0.9 ± 0.4 mm/year) compared with those not receiving the medication (1.8 ± 0.4 mm/year; weighted mean difference [WMD] 0.8 mm/year, 95% confidence interval [CI] 0.5 - 1.1; p < .001; I2 = 89%). Leave one out analysis suggested that the significance of findings did not change after removal of individual studies. A sub-analysis within people with diabetes suggested that metformin reduced AAA growth (WMD 0.7 mm/year, 95% CI 0.3 - 1.0). Metformin prescription was associated with a reduced risk of AAA events (risk ratio 0.6, 95% CI 0.4 - 0.9, p = .028). Three, four, and one studies had low, moderate, and high risk of bias, respectively. Individual patient data analysis suggested that metformin prescription slowed annual AAA growth by 0.5 mm/year (95% CI 0.2 - 0.7). The GRADE summary suggested that the certainty of evidence that metformin limited AAA growth and prevented AAA events was very low.CONCLUSION: Observational studies suggest that metformin prescription is associated with a clinically important significant reduction in both growth and clinically relevant events in people with AAA. These findings support the need for randomised trials to examine the benefit of metformin.
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| 5. |
- Thomas, Zoë A., et al.
(författare)
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Tipping elements and amplified polar warming during the Last Interglacial
- 2020
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Ingår i: Quaternary Science Reviews. - : Elsevier BV. - 0277-3791. ; 233
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Forskningsöversikt (refereegranskat)abstract
- Irreversible shifts of large-scale components of the Earth system (so-called ‘tipping elements’) on policy-relevant timescales are a major source of uncertainty for projecting the impacts of future climate change. The high latitudes are particularly vulnerable to positive feedbacks that amplify change through atmosphere-ocean-ice interactions. Unfortunately, the short instrumental record does not capture the full range of past or projected climate scenarios (a situation particularly acute in the high latitudes). Natural archives from past periods warmer than present day, however, can be used to explore drivers and responses to forcing, and provide data against which to test models, thereby offering insights into the future. The Last Interglacial (129–116,000 years before present) — the warmest interglacial of the last 800,000 years — was the most recent period during which global temperatures were comparable with low-end 21st Century projections (up to 2 °C warmer, with temperature increase amplified over polar latitudes), providing a potentially useful analogue for future change. Substantial environmental changes happened during this time. Here we synthesise the nature and timing of potential high-latitude tipping elements during the Last Interglacial, including sea ice, extent of the boreal forest, permafrost, ocean circulation, and ice sheets/sea level. We also review the thresholds and feedbacks that likely operated through this period. Notably, substantial ice mass loss from Greenland, the West Antarctic, and possibly sectors of the East Antarctic drove a 6–9 m rise in global sea level. This was accompanied by reduced summer sea-ice extent, poleward-extended boreal forest, and reduced areas of permafrost. Despite current chronological uncertainties, we find that tipping elements in the high latitudes all experienced rapid and abrupt change (within 1–2 millennia of each other) across both hemispheres, while recovery to prior conditions took place over multi-millennia. Our synthesis demonstrates important feedback loops between tipping elements, amplifying polar and global change during the Last Interglacial. The high sensitivity and tight interconnections between polar tipping elements suggests that they could exhibit similar thresholds of vulnerability in the future, particularly if the aspirations of the Paris Agreement are not met.
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