Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Population of high-spin states in U-234 by an incomplete-fusion reaction

Excited states in U-234 have been populated using the incomplete-fusion reaction Th-232(Be-9,alpha 3n) at 52 MeV. The emitted gamma rays were observed using the CAESAR array, while the ct particles were detected with an array of 14 plastic scintillator detectors of phoswich type. This reaction can populate U-234 at higher spin than the conventional Th-232(alpha,2n) reaction because the ''He-5'' fragment from breakup of the beam can be viewed as initiating a Th-232(He-5,3n) reaction. Similar reactions could provide a Valuable alternative technique for the study of relatively heavy, neutron-rich isotopes. In the present work, states in the ground-state band of U-234 were observed up to J(pi)=18(+) and previous tentative observations of (9(-)) and (11(-)) states in the octupole band were confirmed. A new state at 1366 keV, which is possibly the 8(+) member of the gamma band, has also been identified. [S0556-2813(99)02911-8]

Clinical presentation, diagnosis and management of therapy-related hematological disorders in women with epithelial ovarian cancer treated with chemotherapy and poly-ADP-ribose polymerase inhibitors : a single-center experience

We investigated the occurrence and management of therapy-related hematological disorders (tr-HDs) in women with epithelial ovarian cancer (EOC) exposed to poly-ADP-ribose polymerase inhibitors (PARPi), after previous chemotherapy. We analyzed 130 consecutive EOC patients treated with PARPi at the European Institute of Oncology, Milan. In line with the literature, overall survival of the entire population was 37% at 5.5 years (89% were advanced stages). Cell blood counts were collected prior to start PARPi, at each new cycle and at monthly intervals. Patients displaying persistent and/or marked hematological abnormalities underwent bone marrow evaluation, with cytogenetic and molecular analysis. Nine patients (6,9%) developed tr-HDs, after a median 22.8 months of PARPi exposure. Two patients died early and could not be treated. Two patients have no indication for active treatment and are presently under close hematological monitoring. Five patients underwent chemotherapy followed, in three cases, by allogeneic hematopoietic transplantation: three patients are in complete remission of their hematological and gynecological malignancies at 13, 19, and 25 months; the remaining two patients died due to progression of their hematological disease. We show the potential risk of hematological disorders in EOC patients treated with chemotherapy and prolonged PARPi therapy. In our series, tr-HDs incidence was higher compared to recent reports in large series. Our observations suggest careful monitoring in order to conclusively define, on large series and prolonged follow-up, the actual risk of tr-HDs in patients under PARPi. Notably, prompt diagnosis of hematological abnormalities and appropriate management allow achievement of remission from severe hematological complications, at least in most patients

Separation of mandelic acid enantiomers using solid-liquid biphasic systems with chiral ionic liquids

This work aims to take full advantage of ionic liquids’ (ILs) “designer solvent” nature in order to expand the applicability of solid-liquid biphasic systems (SLBS) as alternative chiral resolution techniques. To this purpose, twelve chiral ILs, bearing chirality on the cation or the anion, were used as chiral selectors in SLBS to selectively precipitate mandelic acid enantiomers. The precipitation studies were performed using aqueous solutions of the chiral ILs or their chiral precursors, where the impact of the chemical structure and chirality was investigated. The most efficient chiral ILs were employed to evaluate the influence of different operational conditions on the formed precipitate, namely resolution time, resolution speed, temperature, initial concentration of chiral IL, initial concentration of racemic mandelic acid and water content. When compared to their precursors, chiral ILs showed an enhanced ability to induce enantioselective precipitation. The composition of the precipitate formed, and the molecular-level mechanisms leading to enantioselective precipitation, were also uncovered. Due to cooperative interactions between the chiral IL and the target mandelic acid enantiomer, the [N4444][D-Phe]-based SLBS proposed allowed to obtain maximum enantiomeric excess of 51% in a single-step, without any further additives.publishe