Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery

Background: The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE). Methods: Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. The incidences of MACE and bleeding were compared in patients receiving DAPT, monotherapy, and no antiplatelet therapy before surgery. Unadjusted risk ratios were calculated taking monotherapy as the baseline. The adjusted risks of bleeding and MACE were compared in patients receiving monotherapy and DAPT using propensity score matching. Results: A total of 917 patients were recruited and 847 were eligible for inclusion. Ninety-six patients received no antiplatelet therapy, 526 received monotherapy with aspirin, and 225 received DAPT. Thirty-two patients suffered MACE and 22 had bleeding. The unadjusted risk ratio for MACE in patients receiving DAPT compared with monotherapy was 1.9 (0.93–3.88), P=0.08. There was no difference in MACE between no antiplatelet treatment and monotherapy 1.03 (0.31–3.46), P=0.96. Bleeding was more frequent with DAPT 6.55 (2.3–17.96) P=0.0002. In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69–4.85), P=0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15–13.93), P=0.031. Conclusions: OBTAIN showed an increased risk of bleeding with DAPT and found no evidence for protective effects of DAPT from perioperative MACE in patients who have undergone previous PCI

Fractal analysis of rat brain activity after injury

With application of the Higuchi algorithm, fractal dimension (FD) values of the electrocortical activity of the rat parietal cerebral and paravermal cerebellar cortex were calculated, before and after unilateral discrete injury of the left parietal cortex. Immediately following the first acute injury, in a group of six rats, a reversible increase in mean FD was found at the left (ipsilateral side to the injury) cerebral cortex, from 1.38 to 1.59, and at the left cerebellar cortex from 1.51 to 1.73. In addition, an indication of plastic changes after repeated (third) injury was found as an irreversible increase in mean FD: 1.54 on the left and 1.48 on the right side of parietal cortex

Delineation of Source Protection Zones Using Statistical Methods

Source protection zones are increasingly important for securing the long-term viability of drinking water derived from groundwater resources. These may be either time-related capture zones or catchments related to the activity of a pumping well or spring. The establishment of such zones is an indispensable measure for the proper assessment of groundwater resource vulnerability and reduction of risk, which may be induced by human activities. The delineation of these protection zones is usually performed with the aid of models, which are in turn based on site-specific information of the aquifer’s geometry, hydraulic parameters and boundary conditions. Owing to the imperfect knowledge of such information, predicting the location of these zones is inherently uncertain. It is possible to quantify this uncertainty in a statistical manner through the development of probability maps, which shows the probability that a particular surface location belongs to the aquifer’s capture zone (or catchment area). This publication aims at the investigation of the requirements for the establishment of probabilistic source protection zones, the practical use of stochastic methods in their delineation, and the use of data-assimilation for uncertainty reduction. It also provides a methodology for the implementation of these methods by modelling practitioners