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

Evolving relations between agriculture and forest in Viengkham District, Luang Prabang Province

The paper investigates the changes in management and trade of non timber forest products (NTFP) in northern uplands of Laos and how they are related to agricultural production from both landscape and livelihoods perspectives. Surveys were conducted in Luang Prabang province with multiple groups of stakeholders (e.g. villagers, traders, officials from different administrations) to compare the value chains of agricultural and forest products and assess their interactions. Analysis of remote sensing data and literature review complemented field investigations to describe the historical changes in land use and in the management of NTFP and agricultural commodities. The study revealed how forest and agriculture products are complementary from both an economic perspective: i.e. how they complement each other in household economics and traders businesses; and an ecological perspective: i.e. how they complement each other at the landscape level. At the landscape level, the complex mosaics of agriculture and forest patches are key assets in term of resilience of the overall system in the face of unpredictable natural events (e.g. floods, droughts, fires). The main lesson is that the on-going segregation of agricultural and forest spaces tend to increase economical and ecological vulnerability by decreasing diversity in landscapes and livelihood systems. The on-going trend of specialization of farming activities as a result of the shifting cultivation eradication policy should be buffered in such a way that multiple livelihood systems and economic development pathways can be maintained. The loss in the resilience of the socio-ecological system due to simplification of the natural landscape should be compensated by improved mechanisms for landscape governance

Transcription Factors Krüppel-Like Factor 6 and Peroxisome Proliferator-Activated Receptor-γ Mediate High Glucose-Induced Thioredoxin-Interacting Protein

We demonstrated recently that thioredoxin-interacting protein (Txnip) and the transcription factor Krüppel-like factor 6 (KLF6) were up-regulated in both in vivo and in vitro models of diabetic nephropathy, thus promoting renal injury. Conversely, peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists have been shown to be renoprotective. Hence, this study was undertaken to determine whether Txnip expression is regulated by the transcription factors KLF6 and PPAR-γ. By using siRNAs and overexpressing constructs, the role of KLF6 and PPAR-γ in Txnip transcriptional regulation was determined in human kidney proximal tubule cells and in streptozocin-induced diabetes mellitus in Sprague-Dawley rats, in vitro and in vivo models of diabetic nephropathy, respectively. KLF6 overexpression increased Txnip expression and promoter activity, which was inhibited by concurrent exposure to PPAR-γ agonists. In contrast, reduced expression of KLF6 by siRNA or exposure to PPAR-γ agonists attenuated high glucose-induced Txnip expression and promoter activity. KLF6-Txnip promoter binding was decreased in KLF6-silenced cells, whereas PPAR-γ agonists increased PPAR-γ-Txnip promoter binding. Indeed, silencing of KLF6 increased PPAR-γ expression, suggesting endogenous regulation of PPAR-γ expression by KLF6. Moreover, renal KLF6 and Txnip expression increased in rats with diabetes mellitus and was inhibited by PPAR-γ agonist treatment; however, KLF6 expression did not change in HK-2 cells exposed to PPAR-γ agonists. Hence, Txnip expression and promoter activity are mediated via divergent effects of KLF6 and PPAR-γ transcriptional regulation