Apixaban Enhances Endogenous Fibrinolysis in Patients with Atrial Fibrillation

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.AIMS: Approximately 20% of ischaemic stroke patients exhibit spontaneous arterial recanalization, attributable to endogenous fibrinolysis, which strongly relates to improved functional outcome. The impact of oral anticoagulants on endogenous fibrinolysis is unknown. Our aim was to test the hypothesis that apixaban enhances endogenous fibrinolysis in non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: In a prospective cross-sectional analysis, we compared endogenous fibrinolysis in NVAF patients (n = 180) taking aspirin, warfarin, or apixaban. In a prospective longitudinal study, patients were tested before and after apixaban (n = 80). Endogenous fibrinolysis was assessed using the Global Thrombosis Test (GTT) and thromboelastography (TEG). Endogenous fibrinolysis [measured by GTT lysis time (LT)] was shorter on apixaban compared with warfarin or aspirin [median 1850 (IQR 1591-2300) vs. 2758 (2014-3502) vs. 2135 (1752-2463) s, P < 0.0001]. Among TEG indices, a small but significant difference in clot lysis time (CLT) was observed [apixaban 60.0 (45.0-61.0) vs. warfarin 61.0 (57.0-62.0) vs. aspirin 61.0 (59.0-61.0) min, P = 0.036]. Apixaban improved endogenous fibrinolysis measured using the GTT [LT pre-treatment 2204 (1779-2738) vs. on-treatment 1882 (1607-2374) s, P = 0.0003], but not by using TEG. Change in LT (ΔLT) with apixaban correlated with baseline LT (r = 0.77, P < 0.0001). There was weak correlation between ΔLT and ΔCLT in response to apixaban (r = 0.28, P = 0.02) and between on-apixaban LT and CLT (r = 0.25, P = 0.022). CONCLUSION: Apixaban enhances endogenous fibrinolysis, with maximal effect in those with impaired fibrinolysis pre-treatment. Apixaban-treated patients exhibit more favourable fibrinolysis profiles than those taking warfarin or aspirin. Whether apixaban may confer additional thrombotic risk reduction in NVAF patients with impaired fibrinolysis, compared to warfarin, merits further study.Peer reviewedFinal Accepted Versio

Non-linear behavior of ring-down time in cavity ring-down spectroscopy with tapered fibers

The effect of surrounding refractive index (n2) on ring-down time (τ) is studied in conventional and amplified cavity ring-down spectroscopy with tapered fibers. Simulation and experimental results indicate that τ varies as rational function of n2

Spatio-Temporal Impacts of Biofuel Production and Climate Variability on Water Quantity and Quality in Upper Mississippi River Basin

Impact of climate change on the water resources of the United States exposes the vulnerability of feedstock-specific mandated fuel targets to extreme weather conditions that could become more frequent and intensify in the future. Consequently, a sustainable biofuel policy should consider: (a) how climate change would alter both water supply and demand; and (b) in turn, how related changes in water availability will impact the production of biofuel crops; and (c) the environmental implications of large scale biofuel productions. Understanding the role of biofuels in the water cycle is the key to understanding many of the environmental impacts of biofuels. Therefore, the focus of this study is to model the rarely explored interactions between land use, climate change, water resources and the environment in future biofuel production systems. Results from this study will help explore the impacts of the US biofuel policy and climate change on water and agricultural resources. We used the Soil and Water Assessment Tool (SWAT) to analyze the water quantity and quality consequences of land use and land management related changes in cropping conditions (e.g., more use of marginal lands, greater residue harvest, increased yields), plus management practices due to biofuel crops to meet the Renewable Fuel Standard target on water quality and quantity

Performance analysis of frequency shift estimation techniques in Brillouin distributed fiber sensors

The performance of post-processing techniques carried out on the Brillouin gain spectrum to estimate the Brillouin frequency shift (BFS) in standard Brillouin distributed sensors is evaluated. Curve fitting methods with standard functions such as polynomial and Lorentzian, as well as correlation techniques such as Lorentzian Cross-correlation and Cross Reference Plot Analysis (CRPA), are considered for the analysis. The fitting procedures and key parameters for each technique are optimized, and the performance in terms of BFS uncertainty, BFS offset error and processing time is compared by numerical simulations and through controlled experiments. Such a quantitative comparison is performed in varying conditions including signal-to-noise ratio (SNR), frequency measurement step, and BGS truncation. It is demonstrated that the Lorentzian cross-correlation technique results in the largest BFS offset error due to truncation, while exhibiting the smallest BFS uncertainty and the shortest processing time. A novel approach is proposed to compensate such a BFS offset error, which enables the Lorentzian cross-correlation technique to completely outperform other fitting methods

Sub-harmonic injection locking of quantum-dash lasers using spectral enrichment from semiconductor optical amplifiers

We report sub-harmonic injection locking of a 40 GHz passively mode-locked quantum-dash (Q-dash) laser through spectral enrichment in a nonlinear semiconductor optical amplifier. The proposed scheme is demonstrated for injection locking of the Q-dash passively mode-locked laser using data modulated with non-returnto-zero line-coding at 10 G symbols/s with both intensity and phase shift keying modulations

An efficient ensemble VTOPES multi-criteria decision-making model for sustainable sugarcane farms

© 2019 by the authors. The role of Information Technology based decision models for sustainable agriculture has gained immense prominence in recent years. Ranking of agriculture farms based on their yield plays a vital role in sustainable agriculture. In this work, an ensemble decision-making model, namely VIKOR (Vlsekriterijumska Optimizacija I Kompromisno Resenje), TOPSIS (Technique for Order Preference by Similarity to an Ideal Solution), entropy, and standard deviation (VTOPES), is proposed for ranking the sustainable sugarcane farms. VTOPES system model comprises of four significant steps: (i) determination of significance scores of the sub-parameters, (ii) transformation of sub-parameter sequences into main parameter values, (iii) computation of significant scores of main parameters, and (iv) generation of assessment values and deploying it for ranking the sugarcane farms. The ranking results of the proposed VTOPES model are compared with the ranking patterns obtained from five years average yield data acquired from the selected sugarcane farms. Moreover, the outcomes of the VTOPES model are also compared with other prevalent methods. Subsequently, Spearman's rank correlation method is applied for evaluating the impact of correlation of VTOPES ranks in comparison with the average yield ranks. Thus, it can be noticed that the empirical results of the VTOPES model provide reliable and sustainable results. Therefore, it suffices to be a sustainable decision model for any problem where multiple parameters are involved

Ibrutinib plus RICE or RVICI for relapsed/refractory mature B-cell non-Hodgkin lymphoma in children and young adults:SPARKLE trial

Part 1 results of the open-label, randomized, global phase 3 SPARKLE trial supported continued assessment of ibrutinib with either modified rituximab, ifosfamide, carboplatin, and etoposide (RICE) or rituximab, vincristine, ifosfamide, carboplatin, idarubicin, and dexamethasone (RVICI) in pediatric patients with relapsed/refractory (R/R) mature B-cell non-Hodgkin lymphoma (B-NHL). We report final results of Part 2 evaluating the efficacy of ibrutinib plus RICE or RVICI vs RICE/RVICI alone. Patients aged 1 to 30 years (initial diagnosis \u3c18 years) were randomized 2:1 to receive ibrutinib with or without RICE/RVICI. Primary endpoint was event-free survival (EFS) based on independent committee-confirmed events. Fifty-one patients were enrolled. Median age was 15 years; Burkitt lymphoma, Burkitt leukemia, and Burkitt-like lymphoma (total: 45%) and diffuse large B-cell lymphoma/primary mediastinal B-cell lymphoma (51%) were the most common subtypes. At the preplanned interim analysis, median EFS was 6.1 vs 7.0 months with ibrutinib plus RICE/RVICI vs RICE/RVICI, respectively (hazard ratio, 0.9; 90% confidence interval, 0.5-1.6; P = .387); further enrollment was ceased. With ibrutinib plus RICE/RVICI vs RICE/RVICI, median overall survival was 14.1 vs 11.1 months, overall response rate was 69% vs 81%, and 46% vs 44% proceeded to stem cell transplantation. In both treatment arms, 100% of patients experienced grade ≥3 treatment-emergent adverse events. No EFS benefit was seen with ibrutinib. Salvage was generally poor in patients who received prior rituximab, regardless of treatment arm. No new safety signals were observed. Ibrutinib exposure in pediatric patients fell within the target range of exposure in adults. Trial is registered on www.clinicaltrials.gov (NCT02703272)

Vasa previa in singleton pregnancies: Diagnosis and clinical management based on an international expert consensus

There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies. (s): To systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions (FGD) and a Delphi technique. A four-round FGD and a three-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected based on their publication record on vasa previa. First, we convened an FGD panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A three-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa that the experts were asked to rate on a 5-point Likert scale (from strongly disagree = 1 to strongly agree = 5). Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of 3 or less were deemed to have had no consensus and excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and non-consensus statements were then aggregated. Sixty-eight international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on five continents and have contributed to over 80% of published cohort studies on vasa previa, as well as national and international society guidelines. Completion rates were 84%, 93%, 91% for the first, second, and third rounds, respectively, and 71% completed all three rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including: 1) While there is no agreement on a distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2 cm distance; 2) All pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; 3) When a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at around 32 weeks to rule out vasa previa; 4) Outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; 5)Asymptomatic patients with vasa previa should be delivered by scheduled cesarean between 35- and 37-weeks of gestation; and 6) There was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa. Through FGD and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical guidelines. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.