COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease.

BACKGROUND Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications. OBJECTIVES The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients. METHODS COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression. RESULTS Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; P < 0.0001) and were in more advanced physiological stage (P = 0.032) and NYHA functional class (P = 0.01), had lower baseline oxygen saturation (P = 0.0001), and more frequently had a history of atrial arrhythmia (P < 0.0001), previous hospitalization for heart failure (P < 0.0007), and were more likely hospitalized for COVID-19 (P < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; P = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; P = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; P < 0.0001) were independently associated with increased risk of TE/bleeding complications. CONCLUSIONS ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Determining factors driving sustainable performance through the application of lean management practices in horticultural primary production

Erasmus Mundus Inspire Projec

Cerenkov Radiation From Anisotropic Ferrites

122 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1963.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

The Supply Chain Network @ Internet Speed

237hl

Late paleozoic closure of the ob-zaisan ocean along the irtysh shear zone (NW China): Implications for arc amalgamation and oroclinal bending in the central Asian orogenic belt

The largest accretionary orogen in the world, the Central Asian orogenic belt, has evolved through the assembly of various oceanic and continental blocks. Understanding the processes associated with the development of this orogenic belt relies on precise recognition of the boundaries between various terranes. One such major suture zone, which records the collisional history of the Siberian marginal arc system (Chinese Altai) with intra-oceanic arc systems (East/West Junggar), is the Irtysh shear zone in NW China. The spatial continuity and the tectonic nature of this shear zone are still poorly understood, but its development has supposedly made a significant impact on the architecture of the western Central Asian orogenic belt and the formation of the Kazakhstan orocline. Here, we provide new insight into the evolution of this shear zone based on detrital zircon ages, Hf isotope composition, structural data and 40Ar/39Ar age constraints on the timing of deformation. Our results show a major discrepancy in detrital zircon populations and Hf model ages across the southern Chinese Altai and the northern East/West Junggar, thus allowing us to map the exact location of the tectonic boundary. Detrital zircon data constrain the initial closure of the Ob-Zaisan Ocean to the late Carboniferous (&lt;323 Ma), and new structural and 40Ar/39Ar geochronological data shed light on the subsequent collisional processes. We propose that the collisional zone between the Chinese Altai and the East/West Junggar was initially subjected to crustal thickening at ca. 323-295 Ma, followed by orogen-parallel extension (ca. 295 Ma) and transpressional deformation (ca. 286-253 Ma). The closure of the Ob-Zaisan Ocean in NW China postdates the initial phase of oroclinal bending in the western Central Asian orogenic belt, thus indicating that oroclinal bending initiated during subduction. Based on our new constraints and other available geological data, we suggest that the early stage of oroclinal bending was likely driven by slab rollback

Tectonic evolution of the Chinese Tianshan Orogen from subduction to arc-continent collision: Insight from polyphase deformation along the Gangou section, Central Asia

The Central Asian Orogenic Belt, as the largest accretionary orogen on Earth, is an ideal candidate to study the geodynamics of convergent plate boundaries through a prolonged period. The evolution of this orogen has been explained by different tectonic models, which incorporated one, or a combination, of the following mechanisms: lateral stacking of arc systems along major shear zones, arc amalgamation, oroclinal bending, and trench migration. Here we elucidate major mechanisms responsible for the tectonic evolution of the Central Asian Orogenic Belt, focusing on the Chinese Tianshan Orogen in the southern Central Asian Orogenic Belt. Structural observations from the ∼50-km-long Gangou section show evidence of polyphase deformation. The earliest episode of orogen-parallel sinistral shearing, constrained to the Early Devonian (ca. 399 Ma) by syn-deformational intrusions, was possibly controlled by oblique subduction. This was followed by an episode of ∼NE−SW contractional deformation, dated at ca. 356 Ma (40Ar/39Ar age of syn-deformational hornblende), and likely associated with an episode of trench advance. The third stages of deformation during the latest Carboniferous and Permian involved ∼NE-SW contraction, orogen-parallel extension, and dextral transpression. Our new geochronological data constrain the timing of orogen-parallel extension to ca. 303−293 Ma, and confirm that dextral activation along shear zones occurred during the Permian. The results highlight the role of trench migration, oblique tectonics, and syn-collisional orogen-parallel extension in the build-up of the Central Asian Orogenic Belt, and contribute to the pre-collisional reconstruction of this orogenic system