Ancient human genome-wide data from a 3000-year interval in the Caucasus corresponds with eco-geographic regions

Archaeogenetic studies have described the formation of Eurasian 'steppe ancestry' as a mixture of Eastern and Caucasus hunter-gatherers. However, it remains unclear when and where this ancestry arose and whether it was related to a horizon of cultural innovations in the 4 th millennium BCE that subsequently facilitated the advance of pastoral societies in Eurasia. Here we generated genome-wide SNP data from 45 prehistoric individuals along a 3000-year temporal transect in the North Caucasus. We observe a genetic separation between the groups of the Caucasus and those of the adjacent steppe. The northern Caucasus groups are genetically similar to contemporaneous populations south of it, suggesting human movement across the mountain range during the Bronze Age. The steppe groups from Yamnaya and subsequent pastoralist cultures show evidence for previously undetected farmer-related ancestry from different contact zones, while Steppe Maykop individuals harbour additional Upper Palaeolithic Siberian and Native American related ancestry

MANAGEMENT AND OUTCOMES IN ACUTE CORONARY SYNDROME WITH ATRIAL FIBRILLATION IN “NON-INVASIVE” CLINIC

Aim. To evaluate the management and outcomes in acute coronary syndrome patients (ACS) comorbid with atrial fibrillation (AF) during in-patient period and in 12 months from ACS onset.Material and methods. Into multicenter prospective registry (CCH № 29 of Moscow), beginning December 2013, during 12 months, all consecutive patients included, with ACS, and AF on baseline ECG. Follow-up was continued during hospitalization and in 12 months from ACS (phone call).Results. Totally, 234 patients included. Mean age 72,0±11,6 y.o., 65+73,5%, females — 68,8%, anamnesis of myocardial infarction (MI) — 35,9%, diabetes — 23,9%, known AF before ACS — 65,0%, non-ST-elevation ACS — 97,9%, Killip >I — 7,3%, ST depression on baseline ECG — 89,9%, high troponin level — 59,0%, GRACE risk of fatal outcome >140 points. — 75,2%, median CHA2 DS2 -Vasc — 5 pts. At discharge from hospital, 44% patients received double antiplatelet treatment (DAT), 38% — aspirin with oral anticoagulant (OAC), 33% — warfarin, 23% — new OAC (NOAC). During hospitalization (median 14 days) 7 patients died (3,0%). In 12 months the outcomes were followed in 210 patients (89,8%). By 12 months from ACS onset, 18,1% patients died, and in 12 months but after discharge — 15,3%. New MI after discharge had 1,5%, stroke — 2,5%, and bleeding — 3,5% patients. The part of fatal outcomes in 12 months did not differ in DAT or aspirin with OAC groups (12,1% vs 12,8%; p=0,88). The “remained” prescription rate (i.e. adherence) in 12 months after ACS was maximum for aspirin, OAC and NOAC (71%, 58%, 63%, resp.) and minimum for DAT and aspirin with OAC (20% and 27%, resp.). The independent predictors of death after discharge from hospital up to 12 months from ACS onset were the baseline hemoglobin <110 g/L (OR 16,00; 95% CI 2,57-99,50; р=0,003), non-treatment by antithrombotics before ACS (OR 7,22; 95% CI 2,20- 23,68; р=0,001), hospital risk by GRACE >140 pts. (OR 6,88; 95% CI 1,44-32,80; р=0,015) and non-prescription of aspirin in discharge (OR 3,21; 95% CI 1,20-8,61; р=0,02).Conclusion. The results of observational study of ACS and AF patients, admitted to Moscow city “non-invasive” clinic, showed high rate of fatal outcomes in 12 months after ACS (18,1%), low adherence to the prescribed treatment after discharge. Also, in the group studied, there were predictors of fatal outcomes in 12 months after ACS

ST ELEVATION ACUTE CORONARY SYNDROME IN NON-OBSTRUCTIVE LESION OF CORONARY ST ELEVATION ACUTE CORONARY SYNDROME IN NON-OBSTRUCTIVE LESION OF CORONARY ARTERIES: DATA FROM THE REGISTRY RECORD-3

Material and methods. The data used, from the acute coronary syndrome registry RECORD-3, in the emergency cardiology department of Tomsk SRI of Cardiology, together with another 51 center in Russia. Based on the absence of presence of NOCA, patients with ST elevation myocardial infarction, who had undergone coronary arteriography, were selected to two independent groups: 27 with NOCA and 571 with OCA.Results. There were no significant differences in the clinical portrait of NOCA and OCA patient. However, palpitation followed angina attack in NOCA patients. In the NOCA, there was significantly lower number of persons with diagnostically relevant raise of cardio specific enzymes. Indirectly, it points on temporary ischemia with no necrosis, or that the area of necrotic myocardium is not large. In NOCA patients, statistically more significantly were absent reciprocal ECG changes. Endpoints as mortality and novel heart failure development had tendency to statistically more significant decrease of prevalence in NOCA patients. As final diagnosis at discharge, in NOCA patients more often another diagnosis was mentioned (including unstable angina, etc.), but not myocardial infarction. The key issues in hospital management of these two groups were identical, except more often prescription of dihydropiridine calcium channel blockers to NOCA patients, and rarer prescription of antiplatelet drugs at discharge.Conclusion. Regardless the fact that prognosis in ACS with NOCA and intact arteries is better than in OCA, it is necessary to analyze thoroughly pathogenesis of the disease in every case, as in this category of patients especially, it is most heterogenic. As these patients have comorbid factors, it is necessary to select the leading one, and to intensify efforts on this factor directly

Russian register of acute pulmonary embolism SIRENA: characteristics of patients and in-hospital treatment

Aim. To assess the features of diagnosis, treatment and outcomes of pulmonary embolism (PE) in patients of Russian hospitals.Material and methods. The register included all hospitalized patients with PE identified by any diagnostic method. Duration of inclusion was 12 months. In-hospital period management was assessed. Information about the included patients was provided by 20 hospitals from 15 Russian cities.Results. For the period from April 15, 2018 to April 15, 2019, 609 patients were included in the register (women — 50,7%, mean age — 63,0±14,5 years, minimum-maximum — 19-94 years). Among the known risk factors for PE, the most common were lower limb varicose veins (31,4%), heart failure (23,3%), previous deep vein thrombosis (19,4%), cancer (17,1%). The median time from symptom onset to suspicion/confirmation of PE was 4 days (1-3 quartiles — 1-8 days). Shortness of breath, syncope/presyncope, chest pain/discomfort, cough, leg pain or lower extremity asymmetry and hemoptysis were noted in 88,7%, 30,0%, 29,8%, 17,3%, 9,4% and 8,5% of patients, respectively. Echocardiography was performed in 89,5%, and Doppler ultrasound of lower limb veins — in 85,9% of patients. Signs of venous thrombosis were found in 57,8% of patients. Computed tomographic (CT) pulmonary angiography was performed in 89,2% of patients, pulmonary scintigraphy and pulmonary angiography — 0,8% each.Conclusion. Symptoms and main risk factors for PE in Russian patients did not fundamentally differ from those previously known. There was good adherence to modern guidelines for the diagnosis of PE, but adherence to guidelines on drug therapy met requirements only in half of the cases. There was an excessive use of TLT, as well as the use of ineffective methods of administering and monitoring anticoagulant therapy.In total, imaging technologies were used in 90,6% of patients, and signs confirming PE were found in 92,7%. Thrombolytic therapy (TLT) was performed in 25,0%; 92,0% of patients received anticoagulants. At the same time, unfractionated heparin (UFH) was injected subcutaneously in 26,3% of cases, and in one third of patients the drug was injected in doses unadjusted by body weight. In 42,7% of patients received UFH, the target activated partial thromboplastin time was not achieved. With warfarin treatment, the target international normalized ratio was achieved in only 48,4% of patients. Inferior vena cava filter placement and thrombectomy were performed in 1,3% each. During hospitalization (median — 11 days), 9,9% of patients died

Do Professional Developers Benefit from Design Pattern Documentation? A Replication in the Context of Source Code Comprehension

We present the results of a differentiated replication conducted with professional developers to assess whether the presence and the kind of documentation for the solutions or instances of design patterns affect source code comprehension. The participants were divided into three groups and asked to comprehend a chunk of the JHot- Draw source code. Depending on the group, each participant was or not provided with the graphical and textual representations of the design pattern instances implemented within that source code. In the case of graphically documented instances, we used UML class diagrams, while textually documented instances are reported as comment in the source code. The results revealed that participants provided with the documentation of the instances achieved a significantly better comprehension than the participants with source code alone. The effect of the kind of documentation is not statistically significant