1,651 research outputs found
External validation of AF-BLEED for predicting major bleeding and for tailoring NOAC dose in AF patients: A post hoc analysis in the ENGAGE AF-TIMI 48
OBJECTIVE
AF-BLEED, a simple bleeding risk classifier, was found to predict major bleeding (MB) in patients with atrial fibrillation (AF) and identify AF patients at high risk of MB who might potentially benefit from a lower direct oral anticoagulant dose. This post hoc study aimed to externally validate these findings in the ENGAGE AF-TIMI 48 (Effective aNticoaGulation with factor Xa next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction study 48) trial.
METHODS
The ENGAGE AF-TIMI 48 trial randomized AF patients to higher-dose edoxaban regimen (HDER 60/30 mg) versus lower-dose edoxaban regimen (LDER 30/15 mg), with prespecified dose reduction criteria. AF-BLEED was calculated in the modified intention-to-treat cohort (n = 21,026 patients) used for primary outcome analysis. Annualized event rates and hazard ratios (HRs) were obtained for the primary composite outcome (PCO) and its single components (MB, ischemic stroke/systemic embolism and death) to compare LDER 30 mg with HDER 60 mg in both AF-BLEED classes.
RESULTS
AF-BLEED classified 2882 patients (13.7 %) as high-risk, characterized by a two- to three-fold higher MB risk than AF-BLEED classified low-risk patients. AF-BLEED classified high-risk patients randomized to LDER 30 mg demonstrated a 3.3 % reduction in MB at the cost of a 0.5 % increase in ischemic stroke/systemic embolism. LDER 30 mg resulted in a 3.1 % reduction of PCO compared to HDER 60 mg (HR of 0.81; 95%CI 0.65-1.01). Additional to existing dose reduction criteria, another 6 % of patients could potentially benefit of this dose adjustment strategy.
CONCLUSION
AF-BLEED could identify AF patients to be at high risk of major bleeding. Our findings support the hypothesis that LDER 30 mg might provide a reasonable option in AF patients with legitimate bleeding concerns
Effects of comorbidity on Tourette's tic severity and quality of life
Objective The aim of this study is to gain more insight in the differential contributions of anxiety, depression and obsessive-compulsive (OC) symptom severity to quality of life (QoL) and tic severity in adults with Tourette Disorder (TD). Methods Self-reported OC symptom, anxiety and depression severity measures were used to investigate their predictive value on QoL and Tic severity in adult TD patients (N = 187), using correlation, regression, and mediation analyses. Results Tic severity has no effect on QoL. Depression severity directly reduces QoL, whereas anxiety and OC symptom severity have an indirect effect on QoL, mediated by depression severity. OC symptom severity directly affects tic severity, whereas depression and anxiety severity do not have a direct effect on tic or OC severity. Finally, anxiety severity indirectly impacts tic severity, with OC symptom severity functioning as a mediator. Conclusion In line with and extending previous studies, these findings indicate that OC symptom severity directly influences tic symptom severity whereas depression severity directly influences QoL in TD. Results imply that to improve QoL in TD patients, treatment should primarily focus on diminishing OC and depressive symptom severity rather than focusing on tic reduction
Transformation of higher education institutional landscape in post-Soviet countries : from Soviet model to where?
Competition and facilitation between the marine nitrogen-fixing <i>cyanobacterium</i> Cyanothece and its associated bacterial community
N2-fixing cyanobacteria represent a major source of new nitrogen and carbon for marine microbial communities, but little is known about their ecological interactions with associated microbiota. In this study we investigated the interactions between the unicellular N2-fixing cyanobacterium Cyanothece sp. Miami BG043511 and its associated free-living chemotrophic bacteria at different concentrations of nitrate and dissolved organic carbon and different temperatures. High temperature strongly stimulated the growth of Cyanothece, but had less effect on the growth and community composition of the chemotrophic bacteria. Conversely, nitrate and carbon addition did not significantly increase the abundance of Cyanothece, but strongly affected the abundance and species composition of the associated chemotrophic bacteria. In nitrate-free medium the associated bacterial community was co-dominated by the putative diazotroph Mesorhizobium and the putative aerobic anoxygenic phototroph Erythrobacter and after addition of organic carbon also by the Flavobacterium Muricauda. Addition of nitrate shifted the composition toward co-dominance by Erythrobacter and the Gammaproteobacterium Marinobacter. Our results indicate that Cyanothece modified the species composition of its associated bacteria through a combination of competition and facilitation. Furthermore, within the bacterial community, niche differentiation appeared to play an important role, contributing to the coexistence of a variety of different functional groups. An important implication of these findings is that changes in nitrogen and carbon availability due to, e.g., eutrophication and climate change are likely to have a major impact on the species composition of the bacterial community associated with N2-fixing cyanobacteria
Thermal bremsstrahlung probing the thermodynamical state of multifragmenting systems
Inclusive and exclusive hard-photon (E 30 MeV) production in five
different heavy-ion reactions (Ar+Au, Ag, Ni,
C at 60{\it A} MeV and Xe+Sn at 50{\it A} MeV) has been
studied coupling the TAPS photon spectrometer with several charged-particle
multidetectors covering more than 80% of 4. The measured spectra, slope
parameters and source velocities as well as their target-dependence, confirm
the existence of thermal bremsstrahlung emission from secondary nucleon-nucleon
collisions that accounts for roughly 20% of the total hard-photon yield. The
thermal slopes are a direct measure of the temperature of the excited nuclear
systems produced during the reaction.Comment: 4 pages, 3 figures, Proceedings CRIS 2000, 3rd Catania Relativistic
Ion Studies, "Phase Transitions in Strong Interactions: Status and
Perspectives", Acicastello, Italy, May 22-26, 2000 (to be published in Nuc.
Phys. A
Increased genetic marker density reveals high levels of admixture between red deer and introduced Japanese sika in Kintyre, Scotland
Hybridization is a natural process at species range boundaries, but increasing numbers of species are hybridizing due to direct or indirect human activities. In such cases of anthropogenic hybridization, subsequent introgression can threaten the survival of native species. To date, many such systems have been studied with too few genetic markers to assess the level of threat resulting from advanced backcrossing. Here, we use 44,999 single nucleotide polymorphisms (SNPs) and the ADMIXTURE program to study two areas of Scotland where a panel of 22 diagnostic microsatellites previously identified introgression between native red deer (Cervus elaphus) and introduced Japanese sika (Cervus nippon). In Kintyre, we reclassify 26% of deer from the pure species categories to the hybrid category whereas in the NW Highlands we only reclassify 2%. As expected, the reclassified individuals are mostly advanced backcrosses. We also investigate the ability of marker panels selected on different posterior allele frequency criteria to find hybrids assigned by the full marker set and show that in our data, ancestry informative markers (i.e. those that are highly differentiated between the species, but not fixed) are better than diagnostic markers (those markers that are fixed between the species) because they are more evenly distributed in the genome. Diagnostic loci are concentrated on the X chromosome to the detriment of autosomal coverage
Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis.
Background We aimed to review the efficacy and
safety of recanalisation procedures for the treatment of
PE.
Methods We searched PubMed, the Cochrane
Library, EMBASE, EBSCO, Web of Science and CINAHL
databases from inception through 31 July 2015 and
included randomised clinical trials that compared the
effect of a recanalisation procedure versus each other or
anticoagulant therapy in patients diagnosed with PE. We
used network meta-analysis and multivariate randomeffects
meta-regression to estimate pooled differences
between each intervention and meta-regression to
assess the association between trial characteristics and
the reported effects of recanalisation procedures versus
anticoagulation.
Results For all-cause mortality, there were no
significant differences in event rates between any of the
recanalisation procedures and anticoagulant treatment
(full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01;
low-dose thrombolysis: 0.47; 95%CI 0.14 to 1.59; and
catheter-associated thrombolysis: 0.31; 95%CI 0.01 to
7.96). Full-dose thrombolysis increased the risk of major
bleeding (2.00; 95%CI 1.06 to 3.78) compared with
anticoagulation. Catheter-directed thrombolysis was
associated with the lowest probability of dying (surface
under the cumulative ranking curve (SUCRA), 0.67),
followed by low-dose thrombolysis (SUCRA, 0.66) and
full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose
thrombolysis was associated with the lowest probability
of major bleeding (SUCRA, 0.61), followed by catheterdirected
thrombolysis (SUCRA, 0.54) and full-dose
thrombolysis (SUCRA, 0.17). The results were similar in
sensitivity analyses based on restricting only to studies in
haemodynamically stable patients with PE.
Conclusions In the treatment of PE, recanalisation
procedures do not seem to offer a clear advantage
compared with standard anticoagulation. Low-dose
thrombolysis was associated with the lowest probability
of dying and bleedingpre-print549 K
- …