Interpretation of clopidogrel resistance (multiple letters)

Kardiologia Polska634447-450KARP

Modern and ancient amalgamated sandy meander‐belt deposits: recognition and controls on development

Amalgamated sandy meander belts and their deposits are common in modern continental and marine‐connected basins yet comprise a minor constituent of the reported fluvial rock record. This suggests that either amalgamated meander‐belts are uncommon in the rock record or that the recognition criteria are lacking to identify sandy meandering river deposits. To address this apparent discrepancy, the authors document the range and occurrence of amalgamated sandy meander belts (ASMB) from modern basins and the stratigraphic record. ASMB are widely distributed throughout both present and rock record sedimentary basins occurring in foreland, extensional, cratonic, strike‐slip and passive margin basins. They occur in all climatic settings ranging from tundra to hot deserts. Three specific occurrences of ASMB are recognised in modern basins: in the proximal to medial parts of distributive fluvial systems (DFS), as laterally‐confined belts that mainly form axial fluvial systems; and as valley‐confined meander belts that may infill bedrock, alluvial or coastal plain valleys. From the limited amount of rock record examples of ASMB that are available, it is clear that they occur in similar settings to those observed in modern basins, the recognition of which provides a framework for the further prediction and identification of ASMB in the rock record. The lack of recognition of ASMB in the rock record is considered to be due to an absence of characteristics that allow clear distinction between sandy meandering and braided fluvial deposits. Characteristics considered common to both include: multi‐storey, laterally extensive (sheet‐like) amalgamated channel belts, dominance of downstream accreting bedforms, no fining upwards grain‐size profile and little or no fine‐grained sediment and/or soil preservation. In contrast, features considered characteristic of meandering rivers such as inclined heterolithic stratification, high palaeocurrent dispersion, single storey channels and fining upwards grain‐size profiles are absent. The authors suggest that no single criterion can be used to definitively identify sandy meander belt deposits in the rock record and that a combination of systematic variations in accretion direction, palaeocurrent dispersal patterns and recognition of storey scale accretion surfaces is necessary to identify clearly this fluvial style. The common occurrence and distribution of sandy meander belts in modern sedimentary basins together with their limited recognition in the rock record suggests that their true stratigraphic distribution has yet to be determined. This has important implications for palaeogeographic reconstructions, understanding the impact of plant colonisation on fluvial planform style and predicting sandstone body dimensions and internal heterogeneity distribution within hydrocarbon reservoirs and aquifers

What every reader should know about studies using electronic health record data but may be afraid to ask

10.2196/22219Journal of Medical Internet Research233e2221

Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)

BACKGROUND: Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces the rate of cardiovascular events among patients with left-ventricular dysfunction and those at high risk of such events. We assessed whether the ACE inhibitor perindopril reduced cardiovascular risk in a low-risk population with stable coronary heart disease and no apparent heart failure. METHODS: We recruited patients from October, 1997, to June, 2000. 13655 patients were registered with previous myocardial infarction (64%), angiographic evidence of coronary artery disease (61%), coronary revascularisation (55%), or a positive stress test only (5%). After a run-in period of 4 weeks, in which all patients received perindopril, 12218 patients were randomly assigned perindopril 8 mg once daily (n=6110), or matching placebo (n=6108). The mean follow-up was 4.2 years, and the primary endpoint was cardiovascular death, myocardial infarction, or cardiac arrest. Analysis was by intention to treat. FINDINGS: Mean age of patients was 60 years (SD 9), 85% were male, 92% were taking platelet inhibitors, 62% beta blockers, and 58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril patients experienced the primary endpoint, which yields a 20% relative risk reduction (95% CI 9-29, p=0.0003) with perindopril. These benefits were consistent in all predefined subgroups and secondary endpoints. Perindopril was well tolerated. INTERPRETATION: Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent one major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease