Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

The correlation of mutations and expressions of genes within the PI3K/Akt/mTOR pathway in breast cancer : a preliminary study

There is an urgent need to seek new molecular biomarkers helpful in diagnosing and treating breast cancer. In this elaboration, we performed a molecular analysis of mutations and expression of genes within the PI3K/Akt/mTOR pathway in patients with ductal breast cancer of various malignancy levels. We recognized significant correlations between the expression levels of the studied genes. We also performed a bioinformatics analysis of the data available on the international database TCGA and compared them with our own research. Studies on mutations and expression of genes were conducted using High-Resolution Melt PCR (HRM-PCR), Allele-Specific-quantitative PCR (ASP-qPCR), Real-Time PCR molecular methods in a group of women with ductal breast cancer. Bioinformatics analysis was carried out using web source Ualcan and bc-GenExMiner. In the studied group of women, it was observed that the prevalence of mutations in the studied PIK3CA and AKT1 genes was 29.63%. It was stated that the average expression level of the PIK3CA, PIK3R1, PTEN genes in the group of breast cancer patients is lower in comparison to the control group, while the average expression level of the AKT1 and mTOR genes in the studied group was higher in comparison to the control group. It was also indicated that in the group of patients with mutations in the area of the PIK3CA and AKT1 genes, the PIK3CA gene expression level is statistically significantly lower than in the group without mutations. According to our knowledge, we demonstrate, for the first time, that there is a very strong positive correlation between the levels of AKT1 and mTOR gene expression in the case of patients with mutations and without mutations

Inter-laboratory assessment of different digital PCR platforms for quantification of human cytomegalovirus DNA

Quantitative PCR (qPCR) is an important tool in pathogen detection. However, the use of different qPCR components, calibration materials and DNA extraction methods reduces comparability between laboratories, which can result in false diagnosis and discrepancies in patient care. The wider establishment of a metrological framework for nucleic acid tests could improve the degree of standardisation of pathogen detection and the quantification methods applied in the clinical context. To achieve this, accurate methods need to be developed and implemented as reference measurement procedures, and to facilitate characterisation of suitable certified reference materials. Digital PCR (dPCR) has already been used for pathogen quantification by analysing nucleic acids. Although dPCR has the potential to provide robust and accurate quantification of nucleic acids, further assessment of its actual performance characteristics is needed before it can be implemented in a metrological framework, and to allow adequate estimation of measurement uncertainties. Here, four laboratories demonstrated reproducibility (expanded measurement uncertainties below 15%) of dPCR for quantification of DNA from human cytomegalovirus, with no calibration to a common reference material. Using whole-virus material and extracted DNA, an intermediate precision (coefficients of variation below 25%) between three consecutive experiments was noted. Furthermore, discrepancies in estimated mean DNA copy number concentrations between laboratories were less than twofold, with DNA extraction as the main source of variability. These data demonstrate that dPCR offers a repeatable and reproducible method for quantification of viral DNA, and due to its satisfactory performance should be considered as candidate for reference methods for implementation in a metrological framework. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00216-017-0206-0) contains supplementary material, which is available to authorized users

Energy dependence and fluctuations of anisotropic flow in Pb-Pb collisions at √sNN=5.02 and 2.76 TeV

Measurements of anisotropic flow coefficients with two- and multi-particle cumulants for inclusive charged particles in Pb-Pb collisions at sNN=5.02 and 2.76 TeV are reported in the pseudorapidity range |η| < 0.8 and transverse momentum 0.2 < pT < 50 GeV/c. The full data sample collected by the ALICE detector in 2015 (2010), corresponding to an integrated luminosity of 12.7 (2.0) μb−1 in the centrality range 0-80%, is analysed. Flow coefficients up to the sixth flow harmonic (v6) are reported and a detailed comparison among results at the two energies is carried out. The pT dependence of anisotropic flow coefficients and its evolution with respect to centrality and harmonic number n are investigated. An approximate power-law scaling of the form vn(pT) ∼ pTn/3 is observed for all flow harmonics at low pT (0.2 < pT < 3 GeV/c). At the same time, the ratios vn/vmn/ m are observed to be essentially independent of pT for most centralities up to about pT = 10 GeV/c. Analysing the differences among higher-order cumulants of elliptic flow (v2), which have different sensitivities to flow fluctuations, a measurement of the standardised skewness of the event-by-event v2 distribution P(v2) is reported and constraints on its higher moments are provided. The Elliptic Power distribution is used to parametrise P(v2), extracting its parameters from fits to cumulants. The measurements are compared to different model predictions in order to discriminate among initial-state models and to constrain the temperature dependence of the shear viscosity to entropy-density ratio.[Figure not available: see fulltext.]

Anisotropic flow of identified particles in Pb-Pb collisions at √sNN=5.02 TeV

The elliptic (v2), triangular (v3), and quadrangular (v4) flow coefficients of π±, K±, p+p ̄,Λ+Λ ̄,KS0, and the φ-meson are measured in Pb-Pb collisions at sNN=5.02 TeV. Results obtained with the scalar product method are reported for the rapidity range |y| < 0.5 as a function of transverse momentum, pT, at different collision centrality intervals between 0–70%, including ultra-central (0–1%) collisions for π±, K±, and p + p ̄. For pT< 3 GeV/c, the flow coefficients exhibit a particle mass dependence. At intermediate transverse momenta (3 < pT < 8–10 GeV/c), particles show an approximate grouping according to their type (i.e., mesons and baryons). The φ-meson v2, which tests both particle mass dependence and type scaling, follows p + p ̄ v2 at low pT and π±v2 at intermediate pT. The evolution of the shape of vn(pT) as a function of centrality and harmonic number n is studied for the various particle species. Flow coefficients of π±, K±, and p + p ̄ for pT < 3 GeV/c are compared to iEBE-VISHNU and MUSIC hydrodynamical calculations coupled to a hadronic cascade model (UrQMD). The iEBE-VISHNU calculations describe the results fairly well for pT < 2.5 GeV/c, while MUSIC calculations reproduce the measurements for pT < 1 GeV/c. A comparison to vn coefficients measured in Pb-Pb collisions at sNN=2.76 TeV is also provided.[Figure not available: see fulltext.]

Multiplicity dependence of Υ production at forward rapidity in pp collisions at s=13 TeV

The measurement of Υ(1S), Υ(2S), and Υ(3S) yields as a function of the charged-particle multiplicity density, dNch/dη, using the ALICE experiment at the LHC, is reported in pp collisions at s= 13 TeV. The Υ meson yields are measured at forward rapidity (2.5<4) in the dimuon decay channel, whereas the charged-particle multiplicity is defined at central rapidity (|η|<1). Both quantities are divided by their average value in minimum bias events to compute the self-normalized quantities. The increase of the self-normalized Υ(1S), Υ(2S), and Υ(3S) yields is found to be compatible with a linear scaling with the self-normalized dNch/dη, within the uncertainties. The self-normalized yield ratios of excited-to-ground Υ states are compatible with unity within uncertainties. Similarly, the measured double ratio of the self-normalized Υ(1S) to the self-normalized J/ψ yields, both measured at forward rapidity, is compatible with unity for self-normalized charged-particle multiplicities beyond one. The measurements are compared with theoretical predictions incorporating initial or final state effects

First polarisation measurement of coherently photoproduced J/ψ in ultra-peripheral Pb–Pb collisions at sNN=5.02 TeV

The first measurement of the polarisation of coherently photoproduced J/ψ mesons in ultra-peripheral Pb–Pb collisions, using data at sNN=5.02 TeV, is presented. The J/ψ meson is measured via its dimuon decay channel in the forward rapidity interval −4.0<−2.5 using the ALICE detector at the CERN LHC. An event sample corresponding to an integrated luminosity of 750 μb−1 ± 5% (syst) is analysed. Hadronic activity is highly suppressed since the interaction is mediated by a photon. The polar and azimuthal angle distributions of the decay muons are measured, and the polarisation parameters λθ, λφ, λθφ are extracted. The analysis is carried out in the helicity frame. The results are found to be consistent with a transversely polarised J/ψ. These values are compared with previous measurements by the H1 and ZEUS experiments. The polarisation parameters of coherent J/ψ photoproduction in Pb–Pb collisions are found to be consistent with the s-channel helicity conservation hypothesis