On linear functional equations modulo Z

Dedicated to Professor Ludwig Reich on the occasion of his 80th birthday.In this paper, we consider the condition ∑i=0n+1φi(rix+qiy)∈Z for real valued functions defined on a linear space V. We derive necessary and sufficient conditions for functions satisfying this condition to be decent in the following sense: there exist functions fi: V→ R, gi: V→ Z such that φi= fi+ gi, (i= 0 , ⋯ , n+ 1) and ∑i=0n+1fi(rix+qiy)=0 for all x, y∈ V

Profil chorych z nadciśnieniem tętniczym opornym

Introduction. Resistant hypertension (RHT) is recognized when the blood pressure (BP) is equal to or greater than 140/90 mmHg, despite changes in lifestyle and using at least 3 antihypertensive drugs, including diuretics at optimal doses. Often, patients limit the proper control of BP by voluntary reduction and discontinuation of less tolerated drugs, failure to follow healthy lifestyle rules, and taking medications that increase BP. The reason for the lack of effects in treatment of hypertension (HT) is also unrecognized secondary HT. The aim of the study is to evaluate the occurrence of pseudo-RHT in patients with primary RHT diagnosis. Material and methods. The study was conducted in 2012–14 among patients hospitalized in the Department of Cardiology of The Pope John Paul II Province Hospital in Zamość. 99 patients diagnosed with RHT were examined, (59 men) at age 54.5–67.0 on average 60.0 } 9.8 years. Statistical analysis was performed based on Statistica; Chi2 and U-Mann-Whitney tests were used. Results. The final group consisted of 93 people (55 men). In the course of hospitalization, studies were conducted for secondary causes of HT. Efficacy of treatment was evaluated, education on healthy lifestyle was conducted and in some cases pharmacotherapy was modified. As a result of the diagnostic procedure and increased control of applied therapy, 30 patients with true RHT and 63 patients with pseudo-RHT were identified from a group of 93 patients with initial RHT. Patients with true RHT (16 men) were proposed renal artery denervation. Conclusions. A large group of patients with diagnosed RHT are patients with pseudo-RHT. The common cause of RHT is the presence of an undetected secondary HT.Wstęp. Nadciśnienie tętnicze oporne (RHT, resistant hypertension) rozpoznaje się, gdy ciśnienie krwi (BP, blood pressure) jest większe lub rowne 140/90 mmHg, mimo zmiany stylu życia i stosowania co najmniej 3 lekow przeciwnadciśnieniowych, w tym diuretykow, w optymalnych dawkach. Często pacjenci utrudniają osiągnięcie prawidłowej kontroli BP przez samowolne zmniejszanie dawki lub odstawianie gorzej tolerowanych lekow, nieprzestrzeganie zaleceń dotyczących zdrowego stylu życia lub przyjmowanie lekow zwiększających BP. Przyczyną nieskuteczności leczenia nadciśnienia tętniczego (HT, hypertension) może być rownież nierozpoznane wtorne HT. Badanie przeprowadzono w celu oceny częstości występowania rzekomoopornego nadciśnienia tętniczego u chorych z pierwotnym rozpoznaniem RHT. Materiały i metody. Badanie przeprowadzono w latach 2012–2014 wśrod chorych hospitalizowanych na Oddziale Kardiologii Szpitala Wojewodzkiego im. Jana Pawła II w Zamościu. Zbadano 99 chorych (59 mężczyzn) z rozpoznanym RHT w wieku 54,5–67,0 lat (średnia wieku 60,0 } 9,8 r.). Analizy statystyczne przeprowadzono, korzystając z oprogramowania Statistica; wykonano test Chi2 i test U Manna- Whitneya. Wyniki. Ostatecznie badana grupa składała się z 93 chorych (55 mężczyzn). W trakcie hospitalizacji u chorych wykonano badania pod kątem przyczyn wtornego HT. Oceniono skuteczność leczenia, przeprowadzono edukację chorych odnośnie do zdrowego stylu życia, a w niektorych przypadkach zmodyfikowano leczenie farmakologiczne. Po przeprowadzeniu badań diagnostycznych oraz zweryfikowaniu stosowanego leczenia w grupie 93 chorych z pierwotnym rozpoznaniem RHT zidentyfikowano 30 chorych z rzeczywistym RHT i 63 chorych z rzekomoopornym HT. Chorym z rzeczywistym RHT (16 mężczyzn) zaproponowano denerwację tętnic nerkowych. Wnioski. Dużą grupę chorych z rozpoznaniem RHT stanowią pacjenci z rzekomoopornym HT. Częstą przyczyną RHT jest obecność niewykrytego wtornego HT.

Profil pacjentów z nadciśnieniem tętniczym opornym

Wstęp. Nadciśnienie tętnicze (NT) oporne (NTO) jest rozpoznawane, gdy wartość ciśnienia tętniczego (RR) jest równa lub przekracza 140/90 mm Hg, pomimo zmiany stylu życia i stosowania co najmniej trzech leków hipotensyjnych, w tym diuretyku w optymalnych dawkach. Przyczyny braku reakcji na leczenie hipotensyjne mogą być różne. U części pacjentów nie jest możliwe określenie powodów oporności na podstawie dostępnych metod diagnostycznych, u pozostałych NTO jest rozpoznawane mimo wykrywalnej przyczyny. Często prawidłową kontrolę RR ogranicza samowolne odstawianie przez pacjentów leków gorzej tolerowanych, nieprzestrzeganie zasad prozdrowego stylu życia, przyjmowanie leków, które podwyższają RR. Powodem braku efektów w leczeniu NT jest również nierozpoznane wtórne NT. Celem pracy jest ocena występowania pozornego NTO w grupie pacjentów z pierwotnym rozpoznaniem NTO. Materiał i metody. Badanie przeprowadzono w latach 2012–2014 wśród pacjentów hospitalizowanych na Oddziale Kardiologii Samodzielnego Publicznego Szpitala Wojewódzkiego im. Papieża Jana Pawła II w Zamościu. Badana grupa obejmowała początkowo 99 pacjentów z rozpoznaniem NTO (59 mężczyzn) w wieku 54,5–67,0, średnio 60,0 ± 9,8 roku. Częstość występowania prawdziwego i pozornego NTO została poddana analizie w grupie pacjentów z pierwotnym rozpoznaniem NTO. Analizę statystyczną przeprowadzono wykorzystując pakiet Statistica, stosując test Chi2 oraz U-Manna-Whitneya. Wyniki. Badana grupa liczyła ostatecznie 93 osoby (55 mężczyzn), ponieważ 6 pacjentów nie zgłosiło się w uzgodnionym terminie do szpitala bez podania przyczyn. Na etapie zbierania wywiadu stwierdzono, że 8 pacjentów nie przyjmuje regularnie leków hipotensyjnych albo przyjmują tylko niektóre z zapisanych preparatów. Dwie osoby miały uprzednio rozpoznane NT wtórne. W trakcie hospitalizacji wykonano badania w kierunku wtórnych przyczyn NT, oceniono skuteczność leczenia, prowadzono edukację z zakresu prozdrowotnego stylu życia, a w niektórych przypadkach zmodyfikowano farmakoterapię. Po otrzymaniu wyników badań wyodrębniono grupę 24 pacjentów, u których wysunięto podejrzenie występowania NT. Część spośród chorych wymagała dalszej diagnostyki i leczenia specjalistycznego. Po około miesiącu od hospitalizacji pacjenci odbyli wizytę w Poradni Kardiologicznej, podczas której okazało się, że kolejne 24 osoby mają zadowalającą kontrolę RR potwierdzoną ABPM. W wyniku przeprowadzonego postępowania diagnostycznego i zwiększenia kontroli stosowanej terapii z grupy 93 chorych z początkowym rozpoznaniem NTO wyodrębniono 30 pacjentów z prawdziwym NTO oraz 63 osoby z pozornym NTO. Pacjentom z prawdziwym NTO (16 mężczyzn) zaproponowano zabieg denerwacji tętnic nerkowych. Wnioski. Duża grupa pacjentów z rozpoznanym NTO to chorzy z pozornym NTO. Częstą przyczyną NTO jest obecność niewykrytego wtórnego NT, należy więc zachować czujność diagnostyczną lecząc chorych z NTO

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)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Effect of Vitamin D Treatment on Dynamics of Stones Formation in the Urinary Tract and Bone Density in Children with Idiopathic Hypercalciuria

Vitamin D supplementation in patients with urolithiasis and hypercalciuria is considered to be unsafe. We analyzed the impact of vitamin D supplementation on selected health status parameters in children with idiopathic hypercalciuria. The study included 36 children with urolithiasis resulting from excessive calcium excretion. The level of calcium and 25(OH)D (hydroxylated vitamin D - calcidiol) in serum, urinary calcium excretion and the presence of stones in urinary tract were assessed prospectively. Blood and urine samples were collected at the time when the patient was qualified for the study and every three months up to 24 month of vitamin D intake at a dose of 400 or 800 IU/day. At time zero and at 12, and 24 months of vitamin D supplementation, densitometry was performed. Supplementation with vitamin D caused a statistically significant increase in the concentration of 25(OH)D in serum. There were no significant changes in calcium concentration in serum, excretion of calcium in urine but also in bone density. There was no significant increase in the risk of formation or development of stones in the urinary tract. Supplementation with vitamin D (400&ndash;800 IU/day) in children with idiopathic hypercalciuria significantly increases 25(OH)D concentration, does not affect calciuria, but also does not improve bone density