Guideline-directed medical therapy for secondary prevention after coronary artery bypass grafting in patients with depression

AbstractBackgroundWe hypothesized that depressed patients would have lower use of guideline-directed medical therapy for secondary prevention of cardiovascular events following coronary artery bypass grafting (CABG).MethodsWe included all patients who underwent primary isolated CABG in Sweden between 2006 and 2008. We cross-linked individual level data from national Swedish registers. Preoperative depression was defined as at least one antidepressant prescription dispensed before surgery. We defined medication use as at least two dispensed prescriptions in each medication class (antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB), and statins) within a rolling 12 month period. We calculated adjusted risk ratios (RR) for the use of each medication class, and for all four classes, after one and four years, respectively.ResultsDuring the first year after CABG, 93% of all patients (n = 10,586) had at least two dispensed prescriptions for an antiplatelet agent, 68% for an ACEI/ARB, 91% for a beta-blocker, and 92% for a statin. 57% had prescriptions for all four medication classes. After four years (n = 4034), 44% had filled prescriptions for all four medication classes. Preoperative depression was not significantly associated with a lower use of all four medication classes after one year (RR 0.98, 95% confidence interval (CI) 0.93–1.03) or after four years (RR 0.97, 95% CI 0.86–1.09).ConclusionsPreoperative depression was not associated with lower use of guideline-directed medical therapy for secondary prevention after CABG. These findings suggest that the observed higher mortality following CABG among depressed patients is not explained by inadequate secondary prevention medication

Undetectable High-Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction

ObjectivesThis study sought to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level and an electrocardiogram (ECG) without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).BackgroundChest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.MethodsAll patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included. We calculated the negative predictive values of an undetectable hs-cTnT and ECG without ischemia for MI and death within 30 days.ResultsWe included 14,636 patients, of whom 8,907 (61%) had an initial hs-cTnT of <5 ng/l; 21% had 5 to 14 ng/l, and 18% had >14 ng/l. During 30-day follow-up, 39 (0.44%) patients with undetectable hs-cTnT had a MI, of whom 15 (0.17%) had no ischemic ECG changes. The negative predictive value for MI within 30 days in patients with undetectable hs-cTnT and no ischemic ECG changes was 99.8% (95% confidence interval [CI]: 99.7 to 99.9). The negative predictive value for death was 100% (95% CI: 99.9 to 100).ConclusionsAll patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED

Association of Phosphodiesterase-5 Inhibitors Versus Alprostadil With Survival in Men With Coronary Artery Disease

Abstract Background Phosphodiesterase 5 inhibitor (PDE5i) treatment is associated with reduced mortality compared with no treatment for erectile dysfunction after myocardial infarction (MI). Objectives This study sought to investigate the association between treatment with PDE5i or alprostadil and outcomes in men with stable coronary artery disease. Methods All Swedish men with a prior MI or revascularization who received PDE5i or alprostadil during 2006 through 2013 at >6 months after the event were included, using the Swedish Patient Register and the Swedish Prescribed Drug Register. Cox regression was used to estimate adjusted hazard ratios with 95% confidence intervals for all-cause mortality, MI, heart failure, cardiovascular mortality, noncardiovascular mortality, cardiac revascularization, peripheral arterial disease, and stroke in men treated with PDE5i versus alprostadil. Results This study included 16,548 men treated with PDE5i and 1,994 treated with alprostadil. The mean follow-up was 5.8 years, with 2,261 deaths (14%) in the PDE5i group and 521 (26%) in the alprostadil group. PDE5i compared with alprostadil treatment was associated with lower mortality (hazard ratio: 0.88; 95% confidence interval: 0.79 to 0.98) and with similar associations for MI, heart failure, cardiovascular mortality, and revascularization. When quintiles (q) of filled PDE5i prescriptions were compared using q1 as reference, patients in q3, q4, and q5 had lower all-cause mortality. Among alprostadil users, those in q5 had a lower all-cause mortality compared to q1. Conclusions In men with stable coronary artery disease, treatment with PDE5i is associated with lower risks of death, MI, heart failure, and revascularization compared with alprostadil treatment. Although the decrease in all-cause mortality was PDE5i dose dependent, the data do not permit the inference of causality or any clinical benefits of PDE5i because of the observational study design

Combinational expression of tumor testis antigens NY-ESO-1, MAGE-A3, and MAGE-A4 predicts response to immunotherapy in mucosal melanoma patients

PURPOSE: Immunotherapy using immune checkpoint inhibitors (ICI) has revolutionized cancer treatment in recent years, particularly in melanoma. While response to immunotherapy is associated with high tumor mutational burden (TMB), PD-L1 expression, and microsatellite instability in several cancers, tumors lacking these biomarkers can still respond to this treatment. Especially, mucosal melanoma, commonly exhibiting low TMB compared to cutaneous melanoma, may respond to immunotherapy with immune checkpoint inhibitors. Therefore, the aim of our study was to investigate novel biomarkers in mucosal melanoma that predict response to combined ipilimumab and nivolumab. METHODS: We investigated 10 tumor samples from 10 patients (three responders, seven non-responders) before treatment and six tumor samples from five patients after progression using a targeted Next Generation Sequencing (NGS) gene expression panel. The findings were corroborated with an independent method (i.e., immunohistochemical staining) on the same 10 tumor samples before treatment and, to increase the cohort, in addition on three tumor samples before treatment of more recent patients (one responder, two non-responders). RESULTS: With the targeted gene expression panel, we found the three tumor testis antigens CTAG1B (NY-ESO-1), MAGE-A3, and MAGE-A4 to be predominantly expressed in responding tumors. This marker panel was either not or not completely expressed in non-responders (p < 0.01). Using immunohistochemistry for all three markers, we could confirm the elevated expression in tumors responding to the ipilimumab/nivolumab combination therapy. CONCLUSION: In conclusion, these three biomarkers await validation in a larger patient cohort and could be easily used in future routine diagnostics to predict the outcome of ipilimumab/nivolumab combination therapy in mucosal melanoma patients

Uniformity in association schemes and coherent configurations: cometric Q-antipodal schemes and linked systems

Inspired by some intriguing examples, we study uniform association schemes and uniform coherent configurations, including cometric Q-antipodal association schemes. After a review of imprimitivity, we show that an imprimitive association scheme is uniform if and only if it is dismantlable, and we cast these schemes in the broader context of certain --- uniform --- coherent configurations. We also give a third characterization of uniform schemes in terms of the Krein parameters, and derive information on the primitive idempotents of such a scheme. In the second half of the paper, we apply these results to cometric association schemes. We show that each such scheme is uniform if and only if it is Q-antipodal, and derive results on the parameters of the subschemes and dismantled schemes of cometric Q-antipodal schemes. We revisit the correspondence between uniform indecomposable three-class schemes and linked systems of symmetric designs, and show that these are cometric Q-antipodal. We obtain a characterization of cometric Q-antipodal four-class schemes in terms of only a few parameters, and show that any strongly regular graph with a ("non-exceptional") strongly regular decomposition gives rise to such a scheme. Hemisystems in generalized quadrangles provide interesting examples of such decompositions. We finish with a short discussion of five-class schemes as well as a list of all feasible parameter sets for cometric Q-antipodal four-class schemes with at most six fibres and fibre size at most 2000, and describe the known examples. Most of these examples are related to groups, codes, and geometries.Comment: 42 pages, 1 figure, 1 table. Published version, minor revisions, April 201

The Coupled Electron-Ion Monte Carlo Method

In these Lecture Notes we review the principles of the Coupled Electron-Ion Monte Carlo methods and discuss some recent results on metallic hydrogen.Comment: 38 pages, 6 figures, Lecture notes for the International School of Solid State Physics, 34th course: "Computer Simulation in Condensed Matter: from Materials to Chemical Biology", 20 July-1 August 2005 Erice (Italy). To appear in Lecture Notes in Physics (2006

Modelling of Multi-Agent Systems: Experiences with Membrane Computing and Future Challenges

Formal modelling of Multi-Agent Systems (MAS) is a challenging task due to high complexity, interaction, parallelism and continuous change of roles and organisation between agents. In this paper we record our research experience on formal modelling of MAS. We review our research throughout the last decade, by describing the problems we have encountered and the decisions we have made towards resolving them and providing solutions. Much of this work involved membrane computing and classes of P Systems, such as Tissue and Population P Systems, targeted to the modelling of MAS whose dynamic structure is a prominent characteristic. More particularly, social insects (such as colonies of ants, bees, etc.), biology inspired swarms and systems with emergent behaviour are indicative examples for which we developed formal MAS models. Here, we aim to review our work and disseminate our findings to fellow researchers who might face similar challenges and, furthermore, to discuss important issues for advancing research on the application of membrane computing in MAS modelling.Comment: In Proceedings AMCA-POP 2010, arXiv:1008.314

Building a Species Conservation Strategy for the brown howler monkey (Alouatta guariba clamitans) in Argentina in the context of yellow fever outbreaks

El mono aullador marrón (Alouatta guariba clamitans) es endémico del Bosque Atlántico de América del Sur, con una pequeña población que se extiende en la porción norte de la provincia de Misiones en el noreste de Argentina. En el año 2012, debido a su reducida distribución geográfica, su baja densidad poblacional y al dramático impacto de los recientes brotes de Fiebre Amarilla, la especie fue categorizada en Argentina como “en peligro crítico”. En el mes de marzo de 2013 organizamos un taller internacional en Misiones con el objetivo de evaluar el estado de la población de esta especie en Argentina y llevar a cabo un análisis de las principales amenazas para su conservación. Para alcanzar estos objetivos construimos modelos de viabilidad poblacional utilizando los programas Vortex y Outbreak. Los mismos nos permitieron explorar cómo varios parámetros biológicos y demográficos de la especie, así como diversos factores relacionados al impacto de la Fiebre Amarilla, influyen sobre la probabilidad de extinción de la especie. La discusión entre los distintos especialistas y el análisis de los resultados de los modelos identificaron a la Fiebre Amarilla como la principal amenaza para la subsistencia de esta población en Argentina. El análisis de las amenazas se centró en la dinámica de los brotes de Fiebre Amarilla y la severidad de su impacto sobre la población de esta especie, lo que permitió identificar huecos en el conocimiento que permitieron priorizar objetivos y acciones a llevar a cabo para el desarrollo de una estrategia de conservación para esta especie en Argentina.The brown howler monkey (Alouatta guariba clamitans) is endemic to South America’s Atlantic Forest, with a small population extending into the northern portion of Misiones province in northeastern Argentina. In 2012, the species was classified as Critically Endangered in Argentina due to its highly restricted distribution, low population density and dramatic declines from recent Yellow Fever outbreaks. In March 2013, we organized an international workshop in Misiones to evaluate population status in Argentina and conduct a threat analysis. We developed population viability models using Vortex and Outbreak software packages. These tools allowed us to explore how several biological and demographic parameters of brown howlers, as well as factors related to Yellow Fever epidemiology, affect the probability of species extinction. The discussion among diverse specialists and analysis of model results identified Yellow Fever as the main threat to brown howler population persistence in Argentina. Our threat analysis, focused on the dynamics of Yellow Fever outbreaks and their impact on howler populations, led to the identification of gaps in knowledge that helped prioritize objectives and actions for the development of a Species Conservation Strategy in Argentina.Fil: Agostini, Ilaria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina. Centro de Investigaciones del Bosque Atlantico; ArgentinaFil: Holzmann, Ingrid. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina. Centro de Investigaciones del Bosque Atlantico; ArgentinaFil: Di Bitetti, Mario Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina. Centro de Investigaciones del Bosque Atlantico; ArgentinaFil: Oklander, Luciana Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina. Centro de Investigaciones del Bosque Atlantico; ArgentinaFil: Kowalewski, Miguel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Multiples (sede Corrientes); ArgentinaFil: Beldomenico, Pablo Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Ciencias Veterinarias del Litoral. Universidad Nacional del Litoral. Facultad de Cs.veterinarias. Instituto de Ciencias Veterinarias del Litoral; ArgentinaFil: Goenaga, S.. Dirección Nacional de Instituto de Investigación. Adm.nacional de Laboratorio E Instituto de Salud "dr.c.g.malbran". Instituto Nacional de Enfermedades Virales Humanas; ArgentinaFil: Martínez, Mariela Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina. Ministerio de Salud. Instituto Nacional de Medicina Tropical; ArgentinaFil: Moreno, Eduardo S.. Ministerio da Saude; BrasilFil: Lestani, Eduardo. Ministerio de Salud. Instituto Nacional de Medicina Tropical; ArgentinaFil: Desbiez, Arnaud L. J.. Royal Zoological Society of Scotland; Reino Unido. Conservation Breeding Specialist Group; Estados UnidosFil: Miller, Philip. Conservation Breeding Specialist Group; Estados Unido

Precision Monte Carlo Test of the Hartree-Fock Approximation for a trapped Bose Gas

We compare the semiclassical Hartree-Fock approximation for a trapped Bose gas to a direct Path Integral Quantum Monte Carlo simulation. The chosen parameters correspond to current Rb experiments. We observe corrections to the mean-field density profile. The Path Integral calculation reveals an increase of the number of condensed particles, which is of the same order as a previously computed result for a homogeneous system. We discuss the experimental observability of the effect and propose a method to analyze data of in-situ experiments.Comment: 4 pages, 3 figures, revte

Night optimised care technology for users needing assisted lifestyles

There is growing interest in the development of ambient assisted living services to increase the quality of life of the increasing proportion of the older population. We report on the Night Optimised Care Technology for UseRs Needing Assisted Lifestyles project, which provides specialised night time support to people at early stages of dementia. This article explains the technical infrastructure, the intelligent software behind the decision-making driving the system, the software development process followed, the interfaces used to interact with the user, and the findings and lessons of our user-centred approach