The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Humusica 2, Article 9: Histic humus systems and forms\u2014Specific terms, diagnostic horizons and overview

This paper presents the specific terms of vocabulary and diagnostic horizons necessary for a field classification of submerged Histic humipedons (peats, moors). It is simply an exposition of definitions placed side by side with photographic samples, with rather practical interest. The knowledge reported here is mandatory for people wanting to use the key of classification of these humipedons presented in Humusica 2, article 10. The paper illustrates with schemes the spatial and functional relationships between diagnostic horizons of different Histic humipedons.</p

Humusica, regard morpho-fonctionnel sur tous les humipedons de la Terre

R\ue9cemment, tous les humipedons de la plan\ue8te ont \ue9t\ue9 plac\ue9s dans un cadre morpho-fonctionnel, en am\ue9liorant ce qui avait \ue9t\ue9 propos\ue9 pour les sols forestiers et pour les tourbes. Cette classification est propos\ue9e dans une s\ue9rie d\u2019articles qui composent trois Special Issues de Applied Soil Journal (Zanella and Ascher-Jenull, 2018). Dans cette journ\ue9e d\ue9di\ue9e \ue0 l\u2019\ue9tude des sols, je vais vous pr\ue9senter les aspects saillants de cette classification, en focalisant d\u2019un c\uf4t\ue9 sur les avanc\ue9es qu\u2019elle repr\ue9sente pour ses aspects \ue9cologiques et fonctionnels (reli\ue9s \ue0 la biodiversit\ue9) et de l\u2019autre sur les choses qui restent \ue0 faire pour aller plus loin dans la connaissance du sols comme origine et fondement de la biodiversit\ue9 de la plan\ue8te. La pr\ue9sentation sera subdivis\ue9e en 4 parties, d\ue9di\ue9es respectivement aux sols : a) forestiers (Jabiol et al., 2005; A. Zanella et al., 2017b; Augusto Zanella et al., 2017a), b) hydromorphes (Delft et al., 2002; Zanella et al., 2018a), c) \uab bizzarres \ubb (Pietrasiak, 2015; Zanella et al., 2018b)et d) anthropog\ue9niques (Topoliantz et al., 2000; A. Zanella et al., 2017a; Augusto Zanella et al., 2017b). Dans cette derni\ue8re cat\ue9gorie je montrerai comment on peut classer les composts et les sols agricoles en les comparant \ue0 leur \uab matrices d\u2019origine \ubb. Une application pour iPhone permet de ne pas amener sur le terrain la cl\ue9 de classification des humus forestiers et de reconna\ueetre assez facilement les syst\ue8mes et les formes d\u2019humus terrestres. De nombreux sch\ue9mas et figures seront utilis\ue9s pour rendre l\u2019ensemble le moins barbant possible. R\ue9f\ue9rences bibliographiques : Delft, S.P.J. van, Kemmers, R.H., Waal, R.W. de, 2002. Ecologische typering van bodems onder korte vegetaties. Het humusprofiel als graadmeter voor standplaatsontwikkeling. Landsch. Tijdschr. voor Landschapsecologie en Milieukd. 19, 152\u2013164. Jabiol, B., Feller, C., Gr\ue8ve, M.H., 2005. Quand l\u2019humus est \ue0 l \u2019 origine de la p\ue9dologie. Etudes Gest. des Sols 12, 123\u2013134. Pietrasiak, N., 2015. Field Guide to Classify Biological Soil Crusts for Ecological Site Evaluation. Biology Department John Carroll University, USA. Topoliantz, S., Ponge, J.F., Viaux, P., 2000. Earthworm and enchytraeid activity under different arable farming systems, as exemplified by biogenic structures. Plant Soil 225, 39\u201351. doi:10.1023/A:1026537632468 Zanella, A., Ascher-Jenull, J., 2018. Editorial. Appl. Soil Ecol. 122, 1\u20139. doi:https://doi.org/10.1016/j.apsoil.2017.11.029 Zanella, A., De Waal, R., Van Delft, B., Ponge, J.-F., Ferronato, C., De Nobili, M., Le Bayon, R.-C., Andreetta, A., K\uf5lli, R., 2018a. Humusica 2, article 10: Histic humus systems and forms \u2013 Key of classification1. Appl. Soil Ecol. 122, 154\u2013161. doi:https://doi.org/10.1016/j.apsoil.2017.06.035 Zanella, A., Ponge, J.-F., Fritz, I., Pietrasiak, N., Matteodo, M., Nadporozhskaya, M., Juilleret, J., Tatti, D., Bayon, R.-C. Le, Rotschild, L., Mancinelli, R., 2018b. Humusica 2, article 13: Para humus systems and forms. Appl. Soil Ecol. 122, 181\u2013199. doi:https://doi.org/10.1016/j.apsoil.2017.09.043 Zanella, A., Ponge, J.-F., Guercini, S., Rumor, C., Nold, F., Sambo, P., Gobbi, V., Schimmer, C., Chaabane, C., Mouchard, M.-L., Garcia, E., van Deventer, P., 2017a. Humusica 2, article 16: Techno humus systems and recycling of waste. Appl. Soil Ecol. doi:10.1016/j.apsoil.2017.09.037 Zanella, A., Ponge, J.-F., Jabiol, B., Sartori, G., Kolb, E., Gobat, J.M., Bayon, R.C.L., Aubert, M., Waal, R.D., Delft, B.V., Vacca, A., Serra, G., Chersich, S., Andreetta, A., Cools, N., Englisch, M., Hager, H., Katzensteiner, K., Brethes, A., Nicola, C.D., Testi, A., Bernier, N., Graefe, U., Juilleret, J., Banas, D., Garlato, A., Obber, S., Galvan, P., Zampedri, R., Frizzera, L., Tomasi, M., Menardi, R., Fontanella, F., Filoso, C., Dibona, R., Bolzonella, C., Pizzeghello, D., Carletti, P., Langhor, R., Cattaneo, D., Nardi, S., Nicolini, G., Viola, F., 2017b. Humusica 1, article 4: Terrestrial humus systems and forms-Specific terms and diagnostic horizons. Appl. Soil Ecol. doi:10.1016/j.apsoil.2017.07.005 Zanella, A., Ponge, J.-F., Jabiol, B., Sartori, G., Kolb, E., Le Bayon, R.-C., Gobat, J.-M., Aubert, M., De Waal, R., Van Delft, B., Vacca, A., Serra, G., Chersich, S., Andreetta, A., K\uf5lli, R., Jacques Brun, J., Cools, N., Englisch, M., Hager, H., Katzensteiner, K., Br\ueathes, A., De Nicola, C., Testi, A., Bernier, N., Graefe, U., Wolf, U., Juilleret, J., Garlato, A., Obber, S., Galvan, P., Zampedri, R., Frizzera, L., Tomasi, M., Banas, D., Bureau, F., Tatti, D., Salmon, S., Menardi, R., Fontanella, F., Carraro, V., Pizzeghello, D., Concheri, G., Squartini, A., Cattaneo, D., Scattolin, L., Nardi, S., Nicolini, G., Viola, F., 2017a. Humusica 1, article 5_ Terrestrial humus systems and forms \u2014 Keys of classification of humus systems and forms. doi:10.1016/j.apsoil.2017.06.012 Zanella, A., Ponge, J.-F., Topoliantz, S., Bernier, N., Juilleret, J., 2017b. Humusica 2, Article 15: Agro humus systems and forms. doi:10.1016/j.apsoil.2017.10.01

Relations between C9orf72 expansion size in blood, age at onset, age at collection and transmission across generations in patients and presymptomatic carriers

A (GGGGCC)n repeat expansion in C9orf72 gene is the major cause of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). The relations between the repeats size and the age at disease onset (AO) or the clinical phenotype (FTD vs. ALS) were investigated in 125 FTD, ALS, and presymptomatic carriers. Positive correlations were found between repeats number and the AO (p < 10e 124) but our results suggested that the association was mainly driven by age at collection (p < 10e 124). A weaker association was observed with clinical presentation (p = 0.02), which became nonsignificant after adjustment for the age at collection in each group. Importantly, repeats number variably expanded or contracted over time in carriers with multiple blood samples, as well as through generations in parent-offspring pairs, conversely to what occurs in several expansion diseases with anticipation at the molecular level. Finally, this study establishes that measure of repeats number in lymphocytes is not a reliable biomarker predictive of the AO or disease outcome in C9orf72 long expansion carriers

The coffee genome provides insight into the convergent evolution of caffeine biosynthesis

Coffee is a valuable beverage crop due to its characteristic flavor, aroma, and the stimulating effects of caffeine.We generated a high-quality draft genome of the species Coffea canephora, which displays a conserved chromosomal gene order among asterid angiosperms. Although it shows no sign of the whole-genome triplication identified in Solanaceae species such as tomato, the genome includes several species-specific gene family expansions, among them N-methyltransferases (NMTs) involved in caffeine production, defense-related genes, and alkaloid and flavonoid enzymes involved in secondary compound synthesis. Comparative analyses of caffeine NMTs demonstrate that these genes expanded through sequential tandem duplications independently of genes from cacao and tea, suggesting that caffeine in eudicots is of polyphyletic origin

Reduced Cancer Incidence in Huntington's Disease: Analysis in the Registry Study

Background: People with Huntington's disease (HD) have been observed to have lower rates of cancers. Objective: To investigate the relationship between age of onset of HD, CAG repeat length, and cancer diagnosis. Methods: Data were obtained from the European Huntington's disease network REGISTRY study for 6540 subjects. Population cancer incidence was ascertained from the GLOBOCAN database to obtain standardised incidence ratios of cancers in the REGISTRY subjects. Results: 173/6528 HD REGISTRY subjects had had a cancer diagnosis. The age-standardised incidence rate of all cancers in the REGISTRY HD population was 0.26 (CI 0.22-0.30). Individual cancers showed a lower age-standardised incidence rate compared with the control population with prostate and colorectal cancers showing the lowest rates. There was no effect of CAG length on the likelihood of cancer, but a cancer diagnosis within the last year was associated with a greatly increased rate of HD onset (Hazard Ratio 18.94, p < 0.001). Conclusions: Cancer is less common than expected in the HD population, confirming previous reports. However, this does not appear to be related to CAG length in HTT. A recent diagnosis of cancer increases the risk of HD onset at any age, likely due to increased investigation following a cancer diagnosis

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of &lt;30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy