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

Organophosphines in Cis-PtP2CCl Derivatives Structural Aspects

This manuscript summarizes and analyzes X-ray data of monomeric cis-PtP2CCl derivatives. These complexes crystallize in the following crystal systems: tetragonal, P42/n (3), triclinic, Pī (10), orthorhombic, P212121 (prevails)(16), and monoclinic, P21/c (prevails) (36) examples. There are three sub-groups of the respective complexes: Pt(η1-PL)2(η1-CL)(η1-Cl); Pt(η2-P2L)(η1-CL)(η1-Cl) and Pt(η1-PL)(η2-P,CL)(η1-Cl). The chelating P,P-donor ligands form: four-(POP, PCP), five-(PC2P), six-(PC3P, PCNCP), seven-(PC4P) and even ten-(PCNCNCNCP) membered rings. The chelating P.C-donor ligands create three-(PC), four-(PCC) and five-(PC2C) membered rings. The mean Pt-L bond distance elongates in the sequence: 2.10 Å (C, trans to P) < 2.222 Å (P, trans to Cl) < 2.312 Å (P, trans to C) < 2.360 Å (Cl, trans to P). There are examples which exist in two isomeric forms, of the distortion isomer type

Soft X -rays radiation damage on plunge -frozen and freeze -dried maize root s evaluated by FTIR spectromicroscopy

.The radiation damage issue consequent to soft X-rays’ exposure is still an important aspect to be contemplated in soft X-ray microscopy. The work presented here is part of a more extended investigation on the topic and targets the effects of soft X-rays exposure on plant tissues. The aftermaths of soft X-rays’ exposure were evaluated by FTIR spectromicroscopy by comparing irradiated and non-irradiated areas on similar plant structural features, one day and ten days after irradiation, to highlight also a possible time-dependent behavior consequent to air exposure. Our results show partial degradation of lignocellulosic complex and oxidation of cellulose and most probably of hemicellulose; lignin moiety of cell walls in vascular tissue however remains stable. Comparing the current study with our previous works it appears that, as expected, plant tissues seem less prone to soft X-rays radiation damage compared to mammalian cells or tissues

Silicon as an unconventional detector in positron emission tomography

Positron emission tomography (PET) is a widely used technique in medical imaging and in studying small animal models of human disease. In the conventional approach, the 511keV annihilation photons emitted from a patient or small animal are detected by a ring of scintillators such as LYSO read out by arrays of photodetectors. Although this has been successful in achieving ~5mm FWHM spatial resolution in human studies and ~1mm resolution in dedicated small animal instruments, there is interest in significantly improving these figures. Silicon, although its stopping power is modest for 511keV photons, offers a number of potential advantages over more conventional approaches including the potential for high intrinsic spatial resolution in 3D. To evaluate silicon in a variety of PET ''magnifying glass'' configurations, an instrument was constructed that consists of an outer partial-ring of PET scintillation detectors into which various arrangements of silicon detectors are inserted to emulate dual-ring or imaging probe geometries. Measurements using the test instrument demonstrated the capability of clearly resolving point sources of ^2^2Na having a 1.5mm center-to-center spacing as well as the 1.2mm rods of a ^1^8F-filled resolution phantom. Although many challenges remain, silicon has potential to become the PET detector of choice when spatial resolution is the primary consideration

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH