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

How T-cells use large deviations to recognize foreign antigens

A stochastic model for the activation of T-cells is analysed. T-cells are part of the immune system and recognize foreign antigens against a background of the body’s own molecules. The model under consideration is a slight generalization of a model introduced by Van den Berg et al. (J Theor Biol 209:465–486, 2001), and is capable of explaining how this recognition works on the basis of rare stochastic events. With the help of a refined large deviation theorem and numerical evaluation it is shown that, for a wide range of parameters, T-cells can distinguish reliably between foreign antigens and self-antigens

Rare Event Simulation for T-cell Activation

Lipsmeier F, Baake E. Rare Event Simulation for T-cell Activation. JOURNAL OF STATISTICAL PHYSICS. 2009;134(3):537-566.The problem of statistical recognition is considered, as it arises in immunobiology, namely, the discrimination of foreign antigens against a background of the body's own molecules. The precise mechanism of this foreign-self-distinction, though one of the major tasks of the immune system, continues to be a fundamental puzzle. Recent progress has been made by van den Berg, Rand, and Burroughs (J. Theor. Biol. 209:465-486, 2001), who modelled the probabilistic nature of the interaction between the relevant cell types, namely, T-cells and antigen-presenting cells (APCs). Here, the stochasticity is due to the random sample of antigens present on the surface of every APC, and to the random receptor type that characterises individual T-cells. It has been shown previously (van den Berg et al. in J. Theor. Biol. 209:465-486, 2001; Zint et al. in J. Math. Biol. 57:841-861, 2008) that this model, though highly idealised, is capable of reproducing important aspects of the recognition phenomenon, and of explaining them on the basis of stochastic rare events. These results were obtained with the help of a refined large deviation theorem and were thus asymptotic in nature. Simulations have, so far, been restricted to the straightforward simple sampling approach, which does not allow for sample sizes large enough to address more detailed questions. Building on the available large deviation results, we develop an importance sampling technique that allows for a convenient exploration of the relevant tail events by means of simulation. With its help, we investigate the mechanism of statistical recognition in some depth. In particular, we illustrate how a foreign antigen can stand out against the self background if it is present in sufficiently many copies, although no a priori difference between self and nonself is built into the model