Aspirin Dosing for the Prevention and Treatment of Ischemic Stroke: An Indication-Specific Review of the Literature

OBJECTIVE: To evaluate the efficacy of aspirin for the treatment and prevention of ischemic stroke and identify the minimum dose proven to be effective for each indication. DATA SOURCES: PubMed and MEDLINE searches (January 2009–January 2010) were performed to identify primary literature, using search terms including aspirin, stroke prevention, acute ischemic stroke, acetylsalicylic acid, atrial fibrillation, myocardial infarction, and carotid endarterectomy. Additionally, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: Articles published in English were evaluated and relevant primary literature evaluating the efficacy of aspirin in the prevention of stroke was included in this review. DATA SYNTHESIS: Antiplatelet therapy is the benchmark for the prevention of ischemic stroke. Aspirin has been proven to prevent ischemic stroke in a variety of settings. Despite the frequency at which aspirin continues to be prescribed in patients at risk of ischemic stroke, there remains confusion in clinical practice as to what minimum dose is required in various at-risk patients. A thorough review of the primary literature suggests that low-dose (50–81 mg daily) aspirin is insufficient for some indications. Acute ischemic stroke treatment requires 160–325 mg, while atrial fibrillation and carotid arterial disease require daily doses of 325 and 81–325 mg, respectively. CONCLUSIONS: Available evidence suggests that aspirin dosing must be individualized according to indication. Recommendations provided by national guidelines at times recommend lower doses of aspirin than have been proven effective. Higher doses are indicated for stroke prevention in atrial fibrillation (325mg) and acute ischemic stroke patients (160–325 mg). Aspirin has not yet been proven effective for primary prevention of strokes in men, and a minimum dose for these patients cannot be determined from the available data

Site‐specific weed management—constraints and opportunities for the weed research community: Insights from a workshop

The adoption of site‐specific weed management (SSWM) technologies by farmers is not aligned with the scientific achievements in this field. While scientists have demonstrated significant success in real‐time weed identification, phenotyping and accurate weed mapping by using various sensors and platforms, the integration by farmers of SSWM and weed phenotyping tools into weed management protocols is limited. This gap was therefore a central topic of discussion at the most recent workshop of the SSWM Working Group arranged by the European Weed Research Society (EWRS). This insight paper aims to summarise the presentations and discussions of some of the workshop panels and to highlight different aspects of weed identification and spray application that were thought to hinder SSWM adoption. It also aims to share views and thoughts regarding steps that can be taken to facilitate future implementation of SSWM

Intracardiac 4D flow MRI in congenital heart disease : recommendations on behalf of the ISMRM flow & motion study group

Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019.Cardiovascular Aspects of Radiolog

CARDIOKIN1: computational assessment of myocardial metabolic capability in healthy controls and patients with valve diseases

BACKGROUND: Many heart diseases can develop a reduced pumping capacity of the heart muscle. A mismatch between ATP demand and ATP production of cardiomyocytes is one of the possible causes. Assessment of the relation between the myocardial ATP production (MV(ATP)) and cardiac workload is important for better understanding disease development and choice of nutritional or pharmacological treatment strategies. As there is currently no method for the measurement of MV(ATP) in vivo, the use of physiology-based metabolic models in conjunction with protein abundance data is an attractive approach. METHODS: We developed a comprehensive kinetic model of the cardiac energy metabolism (CARDIOKIN1), which recapitulates numerous experimental findings on cardiac metabolism obtained with isolated cardiomyocytes, perfused animal hearts and in vivo studies with humans. We used the model to assess the energy status of the left ventricle (LV) of healthy subjects and patients with aortic stenosis (AS) and mitral valve insufficiency (MI). Maximal enzyme activities were individually scaled by means of protein abundances in LV tissue samples. The energy status of the LV was quantified by the ATP consumption at rest (MV(ATP)(rest)), at maximal workload (MV(ATP)(max)), and by the myocardial ATP production reserve (MAPR) representing the span between MV(ATP)(rest) and MV(ATP)(max). RESULTS: Compared with controls, in both groups of patients, MV(ATP)(rest) was increased and MV(ATP)(max) was decreased resulting in a decreased MAPR, although all patients had preserved ejection fraction. Notably, the variance of the energetic status was high ranging from decreased to normal values. In both patient groups, the energetic status was tightly associated with mechanic energy demand. Moreover, a decrease of MV(ATP)(max) was associated with a decrease of the cardiac output indicating that cardiac functionality and energetic performance of the ventricle are closely coupled. CONCLUSIONS: Our analysis suggests that the ATP producing capacity of the LV of patients with valvular dysfunction is generally diminished and correlates positively with mechanic energy demand and cardiac output. However, large differences exist in the energetic state of the myocardium even in patients with similar clinical or image-based markers of hypertrophy and pump function

Disease- and sex-specific differences in patients with heart valve disease: a proteome study

Pressure overload in patients with aortic valve stenosis and volume overload in mitral valve regurgitation trigger specific forms of cardiac remodeling; however, little is known about similarities and differences in myocardial proteome regulation. We performed proteome profiling of 75 human left ventricular myocardial biopsies (aortic stenosis = 41, mitral regurgitation = 17, and controls = 17) using high-resolution tandem mass spectrometry next to clinical and hemodynamic parameter acquisition. In patients of both disease groups, proteins related to ECM and cytoskeleton were more abundant, whereas those related to energy metabolism and proteostasis were less abundant compared with controls. In addition, disease group-specific and sex-specific differences have been observed. Male patients with aortic stenosis showed more proteins related to fibrosis and less to energy metabolism, whereas female patients showed strong reduction in proteostasis-related proteins. Clinical imaging was in line with proteomic findings, showing elevation of fibrosis in both patient groups and sex differences. Disease- and sex-specific proteomic profiles provide insight into cardiac remodeling in patients with heart valve disease and might help improve the understanding of molecular mechanisms and the development of individualized treatment strategies

Non-orographic gravity waves and turbulence caused by merging jet streams

Jet streams are important sources of non-orographic internal gravity waves and clear air turbulence (CAT). We analyze non-orographic gravity waves and CAT during a merger of the polar front jet stream (PFJ) with the subtropical jet stream (STJ) above the southern Atlantic. Thereby, we use a novel combination of airborne observations covering the meso-scale and turbulent scale in combination with high-resolution deterministic short-term forecasts. Coherent phase lines of temperature perturbations by gravity waves stretching along a highly sheared tropopause fold are simulated by the ECMWF IFS (integrated forecast system) forecasts. During the merging event, the PFJ reverses its direction from approximately antiparallel to parallel with respect to the STJ, going along with strong wind shear and horizontal deformation. Temperature perturbations in limb-imaging and lidar observations onboard the research aircraft HALO during the SouthTRAC campaign show remarkable agreement with the IFS data. Ten hours earlier, the IFS data show an “X-shaped” pattern in the temperature perturbations emanating from the sheared tropopause fold. Tendencies of the IFS wind components show that these gravity waves are excited by spontaneous emission adjusting the strongly divergent flow when the PFJ impinges the STJ. In situ observations of temperature and wind components at 100 Hz confirm upward propagation of the probed portion of the gravity waves. They furthermore reveal embedded episodes of light-to-moderate CAT, Kelvin Helmholtz waves, and indications for partial wave reflection. Patches of low Richardson numbers in the IFS data coincide with the CAT observations, suggesting that this event was accessible to turbulence forecasting

Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support

Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed

Testing a global standard for quantifying species recovery and assessing conservation impact

Recognizing the imperative to evaluate species recovery and conservation impact, in 2012 the International Union for Conservation of Nature (IUCN) called for development of a “Green List of Species” (now the IUCN Green Status of Species). A draft Green Status framework for assessing species’ progress toward recovery, published in 2018, proposed 2 separate but interlinked components: a standardized method (i.e., measurement against benchmarks of species’ viability, functionality, and preimpact distribution) to determine current species recovery status (herein species recovery score) and application of that method to estimate past and potential future impacts of conservation based on 4 metrics (conservation legacy, conservation dependence, conservation gain, and recovery potential). We tested the framework with 181 species representing diverse taxa, life histories, biomes, and IUCN Red List categories (extinction risk). Based on the observed distribution of species’ recovery scores, we propose the following species recovery categories: fully recovered, slightly depleted, moderately depleted, largely depleted, critically depleted, extinct in the wild, and indeterminate. Fifty-nine percent of tested species were considered largely or critically depleted. Although there was a negative relationship between extinction risk and species recovery score, variation was considerable. Some species in lower risk categories were assessed as farther from recovery than those at higher risk. This emphasizes that species recovery is conceptually different from extinction risk and reinforces the utility of the IUCN Green Status of Species to more fully understand species conservation status. Although extinction risk did not predict conservation legacy, conservation dependence, or conservation gain, it was positively correlated with recovery potential. Only 1.7% of tested species were categorized as zero across all 4 of these conservation impact metrics, indicating that conservation has, or will, play a role in improving or maintaining species status for the vast majority of these species. Based on our results, we devised an updated assessment framework that introduces the option of using a dynamic baseline to assess future impacts of conservation over the short term to avoid misleading results which were generated in a small number of cases, and redefines short term as 10 years to better align with conservation planning. These changes are reflected in the IUCN Green Status of Species Standard