The optimal intensity of vitamin k antagonists in patients with mechanical heart valves A meta-analysis

AbstractObjectivesThe purpose of this study was to compare two different intensities of vitamin K antagonists (VKA) among patients with mechanical heart valves using meta-analytic techniques.BackgroundPatients with mechanical heart valves are at increased risk for valve thrombosis and systemic embolism, which can be reduced by VKA. The range of optimal intensity of VKA is still a matter of debate.MethodsA computerized search in the PubMed database was made for relevant articles. A meta-analysis was performed of all eligible studies with data on the incidences of thromboembolic and bleeding complications in patients with mechanical heart valve prostheses during different intensities of VKA therapy. The studies were classified into low-intensity VKA therapy (mean target international normalized ratio [INR] of 3.0 or lower) or high-intensity VKA therapy (mean target INR above 3.0).ResultsThirty-five eligible studies were identified, including in total 23,145 patients, who were studied for 108,792 patient-years. For patients with an aortic valve, high intensity resulted in a lower incidence of thromboembolic events (risk ratio [RR] = 0.73, p < 0.0001); however, the incidence of bleeding was increased (RR = 1.23, p < 0.0001). In the mitral valve group, the incidence rate for thromboembolism was lower in the high-intensity group (RR = 0.74, p < 0.0001), without a significantly increased bleeding incidence (RR = 1.08, p = 0.0524). The total number of thromboembolic and bleeding events was decreased in the high-intensity group compared with low-intensity VKA therapy for both aortic and mitral valve prostheses (RR = 0.94 [p = 0.0067] and 0.84 [p < 0.0001]), respectively.ConclusionsThis meta-analysis shows that both aortic and mitral valves will benefit from a treatment strategy with a target INR higher than 3.0

Distribution and abundance of cephalopods in UK waters: long-term trends and environmental relationships

As part of a project which aimed to evaluate the feasibility of developing indicators of marine ecosystem status based on cephalopods, we analysed spatiotemporal variation in abundance,, and environmental relationships, using trawl survey catch data for cephalopods in UK waters (1980-2013) from Cefas and Marine Scotland Science databases. These data presented some challenges, notably the use of several different trawl gears, variable tow durations, and varying levels of taxonomic resolution. Accounting for gear type and tow duration, data were analysed separately for each cephalopod family and season to account for different phases of the life cycles being present at different times of year. The families investigated were Loliginidae, Octopodidae, Ommastrephidade, Sepiidae and Sepiolidae. A GAM framework was used to summarise spatiotemporal variation in abundance at family level and the relationships of spatial and long-term temporal variation with environmental variables, including depth, substrate (available for inshore waters) and several oceanographic variables (e.g., SST, chl signals), also considering fishing pressure. Long-term trends for each family varied between areas and seasons, although this may reflect the presence of several species within families. In Scotland, where Loligo vulgaris is rare and L. forbesii is normally distinguished from Alloteuthis spp., survey data suggested a peak in abundance of this species around 1990 and a generally increasing trend since the mid-1990s. Spatial patterns in distribution in all families were related to both physiographic and oceanographic features. As expected substrate type had most effect on those families in which eggs are attached to objects on the seabed

Genetic and clinical analyses of psychosis spectrum symptoms in a large multiethnic youth cohort reveal significant link with ADHD

Psychotic symptoms are not only an important feature of severe neuropsychiatric disorders, but are also common in the general population, especially in youth. The genetic etiology of psychosis symptoms in youth remains poorly understood. To characterize genetic risk for psychosis spectrum symptoms (PS), we leverage a community-based multiethnic sample of children and adolescents aged 8–22 years, the Philadelphia Ne

Novel genetic loci associated with hippocampal volume

The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (rg =-0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness

Partitioning the Heritability of Tourette Syndrome and Obsessive Compulsive Disorder Reveals Differences in Genetic Architecture

The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained

Investigating the use of proxies for fecundity to improve management advice for western horse mackerel Trachurus trachurus

Observations of fecundity from the 2001 western horse mackerel spawning-stock biomass survey suggest that the species is an indeterminate spawner. Therefore, estimates of fecundity based on biological analyses and until recently used in the calibration of the stock assessment are now questioned. The stock is assessed by fitting a linked Separable and ADAPT VPA-based model to the catch-at-age data and to the egg production estimates. Currently, the assumption is that egg production and spawning-stock biomass are linked by a constant but unknown fecundity parameter, estimated within the model. In this study, the effects of introducing relationships linking biological indicators of fecundity, such as lipid content or feeding intensity during the spawning season, to actual fecundity are examined within a simulation framework. Simulations suggest that when the underlying relationships between fecundity and the proxy are poorly described, weak, or based on a relatively short time-series of data, the assumption of constant fecundity will result in better management advice than using the prox

An evaluation of the implicit management procedure used for some ICES roundfish stocks

This paper describes a simulation study that evaluated the performance of the scientific advisory process used by ICES to recommend total allowable catches (TACs) for roundfish stocks. A "management strategy evaluation" approach is used, involving development of an operating model to represent the underlying reality, and an observation model to generate pseudo data that are then used within a management procedure. The management procedure comprises an assessment that uses data to estimate parameters of interest and a decision rule to derive TAC recommendations for the following year. There are two important results: including realistic sources and levels of uncertainty can result in far from optimal management outcomes based on the current procedures; and current ICES biomass and fishing mortality reference points are not always consistent, and several are clearly inappropriate. This is because the types of projection used by ICES do not incorporate important lags between assessing stock status and implementing management measures, and they also ignore important sources of uncertainty about the actual dynamics, as well as our ability to collect data and implement management regulations (i.e. model, measurement, and implementation error, respectively). The simulation approach also showed that better management is not necessarily going to be achieved by improving the assessment, because even with a perfect assessment (where the simulated working group knew stock status perfectly), stocks may crash at fishing levels that standard stochastic projections would suggest were safe. It is proposed that, in future, operating models that represent the best available understanding of the actual system dynamics be used to evaluate models and rules considered for application. These operating models should capture the plausible range of characteristics of the underlying dynamics, but not necessarily model their full complexity. In general, they will be more complex than those used by assessment working groups, so developing management procedures that are robust to a broad range of uncertainty. However, the models and rules used as part of the management procedure should be simpler than those used at presen

Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration

Background: Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion. In clinical studies, the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period. The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration. Methods: Elective coronary surgery patients were randomly assigned to four different anesthetic protocols (n = 50 each). In a first group, patients received a propofol based intravenous regimen (propofol group). In a second group, propofol was replaced by sevoflurane from sternotomy until the start of cardiopulmonary bypass (SEVO pre group). In a third group, propofol was replaced by sevoflurane after completion of the coronary anastomoses (SEVO post group). In a fourth group, propofol was administered until sternotomy and then replaced by sevoflurane for the remaining of the operation (SEVO all group). Postoperative concentrations of cardiac troponin I were followed during 48 h. Cardiac function was assessed perioperatively and during 24 h postoperatively. Results: Postoperative troponin I concentrations in the SEVO all group were lower than in the propofol group. Stroke volume decreased transiently after cardiopulmonary bypass in the propofol group but remained unchanged throughout in the SEVO all group. In the SEVO pre and SEVO post groups, stroke volume also decreased after cardiopulmonary bypass but returned earlier to baseline values than in the propofol group. Duration of stay in the intensive care unit was lower in the SEVO all group than in the propofol group. Conclusion: In patients undergoing coronary artery surgery with cardiopulmonary bypass, the cardioprotective effects of sevoflurane were clinically most apparent when it was administered throughout the operation.SCOPUS: ar.jinfo:eu-repo/semantics/publishe