Direct oral anticoagulant use and risk of perioperative bleeding:Evidence of absence or absence of evidence?

Clinical epidemiolog

An Artificial Intelligence Approach to Detect Visual Field Progression in Glaucoma Based on Spatial Pattern Analysis.

Purpose: To detect visual field (VF) progression by analyzing spatial pattern changes. Methods: We selected 12,217 eyes from 7360 patients with at least five reliable 24-2 VFs and 5 years of follow-up with an interval of at least 6 months. VFs were decomposed into 16 archetype patterns previously derived by artificial intelligence techniques. Linear regressions were applied to the 16 archetype weights of VF series over time. We defined progression as the decrease rate of the normal archetype or any increase rate of the 15 VF defect archetypes to be outside normal limits. The archetype method was compared with mean deviation (MD) slope, Advanced Glaucoma Intervention Study (AGIS) scoring, Collaborative Initial Glaucoma Treatment Study (CIGTS) scoring, and the permutation of pointwise linear regression (PoPLR), and was validated by a subset of VFs assessed by three glaucoma specialists. Results: In the method development cohort of 11,817 eyes, the archetype method agreed more with MD slope (kappa: 0.37) and PoPLR (0.33) than AGIS (0.12) and CIGTS (0.22). The most frequently progressed patterns included decreased normal pattern (63.7%), and increased nasal steps (16.4%), altitudinal loss (15.9%), superior-peripheral defect (12.1%), paracentral/central defects (10.5%), and near total loss (10.4%). In the clinical validation cohort of 397 eyes with 27.5% of confirmed progression, the agreement (kappa) and accuracy (mean of hit rate and correct rejection rate) of the archetype method (0.51 and 0.77) significantly (P \u3c 0.001 for all) outperformed AGIS (0.06 and 0.52), CIGTS (0.24 and 0.59), MD slope (0.21 and 0.59), and PoPLR (0.26 and 0.60). Conclusions: The archetype method can inform clinicians of VF progression patterns

Relaxation Effects in the Transition Temperature of Superconducting HgBa2CuO4+delta

In previous studies on a number of under- and overdoped high temperature superconductors, including YBa_{2}Cu_{3}O_{7-y} and Tl_{2}Ba_{2}CuO_{6+\delta}, the transition temperature T_c has been found to change with time in a manner which depends on the sample's detailed temperature and pressure history. This relaxation behavior in T_c is believed to originate from rearrangements within the oxygen sublattice. In the present high-pressure studies on HgBa_{2}CuO_{4+\delta} to 0.8 GPa we find clear evidence for weak relaxation effects in strongly under- and overdoped samples ($T_c\simeq 40 - 50 K$) with an activation energy $E_{A}(1 bar) \simeq 0.8 - 0.9 eV$. For overdoped HgBa_{2}CuO_{4+\delta} E_{A} increases under pressure more rapidly than previously observed for YBa_{2}Cu_{3}O_{6.41}, yielding an activation volume of +11 \pm 5 cm^{3}; the dependence of T_c on pressure is markedly nonlinear, an anomalous result for high-T_c superconductors in the present pressure range, giving evidence for a change in the electronic and/or structural properties near 0.4 GPa

Dynamical effects of subducting ridges: Insights from 3-D laboratory models

We model the subduction of buoyant ridges and plateaus to study their effect on slab dynamics. Oceanic ridges parallel to the trench have a stronger effect on the process of subduction because they simultaneously affect a longer trench segment. Large buoyant slab segments sink more slowly into the asthenosphere, and their subduction result in a diminution of the velocity of subduction of the plate. We observe a steeping of the slab below those buoyant anomalies, resulting in smaller radius of curvature of the slab, that augments the energy dissipated in folding the plate and further diminishes the velocity of subduction. When the 3D geometry of a buoyant plateau is modelled, the dip of the slab above the plateau decreases, as a result of the larger velocity of subduction of the dense "normal" oceanic plate on both sides of the plateau. Such a perturbation of the dip of the slab maintains long time after the plateau has been entirely incorporated into the subduction zone. We compare experiments with the present-day subduction zone below South America. Experiments suggest that a modest ridge perpendicular to the trench such as the present-day Juan Fernandez ridge is not buoyant enough to modify the slab geometry. Already subducted buoyant anomalies within the oceanic plate, in contrast, may be responsible for some aspects of the present-day geometry of the Nazca slab at depth

Seismogenic zone structure of the southern Middle America Trench, Costa Rica

The shallow seismogenic portion of subduction zones generates damaging large and great earthquakes. This study provides structural constraints on the seismogenic zone of the Middle America Trench offshore central Costa Rica and insights into the physical and mechanical characteristics controlling seismogenesis. We have located ~300 events that occurred following the MW 6.9, 20 August 1999, Quepos, Costa Rica, underthrusting earthquake using a three-dimensional velocity model and arrival time data recorded by a temporary local network of land and ocean bottom seismometers. We use aftershock locations to define the geometry and characteristics of the seismogenic zone in this region. These events define a plane dipping at 19° that marks the interface between the Cocos Plate and the Panama Block. The majority of aftershocks occur below 10 km and above 30 km depth below sea level, corresponding to 30–35 km and 95 km from the trench axis, respectively. Relative event relocation produces a seismicity pattern similar to that obtained using absolute locations, increasing confidence in the geometry of the seismogenic zone. The aftershock locations spatially correlate with the downdip extension of the oceanic Quepos Plateau and reflect the structure of the main shock rupture asperity. This strengthens an earlier argument that the 1999 Quepos earthquake ruptured specific bathymetric highs on the downgoing plate. We believe that subduction of this highly disrupted seafloor has established a set of conditions which presently limit the seismogenic zone to be between 10 and 35 km below sea level

Risk of recurrent venous thromboembolism in patients with HIV infection: A nationwide cohort study

Background Multiple studies have described a higher incidence of venous thromboembolism (VTE) in people living with an HIV infection (PWH). However, data on the risk of recurrent VTE in this population are lacking, although this question is more important for clinical practice. This study aims to estimate the risk of recurrent VTE in PWH compared to controls and to identify risk factors for recurrence within this population. Methods and findings PWH with a first VTE were derived from the AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort (2003-2015), a nationwide ongoing cohort following up PWH in care in the Netherlands. Uninfected controls were derived from the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA) follow-up study (1999-2003), a cohort of patients with a first VTE who initially participated in a case-control study in the Netherlands who were followed up for recurrent VTE. Selection was limited to persons with an index VTE suffering from deep vein thrombosis in the lower limbs and/or pulmonary embolism (PE). Participants were followed from withdrawal of anticoagulation to VTE recurrence, loss to follow-up, death, or end of study. We estimated incidence rates, cumulative incidence (accounting for competing risk of death) and hazard ratios (HRs) using Cox proportional hazards regression, adjusting for age, sex, and whether the index event was

cAMP Response Element Binding Protein Is Required for Differentiation of Respiratory Epithelium during Murine Development

The cAMP response element binding protein 1 (Creb1) transcription factor regulates cellular gene expression in response to elevated levels of intracellular cAMP. Creb1−/− fetal mice are phenotypically smaller than wildtype littermates, predominantly die in utero and do not survive after birth due to respiratory failure. We have further investigated the respiratory defect of Creb1−/− fetal mice during development. Lungs of Creb1−/− fetal mice were pale in colour and smaller than wildtype controls in proportion to their reduced body size. Creb1−/− lungs also did not mature morphologically beyond E16.5 with little or no expansion of airway luminal spaces, a phenotype also observed with the Creb1−/− lung on a Crem−/− genetic background. Creb1 was highly expressed throughout the lung at all stages examined, however activation of Creb1 was detected primarily in distal lung epithelium. Cell differentiation of E17.5 Creb1−/− lung distal epithelium was analysed by electron microscopy and showed markedly reduced numbers of type-I and type-II alveolar epithelial cells. Furthermore, immunomarkers for specific lineages of proximal epithelium including ciliated, non-ciliated (Clara), and neuroendocrine cells showed delayed onset of expression in the Creb1−/− lung. Finally, gene expression analyses of the E17.5 Creb1−/− lung using whole genome microarray and qPCR collectively identified respiratory marker gene profiles and provide potential novel Creb1-regulated genes. Together, these results demonstrate a crucial role for Creb1 activity for the development and differentiation of the conducting and distal lung epithelium

Epithelial cell senescence impairs repair process and exacerbates inflammation after airway injury

<p>Abstract</p> <p>Background</p> <p>Genotoxic stress, such as by exposure to bromodeoxyuridine (BrdU) and cigarette smoke, induces premature cell senescence. Recent evidence indicates that cellular senescence of various types of cells is accelerated in COPD patients. However, whether the senescence of airway epithelial cells contributes to the development of airway diseases is unknown. The present study was designed to test the hypothesis that premature senescence of airway epithelial cells (Clara cells) impairs repair processes and exacerbates inflammation after airway injury.</p> <p>Methods</p> <p>C57/BL6J mice were injected with the Clara-cell-specific toxicant naphthalene (NA) on days 0, 7, and 14, and each NA injection was followed by a daily dose of BrdU on each of the following 3 days, during which regenerating cells were allowed to incorporate BrdU into their DNA and to senesce. The p38 MAPK inhibitor SB202190 was injected 30 minutes before each BrdU dose. Mice were sacrificed at different times until day 28 and lungs of mice were obtained to investigate whether Clara cell senescence impairs airway epithelial regeneration and exacerbates airway inflammation. NCI-H441 cells were induced to senesce by exposure to BrdU or the telomerase inhibitor MST-312. Human lung tissue samples were obtained from COPD patients, asymptomatic smokers, and nonsmokers to investigate whether Clara cell senescence is accelerated in the airways of COPD patients, and if so, whether it is accompanied by p38 MAPK activation.</p> <p>Results</p> <p>BrdU did not alter the intensity of the airway epithelial injury or inflammation after a single NA exposure. However, after repeated NA exposure, BrdU induced epithelial cell (Clara cell) senescence, as demonstrated by a DNA damage response, p21 overexpression, increased senescence-associated β-galactosidase activity, and growth arrest, which resulted in impaired epithelial regeneration. The epithelial senescence was accompanied by p38 MAPK-dependent airway inflammation. Senescent NCI-H441 cells impaired epithelial wound repair and secreted increased amounts of pro-inflammatory cytokines in a p38 MAPK-dependent manner. Clara cell senescence in COPD patients was accelerated and accompanied by p38 MAPK activation.</p> <p>Conclusions</p> <p>Senescence of airway epithelial cells impairs repair processes and exacerbates p38 MAPK-dependent inflammation after airway injury, and it may contribute to the pathogenesis of COPD.</p

Fore-arc deformation and underplating at the northern Hikurangi margin, New Zealand

Geophysical investigations of the northern Hikurangi subduction zone northeast of New Zealand, image fore‐arc and surrounding upper lithospheric structures. A seismic velocity (Vp) field is determined from seismic wide‐angle data, and our structural interpretation is supported by multichannel seismic reflection stratigraphy and gravity and magnetic modeling. We found that the subducting Hikurangi Plateau carries about 2 km of sediments above a 2 km mixed layer of volcaniclastics, limestone, and chert. The upper plateau crust is characterized by Vp = 4.9–6.7 km/s overlying the lower crust with Vp > 7.1 km/s. Gravity modeling yields a plateau thickness around 10 km. The reactivated Raukumara fore‐arc basin is >10 km deep, deposited on 5–10 km thick Australian crust. The fore‐arc mantle of Vp > 8 km/s appears unaffected by subduction hydration processes. The East Cape Ridge fore‐arc high is underlain by a 3.5 km deep strongly magnetic (3.3 A/m) high‐velocity zone, interpreted as part of the onshore Matakaoa volcanic allochthon and/or uplifted Raukumara Basin basement of probable oceanic crustal origin. Beneath the trench slope, we interpret low‐seismic‐velocity, high‐attenuation, low‐density fore‐arc material as accreted and recycled, suggesting that underplating and uplift destabilizes East Cape Ridge, triggering two‐sided mass wasting. Mass balance calculations indicate that the proposed accreted and recycled material represents 25–100% of all incoming sediment, and any remainder could be accounted for through erosion of older accreted material into surrounding basins. We suggest that continental mass flux into the mantle at subduction zones may be significantly overestimated because crustal underplating beneath fore‐arc highs have not properly been accounted for

Harmonizing and improving European education in prescribing: An overview of digital educational resources used in clinical pharmacology and therapeutics

Aim: Improvement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re-used widely across a variety of educational systems, they may be ideally suited for this purpose. Methods: With a cross-sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled. Results: Teachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e-learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge-based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in-part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given. Conclusion: Digital educational resources, ranging from e-learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real-life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials