Факторы, ассоциированные с применением сниженных доз прямых оральных антикоагулянтов у больных с фибрилляцией предсердий

The objective was to study the factors associated with inappropriate reduced doses of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (AF) in real outpatient practice.Methods and materials. 10663 case histories of patients hospitalized to the therapeutic clinic of the university for 5 years (2014 — 2018) were studied, 1307/10663 (12,3 %) case histories of patients with AF were selected. Factors associated with inappropriate low doses of anticoagulant therapy (ACT) with NOACs at prehospital treatment were studied.Results. NOACs received 57.7 % (384/665) of patients with AF at the outpatient stage: rivaroxaban — 180/384 (46.9 %) patients, dabigatran etexilate — 110/384 (28.6 %) patients, apixaban — 94/384 (24.5 %) patients. Inappropriate reduced doses of NOACs were revealed in 68/384 (17.7 %) patients: apixaban — 22/94 (23.4 %), dabigatran — 18/110 (16,4 %) and rivaroxaban — 28/180 (15.6 %) (p>0,05). Patients who received inappropriate reduced doses of NOACs as compared to those who received standard doses of NOACs had higher frequency of major bleedings in the past (7.4 and 1.0 %; p=0.014) and had higher risk of bleedings (HAS-BLED 1.7±1,1 and 1.2±1.0; p = 0.0002). Proportion of patients who had HAS-BLED≥3 in these groups were 19.1 % and 8.6 % (p=0.033). All patients who received inappropriate reduced doses of NOACs had modifiable risk factors of bleedings. 85.3 % of patients with AF who received inappropriate reduced doses of NOACs had high risk of stroke according to CHA2DS2-VASc scale.Conclusion. In real outpatient practice, NOACs were recommended to 57.7 % of patients with AF. 17.7 % of patients received NOACs s in inappropriate reduced doses. Frequency of major bleedings in the past and bleeding risk in AF patients with inappropriate reduced doses was higher than in patients with standard doses.Цель — изучить факторы, ассоциированные с необоснованным применением сниженных доз прямых оральных антикоагулянтов (ПОАК) у больных с неклапанной фибрилляцией предсердий (ФП) в реальной амбулаторной практике.Методы и материалы. Из 10 663 историй болезней пациентов, госпитализированных за 5 лет (2014 — 2018) в терапевтическую клинику университета, проведен анализ 1307 (12,3 %) историй болезней пациентов с ФП. Изучены факторы, ассоциированные с применением необоснованно сниженных доз ПОАК на амбулаторном этапе лечения.Результаты. ПОАК на амбулаторном этапе получали 57,7 % (384/665) больных ФП: Ривароксабан — 180/384 (46,9 %) пациентов, Дабигатран — 110/384 (28,6 %) больных, а Апиксабан — 94/384 (24,5 %) пациентов. Выявлено частое применение необоснованно сниженных доз ПОАК — 68/384 (17,7 %), в том числе у 22/94 (23,4 %) больных, получавших Апиксабан, у 18/110 (16,4 %) пациентов, получавших Дабигатран, и у 28/180 (15,6 %) больных, получавших Ривароксабан (р>0,05). У пациентов, получавших необоснованно низкие дозы ПОАК, большие кровотечения в анамнезе встречались чаще, чем у больных, получавших полные дозы ПОАК (7,4 и 1,0 %; р=0,014), риск больших кровотечений по шкале HAS-BLED выше — (1,7±1,1) и (1,2±1,0) балла (р = 0,0002), а доля пациентов, имевших высокий риск кровотечений (>3 баллов по шкале HAS-BLED), — больше и составила 19,1 и 8,6 % (р = 0,033). Все пациенты, получавшие необоснованно низкие дозы ПОАК, имели модифицируемые факторы риска кровотечений. Из больных ФП, получавших необоснованно сниженные дозы ПОАК, 85,3 % имели высокий риск инсульта по шкале CHA2DS2VASc.Заключение. На амбулаторном этапе лечения ПОАК применялись у 57,7 % больных ФП, в том числе у 17,7 % пациентов использовались необоснованно сниженные дозы. Частота больших кровотечений в анамнезе и риск кровотечений по шкале HAS-BLED выше у больных, которым назначались необоснованно сниженные дозы

The role of different types of CuO in CuO–CeO2/Al2O3 for total oxidation

Different types of copper oxide in CuO-CeO2/Al2O3 were investigated structurally and catalytically. Standard preparation lead to the presence of CuO monocrystals and Ce1-xCuxO2-x as evidenced by XRD, HRTEM and EDX. Washing with nitric acid removed the monocrystals, while leaving the Ce1-xCuxO2-x solid solution. The Fourier transformed Cu K patterns for the HNO3-washed catalyst showed a diminished second Cu shell, characteristic for Ce1-xCuxO2-x as well as for X-ray amorphous nano-sized CuAl2O4 spinel phase. XANES analysis and first shell Cu fitting confirmed this CuAl2O4 like structure outside Ce1-xCuxO2-x. By modeling the Ce K EXAFS signal in the washed sample, the amount of Cu in Ce1-xCuxO2-x was determined to be 18 +/- 6 %. Total oxidation of CO and C3H8 as model reactions showed little difference in activity between non-washed and washed CuO-CeO2/Al2O3, indicating that CuO monocrystals were hardly active at temperatures below 450 degrees C. XRD performed in situ during TPR and TPO showed that CeO2 in Ce1-xCuxO2-x added to the redox capacity of both CuO-CeO2/Al2O3 samples as it was partially reduced at 300 degrees C. At higher temperatures, the CuO monocrystals also participated in reaction, leading to a higher activity for the oxidation of CH4

Anticoagulant Therapy in Patients with Non-valvular Atrial Fibrillation in Real Clinical Practice: in Appropriate Dose Reductions

Aim. To study the frequency of administration of direct oral anticoagulant (DOACs) in doses recommended and not recommended by the instructions of the drugs in non-valve atrial fibrillation (AF) patients.Material and methods. 10663 case histories of patients hospitalized for 5 years (2014-2018) were studied, 1307/10663 (12,3%) case histories of patients with AF were selected. In patients with AF, the risk of stroke and systemic embolism, the risk of bleeding, the anticoagulant therapy (ACT) recommended at the prehospital stage and its adequacy was evaluated.Results. 1 261/1 307 (96,5%) patients had a non-valve AF. The risk of stroke and systemic embolism was 4,7±1,5 (CHA2DS2-VASс), 97,5% of patients with non-valve AF (1229/1261) needed ACT. Only 665/1229 (54.1%) patients with AF received ACT at the time of hospitalization and 578/1229 (47,0%) of patients did not receive ACT. Before hospitalization 281/665 (42,3%) patients received vitamin K antagonist (warfarin). The international normalized ratio in the target range (2,0-3,0) was in 111/281 (39,5%) patients. 57,7% (384/665) outpatients with AF received NOAC: rivaroxaban - 180/384 (46,9%) patients, dabigatran etexilate - 110/384 (28,6%) patients, apixaban - 94/384 (24,5%) patients. Inappropriate reduced doses of DOAC were revealed in 68/384 (17,7%) patients: apixaban - 23,4%, dabigatran - 16,4% and rivaroxaban - 15,6% (p>0,05).Conclusion. In real clinical practice 42,3% AF patients used warfarin, only 39,5% of them had INR in target values. DOAC in inappropriate reduced doses used 17,7% patients

Comparative study on La-promoted Ni/γ-Al2O3 for methane dry reforming - spray drying for enhanced nickel dispersion and strong metal-support interactions

Dry reforming of methane (DRM) enables an efficient utilization of two abundant greenhouse gases by converting them into syngas, a versatile feedstock for chemical synthesis. Aiming for high catalyst performance and enhanced coke resistance, different preparation techniques of La-promoted Ni/γ-Al(2)O(3) catalysts for DRM were compared facilitating structure–performance correlations. The studied synthesis techniques comprehend incipient wetness impregnation and co-precipitation as well as alternative techniques such as spray drying. All catalysts were fully characterized before and after reaction by N(2)-physisorption, XRD, H(2)-TPR and STEM-EDX elemental mapping. Additionally, a thorough investigation of carbon deposits has been carried out by TGA/DSC and STEM-EDX, respectively. The different preparation techniques led generally to very different physical properties, structure, chemical species and anti-coking properties of the catalyst. However, some catalysts with similar physicochemical characteristics differed in catalytic performance and coking resistance. Superior catalytic performance could be reached for catalysts prepared by spray drying and related to excellent Ni dispersion, strong metal–support interaction and very low coke formation of only 2.7% of the catalyst weight. After 6 h time on stream only minor sintering occurred, with few Ni nanoparticles up to 10 nm

Ni nanoparticles and the Kirkendall effect in dry reforming of methane

n this study we report a simple preparation technique for Ni/c-Al2O3 catalysts for the dry reforming of methane (DRM) at 800 C to produce CO and H2 (synthesis gas). Hard-templating with low and high surface area activated carbon was applied. The produced synthesis gas exhibited a low product ratio of H2: CO [0.04–0.12], due to reverse water-gas shift. After 75 h time on stream (TOS) minimal deactivation of the catalyst could be observed. A rather unusual activity evolution was found involving a sequence of minimum-maximum-plateau. A scheme was suggested, explaining the activity evolution based on the Ni-nanoparticle positioning from being bare or encapsulated by Al2O3. The Al2O3 shell cracks and undergoes restructuring during reaction making more active sites available for the reaction. Superior metal dispersion was achieved with average nickel nanoparticle size at 4.9 ± 1.3 nm. The sintering mechanism was also investigated. Surprisingly, hollow nickel nanoparticles were observed at 25 h TOS due to the nanoscale Kirkendall effect. This diffusion phenomenon between the core, Ni0 , and the outer shell, NiO, (Ni2+) lead to pronounced structural and morphological changes of the catalyst

Applicability study of pulsed laser beam welding on ferritic-martensitic ODS eurofer steel

Pulsed laser beam welding was used successfully to join the oxide dispersion-strengthened (ODS) Eurofer steel. The joining was conducted with a laser power of 2500 W and a pulsed duration of 4 ms. With the filler material being used, a minor material loss and microvoids were observed in the joint. The microstructure of the fusion zone consists of dual phase elongated structures. The heat-affected zone has a width of around 0.06 mm with finer grains. The transmission electron microscopy observation reveals that nanoprecipitates are finely distributed in the fusion zone. The tensile strength, yield strength and elongation of the joint are slightly inferior to the base material. The fractography results reveal a typical ductile fracture. The experimental results indicate a reasonable joint from the perspective of both the microstructure and mechanical behaviour

Development of Lignin-Based Mesoporous Carbons for the Adsorption of Humic Acid

[Image: see text] There is an increasing urge to make the transition toward biobased materials. Lignin, originating from lignocellulosic biomass, can be potentially valorized as humic acid (HA) adsorbents via lignin-based mesoporous carbon (MC). In this work, these materials were synthesized for the first time starting from modified lignin as the carbon precursor, using the soft-template methodology. The use of a novel synthetic approach, Claisen rearrangement of propargylated lignin, and a variety of surfactant templates (Pluronic, Kraton, and Solsperse) have been demonstrated to tune the properties of the resulting MCs. The obtained materials showed tunable properties (BET surface area: 95–367 m(2)/g, pore size: 3.3–36.6 nm, V(BJH) pore volume: 0.05–0.33 m(3)/g, and carbon and oxygen content: 55.5–91.1 and 3.0–12.2%, respectively) and good performance in terms of one of the highest HA adsorption capacities reported for carbon adsorbents (up to 175 mg/g)

Atrial fibrillation and CHA2DS2VASc score of 1 - is there a problem in clinical practice?

Aim. To study the incidence of nonvalvular atrial fibrillation (AF) in patients with a CHA2DS2VASc score of 1 in actual clinical practice, to determine the major and minor risk factors of thromboembolism and the frequency of oral anticoagulant therapy in these patients.Material and methods. We performed a retrospective analysis of 6575 medical records of patients hospitalized for five years in a therapeutic inpatient unit. To determine the stroke risk, major and minor modifying factors were assessed.Results. Of 1160 patients with nonvalvular AF, 93 (8,0%) patients had a CHA2DS2VASc score of 1: hypertension (87,1%), heart failure (4,3%), vascular diseases (4,3%), diabetes (2,15%) and age 65-74 years (2,2%); minor modifying factors were as follows: left atrial (LA) dilatation (81,7%), obesity (40,9%), persistent/permanent AF (37,6%), proteinuria (26,9%), chronic kidney disease (3,2%). A combination of minor risk factors was observed in 61,3%, the most common of which were obesity, LA dilatation, persistent/permanent AF. Anticoagulants were prescribed to 72% of patients with a CHA2DS2VASc score of 1.Conclusion. In actual clinical practice, patients with nonvalvular AF with a CHA2DS2VASc score of 1 are often found. The most common risk factors for stroke in these patients are hypertension, persistent or permanent AF, LA dilatation, and obesity. The use of anticoagulant therapy in these patients does not contradict current guidelines. However, further prospective follow-up is necessary to determine the effectiveness and safety of this therapy