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

Corona formation around monazite and xenotime during greenschist-facies metamorphism and deformation

Epidote/allanite–fluorapatite coronae around monazite and xenotime are investigated in Permian pegmatites deformed under greenschist-facies conditions during Alpine tectonometamorphism in the Austroalpine basement, Eastern Alps. The aim was to evaluate the replacement reactions involved in the formation of a corona microstructure, its age and relation to deformation. In the corona core, monazite and xenotime single crystals show domains with different composition and age. Monazite (Mnz1) and xenotime (Xen1) dating by electron microprobe (EPM) reveals an age of 250–287 Ma, consistent with the Permian magmatic age of the pegmatites. These are partly replaced by secondary monazite (Mnz2) and xenotime (Xen2) compositions yielding younger Mesozoic (170–210 Ma) and Alpine (30–120 Ma) ages. The same crystallographic orientation of the primary and secondary monazite and xenotime indicates interface-coupled dissolution–precipitation reactions. Allanite U–Th–Pb dating by laser ablation inductively coupled mass spectrometry in the corona revealed an age of 60±6 Ma, interpreted as the age of corona formation. The coronae around monazite consist of an inner zone of equant fluorapatite grains surrounded by prismatic allanite, which are surrounded by epidote enriched in heavy rare earth elements (HREEs) and REE-poor epidote grains. Compared to coronae around monazite, fluorapatite has higher REE contents and no allanite occurs in the coronae surrounding the xenotime. General reactions for monazite and xenotime breakdown can be written as follows: Mnz1+(Si,Ca,Al,Fe,F)fluid→Mnz2+LREE-Ap+Aln+HREE-Ep+Ep+(Th,U)O2+(Th,U)SiO4,Xen1+(Si,Ca,Al,Fe,F)fluid→Xen2+HREE-Ap+HREE-Ep+Ep+(Th,U)O2. The amount of replacement (judged by the relative proportions of monazite and fluorapatite) is low for monazite included in tourmaline but high within the mylonitic foliation. This dependence on the degree of replacement on the local surrounding microfabric indicates that fluid availability along grain boundaries in the matrix and cracks controlled reaction advancement, allowing the elementary mass transfer required for corona formation (e.g. input of Ca, Al, Si, Fe, F). The oblate shape of the coronae aligned within the foliation of the pegmatites and the deflected foliation around the coronae, without an outer rim of prismatic epidote showing signs of deformation, indicate that the main stage of corona formation took place during deformation and reactions were still ongoing after the main stage of deformation. The corona microstructure documents replacement reactions of a single reactant into multiple distinct mineral growth zones by dissolution and precipitation processes at non-isostatic, greenschist-facies conditions, which prevailed in the area to the north of the Defereggen–Antholz–Vals shear zone between the middle Cretaceous and the Oligocene. These reactions ceased before being completed, and REE gradients within single grains within the corona and on the thin-section scale are preserved, which suggests restricted and/or episodic transport of REE in the fluid phase and/or availability of fluid

Radiotherapy for a Phalanx Bone Metastasis of a Lung Adenocarcinoma

Phalanx bone metastasis as the initial presenting sign of lung cancer is a rare presentation. Lung cancer is known to metastasize to the bone, but rarely to the fingers. A 61-year-old male smoker presented with pain in the left ring finger. Severe pain discouraged the patient from using his left hand. An X-ray of the left hand showed a lytic bone lesion. The patient was treated with finger radiotherapy. Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life. Palliative radiotherapy relieved our patient and improved his quality of life

Soot and charcoal as reservoirs of extracellular DNA

The vast potential of using sediment adsorbed DNA as a window to past and present biodiversity rely on the ability of solid surfaces to adsorb environmental DNA. However, a comprehensive insight into DNA adsorption at surfaces in general is lacking. Soot and charcoal are carbonaceous materials widespread in the environment where they readily can come in contact with extracellular DNA shed from organisms. Using batch adsorption, we measured DNA adsorption capacity at soot and charcoal as a function of solution composition, time and DNA length. We observed that the adsorption capacity for DNA is highest at low pH, that it increases with solution concentration and cation valency and that the activation energy for DNA adsorption at both soot and charcoal is ~50 kJmol-1, suggesting strong binding. We demonstrate how the interaction between DNA and soot and charcoal partly occurs via terminal base pairs, suggesting that, besides electrostatic forces, hydrophobic interactions play an important role in binding. The large adsorption capacities and strong binding of DNA to soot and charcoal are features important for eDNA research and provide a motivation for use of carbonaceous materials from, e.g., anthropogenic pollution or wildfire as sources of biodiversity information

Nanoscale Ion Dynamics Control on Amorphous Calcium Carbonate Crystallization: Precise Control of Calcite Crystal Sizes

International audienceAmorphous calcium carbonate (ACC) is an essential component present during the early stages of biomineralization of many calcifying organisms, which is used as a precursor of crystalline calcium carbonate phases. Here, we performed X-ray photon correlation spectroscopy experiments on ACC which show that the amount of adsorbed water has a strong control over its diffusive dynamics. Results of crystallization experiments under conditions of controlled humidity indicate that the adsorbed water is enough to spark crystallization of calcite. A direct proportionality is found between the relative humidity of the environment and the final size of the calcite crystals. Different hypotheses are made to explain this result, with the confinement within the amorphous matrix being the main suspect of controlling the size of the crystallites. Control of water activity and water content is, therefore, a possible way to regulate biomineral crystallinity both in nature and for the design of functional biomimetic materials

Structure of Water Adsorbed on Nanocrystalline Calcium Silicate Hydrate Determined from Neutron Scattering and Molecular Dynamics Simulations

International audienc