Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Java3D Application Development

Bakalaura darbā tiek aprakstīta Java 3D un tās pielietojums lietojumprogrammas izveidē, un izpētīti dažādi modelēšanas rīki, modeļu izveidei. Darba mērķis ir apgūt Java 3D, lai varētu izstrādāt aplikāciju „Apple Collector”, izmantojot Java 3D bibliotēku, un implementēt aplikācijā izstrādātos modeļus.Bachelor thesis describes Java 3D and the use of it in application development, and explored some modeling tools for model creation. The aim of the thesis is to master Java 3D, so that the application „Apple Collector” could be developed by using the Java 3D library, and to implement the created models in to the application

Koksnes acetilesana ar etikskabes anhidridu gazveida stavokli

Summary in English, RussianAvailable from Latvian Academic Library / LAL - Latvian Academic LibrarySIGLELVLatvi

Assessment of sustainable development of Babite rural territory

Eiropas Savienības un nacionālā līmeņa dokumenti ir vērsti uz vienmērīgu un labi sabalansētu teritoriālu attīstību. Viena no galvenajām struktūrvienībām, kas nodrošina šo teritoriālo attīstību, ir pagasta pašvaldība - dzīves kvalitātes un teritorijas ilgtspējīgas attīstības nodrošināšana ir ikvienas pagasta pašvaldības mērķis. Sasniegt šo mērķi ir iespējams ar dažādu attīstības plānošanas dokumentu palīdzību (attīstības programmas, teritorijas attīstības plāni u.c.). Šā darba mērķis ir novērtēt ilgtspējīgas attīstības iespējas Babītes pagasta pašvaldībā, kā arī novērtēt pagasta attīstības plānošanas dokumentu atbilstību Olborgas hartai un no tās izrietošajām saistībām. Pētījuma rezultāti rāda, ka Babītes pagasta attīstības plānošanas dokumentos ir ietvertas Olborgas saistību prasības. Tomēr redzams, ka atsevišķos gadījumos nav izvirzīts konkrēts mērķis un reizē ar to trūkst arī noteiktas rīcības. Darba apjoms: 67 lappuses, 4 nodaļas, 10 tabulas un 38 literatūras avoti.European Union and national level documents predict even and well-balanced teritorial development. Rural municipality is one of the main actors of teritorial development – providing quality of life and sustainable development of territory is the aim of each rural municipality. To reach this aim is possible through different development planning documents (programms of development, plans of teritorial development etc.). The aim of this study is to evaluate possibility of sustainable development in Babite rural municipality, as well as to perform conformity assesment of development planning documents of municipality to Aalborg Charter and to commitments consequent from Aalborg Charter. Results of study show that in development planning documents of Babite rural municipality commitments of Aalborg Charter are included. However, in several cases specified aim is not set up and together with that there is lack of fixed actions. Scope of work: 67 pages, 4 chapters, 10 tables and 38 sources of bibliography

Neuropsychiatric aspects of lyme disease

Laimas slimība ir multifaktoriāla sistēmiska saslimšana, kas pacientam var radīt novājinošu stāvokli dažādās orgānu grupās atkarībā no individuāla trofisma. Neiropsihiatriskie aspekti Laimas slimībai ir maz pētīti Latvijā. Ir svarīgi apzināt plašo neiropsihiatrisko simptomu spektru, lai uzlabotušīs saslimšanas norisi Latvijā. Mērķis: Izpētīt un apzināt neiropsihiatriskos aspektus Laimas slimības pacientu vidū. Uzdevumi: Veikt anonīmu aptauju un apzināt, cik boreliozes pacientu cieš no neiropsihiatriskiem traucējumiem un kāds ir to raksturojums. Materiāli un metodes: Šķērsgriezuma pētījums, kurā brīvprātīgi un anonīmi piedalījās Laimas slimības slimnieku atbalsta grupas biedri no Facebook vietnes. 223 respondents aizpildīja aptauju. Aptaujas atbildes tika savāktas, izmantojot google survey funkcionalitāti, dati tika statistiski apstrādāti IBM SPSS Statistics 22 programmā. Aptauja tika adoptēta no Dr. Roberta Bransfielda izstrādātās aptaujas formas The Neuropsychiatric Assessment of Lyme Disease (Bransfield 2018). Respondenti aizpildīja 6 punktu (0 – nav simptoma, 5 – maksimālā simptoma izpausme) vai 2 punktu (jā, nē) ordinālo datu Likerta skalu. Pētījuma būtiskuma līmenis: p<0,05. Rezultāti: Aptauju aizpildīja 192 sievietes (86.1%) un 31 vīrietis (13.9%). Vidējais vecums 43.6, SD=11.58; Min=18; Max=72 gadi. Depresīvo simptomu skalā bija vērojama tendence prevalēt pozitīvai simptomātikai (Mediāna=3.0, n=48, 21.5 %), līdzīga tendence tika novērota pie bipolāriem traucējumiem (Mediāna = 3.0, n = 46, 20.6 %). Starp abiem šiem simptomiem bija vērojama statistiski ticama (p<0.01) Spīrmana rs= 0.69 korelācija. Līdzvērtīgāks sadalījums bija obsesīvi kompulsīvo traucējumu spektrā (Mediāna = 2.0 n = 49, 22 %) un pie ģeneralizētas vispārējās trauksmes (Mediāna = 2.0, n = 38, 17 %). Starp šiem simptomu kopumiem bija vērojama pat ciešāka Spīrmana rs= 0.71 korelācija. Līdzīga aina izpaudās saistībā ar samazinātām sociālās funkcionēšanas spējām (Mediāna = 3.0, n = 39, 17.5 %), kurai pastāvēja cieša korelācija ar samazinātām spējām skolā/universitātē (rs=0.698), vidēja korelācija bija vērojama starp vairākiem psihiskiem simptomiem(rz=0.54-0.57) sociālo fobiju, rīcības kontroles zudumu, lēnīgumu, vājumu un neprecizitāti domu procesā un depresiju. 1.Dažādas intensitātes depresīvi simptomi prevalēja 51.7% respondentu, bipolāri traucējumi- 50.1%, uzmācīgi kompulsīvi traucējumi- 35.4% respondentu, ģeneralizēta vsipārēja trauksme 48.2%, samazināta sociālā funkcionēšanas spēja bija 54.4% respondentu. Tai pat laikā augstākais psihiatrisko simptomu rādītājs, ko atzīmēja respondenti pirms inficēšanās, bija depresija ar 2.4 % prevalenci. Līdz ar to var secināt, ka liela daļa pacientu ir laima slimības gaitā ieguvuši novājinošas psihiatriskas saslimšanas, kuru etioloģiskais faktors ir B.Burgdorferi vai no saslimšanas izrietoša komplikācija, kura ārstēšanas iznākumi ir atkarīgi no savlaicīgas psihiatra piesaistesLyme disease is a multifactorial systemic disease causing a debilitating condition in different organ groups depending on individual tissue trophism. The neuropsychiatric aspects of Lyme disease have not yet investigated in Latvia. It is important to identify the broad spectrum of neuropsychiatric symptoms to explore the current situation in Latvia. Aim:. To investigate and identify neuropsychiatric aspects among Lyme disease patients. Objectives: To conduct an anonymous survey to find out how many Lyme disease patients suffer from neuropsychiatric disorders and what their characteristics are. Materials and methods. Cross-sectional study was conducted in Lyme disease support group in Facebook. 223 respondents filled out the questionnaire. The answers were collected using google survey functionality and data was statistically analysed in IBM SPSS Statistics 22. The questionnaire has been adapted from M.D. Robert Bransfield’s “The Neuropsychiatric Assessment of Lyme Disease” assessment form. Respondents filled 6-point (0 – no symptoms, 5 – max symptoms) or 2-point (yes, no) Likert scale of ordinal data. Statistical significance level is p<0.05 Results. The survey was completed by 192 women (86.1%) and 31 men (13.9%). Mean age is 43.6, SD = 11.58; Min = 18; Max = 72 years There is serious tendency among responders to gravitate towards positive answer in depression scale (Median = 3.0, n = 48, 21.5%), and the same tendency is explorable for bipolar disorder (Median = 3.0, n = 46, 20.6%). There was a statistically significant (p <0.01) Spearman rs = 0.69 correlation between these two symptoms. There was a more equal distribution in the spectrum of obsessive-compulsive disorder (Median = 2.0 n = 49, 22%) and general anxiety disorder (Median = 2.0, n = 38, 17%). There was an even closer Spearman rs = 0.71 correlation between these sets of symptoms. A similar picture was observed in relation to reduced social functioning (median = 3.0, n = 39, 17.5%), which was closely correlated with lowered performance at school / university (rs = 0.698), a moderate correlation was observed between several mental symptoms (rs = 0.54 -0.57) social phobia, loss of control, slowness, weakness and inaccuracy regarding thinking and depression. Depression of various intensities prevailed in 51.7% of respondents, bipolar disorder - 50.1%, obsessive compulsive disorder - in 35.4% of respondents, general anxiety disorder in 48.2%, lowered social performance in 54.4% of respondents. Among all psychiatric symptoms depression had the highest prevalence of 2.4% before onset of borreliosis. Thus, it can be concluded that a large number of patients have acquired debilitating psychiatric illnesses during the course of Lyme disease, which etiological factor is B. Burgdorferi or a complication resulting from the illness. The treatment results depend on the timely involvement of a psychiatris

Latvian Academic Fraternities and Medicine. The Case of Fraternitas Metropolitana

Latvijas intelektuālās dzīves attīstībā ievērojama nozīme bija studentu korporācijām, kuras Baltijā sākušas veidoties 19 gs. sākumā Tērbatas Universitatā. Daudzi izcili latviešu mediķi bijuši korporāciju biedri vai filistri Tērbatā, Rīgā, Pēterburgā, Maskavā. Īpaši daudz ievērojamu medicīnas zinātnieku nācis no korporācijām "Lettonia" un "Fraternitas Petropolitana (vēlāk - "Fraternitas Metropolitana"). Tādēļ arī šajā krajumā ievietots divu metropolitāņu - pašreizēja "Fraternitas Metropolitana" globālā seniora Egona Rasmaņa un šīs pašas korporācijas ilggadēja locekļa un vēsturnieka Ludviga Reitera (abi - Bostonas konventā, ASV) stāstījums par šīm korporācijām