Anemia is a well-recognized risk factor for both bleeding and ischemic events after percutaneous coronary intervention (PCI). We sought to determine the impact of baseline anemia on dual antiplatelet ...therapy (DAPT) cessation patterns ≤2 years after PCI and the subsequent risk of clinical adverse events.
PARIS (Patterns of Non-Adherence to Dual Anti-Platelet Regimen in Stented Patients) was a prospective multicenter observational registry of PCI-treated patients (n=5018). Anemia was defined as baseline Hb (hemoglobin) <12 g/dL for men and <11 g/dL for women. DAPT cessation modes included physician-recommended discontinuation, temporary interruption (≤14 days), and disruption due to bleeding or noncompliance. The primary end point was 2-year major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, or target vessel revascularization. We identified 824 (18%) anemic and 4194 (82%) nonanemic patients. Anemic patients were older and had a higher rate of diabetes mellitus, hypertension, and prior PCI. DAPT interruption and disruption were significantly more common in anemic patients throughout 2 years after PCI, whereas physician-recommended discontinuation occurred more often in anemic patients during the first year after PCI and in nonanemic patients during the second year. The 2-year adjusted risks of MACE and Bleeding Academic Research Consortium 3 or 5 bleeding events were significantly higher in anemic patients. Compared with uninterrupted DAPT, disruption, but not interruption and physician-recommended discontinuation, was associated with a higher risk of myocardial infarction in nonanemic patients and a higher risk of both myocardial infarction and MACE in anemic patients. There was no significant interaction between anemia and risk of clinical outcomes associated with each DAPT cessation mode.
Baseline anemia was associated with a significantly higher adjusted risk of MACE and major bleeding. Physicians more frequently recommend DAPT discontinuation to anemic patients during the first year, and to nonanemic patients during the second year after PCI. DAPT disruption was associated with a higher risk of MACE outcomes.
Abstract Objective The aim of this study was to determine the differences in the efficacy and efficiency in providing critical care to hospitalized patients in teaching vs nonteaching intensive care ...units (ICUs) in Colombia. Methods A prospective cohort observational study was conducted. Location This study was conducted in 11 teaching and 8 nonteaching ICUs. From June 1 until December 31, 2005, data on 826 patients admitted consecutively to teaching ICUs and 825 patients admitted to nonteaching ICUs were analyzed. Measurements Acute Physiology and Chronic Health Evaluation II, Simplified Therapeutic Intervention Scoring System, ICU discharge status (dead or alive) and ICU length of stay, and standardized mortality ratios were considered in this study. A logistic regression and robust linear regression were performed. Results There were no differences in mortality ( P = .25). Standardized mortality was less than 1 for both types of units. The teaching ICUs length of stay was 1 day longer ( P < .01). Resource use is 25% higher in teaching units ( P = .01). When the Simplified Therapeutic Intervention Scoring System score on the last day was from 21 to 35, a higher ratio of patients from the nonteaching ICUs was observed going floor or home when discharged from the ICU ( P < .01). Conclusions Nonteaching ICUs discharge patients earlier than do teaching ICUs, but the effect of it remains to be clarified with further studies addressing questions as what happens after ICU discharge.
Professor Gabriel discusses and compares the approaches to the battle of the forms taken by England, Australia, New Zealand, the common law provinces of Canada, and the United Nations Convention on ...Contracts for the International Sale of Goods with the approach set out in section 2-207 of the Uniform Commercial Code.
The neural circuits of birdsong appear to utilize specific time delays in their operation. In particular, the anterior forebrain pathway (AFP) is implicated in an approximately 40- to 50- ms time ...delay, DeltaT, playing a role in the relative timing of premotor signals from the nucleus HVc to the nucleus robust nucleus of the archistratium (RA) and control/learning signals from the nucleus lateral magnocellular nucleus of the anterior neostratium (lMAN) to RA. Using a biophysical model of synaptic plasticity based on experiments on mammalian hippocampal and neocortical pyramidal neurons, we propose an understanding of this approximately 40- to 50- ms delay. The biophysical model describes the influence of Ca2+ influx into the postsynaptic RA cells through NMDA and AMPA receptors and the induction of LTP and LTD through complex metabolic pathways. The delay, DeltaT, between HVc --> RA premotor signals and lMAN --> RA control/learning signals plays an essential role in determining if synaptic plasticity is induced by signaling from each pathway into RA. If DeltaT is substantially larger than 40 ms, no plasticity is induced. If DeltaT is much less than 40 ms, only potentiation is expected. If DeltaT approximately 40 ms, the sign of synaptic plasticity is sensitive to DeltaT. Our results suggest that changes in DeltaT may influence learning and maintenance of birdsong. We investigate the robustness of this result to noise and to the removal of the Ca2+ contribution from lMAN --> RA NMDA receptors.
Dynamical model of birdsong maintenance and control Abarbanel, Henry D I; Talathi, Sachin S; Mindlin, Gabriel ...
Physical review. E, Statistical, nonlinear, and soft matter physics,
11/2004, Letnik:
70, Številka:
5 Pt 1
Journal Article
Odprti dostop
The neuroethology of song learning, production, and maintenance in songbirds presents interesting similarities to human speech. We have developed a biophysical model of the manner in which song could ...be maintained in adult songbirds. This model may inform us about the human counterpart to these processes. In songbirds, signals generated in nucleus High Vocal center (HVc) follow a direct route along a premotor pathway to the robust nucleus of the archistriatum (RA) as well as an indirect route to RA through the anterior forebrain pathway (AFP): the neurons of RA are innervated from both sources. HVc expresses very sparse bursts of spikes having interspike intervals of about 2 ms. The expressions of these bursts arrive at the RA with a time difference DeltaT approximately equal to 50+/-10 ms between the two pathways. The observed combination of AMPA and NMDA receptors at RA projection neurons suggests that long-term potentiation and long-term depression can both be induced by spike timing plasticity through the pairing of the HVc and AFP signals. We present a dynamical model that stabilizes this synaptic plasticity through a feedback from the RA to the AFP using known connections. The stabilization occurs dynamically and is absent when the RA-->AFP connection is removed. This requires a dynamical selection of DeltaT. The model does this, and DeltaT lies within the observed range. Our model represents an illustration of a functional consequence of activity-dependent plasticity directly connected with neuroethological observations. Within the model the parameters of the AFP, and thus the magnitude of DeltaT, can also be tuned to an unstable regime. This means that destabilization might be induced by neuromodulation of the AFP.
Background The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was ...to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Methods Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann–Whitney test and considered significant if P is less than .05. Results The moderate and severe degrees of dysphagia were more frequent ( P = .013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia ( P = .045). Conclusions We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy.
General Provisions and Sales Gabriel, Henry D.
The Business lawyer,
08/1996, Letnik:
51, Številka:
4
Journal Article
Recenzirano
As in prior years, 1996's cases that struggled with the scope of Article 2 of the Uniform Commercial Code primarily considered whether the agreement in controversy was a contract for the sale of ...goods or for services. Courts have been fairly consistent in their approach to this issue: they determine whether the agreement is predominantly for goods or for services, and they treat this determination as a question of fact. Cases involving several sections of UCC Article 2 are discussed.
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