To date, limited information is available on the long-term discontinuation rates of antiplatelet therapy after drug-eluting stent implantation. The aim of the present study was to determine the ...prevalence and predictors of premature discontinuation of oral antiplatelet therapy after drug-eluting stent implantation and to evaluate its effects on long-term prognosis. We studied 1,358 consecutive patients successfully treated with drug-eluting stents and discharged with dual oral antiplatelet therapy. Aspirin was to be maintained lifelong, and clopidogrel was prescribed for 12 months. The patients were followed for 36 months. The prevalence and predictors of aspirin and clopidogrel discontinuation were assessed. Major adverse cardiac events, defined as death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke, were recorded. Definite, probable, and possible stent thrombosis (ST) and major and minor bleeding were also determined. Of the 1,358 patients, 8.8% had discontinued one or both antiplatelet agents within the first 12 months (“early” discontinuation) and 4.8% had discontinued aspirin after 1 year (“late” discontinuation). Early discontinuation was predicted by in-hospital major bleeding, the use of oral anticoagulants at discharge, and the lack of a statin prescription. Previous stroke was the only independent predictor of late discontinuation. Patients with early discontinuation experienced a greater incidence of major adverse cardiac events (28.6% vs 13.7%, p <0.001) and ST (7.6% vs 3.4%, p = 0.038). All-cause mortality (13.4% vs 4.7%, p <0.001) and cardiovascular death (5% vs 1.2%, p = 0.007) were significantly more frequent among patients with early discontinuation. In patients with late discontinuation, a nonstatistically significant increase was seen in major adverse cardiac events (20% vs 13.3%, p = 0.128) and ST (6.2% vs 3.2%, p = 0.275). In conclusion, premature discontinuation of antiplatelet therapy is relatively common, especially within the first year, and strongly associated with increased cardiovascular events, including ST and death.
Context. The study of intracluster light (ICL) can help us to understand the mechanisms taking place in galaxy clusters, and to place constraints on the cluster formation history and physical ...properties. However, owing to the intrinsic faintness of ICL emission, most searches and detailed studies of ICL have been limited to redshifts z < 0.4. Aims. To help us extend our knowledge of ICL properties to higher redshifts and study the evolution of ICL with redshift, we search for ICL in a subsample of ten clusters detected by the ESO Distant Cluster Survey (EDisCS), at redshifts 0.4 < z < 0.8, that are also part of our DAFT/FADA Survey. Methods. We analyze the ICL by applying the OV WAV package, a wavelet-based technique, to deep HST ACS images in the F814W filter and to V-band VLT/FORS2 images of three clusters. Detection levels are assessed as a function of the diffuse light source surface brightness using simulations. Results. In the F814W filter images, we detect diffuse light sources in all the clusters, with typical sizes of a few tens of kpc (assuming that they are at the cluster redshifts). The ICL detected by stacking the ten F814W images shows an 8σ detection in the source center extending over a ~50 × 50 kpc2 area, with a total absolute magnitude of −21.6 in the F814W filter, equivalent to about two L∗ galaxies per cluster. We find a weak correlation between the total F814W absolute magnitude of the ICL and the cluster velocity dispersion and mass. There is no apparent correlation between the cluster mass-to-light ratio (M/L) and the amount of ICL, and no evidence of any preferential orientation in the ICL source distribution. We find no strong variation in the amount of ICL between z = 0 and z = 0.8. In addition, we find wavelet-detected compact objects (WDCOs) in the three clusters for which data in two bands are available; these objects are probably very faint compact galaxies that in some cases are members of the respective clusters and comparable to the faint dwarf galaxies of the Local Group. Conclusions. We show that the ICL is prevalent in clusters at least up to redshift z = 0.8. In the future, we propose to detect the ICL at even higher redshifts, to determine wether there is a particular stage of cluster evolution where it was stripped from galaxies and spread into the intracluster medium.
We study the UV properties of a volume-limited sample of early-type galaxies in the Virgo Cluster combining new GALEX far-ultraviolet (1530 AA) and near-ultraviolet (2310 AA) data with ...spectrophotometric data available at other wavelengths. The sample includes 264 elliptical, lenticular, and dwarf galaxies spanning a large range in luminosity (M sub(B) , -15). While the NUV to optical or near-IR color-magnitude relations (CMRs) are similar to those observed at optical wavelengths, with a monotonic reddening of the color index with increasing luminosity, the (FUV - V) and (FUV - H) CMRs show a discontinuity between massive and dwarf objects. An even more pronounced dichotomy is observed in the (FUV - NUV) CMR. For elliptical galaxies, the (FUV - NUV) color becomes bluer with increasing luminosity and with increasing reddening of the optical or near-IR color indices. For the dwarfs, the opposite trend is observed. These observational evidences are consistent with the idea that the UV emission is dominated by hot, evolved stars in giant systems, while in dwarf ellipticals residual star formation activity is more common.
We present the results of a gravitational lensing analysis of the bright z s = 2.957 submillimeter galaxy (SMG) HERMES found in the Herschel/SPIRE science demonstration phase data from the Herschel ...Multi-tiered Extragalactic Survey (HerMES) project. The high-resolution imaging available in optical and near-IR channels, along with CO emission obtained with the Plateau de Bure Interferometer, allows us to precisely estimate the intrinsic source extension and hence estimate the total lensing magnification to be Delta *m = 10.9 ? 0.7. We measure the half-light radius R eff of the source in the rest-frame near-UV and V bands that characterize the unobscured light coming from stars and find R eff, * = 2.0 ? 0.1 kpc, in good agreement with recent studies on the SMG population. This lens model is also used to estimate the size of the gas distribution (R eff, gas = 1.1 ? 0.5 kpc) by mapping back in the source plane the CO (J = 5 -> 4) transition line emission. The lens modeling yields a relatively large Einstein radius R Ein = 410 ? 002, corresponding to a deflector velocity dispersion of 483 ? 16 km s--1. This shows that HERMES is lensed by a galaxy group-size dark matter halo at redshift z l ~ 0.6. The projected dark matter contribution largely dominates the mass budget within the Einstein radius with f dm(< R Ein) ~ 80%. This fraction reduces to f dm(< R eff, G1 4.5 kpc) ~ 47% within the effective radius of the main deflecting galaxy of stellar mass M *, G1 = 8.5 ? 1.6 X 1011 M . At this smaller scale the dark matter fraction is consistent with results already found for massive lensing ellipticals at z ~ 0.2 from the Sloan Lens ACS Survey.
In patients undergoing coronary stenting, long-term dual antiplatelet therapy with aspirin and clopidogrel reduces atherothrombotic events but also increases the risk of bleeding. The potential for ...developing bleeding complications is further enhanced in patients also requiring oral anticoagulant treatment (“triple therapy”). The aim of the study is to assess long-term outcomes associated with the use of triple-therapy in patients undergoing coronary stenting and evaluate how these may be affected by targeting international normalized ratio (INR) values to the lower therapeutic range. We prospectively studied 102 consecutive patients undergoing coronary stenting treated with dual antiplatelet therapy also requiring oral anticoagulation. INR was targeted to the lower therapeutic range (2.0 to 2.5). Patients requiring oral anticoagulant therapy because of mechanical valve prosthesis were excluded. Patients were followed for 18 months, and bleeding, defined according to Thrombolysis in Myocardial Infarction criteria, and major adverse cardiac events were recorded. Outcomes were compared with a control group (n = 102) treated only with dual antiplatelet therapy. The mean duration of triple therapy was 157 ± 134 days. At 18 months, a nonsignificant increase in bleeding was observed in the triple versus dual therapy group (10.8% vs 4.9%, p = 0.1). INR values were higher in patients with bleeding (2.8 ± 1.1 vs 2.3 ± 0.2, p = 0.0001). In patients who had INR values within the recommended target (79.4%), the risk of bleeding was significantly lower compared with patients who did not (4.9 vs 33%, p = 0.00019) and with that observed in the control group (4.9%). An INR >2.6 was the only independent predictor of bleeding. There were no significant differences in major adverse cardiac events between groups (5.8% vs 4.9%, p = 0.7). In conclusion, in patients undergoing coronary stenting on triple therapy, targeting lower therapeutic INR values reduces the risk of bleeding complications.
This paper presents a search for high redshift galaxies from the Euclid Early Release Observations program "Magnifying Lens." The 1.5 deg$^2$ area covered by the twin Abell lensing cluster fields is ...comparable in size to the few other deep near-infrared surveys such as COSMOS, and so provides an opportunity to significantly increase known samples of rare UV-bright galaxies at $z\approx6-8$ ($M_{\rm UV}\lesssim-22$). Beyond their still uncertain role in reionisation, these UV-bright galaxies are ideal laboratories from which to study galaxy formation and constrain the bright-end of the UV luminosity function. Of the 501994 sources detected from a combined $Y_{\rm E}$, $J_{\rm E}$, and $H_{\rm E}$ NISP detection image, 168 do not have any appreciable VIS/$I_{\rm E}$ flux. These objects span a range in spectral colours, separated into two classes: 139 extremely red sources; and 29 Lyman-break galaxy candidates. Best-fit redshifts and spectral templates suggest the former is composed of both $z\gtrsim5$ dusty star-forming galaxies and $z\approx1-3$ quiescent systems. The latter is composed of more homogeneous Lyman break galaxies at $z\approx6-8$. In both cases, contamination by L- and T-type dwarfs cannot be ruled out with Euclid images alone. Additional contamination from instrumental persistence is investigated using a novel time series analysis. This work lays the foundation for future searches within the Euclid Deep Fields, where thousands more $z\gtrsim6$ Lyman break systems and extremely red sources will be identified.
A large-scale hydrodynamical cosmological simulation, Horizon-AGN, is used to investigate the alignment between the spin of galaxies and the cosmic filaments above redshift 1.2. The analysis of more ...than 150 000 galaxies per time step in the redshift range 1.2 < z < 1.8 with morphological diversity shows that the spin of low-mass blue galaxies is preferentially aligned with their neighbouring filaments, while high-mass red galaxies tend to have a perpendicular spin. The reorientation of the spin of massive galaxies is provided by galaxy mergers, which are significant in their mass build-up. We find that the stellar mass transition from alignment to misalignment happens around 3 × 1010 M⊙. Galaxies form in the vorticity-rich neighbourhood of filaments, and migrate towards the nodes of the cosmic web as they convert their orbital angular momentum into spin. The signature of this process can be traced to the properties of galaxies, as measured relative to the cosmic web. We argue that a strong source of feedback such as active galactic nuclei is mandatory to quench in situ star formation in massive galaxies and promote various morphologies. It allows mergers to play their key role by reducing post-merger gas inflows and, therefore, keeping spins misaligned with cosmic filaments.
Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We ...evaluated its effects on morbidity and mortality.
Patients with New York Heart Association class III or IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony who were receiving standard pharmacologic therapy were randomly assigned to receive medical therapy alone or with cardiac resynchronization. The primary end point was the time to death from any cause or an unplanned hospitalization for a major cardiovascular event. The principal secondary end point was death from any cause.
A total of 813 patients were enrolled and followed for a mean of 29.4 months. The primary end point was reached by 159 patients in the cardiac-resynchronization group, as compared with 224 patients in the medical-therapy group (39 percent vs. 55 percent; hazard ratio, 0.63; 95 percent confidence interval, 0.51 to 0.77; P<0.001). There were 82 deaths in the cardiac-resynchronization group, as compared with 120 in the medical-therapy group (20 percent vs. 30 percent; hazard ratio 0.64; 95 percent confidence interval, 0.48 to 0.85; P<0.002). As compared with medical therapy, cardiac resynchronization reduced the interventricular mechanical delay, the end-systolic volume index, and the area of the mitral regurgitant jet; increased the left ventricular ejection fraction; and improved symptoms and the quality of life (P<0.01 for all comparisons).
In patients with heart failure and cardiac dyssynchrony, cardiac resynchronization improves symptoms and the quality of life and reduces complications and the risk of death. These benefits are in addition to those afforded by standard pharmacologic therapy. The implantation of a cardiac-resynchronization device should routinely be considered in such patients.
The declining health of high-elevation red spruce (Picea rubens Sarg.) and Fraser fir (Abies fraseri (Pursh) Poir.) in the southern Appalachian region has long been linked to nitrogen (N) deposition. ...Recently, N deposition has also been proposed as a source of negative health impacts in lower elevation deciduous forests. In 1998 we established 46 plots on six sites in North Carolina and Virginia dominated by American beech (Fagus grandifolia Ehrh.), sugar maple (Acer saccharum Marsh.), and yellow birch (Betula alleghaniensis Britt). We evaluated several response variables across an N deposition gradient, including annual basal area growth; foliage percent N, Al, P, K, Mg, and Ca; and forest floor percent N, Mg, and C, pH, and potential net nitrification and N mineralization rates. We found a significant linear relationship between N deposition and basal area growth in sugar maple, but not in American beech or yellow birch. In addition, we found a significant relationship between N deposition and foliar chemistry (foliar %N in all species, foliar Mg/N and %K in sugar maple, and %P in sugar maple and yellow birch). Foliar %N of the three studied species was high relative to values reported in other studies in the United States and Canada. Several forest floor response variables (%N, C/N, pH, Mg/N, and potential net nitrification and N mineralization rates and nitrification/mineralization fractions) were also correlated with N deposition. The correlations between the above response variables and N deposition are consistent with the influence of chronic N deposition on forested ecosystems measured in other regions and suggest that chronic N deposition may be influencing forest structure and chemistry within the southern region.
PDF
