Major adverse cardiac and cerebrovascular events (MACCE) represent the most common cause of serious perioperative morbidity and mortality. Our aim was to identify risk factors for MACCE in a broad ...surgical population with intermediate-to-high surgery-specific risk and to build and validate a model to predict the risk of MACCE.
A prospective, multicentre study of patients undergoing surgical procedures under general or regional anaesthesia in 23 hospitals. The main outcome was the occurrence of at least one perioperative MACCE, defined as any of the following complications from admittance to discharge: cardiac death, cerebrovascular death, non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, new cardiac arrhythmia, angina, or stroke. The MACCE predictive index was based on β-coefficients and validated in an external data set.
Of 3387 patients recruited, 146 (4.3%) developed at least one MACCE. The regression model identified seven independent risk factors for MACCE: history of coronary artery disease, history of chronic congestive heart failure, chronic kidney disease, history of cerebrovascular disease, preoperative abnormal ECG, intraoperative hypotension, and blood transfusion. The area under the receiver-operating characteristic curve was 75.9% (95% confidence interval, 71.2–80.6%).
The risk score based on seven objective and easily assessed factors can accurately predict MACCE occurrence after non-cardiac surgery in a population at intermediate-to-high surgery-specific risk.
Perioperative discontinuation of antiplatelet therapy (APT) in patients with coronary stents has been associated with major adverse cardiac events. Our aim was to analyse the perioperative management ...of APT in such patients and its relationship to the incidence of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events (MBE) in noncardiac surgery.
We completed a prospective multicentre observational study of patients with coronary stents undergoing noncardiac surgery in 11 hospitals in Spain. The main objectives were to record perioperative events and prospectively analyse the management of APT, and to assess whether the different preoperative APT regimens were associated with MACCE and MBE.
Of 432 surgical procedures studied, 15% experienced a perioperative MACCE and 37% a MBE. Overall mortality was 3.0%. Presurgical APT was prescribed in 95% of procedures, and was preoperatively discontinued in 15%. Surgery was urgent or emergent in 22% of patients, 31% were ASA IV, and 38% had a Revised Cardiac Risk Index of IV. MACCE were related to recent myocardial infarction (P=0.038), chronic kidney disease (P<0.001), insulin-dependent diabetes (P=0.006) and no preoperative APT (P=0.018). MBE also increased MACCE risk (P<0.001). We found statin therapy (P=0.049) and obesity (P=0.016) to be protective factors for MACCE.
Patients with coronary stents undergoing noncardiac surgery suffer a high incidence of perioperative adverse events, even with perioperative APT. Major adverse cardiac and cerebrovascular events are mainly related to previous medical conditions and perioperative major bleeingn events. Our findings should be treated with caution when applied to an elective surgery population.
NCT01171612.
Chronic kidney disease is an independent predictor of perioperative cardiovascular morbidity and mortality. We analysed the preoperative estimated glomerular filtration rate (eGFR) as a risk factor ...for perioperative major adverse cardiovascular and cerebrovascular events (MACCE) in non-cardiac surgery.
In a post hoc analysis of the ANESCARDIOCAT database, patients were classified into six stages of eGFR calculated with the abbreviated Modification of Diet in Renal Disease Study and the Chronic Kidney Disease Epidemiology Collaboration equations: >90 (1), 60–89.9 (2), 45–59.9 (3a), 30–44.9 (3b), 15–29.9 (4), and <15 (5) ml min−1 1.73 m−2. We analysed differences in MACCE, length of hospital stay, and all-cause mortality between eGFR stages.
The eGFR was available in 2323 patients. Perioperative MACCE occurred in 4.5% of patients and cardiac-related mortality was 0.5%. Five hundred and forty-three (23.4%) patients had an eGFR of <60 ml min−1 1.73 m−2 and 127 (5.4%) had an eGFR below 45 ml min−1 1.73 m−2. Logistic regression analysis showed that MACCE increased with eGFR impairment (P<0.001), with a marked increase from stage 3b onwards (odds ratio 1.8 vs 3.9 in 3a and 3b, respectively, P=0.047). All-cause mortality was not related to eGFR (P=0.071), but increased substantially between stages 3b and 4. The length of stay correlated with eGFR (P<0.001).
Perioperative MACCE increase with declining eGFR, primarily when <45 ml min−1 1.73 m−2. We recommend the use of preoperative eGFR for cardiovascular risk assessment.
Multilayer and multiplex networks represent a good proxy for the description of social phenomena where social structure is important and can have different origins. Here, we propose a model of ...opinion competition where individuals are organized according to two different structures in two layers. Agents exchange opinions according to the Abrams-Strogatz model in each layer separately and opinions can be copied across layers by the same individual. In each layer a different opinion is dominant, so each layer has a different absorbing state. Consensus in one opinion is not the only possible stable solution because of the interaction between the two layers. A new mean field solution has been found where both opinions coexist. In a finite system there is a long transient time for the dynamical coexistence of both opinions. However, the system ends in a consensus state due to finite size effects. We analyze sparse topologies in the two layers and the existence of positive correlations between them, which enables the coexistence of inter-layer groups of agents sharing the same opinion.
Abstract
As planets grow, the exchange of angular momentum with the gaseous component of the protoplanetary disc produces a net torque resulting in a variation of the semimajor axis of the planet. ...For low-mass planets not able to open a gap in the gaseous disc, this regime is known as type I migration. Pioneer works studied this mechanism in isothermal discs finding fast inward type I migration rates that were unable to reproduce the observed properties of extrasolar planets. In the last years, several improvements have been made in order to extend the study of type I migration rates to non-isothermal discs. Moreover, it was recently shown that if the planet’s luminosity due to solid accretion is taken into account, inward migration could be slowed down and even reversed. In this work, we study the planet formation process incorporating, and comparing, updated type I migration rates for non-isothermal discs and the role of planet’s luminosity over such rates. We find that the latter can have important effects on planetary evolution, producing a significant outward migration for the growing planets.
One of the more challenging tasks in the understanding of dynamical properties of models on top of complex networks is to capture the precise role of multiplex topologies. In a recent paper, Gómez et ...al. Phys. Rev. Lett. 110, 028701 (2013), some of the authors proposed a framework for the study of diffusion processes in such networks. Here, we extend the previous framework to deal with general configurations in several layers of networks and analyze the behavior of the spectrum of the Laplacian of the full multiplex. We derive an interesting decoupling of the problem that allow us to unravel the role played by the interconnections of the multiplex in the dynamical processes on top of them. Capitalizing on this decoupling we perform an asymptotic analysis that allow us to derive analytical expressions for the full spectrum of eigenvalues. This spectrum is used to gain insight into physical phenomena on top of multiplex, specifically, diffusion processes and synchronizability.
Purpose To identify and quantify the main concepts included in published studies focusing on individuals with schizophrenia using the International Classification of Functioning, Disability and ...Health (ICF). Methods Searches (limited to those published from 2008 to 2012) were performed in MEDLINE, PsycINFO and CINAHL. Included studies described participants with schizophrenia, were original articles and included only subjects who were at least 18 years of age at study entry. All concepts underlying the measures and the text of the articles were extracted, and they were linked to ICF categories using standardized rules. Results From the 3584 abstracts retrieved, 348 were randomly selected, and of these, 206 studies met the inclusion criteria. A total of 17,141 concepts were extracted, 84.8% of which could be linked to 491 ICF categories: 222 (45.21%) of the categories referred to Body Functions, 29 (5.91%) to Body Structures, 186 (37.88%) to Activities and Participation and 54 (11%) to Environmental Factors. Seventy second-level categories were reported in at least 5% of all studies: 30 of these categories referred to Body Functions, 2 to Body Structures, 34 to Activities and Participation and 4 to Environmental Factors. Conclusion The study has allowed us to identify and quantify the main concepts included in studies focusing on people with schizophrenia using the ICF. The majority of the concepts refer to Body Functions and Activities and Participation, rather than to Body Structures and Environmental Factors.
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