This is the first prospective, double-blinded, randomized, placebo-controlled trial to evaluate the safety and efficacy of a stimulant laxative compared with an osmotic agent for the treatment of ...chronic idiopathic constipation.
Patients were randomly administered stimulant laxative (senna, 1.0 g), osmotic agent (magnesium oxide MgO, 1.5 g), or placebo for 28 consecutive days. The primary endpoint was overall symptom improvement. Secondary endpoints were spontaneous bowel movement (SBM), complete SBM, and patient assessment of constipation quality of life (QOL).
Ninety patients (mean age, 42 years; 93% women; mean duration of symptoms, 9.9 years) were enrolled; all completed the study. The response rate for overall improvement was 11.7% in the placebo group, 69.2% in the senna group, and 68.3% in the MgO group (P < 0.0001). Change in SBM was significantly greater in the senna and MgO groups than that in the placebo group (P < 0.001). Similarly, change in complete SBM was significantly greater in the senna and MgO groups than that in the placebo group (P < 0.01). On the patient assessment of constipation QOL, significant improvements were seen in the senna and MgO groups compared with those in the placebo group (senna, P < 0.05; MgO, P < 0.001). The frequency of severe treatment-related adverse events was 0%.
Senna and MgO significantly improved the frequency of bowel movements and QOL score and seem to be effective in the treatment of constipation.
Summary Background Bioresorbable coronary stents might improve outcomes of patients treated with percutaneous coronary interventions. The everolimus-eluting bioresorbable vascular scaffold is the ...most studied of these stent platforms; however, its performance versus everolimus-eluting metallic stents remains poorly defined. We aimed to assess the efficacy and safety of everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents in patients with ischaemic heart disease treated with percutaneous revascularisation. Methods We searched Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), scientific sessions abstracts, and relevant websites for randomised trials investigating everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents published or posted between Nov 30, 2006, and Oct 12, 2015. The primary efficacy outcome was target lesion revascularisation and the primary safety outcome was definite or probable stent (scaffold) thrombosis. Secondary outcomes were target lesion failure (the composite of cardiac death, target-vessel myocardial infarction, or ischaemia-driven target lesion revascularisation), myocardial infarction, death, and in-device late lumen loss. We derived odds ratios (ORs) and weighted mean differences with 95% CIs, and calculated the risk estimates for the main outcomes according to a random-effects model. This study is registered with PROSPERO, number CRD42015026374. Findings We included six trials, comprising data for 3738 patients randomised to receive percutaneous coronary intervention with either an everolimus-eluting bioresorbable vascular scaffold (n=2337) or an everolimus-eluting metallic stent (n=1401). Median follow-up was 12 months (IQR 9–12). Patients treated with bioresorbable vascular scaffolds had a similar risk of target lesion revascularisation (OR 0·97 95% CI 0·66–1·43; p=0·87), target lesion failure (1·20 0·90–1·60; p=0·21), myocardial infarction (1·36 0·98–1·89; p=0·06), and death (0·95 0·45–2·00; p=0·89) as those treated with metallic stents. Patients treated with a bioresorbable vascular scaffold had a higher risk of definite or probable stent thrombosis than those treated with a metallic stent (OR 1·99 95% CI 1·00–3·98; p=0·05), with the highest risk between 1 and 30 days after implantation (3·11 1·24–7·82; p=0·02). Lesions treated with a bioresorbable vascular scaffold had greater in-device late lumen loss than those treated with a metallic stent (weighted mean difference 0·08 95% CI 0·05–0·12; p<0·0001). Interpretation Compared with everolimus-eluting metallic stents, everolimus-eluting bioresorbable vascular scaffolds had similar rates of repeat revascularisation at 1 year of follow-up, despite inferior mid-term angiographic performance. However, patients treated with a bioresorbable vascular scaffold had an increased risk of subacute stent thrombosis. Studies with extended follow-up in a larger number of patients are needed to fully assess the long-term advantages of everolimus-eluting bioresorbable vascular scaffolds. Funding None.
The detection of preslip, occurring hours to days before a large earthquake, using geodetic measurements has been a major focus in earthquake prediction research. A recent study claims to have ...detected a preseismic signal interpreted as accelerating slip near the hypocenter of the 2011 great Tohoku‐oki earthquake, starting approximately 2 hr before the mainshock. This claim is based on a stacking procedure using GNSS (Global Navigation Satellite System) data. However, a follow‐up study demonstrated that the signal disappeared when specific GNSS noise was corrected. Here we utilize tiltmeter records, independent on GNSS, to check whether the claimed preseismic signal is detected using a similar stacking procedure. Our results show no acceleration‐like deformation from 2 hr before the mainshock. This indicates that no precursory slip exceeded the noise level of the tilt data, and if any preslip occurred, it was less than 5.0 × 1018 Nm in seismic moment.
Plain Language Summary
The ability to detect large earthquakes before they occur would be invaluable for mitigating damage. Researchers have been searching for precursory signals in crustal deformation data, believing that if precursory slip (fault movement before a major earthquake) is large enough, it could be detected by GNSS or tiltmeters, enabling earthquake prediction. The 2011 Tohoku‐oki earthquake provided a valuable opportunity to study this phenomenon. Extensive data was collected, but previous studies found no significant pre‐earthquake signals on timescales of hours to days. A recent GNSS study claimed an acceleration‐like change 2 hr before the main shock, but another study using the same data disputed this. While reanalysis using the same GNSS data is important, it is also susceptible to the influence of the same noise sources. To avoid this, this study analyzed tiltmeter data, finding no evidence for the precursory deformation suggested earlier. This result indicates no significant precursory slip before the Tohoku‐oki earthquake that causes deformation larger than a noise level of the tiltmeter data. This result can provide constraints on the magnitude of the precursory slip immediately before the mainshock.
Key Points
Tiltmeter records are used to determine whether a preseismic signal of the 2011 great Tohoku‐oki earthquake is detected
No acceleration‐like tilt deformation from about 2 hr before the mainshock is recorded
An upper bound on the size of the preslip immediately before the mainshock can be estimated from the noise level of the observation data
Little is known about the nationwide trend in the survival of out-of-hospital cardiac arrest (OHCA) in Japan and the differences in incidence and survival by age group and origin of arrest.
A ...nationwide, prospective, population-based observation covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts was conducted from January 2005 to December 2009. The main outcome measure was 1-month survival with favorable neurological outcome. The nationwide trends in OHCA incidence and outcome by age and origin of arrest were assessed. Multiple logistic regression analysis for bystander-witnessed OHCA was used to adjust for factors that were potentially associated with favorable neurological outcome. During 5 years, 547 153 overall OHCAs and 169 360 bystander-witnessed OHCAs were enrolled. The annual incidence significantly increased among overall OHCAs and bystander-witnessed OHCAs. Neurologically favorable survival significantly increased from 1.6% (1676/102 737) in 2005 to 2.8% (3280/115 250) in 2009 (P<0.001), from 2.1% (638/30 556) to 4.3% (1558/36 361) (P<0.001), and from 9.8% (437/4461) to 20.6% (1215/5906) (P<0.001) among overall OHCA, bystander-witnessed OHCA, and bystander-witnessed ventricular fibrillation OHCA, respectively. Public-access automated external defibrillator use, either bystander-initiated chest compression-only cardiopulmonary resuscitation or conventional cardiopulmonary resuscitation, and earlier emergency medical services response time were associated with a better neurological outcome. Favorable neurological outcome among adult OHCA subjects significantly improved, but the outcome among younger children and very elderly subjects did not improve and was poor irrespective of origin of OHCA.
Nationwide improvements of favorable neurological outcome from OHCA were observed in Japan and differed by age group and origin of OHCA.
The spatial distributions of shallow slow earthquakes are related to stress accumulation and structural characteristics of the shallow plate boundary, which are important for understanding megathrust ...earthquakes. To investigate spatiotemporal variation of shallow very low frequency earthquake (SVLFE) activity along the Nankai Trough, we conducted centroid moment tensor inversion method incorporating effects of offshore heterogeneous structures. By applying centroid moment tensor method into long‐term onshore seismograms, we obtained spatiotemporal variation of SVLFE activity occurred from June 2003 to May 2018. We find that SVLFE activities are related to the spatial variations of the slip‐deficit rate and pore fluid around the Philippine Sea plate boundary. SVLFEs are effectively activated by mechanical weakening due to rich pore fluid in areas surrounding strongly locked zones. Our results imply that spatial variations of long‐term SVLFE activity provide information on tectonic environments, which could constrain the rupture behavior of shallow plate boundaries during future megathrust earthquakes.
Plain Language Summary
The spatial distributions of shallow slow earthquakes are related to stress accumulation and structural characteristics of the shallow plate boundary, which are important for understanding megathrust earthquakes. Despite this importance, conventional methods using onshore seismograms and one‐dimensional Earth models cannot well constrain the location and magnitude of shallow slow earthquakes due to the effects of three‐dimensional (3‐D) offshore subsurface structures. Moreover, offshore observations near hypocenters are still limited. By applying a method incorporating the effects of 3‐D subsurface structures into long‐term onshore seismograms, we show the spatial variations of well‐constrained shallow very low frequency earthquakes (SVLFEs) along the Nankai Trough, including events that occurred prior to offshore observations. We find that SVLFE activities are related to the spatial variations of the slip‐deficit rate and pore fluid around the Philippine Sea plate boundary. SVLFEs are effectively activated by mechanical weakening due to rich pore fluid in areas surrounding strongly locked zones. Our results imply that spatial variations of long‐term SVLFE activity provide information on tectonic environments, which could constrain the rupture behavior of shallow plate boundaries during future megathrust earthquakes.
Key Points
We conducted CMT inversions of shallow very low frequency earthquakes (SVLFEs) occurred from June 2003 to May 2018 along the Nankai Trough
Spatiotemporal variation of SVLFE activity are related to slip‐deficit rate and pore fluid along the Philippine Sea plate boundary
SVLFEs are effectively activated by mechanical weakening due to rich pore fluid in areas surrounding strongly locked zones
For many years, bleeding has been perceived as an unavoidable consequence of strategies aimed at reducing thrombotic complications in patients undergoing percutaneous coronary intervention (PCI). ...However, the paradigm has now shifted towards bleeding being recognized as a prognostically unfavourable event to the same extent as having a new or recurrent ischaemic or thrombotic complication. As such, in parallel with progress in device and drug development for PCI, there is clinical interest in developing strategies that maximize not only the efficacy but also the safety (for example, by minimizing bleeding) of any antithrombotic treatment or procedural aspect before, during or after PCI. In this Review, we discuss contemporary data and aspects of bleeding avoidance strategies in PCI, including risk stratification, timing of revascularization, pretreatment with antiplatelet agents, selection of vascular access, choice of coronary stents and antithrombotic treatment regimens.
Near the Boso Peninsula, central Japan, slow slip events (SSEs) accompanied by earthquake swarms repeatedly occur every 4 to 7 years. We apply a Network Inversion Filter to tilt change and Global ...Navigation Satellite Systems displacement data simultaneously in order to obtain the spatiotemporal slip evolution of the Boso Peninsula SSEs in 2007 and 2011. Slip initiates on the eastern offshore area in both of the events and propagates to the northwestward in 2007, whereas the 2011 slip propagates to the west. These slip propagations correlate well both spatially and temporally with the migration of the accompanying seismicity. This indicates that the Boso slow slip is a major driving process for earthquake swarm activities, and that monitoring of interplate slip has the potential to be used in assessing the possibility of an earthquake in near real time.
Key PointsGNSS and tiltmeter records are inverted to retrieve slow slip time evolutionSlip propagation correlates well with the accompanying earthquake migrationBoso slow slip is a major driving process for earthquake swarm activity
BACKGROUND:Recently, the Academic Research Consortium for High Bleeding Risk (ARC-HBR) has been proposed to standardize the definition of HBR, which was arbitrarily defined as a Bleeding Academic ...Research Consortium 3 or 5 bleeding ≥4% at 1-year. However, the prevalence and the expected bleeding event rate of HBR patients defined by ARC-HBR criteria are currently unknown in the real-world percutaneous coronary intervention practice.
METHODS:We applied the ARC-HBR criteria in the CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort-2, a multicenter registry that enrolled 13 058 consecutive patients who underwent their first percutaneous coronary intervention. The primary bleeding end point was defined as the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries moderate/severe bleeding. There were 5570 patients (43%) in the HBR group and 7488 patients in the no-HBR group.
RESULTS:Cumulative incidence of the primary bleeding end point was much higher in the HBR group than in the no-HBR group (10.4% versus 3.4% at 1-year, and 18.9% versus 6.6% at 5-year, P<0.0001). Presence of each ARC-HBR major or even minor criterion, in isolation, with the exception of liver cirrhosis and prior ischemic stroke, was also associated with major bleeding risk higher than 4% at 1-year. Cumulative 5-year incidence of the primary bleeding end point got incrementally higher as the number of the ARC-HBR major criteria increased (≥3 majors49.9%, 2 majors30.6%, 1 major18.5%, ≥2 minors14.7%, and no-HBR6.6%, P<0.0001).
CONCLUSIONS:ARC-HBR criteria successfully identified those patients with very HBR after percutaneous coronary intervention, who represented 43% of patients in this all-comers registry.
PDF
