Abstract
Background
The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF) remains uncertain.
Purpose
This network ...meta-analysis aimed to compare the efficacy and safety of various antithrombotic strategies after LAAO.
Methods
We conducted a comprehensive search of MEDLINE, Cochrane, Embase, and ClinicalTrials.gov databases for studies that reported outcomes after LAAO, stratified by the antithrombotic therapies administered at discharge. Direct oral anticoagulants (DOACs), vitamin-K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no antithrombotic therapy were analyzed. We performed a frequentist random-effects model network meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CI) for each strategy. The surface under the cumulative ranking curve (SUCRA) P-scores provided a ranking of treatments. Quality assessment and risk of bias were conducted in accordance with Cochrane recommendations.
Results
We included 39 studies comprising 10,573 patients with non-valvular AF. As shown in Figure 1, in the network comparison, DAPT (OR 0.33; 95% CI 0.14-0.73), DOAC (OR 0.31; 95% CI 0.11-0.84), DOAC plus SAPT (OR 0.15; 95% CI 0.03-0.68), and VKA (OR 0.29; 95% CI 0.10-0.87) were superior to no therapy in preventing device-related thrombosis (DRT). There was no significant difference between the therapies analyzed in terms of major bleeding (Figure 2). In the SUCRA analysis, DOAC plus SAPT had the highest probability of being the best strategy for preventing DRT, followed by VKA and DOAC monotherapies, respectively. DOAC monotherapy was associated with the lowest probability of major bleeding, followed by DOAC plus SAPT and VKA as monotherapy, respectively.
Conclusion
In patients with non-valvular AF undergoing LAAO, post-discharge therapy with DOAC as monotherapy reduces the incidence of DRT compared with no therapy and is associated with a lower probability of major bleeding compared with other therapies.Figure 1.DRTFigure 2.Major bleeding
The optimal treatment of diabetes in pregnancy requires accurate measurement of blood glucose levels, in order to minimize adverse outcomes for both mother and neonate. Self-monitoring of blood ...glucose is routinely used to measure glycemic control and to assess whether treatment targets are being met; however, the accuracy of blood glucose meters in pregnancy is unclear.
Pregnant women with gestational, type 1, or type 2 diabetes mellitus were eligible to participate. Nonfasting capillary blood glucose levels were measured in duplicate using the BGStar(®) (Sanofi, Sydney, Australia) and FreeStyle Lite(®) (Abbott, Sydney) blood glucose meters. Venous blood samples were collected and analyzed for plasma glucose, hematocrit, and glycated hemoglobin. Capillary blood glucose was compared with plasma glucose and further assessed according to International Organization for Standardization (ISO) 15197:2013 standards.
One hundred ten women were recruited, providing 96 samples suitable for analysis. The mean ± SD laboratory plasma glucose level was 4.6 ± 1.4 mmol/L; the BGStar and FreeStyle Lite capillary blood glucose values were 5.3 ± 1.4 mmol/L and 5.0 ± 1.3 mmol/L, respectively. Both meters showed a positive bias (0.42 mmol/L for the FreeStyle Lite and 0.65 mmol/L for the BGStar). Furthermore, neither meter fulfilled the ISO 15197:2013 standards, and there was a nonsignificant improvement in meter performance at blood glucose levels of ≤4.2 mmol/L. Hematocrit did not affect the results of either blood glucose meter. Clarke Error Grid analysis demonstrated that approximately 70% of the results of both meters would lead to appropriate clinical action.
The BGStar and FreeStyle Lite blood glucose meters did not meet ISO 15197:2013 recommendations for blood glucose monitoring systems when assessed in a population of women with diabetes in pregnancy. Clinicians should consider this difference in blood glucose readings when making diabetes-related treatment decisions.
While auditory verbal hallucinations (AH) are a cardinal symptom of schizophrenia, people with a diagnosis of schizophrenia (SZ) may also experience visual hallucinations (VH). In a retrospective ...analysis of a large sample of SZ and healthy controls (HC) studied as part of the functional magnetic resonance imaging (fMRI) Biomedical Informatics Research Network (FBIRN), we asked if SZ who endorsed experiencing VH during clinical interviews had greater connectivity between visual cortex and limbic structures than SZ who did not endorse experiencing VH.
We analyzed resting state fMRI data from 162 SZ and 178 age- and gender-matched HC. SZ were sorted into groups according to clinical ratings on AH and VH: SZ with VH (VH-SZ; n = 45), SZ with AH but no VH (AH-SZ; n = 50), and SZ with neither AH nor VH (NoH-SZ; n = 67). Our primary analysis was seed based, extracting connectivity between visual cortex and the amygdala (because of its role in fear and negative emotion) and visual cortex and the hippocampus (because of its role in memory).
Compared with the other groups, VH-SZ showed hyperconnectivity between the amygdala and visual cortex, specifically BA18, with no differences in connectivity among the other groups. In a voxel-wise, whole brain analysis comparing VH-SZ with AH-SZ, the amygdala was hyperconnected to left temporal pole and inferior frontal gyrus in VH-SZ, likely due to their more severe thought broadcasting.
VH-SZ have hyperconnectivity between subcortical areas subserving emotion and cortical areas subserving higher order visual processing, providing biological support for distressing VH in schizophrenia.
Economic sociologists have argued that financial markets should be analysed as uncertainty‐processing social networks and intermediary groups. Networks and intermediaries alone cannot confer ...legitimacy upon financial actors and transactions. Status groups are a solution to this problem. They emphasize reputation, honour and good social behaviour as stabilizers of collective action, as means of social control and as indicators of legitimacy. I examine here the emergence and evolution of status groups of brokers in London, New York and Paris, and show how emphasis on honour was used to legitimize financial transactions. I argue that financial markets should be conceived as networks, intermediary and status groups. In global, automated financial markets status groups like securities analysts are gaining in prominence.
In recent years, the cost of several treatment options for renal cancer have been supported by the Romanian healthcare system for both first- and second-line therapies. First-line alternatives ...through real-life efficacy and amplitude of adverse reactions may influence the efficacy and costs of patients treated with second-line treatment.
Estimation of the cost-effectiveness and cost-benefit ratio for first-line treatment alternatives: Sunitinib and Pazopanib from the payer's perspective in the Romanian healthcare system.
We developed a Markov model to calculate the cost-effectiveness and cost-benefit ratio for 2 cohorts of patients using the results from the COMPARZ study for efficacy (progression-free survival, general survivability and quality of life) and safety and costs from national hospital databases. For an estimated population of 800 patients, Pazopanib has a quantified benefit of 7.19 years in progression-free survival, 11.71 life years gained and 8.97 years of quality-adjusted life-years compared to Sunitinib. The analysis is limited by the accuracy of the national data used and the transposition of general data on efficacy and safety at the local level.
Placental development is a complex process which sets the stage for normal fetal development. Any variation/disruption occurring during the initial stages of placental formation leads to placental ...malfunction causing increased maternal-fetal morbidity and mortality. The succenturiate lobe is a structural variation of the placenta that usually appears as a distinct lobe from the main placental mass. Succenturiate lobe is a rare placental anomaly, with high risk of fetal distress, hemorrhage, abruptio placentae and even fetal death because the vessels of this succenturiate lobe are vulnerable to both compression and laceration. Prenatal imaging diagnosis of this pathology improves the fetal prognosis through more careful surveillance and, in case of complications such as abruptio placentae, by shortening the time-to-decision making in favor of cesarean delivery. We present the case of a 27-year-old patient, without risk factors for placental abnormalities, diagnosed antenatally with succenturiate placenta, who presented at 34 weeks of pregnancy for abruptio placentae.
Quantum computing architectures require an accurate and efficient description in terms of many-electron states. Recent implementations include quantum dot arrays, where the ground state of a multi ...q-bit system can be altered by voltages applied to the top gates. An extensive investigation concerning the spectra of the many-electron systems under multiple operation conditions set by external voltages typically requires a relatively large number of Hamiltonian diagonalizations, where the Coulomb interaction is considered in an exact manner. Instead of making exhaustive calculations using high throughput computing, we approach this problem by augmenting numerical diagonalizations with machine learning techniques designed to predict the many-electron eigenvalues and eigenfunctions. To this end, we employ and compare the results from linear regression methods such as multivariate least squares (MLS) as well as non-linear techniques based on kernel ridge regression (KRR), Gaussian process regression (GPR) and artificial neural networks (ANNs). The input feature vectors are assembled from readily available information comprised from a binary representation of the potential and the strength of the Coulomb interaction. Furthermore, employing a linear classifier, we establish a rule for detecting a singlet-triplet transition which may arise for certain potential configurations.
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