Summary
Background
Prosthetic heart valve thrombosis is a life‐threatening condition for which treatment has not been evaluated by randomized trials.
Objectives
To compare surgery with thrombolytic ...therapy for the treatment of prosthetic valve thrombosis.
Methods
A comprehensive systematic review was carried out by independent researchers using PubMed, Web of Knowledge, HINARI, LILACS and EMBASE, including papers indexed up to 23 October 2013 with at least 10 patients, evaluating one or both treatment options. Outcomes of interest were death, stroke, bleeding, embolic events and success. Study quality was assessed by the Newcastle‐Ottawa Scale (ranges from 0 to 9). Comprehensive Meta Analysis Software was used to pool study results, for publication bias analysis and for meta‐regression.
Results
Forty‐eight studies were included (2302 patients). No randomized study was identified, and all were observational in design. Study quality varied from 4 to 6 stars using the Newcastle‐Ottawa Scale. Mortality for surgery was 18.1% (95%CI, 14.6–22.1; I2, 62% 42–75), while mortality for thrombolytic therapy was 6.6% (95% CI, 4.8–8.9; I2, 0% 0–13). Surgical mortality appeared to increase with NYHA‐class, according to meta‐regression. Other results related to surgery and thrombolytic therapy, respectively, were: embolic events, 4.6% (2.9–7.3) and 12.8% (10.8–15.2); stroke, 4.3%,(2.7–6.6%) and 5.6%,(4.3–7.4%); success rate, 81.9% (77.2–85.8) and 80.7% (75.6–85.0); bleeding, 4.6% (2.9–7.1) and 6.8% (5.4–8.6); and death or stroke, 19.0% (14.8–24.2) and 11.4% (8.7–14.7).
Conclusion
Mortality in patients treated by thrombolytic therapy for valve prosthesis thrombosis is significantly lower than in patients treated surgically. As we cannot yet ascertain whether this difference is due to the treatment alone, more studies are now necessary to further clarify these findings.
Tracks and trackways of newborns, calves and juveniles attributed to straight-tusked elephants were found in the MIS 5 site (Upper Pleistocene) known as the Matalascañas Trampled Surface (MTS) at ...Huelva, SW Spain. Evidence of a snapshot of social behaviour, especially parental care, can be determined from the concentration of elephant tracks and trackways, and especially from apparently contemporaneous converging trackways, of small juvenile and larger, presumably young adult female tracks. The size frequency of the tracks enabled us to infer body mass and age distribution of the animals that crossed the MTS. Comparisons of the MTS demographic frequency with the morphology of the fore- and hind limbs of extant and fossil proboscideans shed light into the reproductive ecology of the straight-tusked elephant, Palaeloxodon antiquus. The interdune pond habitat appeared to have been an important water and food resource for matriarchal herds of straight-tusked elephants and likely functioned as a reproductive habitat, with only the rare presence of adult and older males in the MTS. The preservation of this track record in across a paleosol surface, although heavily trampled by different animals, including Neanderthals, over a short time frame, permitted an exceptional view into short-term intraspecific trophic interactions occurring in the Last Interglacial coastal habitat. Therefore, it is hypothesized that Neanderthals visited MTS for hunting or scavenging on weakened or dead elephants, and more likely calves.
In the Iberian Peninsula the fossil record of artiodactyls spans over 53 million years. During the Pleistocene, wild cattle species such as Bison and especially Bos became common. In Late ...Pleistocene, the aurochs (Bos primigenius) was widespread and the only bovine living along the large river valleys of southern Iberia. Although commonly found in fossil sites and especially in cave bone assemblages, the trace fossil record of aurochs was known worldwide only from the Holocene. Large bovine and roe deer/caprine tracks were found in at least five horizons of the early Late Pleistocene (MIS 5) beach and eolian deposits of Cape Trafalgar (Cadiz Province, South of Spain). The large bovine tracks are formally described as Bovinichnus uripeda igen. et isp. nov. and compared with the record of aurochs tracks, large red deer tracks and steppe bison biogeographical distribution in Iberia. Aurochs were the most likely producers of the newly described Trafalgar Trampled Surface (TTS) and some of the large artiodactyl tracks in the Matalascañas Trampled Surface, representing the oldest aurochs track record known. This new evidence, together with comparisons with the record of possible aurochs tracks in the Mid-Late Pleistocene coastal deposits from the Asperillo cliff section in Matalascañas (Huelva Province, SW Spain) and bone assemblages known in Gibraltar, point to a recurrent use of the coastal habitat by these large artiodactyls in SW Iberia.
Species spatial distributions are the result of population demography, behavioral traits, and species interactions in spatially heterogeneous environmental conditions. Hence the composition of ...species assemblages is an integrative response variable, and its variability can be explained by the complex interplay among several structuring factors. The thorough analysis of spatial variation in species assemblages may help infer processes shaping ecological communities. We suggest that ecological studies would benefit from the combined use of the classical statistical models of community composition data, such as constrained or unconstrained multivariate analyses of site-by-species abundance tables, with rapidly emerging and diversifying methods of spatial pattern analysis. Doing so allows one to deal with spatially explicit ecological models of beta diversity in a biogeographic context through the multiscale analysis of spatial patterns in original species data tables, including spatial characterization of fitted or residual variation from environmental models. We summarize here the recent progress for specifying spatial features through spatial weighting matrices and spatial eigenfunctions in order to define spatially constrained or scale-explicit multivariate analyses. Through a worked example on tropical tree communities, we also show the potential of the overall approach to identify significant residual spatial patterns that could arise from the omission of important unmeasured explanatory variables or processes.
The KEYNOTE-826 randomized clinical trial showed statistically significant and clinically meaningful survival benefits with the addition of pembrolizumab to chemotherapy with or without bevacizumab ...in patients with persistent, recurrent, or metastatic cervical cancer. Treatment effects in patient subgroups of the study population are unknown.
To assess efficacy outcomes in patient subgroups of KEYNOTE-826.
Exploratory subgroup analyses were conducted in a global, phase 3, randomized, double-blind, placebo-controlled clinical trial. Participants included women with persistent, recurrent, or metastatic adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma of the cervix that had not been treated with systemic chemotherapy and was not amenable to curative treatment. This subanalysis was conducted from November 20, 2018, to May 3, 2021.
Pembrolizumab, 200 mg, every 3 weeks or placebo for up to 35 cycles plus chemotherapy (paclitaxel, 175 mg/m2, plus cisplatin, 50 mg/m2, or carboplatin AUC 5 area under the free carboplatin plasma concentration vs time curve) with or without bevacizumab, 15 mg/kg.
Overall survival (OS) and progression-free survival (PFS) by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1 in subgroups defined by use of bevacizumab (yes or no), choice of platinum (carboplatin or cisplatin), prior chemoradiotherapy (CRT) exposure only (yes or no), and histologic type (squamous or nonsquamous) in patients with programmed cell death ligand 1-positive tumors (defined as a combined positive score CPS ≥1) and in the intention-to-treat population.
A total of 617 patients (median age, 51 years; range, 22-82 years) were enrolled in the trial. In the CPS greater than or equal to 1 population, hazard ratios (HRs) for OS favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.62; 95% CI, 0.45-0.87) and without bevacizumab (HR, 0.67; 95% CI, 0.47-0.96), use of carboplatin (HR, 0.65; 95% CI, 0.50-0.85) and cisplatin (HR, 0.53; 95% CI, 0.27-1.04), with prior CRT only (HR, 0.56; 95% CI, 0.39-0.81) and without prior CRT only (HR, 0.72; 95% CI, 0.52-1.00), and squamous (HR, 0.60; 95% CI, 0.46-0.79) and nonsquamous (HR, 0.70; 95% CI, 0.41-1.20) histologic type. In the intention-to-treat population, HRs for OS also favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.63; 95% CI, 0.47-0.87) and without bevacizumab (HR, 0.74; 95% CI, 0.53-1.04), use of carboplatin (HR, 0.69; 95% CI, 0.54-0.89) or cisplatin (HR, 0.59; 95% CI, 0.32-1.09), with prior CRT only (HR, 0.64; 95% CI, 0.45-0.91) and without prior CRT only (HR, 0.71; 95% CI, 0.53-0.97), and squamous (HR, 0.61; 95% CI, 0.47-0.80) and nonsquamous (HR, 0.76; 95% CI, 0.47-1.23) histologic type. Similar to OS, the addition of pembrolizumab prolonged PFS across all subgroups in the CPS greater than or equal to 1 and intention-to-treat populations.
The findings of this trial suggest that adding pembrolizumab to chemotherapy with or without bevacizumab improved OS across subgroups of patients with persistent, recurrent, or metastatic cervical cancer.
ClinicalTrials.gov Identifier: NCT03635567.
Iberian pigs fed on acorns and pasture were slaughtered from January until March of 2018 and 2019. The meat from those Iberian pigs is a seasonal food that only can be found fresh, at the ...marketplace, during a limit period of the year. Selling frozen-thawed meat is a legal practice, but consumers must be informed about it on the product label. However, to declare as fresh meat, meat previously frozen, is one of the most frequent meat frauds. The present study compares the performance of two rather different Near Infrared Spectroscopy instruments, based on Fourier Transform and Linear Variable Filter technologies, for the in-situ detection of fresh and frozen-thawed acorns-fed Iberian pig loins using Partial Least Discriminant Analysis (PLS-DA). The performance of the models developed for both instruments offered a very high discriminant ability. Furthermore, the models showed consistent results and interpretation when were evaluated with several scalars and graphical methods.
•Labelling of frozen-thawed meat as “fresh” is a frequent fraud.•NIRS sensors used for rapid detection of frozen-thawed Iberian pig loins.•Two NIRS sensors of different prices, size and portability produce similar results.•PLS-DA yielded 100% classification accuracy for test set.
El objetivo es conocer cómo aprende chino como lengua extranjera (ChLE) un grupo de preadolescentes en el Instituto Confucio de la Universidad de Las Palmas de Gran Canaria (IC-ULPGC). Con el fin de ...mejorar este proceso investigamos las estrategias de aprendizaje (EAL) para mejorar su conocimiento de ChLE. Se analiza el caso de 81 estudiantes de 12 años, que voluntariamente asistieron entre 2019-2020 al IC-ULPGC. A partir del marco teórico se diseña una investigación en la que nos preguntamos la posible relación entre sus factores personales y académicos (L1, sexo, colegio monolingüe/bilingüe y puntuación en el examen final) y las EAL utilizadas. Estos datos se recopilaron mediante una encuesta, que incluía el Strategy-Inventory-for Language-Learning. El análisis estadístico de los resultados muestra que: los sujetos no presentan una alta frecuencia de uso de las EAL; la estrategia más utilizada es la social, y la menos, la cognitiva, aunque son las afectiva y metacognitiva las que tienen correlación significativa con el éxito académico; no se ha establecido correlación entre las variables personales, L1, sexo o tipo de centro educativo, con los resultados de la prueba; pero sí entre la variedad de educación (monolingüe/bilingüe) y el uso de las EAL. Palabras clave: chino como lengua extranjera; preadolescentes; estrategias de aprendizaje; España The objective is to know how a group of pre-adolescents at the Confucius Institute of the University of Las Palmas de Gran Canaria (IC-ULPGC) learn Chinese as a foreign language (ChLE). In order to improve this process, we investigated the learning strategies (EAL) to improve their knowledge of ChLE. The case of 81 12-year-old students, who voluntarily attended between 2019-2020 at the IC-ULPGC, is analyzed. Based on the theoretical framework, an investigation is designed in which we ask ourselves the possible relationship between their personal and academic factors (L1, gender, monolingual/bilingual school and final exam score) and the EALs used. These data were collected through a survey, which included the Strategy-Inventory-for-Language-Learning. Statistical analysis of the results shows that: the subjects do not present a high frequency of EAL use; the most used strategy is the social one, and the least, the cognitive one, although the affective and metacognitive ones have a significant correlation with academic success; no correlation has been established between personal variables, L1, sex or type of school, with the test results; but there is a correlation between the variety of education (monolingual/bilingual) and the use of EALs. Keywords: Chinese as a foreign language; preadolescent; learning strategies; Spain
Pembrolizumab has efficacy in programmed death ligand 1 (PD-L1)-positive metastatic or unresectable cervical cancer that has progressed during chemotherapy. We assessed the relative benefit of adding ...pembrolizumab to chemotherapy with or without bevacizumab.
In a double-blind, phase 3 trial, we randomly assigned patients with persistent, recurrent, or metastatic cervical cancer in a 1:1 ratio to receive pembrolizumab (200 mg) or placebo every 3 weeks for up to 35 cycles plus platinum-based chemotherapy and, per investigator discretion, bevacizumab. The dual primary end points were progression-free survival and overall survival, each tested sequentially in patients with a PD-L1 combined positive score of 1 or more, in the intention-to-treat population, and in patients with a PD-L1 combined positive score of 10 or more. The combined positive score is defined as the number of PD-L1-staining cells divided by the total number of viable tumor cells, multiplied by 100. All results are from the protocol-specified first interim analysis.
In 548 patients with a PD-L1 combined positive score of 1 or more, median progression-free survival was 10.4 months in the pembrolizumab group and 8.2 months in the placebo group (hazard ratio for disease progression or death, 0.62; 95% confidence interval CI, 0.50 to 0.77; P<0.001). In 617 patients in the intention-to-treat population, progression-free survival was 10.4 months and 8.2 months, respectively (hazard ratio, 0.65; 95% CI, 0.53 to 0.79; P<0.001). In 317 patients with a PD-L1 combined positive score of 10 or more, progression-free survival was 10.4 months and 8.1 months, respectively (hazard ratio, 0.58; 95% CI, 0.44 to 0.77; P<0.001). Overall survival at 24 months was 53.0% in the pembrolizumab group and 41.7% in the placebo group (hazard ratio for death, 0.64; 95% CI, 0.50 to 0.81; P<0.001), 50.4% and 40.4% (hazard ratio, 0.67; 95% CI, 0.54 to 0.84; P<0.001), and 54.4% and 44.6% (hazard ratio, 0.61; 95% CI, 0.44 to 0.84; P = 0.001), respectively. The most common grade 3 to 5 adverse events were anemia (30.3% in the pembrolizumab group and 26.9% in the placebo group) and neutropenia (12.4% and 9.7%, respectively).
Progression-free and overall survival were significantly longer with pembrolizumab than with placebo among patients with persistent, recurrent, or metastatic cervical cancer who were also receiving chemotherapy with or without bevacizumab. (Funded by Merck Sharp and Dohme; KEYNOTE-826 ClinicalTrials.gov number, NCT03635567.).
A partir de las cuatro categorías que regulan la propiedad, el acceso y la apropiación de los bienes naturales (i.e., privada, estatal, libre, y comunal), el presente trabajo busca analizar cómo la ...aprobación de una ley que propone conservar el bosque nativo i) genera procesos de cercamiento de bienes comunes, y ii) impacta de manera diferencial sobre distintos actores sociales. La utilización de técnicas cuantitativas y cualitativas, y la combinación de distintas fuentes de información (i.e., entrevistas a distintos actores sociales, medios masivos de comunicación, documentos gubernamentales) permitió analizar los impactos sociales de la implementación de la Ley de Ordenamiento Territorial para los Bosques Nativos, en la Provincia de Córdoba (Argentina). Los resultados sugieren que la nueva ley prioriza la idea de propiedad privada por sobre las normas consuetudinarias, los arreglos locales y el acceso flexible a los servicios ecosistémicos, propios de la lógica productiva campesina. Los productores capitalizados, con mayor poder económico y político, disponen de mecanismos que les permiten atenuar los efectos restrictivos del nuevo régimen legal y están mejor posicionados para recibir compensaciones monetarias de parte del Estado. Así se generan nuevas condiciones sociales que se traducen en nuevos procesos de exclusión social y en asimetrías económicas entre los productores que operan en un mismo territorio. Son los más vulnerables y con menos poder económico y político (i.e., los campesinos), y los más perjudicados en el nuevo escenario emergente. En un mundo globalizado donde domina la lógica económica de mercado, los ecosistemas nativos están sujetos a una lógica extractivista que prioriza la rentabilidad de corto plazo. Esto genera costos ambientales y sociales elevados. El Estado tiene la responsabilidad de proteger estos ecosistemas a fin de garantizar el bienestar común, pero toda legislación ambiental nueva también debe evaluar sus posibles impactos socioeconómicos.
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