3,208 research outputs found
Serum albumin and risk of cardiovascular events in primary and secondary prevention: a systematic review of observational studies and Bayesian meta-regression analysis
No full textThe predictive role of serum albumin (SA) has been evaluated in primary prevention studies. We want to assess the association of SA with the subsequent risk of cardiovascular events (CVE) in primary and secondary prevention studies. We performed a systematic review and Bayesian meta-regression analysis. Studies were identified by PubMed and EMBASE database using a combination of the following terms and MeSH terms: "serum albumin", "myocardial infarction, "cardiovascular events", "percutaneous coronary intervention" and "coronary restenosis". No time restriction of the research was applied. Two experienced physicians reviewed data on outcome measures and assessed the quality rating. The main outcomes were CVE including myocardial infarction, coronary heart disease, percutaneous coronary intervention and coronary restenosis. 15 studies of SA and CVE were identified involving 65,077 subjects with a mean age of 57.89 +/- 6.05 years and a mean follow-up of 9.4 (+/- 5.56) years. Subjects under SA cut-off of 3.8 g/dL had a combined hazard ratio (HR) for CVE of 2.16 [95% confidence interval (CI) 1.93-2.45]. An increased risk for CVE was also evident using SA as a continuous variable (HR = 1.89, 95% CI 1.5-2.39). Females and males had a similar risk for CVE (HR 2.46, 95% CI 1.92-3.16, and HR 1.46, 95% CI 1.27-1.69, respectively). We found a similar risk of CVE between primary and secondary prevention studies (HR 1.79, 95% CI 1.5-2.17, and HR 2.47, 95% CI 2.24-2.75, respectively). Low SA levels are associated with an increased risk of CVE, not only in subjects free from CVE, but also in patients who already experienced a CVE
Use of direct oral anticoagulants in patients with antiphospholipid syndrome. a systematic review and comparison of the international guidelines
No full textAntiphospholipid antibody syndrome (APS) requires long-term anticoagulation to prevent recurrent thrombosis. Direct oral anticoagulants (DOACs) have been increasingly used in APS patients, but contradictory guidelines recommendations on their use do exist. We performed a systematic review of literature including studies investigating the role of DOACs in APS patients. At this aim, PubMed and Cochrane databases were searched according to PRISMA guidelines. We identified 14 studies which investigated the use of DOACs in patients with APS, of which 3 randomized clinical trials (RCTs), 1 post-hoc analysis of 3 RCTs, 7 case series and 3 cohort studies (2 prospective and 1 retrospective). Among DOACs, rivaroxaban was the most used (n = 531), followed by dabigatran (n = 90) and apixaban (n = 46). Regarding guidelines indications, the 2019 European Society of Cardiology (ESC) and American Society of Hematology (ASH) guidelines recommend against the use of DOACs in all APS patients. The European League Against Rheumatism (EULAR), British Society for Haematology (BSH), and International Society on Thrombosis and Haemostasis (ISTH) guidance provided more detailed indications stating that warfarin should be the first-choice treatment but DOACs may be considered in patients (1) already on a stable anticoagulation with a DOAC, (2) with low-quality anticoagulation by warfarin, (3) unwilling/unable to undergo INR monitoring, (4) with contraindications or serious adverse events under warfarin. Patients with arterial APS or triple positivity should be treated with warfarin while venous APS with single or double positivity may be candidate to DOACs, but high-quality studies are needed
serum cytokine levels in children affected with chronic ITP treated with short course high dose methylprednisolone
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Defect characterization in silicon particle detectors irradiated with Li ions
No full textHigh Energy Physics experiments at future very high luminosity colliders will require ultra radiation-hard silicon detectors that can withstand fast hadron fluences up to 10^(16) cm^(-2). In order to test the detectors radiation hardness in this fluence range, long irradiation times are required at the currently available proton irradiation facilities. Energetic (58 MeV) Lithium (Li) ions, with experimental hardness factor about two orders of magnitude higher than 24 GeV protons for 280-300 μm thick detectors, could represent a promising alternative radiation source. In this study, the degradation mechanisms in single pad p+-n Standard Float Zone (STFZ) and Diffusion Oxygenated Float Zone (DOFZ) Si detectors irradiated with Li ions up to the fluence of 2.9×10^(12) Li/cm^(2) have been investigated by means of Photo Induced Current Transient Spectroscopy and Thermally Stimulated Currents. Results are compared with the radiation damage induced by 24 GeV proton, 1 MeV neutron and 60Co γ-ray irradiation. The critical Li ion fluence for cluster formation is found to be in the range 4.1-21×10^(11) Li/cm^(2) and its correlation to the corresponding value for hadrons is discussed
Seronegative antiphospholipid syndrome: Refining the value of “non-criteria” antibodies for diagnosis and clinical management
No full textAntiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by arterial and venous thrombotic manifestations and/or pregnancy-related complications in patients with persistently high antiphospholipid antibodies (aPL), the most common being represented by anticardiolipin antibodies (aCL), anti-beta 2 glycoprotein-I (aß2GPI), and lupus anticoagulant (LAC). A growing number of studies have showed that, in some cases, patients may present with clinical features of APS but with temporary positive or persistently negative titers of aPL. For these patients, the definition of seronegative APS (SN-APS) has been proposed. Nevertheless, the negativity to classic aPL criteria does not imply that other antibodies may be present or involved in the onset of thrombosis. The diagnosis of SN-APS is usually made by exclusion, but its recognition is important to adopt the most appropriate anti-thrombotic strategy to reduce the rate of recurrences. This research is in continuous development as the clinical relevance of these antibodies is far from being completely clarified. The most studied antibodies are those against phosphatidylethanolamine, phosphatidic acid, phosphatidylserine, phosphatidylinositol, vimentin/cardiolipin complex, and annexin A5. Moreover, the assays to measure the levels of these antibodies have not yet been standardized. In this review, we will summarize the evidence on the most studied non-criteria aPL, their potential clinical relevance, and the antithrombotic therapeutic strategies available in the setting of APS and SN-APS
Management of Antithrombotic Therapy in Left Ventricular Thrombus: A Position Paper of the Italian Society of Hemostasis and Thrombosis (SISET)
No full textLeft ventricular thrombus (LVT) represents a potential life-threatening condition burdened by a significant risk of systemic embolism. Despite the relevance of the disease, there are scanty data on antithrombotic management of LVT mostly deriving from small observational studies and few randomized controlled trials. It has been reported that anticoagulant therapy reduces the rate of thrombus formation, allows thrombus resolution in most cases, and limits the risk of embolic complications. Several issues, however, still remain unresolved and clinicians caring for these patients have to decide on the need and on the regimen of antithrombotic therapy based on their expertise and data from different clinical scenario. This position paper of the Italian Society of Hemostasis and Thrombosis (SISET) aims to provide practical advice and guidance in the form of text, tables, and figures for clinicians dealing with LVT. Relevant clinical questions related to LVT have been identified concerning the identification of patients at risk; the role of anticoagulant prophylaxis on LVT development; the type, dose, and duration of anticoagulant therapy; and the management of patients receiving concomitant antiplatelet therapy. A systematic search has been performed to identify available evidence on the topic that has been carefully and critically reviewed by the national expert authors to support the suggestions and recommendations
Integrated care management of patients with atrial fibrillation and risk of cardiovascular events. the abc (atrial fibrillation better care) pathway in the ATHERO-AF study cohort
No full textObjective: To investigate the impact on cardiovascular events (CVEs) in a real-world population of patients with atrial fibrillation (AF) by implementing the Atrial fibrillation Better Care (ABC: A, Avoid stroke with anticoagulation; B, better symptom management; C, Cardiovascular and comorbidity risk management) pathway. Patients and Methods: This prospective single-center cohort study included 907 consecutive patients with nonvalvular AF on vitamin K antagonists from February 2008 to December 2016. The A, B, and C groups were defined as follows: “A” by a Time in Therapeutic Range ≥65%; “B” by a European Heart Rhythm Association (EHRA) symptom scale I-II, and “C” as optimized cardiovascular comorbidity management. Primary end point was a composite outcome of CVEs. Results: During a median follow-up of 36.9 months (interquartile range [IQR] 20.0-57.5; 3022 patient-years), 118 CVEs occurred (3.9% per year; 95% confidence interval [CI], 3.2-4.7). Symptomatic patients (EHRA III-IV) had a higher risk of CVEs compared with those in EHRA I (hazard ratio [HR], 2.73, 95% CI, 1.61-4.63, P<.001). Optimally managed patients in the ABC group (n=198) had a lower risk of CVEs (1.8 [95% CI, 0.9-3.0] vs 4.5% [95% CI, 3.7-5.5] per year, P=.001) compared with those presenting with at least 1 suboptimal ABC factor (HR, 0.40, 95% CI, 0.22-0.74, P=.003). This association was evident using multivariate Cox proportional regression analysis (HR, 0.44, 95% CI, 0.24-0.80, P=.007). Conclusion: Integrated care management according to the ABC pathway resulted in a significantly lower rate of CVEs, suggesting a clear benefit of a holistic approach to optimize the management of patients with AF. Trial Registration: clinicaltrials.gov Identifier: NCT0188211
A new algorithm for convergence verification in circuit level simulations
No full textIn this paper we present a new algorithm, based on Kirchhoff's Current Law (KCL) verification, for assessing convergence in circuit-level simulation and its implementation in the NGSPICE open source circuit simulator. We start from the analysis of false convergence problems appeared in the analysis of test circuits that we found to be related to the convergence checks that NGSPICE simulator inherits from SPICE3F5. These checks are inaccurate in some cases, so we propose to replace them with a new, efficient, algorithm based on KCL verification. The methodology to verify KCL of the circuit is detailed in this paper, along with the extraction flow, required to compute every KCL contribution. We finally present a case study of a circuit showing non converging solution, while the same circuit can be solved using the proposed algorithm
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