435 research outputs found
A study of the image of children who "make efforts" as assessed by their teachers : Its relation to children's feelings about effort, achievement motivation, and academic achievement
No full text
P2Y12 inhibitor or aspirin after percutaneous coronary intervention: individual patient data meta-analysis of randomised clinical trials
No full textObjective: To assess the long term comparative effectiveness of P2Y12 inhibitor monotherapy compared with aspirin monotherapy in patients after percutaneous coronary intervention (PCI) and discontinuation of dual antiplatelet therapy (DAPT).
Design: Individual participant data (IPD) meta-analysis of randomised clinical trials.
Data sources: PubMed/Medline, Scopus, Web of Science, and Ovid/Embase.
Eligibility criteria for selecting studies: Randomised trials investigating monotherapy with a P2Y12 inhibitor or aspirin for secondary prevention of ischaemic events in patients with coronary artery disease who underwent PCI.
Data extraction and synthesis: Anonymised IPD were extracted and transferred to the coordinating centre by dedicated electronic spreadsheets. Data were primarily combined by mixed effects models (one stage analysis) and complemented with multivariable mixed effects models and two stage analyses based on random effects models. The primary and co-primary outcomes were a composite of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding, respectively. The secondary outcomes included a net composite of adverse cardiac and cerebrovascular events (NACCE), derived from the combination of the primary and co-primary outcomes, and individual ischaemic and bleeding events.
Results: A total of 16 117 patients assigned to P2Y12 inhibitor or aspirin monotherapy after PCI and completion of the recommended DAPT regimen (median duration of 12 months) in five randomised trials were included. At a median follow-up of 1351 days (interquartile range 373-1791 days), P2Y12 inhibitor monotherapy was associated with a lower risk of MACCE compared with aspirin monotherapy (one stage analysis: hazard ratio 0.77 (95% confidence interval (CI) 0.67 to 0.89), P<0.001; multivariable one stage analysis: adjusted hazard ratio 0.77 (0.67 to 0.89), P<0.001; two stage analysis: hazard ratio 0.77 (0.67 to 0.89), P<0.001), yielding a number needed to treat to benefit of 45.5 (95% CI 31.4 to 93.6). No significant difference in major bleeding (one stage analysis: hazard ratio 1.26 (0.78 to 2.04), P=0.35; multivariable one stage analysis: 1.12 (0.74 to 1.70), P=0.60; two stage analysis: 1.15 (0.69 to 1.92), P=0.59) was observed. NACCE, myocardial infarction, and stroke were lower in patients assigned to a P2Y12 inhibitor compared with those assigned to aspirin. These findings were confirmed across multiple sensitivity and subgroup analyses.
Conclusions: In patients who had undergone PCI and discontinued DAPT, at a follow-up of about 5.5 years, P2Y12 inhibitor monotherapy with ticagrelor or clopidogrel was associated with lower MACCE, owing to reduced rates of myocardial infarction and stroke compared with aspirin monotherapy, without a concurrent increased risk of major bleeding.
Review registration: PROSPERO CRD42024517983
抗血小板療法の中止と冠動脈ステント留置後の重篤な心血管イベント、CREDO-Kyotoレジストリコホート２からの解析
No full text京都大学0048新制・論文博士博士(医学)乙第12999号論医博第2107号新制||医||1016(附属図書館)32927(主査)教授 川上 浩司, 教授 古川 壽亮, 教授 小池 薫学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDFA
P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials.
No full textOBJECTIVE
To assess the risks and benefits of P2Y12 inhibitor monotherapy compared with dual antiplatelet therapy (DAPT) and whether these associations are modified by patients' characteristics.
DESIGN
Individual patient level meta-analysis of randomised controlled trials.
DATA SOURCES
Searches were conducted in Ovid Medline, Embase, and three websites (www.tctmd.com, www.escardio.org, www.acc.org/cardiosourceplus) from inception to 16 July 2020. The primary authors provided individual participant data.
ELIGIBILITY CRITERIA
Randomised controlled trials comparing effects of oral P2Y12 monotherapy and DAPT on centrally adjudicated endpoints after coronary revascularisation in patients without an indication for oral anticoagulation.
MAIN OUTCOME MEASURES
The primary outcome was a composite of all cause death, myocardial infarction, and stroke, tested for non-inferiority against a margin of 1.15 for the hazard ratio. The key safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or type 5 bleeding.
RESULTS
The meta-analysis included data from six trials, including 24 096 patients. The primary outcome occurred in 283 (2.95%) patients with P2Y12 inhibitor monotherapy and 315 (3.27%) with DAPT in the per protocol population (hazard ratio 0.93, 95% confidence interval 0.79 to 1.09; P=0.005 for non-inferiority; P=0.38 for superiority; τ2=0.00) and in 303 (2.94%) with P2Y12 inhibitor monotherapy and 338 (3.36%) with DAPT in the intention to treat population (0.90, 0.77 to 1.05; P=0.18 for superiority; τ2=0.00). The treatment effect was consistent across all subgroups, except for sex (P for interaction=0.02), suggesting that P2Y12 inhibitor monotherapy lowers the risk of the primary ischaemic endpoint in women (hazard ratio 0.64, 0.46 to 0.89) but not in men (1.00, 0.83 to 1.19). The risk of bleeding was lower with P2Y12 inhibitor monotherapy than with DAPT (97 (0.89%) v 197 (1.83%); hazard ratio 0.49, 0.39 to 0.63; P<0.001; τ2=0.03), which was consistent across subgroups, except for type of P2Y12 inhibitor (P for interaction=0.02), suggesting greater benefit when a newer P2Y12 inhibitor rather than clopidogrel was part of the DAPT regimen.
CONCLUSIONS
P2Y12 inhibitor monotherapy was associated with a similar risk of death, myocardial infarction, or stroke, with evidence that this association may be modified by sex, and a lower bleeding risk compared with DAPT.
REGISTRATION
PROSPERO CRD42020176853
Clinical analysis of 62 patients with blunt renal trauma
No full textSixty two patients with blunt renal trauma were treated and followed in our clinic between 1976 and 1993. Immediate operation was performed in one with major laceration, 3 with ruptures and one with pedicle injury, that is, nephrectomy in 4 and partial nephrectomy in one. Expectant management with the purpose of preserving the injured kidney was performed in 33 contusions, 20 minor lacerations and 5 major lacerations, resulting in no complications. We confirm that expectant management of blunt renal trauma may be reliable if the condition of the patient is stable even in the case of rupture, and the treatment of associated injury is preferential
Calcium/Calmodulin-mediated Action of Calcitonin on Lipid Metabolism in Rats
No full textThe effects of calcitonin on lipid metabolism were investigated in three kinds of rats, one strain of rabbits, and a primary culture of rat hepatocytes. In a short-term experiment, calcitonin decreased serum cholesterol and triglycerides after injection in rats on either an ordinary or high-fat diet. In a longterm experiment, calcitonin decreased the serum cholesterol and triglycerides in uremic rats, hypothalamic obese rats, and Watanabe-heritable hyperlipidemic rabbits. In cultured hepatocytes, calcitonin reduced the incorporation of [14Cjacetate into cholesterol and triglycerides in a dose-dependent way. Treatment with W7, a calmodulin inhibitor, overcame the decrease caused by calcitonin in serum lipids in rats and in the synthesis of triglycerides from acetate or palmitate in the hepatocytes, but did not alter the intracellular cAMP level or incorporation of [2PIPi into PI in the cells. The results suggest that calcitonin lowers serum lipid levels and lipogenesis in hepatocytes in a calcium/calmodulin-dependent way
Radiation-degradation Analysis and a Circuit Performance Improvement Method for Optoelectronic Field Programmable Gate Array
No full textOptimization of Dam Operation Rule to Improve Water Environment in Monobe River
No full textIn the basin of Monobe river, one of the major rivers in Kochi prefecture in Japan, environmental conditions are being worsened. In those environmental problems, draught water flow is especially a fundamental issue because it often decouples and decreases habitat of water creatures. Draught water flow is caused by water right and dam operation rule with emphasis on hydraulic power generation and flood control. In our study, the authors focused on dam operation. Purpose of this study is to quantify tradeoff relationship between hydraulic power generation and protection of river environment. The authors simulated dam operation to evaluate hydraulic power impact for power generation and river environment by changing dam operation rule.conference pape
Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials.
No full textAIMS
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients.
METHODS AND RESULTS
A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (≥6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61-0.94; I2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64-0.99, I2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation.
CONCLUSION
In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a ≥6-month DAPT regimen.
STUDY REGISTRATION
PROSPERO registration number CRD42021284004
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