The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores.We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2.The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007.
Abstract Laser Balloon Angioplasty (LBA) is a technique that may improve the results of balloon angioplasty by thermally sealing arterial dissections and reducing elastic recoil. To define the relationship between laser‐exposure duration and the strength of thermal welds made between separated layers of arterial wall, 360 1‐cm discs of human postmortem aorta were lased for six different exposure intervals at three different temperature ranges, comparing shear strength of thermal welds in the different groups. Twenty discs were lased to achieve plateau adventitial temperatures of 95°C–104°C (group A), 105°C–114°C (group B), or 115°C–124°C (group C) at each of the exposure periods (5, 10, 15, 20, 25, and 30 sec). A 400‐μm fiberoptic coupled to a 1.06 μm continuous wave neodymium:YAG laser was placed perpendicularly 8 mm above the luminal surface of each disc, which had been split midway between the intimal and adventitial surface and reapposed. Mean laser energy ranged 78–378 J delivered in a decremental stepwise fashion to achieve quickly and maintain the target plateau tissue temperature. Mean weld strength increased in relation to both achieved tissue temperature and laser‐exposure duration, with at least 10 sec necessary, at temperatures greater than 95°C, for reliable thermal welding. Laser exposure for greater than 20 sec provided no statistical increment in weld strength. In the anticipated clinical performance of LBA, these data suggest that when thermal fusion of disrupted arterial tissues is desired, a laser‐exposure duration of 10–20 sec is optimal.
Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.
In this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected.
Clinical microbiology laboratory experiences wherein aminoglycoside serum assay results appeared inconsistent with the amount of the compound given when administered in combination with a semisynthetic penicillin led us to compare the interaction of three currently available aminoglycoside antibiotics with carbenicillin, as a representative semisynthetic penicillin given in large doses, and with piperacillin, a new broad-spectrum semisynthetic penicillin. Amikacin, gentamicin, and tobramycin were incubated in serum in vitro with various concentrations of carbenicillin and piperacillin. In the presence of very high concentrations of the two penicillins, tobramycin was the most rapidly inactivated aminoglycoside, gentamicin was next, and amikacin was only slightly inactivated. With low concentrations of the two penicillins, the rates of aminoglycoside inactivation were negligible. Carbenicillin, in high concentration, inactivated the aminoglycosides more rapidly than piperacillin. In patients experiencing renal failure, the maintenance of moderate serum levels of carbenicillin and piperacillin may be important in attempting to maintain adequate aminoglycoside serum levels.
Urine microscopy for bacteriuria remains a useful and valid technique for the evaluation of urinary tract infection; however, established interpretive criteria are not agreed on. Our own data and a review of the literature demonstrate that reliable data can be obtained by enumerating the organisms observed in stained or unstained centrifuged and stained uncentrifuged urine specimens. Criteria are given for the interpretation of urine microscopy for maximum sensitivity and specificity for each method reviewed. For clinicians desiring to perform urine microscopy, we recommend the use of oil-immersion microscopy of Gram-stained centrifuged urine sediment and suggest that observing at least one organism per oil-immersion field corresponds with 95% sensitivity and that observing more than five organisms corresponds with 95% specificity for bacteriuria at a level of 10(5) or more colony-forming units per milliliter. Further testing will be required on any negative specimen from a symptomatic patient.
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