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BACKGROUND: The gut microbiota plays a critical role in regulating brain function through the microbiome-gut-brain axis (MGBA). Dysbiosis of the gut microbiota is associated with neurological impairment in Traumatic brain injury (TBI) patients. Our previous study found that TBI results in a decrease in the abundance of Prevotella copri (P. copri). P. copri has been shown to have antioxidant effects in various diseases. Meanwhile, guanosine (GUO) is a metabolite of intestinal microbiota that can alleviate oxidative stress after TBI by activating the PI3K/Akt pathway. In this study, we investigated the effect of P. copri transplantation on TBI and its relationship with GUO-PI3K/Akt pathway. METHODS: In this study, a controlled cortical impact (CCI) model was used to induce TBI in adult male C57BL/6J mice. Subsequently, P. copri was transplanted by intragastric gavage for 7 consecutive days. To investigate the effect of the GUO-PI3K/Akt pathway in P. copri transplantation therapy, guanosine (GUO) was administered 2 h after TBI for 7 consecutive days, and PI3K inhibitor (LY294002) was administered 30 min before TBI. Various techniques were used to assess the effects of these interventions, including quantitative PCR, neurological behavior tests, metabolite analysis, ELISA, Western blot analysis, immunofluorescence, Evans blue assays, transmission electron microscopy, FITC-dextran permeability assay, gastrointestinal transit assessment, and 16 S rDNA sequencing. RESULTS: P. copri abundance was significantly reduced after TBI. P. copri transplantation alleviated motor and cognitive deficits tested by the NSS, Morris's water maze and open field test. P. copri transplantation attenuated oxidative stress and blood-brain barrier damage and reduced neuronal apoptosis after TBI. In addition, P. copri transplantation resulted in the reshaping of the intestinal flora, improved gastrointestinal motility and intestinal permeability. Metabolomics and ELISA analysis revealed a significant increase in GUO levels in feces, serum and injured brain after P. copri transplantation. Furthermore, the expression of p-PI3K and p-Akt was found to be increased after P. copri transplantation and GUO treatment. Notably, PI3K inhibitor LY294002 treatment attenuated the observed improvements. CONCLUSIONS: We demonstrate for the first time that P. copri transplantation can improve GI functions and alter gut microbiota dysbiosis after TBI. Additionally, P. copri transplantation can ameliorate neurological deficits, possibly via the GUO-PI3K/Akt signaling pathway after TBI.
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Lesões Encefálicas Traumáticas , Modelos Animais de Doenças , Camundongos Endogâmicos C57BL , Animais , Camundongos , Masculino , Reabilitação Neurológica/métodos , Prevotella , Microbioma Gastrointestinal/fisiologia , Fosfatidilinositol 3-Quinases/metabolismoRESUMO
BACKGROUND AND PURPOSE: Flow-diversion treatment for intracranial aneurysms has been associated with the development of in-stent stenosis (ISS) for unclear reasons. We assess whether the size of the stent relative to that of the vessel (the stent-to-vessel diameter ratio, or SVR) may be predictive of the development of ISS after treatment with flow diverters. METHODS: We retrospectively reviewed patients with unruptured intracranial aneurysms who underwent flow-diversion treatment using either the Pipeline or Tubridge embolization device from September 2018 to September 2022. The relationship between SVR and ISS was analyzed. Multiple logistic regression models were used to determine the significant predictors. RESULTS: A total of 458 patients with 481 aneurysms were included. In a mean angiographic follow-up of 10.73 ± 3.97 months, ISS was detected in 68 cases (14.1 %). After adjusting for candidate variables, a higher distal SVR (DSVR) was associated with an increased risk of ISS (adjusted odds ratio [aOR] = 3.420, 95 % confidence interval [CI] = 1.182 - 9.889, p = 0.023). We conducted a subgroup analysis of the two different flow diverters to assess the effects of their individual characteristics. Our results showed a significant association between the DSVR and the incidence of ISS in both the Pipeline (aOR = 4.033, 95 % CI = 1.156-14.072, p = 0.029) and Tubridge groups (aOR = 11.981, 95 % CI=1.005-142.774, p = 0.049). CONCLUSION: A higher DSVR was associated with an increased risk of ISS. This may help neurointerventionalists select an appropriate stent size when conducting flow-diversion treatment for intracranial aneurysms.
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Procedimentos Endovasculares , Aneurisma Intracraniano , Desenho de Prótese , Stents , Humanos , Aneurisma Intracraniano/terapia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Resultado do Tratamento , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Medição de Risco , Fatores de Tempo , Embolização Terapêutica/instrumentação , Embolização Terapêutica/efeitos adversos , Adulto , Angiografia Cerebral , Circulação Cerebrovascular , Grau de Desobstrução VascularRESUMO
This study investigated whether adding Herba Houttuyniae to feed can improve intestinal function and prevent diseases for koi carp (Cyprinus carpio) infected with Aeromonas veronii. There was a total of 168 koi carp with an average body length of (9.43 ± 0.99) cm and an average body weight of (26.00 ± 11.40) g. The K group was the control group fed with basal feed, while the C group was fed with feed with a H. houttuyniae content of six per thousand. After 14 days of feeding, the fish were fasted for a day and then intraperitoneally injected with A. veronii for artificial infection, injection dose is 0.2 mL, and the concentration is 1 × 107 CFU/mL. Samples were collected from the two groups on days 0, 1, 2, and 4. The fold height, intestinal villus width, and muscle layer thickness in the gut of the koi carp were measured. In addition, on day 4, the activities of trypsin, α-amylase, and lipase in the gut were determined, and the intestinal flora of the carp in both groups was tested. The results showed that on the second and fourth days of sampling, the fold height and muscle layer thickness in the C group were significantly higher than those in the K group (P < 0.05). The villus width in the C group was slightly higher than that in the K group, but the difference was not significant (P > 0.05). Microscopic observation revealed that the intestinal structure of the carp in the C4 (day 4 in C group) group was more intact than that in the K4 (day 4 in K group) group. Moreover, the activities of trypsin, α-amylase, and lipase in the foregut and midgut in the C4 group were higher than those in the K4 group (P < 0.05). The activities of trypsin and α-amylase in the hindgut in the C4 group were higher than those in the K4 group (P < 0.05). Furthermore, beneficial bacteria, especially those in the genus Cetobacterium, were more abundant in the intestinal tract of the carp in the C4 group compared to the K group. In addition, comparisons and tests of IL-4 and IL-10 in the intestines of the fish in both groups demonstrated that the H. houttuyniae added to feed enhanced the immune function of the fish intestines after bacterial attack. In conclusion, for koi carp infected with A.veronii, adding H. houttuyniae to their feed not only improves the activity of digestive enzymes and the morphological structure of the intestine but also optimizes the beneficial intestinal microbiota, thereby protecting the intestinal tract.
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Aeromonas veronii , Ração Animal , Carpas , Doenças dos Peixes , Microbioma Gastrointestinal , Infecções por Bactérias Gram-Negativas , Intestinos , Animais , Carpas/microbiologia , Doenças dos Peixes/microbiologia , Doenças dos Peixes/imunologia , Infecções por Bactérias Gram-Negativas/veterinária , Infecções por Bactérias Gram-Negativas/microbiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Intestinos/microbiologia , Ração Animal/análise , Houttuynia , Lipase/metabolismo , Dieta/veterinária , alfa-Amilases/metabolismoRESUMO
A foldable battery with high flexibility provides great potential in various wearable electronic devices for health and fitness tracking, chronic disease management, performance monitoring, navigation tracking, and portable gears for soldiers. We report a highly flexible, self-healing Zn-ion battery with a free-standing cathode that is composed of a 3D gear-like NH4 V4 O10 @C composite on carbon paper. The battery retained a capacity of up to 102.4â mAh g-1 even after being folded 60 times with a high angle of 180°. An aqueous hydrogel consisting polyvinyl alcohol, glycerin and Zn(CF3 SO3 )2 was used as electrolyte, which showed as high as 580 % tensile strain under a loading weight of 78â N. The battery exhibited a better capacity retention of over 100â mAh g-1 and Coulombic efficiency of over 99.8 % after cutting and twisting to 90°, thereby indicating a great self-healing performance. The gear-like geometry greatly improved the volume accommodation due to the increased interval space between the blades and the outward configuration. Meanwhile the Zn2+ ionic conductivity was improved by rapid re-binding of many existing hydroxy groups from the electrolyte and the enhanced contact surface area and diffusion route from the cathode material. The highly flexible, safe aqueous Zn-ion battery opens a practical way to power various carry-on electronics under mechanical agitation.
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[Purpose] To measure the reliability of and quantify the force on the spinous process during lumbar neuromuscular joint facilitation using mechanical measuring gloves. [Participants and Methods] We recruited 12 healthy participants. The operator wore a mechanical measuring glove and performed evaluations in the four modes of neuromuscular joint facilitation of the lumbar spine. The mechanical glove was used to measure the force applied by the fingers on the spinous process during the intervention. [Results] The reliability of measuring the supraspinous force during lumbar neuromuscular joint facilitation with mechanical gloves was found to be good; the force was 30.9 ± 6.6 N for front lifting, 37.1 ± 9.1 N for rear descent, 36.8 ± 9.0 N for forward descent, and 24.6 ± 4.7 N for rear lifting. Overall, the average force was 32.3 ± 9.0 N. No statistical difference was observed between passive and resistance motion. [Conclusion] This study confirmed that the measurement of the force on the spinous process in lumbar neuromuscular joint facilitation using mechanical measurement gloves has good reliability. Furthermore, we determined the average force exerted on the spinous process during lumbar neuromuscular joint facilitation and quantified the operation specifications of this manipulation were.
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Doppler asymmetric spatial heterodyne (DASH) interferometry is a novel concept for observing atmospheric winds. This paper discusses a numerical model for the simulation of fringe patterns and a methodology to correct fringe images for extracting Doppler information from ground-based DASH measurements. Based on the propagation of optical waves, the fringe pattern was modeled considering different angular deviations and optical aberrations. A dislocation between two gratings can introduce an additional spatial modulation associated with the diffraction order, which was seen in laboratory measurements. A phase correction is proposed to remove phase differences between different row interferograms, which is the premise for calculating the average interferogram to improve the signal-to-noise ratio. Laboratory tests, simulation results, and Doppler velocity measurements indicate that a matrix determined in the laboratory can be applied to correct interferograms obtained from ground-based DASH measurements.
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BACKGROUND: Contradictory and limited data are available about the presentation and outcomes of patients with RET-fusion positive metastatic NSCLC as compared to patients without RET fusions. This observational study utilizing a linked electronic health records (EHR) database to genomics testing results was designed to compare characteristics, tumor response, progression-free (PFS) and overall survival (OS) outcomes by RET fusion status among patients with metastatic NSCLC treated with standard therapies. METHODS: Adult patients with metastatic NSCLC with linked EHR and genomics data were eligible who received systemic anti-cancer therapy on or after January 1, 2011. Adjusted, using all available baseline covariates, and unadjusted analyses were conducted to compare tumor response, PFS and OS between patients with RET-fusion positive and RET-fusion negative disease as detected by next-generation sequencing. Tumor response outcomes were analysed using Fisher's exact test, and time-to-event analyses were conducted using Cox proportional hazards model. RESULTS: There were 5807 eligible patients identified (RET+ cohort, N = 46; RET- cohort, N = 5761). Patients with RET fusions were younger, more likely to have non-squamous disease and be non-smokers and had better performance status (all p < 0.01). In unadjusted analyses, there were no significant differences in tumor response (p = 0.17) or PFS (p = 0.06) but OS was significantly different by RET status (hazard ratio, HR = 1.91, 95% CI:1.22-3.0, p = 0.005). There were no statistically significant differences by RET fusion status in adjusted analyses of either PFS or OS (PFS HR = 1.24, 95% CI:0.86-1.78, p = 0.25; OS HR = 1.52, 95% CI: 0.95-2.43, p = 0.08). CONCLUSIONS: Patients with RET fusions have different baseline characteristics that contribute to favorable OS in unadjusted analysis. However, after adjusting for baseline covariates, there were no significant differences in either OS or PFS by RET status among patients treated with standard therapy prior to the availability of selective RET inhibitors.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Mutação , Proteínas de Fusão Oncogênica/genética , Proteínas Proto-Oncogênicas c-ret/genética , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Estados UnidosRESUMO
Metal-organic-frameworks-derived nanostructures have received broad attention for secondary batteries. However, many strategies focus on the preparation of dispersive materials, which need complicated steps and some additives for making electrodes of batteries. Here, we develop a novel free-standing Co9S8polyhedron array derived from ZIF-67, which grows on a three-dimensional carbon cloth for lithium-sulfur (Li-S) battery. The polar Co9S8provides strong chemical binding to immobilize polysulfides, which enables efficiently suppressing of the shuttle effect. The free-standing S@Co9S8polyhedron array-based cathode exhibits ultrahigh capacity of 1079 mAh g-1after cycling 100 times at 0.1 C, and long cycling life of 500 cycles at 1 C, recoverable rate-performance and good temperature tolerance. Furthermore, the adsorption energies towards polysulfides are investigated by using density functional theory calculations, which display a strong binding with polysulfides.
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Rice black-streaked dwarf disease caused by Rice black-streaked dwarf virus (RBSDV) is one of the most destructive viral diseases of rice. Thus, it is imperative that resistant rice germplasms are screened for novel RBSDV-resistant genes. RBSDV resistance of a diverse global collection comprising 1,953 rice accessions was evaluated under natural conditions across 3 years. The average disease incidences of the Xian/indica (XI) subgroup were significantly lower than those of the Geng/japonica (GJ) subgroup. Interestingly, most XI-1A accessions in the Xian subgroup were significantly more susceptible than XI-1B accessions, even though XI-1A and XI-1B have a close phylogenetic relationship. Four Xian accessions stably and highly resistant to RBSDV were consistently identified in 2 years. Ten genomic regions (GRs) with 147 single nucleotide polymorphisms associated with RBSDV resistance were detected by a single-locus genome-wide association study (GWAS), of which five were repeatedly identified in a multilocus GWAS. Two previously reported GRs, grRBSDV-6.1 and grRBSDV-6.3, which were repeatedly detected as stably and highly associated with RBSDV resistance, contained 17 and seven genes, respectively, with significant differences of resistance among haplotypes. Haplotype analyses of the candidate genes LOC_Os06g03150 in grRBSDV-6.1 and LOC_Os06g31190 in grRBSDV-6.3 suggested that the former gene is mainly associated with the differentiation of resistance within the Xian subgroup and the latter gene mainly explains the difference in the resistance between Xian and Geng. Another three novel resistance GRs (grRBSDV-1.1, grRBSDV-7.1, and grRBSDV-9.1) were identified. Our findings may enhance the application of disease-resistant rice germplasms for breeding RBSDV-resistant varieties.
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Oryza , Reoviridae , Estudo de Associação Genômica Ampla , Oryza/genética , Filogenia , Melhoramento Vegetal , Doenças das Plantas/genética , Reoviridae/genéticaRESUMO
We report on a thermally stable monolithic Doppler asymmetric spatial heterodyne (DASH) interferometer with field-widening prisms for thermospheric wind measurements by observing the Doppler shift of the airglow emission. Analytical deduction and numerical simulation are applied to determine the central optical path difference, the thermal compensation condition and the field-widening design. A monolithic interferometer with optimized configuration was built and tested in the laboratory. Laboratory tests show that the best visibility of 0.94 was realized with the 9 ° field-of-view illumination, while the thermal responses of the spatial frequency and the optical phase offset are 0.0154 cm-1/°C and 0.469 rad/°C, respectively.
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OBJECTIVE: To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals. DESIGN AND SETTING: A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals. PATIENTS AND INTERVENTION: In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days. MAIN OUTCOME MEASURES: The incidence of PIs, Braden Scale scores, and the time to development of PIs. MAIN RESULTS: Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5). CONCLUSIONS: The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.
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Leitos/estatística & dados numéricos , Cuidados Críticos/métodos , Movimentação e Reposicionamento de Pacientes/estatística & dados numéricos , Úlcera por Pressão/prevenção & controle , Prevenção Primária/métodos , Adulto , Idoso , China , Desenho de Equipamento , Feminino , Hospitais Comunitários , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Movimentação e Reposicionamento de Pacientes/métodos , Assistência ao Paciente/métodos , Pressão , Prognóstico , Medição de Risco , Fatores de TempoRESUMO
This retrospective observational study was designed to evaluate overall survival in a real-world patient population and to identify predictive factors associated with receipt of second-line therapy. A retrospective analysis of electronic medical records (Flatiron Health, New York) was conducted among patients initiating first-line therapy from January 1, 2013, through April 30, 2018. Eligible patients were diagnosed with advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma and ≥18 years of age at the time of treatment initiation. Patients alive 45 days after discontinuation of first-line therapy were considered potentially eligible for continued therapy and were categorized into those who received and those who did not receive second-line therapy. Survival analyses were conducted using Kaplan-Meier method and log-rank test without adjusting for any baseline covariates. Factors associated with further treatment were evaluated using logistic regression. A total of 3850 patients met eligibility criteria. Among the 2516 patients available to receive second-line therapy, 1515 (60.2%) received second-line therapy and 1001 (39.8%) did not receive further therapy. Among those potentially eligible to receive second-line therapy, median survival was 15.4 months (95% confidence interval [CI]: 14.6-16.0) from initiation of first-line therapy for those who received second-line therapy and 10.0 months (95% CI: 9.3-10.7) for those who did not. Longer duration of first-line therapy (≥169 vs ≤84 days), HER2-positive tumors, initially diagnosed with stage IV disease, less weight loss during first-line therapy, and younger age were associated with receipt of second-line therapy (all P < .001). Longer survival was associated with multiple lines of therapy; however, these results should be interpreted with caution, and no causal relationship can be inferred.
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Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/mortalidade , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/mortalidade , Idoso , Junção Esofagogástrica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Patients with metastatic gastric cancer have a poor prognosis (5-year survival of less than 10%). This study was designed to describe the treatment patterns of patients with gastric cancer and to understand the factors associated with treatment choices to inform evidence-based care. METHODS: A retrospective observational study was conducted using two real-world databases to describe treatment trends and to quantify variability in treatment patterns of patients diagnosed with advanced/metastatic gastric cancer between 1/1/2007 and 9/30/2014 in the U.S. Heterogeneity was measured by the Herfindahl-Hirschman Index (HHI). Predictors (baseline clinical, treatment, and demographic variables) of treatment regimen choice were evaluated using logistic regression. RESULTS: A total of 5772 patients with advanced/metastatic gastric cancer were included in this study [5044 from claims data and 728 from electronic medical records (EMR)]. Of the 5044 from claims data, 2457 had evidence of metastatic disease at diagnosis. Only the fluorouracil + oxaliplatin regimen exceeded 10% utilization in the first-line setting [claims metastatic (12.1%), claims advanced (8.2%), and EMR metastatic (16.6%) cohorts]. The HHI demonstrated extreme heterogeneity (0.14 for first-line therapy and 0.13 for second-line therapy). Patient age and geographic region of residence were significantly associated with treatment choice across all three cohorts in the first-line setting (p < 0.05). CONCLUSION: Treatment of patients with gastric cancer was highly variable. Despite the availability of treatment guidelines, there is a lack of consistent treatment patterns. There is a need to improve evidence-based care for patients with gastric cancer.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Idoso , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Oxaliplatina/administração & dosagem , Estudos Retrospectivos , Estados UnidosRESUMO
This paper presents a method for wind velocity and Doppler temperature retrieval from interferograms of a Doppler asymmetric spatial heterodyne spectrometer. This method is based on the analytic representation of the signal and the subsequent algorithms. It turns out to be more robust than the conventional Fourier transform method at low SNR. The influence of optical dispersion on the accuracy of the retrieved parameters is also characterized. The effective optical path difference is suggested for use in wind and temperature retrieval routines. Computer simulations are used to characterize the accuracy of the proposed method, in particular regarding the influence of optical dispersion.
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KEY MESSAGE: A novel QTL cluster for appearance quality on Chr07 was identified using reciprocal introgression populations in different locations in China. Two secondary F 2 populations validated QTL with significant effect on appearance quality. Appearance quality (AQ) is the main determinants of market value of rice. Identification of QTL affecting AQ is the prerequisite for efficient improvement of AQ through marker-assisted selection (MAS). Two sets of reciprocal introgression lines derived from indica Minghui 63 and japonica 02428 were used to dissect the stability of QTL affecting five AQ traits, including grain length, grain width, length to width ratio, percentage of grains with chalkiness, and degree of endosperm chalkiness using 4568 bin genotype produced from 58,000 SNPs across five different environments. A total of 41 and 30 main-effect QTL were identified in MH63 and 02428 backgrounds, respectively. Among them, 9 background-independent QTL (BI-QTL) were found. There were also 13 and 10 stable-expressed QTL (SE-QTL) across at least two environments in MH63 and 02428 backgrounds, respectively. Two important BI- and SE-QTL regions (BISERs) including BISER-I harboring qPGWC5, qDEC5, qGW5.1, and qLWR5 on chromosome 5 and BISER-II harboring qGL7, qLWR7, qPGWC7, and qDEC7 on chromosome 7 were identified. The BISER-II was newly reported and validated by two secondary F2 populations in the reciprocal backgrounds. Among 59 epistatic QTL (E-QTL) detected in this study, there were only four SE- but no BI-E-QTL detected in different environments, indicating that genetic background has stronger effect on AQ traits than the environmental factors, especially for percentage of grains with chalkiness (PGWC) and degree of endosperm chalkiness (DEC) with lower heritability. BISER-I and BISER-II harboring many BI- and SE-QTL with favorable alleles from slender grain rice are much important for improvement of rice AQ by MAS.
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Meio Ambiente , Oryza/genética , Locos de Características Quantitativas , Sementes/genética , Alelos , Mapeamento Cromossômico , Cruzamentos Genéticos , Grão Comestível/genética , Genótipo , Fenótipo , Polimorfismo de Nucleotídeo ÚnicoRESUMO
BACKGROUND: Contemporary use of dual antiplatelet therapy and consistency with guideline recommendations in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) have not been well characterized. METHODS: The COAPT was a prospective, observational, multicenter, longitudinal study of patients with myocardial infarction (MI) undergoing PCI. Baseline characteristics, treatment patterns, processes of care, factors associated with switching to and from novel adenosine diphosphate receptor inhibitors (ADPris), and in-hospital outcomes are described. RESULTS: Among 2,179 MI patients undergoing PCI during their index hospitalization, 1,328 (60.9%) had ST elevation. Initial ADPri use included clopidogrel in 1,812 (83.2%), prasugrel in 125 (5.7%), and ticagrelor in 242 (11.1%). At discharge, 1,597 patients (73.4%) were prescribed clopidogrel, 220 (10.1%) prasugrel, and 358 (16.5%) ticagrelor. Switching between ADPri therapies during the index hospitalization occurred in 15.3%, 22.4%, and 25.2% of patients initially started on clopidogrel, prasugrel, and ticagrelor, respectively. Most switches over the 15-month study period occurred during the index admission (16.8% of patients vs 4.4% switches postdischarge). Major adverse cardiovascular events occurred in 7.5% of patients during the index hospitalization. In-hospital bleeding events occurred in 6.0% of patients and most were mild. CONCLUSIONS: Despite randomized trial evidence and guideline recommendations, only a minority of Canadian MI patients undergoing PCI initially received or were discharged on one of the newer ADPri agents. These findings suggest an opportunity to improve upon the appropriate selection of the ADPris at index hospitalization and discharge in Canadian MI patients undergoing PCI.
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Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Intervenção Coronária Percutânea , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Adenosina/análogos & derivados , Adenosina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Clopidogrel , Substituição de Medicamentos , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Hemorragia/induzido quimicamente , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Cloridrato de Prasugrel/uso terapêutico , Estudos Prospectivos , Ticagrelor , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Adulto JovemRESUMO
OBJECTIVES: The 30-day clinical outcomes with prasugrel or ticagrelor were compared using a US payer database in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). BACKGROUND: Prasugrel and ticagrelor demonstrated superior efficacy with increased non-coronary artery bypass graft major bleeding compared with clopidogrel in randomized clinical trials. No direct randomized or observational studies have compared clinical outcomes between prasugrel and ticagrelor. METHODS: Patients hospitalized for ACS-PCI between August 1, 2011 and April 30, 2013 and prescribed prasugrel or ticagrelor were selected. Drug treatment cohorts were propensity matched based upon demographic and clinical characteristics. The primary objective compared 30-day net adverse clinical events (NACE) in prasugrel- and ticagrelor-treated patients using a prespecified 20% noninferiority margin. Secondary objectives included comparisons of major adverse cardiovascular events (MACE) and major bleeding. RESULTS: Data were available for 16,098 patients (prasugrel, n = 13,134; ticagrelor, n = 2,964). In unmatched cohorts, prasugrel-treated patients were younger with fewer comorbidities than ticagrelor-treated patients, and 30-day NACE rates were 5.6 and 9.3%, respectively (P < 0.001). Following propensity matching, NACE was noninferior (P < 0.001) and 22% lower in prasugrel-treated than in ticagrelor-treated patients (RR, 0.78; 95% CI, 0.64-0.94). A 30-day adjusted MACE (RR, 0.80; 95% CI, 0.64-0.98) and major bleeding (RR, 0.65; 95% CI, 0.45-0.95) were also lower in prasugrel-treated patients compared with ticagrelor-treated patients. CONCLUSIONS: In this "real-world," retrospective, observational study, physicians appear to preferentially use prasugrel in younger patients with lower risk of bleeding or comorbidities compared with ticagrelor. Following adjustment, clinical outcomes associated with prasugrel use appear as good, if not better, than those associated with ticagrelor in ACS-PCI patients. © 2015 Wiley Periodicals, Inc.
Assuntos
Síndrome Coronariana Aguda/terapia , Adenosina/análogos & derivados , Inibidores da Agregação Plaquetária/uso terapêutico , Padrões de Prática Médica , Cloridrato de Prasugrel/uso terapêutico , Síndrome Coronariana Aguda/diagnóstico por imagem , Adenosina/efeitos adversos , Adenosina/uso terapêutico , Fatores Etários , Idoso , Distribuição de Qui-Quadrado , Comorbidade , Bases de Dados Factuais , Feminino , Hemorragia/induzido quimicamente , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Padrões de Prática Médica/tendências , Cloridrato de Prasugrel/efeitos adversos , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Ticagrelor , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
Sheath blight (SB) is among the most destructive rice (Oryza sativa) diseases worldwide. SB resistance (SBR) is controlled by quantitative trait loci (QTL). Only a few SB resistance QTLs were confirmed previously in field trials that were independent of morphological traits, a crucial factor in plant breeding. Here, we employed 63 chromosome segment substitution lines (CSSLs) to identify SBR QTLs derived from 'HJX74'. Importantly, these CSSLs all carried the same genetic background as 'HJX74', except in the substituted segment introgressed from susceptible 'Amol3(sona)'. In contrast to most reports that mapped SBR QTLs under complex genetic backgrounds, this approach allowed many CSSLs to consistently retain the agronomic traits of 'HJX74' with moderate resistance, giving the needed high reproducibility in SBR scoring. We have identified five SBR QTLs in field tests. Two of them, qSB11HJX74 and qSB1-1HJX74, conferred the greatest reduction in SB ratings by approximately 0.9 to 1.2 on a 0 to 9 scale. qSB11HJX74 exhibited nearly perfect recessive heredity, whereas qSB1-1HJX74 showed dominant heredity. Using a secondary F2 population and overlapping substitution segment lines, we further mapped qSB11HJX74 and qSB1-1HJX74 to regions of approximately 430 and 930 kb, respectively. The results will accelerate the rice breeding process for resistance to SB disease.