Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF

Background In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients with and without previous stroke or transient ischaemic attack (TIA). Methods In ROCKET AF, patients with AF who were at increased risk of stroke were randomly assigned (1:1) in a double-blind manner to rivaroxaban 20 mg daily or adjusted dose warfarin (international normalised ratio 2-0-3.0). Patients and investigators were masked to treatment allocation. Between Dec 18,2006, and June 17,2009,14 264 patients from 1178 centres in 45 countries were randomly assigned. The primary endpoint was the composite of stroke or non-CNS systemic embolism. In this substudy we assessed the interaction of the treatment effects of rivaroxaban and warfarin among patients with and without previous stroke or TIA. Efficacy analyses were by intention to treat and safety analyses were done in the on-treatment population. ROCKET AF is registered with ClinicalTrials.gov, number NCT00403767. Findings 7468 (52%) patients had a previous stroke (n=4907) or TIA (n=2561) and 6796 (48%) had no previous stroke or TIA. The number of events per 100 person-years for the primary endpoint in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (2.79% rivaroxaban vs 2.96% warfarin; hazard ratio [HR] 0-94,95% CI 0.77-1.16) and those without (1.44% vs 1.88%; 0.77, 0.58-1-01; interaction p=0.23). The number of major and non-major clinically relevant bleeding events per 100 person-years in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (13.31% rivaroxaban vs 13.87% warfarin; HR 0.96,95% CI 0.87-1-07) and those without (16.69% vs 15.19%; 1.10, 0.99-1.21; interaction p=0.08). Interpretation There was no evidence that the relative efficacy and safety of rivaroxaban compared with warfarin was different between patients who had a previous stroke or TIA and those who had no previous stroke or TIA. These results support the use of rivaroxaban as an alternative to warfarin for prevention of recurrent as well as initial stroke in patients with AF.

Wie viele soll'ns sein? Gruppierung von Instrumentalwerken im 17. und 18. Jahrhundert

Die Anzahl der Werke, aus der gedruckte Sammlungen von Instrumentalwerken im 17.-18. Jh. zusammengestellt wurden sagt viel über die Wahrnehmung des einzelnen Werkes als einzigartig aus. Die Tendenz einer Verringerung und Normalisierung der Anzahl von Werken in einer Sammlung spricht zum einen für eine verstärkte Individuellisierung der Werke, zum anderen aber für eine Standardisierung der Verlagsstrategien.

Privacy-preserving genomic testing in the clinic: a model using HIV treatment

PURPOSE The implementation of genomic-based medicine is hindered by unresolved questions regarding data privacy and delivery of interpreted results to health-care practitioners. We used DNA-based prediction of HIV-related outcomes as a model to explore critical issues in clinical genomics. METHODS We genotyped 4,149 markers in HIV-positive individuals. Variants allowed for prediction of 17 traits relevant to HIV medical care, inference of patient ancestry, and imputation of human leukocyte antigen (HLA) types. Genetic data were processed under a privacy-preserving framework using homomorphic encryption, and clinical reports describing potentially actionable results were delivered to health-care providers. RESULTS A total of 230 patients were included in the study. We demonstrated the feasibility of encrypting a large number of genetic markers, inferring patient ancestry, computing monogenic and polygenic trait risks, and reporting results under privacy-preserving conditions. The average execution time of a multimarker test on encrypted data was 865 ms on a standard computer. The proportion of tests returning potentially actionable genetic results ranged from 0 to 54%. CONCLUSIONS The model of implementation presented herein informs on strategies to deliver genomic test results for clinical care. Data encryption to ensure privacy helps to build patient trust, a key requirement on the road to genomic-based medicine.Genet Med advance online publication 14 January 2016Genetics in Medicine (2016); doi:10.1038/gim.2015.167.

Analyses of lake La Thuile sediment core

Lake La Thuile, in the Northern French Prealps (874 m a.s.l.), provides an 18 m long sedimentary sequence spanning the entire Lateglacial/Holocene period. The high resolution multi-proxy (sedimentological, palynological, geochemical) analysis of the uppermost 6.2 meters reveals the Holocene dynamics of erosion in the catchment in response to landscape modifications. The mountain belt is at relevant altitude to study past human activities and the watershed is sufficiently disconnected from large valleys to capture a local sedimentary signal. From 12,000 to 10,000 cal. BP (10 to 8 ka cal. BC), the onset of hardwood species triggered a drop in erosion following the Lateglacial/Holocene transition. From 10,000 to 4500 cal. BP (8 to 2.5 ka cal. BC), the forest became denser and favored slope stabilization while erosion processes were very weak. A first erosive phase was initiated at ca . 4500 cal. BP without evidence of human presence in the catchment. Then, the forest declined at approximately 3000 cal. BP, suggesting the first human influence on the landscape. Two other erosive phases are related to anthropic activities: approximately 2500 cal. BP (550 cal. BC) during the Roman period and after 1600 cal. BP (350 cal. AD) with a substantial accentuation in the Middle Ages. In contrast, the lower erosion produced during the Little Ice Age, when climate deteriorations are generally considered to result in an increased erosion signal in this region, suggests that anthropic activities dominated the erosive processes and completely masked the natural effects of climate on erosion in the late Holocene.

Sea surafce temperature reconstruction for sediment core SU81-18

Reconstructing the impact of Heinrich events outside the main belt of ice rafting is crucial to understanding the underlying causes of these abrupt climatic events. A high-resolution study of a marine sediment core from the Iberian margin demonstrates that this midlatitude area was strongly affected both by cooling and advection of low-salinity arctic water masses during the last three Heinrich events. These paleoclimatic time series reveal the internal complexity of each of the last three Heinrich events and illustrate the value of parallel studies of the organic and inorganic fractions of the sediments.

Geochemistry at DSDP Leg 59

Deep Sea Drilling Project Legs 59 and 60 drilled 15 sites along an east-west transect at 18°N from the West Philippine Basin to the Mariana Trench (Fig. 1) in order to study the nature and genesis of the back-arc, marginal basins and the remnant and active arcs of the region. Leg 59 drilled at five sites at the western end of the traverse: Site 447 in the West Philippine Basin; Site 448 on the Palau-Kyushu Ridge; Sites 449 and 450 in the Parece Vela Basin; and Site 451 on the West Mariana Ridge. Penetration into basaltic basement of these sites was 183.5 meters at 447 (8 basalt flows); 623 meters at 448 (46 basalt flows, sills, and dikes and volcaniclastic units); 40.5 meters at 449 (2 basalt flows); 7 meters at 450 (1 basalt intrusion); and 4 meters of basalt breccia at 451 overlain by 861 meters of volcaniclastic sedimentary rocks.