Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack

Background-Patients with acute coronary syndromes and history of stroke or transient ischemic attack (TIA) have an increased rate of recurrent cardiac events and intracranial hemorrhages. Methods and Results-We evaluated treatment effects of ticagrelor versus clopidogrel in patients with acute coronary syndrome with and without a history of prior stroke or TIA in the PLATelet inhibition and patient Outcomes (PLATO) trial. Of the 18 624 randomized patients, 1152 (6.2%) had a history of stroke or TIA. Such patients had higher rates of myocardial infarction (11.5% versus 6.0%), death (10.5% versus 4.9%), stroke (3.4% versus 1.2%), and intracranial bleeding (0.8% versus 0.2%) than patients without prior stroke or TIA. Among patients with a history of stroke or TIA, the reduction of the primary composite outcome and total mortality at 1 year with ticagrelor versus clopidogrel was consistent with the overall trial results: 19.0% versus 20.8% (hazard ratio, 0.87; 95% confidence interval, 0.66-1.13; interaction P=0.84) and 7.9% versus 13.0% (hazard ratio, 0.62; 95% confidence interval, 0.42-0.91). The overall PLATO-defined bleeding rates were similar: 14.6% versus 14.9% (hazard ratio, 0.99; 95% confidence interval, 0.71-1.37), and intracranial bleeding occurred infrequently (4 versus 4 cases, respectively). Conclusions-Patients with acute coronary syndrome with a prior history of ischemic stroke or TIA had higher rates of clinical outcomes than patients without prior stroke or TIA. However, the efficacy and bleeding results of ticagrelor in these high-risk patients were consistent with the overall trial population, with a favorable clinical net benefit and associated impact on mortality.

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.

Landscape and soil regionalization in southern Brazilian Amazon and contiguous areas: methodology and relevance for ecological studies

Soils of a large tropical area with differentiated landscapes cannot be treated uniformly for ecological applications. We intend to develop a framework based on physiography that can be used in regional applications. The study region occupies more than 1.1 million km² and is located at the junction of the savanna region of Central Brazil and the Amazon forest. It includes a portion of the high sedimentary Central Brazil plateau and large areas of mostly peneplained crystalline shield on the border of the wide inner-Amazon low sedimentary plain. A first broad subdivision was made into landscape regions followed by a more detailed subdivision into soil regions. Mapping information was extracted from soil survey maps at scales of 1:250000-1:500000. Soil units were integrated within a homogenized legend using a set of selected attributes such as taxonomic term, the texture of the B horizon and the associated vegetation. For each region, a detailed inventory of the soil units with their area distribution was elaborated. Ten landscape regions and twenty-four soil regions were recognized and delineated. Soil cover of a region is normally characterized by a cluster composed of many soil units. Soil diversity is comparable in the landscape and the soil regions. Composition of the soil cover is quantitatively expressed in terms of area extension of the soil units. Such geographic divisions characterized by grouping soil units and their spatial estimates must be used for regional ecological applications.

La inmortalidad de Drácula: historia, leyenda, ideaciones…

[ES]drácula es un personaje real del siglo XV: príncipe de Valaquia, valiente luchador contra el imperio otomano por la independencia de su país, justo, pero muy cruel con los enemigos, cualidades que le confieren la inmortalidad de los personajes históricos. protagonista de creaciones literarias ya en su vida, se convierte en leyenda y adquiere la inmortalidad del vampiro gracias a stoker. Y, a la vez, la inmortalidad de los persona - jes de leyenda, literarios, pictóricos, musicales y cinematográficos, gracias a las numerosísimas creaciones artísticas inspiradas en su figura.

Pondicherry, India: progetto per il nuovo waterfront

Il tema oggetto della tesi riguarda la riqualificazione del nuovo waterfront per la città di Pondicherry situata nell'India del sud. Dopo una attenta analisi sulla città, comprendente un'ampia analisi storica e cartografica, l'analisi del verde e dell'acqua, del tessuto edilizio e dell'emergenza abitativa che la città si trova ad affrontare, è stato scelto di progettare una nuova darsena come polo attrattivo al cui interno fossero previsti spazi per la comunità ed il turismo: un museo del mare, un hotel, un parco pubblico, un sistema di piazze e zone di sosta all'aperto, un complesso residenziale di espansione.

Physical models for numerical simulation of Si-based nanoscale FETs and sensors

To continuously improve the performance of metal-oxide-semiconductor field-effect-transistors (MOSFETs), innovative device architectures, gate stack engineering and mobility enhancement techniques are under investigation. In this framework, new physics-based models for Technology Computer-Aided-Design (TCAD) simulation tools are needed to accurately predict the performance of upcoming nanoscale devices and to provide guidelines for their optimization. In this thesis, advanced physically-based mobility models for ultrathin body (UTB) devices with either planar or vertical architectures such as single-gate silicon-on-insulator (SOI) field-effect transistors (FETs), double-gate FETs, FinFETs and silicon nanowire FETs, integrating strain technology and high-κ gate stacks are presented. The effective mobility of the two-dimensional electron/hole gas in a UTB FETs channel is calculated taking into account its tensorial nature and the quantization effects. All the scattering events relevant for thin silicon films and for high-κ dielectrics and metal gates have been addressed and modeled for UTB FETs on differently oriented substrates. The effects of mechanical stress on (100) and (110) silicon band structures have been modeled for a generic stress configuration. Performance will also derive from heterogeneity, coming from the increasing diversity of functions integrated on complementary metal-oxide-semiconductor (CMOS) platforms. For example, new architectural concepts are of interest not only to extend the FET scaling process, but also to develop innovative sensor applications. Benefiting from properties like large surface-to-volume ratio and extreme sensitivity to surface modifications, silicon-nanowire-based sensors are gaining special attention in research. In this thesis, a comprehensive analysis of the physical effects playing a role in the detection of gas molecules is carried out by TCAD simulations combined with interface characterization techniques. The complex interaction of charge transport in silicon nanowires of different dimensions with interface trap states and remote charges is addressed to correctly reproduce experimental results of recently fabricated gas nanosensors.

Caratteristiche cliniche ed ecografiche dei Sarcomi Uterini

Obiettivo: descrivere le caratteristiche ecografiche e flussimetriche dei sarcoma uterini Materiali e Metodi: Dall'archivio anatomopatologico di due cliniche Universitarie sono state reclutate retrospettivamente tutte le pazienti con diagnosi anatomopatologica di sarcoma uterino. Tutte le cartelle cliniche, le immagini e i filmati digitalizzati sono stati analizzati e dati raccolti in un database. Risultati: Sono stati inclusi nello studio 49 casi, che comprendono 17 leiomiosarcoma, 14 sarcoma dello stroma endometriale e 18 carcinosarcoma. L'età media alla diagnosi è stata 62 anni (range 35-87). L'ottanta per cento delle pazienti erano in menopausa al momento della diagnosi. Circa la metà delle pazienti presentavano sanguinamento anomalo e il 20% dolore pelvico. La maggior parte delle lesioni sono apparse iso-ipoecogene, senza coni d’ombra (47/49;96%). Conclusioni: I sarcomi uterini sono un gruppo eterogeneo di tumori che presentano aspetti ecografici diversi anche in relazione all’istotipo. Conoscere le diverse caratteristiche può essere utile ai fini di una corretta diagnosi. Nel nostro studio l’assenza dei coni d’ombra risulta essere l’aspetto più significativo.

La mediazione civile e commerciale come strumento di gestione del conflitto. Analisi a seguito dell'entrata in vigore del d.Lgs 4/3/2010 n. 28

Dopo aver analizzato il conflitto, le sue funzioni e le modalità di gestione, l'autore si sofferma dapprima sulle varie tipologie di mediazione per poi focalizzare l'attenzione sulla mediazione civile e commerciale evidenziando i dati disponibili dall'entrata in vigore del tentativo obbligatorio come condizione di procedibilità della domanda giudiziale per le materie civili, alla fine del 2013.

Confronto tra stime GPS e SAR di deformazioni del suolo e di ritardi troposferici

Il Global Positioning System (GPS) e l’Interferometric Synthetic Aperture Radar (InSAR) sono due tecniche osservative di grande importanza che utilizzano segnali nel campo delle microonde. Questa tesi intende contribuire a sviluppare una base di confronto tra i risultati derivati da queste due tecniche osservative. Una parte del lavoro riguarda uno studio delle deformazioni del suolo, in particolare, la stima dei movimenti verticali e di quelli che riguardano la componente Est della posizione delle stazioni. Un secondo ambito di ricerca è invece focalizzato alla determinazione del ritardo introdotto, nella propagazione dei segnali GPS e SAR, dal loro passaggio in atmosfera. In particolare, si è studiato l’effetto della componente umida della troposfera.

Sea level trends in the Mediterranean from tide gauges and satellite altimetry

Sea level variation is one of the parameters directly related to climate change. Monitoring sea level rise is an important scientific issue since many populated areas of the world and megacities are located in low-lying regions. At present, sea level is measured by means of two techniques: the tide gauges and the satellite radar altimetry. Tide gauges measure sea-level relatively to a ground benchmark, hence, their measurements are directly affected by vertical ground motions. Satellite radar altimetry measures sea-level relative to a geocentric reference and are not affected by vertical land motions. In this study, the linear relative sea level trends of 35 tide gauge stations distributed across the Mediterranean Sea have been computed over the period 1993-2014. In order to extract the real sea-level variation, the vertical land motion has been estimated using the observations of available GPS stations and removed from the tide gauges records. These GPS-corrected trends have then been compared with satellite altimetry measurements over the same time interval (AVISO data set). A further comparison has been performed, over the period 1993-2013, using the CCI satellite altimetry data set which has been generated using an updated modeling. The absolute sea level trends obtained from satellite altimetry and GPS-corrected tide gauge data are mostly consistent, meaning that GPS data have provided reliable corrections for most of the sites. The trend values range between +2.5 and +4 mm/yr almost everywhere in the Mediterranean area, the largest trends were found in the Northern Adriatic Sea and in the Aegean. These results are in agreement with estimates of the global mean sea level rise over the last two decades. Where GPS data were not available, information on the vertical land motion deduced from the differences between absolute and relative trends are in agreement with the results of other studies.

Cerebral air embolism caused by a bronchogenic cyst

An unusual case is presented of a tourist who developed fatal cerebral air embolism, pneumomediastinum and pneumopericardium while ascending from low altitude to Europe's highest railway station. Presumably the air embolism originated from rupture of the unsuspected bronchogenic cyst as a result of pressure changes during the ascent. Cerebral air embolism has been observed during surgery, in scuba diving accidents, submarine escapes and less frequently during exposure to very high altitude. People with known bronchogenic cysts should be informed about the risk of cerebral air embolism and surgical removal should be considered. Cerebral air embolism is a rare cause of coma and stroke in all activities with rapid air pressure changes, including alpine tourism, as our unfortunate tourist illustrates.