Prognostic value of PCSK9 levels in patients with acute coronary syndromes.

AIMS Proprotein convertase subtilisin kexin 9 (PCSK9) is an emerging target for the treatment of hypercholesterolaemia, but the clinical utility of PCSK9 levels to guide treatment is unknown. We aimed to prospectively assess the prognostic value of plasma PCSK9 levels in patients with acute coronary syndromes (ACS). METHODS AND RESULTS Plasma PCSK9 levels were measured in 2030 ACS patients undergoing coronary angiography in a Swiss prospective cohort. At 1 year, the association between PCSK9 tertiles and all-cause death was assessed adjusting for the Global Registry of Acute Coronary Events (GRACE) variables, as well as the achievement of LDL cholesterol targets of <1.8 mmol/L. Patients with higher PCSK9 levels at angiography were more likely to have clinical familial hypercholesterolaemia (rate ratio, RR 1.21, 95% confidence interval, CI 1.09-1.53), be treated with lipid-lowering therapy (RR 1.46, 95% CI 1.30-1.63), present with longer time interval of chest pain (RR 1.29, 95% CI 1.09-1.53) and higher C-reactive protein levels (RR 1.22, 95% CI 1.16-1.30). PCSK9 increased 12-24 h after ACS (374 ± 149 vs. 323 ± 134 ng/mL, P < 0.001). At 1 year follow-up, HRs for upper vs. lower PCSK9-level tertiles were 1.13 (95% CI 0.69-1.85) for all-cause death and remained similar after adjustment for the GRACE score. Patients with higher PCSK9 levels were less likely to reach the recommended LDL cholesterol targets (RR 0.81, 95% CI 0.66-0.99). CONCLUSION In ACS patients, high initial PCSK9 plasma levels were associated with inflammation in the acute phase and hypercholesterolaemia, but did not predict mortality at 1 year.

Expected impact of applying new 2013 AHA/ACC cholesterol guidelines criteria on the recommended lipid target achievement after acute coronary syndromes.

BACKGROUND 2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets. METHODS Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years. RESULTS 1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001). CONCLUSION The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.

Reasons for discontinuation of recommended therapies according to the patients after acute coronary syndromes.

BACKGROUND The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. METHODS We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. RESULTS 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients. CONCLUSIONS Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.

Kundmachung: Die Besitzer von Greißlereien, Spezereihandlungen und sonstigen Victualien-Verschleißen ...

Welsch (Projektbearbeiter): Anordnung zur generellen Offenhaltung von Lebensmittelgeschäften außer im Falle 'ernstlicher' Angriffe

Current insights into thrombotic microangiopathies: Thrombotic thrombocytopenic purpura and pregnancy.

The complex relation between thrombotic thrombocytopenic purpura (TTP) and pregnancy is concisely reviewed. Pregnancy is a very strong trigger for acute disease manifestation in patients with hereditary TTP caused by double heterozygous or homozygous mutations of ADAMTS13 (ADisintegrin And Metalloprotease with ThromboSpondin type 1 domains, no. 13). In several affected women disease onset during their first pregnancy leads to the diagnosis of hereditary TTP. Without plasma treatment mother and especially fetus are at high risk of dying. The relapse risk during a next pregnancy is almost 100% but regular plasma transfusion starting in early pregnancy will prevent acute TTP flare-up and may result in successful pregnancy outcome. Pregnancy may also constitute a mild risk factor for the onset of acute acquired TTP caused by autoantibody-mediated severe ADAMTS13 deficiency. Women having survived acute acquired TTP may not be at very high risk of TTP relapse during an ensuing next pregnancy but seem to have an elevated risk of preeclampsia. Monitoring of ADAMTS13 activity and inhibitor titre during pregnancy may help to guide management and to avoid disease recurrence. Finally, TTP needs to be distinguished from the much more frequent hypertensive pregnancy complications, preeclampsia and especially HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelet count) syndrome.

Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys.

OBJECTIVES Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis. DESIGN Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. SETTING All PCPs in the canton of Vaud, Switzerland. PARTICIPANTS Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. INTERVENTION A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. OUTCOME MEASURES The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. RESULTS Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88-99%, p<0.001). CONCLUSIONS An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.

When hybrids go wrong. How hybridization can create invasive species.

Gene flow is the movement of genes from one plant population to another. Gene flow is a natural process and a part of plant evolution. There are two ways for gene flow to occur in plants. The first is through sexual reproduction – pollen lands on a flower and a viable seed develops. The second method is through dispersal of seeds and/or vegetative plant parts (e.g. stolons, rhizomes). Gene flow can produce hybrid offspring with an increased or decreased ability to survive in the landscape. If hybrid offspring have some advantage in the environment, they could become invasive. This poster shows two examples of gene flow in plants and the potential for environmental damage.

Mus Hs 1913b - Prends cette rose aimable comme toi : ode de Ronsard ; Wien, im März 1869

J. St.

Warhaffte vnd zugleich gantz denckwürdige Außlegung, deß von dem thewren, werthen vnd Hocherleuchten Mann Gottes D. Martin Lutheri geführten Wapens

so er selbs ... vberschriben ... ; Erinnert J. G. D. D.

Auffällige Erscheinungen in der Verbreitung von Land- und Süsswassermollusken am Niederrhein

Vin Heinr. Brockmeier

Efecto del tiempo de maceración sobre el color, la composición tánica y la astringencia de vinos Cabernet Sauvignon y Malbec

El objetivo del trabajo fue estudiar el efecto del tiempo de maceración sobre la composición tánica, el color y la astringencia de vinos Cabernet Sauvignon y Malbec, provenientes de la Zona Alta del Río Mendoza y saber qué tiempo de maceración permite una mayor expresión del color y del cuerpo del vino. A partir de dos vinificaciones industriales, se realizaron muestreos para determinar las curvas de extracción de los componentes fenólicos y del color. Además, se llevaron a cabo dos experimentos probando un tiempo de maceración corto, de 5 días, uno “clásico" en la región, de 10 días, y uno largo, de 20 días. En los vinos resultantes se determinó el perfil fenólico, discriminando los componentes tánicos y del color, durante el primer año de conservación en vasijas de vidrio. Se utilizaron técnicas de espectrometría VIS y UV y los vinos fueron evaluados por un panel de expertos degustadores. La variedad Cabernet S. siguió un patrón de extracción de antocianos y taninos durante la maceración acorde con lo que indica la bibliografía. La magnitud del color rojo alcanzó un máximo cerca del 10º día y luego sufrió una caída que, en la maceración de 20 días, significó una pérdida de alrededor de un 10%. Los taninos aumentaron rápidamente hasta el 10º día y luego continuaron creciendo muy lentamente. Los vinos Cabernet S. obtenidos con maceración de 10 días y de 20 días resultaron muy superiores en cuanto a los contenidos de antocianos, color polimérico y taninos. También provocaron sensaciones de concentración y untuosidad mayores. Además resultaron más ásperos, astringentes y secantes que los de 5 días, pero estas sensaciones fueron moderadas. Los vinos de 20 días fueron similares a los de 10 días salvo en que alcanzaron un contenido mayor de polifenoles totales y de taninos no astringentes. La variedad Malbec siguió un patrón de extracción de antocianos y taninos similar al Cabernet S. hasta el 10º día, pero luego ambos mostraron una caída pronunciada, como consecuencia de un deterioro oxidativo. La maceración de 10 días resultó óptima y los vinos se destacaron por su mayor contenido en polifenoles totales, antocianos, color polimérico y taninos. Estos atributos provocaron sensaciones de concentración y untuosidad destacadas y similares a las de los Cabernet S. de 10 y 20 días. Las sensaciones de secante, áspero y astringente fueron menores que en los Cabernet. Los Malbec de 5 días resultaron muy pobres en atributos y los de 20 días con característics intermedias entre los de 5 y los de 10 días. En ambas variedades la pérdida en los contenidos de antocianos copigmentados se acompañó de un aumento proporcional en los contenidos de antocianos polimerizados. Durante el estacionamiento todos los vinos Cabernet S. y Malbec sufrieron una degradación de polifenoles totales, antocianos y taninos. El ritmo de degradación de cada compuesto fue similar para los distintos vinos, sin importar las concentraciones iniciales del compuesto. En ambas variedades los polifenoles totales y los taninos se correlacionaron positivamente con la aspereza, la astringencia, lo secante, la untuosidad y la concentración. Lo secante se asoció negativamente con la proporción de taninos no precipitables con gelatina. La espectrometría VIS y UV, como método instrumental de análisis, resultó suficientemente potente como para permitir una la apreciación del perfil fenólico y diferenciar los vinos Cabernet S. de los Malbec, independientemente del tiempo de maceración con que fueron elaborados.