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.

Nanopartikelcharakterisierung: Untersuchung des Retentionsverhaltens in der AF-FFF und der bimodalen Größenverteilung sauer katalysierter Poly(organosiloxan)-Dispersionen

Polymere Hohlstrukturen eignen sich um eine große Anzahl an Gastmolekülen zu verkapseln und bieten somit interessante Anwendungsmöglichkeiten, z.B. im Bereich kontrollierter Transportsysteme. Solche wohl definierten Strukturen lassen sich mittels des Sol-Gel-Prozesses durch Hydrolyse und Kondensation von Dialkoxydialkyl- und Trialkoxyalkylsilanen in wässriger Dispersion in Gegenwart von Tensiden synthetisieren. Die Methode ermöglicht den Aufbau verschiedener Kern-Schale-Systeme, inklusive Hohlkugelarchitekturen, mit Durchmessern von 10-100 nm. Abhängig von den eingestellten Parametern wird dabei eine bimodale Größenverteilung der Partikel beobachtet. Die bimodalen Proben wurden mittels der circularen asymmetrischen Fluss Feld-Fluss Fraktionierung (CAFFFE) fraktioniert. NMR-Untersuchungen deuten darauf hin, dass die Ursache der bimodalen Verteilung in der Synthese der Kerndispersion zu liegen scheint. MALDI-TOF-MS und GC-Messungen zeigen, dass der Kern der größeren Partikel ausschließlich aus zyklischen Kondensationsprodukten besteht, während im Kernmaterial der kleineren Partikel zusätzlich noch lineare Polydimethylsiloxan-Ketten vorhanden sind. Unter der Annahme, dass PDMS als Ultrahydrophob wirkt, lässt sich die Ostwaldreifung als Ursache der Bimodalität ausmachen. Eine Erhöhung des PDMS-Anteils, der zur Stabilisierung gegen den Reifungsprozess notwendig ist, führt zu einer monomodalen Verteilung der erhaltenen Partikel.

Low prevalence of atrial fibrillation in asymptomatic adults in Geneva, Switzerland

Aims To determine the prevalence of atrial fibrillation (AF) in a population-based sample of adults. Methods and results Between January 2005 and December 2007 individuals aged >/=50 years, residents of the city of Geneva, who had participated in a previous random survey were invited for follow-up examination. AF was assessed on a single resting 6-lead ECG. Reported prevalences were standardized for the age distribution of Canton Geneva. Overall participation was 72.8%. Twenty-nine cases of AF (22 men) were diagnosed among 3285 subjects (1696 men). The crude prevalence of AF (95% CI) was 0.88% (0.86, 0.90) overall, but higher in men [1.30% (1.26, 1.34)] than in women [0.44% (0.41, 0.47)]. The age-standardized AF prevalence was slightly higher [overall: 0.94% (0.91, 0.97), men: 1.23% (1.19, 1.27), women: 0.54% (0.47, 0.61)]. AF prevalence increased with age in both sexes. A 'history of suspected arterial embolism' (brain or legs) was higher in the AF cases (10.3 vs. 3.3%; P = 0.03). Conclusion This population-based survey of a general Swiss population indicates that the prevalence of AF remains below 1%. These results are less alarming than those from previous studies based on patients seeking medical care.

Pathogenesis of AF: impact on intracardiac signals

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and is responsible for the highest number of rhythm-related disorders and cardioembolic strokes worldwide. Intracardiac signal analysis during the onset of paroxysmal AF led to the discovery of pulmonary vein as a triggering source of AF, which has led to the development of pulmonary vein ablation--an established curative therapy for drug-resistant AF. Complex, multicomponent and rapid electrical activity widely involving the atrial substrate characterizes persistent/permanent AF. Widespread nature of the problem and complexity of signals in persistent AF reduce the success rate of ablation therapy. Although signal processing applied to extraction of relevant features from these complex electrograms has helped to improve the efficacy of ablation therapy in persistent/permanent AF, improved understanding of complex signals should help to identify sources of AF and further increase the success rate of ablation therapy.

Effects of Gender on the Incidence of Cardiac Tamponade Following Catheter Ablation of Atrial Fibrillation: Results from a Worldwide Survey in 34,943 AF Ablation Procedures.

BACKGROUND -Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female gender is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. METHODS AND RESULTS -A systematic Medline search was used to locate academic electrophysiologic (EP) centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to gender and their mode of management including any case of related mortality. Nineteen EP centers provided information on 34,943 ablation procedures involving 25,261 (72%) males. Overall 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in females and 169 (0.67%) in males (odds ratio 1.83, P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantial lower risk in high volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; females tended to develop more tamponades during transseptal catheterization. No gender difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high volume centers. Three cases of tamponade (1%) culminated in death. CONCLUSIONS -Tamponade during AF ablation procedures is relatively rare. Women have an almost twofold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high volume centers. Surgical back-up and acute management skills for treating tamponade are important in centers performing AF ablation.

Om den af Keiser Julianus med forenede Jødernes og Hedningenes Kraefer til Spot for Christus og de Christne begyndte Tempelbygning i Jerusalem hvorledes samme ved Hvirvelvind, Lynild, Jordskielv og Ild-Udbrud af Jorden paa en mirakulos Maade blev standset og gandske forhindret : bedraget som et af de alleruimodsigeligste of kraftigste Beviser for den christelige Religions Sandhed...

af [Esaias] Fleischer

Mindeskrift i anledning af hundredaarsdagen for anordningen af 29. marts 1814 en fremstelling af jødiske rets-og livsforhold i udland og indland navnlig i tiden omkring aar 1800 : med an samling arkivalia

Julius Salomon og Josef Fischer. Udgivet af Danmark Loge u. O. B. No. 712

De Hoogduitsche Joden in 's-Gravenhage van af hunne komst tot op heden

door D. S. van Zuiden

Historisk fremstilling af jødernes forhold og stilling i Danmark, navnlig Kjøbenhavn

ved M. L. Nathanson

De mosaiske Troesbekjenderes Stilling i Danmark forhen og nu, historisk fremstillet i et Tidslob af noesten 200 Aar, tilligemed alle Lovsteder og offentlige Foranstaltninger dem angaaende, som ere udkomme fra 1651 til 1836

udarb. af A. D. Cohen

Festskrift i anledning af Professor David Simonsens 70-aarige Fødselsdag

Nir Daṿid likhvod ha-rav he-ḥakham R. Daṿid Simonsen