Patient self-management of oral anticoagulation with vitamin k antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.

Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years). Median age at the time of training was 54.2 years (range 18.2-85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p<0.001), patients>50 years of age (2.0; 1.6-2.6; p<0.001), and men (1.6; 1.2-2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2-0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.

A 12,000 Year Record of Explosive Volcanism in the Siple Dome Ice Core, West Antarctica

Air mass trajectories in the Southern Hemisphere provide a mechanism for transport to and deposition of volcanic products on the Antarctic ice sheet from local volcanoes and from tropical and subtropical volcanic centers. This study extends the detailed record of Antarctic, South American, and equatorial volcanism over the last 12,000 years using continuous glaciochemical series developed from the Siple Dome A (SDMA) ice core, West Antarctica. The largest volcanic sulfate spike ( 280 mu g/L) occurs at 5881 B. C. E. Other large signals with unknown sources are observed around 325 B. C. E. ( 270 mu g/L) and 2818 B. C. E. ( 191 mu g/L). Ages of several large equatorial or Southern Hemisphere volcanic eruptions are synchronous with many sulfate peaks detected in the SDMA volcanic ice chemistry record. The microprobe "fingerprinting'' of glass shards in the SDMA core points to the following Antarctic volcanic centers as sources of tephra found in the SDMA core: Balenny Island, Pleiades, Mount Berlin, Mount Takahe, and Mount Melbourne as well as Mount Hudson and possibly Mount Burney volcanoes of South America. Identified volcanic sources provide an insight into the poorly resolved transport history of volcanic products from source volcanoes to the West Antarctic ice sheet.

New Data on Welshite, e.g. Ca2Mg3.8Mn0.62+Fe0.12+Sb1.55+O2 [Si2.8Be1.7Fe0.653+Al0.7As0.17O18], an Aenigmatite-Group Mineral

Electron and ion microprobe data on two samples of welshite from the type locality of Langban, Sweden, gave analytical totals of 99.38-99.57 wt.% and BeO contents of 4.82-5.11 wt.%, corresponding to 1.692-1.773 Be/20 O. Mossbauer and optical spectra of one of these samples gave Fe-[iv](3+)/Sigma Fe = 0.91, Fe-[iv](2+)/Sigma Fe = 0.09, and no evidence of Mn3+. The resulting formula for this sample is Ca2Mg3.8Mn0.62+Fe0.12+Sb1.55+O2[Si2.8Be1.7Fe0.653+Al0.7As0.17O18], and that for the second sample, Ca2Mg3.8Mn0.12+Fe0.12+F0.83+Sb1.25+O2[Si2.8Be1.8F0.653+Al0.25As0.25O18], is related by the substitution involving tetrahedral and octahedral sites: 0.59([vi,iv])(Fe,Al)(3+) approximate to 0.42([vi])(Mg,Mn,Fe)(2+) + 0.21(Sb-[vi],As-[iv])(5+), i.e. 3([vi,iv]) M3+ = 2([vi])M(2+) + M-[vi,iv](5+). WelShite is distinctive among aenigmatite-group minerals in the high proportion of Fe 3+ in tetrahedral coordination and is unique in its Be content, substantially exceeding 1Be per formula unit. Given the cation distributions in other minerals related to aenigmatite, we think it is reasonable to assume that at least one tetrahedral site is >50% occupied by Be and that one octahedral site is >50% occupied by Sb, so that welshite should be retained as a distinct species with its own name in the aenigmatite group.

High-Spin Molecules: Synthesis, X-ray Characterization, and Magnetic Behavior of Two New Cyano-Bridged Ni II 9 Mo V 6 and Ni II 9 W V 6 Clusters with a S = 12 Ground State

The preparations, X-ray structures, and magnetic characterizations are presented for two new pentadecanuclear cluster compounds:  [NiII{NiII(MeOH)3}8(μ-CN)30{MV(CN)3}6]·xMeOH·yH2O (MV = MoV (1) with x = 17, y = 1; MV = WV (2) with x = 15, y = 0). Both compounds crystallize in the monoclinic space group C2/c, with cell dimensions of a = 28.4957(18) Å, b = 19.2583(10) Å, c = 32.4279(17) Å, β = 113.155(6)°, and Z = 4 for 1 and a = 28.5278(16) Å, b = 19.2008(18) Å, c = 32.4072(17) Å, β = 113.727(6)°, and Z = 4 for 2. The structures of 1 and 2 consist of neutral cluster complexes comprising 15 metal ions, 9 NiII and 6 MV, all linked by μ-cyano ligands. Magnetic susceptibilities and magnetization measurements of compounds 1 and 2 in the crystalline and dissolved state indicate that these clusters have a S = 12 ground state, originating from intracluster ferromagnetic exchange interactions between the μ-cyano-bridged metal ions of the type NiII−NC−MV. Indeed, these data show clearly that the cluster molecules stay intact in solution. Ac magnetic susceptibility measurements reveal that the cluster compounds exhibit magnetic susceptibility relaxation phenomena at low temperatures since, with nonzero dc fields, χ‘ ‘M has a nonzero value that is frequency dependent. However, there appears no out-of-phase (χ‘ ‘M) signal in zero dc field down to 1.8 K, which excludes the expected signature for a single molecule magnet. This finding is confirmed with the small uniaxial magnetic anisotropy value for D of 0.015 cm-1, deduced from the high-field, high-frequency EPR measurement, which distinctly reveals a positive sign in D. Obviously, the overall magnetic anisotropy of the compounds is too low, and this may be a consequence of a small single ion magnetic anisotropy combined with the highly symmetric arrangement of the metal ions in the cluster molecule.

General Practitioners' vitamin K antagonist monitoring is associated with better blood pressure control in patients with hypertension - a cross-sectional database study.

BACKGROUND Patients requiring anticoagulation suffer from comorbidities such as hypertension. On the occasion of INR monitoring, general practitioners (GPs) have the opportunity to control for blood pressure (BP). We aimed to evaluate the impact of Vitamin-K Antagonist (VKA) monitoring by GPs on BP control in patients with hypertension. METHODS We cross-sectionally analyzed the database of the Swiss Family Medicine ICPC Research using Electronic Medical Records (FIRE) of 60 general practices in a primary care setting in Switzerland. This database includes 113,335 patients who visited their GP between 2009 and 2013. We identified patients with hypertension based on antihypertensive medication prescribed for ≥6 months. We compared patients with VKA for ≥3 months and patients without such treatment regarding BP control. We adjusted for age, sex, observation period, number of consultations and comorbidity. RESULTS We identified 4,412 patients with hypertension and blood pressure recordings in the FIRE database. Among these, 569 (12.9 %) were on Phenprocoumon (VKA) and 3,843 (87.1 %) had no anticoagulation. Mean systolic and diastolic BP was significantly lower in the VKA group (130.6 ± 14.9 vs 139.8 ± 15.8 and 76.6 ± 7.9 vs 81.3 ± 9.3 mm Hg) (p < 0.001 for both). The difference remained after adjusting for possible confounders. Systolic and diastolic BP were significantly lower in the VKA group, reaching a mean difference of -8.4 mm Hg (95 % CI -9.8 to -7.0 mm Hg) and -1.5 mm Hg (95 % CI -2.3 to -0.7 mm Hg), respectively (p < 0.001 for both). CONCLUSIONS In a large sample of hypertensive patients in Switzerland, VKA treatment was independently associated with better systolic and diastolic BP control. The observed effect could be due to better compliance with antihypertensive medication in patients treated with VKA. Therefore, we conclude to be aware of this possible benefit especially in patients with lower expected compliance and with multimorbidity.

Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia: 12-month results from the IN.PACT DEEP randomized trial.

BACKGROUND Drug-eluting balloons (DEB) may reduce infrapopliteal restenosis and reintervention rates versus percutaneous transluminal angioplasty (PTA) and improve wound healing/limb preservation. OBJECTIVES The goal of this clinical trial was to assess the efficacy and safety of IN.PACT Amphirion drug-eluting balloons (IA-DEB) compared to PTA for infrapopliteal arterial revascularization in patients with critical limb ischemia (CLI). METHODS Within a prospective, multicenter, randomized, controlled trial with independent clinical event adjudication and angiographic and wound core laboratories 358 CLI patients were randomized 2:1 to IA-DEB or PTA. The 2 coprimary efficacy endpoints through 12 months were clinically driven target lesion revascularization (CD-TLR) and late lumen loss (LLL). The primary safety endpoint through 6 months was a composite of all-cause mortality, major amputation, and CD-TLR. RESULTS Clinical characteristics were similar between the 2 groups. Significant baseline differences between the IA-DEB and PTA arms included mean lesion length (10.2 cm vs. 12.9 cm; p = 0.002), impaired inflow (40.7% vs. 28.8%; p = 0.035), and previous target limb revascularization (32.2% vs. 21.8%; p = 0.047). Primary efficacy results of IA-DEB versus PTA were CD-TLR of 9.2% versus 13.1% (p = 0.291) and LLL of 0.61 ± 0.78 mm versus 0.62 ± 0.78 mm (p = 0.950). Primary safety endpoints were 17.7% versus 15.8% (p = 0.021) and met the noninferiority hypothesis. A safety signal driven by major amputations through 12 months was observed in the IA-DEB arm versus the PTA arm (8.8% vs. 3.6%; p = 0.080). CONCLUSIONS In patients with CLI, IA-DEB had comparable efficacy to PTA. While primary safety was met, there was a trend towards an increased major amputation rate through 12 months compared to PTA. (Study of IN.PACT Amphirion™ Drug Eluting Balloon vs. Standard PTA for the Treatment of Below the Knee Critical Limb Ischemia [INPACT-DEEP]; NCT00941733).

Ms. germ. fol. 12 - Weltchronik

Vorbesitzer: Antiquariat K. W. Hiersemann, Leipzig

Durch Vermittlung des Ministerrathes wurden vom Kriegsministerium der vereinigten Nationalgarde und akademischen Legion 12 Geschütze auszufolgen bewilliget ...

Welsch (Projektbearbeiter): Übergabe von 12 Geschützen aus Beständen des Kriegsministeriums an die Nationalgarde sowie die Akademische Legion

Kundmachung: Morgen den 16. Juni kömmt mittelst Eisenbahn ein Ergänzungs-Transport von 81 Mann des 12. Jäger-Bataillons ...

Welsch (Projektbearbeiter): Bekanntgabe von Truppentransporten über Wien nach Oberitalien

Programm für die Feier des Empfanges Sr. Majestät des Kaisers: Samstag den 12. August d. J. früh Morgens um 5 Uhr fährt der Gemeinde-Ausschuß in Begleitung ...

Welsch (Projektbearbeiter): Programm anläßlich des feierlichen Empfangs Kaiser Ferdinands in der Residenzstadt Wien (12. August 1848)

Akademische Legion, Techniker-Corps: Corps-Befehl: Zu der, Dienstag den 12. September 1848, Vormittags 8 Uhr stattfindenden Musterung ...

Welsch (Projektbearbeiter): Musterungsvorladung der Garden des Techniker-Korps; Aufruf zur Bekämpfung des Mißbrauchs militärischer Abzeichen

Kundmachung: Im Nachhange zu der Kundmachung des Ministers des Inneren vom 12. d. M. wird hiemit zur öffentlichen Kenntniß gebracht, daß die Commission zur Liquidirung ...

Welsch (Projektbearbeiter): Bekanntgabe der Modalitäten bei der Einlösung der Swobodaschen Aktien (Beginn mit den 10-Gulden-Anteilen; Einlösung gegen ein Fünftel des Nennwertes in bar)

An die gesammte Volkswehr der Stadt Wien und Umgebung: Cameraden! Durch Ministerial-Erlaß vom 12. d. bin ich im Einverständnisse mit dem Reichstags-Ausschusse ...

Welsch (Projektbearbeiter): Cäsar Wenzel Messenhauser gibt seine Ernennung zum provisorischen Oberkommandanten der Nationalgarde bekannt. Aufruf zu Friede, Ordnung, Achtung des Gesetzes sowie zur Verteidigung des "constitutionellen Thrones unter dem Banner volksthümlicher Freiheit"

12. Armee-Bulletin: Seine Durchlaucht der Feldmarschall Fürst Windischgrätz ist am 5. dieses Mittags an der Spitze der kaiserlichen Truppen ...

Welsch (Projektbearbeiter): Kampfloser Einzug von Windisch-Graetz in Ofen (Buda) und Pest

Kundmachung: Mit dem heutigen Tage um 12 Uhr läuft die von dem Herrn Feldmarschall Fürsten Windischgrätz der Stadt gestellte Frist ab ...

Welsch (Projektbearbeiter): Aufruf anläßlich des Verstreichens des von Fürst Windisch-Graetz gestellten Ultimatums zur Übergabe Wiens, die Barrikadenbauten fortzuführen und Ruhe und Besonnenheit zu bewahren. Mit einer Beschießung der Stadt muß gerechnet werden. Warnung vor der Verschwendung von "Kanonen, Munition und Menschen"