First Year Of Observation Research Articles

Risk of stroke among patients with borderline personality disorder: A nationwide longitudinal study

BackgroundPrevious studies suggested that patients with borderline personality disorder (BPD) had a higher prevalence of stroke-related risk factors, such as hypertension, dyslipidemia, and diabetes mellitus. But, the association between BPD and subsequent stroke has been rarely investigated. MethodsUsing the Taiwan National Health Insurance Research Database, 5969 borderline patients aged 18 years and older and 23,876 age-and sex-matched controls were enrolled between 2002 and 2009, and followed up to the end of 2011 to identify the development of stroke. ResultsThe Cox regression model after adjusting for demographic data, psychiatric comorbidities, and medical comorbidities showed that BPD was associated with an increased risk of developing any stroke (HR: 4.82, 95% CI: 2.77–8.40) and ischemic stroke (HR: 5.67, 95% CI: 2.49–12.93). The findings of sensitivity analysis after excluding the first year of observation were consistent: any stroke (HR: 3.44, 95% CI: 1.83–6.47) and ischemic stroke (HR: 4.75, 95% CI: 1.91–11.77). DiscussionPatients with BPD had an elevated vulnerability to subsequent stroke and ischemic stroke compared to those without BPD. Further studies would be required to investigate the underlying mechanisms.

Results from Polish Spondyloarthritis Initiative registry (PolSPI) - methodology and data from - the first year of observation.

ObjectivesReport on one-year results from the Polish Spondyloarthritis Initiative registry (PolSPI), containing the cross-sectional analysis of clinical and imaging data as well as database methodology.Material and methodsThe PolSPI registry includes patients with axial (axSpA) and peripheral (perSpA) spondyloarthritis according to ASAS classification criteria, and/or patients with ankylosing spondylitis according to modified New York criteria, psoriatic arthritis according to CASPAR criteria, arthropathy in inflammatory bowel disease, reactive arthritis, juvenile spondyloarthritis or undifferentiated spondyloarthritis. Epidemiologic data and history of signs, symptoms and treatment of spondyloarthritis are collected and assessment of disease activity is performed. Radiographic images of sacroiliac joint, cervical and lumbar spine, and results of bone densitometry are collected. Every 6 months blood samples for inflammatory markers, and for long-term storage are taken.ResultsDuring a one-year period from September 2015 to August 2016, 63 patients were registered on an electronic database; 44 (69.8%) of patients were classified as axial spondyloarthritis (axSpA) and 19 (30.2%) as peripheral spondyloarthritis (perSpA) according to ASAS criteria. Statistically significant differences between axSpA and perSpA were discovered in the percentage of HLA-B27 antigen occurrence (92.6% and 50%, respectively), BASDAI (2.8% and 4.1%, respectively), DAS 28 (2.66% and 4.03%, respectively), percentage of peripheral arthritis (20% and 88.8%, respectively), enthesitis (26.7% and 70.6%, respectively), dactylitis (6.7% and 88.9%, respectively), as well as extra-articular symptoms: acute anterior uveitis (26.7% and 5.6%, respectively) and psoriasis (6.9% and 55.6%, respectively). Patients with axSpA had significantly higher mean grade of sacroiliac involvement according to New York criteria, higher mSASSS score, and lower T-score in femoral neck in bone densitometry.ConclusionsAt the early stage of the disease patients with axSpA compared to those with perSpA, have more advanced structural damage of sacroiliac joints and spine, and lower bone mineral density in the femoral neck. In the upcoming years the PolSPI registry will prospectively follow-up patients with SpA, recording response to treatment and carrying out research on interaction of inflammation and bone remodelling.

Virulence structure of the Blumeria graminis DC.f. sp. avenae populations occurring in Poland across 2010\u20132013

The aim of the present study was to determine the virulence structure of powdery mildew of oats (Blumeria graminis DC.f. sp. avena) in Poland in the years 2010–2013. For this purpose, powdery mildew isolates were collected from three experimental stations in Poland. To assess the virulence of the isolates, eight oat varieties with different responses to the pathogen were used. The results showed that a significant proportion of powdery mildew isolates found in Poland overcame the resistance genes of varieties Bruno (Pm6), Jumbo (Pm1) and Mostyn (Pm3). In contrast, lines Av1860 (Pm4), Am27 (Pm5) and Cc3678 (Pm2) were completely resistant to all pathogen isolates involved in the experiment. Changes constantly occurring in the powdery mildew population perfectly reflect diversity indexes, which were the smallest in the first year of observation, where in the following years these parameters were significantly higher. It is worth noting that the presence of powdery mildew is seasonal and local, which is reflected in the prevalence of the disease in a defined area of the country.

Impact of nonadherence on complication risks and healthcare costs in patients newly-diagnosed with diabetes.

To investigate the association between nonadherence to diabetes treatment and the occurrence of diabetes complications. Our study retrospectively identified adherence and nonadherence to diabetes treatment in patients during the first year of observation after new diagnoses of type 2 diabetes enrolled in commercial database from 52 health insurers in Japan. Participants were insurance enrollees with type 2 diabetes who received healthcare between 2005 and 2013, and who could be tracked for more than 12months from the initiation of diabetes treatment. We compared the occurrence of diabetes-related complications (retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion) and all-cause healthcare expenditure during the second to eighth years. We identified 1784 nonadherent patients and 9547 adherent patients. Cox proportional hazard models showed that the occurrence of microvascular complications was significantly higher in the nonadherent group: the hazard ratios (95% confidence intervals) for retinopathy, nephropathy, and neuropathy were 2.04 (1.57-2.66), 1.91 (1.35-2.72), and 1.83 (1.02-3.27), respectively. However, no significant differences were observed between the adherent and nonadherent groups for the macrovascular complications (ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion). In addition, the nonadherent group had a significantly higher cumulative healthcare expenditure than the adherent group during the second-to-fifth-year period (p=0.029) and the second-to-sixth-year period (p=0.009) after treatment initiation. Nonadherence in the first year of diabetes may increase the incidence of complications and result in higher expenditures for patients and payers.

Coronary circulation and renewal of heart coronary disease clinic after intracoronary stenting

Purpose. To evaluate the role of changes in coronary blood flow in ischemic heart disease clinic reopening after PCI. Materials and methods. The study included 90 patients with coronary heart disease by 40 to 75 years, who underwent emergency PCI (15 patients) and planned (75 patients) procedure. The risk of complications is calculated on a scale Syntax Score. We investigated the venous blood obtained before and after 6 and 12 months following PCI. In the same period, performed stress echocardiography. In case of resumption of CAD patients clinic conducted stress echocardiography and repeated PCI. The intensity of thrombin formation was assessed using a thrombin generation test (TGT) in platelet-poor plasma and the modified reaction mixture by adding human recombinant thrombomodulin (rh-TM) to assess the degree of activation of the protein C system. Results. A total of 4 years of observation, a total of 30 cases of coronary heart disease is ascertained clinic renewal. Despite the different risk of complications on a scale Syntax Score, the incidence of complications between the groups did not differ. Among the factors that determine the risk of complications during the first year of observation, the most important is the degree of stenosis of the left circumflex artery and a violation of regional contractility in the basin of the artery. In the development of complications of the next 3 years of follow up indicators of stress echocardiography, the intensity of the formation of thrombin and lack of exercise. Conclusions. It was found that CAD clinics renewal is not only a violation of the coronary blood flow. CAD risk clinical relapse rate also depends on the formation of thrombin and protein C system activity.

Changes in pathways and vectors of biological invasions in Northwest Europe

We assessed how establishment patterns of non-native freshwater, marine and terrestrial species into Northwest Europe (using Great Britain, France, Belgium and the Netherlands as the study countries) have changed over time, and identified the prevalent pathways and vectors of recent arrivals. Data were extracted from 33 sources on (a) presence/absence and (b) first year of observation in the wild in each country, and (c) continent(s) of origin, (d) invasion pathway(s), (e) invasion vector(s) and (f) environment(s) for 359 species, comprising all non-native Mollusca, Osteichthyes (bony fish), Anseriformes (wildfowl) and Mammalia, and non-native invasive Angiospermae present in the area. Molluscs, fish and wildfowl, particularly those originating from South America, arrived more recently into Northwest Europe than other groups, particularly mammals, invasive plants and species originating from North America. Non-deliberate introductions, those of aquatic species and those from elsewhere in Europe and/or Asia increased strongly in importance after the year 2000 and were responsible for 69, 83 and 89 % of new introductions between 2001 and 2015, respectively. Non-deliberate introductions and those from Asia and North America contributed significantly more to introductions of invasive species in comparison to other non-native species. From the 1960s, ornamental trade has increased in importance relative to other vectors and was responsible for all deliberate introductions of study groups since 2001. Non-deliberate introductions of freshwater and marine species originating from Southeast Europe and Asia represent an increasingly important ecological and economic threat to Northwest Europe. Invertebrates such as molluscs may be particularly dangerous due to their small size and difficulties in detection. Prevention of future invasions in this respect will require intensive screening of stowaways on boats and raising of public awareness.

Fatigue in early Parkinson's disease: the Norwegian ParkWest study.

Fatigue is a common and disabling non-motor symptom in Parkinson's disease (PD). The pathogenesis is unknown, and the treatment options are limited. The aim of the present study was to investigate the development of fatigue during the first year after diagnosis. The study design was a prospective, controlled population-based longitudinal cohort study, comprising 181 de novo, drug-naïve patients with PD and 162 control participants. PD was diagnosed according to the Gelb criteria. Fatigue was assessed by the Fatigue Severity Scale (FSS). Both groups were assessed for fatigue at baseline and after 1 year. Patients reported more fatigue than the control subjects at baseline and at the 1-year follow-up evaluation. The FSS scores in the patient group improved from a mean score of 4.4 (SD 1.6) to 4.0 (SD 1.6). Patients with fatigue at baseline received higher doses of dopaminergic medication during follow-up. Patients who received dopamine agonists improved slightly more than patients who received levodopa. A regression analysis did not show a correlation between an improvement in fatigue and a change in disease severity, depressive symptoms, sleep problems, apathy or cognitive impairment. Fatigue is a common symptom in PD, also in early, untreated patients. During the first year of observation, an improvement in the fatigue scores was found. The improvement could not be attributed to a change in disease severity or depressive symptoms. The results indicate a better effect of dopamine agonists than of levodopa. This may have implications for treatment in patients with PD-associated fatigue.

INTRAPERITONEAL AEROSOL CHEMOTHERAPY UNDER PRESSURE (IACUP) – AN INNOVATIVE METHOD OF TREATMENT OF PATIENTS WITH PERITONEAL CARCINOMATOSIS

Widespread peritoneal carcinomatosis in gastric cancer, in fact, is the end-stage of the disease. The survival median of patients is no more than 3–6 months. Development of various methods of intraperitoneal chemotherapy can improve the prognosis of this category of patients. Objective. To evaluate the efficacy and safety of intraperitoneal aerosol chemotherapy under pressure (IACUP) in patients with gastric cancer with peritoneal carcinomatosis. Materials and methods. The treatment Protocol consisted of a laparotomy or laparoscopy for the staging of the tumor process, 3–4 courses of systemic chemotherapy scheme XELOX followed by conducting at least 3 sessions of intraperitoneal aerosol chemotherapy under pressure (IACUP) with an interval of 6 weeks on the background of chemotherapy. In the case of progression the patient was excluded from the study. Currently, the study included 27 patients with disseminated gastric cancer who underwent 46 procedures of IACUP. There were 8 men and 19 women. The average age of patients was 50.6 years. Results. In the framework of the safety assessment of IACUP there were 3 cases of adverse effects. Two patients (7,4%) noted nausea for the first 2 days after running the session of IACUP. In one patient the iatrogenic perforation of the diaphragm during biopsy of the peritoneum with the development of carbonetworks occurred. The survival median was 11 months. One-year survival rate (by KaplanMeier) was 50.7%. 14 patients are alive and continue to participate in the study during the first year of observation. Conclusion. Intraperitoneal aerosol chemotherapy under pressure (IACUP) is a simple, minimally invasive and safe method for the palliative treatment of patients with disseminated carcinomatosis of gastric cancer. We developed the treatment Protocol that allows us to achieve one-year survival of more than half of patients.

Effect of Antimicrobial Consumption and Production Type on Antibacterial Resistance in the Bovine Respiratory and Digestive Tract.

The aim of this study was to investigate the relationship between antimicrobial use and the occurrence of antimicrobial resistance in the digestive and respiratory tract in three different production systems of food producing animals. A longitudinal study was set up in 25 Belgian bovine herds (10 dairy, 10 beef, and 5 veal herds) for a 2 year monitoring of antimicrobial susceptibilities in E. coli and Pasteurellaceae retrieved from the rectum and the nasal cavity, respectively. During the first year of observation, the antimicrobial use was prospectively recorded on 15 of these farms (5 of each production type) and transformed into the treatment incidences according to the (animal) defined daily dose (TIADD) and (actually) used daily dose (TIUDD). Antimicrobial resistance rates of 4,174 E. coli (all herds) and 474 Pasteurellaceae (beef and veal herds only) isolates for 12 antimicrobial agents demonstrated large differences between intensively reared veal calves (abundant and inconstant) and more extensively reared dairy and beef cattle (sparse and relatively stable). Using linear mixed effect models, a strong relation was found between antimicrobial treatment incidences and resistance profiles of 1,639 E. coli strains (p<0.0001) and 309 Pasteurellaceae (p≤0.012). These results indicate that a high antimicrobial selection pressure, here found to be represented by low dosages of oral prophylactic and therapeutic group medication, converts not only the commensal microbiota from the digestive tract but also the opportunistic pathogenic bacteria in the respiratory tract into reservoirs of multi-resistance.

The clinical course and prognosis factors of stomach cancer patients with metastases in the ovaries

We analyzed the data of 53 patients with metastatic gastric cancer in ovaries treated in the N.N. Blokhin Russian Cancer Research Center in 2009–2014. These patients are the main group. The control group consisted of 55 patients stage III–IV locally advanced gastric cancer without metastases in the ovaries treated with surgical and combined treatment in the period from 2009 to 2014. The main group and control group were matched by major demographic and clinical characteristics. It was found that gastric cancer patients stage III–IV are prognostically unfavorable group. More than half of patients (51 %) with disseminated cancer of the stomach simultaneously diagnosed metastatic ovarian failure. When studying the remote indicators, it is evident that the presence of metastases in the ovaries is significant unfavorable prognostic factor of 2 years overall survival of postmenopausal patients over 50 years old who received only surgical treatment. However, carrying out combined treatment of patients with metastases to the ovary, without significant impairment in the first year of observation, significantly increases the 3–5-year survival (68 %).

THE PROGNOSIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION

Aim. To study the effect of transcatheter aortic valve implantation (TAVI), performed by different types of prostheses and various surgical access, on the prognosis of patients with critical aortic stenosis and comorbidities. Material and methods. Patients (n=130) that had consistently performed 80 TAVI by Edwards valve transfemoral (n=50) and transapical (n=30) access, as well as 50 transcatheter aortic valve replacement by CoreValve system were included into the study. Complications including perioperative mortality, total 30-day mortality, as well as post-hospital mortality were registered during aortic valve replacement, immediately after surgery, before the expiry of 30 days. Mean follow-up was 2.2 years (range 0.2 to 5.2 years). Results. Hospital mortality was on average 6.9%. 121 patients had been discharged from the department after the surgery. The number of deaths in the post-hospital period was 14.8%. Valve type and the type of access had no effect on post-hospital mortality. Men died more than 2.5 times often than women, regardless of age. Atrioventricular block, pacemaker implantation, and history of chronic obstructive pulmonary disease were the most significant prognostic factors. An important role of minor stroke and renal failure should be noted. Mortality did not depend on the surgical access or valve type. All parameters characterizing the intervention were significantly associated with mortality, both during and after surgery. The proportion of survivors at the end of the first year of observation using Corvalve system was 86.9%, Edwards valve by transfemoral access - 88% and Edwards valve by transapical access – 85.4% (insignificant differences for all groups, p&gt;0.05). Two-year survival was 77.5%, 82.5% and 82.7%, respectively (also insignificant differences for all groups, p&gt;0.05). Conclusion. TAVI is the method of choice, reasonable alternative approach for surgical valve replacement in patients with high surgical risk, although mortality after TAVI is still quite high and amounted to 6.9% in our study. It makes it possible to extend life and improve its quality that is of great social importance in the global trend of an aging population.

The Efficacy and Safety of Oral Rivaroxaban in Patients with Permanent Inferior Vena Cava Filter: A Pilot Case-Control Study

Aim: to evaluate the efficacy and safety of direct oral anticoagulant Rivaroxaban in patients with permanent Inferior Vena Cava (IVC) filter.Methods. This was a prospective case-control study involving 30 patients with acute DVT after implantation of IVC filter. The indication for temporary IVC filter implantation was proximal deep vein thrombosis (DVT) with ≥ 4 cm free-floating head. In the study were included patients in whom IVC filter was not removed 3 weeks after implantation because of technical failure (66.7%), persistence of irreversible risk factors or free-floating head (23.3% and 10%). After IVC filter implantation all patients were initially treated with low molecular weight heparins for 48 hours and then assigned to a standard anti-vitamin K therapy (AVK). Those who refused standard anticoagulation were allowed to choose a new oral anticoagulant and some of them were treated with Rivaroxaban 15 mg twice daily for the first 3 weeks, followed by 20 mg once daily. Totally 15 patients were treated with oral Rivaroxaban on their own: 8 men and 7 women, 35-87 years old (mean - 65.6±15.2) with 1-6 individual risk factors for venous thromboembolism (mean - 2.9±1.4). For each case patient the control one treated with AVK was matched by age (±5 years), sex and the number of individual risk factors (±1). Matching was successful in 100%.Patients were evaluated at 6th, 12th, 18th and 24th month after intervention with clinical examination, duplex ultrasound of IVC system and inspection of medical records. The endpoints of the study were: the patency of IVC filter, the rates of recurrent DVT, pulmonary embolism (PE) and bleeding.Results. During 12 month we followed up all 30 patients, during 18 month we followed up 9 cases and 14 controls and during 24 month - 2 cases and 6 controls. We found no IVC filter obstruction or PE in all patients treated with Rivaroxaban or AVK during the whole time of observation. At 6th month after intervention, we found no recurrent DVT. Hemorrhagic complications were found in one case and two controls (6.6% vs 13.3%, n.s.). At 12th month after intervention, we found one recurrent DVT in control patient (0% vs 6.6%, n.s.). New hemorrhagic complications were found in one case and one control. Totally hemorrhagic complications during first year of observation were found in 2 patients at Rivaroxaban and 3 patients at AVK without any statistically significant difference (13.3% vs 20.0%), but in controls they were more severe: one intracranial hemorrhage and two skin hemorrhage versus one skin and one gingival hemorrhage. During the second year of observation we found no new cases of DVT or bleeding.Conclusion. Using of oral Rivaroxaban in patients with permanent IVC filter seems to be not less effective and safe as standard therapy with AVK and does not lead to filter obstruction. These findings need to be confirmed in a randomized controlled trial. DisclosuresLobastov:HemaCore Company: Honoraria, Other: travel funding, Research Funding; Bayer: Honoraria, Other: travel funding. Off Label Use: Prolonged treatment of DVT with Rivaroxaban in patients with permanent inferior vena cava filter. Schastlivtsev:Bayer: Honoraria, Other: travel finding. Barinov:Bayer: Honoraria, Other: travel funding.

Changes in Endurance Performance in Young Athletes During Two Training Seasons.

The aim of the study was to assess changes in endurance performance in young runners (females and males) during two training seasons. It involved 19 male and 16 female athletes aged 15–17 specializing in track-and-field middle and long distances runs. The following parameters were measured three times during the training season: maximal oxygen uptake, running economy, and the level of the second ventilatory threshold. Training volume and intensity during each season were analyzed within an 8-week period prior to the exercise tests. The volume and intensity of training at various stages of preparation in both seasons were similar. During the first year of observation, significant improvements in relative volume of maximal oxygen uptake were reported both in female and male athletes. During the second training season, it was found that running economy improved both in women and men, with no changes in maximal oxygen uptake. The same (in terms of volume and intensity) endurance training carried out with young runners during two consecutive training seasons can result in different training effects.

Abstract 19642: Consistent Benefit of Ticagrelor Both Early and Late in Patients With Prior MI in PEGASUS-TIMI 54

Objectives: Ticagrelor reduced the risk of CV death, MI or stroke in stable patients with prior MI in PEGASUS-TIMI 54. We investigated the consistency of ticagrelor’s efficacy and safety over time and quantified the magnitude of benefit in patients who tolerated ticagrelor for the first year, analogous to the clinical situation of extending therapy in patients after 1 year. Methods: PEGASUS-TIMI 54 randomized pts with a prior MI (median 1.7 yrs prior to randomization) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily or placebo. The rate CVD/MI/stroke and TIMI major bleeding were analyzed for the pooled ticagrelor doses compared to placebo for the first year of observation and then as a landmark analysis beginning after the first year in all patients alive at that time point. Results: 21,162 patients were randomized and followed for a median of 33 months, with 29% of patients ≥5 yrs from their most recent MI by the end of the trial. The rate of CVD/MI/stroke in the placebo arm remained roughly constant over the trial at ∼3%/y. Ticagrelor significantly reduced CVD/MI/stroke both over the first year (HR 0.84, 95% CI 0.71-0.98, P=0.029, Figure Left) and after year one (HR 0.85, 95% CI 0.74-0.97, P=0.017, Figure Right), with the event curves continuing to diverge through the end of follow-up. TIMI Major bleeding was increased with ticagrelor within the first year (HR 3.46, 95% CI 2.07-5.77) but numerically less so after the first year (HR 2.06, 95% CI 1.43-2.96). When examining patients who successfully completed one year of treatment, continued ticagrelor significantly reduced CVD/MI/Stroke by over 20% over the following two years (HR 0.79, 95% CI 0.68-0.91). Conclusion: Patients with a history of MI remain at persistent risk for CVD/MI/Stroke over time. Ticagrelor reduces this risk during the first year as well as in the subsequent years of treatment, supporting prolonged therapy.

Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses

The management of women with asymptomatic adnexal masses should aim to balance potential benefit with potential harm. While masses with highly worrisome features or other signs of malignancy should be referred for surgery, the vast majority of masses have an indeterminate or benign appearance and are candidates for observation. Evidence supports the use of initial short-term serial ultrasound in distinguishing between benign and malignant masses. However, benefit from prolonged, potentially life-long monitoring of stable masses has not been demonstrated. Since the goal of monitoring an adnexal mass is to observe for worrisome growth or increasing complexity as an indicator of malignancy, if the mass remains stable, the likelihood of malignancy and therefore, the potential benefit of observation wanes with time. The recognition that Type 2 high grade serous cancers, which are responsible for the majority of deaths from ovarian cancer, arise from fallopian tube rather than ovarian precursors, further diminishes the likelihood that monitoring a stable ovarian mass will lead to early diagnosis of high grade disease. While some Type 1 cancers may develop from ovarian precursors, the available data suggest that any measurable benefit of monitoring known lesions for detection of these cancers is realized within the first year of observation. The argument in favor of indefinite, potentially life-long monitoring of stable masses also fails to adequately account for the risks of perpetual imaging, which include the risk of incidental findings, an increased likelihood of unnecessary surgery, patient anxiety and cost. It is not always better to order a test than not order a test. Given the absence of evidence of benefit, observation of stable small adnexal masses should be limited in duration in order to minimize potential harms.

Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study.

Previous evidence has shown positive associations between post-traumatic stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes mellitus, which are all risk factors for stroke, but the role of PTSD in the subsequent development of stroke is still unknown. To investigate the temporal association between PTSD and the development of stroke. Identified from the Taiwan National Health Insurance Research Database, 5217 individuals aged ≥18 years, with PTSD but with no history of stroke, and 20 868 age- and gender-matched controls were enrolled between 2002 and 2009, and followed up until the end of 2011 to identify the development of stroke. Individuals with PTSD had an increased risk of developing any stroke (hazard ratio (HR) 3.37, 95% CI 2.44-4.67) and ischaemic stroke (HR = 3.47, 95% CI 2.23-5.39) after adjusting for demographic data and medical comorbidities. Sensitivity tests showed consistent findings (any stroke HR = 3.02, 95% CI 2.13-4.28; ischaemic stroke HR = 2.89, 95% CI 1.79-4.66) after excluding the first year of observation. Individuals with PTSD have an increased risk of developing any stroke and ischaemic stroke. Further studies are required to investigate the underlying mechanisms.

Duration of anticoagulation after venous thromboembolism in real world clinical practice

IntroductionVenous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants should be administered for a minimum of three months. Since little is known about real life management of VTE, we aimed to describe current practice in the secondary prevention of VTE. Materials and MethodsUsing the database of an international, prospective registry on patients treated for VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant treatment, and clinical outcomes during follow up. Multivariate analysis using logistic regression was performed to identify predictors of treatment duration. ResultsOf 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient risk factors, 27.1% had cancer. After the exclusion of patients who died during the first year of observation, the rate of patients treated for >12months was 55.1%, 41.9%, and 43.2%, respectively (p<0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic heart failure and age >65years were independently associated with treatment for >12months. Body weight <75kg, anemia, cancer, and the presence of transient risk factors were associated with treatment for 12months or less. Major bleeding occurred more frequently than recurrent VTE in patients with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent than fatal recurrent PE in all subgroups. ConclusionsWe observed heterogeneous duration of anticoagulant treatment for the secondary prevention of VTE. A substantial proportion of patients, in particular those with VTE secondary to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.

Time to pregnancy in subfertile women in German gynecological practices: analysis of a representative cohort of more than 60,000 patients.

The aim of this study was to assess the time from the first subfertility diagnosis to pregnancy (TTP) and to elucidate factors influencing TTP for patients in German gynecological practices comprising a representative sample and provide a realistic picture of the current situation in Germany. The study collective included all women with first-time diagnoses of female infertility (ICD: N97) or unfulfilled desire for children (ICD: Z31) from the representative database (IMS Disease Analyzer). Demographic data on patients such as their age (ranges 18-25, 26-30, 31-35, 36-40 or 51-50) and information on previous pregnancies and births and concomitant diseases were collected. Data pertaining to 61,815 women from 433 gynecological practices in Germany with a first diagnosis of female infertility or an unfulfilled desire for children were analyzed. The period of data collection was between January 1, 2001 to December 31, 2012 (=144 months). The mean observation period for the patients after the first gynecological consultation was 1,420 days (=47.3 months), with a standard deviation of 879 days. A total of 22,744 patients became pregnant during the first year of observation (36.8%). The highest cumulative pregnancy rate was seen in women between 18 and 30 years of age (74.8%). The older the women were, the lower the cumulative pregnancy rate became (18.1% in the group of 41- to 50-year-old women). Cox regression calculations showed that the following factors considerably impaired the chances of pregnancy: age, endometriosis, diabetes mellitus, ovarian dysfunction, PCOS, previous infection of the genitourinary tract. In contrast, a couple of factors were proven to increase pregnancy rates, namely previous use of hormonal contraceptives, private insurance, previous birth, previous pregnancy and progesterone therapy (at any time). Along with information about reproductive physiology, such as decreasing fertility with maternal age, counseling in daily practice should also include individual factors influencing fertility. It is of the utmost importance to further increase public awareness of the impact of advanced female and male age on the reproductive outcome so that people can make well-informed decisions on when to start a family.

One-year survival rate of patients with primary malignant central nervous system tumors after surgery in Kazakhstan.

This study was conducted to evaluate the one-year survival rate of patients with primary malignant central nervous system (CNS) tumors after surgical treatment in Kazakhstan. Retrospective data of patients undergoing operations in the Department of Central Nervous System Pathology in the JSC National Centre for Neurosurgery in the period from 2009 to 2011 were used as the research material. Kaplan-Meier survival analysis was performed with the following information: gender, date of birth, place of residence, diagnosis according to ICD- 10, the date of the operation, the morphological type of tumor, clinical stage, state at the end of the first year of observation, and the date of death. The study was approved by the ethical committee of the JSC National Centre for Neurosurgery. The overall one-year overall survival rate (n=152) was 56.5% (95% confidence interval (CI): 50.2-62.7), and 79.5% (95% CI 72.2-86.8) and 33.1% (95% CI: 21.0-42.3) for Grades I-II (n=76) and Grades III-IV (n=76), respectively. Significant prognostic factors which affected the survival rate were age and higher tumor grade (Grades III-IV), corresponding with results described elsewhere in the world.

Predicting outcomes in pulmonary arterial hypertension based on the 6-minute walk distance

Clinical studies of pulmonary arterial hypertension have used the change in the 6-minute walk distance (6MWD) as a clinical end point; however, its association with survival outcomes has not been well established. In this analysis, we examined the prognostic value of the baseline 6MWD, absolute thresholds of the 6MWD, and change in the 6MWD. Patients in the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) with 6MWD at enrollment, with or without a follow-up assessment within the first year of observation, were included. Kaplan-Meier survival estimates were computed for sub-sets with baseline 6MWD results that were above or below all possible thresholds and for sub-sets with a change in the 6MWD that was 10 percentage points above or below all possible thresholds, including improvement thresholds and worsening thresholds. Multivariable Cox regression models assessed the effect of improvement and worsening in the 6MWD on 1-year survival, adjusted for baseline factors. One-year survival estimates were higher for patients with a baseline 6MWD above vs below a threshold, although no specific threshold was more prognostic than another. In a model adjusted for the baseline 6MWD and risk score, worsening of the 6MWD over time significantly predicted decreased survival, but improvement in the 6MWD did not affect survival. No 6MWD improvement threshold carries particular prognostic value. Improvement in the 6MWD was not associated with survival, but worsening of the 6MWD was strongly and significantly associated with poor prognosis.