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Al-Badawi IA, Alomar O, Alsehaimi SO, Jamjoom MZ, Abdulmalik NA, Bukhari IA, Alyousef A, Alabdrabalamir S, Baradwan S, Sayasneh A, Alqarni SMS, Abu-Zaid A. Cardiovascular Mortality in Ovarian Cancer Patients: An Analysis of Patient Characteristics Using the SEER Database. Medicina (Kaunas) 2023;59:1476. [PMID: 37629766 PMCID: PMC10456264 DOI: 10.3390/medicina59081476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]

Vasilev S, Ciupescu LM, Lalkovski N, Balic D, Vasilev D, Marucci G. Trichinella proficiency testing in Southeastern European countries. Vet Parasitol 2023;320:109982. [PMID: 37421926 DOI: 10.1016/j.vetpar.2023.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]

Abellan Beteta C, Andreou D, Artuso M, Beiter A, Blusk S, Bugiel R, Bugiel S, Carbone A, Carli I, Chen B, Conti N, De Benedetti F, Ding S, Ely S, Firlej M, Fiutowski T, Gandini P, Germann D, Grieser N, Idzik M, Jiang X, Krupa W, Li Y, Li Z, Liang X, Liu S, Lu Y, Mackey L, Moron J, Mountain R, Petruzzo M, Pham H, Schmidt B, Sheng S, Spadaro Norella E, Swientek K, Szumlak T, Tobin M, Wang J, Wilkinson M, Wu H, Zhang F, Zou Q. The SALT-Readout ASIC for Silicon Strip Sensors of Upstream Tracker in the Upgraded LHCb Experiment. Sensors (Basel) 2021;22:107. [PMID: 35009648 PMCID: PMC8747391 DOI: 10.3390/s22010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]

Affiliation(s)

Carlos Abellan Beteta Physik-Institut, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland;
Dimitra Andreou Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Marina Artuso Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Andy Beiter Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Steven Blusk Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Roma Bugiel Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Szymon Bugiel Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Antonio Carbone INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy; (A.C.); (N.C.); (F.D.B.); (P.G.); (M.P.); (E.S.N.)
Ina Carli Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Bo Chen Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.) Physics and Micro Electronic College, Hunan University, Lushan Road (S), Yuelu District, Changsha 410082, China
Nadim Conti INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy; (A.C.); (N.C.); (F.D.B.); (P.G.); (M.P.); (E.S.N.)
Federico De Benedetti INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy; (A.C.); (N.C.); (F.D.B.); (P.G.); (M.P.); (E.S.N.)
Shuchong Ding Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Scott Ely Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Miroslaw Firlej Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Tomasz Fiutowski Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Paolo Gandini INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy; (A.C.); (N.C.); (F.D.B.); (P.G.); (M.P.); (E.S.N.)
Danielle Germann Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Nathan Grieser Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Marek Idzik Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Xiaojie Jiang Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Wojciech Krupa Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Yiming Li Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Zhuoming Li Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Xixin Liang Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Shuaiyi Liu Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Yu Lu Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Lauren Mackey Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Jakub Moron Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Ray Mountain Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Marco Petruzzo INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy; (A.C.); (N.C.); (F.D.B.); (P.G.); (M.P.); (E.S.N.)
Hang Pham Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Burkhard Schmidt European Organization for Nuclear Research, CERN, CH-1211 Geneve, Switzerland;
Shuqi Sheng Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Elisabetta Spadaro Norella INFN Sezione di Milano, Via Celoria 16, 20133 Milano, Italy; (A.C.); (N.C.); (F.D.B.); (P.G.); (M.P.); (E.S.N.)
Krzysztof Swientek Physik-Institut, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland;
Tomasz Szumlak Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland; (R.B.); (S.B.); (M.F.); (T.F.); (M.I.); (W.K.); (J.M.); (T.S.)
Mark Tobin Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Jianchun Wang Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)
Michael Wilkinson Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Hangyi Wu Physics Department, Syracuse University, 900 South Crouse Ave, Syracuse, NY 13244, USA; (D.A.); (M.A.); (A.B.); (S.B.); (S.D.); (S.E.); (D.G.); (Z.L.); (X.L.); (L.M.); (R.M.); (H.P.); (M.W.); (H.W.)
Feihao Zhang Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.) Physics and Micro Electronic College, Hunan University, Lushan Road (S), Yuelu District, Changsha 410082, China
Quan Zou Institute of High Energy Physics, Chinese Academy of Sciences, 19B Yuquan Road, Shijingshan District, Beijing 100049, China; (I.C.); (B.C.); (N.G.); (X.J.); (Y.L.); (S.L.); (Y.L.); (S.S.); (M.T.); (J.W.); (F.Z.); (Q.Z.)

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Ro D, Min C, Kang M, Chang IJ, Lee HM. A Radiation-Hardened SAR ADC with Delay-Based Dual Feedback Flip-Flops for Sensor Readout Systems. Sensors (Basel) 2019;20:E171. [PMID: 31892184 DOI: 10.3390/s20010171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/08/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022]

Jakovljevic MB, Vukovic M, Fontanesi J. Life expectancy and health expenditure evolution in Eastern Europe-DiD and DEA analysis. Expert Rev Pharmacoecon Outcomes Res 2015;16:537-46. [PMID: 26606654 DOI: 10.1586/14737167.2016.1125293] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Velickovic V, Simovic A, Lazarevic G, Lazarevic M, Jakovljevic M. Improvements in Neonatal and Childhood Medical Care - Perspective from the Balkans. Front Public Health 2015;3:206. [PMID: 26380251 PMCID: PMC4550749 DOI: 10.3389/fpubh.2015.00206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/11/2015] [Indexed: 12/03/2022] Open

Wroe AJ. Evaluation and Mitigation of Secondary Dose Delivered to Electronic Systems in Proton Therapy. Technol Cancer Res Treat 2015;15:3-11. [PMID: 25616623 DOI: 10.1177/1533034614567369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/04/2014] [Indexed: 11/16/2022] Open

Abstract

PURPOSE

To evaluate the scattered and secondary radiation fields present in and around a passive proton treatment nozzle. In addition, based on these initial tests and system reliability analysis, to develop, install, and evaluate a radiation shielding structure to protect sensitive electronics against single-event effects (SEE) and improve system reliability.

METHODS AND MATERIALS

Landauer Luxel+ dosimeters were used to evaluate the radiation field around one of the gantry-mounted passive proton delivery nozzles at Loma Linda University Medical Center's James M Slater, MD Proton Treatment and Research Center. These detectors use optically stimulated luminescence technology in conjunction with CR-39 to measure doses from X-ray, gamma, proton, beta, fast neutron, and thermal neutron radiation. The dosimeters were stationed at various positions around the gantry pit and attached to racks on the gantry itself to evaluate the dose to electronics. Wax shielding was also employed on some detectors to evaluate the usefulness of this material as a dose moderator. To create the scattered and secondary radiation field in the gantry enclosure, a polystyrene phantom was placed at isocenter and irradiated with 250 MeV protons to a dose of 1.3 kGy over 16 hours. Using the collected data as a baseline, a composite shielding structure was created and installed to shield electronics associated with the precision patient positioner. The effectiveness of this shielding structure was evaluated with Landauer Luxel+ dosimeters and the results correlated against system uptime.

RESULTS

The measured dose equivalent ranged from 1 to 60 mSv, with proton/photon, thermal neutron, fast neutron, and overall dose equivalent evaluated. The position of the detector/electronics relative to both isocenter and also neutron-producing devices, such as the collimators and first and second scatterers, definitely had a bearing on the dose received. The addition of 1-inch-thick wax shielding decreased the fast neutron component by almost 50%, yet this yielded a corresponding average increase in thermal neutron dose of 150% as there was no Boron-10 component to capture thermal neutrons. Using these data as a reference, a shielding structure was designed and installed to minimize radiation to electronics associated with the patient positioner. The installed shielding reduced the total dose experienced by these electronics by a factor of 5 while additionally reducing the fast and thermal neutron doses by a factor of 7 and 14, respectively. The reduction in radiation dose corresponded with a reduction of SEE-related downtime of this equipment from 16.5 hours to 2.5 hours over a 6-month reporting period.

CONCLUSIONS

The data obtained in this study provided a baseline for radiation exposures experienced by gantry- and pit-mounted electronic systems. It also demonstrated and evaluated a shielding structure design that can be retrofitted to existing electronic system installations. It is expected that this study will benefit future upgrades and facility designs by identifying mechanisms that may minimize radiation dose to installed electronics, thus improving facility uptime.

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Cleary M, Trefz F, Muntau AC, Feillet F, van Spronsen FJ, Burlina A, Bélanger-Quintana A, Giżewska M, Gasteyger C, Bettiol E, Blau N, MacDonald A. Fluctuations in phenylalanine concentrations in phenylketonuria: a review of possible relationships with outcomes. Mol Genet Metab 2013;110:418-23. [PMID: 24090706 DOI: 10.1016/j.ymgme.2013.09.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/21/2022]

Fukuda DH, Smith-Ryan AE, Kendall KL, Moon JR, Stout JR. Simplified method of clinical phenotyping for older men and women using established field-based measures. Exp Gerontol 2013;48:1479-88. [PMID: 24140621 DOI: 10.1016/j.exger.2013.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/02/2013] [Accepted: 10/08/2013] [Indexed: 12/25/2022]

Abstract

The purpose of this investigation was to determine body composition classification using field-based testing measurements in healthy elderly men and women. The use of isoperformance curves is presented as a method for this determination. Baseline values from 107 healthy Caucasian men and women, over the age of 65years old, who participated in a separate longitudinal study, were used for this investigation. Field-based measurements of age, height, weight, body mass index (BMI), and handgrip strength were recorded on an individual basis. Relative skeletal muscle index (RSMI) and body fat percentage (FAT%) were determined by dual-energy X-ray absorptiometry (DXA) for each participant. Sarcopenia cut-off values for RSMI of 7.26kg·m(-2) for men and 5.45kg·m(-2) for women and elderly obesity cut-off values for FAT% of 27% for men and 38% for women were used. Individuals above the RSMI cut-off and below the FAT% cut-off were classified in the normal phenotype category, while individuals below the RSMI cut-off and above the FAT% cut-off were classified in the sarcopenic-obese phenotype category. Prediction equations for RSMI and FAT% from sex, BMI, and handgrip strength values were developed using multiple regression analysis. The prediction equations were validated using double cross-validation. The final regression equation developed to predict FAT% from sex, BMI, and handgrip strength resulted in a strong relationship (adjusted R(2)=0.741) to DXA values with a low standard error of the estimate (SEE=3.994%). The final regression equation developed to predict RSMI from the field-based testing measures also resulted in a strong relationship (adjusted R(2)=0.841) to DXA values with a low standard error of the estimate (SEE=0.544kg·m(-2)). Isoperformance curves were developed from the relationship between BMI and handgrip strength for men and women with the aforementioned clinical phenotype classification criteria. These visual representations were used to aid in the classification and evaluation of sarcopenia, obesity, and sarcopenic-obesity in elderly individuals. Future research should replicate the current findings with an increased sample size and the development of tailored interventions for each body composition category.

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Reilly PA, Lehr T, Haertter S, Connolly SJ, Yusuf S, Eikelboom JW, Ezekowitz MD, Nehmiz G, Wang S, Wallentin L. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J Am Coll Cardiol 2013;63:321-8. [PMID: 24076487 DOI: 10.1016/j.jacc.2013.07.104] [Citation(s) in RCA: 630] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/17/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022]

Abstract

OBJECTIVES

The goal of this study was to analyze the impact of dabigatran plasma concentrations, patient demographics, and aspirin (ASA) use on frequencies of ischemic strokes/systemic emboli and major bleeds in atrial fibrillation patients.

BACKGROUND

The efficacy and safety of dabigatran etexilate were demonstrated in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, but a therapeutic concentration range has not been defined.

METHODS

In a pre-specified analysis of RE-LY, plasma concentrations of dabigatran were determined in patients treated with dabigatran etexilate 110 mg twice daily (bid) or 150 mg bid and correlated with the clinical outcomes of ischemic stroke/systemic embolism and major bleeding using univariate and multivariate logistic regression and Cox regression models. Patient demographics and ASA use were assessed descriptively and as covariates.

RESULTS

Plasma concentrations were obtained from 9,183 patients, with 112 ischemic strokes/systemic emboli (1.3%) and 323 major bleeds (3.8%) recorded. Dabigatran levels were dependent on renal function, age, weight, and female sex, but not ethnicity, geographic region, ASA use, or clopidogrel use. A multiple logistic regression model (c-statistic 0.657, 95% confidence interval [CI]: 0.61 to 0.71) showed that the risk of ischemic events was inversely related to trough dabigatran concentrations (p = 0.045), with age and previous stroke (both p < 0.0001) as significant covariates. Multiple logistic regression (c-statistic 0.715, 95% CI: 0.69 to 0.74) showed major bleeding risk increased with dabigatran exposure (p < 0.0001), age (p < 0.0001), ASA use (p < 0.0003), and diabetes (p = 0.018) as significant covariates.

CONCLUSIONS

Ischemic stroke and bleeding outcomes were correlated with dabigatran plasma concentrations. Age was the most important covariate. Individual benefit-risk might be improved by tailoring dabigatran dose after considering selected patient characteristics. (Randomized Evaluation of Long Term Anticoagulant Therapy [RE-LY] With Dabigatran Etexilate; NCT00262600).

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Bino S, Cavaljuga S, Kunchev A, Lausevic D, Kaic B, Pistol A, Kon P, Karadjovski Z, Georghita S, Cicevalieva S. Southeastern European Health Network (SEEHN) Communicable Diseases Surveillance: a decade of bridging trust and collaboration. Emerg Health Threats J 2013;6:19950. [PMID: 23362410 PMCID: PMC3557907 DOI: 10.3402/ehtj.v6i0.19950] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]