BackgroundEarly aspirin withdrawal, also known as P2Y12-inhibitor monotherapy, following percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) can... Show moreBackgroundEarly aspirin withdrawal, also known as P2Y12-inhibitor monotherapy, following percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) can reduce bleeding without a trade-off in efficacy. Still the average daily bleeding risk is highest during the first months and it remains unclear if aspirin can be omitted immediately following PCI.MethodsThe LEGACY study is an open-label, multicenter randomized controlled trial evaluating the safety and efficacy of immediate P2Y12-inhibitor monotherapy versus dual antiplatelettherapy (DAPT) for 12 months in 3,090 patients. Patients are randomized immediately following successful PCI for NSTE-ACS to 75-100 mg aspirin once daily versus no aspirin. The primary hypothesis is that immediately omitting aspirin is superior to DAPT with respect to major or minor bleeding defined as Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, while maintaining noninferiority for the composite of all-cause mortality, myocardial infarction and stroke compared to DAPT.ConclusionsThe LEGACY study is the first randomized study that is specifically designed to evaluate the impact of immediately omitting aspirin, and thus treating patients with P2Y12-inhibitor monotherapy, as compared to DAPT for 12 months on bleeding and ischemic events within 12 months following PCI for NSTE-ACS. Show less
Bax, M.; Marsan, N.A.; Delgado, V.; Bax, J.J.; Bijl, P. van der 2022
Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical... Show moreAtrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 +/- 5.6 ml/m(2), and the mean RA volume index was 71.0 +/- 21.6 ml/m(2). Mean LA reservoir strain was 24.3 +/- 15.1%, compared with the mean RA reservoir strain of 21.6 +/- 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p < 0.001). Patients with permanent AF had larger LA volumes (44.0 [IQR 33.7 to 55.2] ml/m(2) vs 36.9 [IQR 30.1 to 47.1] ml/m(2), p = 0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy. (c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) Show less
Zilinskas, M.; Miguel, Y.; Lyu, Y.P.; Bax, M. 2021
We show that in extremely irradiated atmospheres of hot super-Earths shortwave absorption of CN can cause strong temperature inversions. We base this study on previous observations of 55 Cancri e,... Show moreWe show that in extremely irradiated atmospheres of hot super-Earths shortwave absorption of CN can cause strong temperature inversions. We base this study on previous observations of 55 Cancri e, which lead us to believe that ultrashort-period super-Earths can sustain volatile atmospheres, rich in nitrogen and/or carbon. We compute our model atmospheres in a radiative-convective equilibrium for a variety of nitrogen-rich cases and orbital parameters. We demonstrate the effects caused by thermal inversions on the chemistry and compute low-resolution synthetic emission spectra for a range of 0.5-28 mu m. Our results indicate that due to shortwave absorption of CN, atmospheres with temperatures above 2000 K and C/O >= 1.0 are prone to thermal inversions. CN is one of the few molecules that is extremely stable at large temperatures occurring on the dayside of short-period super-Earths. The emission spectrum of such atmospheres will differ substantially from non-inverted cases. In the case of inversions, absorption features become inverted, showing higher than expected flux. We propose that inversions in hot atmospheres should be the expected norm. Hot super-Earths are some of the most extreme natural laboratories for testing predictions of atmospheric chemistry and structure. They are frequently occurring, bright in emission and have short orbital periods. All these factors make them perfect candidates to be observed with JWST and ARIEL missions. Show less
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting 0.5-1% of the population worldwide. The disease has a heterogeneous character, including clinical subsets of anti-citrullinated... Show moreRheumatoid arthritis (RA) is a chronic autoimmune disease affecting 0.5-1% of the population worldwide. The disease has a heterogeneous character, including clinical subsets of anti-citrullinated protein antibody (ACPA)-positive and APCA-negative disease. Although the pathogenesis of RA is poorly understood, progress has been made in identifying genetic factors that contribute to the disease. The most important genetic risk factor for RA is found in the human leukocyte antigen (HLA) locus. In particular, the HLA molecules carrying the amino acid sequence QKRAA, QRRAA, or RRRAA at positions 70-74 of the DR beta 1 chain are associated with the disease. The HLA molecules carrying these "shared epitope" sequences only predispose for ACPA-positive disease. More than two decades after the discovery of HLA-DRB1 as a genetic risk factor, the second genetic risk factor for RA was identified in 2003. The introduction of new techniques, such as methods to perform genome-wide association has led to the identification of more than 20 additional genetic risk factors within the last 4 years, with most of these factors being located near genes implicated in immunological pathways. These findings underscore the role of the immune system in RA pathogenesis and may provide valuable insight into the specific pathways that cause RA. Show less
Wang, J.; Bax, M.; Balog, C.I.A.; Stavenhagen, K.; Koeleman, C.A.M.; Scherer, H.U.; ... ; Wuhrer, M. 2011
