title: Impact of Concomitant Surgical Atrial Fibrillation Ablation in Patients Undergoing Aortic Valve Replacement

authors: Yoo, Jae Suk

subjects: Science & Technology

abstract: Background: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain.
Methods and Results: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9–47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56–2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001).
Conclusions: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.

text: Impact of Concomitant Surgical Atrial Fibrillation Ablation in Patients Undergoing Aortic Valve Replacement Background: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain.
Methods and Results: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9–47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56–2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001).
Conclusions: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.

year: 2014-06

title: Interhemispheric gradient of atmospheric radiocarbon reveals natural variability of Southern Ocean winds

authors: Rodgers, K.B.

subjects: Δ¹⁴C

abstract: Tree ring Δ¹⁴C data (Reimer et al., 2004; McCormac et al., 2004) indicate that atmospheric Δ¹⁴C varied on multi-decadal to centennial timescales, in both hemispheres, over the pre-industrial period AD 950–1830. Although the Northern and Southern Hemispheric Δ¹⁴C records display similar variability, it is difficult from these data alone to distinguish between variations driven by ¹⁴CO₂ production in the upper atmosphere (Stuiver, 1980) and exchanges between carbon reservoirs (Siegenthaler, 1980). Here we consider rather the Interhemispheric Gradient in atmospheric Δ¹⁴C as revealing of the background pre-bomb air-sea Disequilbrium Flux between 14CO₂ and CO₂. As the global maximum of the Disequilibrium Flux is squarely centered in the open ocean regions of the Southern Ocean, relatively modest perturbations to the winds over this region drive significant perturbations to the Interhemispheric Gradient. The analysis presented here implies that changes to Southern Ocean windspeeds are likely a main driver of the observed variability in the Interhemispheric Gradient over 950–1830, and further, that this variability may be larger than the Southern Ocean wind trends that have been reported for recent decades (notably 1980–2004). This interpretation also implies a significant weakening of the winds over the Southern Ocean within a few decades of AD 1375, associated with the transition between the Medieval Climate Anomaly and the Little Ice Age. The driving forces that could have produced such a shift in the winds remain unkown.

text: Interhemispheric gradient of atmospheric radiocarbon reveals natural variability of Southern Ocean winds Tree ring Δ¹⁴C data (Reimer et al., 2004; McCormac et al., 2004) indicate that atmospheric Δ¹⁴C varied on multi-decadal to centennial timescales, in both hemispheres, over the pre-industrial period AD 950–1830. Although the Northern and Southern Hemispheric Δ¹⁴C records display similar variability, it is difficult from these data alone to distinguish between variations driven by ¹⁴CO₂ production in the upper atmosphere (Stuiver, 1980) and exchanges between carbon reservoirs (Siegenthaler, 1980). Here we consider rather the Interhemispheric Gradient in atmospheric Δ¹⁴C as revealing of the background pre-bomb air-sea Disequilbrium Flux between 14CO₂ and CO₂. As the global maximum of the Disequilibrium Flux is squarely centered in the open ocean regions of the Southern Ocean, relatively modest perturbations to the winds over this region drive significant perturbations to the Interhemispheric Gradient. The analysis presented here implies that changes to Southern Ocean windspeeds are likely a main driver of the observed variability in the Interhemispheric Gradient over 950–1830, and further, that this variability may be larger than the Southern Ocean wind trends that have been reported for recent decades (notably 1980–2004). This interpretation also implies a significant weakening of the winds over the Southern Ocean within a few decades of AD 1375, associated with the transition between the Medieval Climate Anomaly and the Little Ice Age. The driving forces that could have produced such a shift in the winds remain unkown.

year: 2011

title: Characteristics and outcomes of patients with small cell lung cancer - findings from a New Zealand SACT database

authors: Lawrenson, Ross

abstract: Background Small Cell Lung Cancer (SCLC) SCLC generally presents late and is treated with systemic anti-cancer treatment (SACT). Māori are over represented in Lung Cancer statistics but disparities between Māori and non-Māori in patterns of care and survival from SCLC have not been previously reported. 
Methods We used the custom-built SACT database collected by the Oncology Department at Waikato Hospital NZ, which recorded comprehensive lung cancer patient factors and SACT regimens from 2000 to 2021. We reported summary statistics to review the treatment by ethnicity, explored Kaplan Meier all-cause survival of patients, and estimated the unadjusted and adjusted odds ratios of surviving 12 months. 
Results 742 patients with SCLC were included in this study, with 43% identified as Māori. Approximately 75% of patients received SACT, and there was no difference in the uptake of SACT between Māori and non-Māori. The median survival for SCLC was 8.5 months. After adjustment, patients treated with carboplatin plus etoposide (with/without durvalumab) or cisplatin plus etoposide were 1.5 times or 4.9 times respectively more likely to survive 12 months than those without a SACT regimen.
Conclusion There was no significant evidence of disparities in patterns of care and outcomes between Māori and non-Māori with SCLC. Carboplatin/cisplatin in combination with etoposide remained the primary first line SACT regimen for patients with SCLC in this New Zealand cancer treatment centre.

text: Characteristics and outcomes of patients with small cell lung cancer - findings from a New Zealand SACT database Background Small Cell Lung Cancer (SCLC) SCLC generally presents late and is treated with systemic anti-cancer treatment (SACT). Māori are over represented in Lung Cancer statistics but disparities between Māori and non-Māori in patterns of care and survival from SCLC have not been previously reported. 
Methods We used the custom-built SACT database collected by the Oncology Department at Waikato Hospital NZ, which recorded comprehensive lung cancer patient factors and SACT regimens from 2000 to 2021. We reported summary statistics to review the treatment by ethnicity, explored Kaplan Meier all-cause survival of patients, and estimated the unadjusted and adjusted odds ratios of surviving 12 months. 
Results 742 patients with SCLC were included in this study, with 43% identified as Māori. Approximately 75% of patients received SACT, and there was no difference in the uptake of SACT between Māori and non-Māori. The median survival for SCLC was 8.5 months. After adjustment, patients treated with carboplatin plus etoposide (with/without durvalumab) or cisplatin plus etoposide were 1.5 times or 4.9 times respectively more likely to survive 12 months than those without a SACT regimen.
Conclusion There was no significant evidence of disparities in patterns of care and outcomes between Māori and non-Māori with SCLC. Carboplatin/cisplatin in combination with etoposide remained the primary first line SACT regimen for patients with SCLC in this New Zealand cancer treatment centre.

year: 2023-02-10