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CYP2C19 polymorphism is significantly associated with risk of adverse clinical events in clopidogrel-treated patients.

We developed the first tree-ring chronology, based on 73 cores from 29 Pinus tabulaeformis trees, for the Xiaolong Mountain area of central China, a region at the boundary of the Asian summer monsoon. This chronology exhibits significant (at 0.01 level) positive correlations with precipitation in May and June, and negative correlations with temperature in May, June and July. Highest linear correlation is observed between tree growth and the seasonalized (April-July) precipitation, suggesting that tree rings tend to integrate the monthly precipitation signals. Accordingly, the April-July total precipitation was reconstructed back to 1629 using these tree rings, explaining 44.7 % of the instrumental variance. A severe drought occurred in the area during the 1630s-1640s, which may be related to the weakened Asian summer monsoon caused by a low land-sea thermal gradient. The dry epoch during the 1920s-1930s and since the late 1970s may be explained by the strengthened Hadley circulation in a warmer climate. The dry (wet) epochs of the 1920s-1930s (the 1750s and 1950s) occurred during the warm (cold) phases of the El Niño-Southern Oscillation and the Pacific Decadal Oscillation that are often associated with weakened (strengthened) East Asian summer monsoon. These relationships indicate significant teleconnections operating over the past centuries in central China related to large-scale synoptic features.

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Objective. This meta-analysis with trial sequential analysis (TSA) compared the clinical efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) with conventional CPR (CCPR) for adult patients who experienced in-hospital cardiac arrest (IHCA) or out-of-hospital CA (OHCA). Methods. A literature search was used to identify eligible publications (up to 30 July 2018) from PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase. Two investigators independently conducted the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and TSA were used to analyze each outcome, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the level of evidence. The primary outcome was 30-day survival, and the secondary outcomes were 30-day neurologic outcome, 3-6 months’ survival, 3-6 months’ neurological outcome, 1-year survival, and 1-year neurological outcome. Results. We identified 13 eligible observational studies for the final analysis. Pooled analyses showed that ECPR was associated with a significantly better 30-day survival (RR = 1.60, 95% CI = 1.25–2.06) and 30-day neurologic outcome (RR = 2.69, 95% CI = 1.63–4.46), and TSA confirmed these results. However, subgroup analysis of patients with OHCA indicated that ECPR and CCPR had similar effects on 30-day survival (RR = 1.18, 95% CI = 0.71–1.97), which was not confirmed by TSA. Analysis of OHCA patients indicated that ECPR provided a better 30-day neurological outcome (RR = 3.93, 95% CI = 1.00–15.50), but TSA did not support these results. Analysis of IHCA patients indicated that ECPR was associated with a better 30-day survival (RR 1.90, 95% CI 1.43–2.52) and 30-day neurologic outcome (RR 2.02, 95% CI 1.21–3.39), and TSA supported these results. Other subgroup analyses showed that the results were generally consistent, regardless of nation, propensity score matching, presumed etiology, whether the CA was witnessed or not, and study quality. Conclusions. Relative to CCPR, ECPR improved the survival and neurological outcome of patients who had IHCA. Compared to IHCA patients, TSA could not confirm better survival and neurologic outcome of ECPR in OHCA patients, suggesting that further studies are needed. Trial Registration. This trial was registered with PROSPERO (CRD42018100513) on 17 July 2018.