52,093 research outputs found
Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology
No full textThe most recent atrial fibrillation (AF) guidelines delivered by European Society of Cardiology (ESC) offer an updated approach to AF management, with the perspective of improved characterization of the arrhythmia, the cardiac substrate and the patients profile in terms of associated risk factors and comorbidities. Recommendations were based on careful scrutiny and assessment of all available evidence with the final aim to offer to practitioners a lower level of uncertainty in the complex process of decision making for patients with AF. The 2020 ESC guidelines on AF propose a paradigm shift in the clinical approach to AF patients, moving from a single-domain AF classification to comprehensive characterization of AF patients. Given the complex nature of AF, an integrated holistic management of AF patients is suggested by the guidelines for improving patients outcomes through the formal introduction of the CC (Confirm AF and Characterize AF) to ABC (Atrial fibrillation Better Care) pathway. In line with this concept, these new guidelines underline the importance of a more comprehensive management of AF patients which should not be limited to simply prescribe oral anticoagulation or decide between a rhythm or rate control strategy. Indeed, each step of the ABC pathway represents one of the pivotal pillars in the management of AF and only a holistic approach has the potential to improve patients’ outcomes. In this review we will discuss the background that supports some of the new recommendations of 2020 ESC guidelines, with important implications for daily management of AF patients
The role of amiodarone in contemporary management of complex cardiac arrhythmias
No full textAmiodarone is an iodinated benzofuran derivative, a highly lipophilic drug with unpredictable pharmacokinetics. Although originally classified as a class III agent due to its ability to prolong refractoriness in cardiac regions and prevent/terminate re-entry, amiodarone shows antiarrhythmic properties of all four antiarrhythmic drug classes. Amiodarone is a potent coronary and peripheral vasodilator and can be safely used in patients with left ventricular dysfunction after myocardial infarction or those with congestive heart failure or hypertrophic cardiomyopathy. Its use is regularly accompanied with QT and QTc-interval prolongation but rarely with ventricular proarrhythmia. It is the most powerful pharmacological agent for long-term sinus rhythm maintenance in patients with atrial fibrillation. Amiodarone, particularly if co-administered with beta-blockers, reduces the rate of arrhythmic death due to ventricular tachyarrhythmias in patients with heart failure, but its benefit on cardiovascular and overall survival in these patients is uncertain. In addition, amiodarone is an important adjuvant drug for the reduction of shocks in patients with an implantable cardioverter-defibrillator. Over the past 40 years, amiodarone became the most prescribed antiarrhythmic. Nevertheless, the slow onset of its antiarrhythmic action requires a loading dose while the high risk of non-cardiac toxicity and common drug-drug interactions limit its long-term use. Furthermore patients treated with amiodarone require a close supervision by the treating physician. Therefore amiodarone is generally considered a secondary therapeutic option. Long-term treatment with amiodarone should be based on the use of minimal doses for satisfactory arrhythmia outcome and serial screening for thyroid, liver and pulmonary toxicity
Acoustic radiation due to scattering of T-S wave by the mean-flow distortion induced by steady local suction
No full textSubstantial sound waves can be generated by boundary-layer instability modes when the latter are scattered by a rapid mean-flow distortion. This is a rather generic mechanism and operates when an oncoming T-S wave is scattered by a steady local suction slot. This paper focuses on this problem by extending a recently developed Local Scattering Theory (Wu & Dong, J. Fluid Mech. submitted), where a so-called transmission coefficient, defined as the ratio of the T-S wave amplitude downstream of the scatter to that upstream, is introduced to characterize the effect of a local scatter on boundary-layer instability and transition. As in the earlier work, the mathematical formulation is based on triple-deck formulism, but in order to accommodate the acoustic far field, which was not considered in the paper mentioned, the unsteady terms in the upper deck, which play a leading-order role in radiation, are retained, and the influence of the radiated sound on the near-wall perturbation is included. The upper deck equation for the pressure is the Helmholtz equation rather than the Laplace equation. This leads to a modified pressure-displacement relation, which is coupled with the linearized boundary-layer equations in the lower deck. Discretization of the whole system formulates a generalized eigenvalue problem, which is solved numerically. It is found that suction suppresses oncoming T-S waves, and this effect increases with the suction velocity and the slot width. The directivity is ndependent of the flow parameters only when the Mach number is low. The intensity of the radiated sound in general increases with the frequency, the suction velocity and the width of the suction slot. Interestingly, for O(1) suction velocities, the radiated sound is very weak, indicating that the gain of stabilizing effect does not cause aeroacoustic penalty
SERUM cardiac-specific biomarkers and atrial fibrillation in myotonic dystrophy type I
No full textIntroduction: The aim of the present study was to evaluate the role of high-sensitivity cardiac troponin I, N terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase-MB mass concentration (CK-MB mass) and copeptin (CP) in predicting incident atrial fibrillation (AF) in myotonic dystrophy type 1 (DM1) patients. Materials and methods: The study enrolled 60 consecutive DM1 patients (age 50.3 ± 7.3 years, 34 male) who underwent pacemaker (PM) implantation for cardiac rhythm abnormalities and 60 PM recipients whose age and sex matched served as control group. All DM1 patients underwent a 12-lead electrocardiogram, 2D color Doppler echocardiogram, biomarkers measurements and device interrogation at implantation, 1 month after and every 6 months thereafter for a minimum of 2-year follow-up. Results: The study population was divided into two groups according to the presence of AF (AF group vs non-AF group). The AF group was older (47.3 ± 8 vs 38.6 ± 7 years, P =.03) and showed higher serum levels of NT-proBNP (151 ± 38.4 vs 107.3 ± 24.2 pg/mL, P <.001) and CP (18.9 ± 4.5 vs 7 ± 2.3 P <.001) than non-AF Group. NT-proBNP (P <.001) and CP (P <.001) were found to be an independent predictor of AF. Based on the receiver-operating characteristics curve analysis, the cut-off value for NT-proBNP that best predicted AF event in DM1 patients was 123 pg/ml (sensitivity of 83.3% and specificity of 86.5%); the cut-off value for CP that best predicted AF event in DM1 patients was 9 pmol/L (sensitivity of 89% and specificity of 87%). Conclusion: NT-proBNP and CP represent two independent predictors of AF onset in DM1 population with conduction disturbances underwent PM implantation
Peri-procedural management, implantation feasibility, and short-term outcomes in patients undergoing implantation of leadless pacemakers: European Snapshot Survey
No full textThe aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess procedural settings, safety measures, and short-term outcomes associated with implantation of leadless pacemakers (LLPM), across a broad range of tertiary European electrophysiology centres. An internet-based electronic questionnaire (30 questions) concerning implantation settings, peri-procedural routines, complications, and in-hospital patient outcomes was circulated to centres routinely implanting both LLPMs and transvenous pacemakers (TV-PM). The centres were requested to prospectively include consecutive patients implanted with either LLPMs or TV-PMs during the 10-week enrolment period. Overall, 21 centres from four countries enrolled 825 consecutive patients between November 2018 and January 2019, including 69 (9%) implanted with LLPMs. Leadless pacemakers were implanted mainly under local anaesthesia (69%), by an electrophysiologist (60%), in the electrophysiology laboratory (71%); 95% of patients received prophylactic antibiotics prior to implantation. Most patients on chronic oral anticoagulation were operated on-drug (35%), or during short-term (to 48 h) drug withdrawal (54%). Implantation was successful in 98% of patients and the only in-hospital procedure-related complication was groyne haematoma in one patient. This EHRA snapshot survey provides important insights into LLPM implantation routines and patient outcomes. These findings suggest that despite the unfavourable clinical profile of pacemaker recipients, LLPM implantation is associated with relatively low risk of complications and good short-term outcomes
Measuring industry-science links through inventor-author relations: A profiling method
No full textIn this pilot study we examine the performance of text-based profiling in recovering a set of validated inventor-author links. In a first step we match patents and publications solely based on their similarity in content. Next, we compare inventor and author names on the highest ranked matches for the occurrence of name matches. Finally, we compare these candidate matches with the names listed in a validated set of inventor-author names. Our text-based profile methodology performs significantly better than a random matching of patents and publications, suggesting that text-based profiling is a valuable complementary tool to the name searches used in previous studies.innovation; industry-science links; text-based profiling;
The maternal immune system during pregnancy and its influence on fetal development
No full textThe maternal immune system plays a critical role in the establishment, maintenance, and completion of a healthy pregnancy. However, the specific mechanisms utilized to achieve these goals are not well understood. Various cells and molecules of the immune system are key players in the development and function of the placenta and the fetus. Effector cells of the immune system act to promote and yet limit placental development. The T helper 1 (Th1)/T helper 2 (Th2) immune shift during pregnancy is well established. A fine balance between proinflammatory and anti-inflammatory influences is required. We herein review the evidence regarding maternal tolerance of fetal tissues and the underlying cell-mediated immune and humoral (hormones and cytokines) mechanisms. We also note the many unanswered questions in our understanding of these mechanisms. In addition, we summarize the clinical manifestations of an altered maternal immune system during pregnancy related to susceptibility to common viral, bacterial, and parasitic infections, as well as to autoimmune diseases.Peer reviewe
S-heterocyclic carbene with a disilane backbone
No full textPT: J; CR: AKASAKA T, 1999, ORG LETT, V1, P1509 AKASAKA T, 2000, J AM CHEM SOC, V122, P7134 ALCARAZO M, 2004, J AM CHEM SOC, V126, P13242 ALDER RW, 1999, CHEM COMMUN 0207, P241 ARDUENGO AJ, 1991, J AM CHEM SOC, V113, P361 ARDUENGO AJ, 1995, J AM CHEM SOC, V117, P11027 BAZINET P, 2003, J AM CHEM SOC, V123, P13314 BECKE AD, 1988, PHYS REV A, V38, P30989 BECKE AD, 1993, J CHEM PHYS, V98, P5648 BOURISSOU D, 2000, CHEM REV, V100, P39 DESPAGNETAYOUB E, 2004, J AM CHEM SOC, V126, P10198 DESPAGNETAYOUB E, 2005, ORGANOMETALLICS, V24, P338 ENDERS D, 2001, J ORGANOMET CHEM, V617 FABIAN J, 2000, J ORG CHEM, V65, P8940 FEKETE A, 2002, J ORGANOMET CHEM, V643, P278 FRANCL MM, 1982, J CHEM PHYS, V77, P3654 GRAHAM DC, 2005, J PHYS ORG CHEM, V18, P298 HAHN FE, 2000, ANGEW CHEM INT EDIT, V39, P541 HAHN FE, 2000, ANGEW CHEM, V112, P551 HERRMANN WA, 2002, ANGEW CHEM INT EDIT, V41, P1290 HERRMANN WA, 2002, ANGEW CHEM, V114, P1342 HILLIER AC, 2002, J ORGANOMET CHEM, V653, P69 HIRSCH A, 1993, CHEM BER, V126, P1061 HOZ T, 1993, CHEM SULFUR CONTAINI, P1 ISHITSUKA MO, 2004, TETRAHEDRON LETT, V45, P6321 JAFARPOUR L, 2001, ADV ORGANOMET CHEM, V46, P181 KRAHULIC KE, 2005, J AM CHEM SOC, V127, P4142 KYUSHIN S, 1994, CHEM LETT, P997 KYUSHIN S, 1996, J ORGANOMET CHEM, V521, P413 KYUSHIN S, 2000, CHEM LETT 0505, P494 LEE C, 1988, PHYS REV B, V37, P785 LIU MTH, 2003, J ORG CHEM, V68, P7471 MARTIN D, 2005, ANGEW CHEM INT EDIT, V44, P1700 MARTIN D, 2005, ANGEW CHEM, V117, P1728 MATSUMOTO H, 2000, J ORGANOMET CHEM, V611, P52 MOSS RA, 1980, ACCOUNTS CHEM RES, V13, P58 MOSS RA, 1988, J AM CHEM SOC, V110, P4443 OTTO M, 2004, J AM CHEM SOC, V126, P1016 PERRY MC, 2003, TETRAHEDRON-ASYMMETR, V14, P951 PIETRO WJ, 1982, J AM CHEM SOC, V104, P5039 WAKAHARA T, 2002, J AM CHEM SOC, V124, P9465 WIBERG N, 2002, CHEM-EUR J, V8, P2730 WIN WW, 1994, J ORG CHEM, V59, P5817; NR: 43; TC: 1; J9: ANGEW CHEM INT ED; PG: 4; GA: 989STSource type: Electronic(1
Heterogeneous and tissue-specific regulation of effector T cell responses by IFN-gamma during Plasmodium berghei ANKA infection.
No full textIFN-γ and T cells are both required for the development of experimental cerebral malaria during Plasmodium berghei ANKA infection. Surprisingly, however, the role of IFN-γ in shaping the effector CD4(+) and CD8(+) T cell response during this infection has not been examined in detail. To address this, we have compared the effector T cell responses in wild-type and IFN-γ(-/-) mice during P. berghei ANKA infection. The expansion of splenic CD4(+) and CD8(+) T cells during P. berghei ANKA infection was unaffected by the absence of IFN-γ, but the contraction phase of the T cell response was significantly attenuated. Splenic T cell activation and effector function were essentially normal in IFN-γ(-/-) mice; however, the migration to, and accumulation of, effector CD4(+) and CD8(+) T cells in the lung, liver, and brain was altered in IFN-γ(-/-) mice. Interestingly, activation and accumulation of T cells in various nonlymphoid organs was differently affected by lack of IFN-γ, suggesting that IFN-γ influences T cell effector function to varying levels in different anatomical locations. Importantly, control of splenic T cell numbers during P. berghei ANKA infection depended on active IFN-γ-dependent environmental signals--leading to T cell apoptosis--rather than upon intrinsic alterations in T cell programming. To our knowledge, this is the first study to fully investigate the role of IFN-γ in modulating T cell function during P. berghei ANKA infection and reveals that IFN-γ is required for efficient contraction of the pool of activated T cells
Letter from Carl Hayden to Fred S. Breen
No full textLetter from Carl T. Hayden to Fred S. Breen concerning the expenditure of $100,000 to purchase Bright Angel Trail
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