Inflammatory cardiomyopathy - diagnosis and risk stratification in myocarditis

Background: Acute myocarditis remains a challenging clinical diagnosis with limited epidemiological data and poorly defined markers of adverse risk. We sought to build a better understanding of myocarditis epidemiology and to integrate clinical, genetic and advanced imaging data to generate new insights into myocarditis pathobiology. Methods and Results: (1) Evaluation of population-level hospital admission data from NHS England from 1998-2017 revealed a rising incidence of myocarditis, at least two-fold greater than that reported from pathological registries, most commonly amongst men with median age 36 years and women aged 46 years, with distinct peaks over Winter and the greatest burden in London. (2) Cardiovascular magnetic resonance (CMR) phenotype study of a 114 prospectively recruited patients with acute myocarditis demonstrated the natural history of changes in left ventricular parameters over 12 months and revealed a correlation between change in myocardial mechanics, specifically circumferential strain, and extent of myocardial oedema by T2 mapping (R=-0.70, p=0.01). (3) Genetic sequencing of 231 unrelated patients recruited with acute myocarditis revealed the presence of truncating variants in key cardiomyopathy genes in 4.8% of the cohort, particularly linked to arrhythmogenic ventricular cardiomyopathy (AVC) with significant enrichment compared with 1054 healthy volunteers indicating a potential overlap between myocarditis and AVC (odds ratio 8.2; 95% CI 2.4-28.3; p=0.001). (4) Retrospective long-term clinical outcome study of 401 patients with mid-wall/subepicardial late gadolinium enhancement (LGE) but otherwise normal LV volumes and function suggestive of healed myocarditis demonstrated a low risk of actual or aborted sudden cardiac death over a median follow-up of 4.3 years (incidence rate per 100 patient-years of 0.05%). (5) Psychological study of post-traumatic stress disorder amongst 231 patients with acute myocarditis compared with 44 patients with acute myocardial infarction highlighted the profound and long-lasting psychological morbidity associated uniquely with myocarditis. Conclusion: Myocarditis is a heterogeneous disease that remains vastly underestimated in prevalence. Integration of advanced CMR techniques with genomic data may provide incremental value in early diagnosis, non-invasive surveillance and identification of high-risk individuals who may benefit from a more personalised approach with close monitoring and targeted therapy.Open Acces

11th European Headache Federation Congress jointly with 31st Congress of the Italian Society for the Study of Headaches : Rome, Italy. 01-03 December 2017

. Aims of the study were explore the relationship between peripheral chromatic and central visual dysfunction evaluating also the presence of functional receptor impairment in patients with migraine, with and without aura examined interictally

Oral application of L-menthol in the heat: From pleasure to performance

When menthol is applied to the oral cavity it presents with a familiar refreshing sensation and cooling mint flavour. This may be deemed hedonic in some individuals, but may cause irritation in others. This variation in response is likely dependent upon trigeminal sensitivity toward cold stimuli, suggesting a need for a menthol solution that can be easily personalised. Menthol’s characteristics can also be enhanced by matching colour to qualitative outcomes; a factor which can easily be manipulated by practitioners working in athletic or occupational settings to potentially enhance intervention efficacy. This presentation will outline the efficacy of oral menthol application for improving time trial performance to date, either via swilling or via co-ingestion with other cooling strategies, with an emphasis upon how menthol can be applied in ecologically valid scenarios. Situations in which performance is not expected to be enhanced will also be discussed. An updated model by which menthol may prove hedonic, satiate thirst and affect ventilation will also be presented, with the potential performance implications of these findings discussed and modelled. Qualitative reflections from athletes that have implemented menthol mouth swilling in competition, training and maximal exercise will also be included

Analysis of a worker-based participatory action research approach to the identification of selected occupational health and safety problems in Canada using mapping

There are limitations to conventional occupational health and safety research approaches and practices and numerous barriers to overcome in order to achieve progress. Occupational health and safety is impacted by the broader social-political environment. Corporatism affects the directions, ideas and practice of regulators, educators, the labour movement, scientists, medical professionals, and society as a whole, thus inhibiting workers' power to influence change. The thesis therefore explores both the wider influences and barriers to occupational health and safety advances, focusing particularly on the Canadian situation, through the general research questions: What has influenced occupational health and safety policies and practices, especially in Canada? What are some of the limitations of conventional occupational health and safety research and practices? To what extent can participatory action research and mapping address identified limitations? These questions are explored from the perspective of the population potentially at risk. New theories and approaches to occupational health and safety research are then applied in this thesis in order to explore a more specific multi-part research question: Can mapping within worker-based participatory action research be used to explore occupational health and safety conditions? In particular, can mapping contribute to occupational health and safety improvements at a local level and beyond; establish workers' previous exposures for compensation purposes; support efforts to bring about justice through compensation for workers affected by unsafe working conditions; and raise worker and public awareness of health and safety? These questions are explored through two different case studies, which examine, in depth, occupational health and safety action and possible remedies. Casino gaming workers in Windsor, Ontario, Canada undertook a collaborative study to investigate and improve current health and safety conditions. Former Holmes foundry and asbestos insulation workers in Sarnia, Ontario, Canada undertook a collaborative study to provide evidence of exposures and ensuing health problems to support claims for compensation. The outcomes of the case studies shed light on the bigger Canadian health and safety picture and demonstrate that mapping as a data collection method used within a participatory action research approach can accomplish a broad range of objectives. Mapping can raise workers' awareness, facilitate communication, build solidarity and cohesiveness, foster community support, mobilise workers to take action to reduce hazards or win compensation, in turn influencing employers, the compensation board and government agencies. The case studies accomplished the shared objective of raising worker and public awareness. The casino workers also gained occupational health and safety improvements and the Holmes workers were successful in gaining compensation

Health effects of indoor nitrogen dioxide

Rationale: Exposure to indoor NO2 has been implicated as a cause of respiratory symptoms suggestive of asthma but evidence has been inconsistent. Objective: To review the existing evidence and examine the effects of indoor NO2 in adult asthma-related symptoms using data from an adult multi-centre cohort (ECRHS) followed up for 20 years. Methods: Studies on respiratory health and indoor NO2 were systematically reviewed and meta-analyses performed. Cross-sectional analyses within a sub-set of ECRHS participants with indoor NO2 measurements were conducted to assess the associations of asthma severity and wheeze prevalence with NO2. A regression model was developed to predict indoor NO2 for a larger ECRHS sample without indoor NO2 measurements. GEE analyses were conducted to examine the long-term effects of gas cooking and modelled indoor NO2 on wheeze and asthma score. To investigate the effect of gas-generating NO2 peaks on asthma exacerbation a panel study was also piloted using a new-to-market portable NO2 sensor. Main results: The systematic review identified 50 studies, mainly in children. Results of meta-analyses suggested a significant association between 12-month period prevalence of wheeze and indoor NO2. Within ECRHS prevalence of wheeze but not asthma severity was associated with measured indoor NO2. Long-term associations of asthma-related symptoms with predicted indoor NO2 exposure but not gas cooking were significant. Interpreting this is difficult as the latter analyses (gas cooking) included a larger number of centres and some heterogeneity across centres was observed in the analysis on asthma score. Gas appliances, outdoor NO2, monthly temperature and country were the main predictors of indoor NO2. Evaluation of the pilot study recommends better recruitment strategies and independent calibration of NO2 sensor. Conclusions: There is some evidence for a link between indoor NO2 and asthma-related symptoms. Health risks may be small but are applied to a substantial proportion of the population.Open Acces