2020 Clinical guidelines for Atrial fibrillation and atrial flutter

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health

Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure

Case Report of an Acute Myocardial Infarction as a Result of Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia

Background. Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and rare cause of myocardial infarction (MI). SCAD is defined as the separation of the coronary artery wall by hemorrhage with or without intimal tear. It causes acute coronary syndrome in 1.7% to 4% of cases. Case Summary. We report a case of a patient with acute MI caused by SCAD with marked progression of dissection within 4 days and spontaneous healing in 2 months. Fibromuscular dysplasia (FMD) of the arteries is an associated condition of SCAD that was found in our patient. Conclusion. In young women admitted to the clinic with signs of acute myocardial infarction, SCAD should be suspected. FMD as an associated condition that should be ruled out in every SCAD patient. Conservative treatment of SCAD is the most preferable strategy

Combined fMRI-fMRS dataset in an inference task in humans

For more information and download, see: https://data.mrc.ox.ac.uk/data-set/fmri-fmrs-inference This dataset consists of the following components: fMRI data showing group maps for contrasts of interest (nifti) raw fMRS data of 19 subjects (dicom) preprocessed fMRS data of 19 subjects, preprocessed in MRspa (mat) behavioural data from inference task during MRI scan (mat) behavioural data from associative test post MRI scan (mat) Participants performed a three-stage inference task across three days. On day 1 participants learned up to 80 auditory-visual associations. On day 2, each visual cue was paired with either a rewarding (set 1, monetary reward) or neutral outcome (set 2, woodchip). On day 3, auditory cues were presented in isolation (‘inference test’), without visual cues or outcomes, and we measured evidence for inference from the auditory cues to the appropriate outcome. Participants performed the inference test in an MRI scanner where fMRI-fMRS data was acquired. After the MRI scan, participants completed a surprise ­associative test for auditory-visual associations learned on day 1

Code used for analysis of task-relevant, time-resolved functional Magnetic Resonance Spectroscopy (fMRS)

The dataset is available to download at: https://data.mrc.ox.ac.uk/data-set/frms-code This package contains code for Preprocessing of fMRS data (matlab) fsl_mrs code for simulations of fMRS data (python) Code for analysis of behavioural data (matlab) Code to assess relationship between fMRI and fMRS data (matlab) Plotting function

Multiple associative structures created by reinforcement and incidental statistical learning mechanisms

Learning the structure of the world can be driven by reinforcement but also occurs incidentally through experience. Reinforcement learning theory has provided insight into how prediction errors drive updates in beliefs but less attention has been paid to the knowledge resulting from such learning. Here we contrast associative structures formed through reinforcement and experience of task statistics. BOLD neuroimaging in human volunteers demonstrates rigid representations of rewarded sequences in temporal pole and posterior orbito-frontal cortex, which are constructed backwards from reward. By contrast, medial prefrontal cortex and a hippocampal-amygdala border region carry reward-related knowledge but also flexible statistical knowledge of the currently relevant task model. Intriguingly, ventral striatum encodes prediction error responses but not the full RL- or statistically derived task knowledge. In summary, representations of task knowledge are derived via multiple learning processes operating at different time scales that are associated with partially overlapping and partially specialized anatomical regions

The specifics of clotting and endogenic fibrinolysis in acute coronary syndrome patients

Aim. To assess the processes of clot formation in relation to endogenic fibrinolysis in patients with various types of acute coronary syndrome (ACS).Material and methods. To the study, 89 persons (40 males) included: 59 with ACS, 30 — control group. Among the ACS patients, 28 were ST-elevation (STEMI), 31 with non-ST-elevation ACS (NSTEACS). All participants were assessed for clotting formation parameters and thrombus lysis with rotational elastometry on ROTEM equipment (Germany) and “Hemacore” Thrombodynamics (Russia), before coronary arteriography.Results. Clot density and its size in 10 minutes were significantly higher in ACS comparing to control patients (2867 units vs 25084 units, p<0,001; 41,8 mm vs 36,4 mm, p<0,05, respectively). The time from onset of thrombus lysis was lower in ACS (79,4 min vs 69,3 min, p<0,05). The percent of lysis by the end of process registration was lower in ACS (20,1% vs 23,1%, p<0,05). Amplitude of clot formation in 20 minutes from the onset of clotting, as the maximum density of clot were significantly higher in NSTEACS comparing to STEMI (56,2 mm vs 49,7 mm, p=0,018; 59 mm vs 53,2 mm, p=0,011; respectively). Thrombus lysis was slower in NSTEACS patients comparing to STEMI (62,26 min vs 45,5 min, p=0,02).Conclusion. With the measurement in vitro, the process of clotting and thrombus lysis is more active in ACS patients comparing to controls, that point on a baseline activated hemostasis. Within the ACS group, higher the existing clot in vessel lumen, more active the shift of the balance to anticoagulation and fibrinolysis

Multiple associative structures created by reinforcement and incidental statistical learning mechanisms

Learning the structure of the world can be driven by reinforcement but also occurs incidentally through experience. Reinforcement learning theory has provided insight into how prediction errors drive updates in beliefs but less attention has been paid to the knowledge resulting from such learning. Here we contrast associative structures formed through reinforcement and experience of task statistics. BOLD neuroimaging in human volunteers demonstrates rigid representations of rewarded sequences in temporal pole and posterior orbito-frontal cortex, which are constructed backwards from reward. By contrast, medial prefrontal cortex and a hippocampal-amygdala border region carry reward-related knowledge but also flexible statistical knowledge of the currently relevant task model. Intriguingly, ventral striatum encodes prediction error responses but not the full RL- or statistically derived task knowledge. In summary, representations of task knowledge are derived via multiple learning processes operating at different time scales that are associated with partially overlapping and partially specialized anatomical regions

The diagnostic value of low-dose chest computed tomography for calcium score determining compared with the standard method and the results of computed tomography and selective coronary angiography

Aim. Coronary artery calcification is a characteristic of coronary atherosclerosis, which is often detected by chest computed tomography (CT). The aim of this study is to assess the efficiency of low-dose chest CT in calcium score (CS) determining and to compare it with conventional method and results of CT and selective coronary angiography.Material and methods. A total of 251 patients underwent a low-dose chest CT and a CS determining. Coincidence between the two methods was evaluated by the absolute CS values and by stratification of patients into five risk categories (“zero” CS values were excluded from the analysis). Eighty patients underwent CT or selective coronary angiography and the results were divided into two groups according to the degree of coronary stenosis — ˂50% and ≥50%. The CS values determined by chest CT are compared with the results of coronary angiography. Results. In 79 patients (31%), the CS was 0 and they were excluded from further analysis. The absolute CS values comparability between the two scanning methods in other 172 patients was very high (r=0,978, p<0,05). The coincidence in stratification of patients by risk groups was also high (contingency coefficient k=0,846). The CS specificity compared with coronary angiography was 97,5%, but with a low sensitivity of 43,6%, if the CS value is set to 400, above which coronary stenosis will considered significant. In comparing CS values with results of CT, the relationship of high CS values with coronary stenosis, were statistically proved: in 17 patients from 18 with CS >400 significant coronary stenosis was detected, in comparison with 22 patients from 52 patients with a CS more than 400 (p<0,05). Conclusion. The research showed that low-dose chest CT can be used to determine CS. Studied values correlate with the results of coronary angiography