Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Neuroendocrinologie et neuroimmunologie chez un modèle invertébré, l'huître Crassostrea gigas

In invertebrates, the immune and neuroendocrine systems communicate and interact via diverse cytokines and hormones. Thus, both systems constitute an integrated network allowing the organism to elicit neuroendocrine as well as immune responses to both cognitive and non-cognitive stimuli. This neuro-immune system axis plays essential roles in the maintenance of homeostasis, particularly when the animal faces stressful situations. The present work aimed at providing further knowledge concerning the evolutionary origins of these adaptative mechanisms by studying neuroendocrinology and neuroimmunlogy of stress in an invertebrate model.Our biological model was chosen among molluscs because these organisms possess a relatively immune system and because their nervous system is well characterized at the functional, cellular and molecular levels. Among molluscs, we focused on the Pacific oyster Crassostrea gigas because this bivalve is of economical interest and because research on the physiology of stress in oysters can be directly applied in aquaculture. We provide evidence that oysters possess a form of neuroendocrine response to stress. Indeed, two catecholamines, namely noradrenaline and dopamine, are released in the hemolymph when the animal encounters stressful situations. Oyster catecholamine-secreting cells possess morphological, biochemical and functional characteristics of vertebrate chromaffin cells. Moreover, these cells exhibit a remarkable plasticity since they can transdifferentiate into either neuron-like or glial-like cells.Noradrenaline produced bu chromaffin cells modulate certain immune functions such as the production of reactive oxygen species and phagocytosis. This catecholamine can also trigger hemocyte apoptosis and/or upregulate the transcription of the heat stress protein 70 (hsp70) gene in immune cells. These mechanisms involve α and β-adrenergic receptors, GTPases of the Ras family such as Rho, MAP kinases and P35-sensitive caspases. Finally, we found that stress and stress-induced noradrenaline secretion modulate oyster resistence to bacterial pathogens. These results are of interest in terms of comparative neuroendocrinology and neuroimmunlogy because they point out the existence of complex neuro-immune interactions that preceded the emergence of vertebrates. In addition, this work provides further insights into immunoregulatory mechanisms and host-pathogen interactions in molluscs. Finally, information and tools provided by this research work help understanding how pathologies appear in cultured oyster stocks.Chez les vertébrés, le système immunitaire et le système neuroendocrine communiquent de façon étroite grâce à diverses cytokines et hormones. Ce type de communication joue un rôle primordial dans le maintien de l'homéostasie, particulièrement lorsque l'animal fait face à une situation de stress. Afin d'améliorer nos connaissances concernant l'origine évolutive de ces mécanismes adaptatifs, nous avons étudié la neuroendocrinologie et de la neuroimmunologie du stress chez un modèle invertébré. Notre modèle d'étude a été choisi parmi les mollusques parce que ces organismes possèdent un système immunitaire relativement simple et parce que leur système nerveux est assez bien caractérisé aux niveaux fonctionnel, cellulaire et moléculaire. Parmi les mollusques, nous avons choisi l'huître Crassostrea gigas, parce que ce bivalve présente un intérêt économique important et parce que les recherches concernant la physiologie du stress chez l'huître sont applicables en aquaculture.Nous avons pu déterminer que l'huître possède une forme primitive de réponse neuroendocrine au stress. En effet, deux catécholamines, la noradrénaline et la dopamine, sont libérées dans l'hémolymphe lorsque l'animal se trouve en situation de stress. Les cellules responsables de la sécrétion de catécholamines chez l'huître présentent des similitudes morphologiques, biochimiques et fonctionnelles avec les cellules chromaffines de vertébrés. De plus, les cellules chromaffines d'huîtres peuvent se différencier en cellules nerveuses, comme chez les vertébrés, ou en phagocytes apparentés aux cellules gliales. La noradrénaline produite par les cellules chromaffines contrôle certaines fonctions immunitaires (production d'espèces oxygénées réactives, phagocytose). Cette hormone peut aussi déclencher des mécanismes d'apoptose et/ou l'expression de gènes de protéines de stress (hsp70) au sein des immunocytes d'huîtres. Ces mécanismes impliquent des récepteurs α et β-adrénergiques, des GTPases de la famille des protéines Ras (Rho), des MAP kinases et caspases P35 sensibles.Nous avons finalement pu montrer que le stress et la sécrétion de noradrénaline induite par le stress, modulent les capacités de résistance des huîtres à des pathogènes bactériens. Ces résultats présentent un intérêt en termes de neuroendocrinologie et d'immunologies comparées et ils indiquent que des interactions neuroendocrino-immunitaires complexes existaient avant l'apparition des vertébrés. Ce travail apporte de nouvelles informations en ce qui concerne les mécanismes d'immunorégulation et les relations hôte-pathogène chez les mollusques. Enfin, ces informations, ainsi que les outils mis au point au cours de cette thèse, permettent de mieux comprendre comment apparaissent des pathologies en conchyliculture

NEUROENDOCRINOLOGIE ET NEUROIMMUNOLOGIE DU STRESS CHEZ UN MODELE INVERTEBRE, L'HUITRE CRASSOSTREA GIGAS

CHEZ LES VERTEBRES, LE SYSTEME IMMUNITAIRE ET LE SYSTEME NEUROENDOCRINE COMMUNIQUENT DE FACON ETROITE GRACE A DIVERSES CYTOKINES ET HORMONES. CE TYPE DE COMMUNICATION JOUE UN ROLE PRIMORDIAL DANS LE MAINTIEN DE L'HOMEOSTASIE, PARTICULIEREMENT LORSQUE L'ANIMAL FAIT FACE A UNE SITUATION DE STRESS. AFIN D'AMELIORER NOS CONNAISSANCES CONCERNANT L'ORIGINE EVOLUTIVE DE CES MECANISMES ADAPTATIFS, NOUS AVONS ETUDIE LA NEUROENDOCRINOLOGIE ET DE LA NEUROIMMUNOLOGIE DU STRESS CHEZ UN MODELE INVERTEBRE. NOTRE MODELE D'ETUDE A ETE CHOISI PARMI LES MOLLUSQUES PARCE QUE CES ORGANISMES POSSEDENT UN SYSTEME IMMUNITAIRE RELATIVEMENT SIMPLE ET PARCE QUE LEUR SYSTEME NERVEUX EST ASSEZ BIEN CARACTERISE AUX NIVEAUX FONCTIONNEL, CELLULAIRE ET MOLECULAIRE. PARMI LES MOLLUSQUES, NOUS AVONS CHOISI D'HUITRE CRASSOSTREA GIGAS, PARCE QUE CE BIVALVE PRESENTE UN INTERET ECONOMIQUE IMPORTANT ET PARCE QUE LES RECHERCHES CONCERNANT LA PHYSIOLOGIE DU STRESS CHEZ L'HUITRE SONT APPLICABLES EN AQUACULTURE. NOUS AVONS PU DETERMINER QUE L'HUITRE POSSEDE UNE FORME PRIMITIVE DE REPONSE NEUROENDOCRINE AU STRESS. EN EFFET, DEUX CATECHOLAMINES, LA NORADRENALINE ET LA DOPAMINE, SONT LIBEREES DANS L'HEMOLYMPHE LORSQUE L'ANIMAL SE TROUVE EN SITUATION DE STRESS. LES CELLULES RESPONSABLES DE LA SECRETION DE CATECHOLAMINES CHEZ L'HUITRE PRESENTENT DES SIMILITUDES MORPHOLOGIQUES, BIOCHIMIQUES ET FONCTIONNELLES AVEC LES CELLULES CHROMAFFINES DE VERTEBRES. DE PLUS, LES CELLULES CHROMAFFINES D'HUITRES PEUVENT SE DIFFERENCIER EN CELLULES NERVEUSES, COMME CHEZ LES VERTEBRES, OU EN PHAGOCYTES APPARENTES AUX CELLULES GLIALES. LA NORADRENALINE PRODUITE PAR LES CELLULES CHROMAFFINES CONTROLE CERTAINES FONCTIONS IMMUNITAIRES (PRODUCTION D'ESPECES OXYGENEES REACTIVES, PHAGOCYTOSE). CETTE HORMONE PEUT AUSSI DECLENCHER DES MECANISMES D'APOPTOSE ET/OU L'EXPRESSION DE GENES DE PROTEINES DE STRESS (HSP70) AU SEIN DES IMMUNOCYTES D'HUITRES. CES MECANISMES IMPLIQUENT DES RECEPTEURS ET -ADRENERGIQUES, DES GTPASES DE LA FAMILLE DES PROTEINES RAS (RHO), DES MAP KINASES ET DES CASPASES P35 SENSIBLES. NOUS AVONS FINALEMENT PU MONTRER QUE LE STRESS ET LA SECRETION DE NORADRENALINE INDUITE PAR LE STRESS, MODULENT LES CAPACITES DE RESISTANCE DES HUITRES A DES PATHOGENES BACTERIENS. CES RESULTATS PRESENTENT UN INTERET EN TERMES DE NEUROENDOCRINOLOGIE ET D'IMMUNOLOGIE COMPAREES ET ILS INDIQUENT QUE DES INTERACTIONS NEUROENDOCRINO-IMMUNITAIRES COMPLEXES EXISTAIENT AVANT L'APPARITION DES VERTEBRES. CE TRAVAIL APPORTE DE NOUVELLES INFORMATIONS EN CE QUI CONCERNE LES MECANISMES D'IMMUNOREGULATION ET LES RELATIONS HOTE-PATHOGENE CHEZ LES MOLLUSQUES. ENFIN, CES INFORMATIONS, AINSI QUE LES OUTILS MIS AU POINT AU COURS DE CETTE THESE, PERMETTENT DE MIEUX COMPRENDRE COMMENT APPARAISSENT DES PATHOLOGIES EN CONCHYLICULTURE.PARIS-BIUSJ-Thèses (751052125) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocROSCOFF-Observ.Océanol. (292393008) / SudocSudocFranceF

Symmetry influences packaging aesthetic evaluation and purchase intention

International audiencePurposeThe purpose of this paper is to examine the influence of the symmetrical disposition of information items displayed on the front of product packaging on perceived complexity, perceptual fluency, aesthetic evaluation and product purchase intention.Design/methodology/approachA sample of 104 participants was exposed to fast-moving consumer goods packaging. A within-subject design experiment was carried out to assess the influence of the symmetrical disposition of information items displayed on the front of the packaging. ANOVA and a PROCESS procedure to assess mediation (Hayes, 2013) examined the relationships among the factors influenced by symmetry.FindingsThis study found that the symmetrical disposition of information items around the vertical axis (mirror symmetry) decreased visual complexity and highlighted an “indirect-only mediation” of visual complexity on the aesthetic evaluation of the packaging through processing fluency. This research also highlighted the fact that packaging aesthetic evaluation had a positive influence on purchase intention.Originality/valueThis study extends knowledge on package design by showing that the elements on which the producer can act (in this case, symmetry on the front of packaging) have an influence on the consumer’s evaluation of the product and intention to purchase

Front of pack symmetry influences visual attention

International audienceThis paper investigates the impact on visual attention of a symmetrical versus an asymmetrical arrangement on the front of pack (FOP) of FMCGs. The authors conducted a laboratory experiment using an eye-tracking method. Two FOPs were designed for each product category (orange juice, chocolate bars, pasta and biscuits). In one version the information items were arranged symmetrically around a vertical axis, and in another they were asymmetrically arranged. The findings show that symmetry influences viewers' attention, first by influencing the visual attention paid to the entire FOP and, second, by its impact on the capacity of specific FOP areas to capture and hold visual attention

Tensile strength of aligned discontinuous composites

L’utilisation de fibres de carbone recyclées offre l’opportunité de réaliser un semi produit sous la forme d’une bande unidirectionnelle constituée de mèches alignées et discontinues. Les composites réalisés à partir de ce semi produit présentent actuellement des propriétés mécaniques prometteuses, mais avec une dispersion encore trop importante. Le transfert de charge entre mèches constitue un facteur clé de la résistance mécanique de ces composites. Afin d’appréhender ce mécanisme, des plaques sont réalisées avec des plis unidirectionnels coupés. Des architectures à double recouvrement permettent d’identifier les principales propriétés de l’interface, en s’appuyant sur une expression simplifiée du taux de restitution d’énergie. Enfin, la résistance d’architectures à simple recouvrement sont comparées avec des prédictions numériques effectuées sur Abaqus.Recycled carbon fibres allows creating a unidirectional tape composed of aligned and discontinuous tows. Composites made from this semi-product have promising, but still scattered mechanical properties. The stress-transfer between tows is a key factor affecting the strength of these composites. In order to understand this mechanism, plates were manufactured with interrupted unidirectional plies. Double overlap architectures allow defining the main properties of the interface, based on a simplified expression of the energy release rate. Finally the strength of single overlap architectures was compared with Abaqus numerical predictions