Combined esophageal intraluminal impedance, pH and skin conductance monitoring to detect discomfort in GERD infants

BACKGROUND: The clinical significance of weakly acidic reflux in infants is unclear. Skin conductance is a novel not-invasive method to evaluate discomfort. The aim of our study was to evaluate reflux-induced discomfort in infants with gastroesophageal reflux disease using simultaneously combined skin conductance and esophageal multichannel intraluminal impedance and pH monitoring. METHODOLOGY/PRINCIPAL FINDINGS: Infants with gastroesophageal reflux symptoms were investigated for almost 20 hours divided into 120-second intervals. Temporal relationships between refluxes and discomfort were evaluated calculating the symptom association probability. Twelve infants aged 17-45 days were studied. Out of 194.38 hours of adequate artifact-free MII/pH and skin conductance monitoring, 584 reflux events were observed; 35.78% were positive for stress, of which 16.27% were acid and 83.73% weakly acidic. A significant association between refluxes and discomfort (p<0.05) was present in all infants. The intervals with reflux events showed increased skin conductance values compared to reflux-free intervals (p<0.001); SC values were similar for acid and weakly acidic reflux events. CONCLUSION/SIGNFICANCE: Discomfort was significantly associated with reflux events and did not differ between weakly acidic and acid refluxes. Our results may raise concerns about the over-prescription use of antacid drugs in the management of gastroesophageal reflux symptoms in infancy

Etiological diagnosis, prognostic significance and role of electrophysiological study in patients with Brugada ECG and syncope.

BACKGROUND: Syncope is considered a risk factor for life-threatening arrhythmias in Brugada patients. Distinguishing a benign syncope from one due to ventricular arrhythmias is often difficult, unless an ECG is recorded during the episode. Aim of the study was to analyze the characteristics of syncopal episodes in a large population of Brugada patients and evaluate the role of electrophysiological study (EPS) and the prognosis in the different subgroups. METHODS AND RESULTS: One hundred ninety-five Brugada patients with history of syncope were considered. Syncope were classified as neurally mediated (group 1, 61%) or unexplained (group 2, 39%) on the basis of personal and family history, clinical features, triggers, situations, associated signs, concomitant therapy. Most patients underwent EPS; they received ICD or implantable loop-recorder on the basis of the result of investigations and physician's judgment. At 62±45months of mean follow-up, group 1 showed a significantly lower incidence of arrhythmic events (2%) as compared to group 2 (9%, p<0.001). Group 2 patients with positive EPS showed the highest risk of arrhythmic events (27%). No ventricular events occurred in subjects with negative EPS. CONCLUSION: Etiological definition of syncope in Brugada patients is important, as it allows identifying two groups with different outcome. Patients with unexplained syncope and ventricular fibrillation induced at EPS have the highest risk of arrhythmic events. Patients presenting with neurally mediated syncope showed a prognosis similar to that of the asymptomatic and the role of EPS in this group is unproven

Potential sources of particulate iron in surface and deep waters of the terra nova bay (Ross sea, antarctica)

The distribution of particulate Fe (pFe), suspended particulate matter (SPM), and other particulate trace metals were investigated in Terra Nova Bay as part of CDW Effects on glaciaL mElting and on Bulk of Fe in the Western Ross sea (CELEBeR) and Plankton biodiversity and functioning of the Ross Sea ecosystems in a changing Southern Ocean (P-ROSE) projects. Variable concentrations of SPM (0.09–97 mg L−1 ), pFe (0.51–8.70 nM) and other trace metals were found in the Antarctic Surface waters (AASW) layer, where the addition of meltwater contributed to the pool with both lithogenic and biogenic forms. The deeper layer of the water column was occupied by High Salinity Shelf Water (HSSW) and Terra Nova Bay Ice Shelf Water (TISW) encompassing glacial water as confirmed by the lightest δ18 O measured values. The concentration of pFe in TISW (11.7 ± 9.2 nM) was higher than in HSSW samples (5.55 ± 4.43 nM), suggesting that the drainage of material released from glaciers surrounding the area is relevant in terms of pFe contribution. Particulate Fe/Al and Mn/Al ratios were substantially in excess compared with the mean crustal ratios. Microscopic analyses confirmed that more labile Fe oxyhydroxides and authigenic MnO2 phases were present together with biogenic sinking material. Future expected increasing melt rates of these glaciers enlarge Fe input, thus having a greater role in supplying iron and counteracting the reductions in sea ice cover around Terra Nova Bay

Spatial-Related Community Structure and Dynamics in Phytoplankton of the Ross Sea, Antarctica

The Ross Sea exhibits the largest continental shelf and it is considered to be the most productive region in Antarctica, with phytoplankton communities that have so far been considered to be driven by the seasonal dynamics of the polynya, producing the picture of what is considered as the classical Antarctic food web. Nevertheless, the Ross Sea is made up of a complex mosaic of sub-systems, with physical, chemical, and biological features that change on different temporal and spatial scales. Thus, we investigated the phytoplankton community structure of the Ross Sea with a spatial scale, considering the different ecological sub-systems of the region. The total phytoplankton biomass, maximum quantum efficiency (Fv/Fm), size classes, and main functional groups were analyzed in relation to physical–chemical properties of the water column during the austral summer of 2017. Data from our study showed productivity differences between polynyas and other areas, with high values of biomass in Terra Nova Bay (up to 272 mg chl a m–2) and the south-central Ross Sea (up to 177 mg chl a m–2) that contrast with the HNLC nature of the off-shore waters during summer. Diatoms were the dominant group in all the studied subsystems (relative proportion ≥ 50%) except the southern one, where they coexisted with haptophytes with a similar percentage. Additionally, the upper mixed layer depth seemed to influence the level of biomass rather than the dominance of different functional groups. However, relatively high percentages of dinoflagellates (∼30%) were observed in the area near Cape Adare. The temporal variability observed at the repeatedly sampled stations differed among the sub-systems, suggesting the importance of Long-Term Ecological Research (L-TER) sites in monitoring and studying the dynamics of such an important system for the global carbon cycle as the Ross Sea. Our results provide new insights into the spatial distribution and structure of phytoplankton communities, with different sub-systems following alternative pathways for primary production, identifiable by the use of appropriate sampling scales

PICKING THE BEST NOVEL ORAL ANTICOAGULANT FOR ATRIAL FIBRILLATION: EVIDENCE FROM A WARFARIN-CONTROLLED NETWORK META-ANALYSIS

Warfarin is a mainstay atrial ibrillation (AF) treatment, yet it has a narrow therapeutic window. Novel agents have been successfully tested against warfarin, yet no direct comparison among them is available. We thus performed a pair-wise and warfarin-adjusted network metaanalyses of novel oral anticoagulants for AF

Use and misuse of multivariable approaches in interventional cardiology studies on drug-eluting stents: a systematic review.

Aims: Randomized clinical trials (RCTs) are the most reliable evidence, even if they require important resource and logistic efforts. Large, cost-free and real-world datasets may be easily accessed yielding to observational studies, but such analyses often lead to problematic results in the absence of careful methods, especially from a statistic point of view. We aimed to appraise the performance of current multivariable approaches in the estimation of causal treatment and effects in studies focusing on drug-eluting stents (DES). Methods and Results: Pertinent studies published in the literature were searched, selected, abstracted, and appraised for quality and validity features. Six studies with a logistic regression were included, all of them reporting more than 10 events for covariates and different length of follow-up, with an overall low risk of bias. Most of the 15 studies with a Cox proportional hazard analysis had a different follow-up, with less than 10 events for covariates, yielding an overall low or moderate risk of bias. Sixteen studies with propensity score were included: the most frequent method for variable selection was logistic regression, with underlying differences in follow-up and less than 10 events for covariate in most of them. Most frequently, calibration appraisal was not reported in the studies, on the contrary of discrimination appraisal, which was more frequently performed. In seventeen studies with propensity and matching, the latter was most commonly performed with a nearest neighbor-matching algorithm yet without appraisal in most of the studies of calibration or discrimination. Balance was evaluated in 46% of the studies, being obtained for all variables in 48% of them. Conclusions: Better exploitation and methodological appraisal of multivariable analysis is needed to improve the clinical and research impact and reliability of nonrandomized studies. (J Interven Cardiol 2012;**:1-1

Left atrial function after atrial fibrillation cryoablation concomitant to minimally invasive mitral valve repair: A pilot study on long-term results and clinical implications

Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 &plusmn; 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 &plusmn; 13.1 mL/mq and 25.1 &plusmn; 7.3%) were significantly better than in those with AF relapses (76.8 &plusmn; 16.2 mL/mq and 17.5 &plusmn; 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 &plusmn; 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 &plusmn; 13.7%; patients with strokes in SR showed very enlarged LA volume (&gt;70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR

Spatial relationship between bone formation and mechanical stimulus within cortical bone: Combining 3D fluorochrome mapping and poroelastic finite element modelling

Bone is a dynamic tissue and adapts its architecture in response to biological and mechanical factors. Here we investigate how cortical bone formation is spatially controlled by the local mechanical environment in the murine tibia axial loading model (C57BL/6). We obtained 3D locations of new bone formation by performing ‘slice and view’3D fluorochrome mapping of the entire bone and compared these sites with the regions of high fluid velocity or strain energy density estimated using a finite element model, validated with ex-vivo bone surface strain map acquired ex-vivo using digital image correlation. For the comparison, 2D maps of the average bone formation and peak mechanical stimulus on the tibial endosteal and periosteal surface across the entire cortical surface were created. Results showed that bone formed on the periosteal and endosteal surface in regions of high fluid flow. Peak strain energy density predicted only the formation of bone periosteally. Understanding how the mechanical stimuli spatially relates with regions of cortical bone formation in response to loading will eventually guide loading regime therapies to maintain or restore bone mass in specific sites in skeletal pathologies