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

Life strategy of Antarctic silverfish promote large carbon export in Terra Nova Bay, Ross Sea

Antarctic silverfish Pleuragramma antarcticum is the most abundant pelagic fish in the High Antarctic shelf waters of the Southern Ocean, where it plays a pivotal role in the trophic web as the major link between lower and higher trophic levels. Despite the ecological importance of this species, knowledge about its role in the biogeochemical cycle is poor. We determine the seasonal contribution of Antarctic silverfish to carbon flux in terms of faeces and eggs, from samples collected in the Ross Sea. We find that eggs and faeces production generate a flux accounting for 41% of annual POC flux and that the variability of this flux is modulated by spawning strategy. This study shows the important role of this organism as a vector for carbon flux. Since Antarctic silverfish are strongly dependent on sea-ice, they might be especially sensitive to climatic changes. Our results suggest that a potential decrease in the biomass of this organism is likely to impact marine biogeochemical cycles, and this should be factored in when assessing Southern Ocean carbon budget

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

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

La libertad dentro del encierro. Espacios educativos y enfoque de derechos con adolescentes bajo control penal

Con esta ponencia buscamos compartir algunos resultados de trabajo interdisciplinario que articula la investigación y la extensión para abordar la problemática del acceso a derechos de adolescentes que transitan programas de control penal.[1]En el acercamiento a distintos actores vinculados a instituciones de la SENAF[2] que alojan a los jóvenes privados de la libertad o aplican, luego del encierro o en vez del mismo, medidas alternativas a la privación de libertad; nos encontramos con una diversidad de actores, trayectorias y compromisos de quienes, de una u otra forma, están a cargo de llevar a cabo lo que la institución se propone explícitamente con estas medidas: restituir derechos vulnerados a los adolescentes.Sin embargo, la experiencia muestra que los incipientes intentos de desarrollar acciones orientadas hacia ese objetivo, quedan minimizados ante las dinámicas que históricamente permanecen en entornos institucionales altamente obstaculizadores de dicha posibilidad.Las lógicas imperantes, tan similares a las carcelarias, permanecen orientadas al paradigma de la situación irregular o, mejor dicho, crean un híbrido: la protección irregular. Este paradigma, a diferencia de su significado en ciencias naturales, sí produce efectos y consecuencias que impactan en las subjetividades.Reconociendo que, en los hechos, la edad de imputabilidad ha bajado, nos preguntamos cómo afectan estas dinámicas carcelarias no sólo a las subjetividades de los y[1] Equipo que incluye psicólogos, antropólogos, abogados y socioeducadores que integran el proyecto de investigación Dinámicas institucionales y producción de subjetividad: acceso a derechos de adolescentes bajo control penal. Aprobado y subsidiado porSeCyT, UNC para el período 2014-2015. Asimismo son parte del Proyecto de extensión Juventud y ciudadanía: un aporte al proceso de acceso a derechos en los programas socioeducativos para adolescentes subsidiado por la Secretaría de Extensión Universitaria de la UNC para el período 2014-2016. Ambos dirigidos por Mariel C. Castagno y M. Elena Previtali.[2]Secretaría de Niñez, Adolescencia y Familia, Ministerio de Desarrollo Social, Provincia de Córdoba.las adolescentes entre 13 y 18 años que allí permanecen sino también, en los técnicos, profesionales y operadores, en sus procesos de apropiación del paradigma de derechos.En este contexto, adverso para que el Paradigma de la Protección Integral de Derechos prenda y se aprehenda, nos encontramos a su vez con diferentes espacios, generalmente dependientes de instituciones educativas, que instituyen otras prácticas, que producen otros vínculos y dan lugar a otros procesos de subjetivación.Batallando en dinámicas institucionales que se estructuran como ordenamientos no sólo normativos, sino más bien como un orden simbólico y una cultura que instaura modos legitimados de ser y de vivenciar las prácticas allí impartidas, estos espacios educativos terminan siendo vividos, por los adolescentes, como la libertad dentro del encierro. Sin embargo, para otros actores institucionales estas actividades artístico-culturales tienen la finalidad de distraer y entretener a los/las adolescentes, para otros, mitiga el efecto del encierro, para algunos son una amenaza a la seguridad institucional, desde nuestra perspectiva se instituyen como espacios islas de ejercicio de derechos. Pequeñas islas que, en un mar de vulneraciones, rescatan náufragos que, por un tiempo y un lugar limitados en sus vidas, intentan construir balsas que avizoran un horizonte diferente

An after-school football session transiently improves cognitive function in children

The aim of the present study was to evaluate the effect of a real-world after-school football session on subsequent cognitive function in primary school children. Following ethical approval, 100 children (aged 8–9 year) from the same after-school football club were randomly assigned to either an intervention (60 min football activity) or control (continued to rest) group. Cognitive function (selective visual attention, short term memory and long-term memory) was assessed prior to, immediately following and 45 min following the football session (and at the respective timepoints in the control group). Data were analysed via two-way (group * time) mixed methods ANOVA. The pattern of change in all domains of cognition over time, was different between the football and control groups (group * time, all p < 0.001). Specifically, performance on all cognitive tasks was greater immediately following the football session in the intervention group compared to the control group (selective visual attention, p = 0.003; short-term memory, p = 0.004; long-term memory, p < 0.001). However, there was no difference between the group 45 min following the football session (p = 0.132–0.393). These findings suggest that an after-school football session enhances cognition immediately post-activity in primary school children

Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era

Human immunodeficiency virus infection (HIV) has been associated with cardiac dysfunction that, if present, can negatively affect morbidity and mortality of HIV-infected patients. Unfortunately, many of the studies on this topic were performed before the highly active antiretroviral therapy (HAART) was established. Thus, we performed a comprehensive meta-analysis to critically appraise the incidence of cardiac dysfunction in HIV-infected pauci symptomatic patients. Medline, Cochrane Library, and Biomed Central were systematically screened for studies reporting on systolic and/or diastolic dysfunctions in HIV pauci-symptomatic patients. Baseline treatment and cardiac imaging data were appraised and pooled with random effect methods computing summary. At pooled analysis, including a total of 2242 patients from 11 studies, an overall average incidence of traditional cardiovascular risk factors was observed, while a low rate of previous coronary artery disease was reported. Incidence of systolic and diastolic left ventricular dysfunction was 8.33 (95 CI: 2.2014.25) and 43.38 (95 CI: 31.7355.03), respectively. Diastolic dysfunction was graded as first [31.85 (95 CI: 24.8543.73)], second [8.53 (95 CI: 2.1214.93)], and third degree [3.02 (95 CI: 1.784.27)]. At multivariate analysis, a high sensitivity C-reactive protein level 5 mg/L, active tobacco smoking and previous history of myocardial infarction were predictors of left ventricular systolic dysfunction [odd ratio 1.70 (95 CI: 1.032.77); 1.57 (95 CI: 1.032.34); and 15.90 (95 CI: 1.94329.00), respectively]. Hypertension (OR 2.30; 95 CI: 1.204.50) and older age (OR 2.50 per 10 years increase; 95 CI: 1.703.60) were predictors of left ventricular diastolic dysfunction (Figure 3). Systolic and diastolic dysfunction represent a common finding in pauci symptomatic HIV-infected patients, regardless to HAART