Νεκρωτική εντεροκολίτιδα και μητρικός θηλασμός

Εισαγωγή: Η Νεκρωτική Εντεροκολίτιδα παραμένει μία από τις πιο δραματικές επιπλοκές στα νεογνά, ειδικά σε αυτά με χαμηλό βάρος γέννησης. Παρά τις εντατικές μελέτες, η αιτιοπαθογένεια της νόσου δεν έχει ακόμη αποσαφηνιστεί πλήρως. Σκοπός: Σκοπός της παρούσας μελέτης ήταν η διερεύνηση παραγόντων κινδύνου για την εμφάνιση ΝΕΚ και η θετική επίδραση του μητρικού γάλακτος. Υλικό και Μέθοδος: Το δείγμα της μελέτης αποτέλεσαν νεογνά που νοσηλεύτηκαν στη Μονάδα Εντατικής Νοσηλείας Νεογνών (ΜΕΝΝ) του Πανεπηστημιακου Αττικού Νοσοκομείου την τελευταία 7ετια (Νοεμβριος 2011 έως Δεκέμβριος 2018). Τα στοιχεία συλλέχθηκαν με ερωτηματολόγιο, ειδικά διαμορφωμένο για τους σκοπούς της μελέτης. Τα δεδομένα αναλύθηκαν με την εφαρμογή της στατιστικής δοκιμασίας x2 test. Το επίπεδο σημαντικότητας p του ελέγχου ορίστηκε στις τιμές <0,05. Αποτελέσματα: Το σύνολο του δείγματος ήταν 34νεογνά, εκ των οποίων το 55,88% ήταν άρρενα και το 44,11% ήταν θήλεα. Από το σύνολο του δείγματος το 32,35% εμφάνισαν ΝΕΚ. Από τα 11 νεογνά τα οποία εμφάνισαν ΝΕΚ, το 45,4% εκδήλωσε ΝΕΚ πρώτου σταδίου, το 27,27% δεύτερου σταδίου και το 27,27% τρίτου σταδίου. Στατιστικά σημαντικοί νεογνικοί παράγοντες αναδείχτηκαν η μικρότερη ηλικία κύησης (p=0,023 για ΗΚ <37w και p=0,001 για ΗΚ<34w) το χαμηλότερο βάρος γέννησης (p=0,003 για ΒΓ<2500gr και p<0,001 για ΒΓ<1500gr), η καθυστερημένη έναρξη εντερικής σίτισης (p=0,008), η νεογνική λοίμωξη (p=0,033), η χορήγηση αντιβιοτικών στο νεογνό (p<0,001), ο καθετηριασμός των ομφαλικών αγγείων (p=0,026), οι μεταγγίσεις (p<0,001) και η χορήγηση επιφανειοδραστικού παράγοντα (p=0,015). Στατιστικά σημαντικός μητρικός παράγοντας αναδείχτηκε η λήψη εθιστικών ουσιών από τη μητέρα στην εγκυμοσύνη (p=0,038). Συμπέρασματα: Για την εκδήλωση της ΝΕΚ ευθύνονται τόσο νεογνικοί όσο και μητρικοί παράγοντες. Η έγκαιρη διάγνωση της νόσου διαδραματίζει καθοριστικό ρόλο στην καλύτερη αποκατάσταση της υγείας των νεογνών. Ο μητρικός θηλασμός δρα ευεργετικά τόσο στην προστασία όσο και στην θεραπεία της ΝΕΚ .Το ιατρονοσηλευτικό προσωπικό των μονάδων εντατικής νοσηλείας νεογνών μπορεί να συμβάλλει αποφασιστικά στη μείωση της νοσηρότητας με την έγκαιρη αναγνώριση της νόσου στα πρώιμα στάδια.Necrotizing enterocolitis remains one of the most serious complications in newborn infants, particularly those of low birth weight. Despite the repeated literature attempts, there is still no validated algorithm to prevent development of NEC. Aim: The aim of this study was to identify the neonatal and maternal risk factors possibly associated with the development of NEC and positive influence of breastfeeding. Method and material: This was a retrospective case-control study of infants with a confirmed diagnosis of NEC in the NICU at university Attikon Hospital from 2011 to 2018. Data were collected with a questionnaire specifically design for the purpose of the study. The data were analyzed by applying the statistical test, x2- test. The significance level p was set to values <0,005. Results: The sample consisted of 34 neonates, the 55.88% was male and the 44,11% was female. The 32.35% of the sample had a confirmed diagnosis of NEC. Among the 11 neonates with NEC, the 45,4% had NECI, the 27,27% had NECII and the 27,27% had NECIII. Variables which were shown to be significantly associated with NEC were the gestational age less than 37 weeks (p=0,023) and less than 34 weeks (p=0,001), the LBW (p=0,003) and the VLBW (p<0,001), the late introduction of enteral feedings (p=0,008), the sepsis (p=0,033), the antenatal exposure to antibiotics (p<0,001), the umbilical vessel catheterization (p=0,026), the red blood cell transfusions (p<0,001) and the administration of surfactant (p=0,015). Only exposure to maternal neuroleptic medication in the prenatal period was significantly correlated with the development of NEC (p=0,038). Conclusions: Both neonatal and maternal risk factors are possibly associated with the development of NEC. The earlier NEC is detected and diagnosed, the earlier intervention can begin and help prevent more severe symptoms developing.Maternal breastfeeding acts beneficially to the protection us much us the therapy of NEC

Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter?

Background: Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience. Methods: All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B). Results: The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found. Conclusions: The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVSis not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized

Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures

Background: The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation.Methods: Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP.Results: A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788).Conclusions: There was no clear benefit of single or double TSP in AF ablation

Lipoprotein-Associated Phospholipase A2 Bound on High-Density Lipoprotein Is Associated With Lower Risk for Cardiac Death in Stable Coronary Artery Disease Patients A 3-Year Follow-Up

ObjectivesThe aim of this study was to examine the prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) associated with high-density lipoprotein (HDL) (HDL-Lp-PLA2) in patients with stable coronary artery disease (CAD).BackgroundLp-PLA2 is a novel risk factor for cardiovascular disease. It has been postulated that the role of Lp-PLA2 in atherosclerosis may depend on the type of lipoprotein with which it is associated.MethodsTotal plasma Lp-PLA2 and HDL-Lp-PLA2 mass and activity, lipids, and C-reactive protein were measured in 524 consecutive patients with stable CAD who were followed for a median of 34 months. The primary endpoint was cardiac death, and the secondary endpoint was hospitalization for acute coronary syndromes, myocardial revascularization, arrhythmic event, or stroke.ResultsFollow-up data were obtained from 477 patients. One hundred twenty-three patients (25.8%) presented with cardiovascular events (24 cardiac deaths, 47 acute coronary syndromes, 28 revascularizations, 22 arrhythmic events, and 2 strokes). Total plasma Lp-PLA2 mass and activity were predictors of cardiac death (hazard ratio [HR]: 1.013; 95% confidence interval [CI]: 1.005 to 1.021; p = 0.002; and HR: 1.040; 95% CI: 1.005 to 1.076; p = 0.025, respectively) after adjustment for traditional risk factors for CAD. In contrast, HDL-Lp-PLA2 mass and activity were associated with lower risk for cardiac death (HR: 0.972; 95% CI: 0.952 to 0.993; p = 0.010; and HR: 0.689; 95% CI: 0.496 to 0.957; p = 0.026, respectively) after adjustment for traditional risk factors for CAD.ConclusionsTotal plasma Lp-PLA2 is a predictor of cardiac death, while HDL-Lp-PLA2 is associated with lower risk for cardiac death in patients with stable CAD, independently of other traditional cardiovascular risk factors

Impact of centre volume on atrial fibrillation ablation outcomes in Europe: a report from the ESC EHRA EORP Atrial Fibrillation Ablation Long-Term (AFA LT) Registry

Abstract Aims  The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. Methods and results  Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. Conclusion  Low-volume centres tended to present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres

PHY Abstraction Methodsfor OFDM and NOFDM Systems, Journal of Telecommunications and Information Technology, 2009 nr 3

In the paper various PHY abstraction methods for both orthogonal and non-orthogonal systems are presented, which allow to predict the coded block error rate (BLER) across the subcarriers transmitting this FEC-coded block for any given channel realization. First the efficiency of the selected methods is investigated and proved by the means of computer simulations carried out in orthogonal muticarrier scenario. Presented results are followed by the generalization and theoretical extension of these methods for non-orthogonal systems

Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey

The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations