Rhythm Control in AF: Have We Reached the Last Frontier?

AF is a worldwide epidemic, affecting approximately 33 million people, and its rising prevalence is expected to account for increasing clinical and public health costs. AF is associated with an increased risk of MI, heart failure, stroke, dementia, chronic kidney disease and mortality. Preserving sinus rhythm is essential for a better outcome. However, because of the inherent limits of both pharmacological and interventional methods, rhythm strategy management is reserved for symptom and quality-of-life improvement. While ‘classical’ antiarrhythmic drug therapy remains the first-line therapy for rhythm control, its efficacy and safety are limited by empirical use, proarrhythmic risk and organ toxicity. Ablative techniques have had an impressive development, but AF ablation still failed to demonstrate a significant impact on hard endpoints. Understanding of the complex mechanisms of AF will help to develop new vulnerable targets to therapy. Promising molecules are under development, intended to fill the gap between the current pharmacological treatment aimed at maintaining sinus rhythm and the expectations from rhythm strategy

Echocardiographic Prognostic Factors in Pulmonary Hypertension

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure of ≥25 mmHg at rest by right heart catheterization. Echocardiography estimates systolic pulmonary arterial pressure on the tricuspid regurgitation jet velocity, mean and diastolic pressure based on the pulmonary regurgitation jet, and data regarding the function of the right ventricle. ESC guidelines propose an echocardiographic risk assessment in PH according to right atrial area > 26 cm2 and pericardial effusion. Other risk factors correlated with the severity of the PH include right atrial pressure > 15 mmHg, tricuspid regurgitation more than moderate, TAPSE 1.7 combined with TAPSE <15 mm was associated with a higher death rate compared to patients with normal values. However, each of these parameters used in the assessment of the right ventricle has technical limitations, and it is necessary to use multiple tests for a correct evaluation of the prognosis of PH

Topic Classification for Short Texts

In the context of TV and social media surveillance, constructing models to automate topic identification of short texts is key task. This paper formalizes the topic classification as a top-K multinomial classification problem and constructs worth-to-consider models for practical usage. We describe the full data processing pipeline, discussing about dataset selection, text preprocessing, feature extraction, model selection and learning, including hyperparameter optimization. When computing time and resources are limited, we show that a classical model like SVM performs as well as an advanced deep neural network, but with shorter model training time

Diagnostic Pitfalls in a Man with Systemic Lupus Erythematous

Systemic lupus erythematosus (SLE) is a chronic multi-systemic immune-mediated disease with confusing symptoms and delayed diagnosis. We report the case of a 32-year-old man with a persistent Venereal Disease Research Laboratory (VDRL)-positive reaction treated for syphilis 5 years previously, who was admitted for rash, weight loss, pancytopenia, inflammatory syndrome, and an important spontaneous prolongation of activated partial thromboplastin time (aPTT). Antiphospholipid antibodies were identified in the patient and he was diagnosed with SLE. The unrecognized false positive VDRL reaction and the delayed diagnosis of SLE were harmful as the patient had developed renal and cardiac complications by the time of diagnosis

Ezetimibe/simvastatin 10/40 mg versus atorvastatin 40 mg in high cardiovascular risk patients with primary hypercholesterolemia: a randomized, double-blind, active-controlled, multicenter study

<p>Abstract</p> <p>Background</p> <p>A considerable number of patients with severely elevated LDL-C do not achieve recommended treatment targets, despite treatment with statins. Adults at high cardiovascular risk with hypercholesterolemia and LDL-C ≥ 2.59 and ≤ 4.14 mmol/L (N = 250), pretreated with atorvastatin 20 mg were randomized to ezetimibe/simvastatin 10/40 mg or atorvastatin 40 mg for 6 weeks. The percent change in LDL-C and other lipids was assessed using a constrained longitudinal data analysis method with terms for treatment, time, time-by-treatment interaction, stratum, and time-by-stratum interaction. Percentage of subjects achieving LDL-C < 1.81 mmol/L, < 2.00 mmol/L, or < 2.59 mmol/L was assessed using a logistic regression model with terms for treatment and stratum. Tolerability was assessed.</p> <p>Results</p> <p>Switching to ezetimibe/simvastatin resulted in significantly greater changes in LDL-C (-26.81% vs.-11.81%), total cholesterol (-15.97% vs.-7.73%), non-HDL-C (-22.50% vs.-10.88%), Apo B (-17.23% vs.-9.53%), and Apo A-I (2.56% vs.-2.69%) vs. doubling the atorvastatin dose (all <it>p </it>≤ 0.002), but not HDL-C, triglycerides, or hs-CRP. Significantly more subjects achieved LDL-C < 1.81 mmol/L (29% vs. 5%), < 2.00 mmol/L (38% vs. 9%) or < 2.59 mmol/L (69% vs. 41%) after switching to ezetimibe/simvastatin vs. doubling the atorvastatin dose (all <it>p </it>< 0.001). The overall safety profile appeared generally comparable between treatment groups.</p> <p>Conclusions</p> <p>In high cardiovascular risk subjects with hypercholesterolemia already treated with atorvastatin 20 mg but not at LDL-C < 2.59 mmol/L, switching to combination ezetimibe/simvastatin 10/40 mg provided significantly greater LDL-C lowering and greater achievement of LDL-C targets compared with doubling the atorvastatin dose to 40 mg. Both treatments were generally well-tolerated.</p> <p>Trial registration</p> <p>Registered at clinicaltrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00782184">NCT00782184</a></p

Adherence to the 4S-AF Scheme in the Balkan region:insights from the BALKAN-AF survey

BackgroundThe 4S-AF scheme includes stroke risk, symptoms, severity of burden, and substrate severity domain.AimWe aimed to assess the adherence to the 4S-AF scheme in patients classified according to stroke risk in post hoc analysis of the BALKAN-AF dataset.MethodsA 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015.ResultsLow stroke risk (CHA2DS2-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) patients. 2 099 (77.4%) patients had CHA2DS2-VASc score ≥3 in females or ≥2 in males (high stroke risk), and 613 (22.6%) had CHA2DS2-VASc score ConclusionsOAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered a rhythm control strategy was low

An econometric approach on production, costs and profit in Romanian coal mining enterprises

Global economic growth is based on increased consumption of electricity both from renewable resources, such as water and wind and non-renewable resources, such as coal (lignite), natural gas or petroleum. Coal continues to represent an important energy source in the European Union, particularly in Germany, France and Spain, where it accounts for 15% of the primary energy, out of which 80% is used in electricity supply. The coal (lignite) mines from the Oltenia region contribute significantly to generating power in Romania. The study aims to show that an increase in production within the coal (lignite) mining industry can be determined by increasing direct and indirect costs or by increasing variable costs and profit. We also examine the non-linear relation between variable costs and production on the one hand and between profit and production on the other hand. Our results show that there is a concave relationship between variable costs and production, and also a concave relationship between profit and production, which indicate that Romanian coal enterprises have an optimal production level that maximises both variable costs and their profitability. In addition, a robustness check of our results confirms that variable costs and profitability decrease as they move away from their optimal level

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

Oscillatory behavior of hollow grid cathode discharges

Multiple complex space-charge structures in unmagnetized low-temperature plasmas arise from ionization phenomena near additional negatively or positively biased electrodes or due to local constraints. Because of their usually spherical form, such structures are called fireballs. If they appear inside hollow grids, they are called inverted fireballs or plasma bubbles. The temporal evolution of such structures is often accompanied by strong plasma instabilities. The dynamics of complex space-charge structures have been investigated by using single spherical grid cathode with an orifice. Langmuir probe and optical emission spectroscopy were used to diagnose the structures. Measurements delivered the axial profiles of the plasma potential, electron temperature and density, and the densities of excited atoms and ions, that confirmed the formation of a fireball in the region near the orifice (also evidenced by visual observation). Inside the grid, a plasma bubble has developed, with a high ion density inside due to the hollow cathode effect. Information on the nonlinear dynamics of the complex space charge structures was obtained from the analysis of the oscillations of the discharge current