Ganglionated plexi as neuromodulation targets for atrial fibrillation

The autonomic nervous system plays an important role in the genesis of atrial fibrillation and is one of the candidate targets for atrial fibrillation therapy. This review focuses on the role of the autonomic nervous system in atrial fibrillation development and discusses the results of the ganglionated plexi catheter and surgical ablation in preclinical and clinical studies. The heart is innervated by the extrinsic and intrinsic autonomic nervous systems. The intrinsic autonomic nervous system consists of multiple ganglionated plexi and axons, which innervate the neighboring atrial myocardium and control their electrophysiological properties. Abnormal autonomic innervation has been observed in an animal model of atrial fibrillation and in humans. Direct recordings of autonomic nerve activity in canine models showed that atrial tachyarrhythmia episodes were invariably preceded by intrinsic cardiac autonomic nerve activity, thus supporting the importance of intrinsic cardiac autonomic nerve activity as the triggers for atrial tachyarrhythmia. Targeting ganglionated plexi with catheter ablation improves the outcomes of paroxysmal atrial fibrillation ablation in addition to pulmonary vein antrum isolation. Ablation of ganglionated plexi alone without pulmonary vein isolation is also useful in controlling paroxysmal atrial fibrillation in some patients. However, surgical ganglionated plexi ablation in patients with a large left atrium, persistent atrial fibrillation, and/or a history of prior catheter ablation does not result in additional benefits. These different outcomes suggest that ganglionated plexi ablation is effective in managing patients with paroxysmal atrial fibrillation, but its effects in patients with persistent atrial fibrillation and advanced atrial diseases might be limited

Education, social capital and social inclusion

This study covers a two-year span with implications to future training provisions offered by the Let Me Learn Centre – Malta. This study is concluded but the analytic part is still in progress.peer-reviewe

Exploring Care Givers’ Desires for their Older Counterparts toward the Advanced Information and Communications Technology with market oriented approach

There are many countries which suffer from high increase rate of old people population over the world. The steep increase in elderly has caused many changes and challenges, and one of the most serious and biggest challenges is caring issues. It became hard for the aged care receivers to receive caring from human caregivers, and also difficult for caregivers to take care of the aged well due to many reasons. Thus, it is time to find alternatives which can support or help caregivers‟ caring activities. The research focuses on exploring caregivers‟ intention which want to use ICT as supporter or helper of their caring. Moreover, it reveals more specific needs under different circumstances, and common values which caregivers want to receive from ICT caring services. The findings shows there are enough needs for ICT as helper or supporter for caring in the market and exploration of more specific needs and common values provides useful guideline for the ICT service providers

Suggesting A Guideline To Information And Communication Technolgoy Service Development In Accordance With User Value Driven Perspective

Information and Communication Technology (ICT) service industry, especially the mobile service market, has been one of the core growth engines for Korean economy during the last decades. However, ICT service market is currently experiencing severe stagnation mainly due to the saturation in customer expenditure. Until recently, a technology intensive approach has been playing a critical role in terms of ICT service development in Korea. However, limitations in this technology based method have been exposed with respect to locating and addressing dynamic and in-depth user needs and demands. Various ICT services have been introduced into the market in accordance with the technology intensive approach; however, there is only the mere presence of success in fulfilling user satisfaction. Thus, nowadays, a user value-driven approach is widely gaining attention as a substitute or/and complement to conventional methods. In fact, user value-driven approach is not a brand new idea; it has been broadly practiced in many none-ICT relevant fields, however, as for ICT industry, user-driven approach is still in early stage of the adoption. Therefore, the major research question of this study is to explore user’s hidden needs and demands and consider appropriate methods to apply them into ICT service developments

Nonalcoholic fatty liver disease and the risk of atrial fibrillation stratified by body mass index:a nationwide population-based study

We evaluated the association between nonalcoholic fatty liver disease (NAFLD) and incident atrial fibrillation (AF) and analyzed the impact of NAFLD on AF risk in relation to body mass index (BMI). A total of 8,048,055 subjects without significant liver disease who were available fatty liver index (FLI) values were included. Subjects were categorized into 3 groups based on FLI: 2), higher FLI raised the risk of AF (by 1.6-fold in 30 ≤ FLI 2. The impact of NAFLD on AF risk was accentuated in lean subjects with underweight

Efficacy and Safety of Oral Anticoagulants for Atrial Fibrillation Patients With Chronic Kidney Disease:A Systematic Review and Meta-Analysis

BACKGROUND: Data on different direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with renal impairment are insufficient. We aimed to perform pairwise and network meta-analysis comparing oral anticoagulants (OACs) in AF patients with renal impairment, including advanced chronic kidney disease (CKD) with creatinine clearance <30 mL/min. METHODS: PubMed, Embase, Cochrane Database, and references of related articles were searched up to April 2021. We included randomized trials and non-randomized studies using propensity-score or multivariable-model adjustments that compared clinical outcomes among OACs. Hazard ratios (HRs) for stroke or thromboembolism, major bleeding, and all-cause death were pooled using random-effects model. RESULTS: From 19 studies, 124,628 patients were included. In patients with AF and CKD, DOACs presented significantly lower risks of stroke or thromboembolism [HR(pooled) = 0.78, 95% confidence interval (CI) = 0.73–0.85, I(2) = 16.6%] and major bleeding [HR(pooled) = 0.76 (0.64–0.89), I(2) = 85.7%] when compared with warfarin, regardless of the severity of renal impairment. Results were consistent in advanced CKD patients for stroke or thromboembolism [HR(pooled) = 0.60 (0.43–0.85), I(2) = 0.0%] and major bleeding [HR(pooled) = 0.74 (0.59–0.93), I(2) = 30.4%]. In the network meta-analysis, edoxaban and apixaban presented the highest rank probability to reduce the risk of stroke or thromboembolism (edoxaban, P-score = 94.5%) and major bleeding (apixaban, P-score = 95.8%), respectively. Apixaban remained the safest OAC with the highest rank probability for major bleeding (P-score = 96.9%) in patients with advanced CKD. CONCLUSION: DOACs, particularly apixaban and edoxaban, presented superior efficacy and safety than warfarin in AF patients with CKD. Apixaban was associated with the lowest risk of major bleeding among OACs for patients with advanced CKD. SYSTEMATIC REVIEW REGISTRATION: [PROSPERO], identifier [CRD42021241718]