Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding

Atrial fibrillation (AF) is a common cardiac arrhythmia with an estimated prevalence of 1% in the general population. It is associated with an increased risk of ischemic stroke, silent cerebral ischemia, and cognitive impairment. Due to the blood flow stasis and morphology, thrombus formation occurs mainly in the left atrial appendage (LAA), particularly in the setting of nonvalvular AF (NVAF). Previous studies have shown that >90% of emboli related to NVAF originate from the LAA, thus prevention of systemic cardioembolism is indicated. According to the current guidelines, anticoagulant therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), represents the standard of care in AF patients, in order to prevent ischemic stroke and peripheral embolization. Although these drugs are widely used and DOACs have shown, compared to VKAs, non-inferiority for stroke prevention with significantly fewer bleeding complications, some issues remain a matter of debate, including contraindications, side effects, and adherence. An increasing number of patients, indeed, because of high bleeding risk or after experiencing life-threatening bleedings, must take anticoagulants with extreme caution if not contraindicated. While surgical closure or exclusion of LAA has been historically used in patients with AF with contradictory results, in the recent years, a novel procedure has emerged to prevent the cardioembolic stroke in these patients: The percutaneous left atrial appendage occlusion (LAAO). Different devices have been developed in recent years, though not all of them are approved in Europe and some are still under clinical investigation. Currently available devices have shown a significant decrease in bleeding risk while maintaining efficacy in preventing thromboembolism. The procedure can be performed percutaneously through the femoral vein access, under general anesthesia. A transseptal puncture is required to access left atrium and is guided by transesophageal echocardiography (TEE). Evidence from the current literature indicates that percutaneous LAAO represents a safe alternative for those patients with contraindications for long-term oral anticoagulation. This review summarizes scientific evidences regarding LAAO for stroke prevention including clinical indications and an adequate patient selection

Wet-dry-wet drug screen leads to the synthesis of TS1, a novel compound reversing lung fibrosis through inhibition of myofibroblast differentiation

Therapies halting the progression of fibrosis are ineffective and limited. Activated myofibroblasts are emerging as important targets in the progression of fibrotic diseases. Previously, we performed a high-throughput screen on lung fibroblasts and subsequently demonstrated that the inhibition of myofibroblast activation is able to prevent lung fibrosis in bleomycin-treated mice. High-throughput screens are an ideal method of repurposing drugs, yet they contain an intrinsic limitation, which is the size of the library itself. Here, we exploited the data from our “wet” screen and used “dry” machine learning analysis to virtually screen millions of compounds, identifying novel anti-fibrotic hits which target myofibroblast differentiation, many of which were structurally related to dopamine. We synthesized and validated several compounds ex vivo (“wet”) and confirmed that both dopamine and its derivative TS1 are powerful inhibitors of myofibroblast activation. We further used RNAi-mediated knock-down and demonstrated that both molecules act through the dopamine receptor 3 and exert their anti-fibrotic effect by inhibiting the canonical transforming growth factor β pathway. Furthermore, molecular modelling confirmed the capability of TS1 to bind both human and mouse dopamine receptor 3. The anti-fibrotic effect on human cells was confirmed using primary fibroblasts from idiopathic pulmonary fibrosis patients. Finally, TS1 prevented and reversed disease progression in a murine model of lung fibrosis. Both our interdisciplinary approach and our novel compound TS1 are promising tools for understanding and combating lung fibrosis

Relationship between low Ankle-Brachial Index and rapid renal function decline in patients with atrial fibrillation: A prospective multicentre cohort study

OBJECTIVE: To investigate the relationship between Ankle-Brachial Index (ABI) and renal function progression in patients with atrial fibrillation (AF). DESIGN: Observational prospective multicentre cohort study. SETTING:Atherothrombosis Center of I Clinica Medica of 'Sapienza' University of Rome; Department of Medical and Surgical Sciences of University Magna Græcia of Catanzaro; Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study. PARTICIPANTS: 897 AF patients on treatment with vitamin K antagonists. MAIN OUTCOME MEASURES: The relationship between basal ABI and renal function progression, assessed by the estimated Glomerular Filtration Rate (eGFR) calculated with the CKD-EPI formula at baseline and after 2 years of follow-up. The rapid decline in eGFR, defined as a decline in eGFR >5 mL/min/1.73 m(2)/year, and incident eGFR<60 mL/min/1.73 m(2) were primary and secondary end points, respectively. RESULTS: Mean age was 71.8±9.0 years and 41.8% were women. Low ABI (ie, ≤0.90) was present in 194 (21.6%) patients. Baseline median eGFR was 72.7 mL/min/1.73 m(2), and 28.7% patients had an eGFR60 mL/min/1.73 m(2), 153 (23.9%) had a reduction of the eGFR <60 mL/min/1.73 m(2). ABI ≤0.90 was also an independent predictor for incident eGFR<60 mL/min/1.73 m(2) (HR 1.851, 95% CI 1.205 to 2.845, p=0.005). CONCLUSIONS: In patients with AF, an ABI ≤0.90 is independently associated with a rapid decline in renal function and incident eGFR<60 mL/min/1.73 m(2). ABI measurement may help identify patients with AF at risk of renal function deterioration

Mesenchymal stem cells: from experiment to clinic

There is currently much interest in adult mesenchymal stem cells (MSCs) and their ability to differentiate into other cell types, and to partake in the anatomy and physiology of remote organs. It is now clear these cells may be purified from several organs in the body besides bone marrow. MSCs take part in wound healing by contributing to myofibroblast and possibly fibroblast populations, and may be involved in epithelial tissue regeneration in certain organs, although this remains more controversial. In this review, we examine the ability of MSCs to modulate liver, kidney, heart and intestinal repair, and we update their opposing qualities of being less immunogenic and therefore tolerated in a transplant situation, yet being able to contribute to xenograft models of human tumour formation in other contexts. However, such observations have not been replicated in the clinic. Recent studies showing the clinical safety of MSC in several pathologies are discussed. The possible opposing powers of MSC need careful understanding and control if their clinical potential is to be realised with long-term safety for patients

Measurement of the azimuthal anisotropy of charged-particle production in Xe+Xe collisions at sNN =5.44 TeV with the ATLAS detector

This paper describes the measurements of flow harmonics v2-v6 in 3μb-1 of Xe+Xe collisions at sNN=5.44 TeV performed using the ATLAS detector at the Large Hadron Collider (LHC). Measurements of the centrality, multiplicity, and pT dependence of the vn obtained using two-particle correlations and the scalar product technique are presented. The measurements are also performed using a template-fit procedure, which was developed to remove nonflow correlations in small collision systems. This nonflow removal is shown to have a significant influence on the measured vn at high pT, especially in peripheral events. Comparisons of the measured vn with measurements in Pb+Pb collisions and p+Pb collisions at sNN=5.02 TeV are also presented. The vn values in Xe+Xe collisions are observed to be larger than those in Pb+Pb collisions for n=2, 3, and 4 in the most central events. However, with decreasing centrality or increasing harmonic order n, the vn values in Xe+Xe collisions become smaller than those in Pb+Pb collisions. The vn in Xe+Xe and Pb+Pb collisions are also compared as a function of the mean number of participating nucleons, (Npart), and the measured charged-particle multiplicity in the detector. The v3 values in Xe+Xe and Pb+Pb collisions are observed to be similar at the same (Npart) or multiplicity, but the other harmonics are significantly different. The ratios of the measured vn in Xe+Xe and Pb+Pb collisions, as a function of centrality, are also compared to theoretical calculations

Search for diboson resonances in hadronic final states in 139 fb −1 of pp collisions at s = 13 TeV with the ATLAS detector

Abstract: Narrow resonances decaying into W W, W Z or ZZ boson pairs are searched for in 139 fb−1 of proton-proton collision data at a centre-of-mass energy of s = 13 TeV recorded with the ATLAS detector at the Large Hadron Collider from 2015 to 2018. The diboson system is reconstructed using pairs of high transverse momentum, large-radius jets. These jets are built from a combination of calorimeter- and tracker-inputs compatible with the hadronic decay of a boosted W or Z boson, using jet mass and substructure properties. The search is performed for diboson resonances with masses greater than 1.3 TeV. No significant deviations from the background expectations are observed. Exclusion limits at the 95% confidence level are set on the production cross-section times branching ratio into dibosons for resonances in a range of theories beyond the Standard Model, with the highest excluded mass of a new gauge boson at 3.8 TeV in the context of mass-degenerate resonances that couple predominantly to gauge bosons

Measurement of hadronic event shapes in high-p T multijet final states at √s = 13 TeV with the ATLAS detector

A measurement of event-shape variables in proton-proton collisions at large momentum transfer is presented using data collected at s = 13 TeV with the ATLAS detector at the Large Hadron Collider. Six event-shape variables calculated using hadronic jets are studied in inclusive multijet events using data corresponding to an integrated luminosity of 139 fb−1. Measurements are performed in bins of jet multiplicity and in different ranges of the scalar sum of the transverse momenta of the two leading jets, reaching scales beyond 2 TeV. These measurements are compared with predictions from Monte Carlo event generators containing leading-order or next-to-leading order matrix elements matched to parton showers simulated to leading-logarithm accuracy. At low jet multiplicities, shape discrepancies between the measurements and the Monte Carlo predictions are observed. At high jet multiplicities, the shapes are better described but discrepancies in the normalisation are observed. [Figure not available: see fulltext.

Search for light long-lived neutral particles produced in pp collisions at s = 13 TeV and decaying into collimated leptons or light hadrons with the ATLAS detector

Abstract: Several models of physics beyond the Standard Model predict the existence of dark photons, light neutral particles decaying into collimated leptons or light hadrons. This paper presents a search for long-lived dark photons produced from the decay of a Higgs boson or a heavy scalar boson and decaying into displaced collimated Standard Model fermions. The search uses data corresponding to an integrated luminosity of 36.1 fb-1 collected in proton–proton collisions at s=13 Te recorded in 2015–2016 with the ATLAS detector at the Large Hadron Collider. The observed number of events is consistent with the expected background, and limits on the production cross section times branching fraction as a function of the proper decay length of the dark photon are reported. A cross section times branching fraction above 4 pb is excluded for a Higgs boson decaying into two dark photons for dark-photon decay lengths between 1.5 mm and 307 mm

Search for squarks and gluinos in final states with same-sign leptons and jets using 139 fb−1^{-1} of data collected with the ATLAS detector

A search for supersymmetric partners of gluons and quarks is presented, involving signatures with jets and either two isolated leptons (electrons or muons) with the same electric charge, or at least three isolated leptons. A data sample of proton-proton collisions at $\sqrt{s}$ = 13 TeV recorded with the ATLAS detector at the Large Hadron Collider between 2015 and 2018, corresponding to a total integrated luminosity of 139 fb$^{-1}$, is used for the search. No significant excess over the Standard Model expectation is observed. The results are interpreted in simplified supersymmetric models featuring both R-parity conservation and R-parity violation, raising the exclusion limits beyond those of previous ATLAS searches to 1600 GeV for gluino masses and 750 GeV for bottom and top squark masses in these scenarios

Measurements of the production cross-section for a Z boson in association with b -jets in proton-proton collisions at s = 13 TeV with the ATLAS detector

Abstract: This paper presents a measurement of the production cross-section of a Z boson in association with b-jets, in proton-proton collisions at s = 13 TeV with the ATLAS experiment at the Large Hadron Collider using data corresponding to an integrated luminosity of 35.6 fb−1. Inclusive and differential cross-sections are measured for events containing a Z boson decaying into electrons or muons and produced in association with at least one or at least two b-jets with transverse momentum pT> 20 GeV and rapidity |y| < 2.5. Predictions from several Monte Carlo generators based on leading-order (LO) or next-to-leading-order (NLO) matrix elements interfaced with a parton-shower simulation and testing different flavour schemes for the choice of initial-state partons are compared with measured cross-sections. The 5-flavour number scheme predictions at NLO accuracy agree better with data than 4-flavour number scheme ones. The 4-flavour number scheme predictions underestimate data in events with at least one b-jet