Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Cancer data quality and harmonization in Europe: the experience of the BENCHISTA Project – international benchmarking of childhood cancer survival by stage

IntroductionVariation in stage at diagnosis of childhood cancers (CC) may explain differences in survival rates observed across geographical regions. The BENCHISTA project aims to understand these differences and to encourage the application of the Toronto Staging Guidelines (TG) by Population-Based Cancer Registries (PBCRs) to the most common solid paediatric cancers.MethodsPBCRs within and outside Europe were invited to participate and identify all cases of Neuroblastoma, Wilms Tumour, Medulloblastoma, Ewing Sarcoma, Rhabdomyosarcoma and Osteosarcoma diagnosed in a consecutive three-year period (2014-2017) and apply TG at diagnosis. Other non-stage prognostic factors, treatment, progression/recurrence, and cause of death information were collected as optional variables. A minimum of three-year follow-up was required. To standardise TG application by PBCRs, on-line workshops led by six tumour-specific clinical experts were held. To understand the role of data availability and quality, a survey focused on data collection/sharing processes and a quality assurance exercise were generated. To support data harmonization and query resolution a dedicated email and a question-and-answers bank were created.Results67 PBCRs from 28 countries participated and provided a maximally de-personalized, patient-level dataset. For 26 PBCRs, data format and ethical approval obtained by the two sponsoring institutions (UCL and INT) was sufficient for data sharing. 41 participating PBCRs required a Data Transfer Agreement (DTA) to comply with data protection regulations. Due to heterogeneity found in legal aspects, 18 months were spent on finalizing the DTA. The data collection survey was answered by 68 respondents from 63 PBCRs; 44% of them confirmed the ability to re-consult a clinician in cases where stage ascertainment was difficult/uncertain. Of the total participating PBCRs, 75% completed the staging quality assurance exercise, with a median correct answer proportion of 92% [range: 70% (rhabdomyosarcoma) to 100% (Wilms tumour)].ConclusionDifferences in interpretation and processes required to harmonize general data protection regulations across countries were encountered causing delays in data transfer. Despite challenges, the BENCHISTA Project has established a large collaboration between PBCRs and clinicians to collect detailed and standardised TG at a population-level enhancing the understanding of the reasons for variation in overall survival rates for CC, stimulate research and improve national/regional child health plans

Effect of growth regulators on the fertility of fruit species from the Capsicum genus

Najważniejszym gatunkiem z rodzaju Capsicum jest papryka roczna (Capsicum annuum L). Należą do niego wszystkie zarejestrowane i uprawiane w Polsce odmiany uprawne. W badaniach nad poliembrionią stwierdzono, że regulatory wzrostu wpływają na zwiększenie częstotliwości tego zjawiska. Niektóre z nich mogą również indukować haploidalną embriogenezę. Celem badań była ocena wpływu regulatorów wzrostu: kwasu 2,4-dwuchlorofenoksyoctowego (2,4-D) i ß-naftoksyoctowego (ß-NOA), użytych samodzielnie lub w mieszaninie z benzyloaminopuryną (BAP), na płodność owoców gatunków z rodzaju Capsicum. Wykorzystane w doświadczeniu regulatory wzrostu spowodowały redukcję liczby nasion w owocach przy jednoczesnej poprawie zdolności kiełkowania. Efekty ich działania były charakterystyczne dla gatunku. Wpływ substancji wzrostowych na częstotliwość poliembrionii przy jednoczesnym ograniczeniu płodności może być korzystne z praktycznego punktu widzenia. Zmniejsza się bowiem pracochłonność analizy kiełkujących nasion.The annual pepper (Capsicum annuum L.) is the most important species from the Capsicum genus. All varieties of peppers registered and cultivated in Poland belong to this species. In the studies on polyembryony, it was found that the growth regulators could increase the frequency of this phenomenon. Some of them may also induce the haploid embryogenesis. The aim of study was to determine the effect of growth regulators, 2,4-dichlorophenoxyacetic acid (2,4-D) and ß-naphtoxyacetic acid (ß-NOA), used separately and in a mixture with benzyl- aminopurine (BAP), on the fertility of fruit species from the Capsicum genus. The growth regulators used in the study decreased the number of seeds in fruits at simultaneous improving their germination ability. The effect of their impact action was characteristic for the species. The influence of growth substances on the frequency of polyembryony with simultaneous fertility reduction may be advantageous from a practical point of view as it makes the tests of germinating seeds less laborious

Porosty na terenach pogórniczych rud cynkowo-ołowiowych

A list of lichens from areas of zinc-lead ores in Southern Poland and a review of the characteristic lichen biota of these sites is provided. In spite of the devastated and heavy metal contaminated environment, a highly diverse epigeic and epilithic lichen biota was found, including species characteristic of various anthropogenic habitats, particularly zinc and lead enriched substrates (Diploschistes muscorum, Steinia geophana, Sarcosagium campestre, Vezdaea aestivalis and V. leprosa). Also, the high-mountain species Leucocarpia biatorella, as well as very rare in Europe Thelocarpon imperceptum, and several species categorized as very rare, endangered and protected in Poland were recorded. Crustose lichens are the most abundant; among fruticose forms Cladonia spp. predominate and Stereocaulon incrustatum is commonPraca prezentuje wyniki badań lichenologicznych przeprowadzonych na wybranych powierzchniach Wyżyny Śląsko-Krakowskiej związanych z eksploatacją rud cynkowo-ołowiowych. Lista porostów tego terenu liczy 89 taksonów, z których 76 zawartych jest w tabeli 1. Pomimo trudnych warunków siedliskowych (brak wody oraz niektórych składników pokarmowych, wysoka zawartość metali ciężkich – głównie cynku, ołowiu i kadmu, - silna insolacja oraz silne działania wiatrów), występuje tu bardzo zróżnicowana i specyficzna biota porostów. Porosty były badane na wszystkich dostępnych substratach. Najmniej liczne są epifity i epiksylity, ograniczone do kilku najpospolitszych, toksytolerancyjnych gatunków. Dominują gatunki naziemne i naskalne, z których te ostatnie rosną głównie na kamieniach i drobnych kamykach. Wśród form morfologicznych zdecydowanie liczebną przewagę mają porosty skorupiaste, choć o fizjonomii zbiorowisk decydują porosty krzaczkowate, zwłaszcza Cladonia spp., które występują obficie i tworzą duże populacje. Z nielicznych form listkowatych obecne są Peltigera rufescens i P. didactyla, które poprzez zdolność wiązania wolnego azotu przez symbiotyczne sinice, są ważnym ogniwem łańcucha troficznego. Występują gatunki związane z substratami zawierającymi cynk i ołów, które mogą być wskaźnikami ich obecności w podłożu: Diploschistes muscorum, Sarcosagium campestre, Steinia geophana, Vezdaea aestivalis i V. leprosa. Wiele spośród odnotowanych porostów to gatunki rzadkie lub bardzo rzadkie w Polsce, pięć z nich podlega ochronie prawnej, a siedem – znajduje się na krajowej czerwonej liście. Badany teren jest również ostoją rzadkich porostów górskich, na przykład Leucocarpia biatorella oraz bardzo rzadkiego w E E uropie Thelocarpon imperceptum. Analizowana lichenobiota jest porównywalna ze składem gatunkowym porostów z innych terenów pogórniczych Europy

Genome size, leaf, fruit and seed traits-taxonomic tools for species identification in the Genus nasturtium R.Br.

Flow cytometry estimation of 2C nuclear DNA content of the examined Nasturtium species resulted in taxonomic identification of N. × sterile in eight new localities, N. microphyllum in four new localities and N. officinale in one new locality in western Poland. Scanning electron microscopy proved a few of the micromorphological traits of seeds and fruits (size and shape of cells on the fruit septum surface, their anticlinal walls; secondary sculpture on the outer periclinal walls of cells on the siliqua valve internal surface) to be of taxonomic importance

Heavy metals in soil affect reproductive processes more than morphological characters in Viola tricolor

Viola tricolor (Violaceae), a species very differentiated morphologically and showing intra- and interpopulation variability, occupies metalliferous (Zn, Pb, Cd, Cu) and nonmetalliferous sites through its geographic range. Here we analyzed morphological and anatomical features and also sexual reproduction in metallicolous and nonmetallicolous populations to determine whether and how they differ. Two-dimensional correspondence analysis based on selected morphological characters of vegetative and generative organs showed that plants from metalliferous soils did not form a compact group separated from those growing on nonmetalliferous soils. SEM of leaf and stipule anatomy showed differences in leaf hair ornamentation. There were significant differences in embryological processes in ovules and anthers: disturbed microsporogenesis (metallicolous 33% vs. nonmetallicolous 18%), lower pollen stainability (75% and 78% vs. 84% and 93%, depending on test), and higher frequency of degeneration in ovules (23% vs. 4%). These ultimately did not impede sexual reproduction of metallicolous populations but they do provide evidence that reproductive processes are sensitive to elevated heavy metals in soil and therefore can be viewed as a cost of metal tolerance