Bigeminy and the bifid papillary muscle

Various structural anomalies of the left ventricular papillary muscles have been observed in recent years. Many of these have been linked to electrocardiographic aberrations

Burning issues in the prevention of heart failure

Chronic heart failure is common, debilitating, and often the culmination of pervasive cardiovascular insults that systematically undermine the heart’s circulatory capacity and invoke counterproductive neuro-hormonal compensatory changes. Prevention of chronic heart failure therefore requires minimising the impact of traditional cardiovascular risk factors with incisive treatment of hypertension and type 2 diabetes mellitus (T2DM) and prompt lifestyle interventions for smoking, lack of exercise, obesity and hypercholesterolemia. This review is narrative, with selected emphasis on major studies, rather than structured on a specific clinical question, and should be read as such

The canonical effect in statistical models for relativistic heavy ion collisions

Enforcing exact conservation laws instead of average ones in statistical thermal models for relativistic heavy ion reactions gives raise to so called canonical effect, which can be used to explain some enhancement effects when going from elementary (e.g. pp) or small (pA) systems towards large AA systems. We review the recently developed method for computation of canonical statistical thermodynamics, and give an insight when this is needed in analysis of experimental data.Comment: 4 pages, 3 figures. Talk given in Strangeness in Quark Matter, Frankfurt am Main 2001. Submitted to J. Phys. G: Nucl. Part. Phy

Structural Causes of Right Bundle Branch Block—Time for a Closer Look?

Right bundle branch block is an electrocardiographic phenomenon with specific criteria

Effects of tranexamic acid on surgical, traumatic and obstetric bleeding: a critical analysis of the evidence from randomised trials using systematic reviews and meta-analytic techniques

BACKGROUND Surgical, traumatic and obstetric bleeding are important causes of mortality and morbidity. The antifibrinolytic drug, tranexamic acid (TXA), inhibits clot breakdown and may have a role in the management of excessive bleeding. AIM: Evaluate the evidence from randomised trials for the effects of TXA in patients with surgical bleeding, traumatic bleeding, and for preventing postpartum haemorrhage (PPH). METHODS: Using systematic reviews and meta-analytic techniques, evaluate the evidence from randomised trials to: i) quantify the effects of TXA for surgical bleeding; ii) investigate the quality of trials of TXA for surgical bleeding; iii) to quantify the effects of TXA for traumatic bleeding; iv) estimate the number of avoidable trauma deaths by the routine use of TXA; v) quantify the effects of TXA for preventing PPH; and vi) propose a trial of TXA for preventing PPH. RESULTS: A systematic review including 129 trials involving 10,488 patients suggests that TXA reduces bleeding in surgical patients by about one third, although its effect on death and thromboembolic events is uncertain. Evidence that TXA reduces surgical bleeding has been available for many years, although, poor methodological quality of trials may mean that it is unreliable. There is reliable evidence that TXA reduces death due to bleeding in trauma patients. This evidence originates from a large, high quality randomised trial in 20,211 patients. If TXA was given to all patients soon (<3 hours) after injury over 100,000 deaths could be prevented every year. A systematic review including 26 trials involving 4191 women suggests that there is no reliable evidence for the effects of TXA for preventing PPH. The trials are poor quality and contain serious flaws. The proposed WOMAN-2 trial of TXA for preventing PPH in 10,000 women with anaemia aims to resolve the uncertainties. CONCLUSIONS: Most trials assessing the effect of TXA for surgical bleeding and for preventing PPH are small and poor quality. Although together they provide promising evidence that TXA reduces bleeding, further evidence from large trials at low risk of bias is required to determine reliably the effects of TXA for these indications. There is reliable evidence that TXA reduces the risk of death in trauma patients and no further trials are required. Instead, dissemination of the evidence and implementation of TXA into trauma protocols worldwide, should be a priority. Although there is no evidence from randomised trials that it increases risk, the effect of TXA on thromboembolic events remains uncertain

The effectiveness and safety of antifibrinolytics in patients with acute intracranial haemorrhage: statistical analysis plan for an individual patient data meta-analysis

Introduction: The Antifibrinolytic Trialists Collaboration aims to increase knowledge about the effectiveness and safety of antifibrinolytic treatment by conducting individual patient data (IPD) meta-analyses of randomised trials. This article presents the statistical analysis plan for an IPD meta-analysis of the effects of antifibrinolytics for acute intracranial haemorrhage. Methods: The protocol for the IPD meta-analysis has been registered with PROSPERO (CRD42016052155). We will conduct an individual patient data meta-analysis of randomised controlled trials with 1000 patients or more assessing the effects of antifibrinolytics in acute intracranial haemorrhage. We will assess the effect on two co-primary outcomes: 1) death in hospital at end of trial follow-up, and 2) death in hospital or dependency at end of trial follow-up. The co-primary outcomes will be limited to patients treated within three hours of injury or stroke onset. We will report treatment effects using odds ratios and 95% confidence intervals. We use logistic regression models to examine how the effect of antifibrinolytics vary by time to treatment, severity of intracranial bleeding, and age. We will also examine the effect of antifibrinolytics on secondary outcomes including death, dependency, vascular occlusive events, seizures, and neurological outcomes. Secondary outcomes will be assessed in all patients irrespective of time of treatment. All analyses will be conducted on an intention-to-treat basis. Conclusions: This IPD meta-analysis will examine important clinical questions about the effects of antifibrinolytic treatment in patients with intracranial haemorrhage that cannot be answered using aggregate data. With IPD we can examine how effects vary by time to treatment, bleeding severity, and age, to gain better understanding of the balance of benefit and harms on which to base recommendations for practice

Non-operatively managed small to medium-sized subscapularis tendon tears: MRI evaluation with a minimum of 5 years follow-up

Background Isolated or combined subscapularis (SSC) tendon tears are frequently found in patients with shoulder pain. The purpose of this study was to evaluate the structural changes associated with SSC tear in a consecutive series of patients with nonoperatively treated small size to midsize SSC tendon tears using magnetic resonance imaging (MRI). Methods In this retrospective case series, all patients with an isolated or combined SSC tendon tear treated nonoperatively between 1999 and 2019 were identified from our MRI and clinical databases. Twenty-one patients with a mean age of 52.6 years (range 26.6-64.8, standard deviation 9.3) with a second MRI scan at a minimum of 5 years of follow-up were enrolled. The mean follow-up was 8.6 years (range 5.6-12.6, standard deviation 1.8). Initial and last follow-up MRI scans were used to determine concomitant cuff lesions, size of the SSC tear, fatty infiltration of the SSC muscle, and biceps pathology. Results Five patients had an isolated SSC lesion; 7 patients had a concomitant tear of the supraspinatus, and 9 patients had a supraspinatus and anterior infraspinatus tendon tear. At diagnosis, 14 patients had a type 1 SSC lesion as classified by Lafosse et al, 4 patients had type 2, and 3 patients had type 3 lesions. Nineteen patients (90%) were found to have an SSC tear progression of at least one Lafosse grade (P < .001); however, no tear had progressed to an irreparable type lesion (defined as Lafosse type 5). In addition, the size of SSC tendon tears increased significantly from 75 mm2 to 228 mm2 (P < .001). At the final MRI scan, the grading of fatty infiltration increased by 1 grade in 4 cases and by 2 grades in 4 cases (P = .042). At the final follow-up, in eight patients, the condition of the long head of biceps tendon was unchanged from the initial MRI; in nine patients, there was a newly subluxated biceps tendon, and in 6 patients, there was a newly ruptured long head of biceps tendon (P < .001). Conclusion After a mean of 8.6 years, almost all nonoperatively treated SSC tendon tears had increased in size, but only one-third showed additional progression of muscle fatty degeneration on MRI scan. None of the SSC lesions became irreparable during the observation period

A review of internet of energy based building energy management systems: Issues and recommendations

© 2013 IEEE. A building energy management system (BEMS) is a sophisticated method used for monitoring and controlling a building's energy requirements. A number of potential studies were conducted in nearly or net zero energy buildings (nZEBs) for the optimization of building energy consumption through efficient and sustainable ways. Moreover, policy makers are approving measures to improve building energy efficiency in order to foster sustainable energy usages. However, the intelligence of existing BEMSs or nZEBs is inadequate, because of the static set points for heating, cooling, and lighting, the complexity of large amounts of BEMS data, data loss, and network problems. To solve these issues, a BEMS or nZEB solution based on the Internet of energy (IoE) provides disruptive opportunities for revolutionizing sustainable building energy management. This paper presents a critical review of the potential of an IoE-based BEMS for enhancing the performance of future generation building energy utilization. The detailed studies of the IoE architecture, typical nZEB configuration, different generations of nZEB, and smart building energy systems for future BEMS are investigated. The operations, advantages, and limitations of the existing BEMSs or nZEBs are illustrated. A comprehensive review of the different types of IoE-based BEMS technologies, such as energy routers, storage systems and materials, renewable sources, and plug-and-play interfaces, is then presented. The rigorous review indicates that existing BEMSs require advanced controllers integrated with IoE-based technologies for sustainable building energy usage. The main objective of this review is to highlight several issues and challenges of the conventional controllers and IoE applications of BEMSs or nZEBs. Accordingly, the review provides several suggestions for the research and development of the advanced optimized controller and IoE of future BEMSs. All the highlighted insights and recommendations of this review will hopefully lead to increasing efforts toward the development of the future BEMS applications