Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey

Atrial fibrillation (AF) is a major challenge for the healthcare field. Pulmonary vein isolation is the most effective treatment for the maintenance of sinus rhythm. However, clinical endpoints for the procedure vary significantly among studies. There is no consensus on the definition of recurrence and no clear roadmap on how to deal with recurrences after a failed ablation. The purpose of this study was to perform a survey in order to show how clinicians currently approach this knowledge gap. An online survey, supported by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, was conducted between 1 April 2022 and 8 May 2022. An anonymous questionnaire was disseminated via social media and EHRA newsletters, for clinicians to complete. This consisted of 18 multiple-choice questions regarding rhythm monitoring, definitions of a successful ablation, clinical practices after a failed AF ablation, and the continuance of anticoagulation. A total of 107 replies were collected across Europe. Most respondents (82%) perform routine monitoring for AF recurrences after ablation, with 51% of them preferring a long-term monitoring strategy. Cost was reported to have an impact on the choice of monitoring strategy. Self-screening was recommended by most (71%) of the respondents. The combination of absence of symptoms and recorded AF was the definition of success for most (83%) of the respondents. Cessation of anticoagulation after ablation was an option mostly for patients with paroxysmal AF and a low CHA2DS2-VASc score. The majority of physicians perform routine monitoring after AF ablation. For most physicians, the combination of the absence of symptoms and electrocardiographic endpoints defines a successful result after AF ablation

6-thioguanine treatment in inflammatory bowel disease: A critical appraisal by a European 6-TG working party

Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6-12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity. Copyright (c) 2006 S. Karger AG, Basel

Resolved Sideband Cooling of a Micromechanical Oscillator

Micro- and nanoscale opto-mechanical systems provide radiation pressure coupling of optical and mechanical degree of freedom and are actively pursued for their ability to explore quantum mechanical phenomena of macroscopic objects. Many of these investigations require preparation of the mechanical system in or close to its quantum ground state. Remarkable progress in ground state cooling has been achieved for trapped ions and atoms confined in optical lattices. Imperative to this progress has been the technique of resolved sideband cooling, which allows overcoming the inherent temperature limit of Doppler cooling and necessitates a harmonic trapping frequency which exceeds the atomic species' transition rate. The recent advent of cavity back-action cooling of mechanical oscillators by radiation pressure has followed a similar path with Doppler-type cooling being demonstrated, but lacking inherently the ability to attain ground state cooling as recently predicted. Here we demonstrate for the first time resolved sideband cooling of a mechanical oscillator. By pumping the first lower sideband of an optical microcavity, whose decay rate is more than twenty times smaller than the eigen-frequency of the associated mechanical oscillator, cooling rates above 1.5 MHz are attained. Direct spectroscopy of the motional sidebands reveals 40-fold suppression of motional increasing processes, which could enable reaching phonon occupancies well below unity (<0.03). Elemental demonstration of resolved sideband cooling as reported here should find widespread use in opto-mechanical cooling experiments. Apart from ground state cooling, this regime allows realization of motion measurement with an accuracy exceeding the standard quantum limit.Comment: 13 pages, 5 figure

Impact of soil and water conservation measuren on catchment hydrological response: a case in north Ethiopia

Impact studies of catchment management in the developing world rarely include detailed hydrological components. Here, changes in the hydrological response of a 200-ha catchment in north Ethiopia are investigated. The management included various soil and water conservation measures such as the construction of dry masonry stone bunds and check dams, the abandonment of post-harvest grazing, and the establishment of woody vegetation. Measurements at the catchment outlet indicated a runoff depth of 5 mm or a runoff coefficient (RC) of 1·6% in the rainy season of 2006. Combined with runoff measurements at plot scale, this allowed calculating the runoff curve number (CN) for various land uses and land management techniques. The pre-implementation runoff depth was then predicted using the CN values and a ponding adjustment factor, representing the abstraction of runoff induced by the 242 check dams in gullies. Using the 2006 rainfall depths, the runoff depth for the 2000 land management situation was predicted to be 26·5mm(RCD 8%), in line with current RCs of nearby catchments. Monitoring of the ground water level indicated a rise after catchment management. The yearly rise in water table after the onset of the rains (ΔT) relative to the water surplus (WS) over the same period increased between 2002-2003 (ΔT/WS D 3·4) and 2006 (ΔT/WS >11·1). Emerging wells and irrigation are other indicators for improved water supply in the managed catchment. Cropped fields in the gullies indicate that farmers are less frightened for the destructive effects of flash floods. Due to increased soil water content, the crop growing period is prolonged. It can be concluded that this catchment management has resulted in a higher infiltration rate and a reduction of direct runoff volume by 81% which has had a positive influence on the catchment water balance. © 2010 John Wiley & Sons, Ltd

Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicentre, randomised, phase III clinical trial

Introduction: We assessed whether modest systemic cooling started within 6 hours of symptom onset improves functional outcome at three months in awake patients with acute ischaemic stroke. Patients and methods: In this European randomised open-label clinical trial with blinded outcome assessment, adult patients with acute ischaemic stroke were randomised to cooling to a target body temperature of 34.0–35.0°C, started within 6 h after stroke onset and maintained for 12 or 24 h , versus standard treatment. The primary outcome was the score on the modified Rankin Scale at 91 days, as analysed with ordinal logistic regression. Results: The trial was stopped after inclusion of 98 of the originally intended 1500 patients because of slow recruitment and cessation of funding. Forty-nine patients were randomised to hypothermia versus 49 to standard treatment. Four patients were lost to follow-up. Of patients randomised to hypothermia, 15 (31%) achieved the predefined cooling targets. The primary outcome did not differ between the groups (odds ratio for good outcome, 1.01; 95% confidence interval, 0.48–2.13; p = 0.97). The number of patients with one or more serious adverse events did not differ between groups (relative risk, 1.22; 95% confidence interval, 0.65–1.94; p = 0.52). Discussion: In this trial, cooling to a target of 34.0–35.0°C and maintaining this for 12 or 24 h was not feasible in the majority of patients. The final sample was underpowered to detect clinically relevant differences in outcomes. Conclusion: Before new trials are launched, the feasibility of cooling needs to be improved

Autoimmune Response as a Mechanism for a Dobzhansky-Muller-Type Incompatibility Syndrome in Plants

Epistatic interactions between genes are a major factor in evolution. Hybrid necrosis is an example of a deleterious phenotype caused by epistatic interactions that is observed in many intra- and interspecific plant hybrids. A large number of hybrid necrosis cases share phenotypic similarities, suggesting a common underlying mechanism across a wide range of plant species. Here, we report that approximately 2% of intraspecific crosses in Arabidopsis thaliana yield F1 progeny that express necrosis when grown under conditions typical of their natural habitats. We show that several independent cases result from epistatic interactions that trigger autoimmune-like responses. In at least one case, an allele of an NB-LRR disease resistance gene homolog is both necessary and sufficient for the induction of hybrid necrosis, when combined with a specific allele at a second locus. The A. thaliana cases provide insights into the molecular causes of hybrid necrosis, and serve as a model for further investigation of intra- and interspecific incompatibilities caused by a simple epistatic interaction. Moreover, our finding that plant immune-system genes are involved in hybrid necrosis suggests that selective pressures related to host–pathogen conflict might cause the evolution of gene flow barriers in plants

Neuregulin 1 Type III/ErbB Signaling Is Crucial for Schwann Cell Colonization of Sympathetic Axons

Analysis of Schwann cell (SC) development has been hampered by the lack of growing axons in many commonly used in vitro assays. As a consequence, the molecular signals and cellular dynamics of SC development along peripheral axons are still only poorly understood. Here we use a superior cervical ganglion (SCG) explant assay, in which axons elongate after treatment with nerve growth factor (NGF). Migration as well as proliferation and apoptosis of endogenous SCG-derived SCs along sympathetic axons were studied in these cultures using pharmacological interference and time-lapse imaging. Inhibition of ErbB receptor tyrosine kinases leads to reduced SC proliferation, increased apoptosis and thereby severely interfered with SC migration to distal axonal sections and colonization of axons. Furthermore we demonstrate that SC colonization of axons is also strongly impaired in a specific null mutant of an ErbB receptor ligand, Neuregulin 1 (NRG1) type III. Taken together, using a novel SC development assay, we demonstrate that NRG1 type III serves as a critical axonal signal for glial ErbB receptors that drives SC development along sympathetic axons

Couple’s Relationship After the Death of a Child: a Systematic Review

When a child dies, the parents must address the changes in their relationship as well as the way that these changes affect their individual adjustment. These two perspectives are addressed in this systematic review. Five databases were systematically searched for papers published in English between January 2000 and February 2014. Of the 646 publications, 24 papers met the inclusion criteria. The results suggest that a child’s death can cause cohesive as well as detrimental effects on a couple’s relationship. Variables that may produce differential outcomes for the marital relationship include situational factors, such as the cause and type of death and the child’s age at the time of death; dyad-level factors, such as surviving children, the pre-death characteristics of the relationship, communication and incongruent grieving; and individuallevel factors, such as the family of origin’s processing of trauma, social support, religious affiliation and finding meaning. Aspects such as marital quality and the couple’s interdependence were found to influence each parent’s individual adjustment. Larger, prospective, ethically conducted studies should be implemented to consolidate these findings. Mental health professionals may benefit from a deeper understanding of the risk and protective factors regarding marital adjustment after a child’s death

Anesthetics Impact the Resolution of Inflammation

Local and volatile anesthetics are widely used for surgery. It is not known whether anesthetics impinge on the orchestrated events in spontaneous resolution of acute inflammation. Here we investigated whether a commonly used local anesthetic (lidocaine) and a widely used inhaled anesthetic (isoflurane) impact the active process of resolution of inflammation.Using murine peritonitis induced by zymosan and a systems approach, we report that lidocaine delayed and blocked key events in resolution of inflammation. Lidocaine inhibited both PMN apoptosis and macrophage uptake of apoptotic PMN, events that contributed to impaired PMN removal from exudates and thereby delayed the onset of resolution of acute inflammation and return to homeostasis. Lidocaine did not alter the levels of specific lipid mediators, including pro-inflammatory leukotriene B(4), prostaglandin E(2) and anti-inflammatory lipoxin A(4), in the cell-free peritoneal lavages. Addition of a lipoxin A(4) stable analog, partially rescued lidocaine-delayed resolution of inflammation. To identify protein components underlying lidocaine's actions in resolution, systematic proteomics was carried out using nanospray-liquid chromatography-tandem mass spectrometry. Lidocaine selectively up-regulated pro-inflammatory proteins including S100A8/9 and CRAMP/LL-37, and down-regulated anti-inflammatory and some pro-resolution peptides and proteins including IL-4, IL-13, TGF-â and Galectin-1. In contrast, the volatile anesthetic isoflurane promoted resolution in this system, diminishing the amplitude of PMN infiltration and shortening the resolution interval (Ri) approximately 50%. In addition, isoflurane down-regulated a panel of pro-inflammatory chemokines and cytokines, as well as proteins known to be active in cell migration and chemotaxis (i.e., CRAMP and cofilin-1). The distinct impact of lidocaine and isoflurane on selective molecules may underlie their opposite actions in resolution of inflammation, namely lidocaine delayed the onset of resolution (T(max)), while isoflurane shortened resolution interval (Ri).Taken together, both local and volatile anesthetics impact endogenous resolution program(s), altering specific resolution indices and selective cellular/molecular components in inflammation-resolution. Isoflurane enhances whereas lidocaine impairs timely resolution of acute inflammation