IMPACT OF ANEMIA ON CLINICAL OUTCOME IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE AFCAS REGISTRY

OBJECTIVES: Anaemia has an adverse impact on the outcome in the general patient population undergoing percutaneous coronary intervention (PCI). The aim of this study was to analyse the impact of anaemia on the 12-month clinical outcome of patients with atrial fibrillation (AF) undergoing PCI and therefore requiring intense antithrombotic treatment. We hypothesised that anaemia might be associated with a worse outcome and more bleeding in these anticoagulated patients. SETTING: Data were collected from 17 secondary care centres in Europe. PARTICIPANTS: Consecutive patients with AF undergoing PCI were enrolled in the prospective, multicenter AFCAS (Atrial Fibrillation undergoing Coronary Artery Stenting) registry. Altogether, 929 patients participated in the study. Preprocedural haemoglobin concentration was available for 861 (92.7%; 30% women). The only exclusion criteria were inability or unwillingness to give informed consent. Anaemia was defined as a haemoglobin concentration of <12 g/dL for women and <13 g/dL for men. OUTCOME MEASURES: The primary endpoint was occurrence of major adverse cardiac and cerebrovascular events (MACCE) or bleeding events. RESULTS: 258/861 (30%) patients had anaemia. Anaemic patients were older, more often had diabetes, higher CHA(2)DS(2)-VASc scores, prior history of heart failure, chronic renal impairment and acute coronary syndrome. Anaemic patients had more MACCE than non-anaemic (29.1% vs 19.4%, respectively, p=0.002), and minor bleeding events (7.0% vs 3.3%, respectively, p=0.028), with a trend towards more total bleeding events (25.2% vs 21.7%, respectively, p=0.059). No difference was observed in antithrombotic regimens at discharge. In multivariate analysis, anaemia was an independent predictor of all-cause mortality at 12-month follow-up (hazard ratio 1.62, 95% CI 1.05 to 2.51, p=0.029). CONCLUSIONS: Anaemia was a frequent finding in patients with AF referred for PCI. Anaemic patients had a higher all-cause mortality, more thrombotic events and minor bleeding events. Anaemia seems to be an identification of patients at risk for cardiovascular events and death. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00596570

A curated DNA barcode reference library for parasitoids of northern European cyclically outbreaking geometrid moths

Large areas of forests are annually damaged or destroyed by outbreaking insect pests. Understanding the factors that trigger and terminate such population eruptions has become crucially important, as plants, plant-feeding insects, and their natural enemies may respond differentially to the ongoing changes in the global climate. In northernmost Europe, climate-driven range expansions of the geometrid moths Epirrita autumnata and Operophtera brumata have resulted in overlapping and increasingly severe outbreaks. Delayed density-dependent responses of parasitoids are a plausible explanation for the 10-year population cycles of these moth species, but the impact of parasitoids on geometrid outbreak dynamics is unclear due to a lack of knowledge on the host ranges and prevalences of parasitoids attacking the moths in nature. To overcome these problems, we reviewed the literature on parasitism in the focal geometrid species in their outbreak range and then constructed a DNA barcode reference library for all relevant parasitoid species based on reared specimens and sequences obtained from public databases. The combined recorded parasitoid community of E. autumnata and O. brumata consists of 32 hymenopteran species, all of which can be reliably identified based on their barcode sequences. The curated barcode library presented here opens up new opportunities for estimating the abundance and community composition of parasitoids across populations and ecosystems based on mass barcoding and metabarcoding approaches. Such information can be used for elucidating the role of parasitoids in moth population control, possibly also for devising methods for reducing the extent, intensity, and duration of outbreaks.publishedVersio

Aorttaläppäahtauman katetrihoito oli turvallista myös keskussairaaloissa

Vertaisarvioitu.Lähtökohdat : Vuoden 2018 alussa voimaan tullut keskittämisasetus kielsi vaikean aorttaläppäahtauman hoitamisen TAVI-toimenpiteellä (transcatheter aortic valve implantation) sairaaloissa, joissa ei ole avosydänkirurgiaa. Ennen asetuksen voimaantuloa TAVI- oimenpiteet ehdittiin aloittaa neljässä keskussairaalassa. Menetelmät : Vuosina 2015–2018 TAVI-toimenpide tehtiin keskussairaalassa 174 potilaalle yhdellä itsestään laajentuvalla läppätyypillä. Yhtä lukuun ottamatta kaikki toimenpiteet suoritettiin paikallispuudutuksessa nivusvaltimon kautta sydänangiosalissa. Tulokset : Potilaiden keski-ikä oli 83 vuotta. Potilaat olivat hyvin oireisia; 80 %:lla oli vähintään NYHA (New York Heart Association) -luokan 3 oireisto. Hengenahdistusoireisto parani seurannassa 84 %:lla potilaista. 97 %:lla ei todettu merkittää läppäproteesin vierusvuotoa. Kirurgiaa vaatineita verisuonikomplikaatioita sattui kolmelle (1,7 %) potilaalle. Kaksi potilasta kuoli toimenpiteeseen (1,1 %). Viisi (2,9 %) potilasta kuoli 30 vuorokauden aikana ja yhdeksän (5,2 %) 12 kuukauteen mennessä. Päätelmät : Keskussairaaloissa ilman avosydänkirurgista valmiutta tehdyt TAVI-toimenpiteet olivat turvallisia. Tutkimuksen perusteella TAVI-toimenpiteiden keskittämisellä viiteen yliopistosairaalaan ei saavuteta hyötyä potilasturvallisuuden kannaltaPeer reviewe

Aorttaläppäahtauman katetrihoito oli turvallista myös keskussairaaloissa

Lähtökohdat : Vuoden 2018 alussa voimaan tullut keskittämisasetus kielsi vaikean aorttaläppäahtauman hoitamisen TAVI-toimenpiteellä (transcatheter aortic valve implantation) sairaaloissa, joissa ei ole avosydänkirurgiaa. Ennen asetuksen voimaantuloa TAVI- oimenpiteet ehdittiin aloittaa neljässä keskussairaalassa. Menetelmät : Vuosina 2015–2018 TAVI-toimenpide tehtiin keskussairaalassa 174 potilaalle yhdellä itsestään laajentuvalla läppätyypillä. Yhtä lukuun ottamatta kaikki toimenpiteet suoritettiin paikallispuudutuksessa nivusvaltimon kautta sydänangiosalissa. Tulokset : Potilaiden keski-ikä oli 83 vuotta. Potilaat olivat hyvin oireisia; 80 %:lla oli vähintään NYHA (New York Heart Association) -luokan 3 oireisto. Hengenahdistusoireisto parani seurannassa 84 %:lla potilaista. 97 %:lla ei todettu merkittää läppäproteesin vierusvuotoa. Kirurgiaa vaatineita verisuonikomplikaatioita sattui kolmelle (1,7 %) potilaalle. Kaksi potilasta kuoli toimenpiteeseen (1,1 %). Viisi (2,9 %) potilasta kuoli 30 vuorokauden aikana ja yhdeksän (5,2 %) 12 kuukauteen mennessä. Päätelmät : Keskussairaaloissa ilman avosydänkirurgista valmiutta tehdyt TAVI-toimenpiteet olivat turvallisia. Tutkimuksen perusteella TAVI-toimenpiteiden keskittämisellä viiteen yliopistosairaalaan ei saavuteta hyötyä potilasturvallisuuden kannaltaPeer reviewe

The Effects of Intensive Weight Reduction on Body Composition and Serum Hormones in Female Fitness Competitors

Worries about the potential negative consequences of popular fat loss regimens for aesthetic purposes in normal weight females have been surfacing in the media. However, longitudinal studies investigating these kinds of diets are lacking. The purpose of the present study was to investigate the effects of a 4-month fat-loss diet in normal weight females competing in fitness-sport. In total 50 participants finished the study with 27 females (27.2 +/- 4.1 years) dieting for a competition and 23 (27.7 +/- 3.7 years) acting as weight-stable controls. The energy deficit of the diet group was achieved by reducing carbohydrate intake and increasing aerobic exercise while maintaining a high level of protein intake and resistance training in addition to moderate fat intake. The diet led to a similar to 12% decrease in body weight (P <0.001) and a similar to 3550% decrease in fat mass (DXA, bioimpedance, skinfolds, P <0.001) whereas the control group maintained their body and fat mass (diet x group interaction P <0.001). A small decrease in lean mass (bioimpedance and skinfolds) and in vastus lateralis muscle cross-sectional area (ultrasound) were observed in diet (P <0.05), whereas other results were unaltered (DXA: lean mass, ultrasound: triceps brachii thickness). The hormonal system was altered during the diet with decreased serum concentrations of leptin, triiodothyronine (T3), testosterone (P <0.001), and estradiol (P <0.01) coinciding with an increased incidence of menstrual irregularities (P <0.05). Body weight and all hormones except T3 and testosterone returned to baseline during a 34 month recovery period including increased energy intake and decreased levels aerobic exercise. This study shows for the first time that most of the hormonal changes after a 3550% decrease in body fat in previously normal-weight females can recover within 34 months of increased energy intake.Peer reviewe

A curated DNA barcode reference library for parasitoids of northern European cyclically outbreaking geometrid moths

Large areas of forests are annually damaged or destroyed by outbreaking insect pests. Understanding the factors that trigger and terminate such population eruptions has become crucially important, as plants, plant-feeding insects, and their natural enemies may respond differentially to the ongoing changes in the global climate. In northernmost Europe, climate-driven range expansions of the geometrid moths Epirrita autumnata and Operophtera brumata have resulted in overlapping and increasingly severe outbreaks. Delayed density-dependent responses of parasitoids are a plausible explanation for the 10-year population cycles of these moth species, but the impact of parasitoids on geometrid outbreak dynamics is unclear due to a lack of knowledge on the host ranges and prevalences of parasitoids attacking the moths in nature. To overcome these problems, we reviewed the literature on parasitism in the focal geometrid species in their outbreak range and then constructed a DNA barcode reference library for all relevant parasitoid species based on reared specimens and sequences obtained from public databases. The combined recorded parasitoid community of E. autumnata and O. brumata consists of 32 hymenopteran species, all of which can be reliably identified based on their barcode sequences. The curated barcode library presented here opens up new opportunities for estimating the abundance and community composition of parasitoids across populations and ecosystems based on mass barcoding and metabarcoding approaches. Such information can be used for elucidating the role of parasitoids in moth population control, possibly also for devising methods for reducing the extent, intensity, and duration of outbreaks

Early life origins cognitive decline: findings in elderly men in the helsinki birth cohort study.

OBJECTIVES: To examine whether the adverse effects of slow prenatal and postnatal growth on cognitive function persist to old age and predict age related cognitive decline. DESIGN AND SETTING: A longitudinal birth cohort study of men born in Helsinki, Finland 1934-44. PARTICIPANTS: Nine-hundred-thirty-one men of the Helsinki Birth Cohort Study, with detailed data on growth from birth to adulthood, aged 20.1 (SD = 1.4) at the first and 67.9 (SD = 2.5) years at the second cognitive testing. MAIN OUTCOME MEASURES: The Finnish Defense Forces Basic Intellectual Ability Test assessed twice over nearly five decades apart. RESULTS: Lower weight, length and head circumference at birth were associated with lower cognitive ability at 67.9 years (1.04-1.55 points lower ability per each standard deviation [SD] unit decrease in body size, 95% Confidence Interval [95%CI]: 0.05 to 2.72) and with cognitive decline after 20.1 years (0.07-0.11 SD decline over time per each SD decrease in body size, 95%CI:0.00 to 0.19). Men who were born larger were more likely to perform better in the cognitive ability test over time (1.22-1.43 increase in odds to remain in the top relative to the lower two thirds in ability over time per each SD increase in body size, 95%CI:1.04 to 1.79) and were more resilient to cognitive decline after 20.1 years (0.69 to 0.76 decrease in odds to decline from than remain in the top third of ability over time per each SD increase in body size, 95%CI:0.49 to 0.99). Slower growth between birth and two years in weight, height and body mass index was associated with lower cognitive ability at 67.9 years, but not with cognitive decline. CONCLUSIONS: Poorer lifetime cognitive ability is predicted by slower growth before and after birth. In predicting resilience to age related cognitive decline, the period before birth seems to be more critical.Peer reviewe

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D