Usefulness of transesophageal echocardiography before cardioversion in atrial arrhythmias

Background: Although many thromboembolism risk factors are well defined, formation of thrombus ordense spontaneous contrast (sludge) in the left atrium remains enigmatic and confounding. Exclusionof the thrombus is extremely important with respect to planned reversal of sinus rhythm. Data regardingthe routine transesophagal echocardiography (TEE) before cardioversion are inconclusive. The authorsfocused on analyzing the usefulness of TEE before cardioversion by assessment of factors influencing therisk of thrombus and/or dense spontaneous echo contrast with the intention of extending indications forTEE in the group with a high risk of thrombus or to forgo TEE in the low risk group. Methods: Two hundred sixty-nine consecutive patients with persistent (> 48 h) atrial fibrillationor atrial flutter, in whom a direct current cardioversion was planned, were undergoing TEE for thedetection of the left atrial thrombus or dense spontaneous echo contrast. Additional clinical and echocardiographic data were collected. The relationship between both thrombus and dense spontaneous echo contrast and covariates was analyzed with the use of binary logistic regression. Results: Left atrium (LA) appendage (LAA) thrombus and/or sludge were detected in 79 (29%)patients. Signs of dementia in mini-mental state examination (hazard ratio [HR]: 1.16; p = 0.005),low velocities in LAA (HR: 3.38; p = 0.032); presence of spontaneous echo contrast in LA (HR: 3.38;p = 0,003) consecutive episode of AF (HR: 2.27; p = 0,046); longer duration of atrial fibrillation (HR:1.009; p = 0.022); were significant predictors of thrombus and/or dense spontaneous echo contrast.None of the patients with a CHA2DS2VASc score ≤ 1 had thrombus or sludge in the LAA. Among patientswith a CHA2DS2VASc score > 1, the prevalence of thrombus or sludge in LAA was independentof the CHA2DS2VASc score value.Conclusions: Amongst many factors, including an established as risk for thromboembolism onlya few of them increased the risk for the presence of thrombus in LAA: low velocities in LAA, presenceof spontaneous echo contrast, longer duration of arrhythmia, consecutive (not first) arrhythmia episodeand signs of dementia from a mini-mental state examination questionnaire. It was believed that therecould be a need for an extension of indications of TEE in vast majority of the patients with atrial arrhythmias, due most often to an unpredictable occurrence of thrombus and potentially disastrousthromboembolism. The only exception could have been the group of the patients with a CHA2DS2VAScscore ≤ 1

Podwyższenie progu stymulacji u chorego z implantowanym układem stymulującym AAI w przebiegu ogólnoustrojowego zakażenia

W niniejszej pracy przedstawiono przypadek 72-letniego mężczyzny z wszczepionym rozrusznikiem typu AAI oraz znacznym zwiekszeniem wartości progu stymulacji ponad 4 lata po zabiegu implantacji. Obserwowano zalezność między narastaniem progu stymulacji i ogólnoustrojowym zakażeniem. W miarę pogarszania się stanu ogólnego pacjenta w przebiegu urosepsy odnotowano stopniowe narastanie, a następnie niemierzalne wartości progu stymulacji w kanale przedsionkowym. Po zastosowaniu skutecznej terapii wartości progu stymulacji obniżyły się. (Folia Cardiol. 2004; 11: 619–623

Podwyższenie progu stymulacji u chorego z implantowanym układem stymulującym AAI w przebiegu ogólnoustrojowego zakażenia

W niniejszej pracy przedstawiono przypadek 72-letniego mężczyzny z wszczepionym rozrusznikiem typu AAI oraz znacznym zwiekszeniem wartości progu stymulacji ponad 4 lata po zabiegu implantacji. Obserwowano zalezność między narastaniem progu stymulacji i ogólnoustrojowym zakażeniem. W miarę pogarszania się stanu ogólnego pacjenta w przebiegu urosepsy odnotowano stopniowe narastanie, a następnie niemierzalne wartości progu stymulacji w kanale przedsionkowym. Po zastosowaniu skutecznej terapii wartości progu stymulacji obniżyły się. (Folia Cardiol. 2004; 11: 619–623

Association of germline genetic variants in RFC, IL15 and VDR genes with minimal residual disease in pediatric B-cell precursor ALL

Minimal residual disease (MRD) enables reliable assessment of risk in acute lymphoblastic leukemia (ALL). However, little is known on association between MRD status and germline genetic variation. We examined 159 Caucasian (Slavic) patients with pediatric ALL, treated according to ALL-IC-BFM 2002/2009 protocols, in search for association between 23 germline polymorphisms and MRD status at day 15, day 33 and week 12, with adjustment for MRD-associated clinical covariates. Three variants were significantly associated with MRD: rs1544410 in VDR (MRD-day15); rs1051266 in RFC (MRD-day33, MRD-week12), independently and in an additive effect with rs10519613 in IL15 (MRD-day33). The risk alleles for MRD-positivity were: A allele of VDR (OR = 2.37, 95%CI = 1.07–5.21, P = 0.03, MRD-day15); A of RFC (OR = 1.93, 95%CI = 1.05–3.52, P = 0.03, MRD-day33 and MRD-week12, P < 0.01); A of IL15 (OR = 2.30, 95%CI = 1.02–5.18, P = 0.04, MRD-day33). The risk for MRD-day33-positive status was higher in patients with risk alleles in both RFC and IL15 loci than in patients with risk alleles in one locus or no risk alleles: 2 vs. 1 (OR = 3.94, 95% CI = 1.28–12.11, P = 0.024), 2 vs. 0 (OR = 6.75, 95% CI = 1.61–28.39, P = 0.012). Germline variation in genes related to pharmacokinetics/pharmacodynamics of anti-leukemic drugs and to anti-tumor immunity of the host is associated with MRD status and might help improve risk assessment in ALL

Polylactide as a Substitute for Conventional Polymers—Biopolymer Processing under Varying Extrusion Conditions

The polymer processing industry is paying more attention to biodegradable materials synthesized from renewable sources. One of the most popular of them is polylactide (PLA). Except the material from which a given product is made, particularly important is the process of manufacturing a polymer material, processing, use by the consumer, and finally, recycling it. Neither of these steps is indifferent to the environment. The processing of polymers can often lead to material degradation, which affects the properties of the material and leads to the generation of substantial amounts of post-production waste that cannot be reused by processors. The aim of this work is to evaluate selected properties of PLA subjected to the extrusion process under variable extrusion conditions. This is important due to the large losses of material and energy resulting from the extrusion of biodegradable polymers under poorly selected processing conditions, which, apart from the economic effects, has a negative impact on the environment. The research proved that both the temperature and the structure of the plasticizing system as well as the rotational speed of the screws affect the mechanical properties of the final product. For PLA optimization, this process will directly contribute to the improvement of the PLA processing process, and indirectly help to act for the benefit of the environment by reducing the consumption of energy, raw materials, and the amount of post-production waste. The obtained results allowed for the selection of appropriate parameters depending on the expectations regarding the properties of the final product. The conducted research will help to optimize processing processes and reduce the consumption of raw materials, which in the future will also affect the environment

Bactericidal Properties of Low-Density Polyethylene (LDPE) Modified with Commercial Additives Used for Food Protection in the Food Industry

This study investigated the influence of commercially available food preservatives: Natamax® (containing natamycin) and Nisaplin® (containing nisin) on the antimicrobial properties of LDPE film, commonly used for food packaging. Studies have shown that the addition of 3% Natamax® or, alternatively, the addition of 5% Nisaplin® provides an LDPE film with effective antimicrobial protection. The applied biocides did not significantly affect the strength and rheological properties of LDPE. However, differences in optical properties were observed. The transparency of the samples decreased slightly with the addition of 3% or 5% Natamax® (by approx. 1% and 3%, respectively). A significant change was observed in the film haze, the addition of 5% Natamax® increased this parameter by approx. 80%, while 5% Nisaplin® increased it by approx. 19%. Both Natamax® and Nisaplin® agents can be successfully used to manufacture food packaging materials with antimicrobial protection. Natamax® showed a stronger bactericidal effect, while Nisaplin® changed other properties less significantly

Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

INTRODUCTION: The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection. METHODS: That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation. RESULTS: LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03-7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02-7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25-10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk. CONCLUSION: Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk

Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC). METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation. RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p &lt; 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p &lt; 0.01), even after propensity score weighting (13% vs. 7.5%; p &lt; 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p &lt; 0.01 for both comparisons), however, not after propensity score weighting. CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs

Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter

AIMS: The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes. METHODS AND RESULTS: The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001). CONCLUSION: The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation