Association between air pollution and ventricular arrhythmias in high-risk patients (ARIA study): a multicentre longitudinal study

Summary Background Although the effects of air pollution on mortality have been clearly shown in many epidemiological and observational studies, the pro-arrhythmic effects remain unknown. We aimed to assess the short-term effects of air pollution on ventricular arrhythmias in a population of high-risk patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation therapy defibrillators (ICD-CRT). Methods In this prospective multicentre study, we assessed 281 patients (median age 71 years) across nine centres in the Veneto region of Italy. Episodes of ventricular tachycardia and ventricular fibrillation that were recorded by the diagnostic device were considered in this analysis. Concentrations of particulate matter of less than 10 μm (PM 10 ) and less than 2·5 μm (PM 2·5 ) in aerodynamic diameter, carbon monoxide, nitrogen dioxide, sulphur dioxide, and ozone were obtained daily from monitoring stations, and the 24 h median value was considered. Each patient was associated with exposure data from the monitoring station that was closest to their residence. Patients were followed up for 1 year and then scheduled to have a closing visit, within 1 more year. This study is registered with ClinicalTrials.gov, number NCT01723761. Findings Participants were enrolled from April 1, 2011, to Sept 30, 2012, and follow-ups (completed on April 5, 2014) ranged from 637 to 1177 days (median 652 days). The incidence of episodes of ventricular tachycardia and ventricular fibrillation correlated significantly with PM 2·5 (p 10 . An analysis of ventricular fibrillation episodes alone showed a significant increase in risk of higher PM 2·5 (p=0·002) and PM 10 values (p=0·0057). None of the gaseous pollutants were significantly linked to the occurrence of ventricular tachycardia or ventricular fibrillation. In a subgroup analysis of patients with or without a previous myocardial infarction, only the first showed a significant association between particulate matter and episodes of ventricular tachycardia or ventricular fibrillation. Interpretation Particulate matter has acute pro-arrhythmic effects in a population of high-risk patients, which increase on exposure to fine particles and in patients who have experienced a previous myocardial infarction. The time sequence of the arrhythmic events suggests there is an underlying neurally mediated mechanism. From a clinical point of view, the results of our study should encourage physicians to also consider environmental risk when addressing the prevention of arrhythmic events, particularly in patients with coronary heart disease, advising them to avoid exposure to high levels of fine particulate matter. Funding There was no funding source for this study

Hybrid multiple-site mass closure and source apportionment of PM2.5 and aerosol acidity at major cities in the Po Valley

This study investigates the major chemical components, particle-bound water content, acidity (pH), and major potential sources of PM2.5 in major cities (Belluno, Conegliano, Vicenza, Mestre, Padua, and Rovigo) in the eastern end of the Po Valley. The measured PM2.5 mass was reconstructed using a multiple-site hybrid chemical mass closure approach that also accounts for aerosol inorganic water content (AWC) estimated by the ISORROPIA-II model. Annually, organic matter accounted for 31-45% of the PM2.5 at all sites, followed by nitrate (10-19%), crustal material (10-14%), sulfate (8-10%), ammonium (5-9%), elemental carbon (4-7%), other inorganic ions (3-4%), and trace elements (0.2-0.3%). Water represented 7-10% of measured PM2.5. The ambient aerosol pH varied from 1.5 to 4.5 with lower values in summer (average in all sites 2.2±0.3) and higher in winter (3.9±0.3). Six major PM2.5 sources were quantitatively identified with multiple-site positive matrix factorization: secondary sulfate (34% of PM2.5), secondary nitrate (30%), biomass burning (17%), traffic (11%), re-suspended dust (5%), and fossil fuel combustion (3%). Biomass burning accounted for ∼90% of total PAHs. Inorganic aerosol acidity was driven primarily by secondary sulfate, fossil fuel combustion (decreasing pH), secondary nitrate, and biomass burning (increasing pH). Secondary nitrate was the primary driver of the inorganic AWC variability. A concentration-weighted trajectory (multiple-site) analysis was used to identify potential source areas for the various factors and modeled aerosol acidity. Eastern and Central Europe were the main source areas of secondary species. Less acidic aerosol was associated with air masses originating from Northern Europe owing to the elevated presence of the nitrate factor. More acidic particles were observed for air masses traversing the Po Valley and the Mediterranean, possibly due to the higher contributions of fossil fuel combustion factor and the loss of nitric acid due to its interaction with coarse sea-salt particles

Late time response analysis in UWB radar for concealed weapon detection : feasibility study

Remote detection of body-worn concealed weapons or explosives (CWE) is a field of ongoing research. In this Thesis the feasibility of CWE detection by using the UWB radar is explored. The CWE detection is based on the analysis of the Late Time Response (LTR) of the human which has been illuminated by the UWB signal. A specific set of LTR parameters characterizes the target signature. Therefore the existence of a CWE attached on the human body will influence the LTR characteristics and give the composite object i.e. human-CWE a different signature than the simple object i.e. human. The CWE detection methodology is verified by theoretical analysis, modelling and extensive laboratory experimentation. Investigation of the way the LTR parameters are influenced by the existence of the CWE signifies the differences of the LTR signature between the human and human-CWE. So the resolution of the differences in the LTR of a human with and without a CWE as the main objective of the research, are presented in the Thesis. The results verify that CWE detection with the use of LTR is feasible under the experimental conditions presented. Furthermore consideration of all possible detection scenarios is out of the scope of this Thesis.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Deep execution monitor for robot assistive tasks

We consider a novel approach to high-level robot task execution for a robot assistive task. In this work we explore the problem of learning to predict the next subtask by introducing a deep model for both sequencing goals and for visually evaluating the state of a task. We show that deep learning for monitoring robot tasks execution very well supports the interconnection between task-level planning and robot operations. These solutions can also cope with the natural non-determinism of the execution monitor. We show that a deep execution monitor leverages robot performance. We measure the improvement taking into account some robot helping tasks performed at a warehouse

Frovatriptan versus zolmitriptan for the acute treatment of migraine with aura: a subgroup analysis of a double-blind, randomized, multicenter, Italian study

Migraine with aura affects ~20–30 % of migraineurs and it is much less common than migraine without aura. The aim of this study was to compare the efficacy of frovatriptan 2.5 mg and zolmitriptan 2.5 mg in the treatment of migraine with aura. Analysis was carried out in a subset of 18 subjects with migraine with aura (HIS criteria) out of the 107 enrolled in a multicenter, randomized, double-blind, cross-over study. According to the study design, each patient had to treat three episodes of migraine in no more than 3 months with one drug, before switching to the other treatment. The rate of pain-free episodes at 2 h was significantly (p < 0.05) larger under frovatriptan (45.8 %) than under zolmitriptan (16.7 %). Pain free at 4 h, pain relief at 2 and 4 h and recurrent episodes were similar between the two treatments, while sustained pain-free episode was significantly (p < 0.05) more frequent during frovatriptan treatment (33.3 vs. 8.3 % zolmitriptan). Our study suggests that frovatriptan is superior to zolmitriptan in the immediate treatment of patients with migraine with aura, and it is capable of maintaining its acute analgesic effect over 48 h

Frovatriptan versus zolmitriptan for the acute treatment of migraine: a double-blind, randomized, multicenter, Italian study

The objective of this study is to assess patients’ satisfaction with migraine treatment with frovatriptan (F) or zolmitriptan (Z), by preference questionnaire. 133 subjects with a history of migraine with or without aura (IHS criteria) were randomized to F 2.5 mg or Z 2.5 mg. The study had a multicenter, randomized, double-blind, cross-over design, with each of the two treatment periods lasting no more than 3 months. At the end of the study, patients were asked to assign preference to one of the treatments (primary endpoint). The number of pain-free (PF) and pain-relief (PR) episodes at 2 h, and number of recurrent and sustained pain-free (SPF) episodes within 48 h were the secondary study endpoints. Seventy-seven percent of patients expressed a preference. Average score of preference was 2.9 ± 1.3 (F) versus 3.0 ± 1.3 (Z; p = NS). Rate of PF episodes at 2 h was 26% with F and 31% with Z (p = NS). PR episodes at 2 h were 57% for F and 58% for Z (p = NS). Rate of recurrence was 21 (F) and 24% (Z; p = NS). Time to recurrence within 48 h was better for F especially between 4 and 16 h (p < 0.05). SPF episodes were 18 (F) versus 22% (Z; p = NS). Drug-related adverse events were significantly (p < 0.05) less under F (3 vs. 10). In conclusion, our study suggests that F has a similar efficacy of Z, with some advantage as regards tolerability and recurrence

Transcriptional regulation of the IGF signaling pathway by amino acids and insulin-like growth factors during myogenesis in Atlantic salmon

The insulin-like growth factor signalling pathway is an important regulator of skeletal muscle growth. We examined the mRNA expression of components of the insulin-like growth factor (IGF) signalling pathway as well as Fibroblast Growth Factor 2 (FGF2) during maturation of myotubes in primary cell cultures isolated from fast myotomal muscle of Atlantic salmon (Salmo salar). The transcriptional regulation of IGFs and IGFBP expression by amino acids and insulin-like growth factors was also investigated. Proliferation of cells was 15% d(-1) at days 2 and 3 of the culture, increasing to 66% d(-1) at day 6. Three clusters of elevated gene expression were observed during the maturation of the culture associated with mono-nucleic cells (IGFBP5.1 and 5.2, IGFBP-6, IGFBP-rP1, IGFBP-2.2 and IGF-II), the initial proliferation phase (IGF-I, IGFBP-4, FGF2 and IGF-IRb) and terminal differentiation and myotube production (IGF2R, IGF-IRa). In cells starved of amino acids and serum for 72 h, IGF-I mRNA decreased 10-fold which was reversed by amino acid replacement. Addition of IGF-I and amino acids to starved cells resulted in an 18-fold increase in IGF-I mRNA indicating synergistic effects and the activation of additional pathway(s) leading to IGF-I production via a positive feedback mechanism. IGF-II, IGFBP-5.1 and IGFBP-5.2 expression was unchanged in starved cells, but increased with amino acid replacement. Synergistic increases in expression of IGFBP5.2 and IGFBP-4, but not IGFBP5.1 were observed with addition of IGF-I, IGF-II or insulin and amino acids to the medium. IGF-I and IGF-II directly stimulated IGFBP-6 expression, but not when amino acids were present. These findings indicate that amino acids alone are sufficient to stimulate myogenesis in myoblasts and that IGF-I production is controlled by both endocrine and paracrine pathways. A model depicting the transcriptional regulation of the IGF pathway in Atlantic salmon muscle following feeding is proposed.Publisher PDFPeer reviewe

Real-time evaluation of longitudinal peak systolic strain (speckle tracking measurement) in left and right ventricles of athletes

<p>Abstract</p> <p>Background</p> <p>Strain, and particularly Longitudinal Peak Systolic Strain (LPSS), plays a role in investigating the segmental and overall contractility of the heart which is a particularly interesting feature in athletes in whom regular training determines several morphological and functional modifications in both the ventricles, that normally work at different loads. Speckle tracking techniques assess the LPSS of LV and RV from B-mode imaging in real time, with uniform accuracy in all segments, and can verify the possible dissimilar segmental contributions of the two chambers to overall myocardial contraction. The aim of the study is to quantify the LPSS in real time in both the ventricles in order to estimate any possible different deformation properties in them during a systolic period.</p> <p>Methods</p> <p>32 subjects (20 athletes and 18 controls) were submitted to a standard echocardiographic examination at rest and after a Hand Grip (HG) stress. From a four-chamber-view image, the LPSS parameter was measured with Speckle Tracking analysis in the basal and medium-apical segments of the two ventricles, at rest and after HG.</p> <p>Results</p> <p>In both athletes and controls, LPSS values were significantly higher in the RV of athletes (RV LPSS ^{medium-apical}-23.87 ± 4.94; ^{basalfreewall}-25.04 ± 4.12 at rest) and controls (RV LPSS^{medium-apical}-25.21 ± 4.97; ^{basalfreewall}-28.69 ± 4.62 at rest) than in the LV of both (athletes LV LPSS ^{medium-apical}-18.14 ± 4.16; ^{basallateralwall}-16.05 ± 12.32; controls ^{medium-apical}-18.81 ± 2.64; ^{basallateralwall}-19.74 ± 3.84) With the HG test a significant enhancement of the LPSS(with P < .05) in the medium-apical segments of LV and RV was evident, but only in athletes; there was no modification of the standard echo-parameters in either group.</p> <p>Conclusion</p> <p>ST analysis is an easy method for investigating the contractility of the RV through deformation parameters, showing greater involvement of the RV than LV at rest. In athletes only, after isometric stress the two ventricles show particular myocardial deformation properties of the regions around the apex where the curvature of the wall is more marked. The clinical application of this new approach in athletes and normal subjects requires further investigation.</p

Takotsubo cardiomyopathy after a dancing session: a case report

<p>Abstract</p> <p>Introduction</p> <p>Stress-induced (Takotsubo) cardiomyopathy is a rare form of cardiomyopathy which presents in a manner similar to that of acute coronary syndrome. This sometimes leads to unnecessary thrombolysis therapy. The pathogenesis of this disease is still poorly understood. We believe that reporting all cases of Takotsubo cardiomyopathy will contribute to a better understanding of this disease. Here, we report a patient who, in the absence of any recent stressful events in her life, developed the disease after a session of dancing.</p> <p>Case presentation</p> <p>A 69-year-old Caucasian woman presented with features suggestive of acute coronary syndrome shortly after a session of dancing. Echocardiography and a coronary angiogram showed typical features of Takotsubo cardiomyopathy and our patient was treated accordingly. Eight weeks later, her condition resolved completely and the results of echocardiography were totally normal.</p> <p>Conclusions</p> <p>Takotsubo cardiomyopathy, though transient, is a rare and serious condition. Although it is commonly precipitated by stressful life events, these are not necessarily present. Our patient was enjoying one of her hobbies (that is, dancing) when she developed the disease. This case has particular interest in medicine, especially for the specialties of cardiology and emergency medicine. We hope that it will add more information to the literature about this rare condition.</p