Do we need another heart failure biomarker. focus on soluble suppression of tumorigenicity 2 (sST2)

If sST2 indeed turns into the HbA1c of heart failure, its value should increase exponentially in our management of patients with heart failure. Serial sST2 levels should allow us to titrate therapy and monitor the clinical state of the patient. In addition, since sST2 is such a strong marker of the risk of death, it would not be surprising to see a level be used to make decisions when patients are on the cusp of such therapies as ICD, CRT, CardioMems implantation and even left ventricular assist devices. A discussion about the use of biomarkers would not be complete without mentioning the issue of surrogates for determining the therapy effectiveness of some of the newer heart failure drugs. Novartis’s EntrestoVR , the brand name for its recently CE marked and FDA approved ARNI1 drug (previously known as LCZ696) and Servier’s ivabradine drug CorlanorVR (marketed by Amgen in the USA), also CE marked and FDA approved, while offering exciting potential benefits to heart failure patients—even being hailed ‘game-changer’ drugs by some—raises the thorny issue of cost vs. benefit. These new drugs are several times the cost of the generics that have become the mainstay of heart failure treatment, i.e. ACE inhibitors, angiotensin receptor blocker (ARBs), beta-blockers, etc. Pushback is therefore expected from payers. Because sST2 changes rapidly with the underlying condition of the patient, is not affected by normal confounding factors, and has a single cut point, it may be ideally suited to help clinicians determine if these newer mediations are effective for each patient, are improving quality of life, and whether dosing needs to be titrated or changed. The new reality of heart failure care is that while more treatment options have opened up, which can literally be a lifesaver for millions of patients, the burden on healthcare systems has skyrocketed. Biomarkers, and particularly sST2, could offer physicians and payers a way to bring treatment down to an individual patient level, providing

A Burial Grave at Tell Keila, Palestine

[EN] The recent excavation of the Tell Keila archaeological site in the Hebron Governorate (Palestine) has revealed new burial graves among the already known in the region of Judea (Yezerski, 2013), providing innovative guidelines for understanding the scope of the funeral typology which was characteristic of the Second Iron Age and Hellenistic, Roman and Byzantian periods and their subsequent occupations. 49 tombs have been inventoried in total, among which it is worth noting the largest, number 26, which is located in the immediate surroundings of the Tell. Its rich architecture has enabled a more comprehensive study and comparison, and when the excavation campaign ended in 2018 numerous elements characteristic of the funeral customs, local ways of life at the time, and state of conservation of the construction had been identified. The geometry and spaces were exactly identified with a complete metric and photo-rectified survey of the tomb which took into consideration the limitations imposed on the work by the local socio-cultural and socio-economic context.This research project is developed within the collaboration of Camilla Mileto and Fernando Vegas with the archaeological project in Tell Keila, being developed under the direction of Sylvie Blétry with the support of EA 4424 CRISES, the Ministry of Tourism and Antiquities, the Scientific Council of the Montpellier University3, the team of the season carried out in 2018 and the local families participating in the excavations.Manzano-Fernández, S.; Vegas López-Manzanares, F.; Cristini, V.; Hueto-Escobar, A. (2020). A Burial Grave at Tell Keila, Palestine. International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences (Online). 44:999-1004. https://doi.org/10.5194/isprs-archives-XLIV-M-1-2020-999-2020S99910044

ST2 levels increased and were associated with changes in left ventricular systolic function during a three-year follow-up after adjuvant radiotherapy for breast cancer

Objectives: To search for biomarkers of RT-induced cardiotoxicity, we studied the behavior of ST2 during RT and three years after RT, and the associations with echocardiographic changes. Materials and methods: We measured soluble ST2 (ng/ml) in serum samples from 63 patients receiving RT for early breast cancer. Sampling and echocardiography were performed at baseline, after RT and at the three-year follow-up. Patients were grouped by >15% (group 1) and Results: ST2 levels tended to increase during RT, from a median (interquartile range; IQR) of 17.9 (12.4 - 22.4) at baseline to 18.2 (14.1-23.5) after RT (p = 0.075). By the three-year follow up, ST2 levels increased to 18.7 (15.8-24.2), p = 0.018. The increase in ST2 level was associated with worsening cardiac systolic function at three-year follow-up, GLS (rho = 0.272, p = 0.034) and left ventricular ejection fraction (LVEF) (rho = -0.343, p = 0.006). Group 1 (n = 14) had a significant increase in ST2 levels from 17.8 (12.3-22.5) at baseline to 18.4 (15.6-22.6) after RT, p = 0.035 and to 19.9 (16.0-25.1) three years after RT, p = 0.005. ST2 levels were stable in group 2 (n = 47): 17.8 (12.3-22.0) at baseline, 17.7 (12.6-23.5) after RT and 18.0 (15.5-22.4) at three years. Conclusion: ST2 may be useful for determining which patients are at risk for long-term cardiovascular toxicity following adjuvant breast cancer RT, but prospective clinical studies are needed to confirm this hypothesis. (C) 2019 Elsevier Ltd.Peer reviewe

What Works in Peer Support for Breast Cancer Survivors: a Qualitative Systematic Review and Meta-Ethnography

Breast cancer is associated with adverse physical and psychological consequences. Although research has identified the various benefits linked to psychosocial interventions, mixed results have been found in relation to peer support. The aim of the present systematic review and meta-ethnography is to explore the qualitative evidence on the experience of breast cancer survivors in peer support. A systematic search of the literature was conducted until June 2023, and a metaethnographic approach was used to synthesize the included papers. Eleven articles were included, collecting the experience of 345 participants. The following four core areas involved in peer support implementation were identified from the synthesis: Peer support can create understanding and a mutual therapeutic and emotional connection; peer support can facilitate an educational and supportive patient-centered journey; peer support should monitor group members for unpleasant emotional experiences; peer support should have professional supervision of recruitment and training to prioritize quality. These results can be used as patient-centered insights by healthcare professionals to provide evidence-informed peer support programs and address current limitations in the field

ADPKD: Prototype of Cardiorenal Syndrome Type 4

The cardiorenal syndrome type 4 (Chronic Renocardiac Syndrome) is characterized by a condition of primary chronic kidney disease (CKD) that leads to an impairment of the cardiac function, ventricular hypertrophy, diastolic dysfunction, and/or increased risk of adverse cardiovascular events. Clinically, it is very difficult to distinguish between CRS type 2 (Chronic Cardiorenal Syndrome) and CRS type 4 (Chronic Renocardiac Syndrome) because often it is not clear whether the primary cause of the syndrome depends on the heart or the kidney. Autosomal dominant polycystic kidney disease (ADPKD), a genetic disease that causes CKD, could be viewed as an ideal prototype of CRS type 4 because it is certain that the primary cause of cardiorenal syndrome is the kidney disease. In this paper, we will briefly review the epidemiology of ADPKD, conventional and novel biomarkers which may be useful in following the disease process, and prevention and treatment strategies

Linking corporate social responsibility, cooperation and innovation: the triple bottom line perspective

Purpose – Drawing on the resource-based view (RBV) and knowledge-based view (KBV) theories, this studycontributes to deepen the knowledge that corporate social responsibility (CSR) exerts on firms’ innovation,considering the role played by cooperation. The research also seeks to ascertain the factors that influence thedevelopment of business cooperation. Design/methodology/approach – The database used is the Community Innovation Survey (CIS, 2014)applied in the European Union (EU) during the time period 2012–2014. A sample of 7083 Portuguese firms wereanalyzed through the partial least squares structural equation modeling (PLS-SEM). Findings – The results suggest that CSR positively relates with firms’ innovation, and business cooperationpartially mediates this relationship. The outcomes also reveal that investing in certain types of innovationactivities increases the firms’ willingness to cooperate. Originality/value – The findings contribute to encourage an open innovation strategy as an easy andeffective way to cope with rapid trends and changes, since it demonstrates the complementary betweeninnovation and cooperation, as sources of value creation. From a triple bottom line (TBL) perspective, it alsohighlights that CSR must include social, economic and environmental initiatives, and should be a part of thefirms’ innovation strategy. As a result, managers who intend to contribute for society in the long term shouldplan, monitor and manage all CSR dimensions

Evaluación de la función renal en pacientes con insuficiencia cardiaca descompensada en servicios de medicina interna

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 04-04-201

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes