Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Effects of yoga practice heart rate variability and respiratory rate

O objetivo deste estudo é avaliar os efeitos da prática da ioga na freqüência cardíaca, na variabilidade da freqüência cardíaca e na freqüência respiratória. Foram estudados praticantes de ioga (IOGA, n = 8) e não praticantes controles (CT, n = 8) com idade entre 30 e 45 anos. Dois sub-grupos de quatro indivíduos cada, com atividade física regular foram também comparados (IOGAativ e CTativ). Os participantes realizaram prática de asanas (IOGA) ou simulação (CT) precedidos e sucedidos por relaxamento, sendo registrados (20 min) o eletrocardiograma e respirograma antes e após os asanas ou simulação. A freqüência cardíaca foi menor no grupo IOGA comparado ao CT (58,9 ± 6,6 e 64,3 ± 5,6 bpm) e no grupo IOGAativ comparado ao CTativ (55,0 ± 3,6 e 63,2 ± 5,5 bpm). Não foram encontradas diferenças na freqüência respiratória. O intervalo de pulso (IP) foi maior no grupo IOGA (1036,0 ± 111,2 ms) comparado ao CT (943,9 ± 85,3 ms) e IOGAativ (1101,6 ± 72,6 ms) comparado ao CTativ (957,8 ± 92,6 ms). Também o desvio padrão do IP foi maior no grupo IOGA (68,8 ± 22,8 ms) comparado ao CT (51,1 ± 21,7 ms) e grupo IOGAativ (77,8 ± 14,1 ms) comparado ao CTativ (41,5 ± 17,8 ms). A potência espectral do IP foi maior no grupo IOGAativ comparada ao CTativ na faixa de muito baixa freqüência (2157,3 ± 1159,4 vs. 876,0 ± 989,4 ms2) e maior nas faixas de baixa (1523,7 ± 964,6 vs. 494,7 ± 417,1 ms2) e alta freqüências (1684,4 ± 847,9 vs. 462,6 ± 375,1 ms2) comparando-se os valores obtidos após os asanas ou simulação. Os resultados sugerem que a combinação de exercícios físicos e ioga pode aumentar os benefícios destes à saúde.The objective of this work is to evaluate the effects of yoga practice in heart rate (HR), HR variability and respiratory rate using spectral analysis. We compared yoga students (IOGA, n = 8) with non-practicing controls (CT, n = 8), between 30 and 45 years of age. These groups were subdivided in two subgroups (n = 4) having regular practice of physical activities besides yoga (IOGAactiv and CTactiv). The participants practiced the yoga asanas (IOGA) or physical simulation (CT) preceded and succeeded by relaxation, after which the electrocardiogram and respirogram was recorded for 20 min. Heart rate was lower in IOGA when compared to CT (58,9 ± 6,6 vs. 64,3 ± 5,6 bpm) and in IOGAactiv compared to CTactiv (55,0 ± 3,6 vs. 63,2 ± 5,5 bpm). No diferences in respiratory rate were found between groups. Pulse interval (PI) was higher in IOGA when compared to CT (1036,0 ± 111,2 vs. 943,9 ± 85,3 ms) and IOGAactiv compared to CTactiv (1101,6 ± 72,6 vs. 957,8 ± 92,6 ms). Standard deviation of pulse interval was greater in IOGA when compared to CT (68,8 ± 22,8 vs. 51,1 ± xix 21,7 ms) and IOGAactiv compared to CTactiv (77,8 ± 14,1 vs. 41,5 ± 17,8 ms). The spectral power of the PI was higher in the IOGAactiv group in relation to the CTactiv in the bands of very low (2157,3 ± 1159,4 vs. 876,0 ± 989,4 ms2) and in the band of low (1523,7 ± 964,6 vs. 494,7 ± 417,1 ms2) and high frequency (1684,4 ± 847,9 vs. 462,6 ± 375,1 ms2) after the practice of yoga asanas. These results suggest that combination of physical exercises and yoga may increase their healthy benefits

Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

International audienceImportance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE).Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT.Design, setting, and participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection.Main outcomes and measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE.Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).Conclusions and relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Growing knowledge: an overview of Seed Plant diversity in Brazil

Abstract An updated inventory of Brazilian seed plants is presented and offers important insights into the country's biodiversity. This work started in 2010, with the publication of the Plants and Fungi Catalogue, and has been updated since by more than 430 specialists working online. Brazil is home to 32,086 native Angiosperms and 23 native Gymnosperms, showing an increase of 3% in its species richness in relation to 2010. The Amazon Rainforest is the richest Brazilian biome for Gymnosperms, while the Atlantic Rainforest is the richest one for Angiosperms. There was a considerable increment in the number of species and endemism rates for biomes, except for the Amazon that showed a decrease of 2.5% of recorded endemics. However, well over half of Brazillian seed plant species (57.4%) is endemic to this territory. The proportion of life-forms varies among different biomes: trees are more expressive in the Amazon and Atlantic Rainforest biomes while herbs predominate in the Pampa, and lianas are more expressive in the Amazon, Atlantic Rainforest, and Pantanal. This compilation serves not only to quantify Brazilian biodiversity, but also to highlight areas where there information is lacking and to provide a framework for the challenge faced in conserving Brazil's unique and diverse flora