Cardiac resynchronization therapy in heart failure patients: An update

Heart failure continues to be a major public health problem with high morbidity and mortality rates, despite the advances in medical treatment. Advanced heart failure patients have severe persistent symptoms and a poor quality of life. Cardiac resynchronization therapy (CRT), an invasive therapy which involves synchronized pacing of both right and left ventricles, improves ventricular conduction delay and left ventricular performance. Several clinical trials of CRT in medically refractory heart failure patients with wide QRS (> 120 ms), left ventricular ejection fraction &#163; 35% and New York Heart Association (NYHA) class III and IV have shown improved quality of life, NYHA class, left ventricular ejection fraction and reduced mortality. About 30% of heart failure patients who receive CRT do not respond to treatment. Mechanical dyssynchrony may play a role in identifying patients who may respond better to CRT treatment. However, recent large scale clinical trials PROSPECT and RethinQ have challenged this concept. The role of CRT in heart failure patients with narrow QRS (< 120 ms), NYHA class I and II, atrioventricular nodal ablation in patients with atrial fibrillation and triple site pacing are evolving. Our review discusses the current evidence, indications, upcoming trials and future directions

Catheter ablation of atrial fibrillation in the elderly: Where do we stand?

Catheter ablation has emerged as an important therapy for the management of drug refractory symptomatic paroxysmal and persistent atrial fibrillation (AF). Although the elderly account for the majority of patients with AF, limited data exists regarding the use of catheter ablation for elderly patients with AF. As AF ablation has become more widespread, ablation techniques have improved and the complication rate has decreased. As a result, referrals of elderly patients for catheter ablation of AF are on the rise. Two retrospective analyses have recently demonstrated that catheter ablation of AF in the elderly can safely be performed and results are comparable to a younger population with up to 80% or more of patients maintaining sinus rhythm at 12 months follow-up. We compared the results of 15 consecutive patients &#8805; 70 years old with symptomatic paroxysmal atrial fibrillation who underwent catheter ablation of AF at our institution to 45 randomly sampled younger patients. The primary endpoint of our study, presence of sinus rhythm in the absence of symptoms at 12 months follow-up, was present in 60% of elderly patients and 80% of younger patients (p = 0.17). There was no statistically significant difference in complication rate between the younger and elderly patients. In this article we present the results of our study and review the published literature to date regarding the clinical efficacy and safety of catheter ablation for AF in elderly patients with paroxysmal and persistent atrial fibrillation

Hybrids of gold nanoparticles and oligo(p-phenyleneethynylene)s end-functionalized with alkynylruthenium groups: Outstanding two-photon absorption in the second biological window

Oligo(p-phenyleneethynylene)s (OPEs) end-capped with (alkynyl)bis(diphosphine)ruthenium and thiol/thiolate groups stabilize ca. 2 nm diameter gold nanoparticles (AuNPs). The morphology, elemental composition and stability of the resultant organometallic OPE/AuNP hybrid materials have been defined using a combination of molecular- and nano-material chacterization techniques. The hybrids display long-term stability in solution (more than a month), good solubility in organic solvents, reversible ruthenium-centered oxidation, and transparency beyond 800 nm, and possess very strong nonlinear absorption activity at the first biological window, and unprecedented two-photon absorption activity in the second biological window (σ2 up to 38,000 GM at 1,050 nm).We thank the Australian Research Council (DP170100411: M. G. H. and M. S.) and the National Science Centre (NCN) Poland (UMO-2016/22/M/ST4/00275: J. K. Z. and M. S.) for support of this work. C. Q. thanks Becas Chile (Agencia Nacional de Investigación y Desarrollo) for financial support in the form of a PhD scholarship (2015-72160061), J. P. L. M. thanks the Australian Government for an Australian Postgraduate Award, J. D. thanks the China Scholarship Council and the Australian National University for a CSC-ANU scholarship, and J. K. Z. thanks the Foundation for Polish Science (FNP) for support. The authors acknowledge the facilities, and the scientific and technical assistance, of the Australian Microscopy & Microanalysis Research Facility and the Centre of Advanced Microscopy at the Australian National University

Increased oxidative stress in asthma - relation to inflammatory blood and lung biomarkers and airway remodeling indices

Airway inflammation in asthma is related to increased reactive oxygen species generation, potentially leading to tissue injury and subsequent airway remodeling. We evaluated oxidative stress in peripheral blood from asthmatic subjects (n = 74) and matched controls (n = 65), using recently developed real-time monitoring of the protein hydroperoxide (HP) formation by the coumarin boronic acid (CBA) assay. We also investigated the relation of the systemic oxidative stress response in asthma to disease severity, lung function, airway remodeling indices (lung computed tomography and histology), and blood and bronchoalveolar lavage fluid (BAL) inflammatory biomarkers. We documented enhanced systemic oxidative stress in asthma, reflected by 35% faster and 58% higher cumulative fluorescent product generation in the CBA assay (p < 0.001 for both). The dynamics of HP generation correlated inversely with lung function but not with asthma severity or histological measures of airway remodeling. HP generation was associated positively with inflammatory indices in the blood (e.g., C-reactive protein) and BAL (e.g., interleukin [IL]-6, IL-12p70, and neutrophil count). Bronchial obstruction, thicker airway walls, increased BAL IL-6, and citrullinated histone 3 in systemic circulation independently determined increased HP formation. In conclusion, a real-time CBA assay showed increased systemic HP generation in asthma. In addition, it was associated with inflammatory biomarkers, suggesting that proper disease control can also lead to a decrease in oxidative stress

Permanent Campaigning: A Meta-Analysis and Framework for Measurement

Permanent campaigning emerged as a concept in the 1970s in studies of US politics but is now recognized as a universal phenomenon. Despite its long history, there has been no attempt to build a holistic picture of the elements that constitute a permanent campaign. Generally, researchers focus on tactical elements, situating their use within an overall strategy, but there is a lack of a broader methodological framework for holistically measuring adherence to the permanent campaigning. This article presents results of a meta-analysis of relevant research to provide a framework to understand how permanent campaigning is practiced. Our study showed there were three reasonably discrete forms of campaigning activities that had been identified: those in which permanent campaign strategies are related to capacity building and strategy; a second, in which permanent campaigning relates to paid and owned media; and a third in which earned media is the main focus. In mapping these studies, we identify the common features of permanent campaigning, identifying strong and weak indicators and the extent these are employed by the government, parties, or elected representatives and within which political systems: parliamentarism or presidentialism. Our framework can be applied in future comparative research to understand trends in political communication

Physicians&#8217; knowledge and attitudes regarding implantable cardioverter-defibrillators

Background: Information is limited regarding the knowledge and attitudes of physicians typically involved in the referral of patients for implantable cardioverter-defibrillator (ICD) implantation. Methods: We conducted a survey of primary care physicians and cardiologists at the University of Rochester Medical Center and the Unity Health System Rochester, NY from December 2008 to February 2009. The survey collected information regarding physicians&#8217; knowledge of and attitudes towards ICD therapy. Results: Of the 332 surveys distributed, 110 (33%) were returned. Over-all 94 (87%) physicians reported referring patients for ICD implantation. Eighteen (17%) physicians reported unawareness of guidelines for ICD use. Sixty-four (59%) physicians recommended ICD in patients with ischemic cardiomyopathy and left ventricular ejection fraction (LVEF) &#8804; 35%. Sixty-five (62%) physicians use &#8804; 35% as the LVEF criterion for ICD referral in patients with non-ischemic cardiomyopathy. Cardiologists were more familiar than primary care physicians with LVEF criteria for implantation of ICD in patients with ischemic and non-ischemic cardiomyopathy (p value 0.005 and 0.002, respectively). Twenty-nine (27%) participants were unsure regarding the benefits of ICDs in eligible women and blacks. Eighty two (76%) physicians believed that an ICD could benefit patients &#8805; 70 years old, whereas only 53 (49%) indicated that an ICD would benefit patients &#8805; 80. Conclusions: A lack of familiarity with current clinical guidelines regarding ICD implantation exists. Primary care physicians are less aware of clinical guidelines than are cardiologists. This finding highlights the need to improve the dissemination of guidelines to primary care physicians in an effort to improve ICD utilization. (Cardiol J 2010; 17, 3: 267-273

Effect of marital distance on birth weight and length of offspring

Marital distance (MD), the geographical distance between birthplaces of spouses, is considered an agent favouring occurrence of heterosis and can be used as a measure of its level. Heterosis itself is a phenomenon of hybrid vigour and seems to be an important factor regulating human growth and development. The main aim of the study is to examine potential effects of MD on birth weight and length of offspring, controlling for socioeconomic status (SES), mother’s age and birth order. Birth weight (2562 boys and 2572 girls) and length (2526 boys, 2542 girls) of children born in Ostrowiec Swietokrzyski (Poland) in 1980, 1983, 1985 and 1988 were recorded during cross-sectional surveys carried out between 1994-1999. Data regarding the socio-demographic variables of families were provided by the parents. Analysis of covariance showed that MD significantly affected both birth weight and length, allowing for sex, birth order, mother’s age and SES of family. For both sexes, a greater marital distance was associated with a higher birth weight and a longer birth length. Our results support the hypothesis that a greater geographical distance between the birth places of parents may contribute to the heterosis effects in offspring. Better birth outcomes may be one of the manifestations of these effects

Immunohistochemical Fascin-1 expression correlate with lymph node and distant metastases in pancreatic ductal adenocarcinoma

Introduction: Pancreatic cancer is characterized by its aggressiveness and poor prognosis. Furthermore, mortality is one of the highest among all types of cancers. It has been observed that the expression of Fascin-1 (the actin-bundling protein which enables the motility of cells) is higher in cancer cells and is correlated with invasiveness and metastasis. Purpose: To investigate the expression of Fascin-1 in histopathological specimens from patients treated for pancreatic cancer and its relationship with histopathological parameters. Materials and methods: The study was performed on a group of 52 patients diagnosed with pancreatic cancer in the Medical University of Bialystok Clinical Hospital. The expression of Fascin-1 was evaluated in tissue samples using the immunohistochemical method and was rated as “present” or “absent”. The analysis of histopathological parameters was performed in correlation with Fascin-1 expression. Results: Fascin-1 expression was observed in the cytoplasm of cancer cells in 42/52 cases (80.8%). Fascin-1 expression occurred more frequently among patients with lymph node metastases (92.6%) than without this type of metastases (68%) (p=0.024). Likewise, the expression of the investigated protein was observed more often with the presence of distant metastases (100%) than without those metastases (74.4%) (p=0.043). There were no statistically significant differences about age, sex, histological type of cancer, grade of histological differentiation, desmoplasia, inflammatory infiltration, foci of hemorrhage, necrosis, and MVD. Conclusion: The expression of Fasicn-1 is correlated with the presence of metastases and can be a useful marker of pancreatic cancer involvement