Rhythm-control vs rate-control in the elderly: When to do it and which drug to prefer?

Atrial fibrillation (AF) is a relevant cardiovascular condition that is more prevalent in the elderly patients aged over 65 years. AF, with abnormal rate and rhythm can cause symptoms directly or indirectly by exacerbating other frequently coexisting cardiac conditions such as valvular heart disease, hypertension, ischemic cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy. Evidence suggests that aging-related cardiovascular changes predispose to the elderly to AF. Current therapeutic options such as antiarrhythmic drugs have not been extensively evaluated in the elderly population. Emerging pharmacological and non-pharmacological treatment options for the management of AF, such as dronedarone or catheter ablation, are of particular interest in the elderly. The present paper reviews the pathophysiology, diagnosis, and the management of AF in the elderly patient

Use and Prescription of Direct Oral Anticoagulants in Older and Frail Patients with Atrial Fibrillation: A Multidisciplinary Consensus Document

In the last twelve years the clinical management of patients with atrial fibrillation has been revolutionised by the introduction of direct oral anticoagulants. Despite the large amount of evidence produced, some populations remain relatively poorly explored regarding the effectiveness and safety of direct oral anticoagulants, such as the oldest and/or frailest individuals. Frailty is clinical syndrome characterized by a reduction of functions and physiological reserves which results in individuals having higher vulnerability. While current evidence underlines a relationship between atrial fibrillation and frailty, particularly in determining a higher risk of adverse outcomes, data regarding effectiveness and safety of direct oral anticoagulants in frailty atrial fibrillation patients are still lacking, leaving uncertainty about how to guide prescription in this specific subgroup. On these premises, this multidisciplinary consensus document explains why it would be useful to integrate the clinical evaluation performed through comprehensive geriatric assessment to gather further elements to guide prescription of direct oral anticoagulants in such a high-risk group of patients

Secondary SOLID Tumors after Allogeneic STEM CELL Transplantation: A CROSS-Sectional Evaluation in 260 Adults at 1-Year Follow-up

n/

Evidence for an excess of B -> D(*) Tau Nu decays

Based on the full BaBar data sample, we report improved measurements of the ratios R(D(*)) = B(B -> D(*) Tau Nu)/B(B -> D(*) l Nu), where l is either e or mu. These ratios are sensitive to new physics contributions in the form of a charged Higgs boson. We measure R(D) = 0.440 +- 0.058 +- 0.042 and R(D*) = 0.332 +- 0.024 +- 0.018, which exceed the Standard Model expectations by 2.0 sigma and 2.7 sigma, respectively. Taken together, our results disagree with these expectations at the 3.4 sigma level. This excess cannot be explained by a charged Higgs boson in the type II two-Higgs-doublet model. We also report the observation of the decay B -> D Tau Nu, with a significance of 6.8 sigma.Comment: Expanded section on systematics, text corrections, improved the format of Figure 2 and included the effect of the change of the Tau polarization due to the charged Higg

Search for the decay modes D^0 → e^+e^-, D^0 → μ^+μ^-, and D^0 → e^±μ∓

We present searches for the rare decay modes D^0→e^+e^-, D^0→μ^+μ^-, and D^0→e^±μ^∓ in continuum e^+e^-→cc events recorded by the BABAR detector in a data sample that corresponds to an integrated luminosity of 468  fb^(-1). These decays are highly Glashow–Iliopoulos–Maiani suppressed but may be enhanced in several extensions of the standard model. Our observed event yields are consistent with the expected backgrounds. An excess is seen in the D^0→μ^+μ^- channel, although the observed yield is consistent with an upward background fluctuation at the 5% level. Using the Feldman–Cousins method, we set the following 90% confidence level intervals on the branching fractions: B(D^0→e^+e^-)<1.7×10^(-7), B(D^0→μ^+μ^-) within [0.6,8.1]×10^(-7), and B(D^0→e^±μ^∓)<3.3×10^(-7)

Gestione e miglioramento di pascoli italiani

Experimental results of trials on pastures management and improvement, conducted by 10 University Institutes within the study team «Characterization of italian pastures» are reported. The trials carried out in different soil and climate conditions, ranging from the Alps to the southern Appennines and to the Islands, in different years, provide some conclusive and generaI considerations. With periodical cuts, the forage availability period becomes longer, while using one cut at flowering yield results are higher. As far as management techniques are concerned, fertilization with the three main nutrients affects positively quanti-qualitative yield, although in real situations the application of one or two elements may be sufficient and more economically convenient, and in relation to the botanical composition. Undersowing determines positive effects both on botanical composition and on pasture utilization. Positive results, furthermore, are obtained by mechanical scrub clearing. Vengono riferiti i risultati sperimentali delle prove sulla gestione e sul miglioramento dei pascoli condotte da dieci Istituti Universitari costituenti il gruppo di studio «Caratterizzazione di pascoli italiani», Dalle prove condotte in ambienti pedoclimatici diversi, dalle alpi all'appennino meridionale ed alle isole, e in annate differenti, sono emerse come generalizzabili alcune considerazioni conclusive. Con sfalci periodici si allunga il periodo di disponibilità di foraggio verde, mentre con quello unico alla fioritura la produzione risulta più elevata. Per gli interventi tecnici, la concimazione con i tre macroelementi influisce favorevolmente sull'entità e sulla qualità della produzione, anche se, nelle situazioni concrete, può essere sufficiente, e più vantaggioso dal lato economico, la somministrazione di uno o due elementi, anche in relazione alla facies floristica. La trasemina determina effetti favorevoli sia sulla composizione floristica sia nella migliore utilizzazione del pascolo. Risultati positivi, infine, si conseguono con il decespugliamento meccanico

Caratterizzazione della dinamica produttiva di pascoli naturali italiani

This work studies herbage production and its seasonal distribution in indigenous pastures, and analyses the relationship between the environmental factors (soil, clima, vegetation) and the productivity of these resources. The investigations have been carried on during the period 1983-90 by the joint activity of 10 different University Istitutions in 23 different environments distributed along the Italian peninsula and the main islands. For each environment, pasture production has been measured with the Corrall and Fenlon method, analysing the more important vegetational and ecological conditions; altogether the total yearly production and the seasonal pattern of herbage production have been detected on 104 pastures. The total herbage yield is not significantly influenced by the latitudinal gradient, and the overall regional (alps, central Appenine, south Apennine and islands) production is about 2.3 t ha-1 year-1 The wide range (0.5-6.3 t ha-1 year-1) of herbage production, on small or medium scale, seems to be due to evident changeof environmental or management factors. Five types of seasonal distribution of herbage growth are evidenced with multivariate analysis methods, based on the growing season and the amplitude of the growth. With mean temperature above 12°C and total rainfall below 800 mm, herbage distribution shows a standstill during summer period and an evident regrowth in autumn. On the contrary, for the 4 other distribution types, the winter standstill become important, and the types are distinct by summer growth amplitude and by the growing season lenght. With cluster analysis method, for each type of herbage distribution, have been pointed out under-types characterized by interannual herbage production variation. Among the environmental factors, vegetation characheristics, expressed as Pasture Value following Daget and Poissonet seems to be strictly correlated with total production. The comparative poor role played by the soil and climatic factor, may be due to the strong past and present antropic influence, related with management and utilization techniques. Il presente lavoro ha come scopo l'approfondimento delle conoscenze sulla produzione e sulla distribuzione stagionale della crescita dell'erba dei pascoli naturali, nonché l'analisi delle interazioni tra i fattori ambientali, pedo-climatici e vegetazionali, e la risposta produttiva di queste risorse. La ricerca è stata condotta nel periodo 1983-90 da 10 diverse Istituzioni Universitarie, in 23 ambienti differenti, distribuiti lungo tutta la penisola e le isole maggiori. Per ogni ambiente, con il metodo di rilievo di Corrall e Fenlon, è stata saggiata la risposta produttiva di pascoli rappresentativi delle principali situazioni vegetazionali e di giacitura; complessivamente sono state rilevate la produzione totale annua e la curva di produttività media pluriennale di 104 pascoli. Riguardo la produzione annua complessiva si è osservato che essa non presenta variazioni significative lungo il gradiente latitudinale, collocandosi tra le diverse regioni (alpina, centro appenninica, suq, appenninica e insulare) attorno a 2.3 t ha-1 anno-1. La fitomassa raccolta è soggetta invece a variazioni sensibili (0.5-6.3 t ha-1 anno-1) riconducibili a fattori ambientali e gestionali che si esprimono su piccola e media scala. Con metodi di analisi multivariata si sono individuate 5 tipologie distributive della crescita dell'erba, in rapporto alla stagione vegetativa e alle variazioni dell'intensità di crescita nel corso della stagione stessa. Con temperature medie e precipitazioni annue rispettivamente maggiori di 12°C e minori di 800 mm, risulta evidente la stasi vegetativa nel trimestre estivo e la ripresa vegetativa autunnale. Nel caso opposto la stasi è invernale e le 4 tipologie afferenti a questo modello, sono distinguibili dall'entità della crescita nei mesi estivi e dalla durata della stagione vegetativa. Per ogni tipologia produttiva, sono state evidenziate, tramite l'analisi cluster, sotto-tipologie distinte per la variabilità produttiva interannuale. Tra i fattori ambientali, la vegetazione, espressa attraverso l'indice del valore pastorale di Daget e Poissonet, presenta una buona capacità predittiva nei confronti del livello produttivo dei pascoli. Il contributo comparativamente modesto offerto dai fattori pedoclimatici sembra attribuibile alla forte influenza antropica, pregressa e attuale, attraverso le cure colturali e l'utilizzazione

Bottomonium spectroscopy and radiative transitions involving the chi(bJ)(1P, 2P) states at BABAR

We use (121 +/- 1) million Upsilon(3S) and (98 +/- 1) million Upsilon(2S) mesons recorded by the BABAR detector at the PEP-II e(+)e(-) collider at SLAC to perform a study of radiative transitions involving the chi(bJ)(1P, 2P) states in exclusive decays with mu(+)mu(-)gamma gamma final states. We reconstruct twelve channels in four cascades using two complementary methods. In the first we identify both signal photon candidates in the electromagnetic calorimeter (EMC), employ a calorimeter timing-based technique to reduce backgrounds, and determine branching-ratio products and fine mass splittings. These results include the best observational significance yet for the chi(b0)(2P) -> gamma Upsilon(2S) and chi(b0)(1P) -> gamma Upsilon(1S) transitions. In the second method, we identify one photon candidate in the EMC and one which has converted into an e(+)e(-) pair due to interaction with detector material, and we measure absolute product branching fractions. This method is particularly useful for measuring Upsilon(3S) -> gamma chi(b1,2)(1P) decays. Additionally, we provide the most up-to-date derived branching fractions, matrix elements and mass splittings for chi(b) transitions in the bottomonium system. Using a new technique, we also measure the two lowest-order spin-dependent coefficients in the nonrelativistic QCD Hamiltonian

Search for a light Higgs resonance in radiative decays of the (1S) with a charm tag

A search is presented for the decay (1S)→γA0, A0→cc¯, where A0 is a candidate for the CP-odd Higgs boson of the next-to-minimal supersymmetric standard model. The search is based on data collected with the BABAR detector at the (2S) resonance. A sample of (1S) mesons is selected via the decay (2S)→π+π-(1S). The A0→cc¯ decay is identified through the reconstruction of hadronic D0, D+, and D∗(2010)+ meson decays. No significant signal is observed. The measured 90% confidence-level upper limits on the product branching fraction B((1S)→γA0)×B(A0→cc¯) range from 7.4×10-5 to 2.4×10-3 for A0 masses from 4.00 to 8.95GeV/c2 and 9.10 to 9.25GeV/c2, where the region between 8.95 and 9.10GeV/c2 is excluded because of background from (2S)→γχbJ(1P), χbJ(1P)→γ(1S) decays