Frequent periodic leg movement during sleep is associated with left ventricular hypertrophy and adverse cardiovascular outcomes

BACKGROUND: Sleep disturbance caused by obstructive sleep apnea is recognized as a contributing factor to adverse cardiovascular outcomes. However, the effect of restless legs syndrome, another common cause of fragmented sleep, on cardiac structure, function, and long-term outcomes is not known. The aim of this study was to assess the effect of frequent leg movement during sleep on cardiac structure and outcomes in patients with restless legs syndrome. METHODS: In our retrospective study, patients with restless legs syndrome referred for polysomnography were divided into those with frequent (periodic movement index \u3e 35/hour) and infrequent (≤ 35/hour) leg movement during sleep. Long-term outcomes were determined using Kaplan-Meier and logistic regression models. RESULTS: Of 584 patients, 47% had a periodic movement index \u3e 35/hour. Despite similarly preserved left ventricular ejection fraction, the group with periodic movement index \u3e 35/hour had significantly higher left ventricular mass and mass index, reflective of left ventricular hypertrophy (LVH). There were no significant baseline differences in the proportion of patients with hypertension, diabetes, hyperlipidemia, prior myocardial infarction, stroke or heart failure, or the use of antihypertensive medications between the groups. Patients with frequent periodic movement index were older, predominantly male, and had more prevalent coronary artery disease and atrial fibrillation. However, on multivariate analysis, periodic movement index \u3e 35/hour remained the strongest predictor of LVH (odds ratio, 2.45; 95% confidence interval, 1.67-3.59; P \u3c .001). Advanced age, female sex, and apnea-hypopnea index were other predictors of LVH. Patients with periodic movement index \u3e 35/hour had significantly higher rates of heart failure and mortality over median 33-month follow-up. CONCLUSIONS: Frequent periodic leg movement during sleep is an independent predictor of severe LVH and is associated with increased cardiovascular morbidity and mortality

Monitoring Studies of Arthropod Complex Fauna Associated with Rapeseed- Mustard Crop Grown in Kashmir Himalayas

Kashmir has quietly undergone a yellow revolution as thousands of hectares of land have been brought under mustard cultivation to double the farmers' income. Earlier, most of the land in Kashmir was used only for growing a single crop -- paddy in most areas but now farmers are rotating crops in Kharif and Rabi seasons just like in other parts of the country. There is still many challlanges which are hurdle in high production goal. Insect biodiversity is associated with the quantity and type of host plants available, environmental factors, and their physiological state. Arthropod complex of mustard was studied and about eight species of insects-pests at Mountain Research centre for field crops (MRCFC) during Rabi 2020 -21 was recorded. It has been observed that the mustard aphid, Lipaphis erysimi Kalt., persists constantly in a sizable population and causes substantial crop damage from the blossoming to the maturity stage. Phyllotreta cruciferae Goeze (flea beetle) occurred at the seedling stage, and Carpocoris sp. (shield bug) caused little harm to the crop from the seedling to the maturity stage. Leaves have been only infested by cabbage aphid, Brevicoryne brassicae, mustard aphid, Lipaphis erysimi (Kalt.), and mustard leaf miner, Chromatomyia horticola, and they been detected in sporadic, low-population occurrences. Among them, Brevicoryne brassicae is found at flowering stage. Pieris brassicae, the cabbage butterfly, occurs sporadically and with high abundance. The status of all eight insect-pests on Brassica species was observed as minor with irregular occurrence while L. erysimi as a regular key pest.six Insect pollinators were recorded during the bloom period of the crop

Frequent periodic leg movement during sleep is an unrecognized risk factor for progression of atrial fibrillation.

Sleep apnea has been recognized as a factor predisposing to atrial fibrillation recurrence and progression. The effect of other sleep-disturbing conditions on atrial fibrillation progression is not known. We sought to determine whether frequent periodic leg movement during sleep is a risk factor for progression of atrial fibrillation. In this retrospective study, patients with atrial fibrillation and a clinical suspicion of restless legs syndrome who were referred for polysomnography were divided into two groups based on severity of periodic leg movement during sleep: frequent (periodic movement index >35/h) and infrequent (≤35/h). Progression of atrial fibrillation to persistent or permanent forms between the two groups was compared using Wilcoxon rank-sum test, chi-square tests and logistic regression analysis. Of 373 patients with atrial fibrillation (77% paroxysmal, 23% persistent), 108 (29%) progressed to persistent or permanent atrial fibrillation during follow-up (median, 33 months; interquartile range, 16-50). Compared to patients with infrequent periodic leg movement during sleep (n=168), patients with frequent periodic leg movement during sleep (n=205) had a higher rate of atrial fibrillation progression (23% vs. 34%; p=0.01). Patients with frequent periodic leg movement during sleep were older and predominantly male; however, there were no significant differences at baseline in clinical factors that promote atrial fibrillation progression between both groups. On multivariate analysis, independent predictors of atrial fibrillation progression were persistent atrial fibrillation at baseline, female gender, hypertension and frequent periodic leg movement during sleep. In patients with frequent periodic leg movement during sleep, dopaminergic therapy for control of leg movements in patients with restless legs syndrome reduced risk of atrial fibrillation progression. Frequent leg movement during sleep in patients with restless legs syndrome is associated with progression of atrial fibrillation to persistent and permanent forms

A novel visually guided radiofrequency balloon ablation catheter for pulmonary vein isolation: one-year outcomes of the multicenter AF-FICIENT 1 trial

BACKGROUND: A multielectrode saline-irrigated radiofrequency balloon catheter with an integrated camera system was designed to perform single-shot pulmonary vein (PV) isolation. To optimize ablation, simultaneous circumferential radiofrequency energy can be delivered, albeit with power output that is tailored to individual electrodes based on direct visualization of tissue-electrode contact. In a first-in-human multicenter clinical trial, we studied the feasibility, performance, safety, and efficacy of PV isolation using this novel ablation catheter to treat atrial fibrillation. METHODS: AF-FICIENT-1 was a prospective, 5-center, single-arm study. After transseptal puncture, the radiofrequency balloon was positioned over the wire at each pulmonary (PV) ostium using a 13.3F sheath. Radiofrequency energy was titrated based on visual contact (6-10 W; up to 60 seconds per ablation). Electrical PV isolation was confirmed using either, (1) sensing mini-electrodes situated on the RF balloon itself or (2) a circular mapping catheter. Patients were clinically assessed for recurrent atrial arrhythmias lasting >30 s over 12 months, after a 3-month blanking period. RESULTS: Six operators performed de novo PV isolation in 99 patients (95 paroxysmal/4 persistent; age, 58±11; men, 67.7%). Median times, including procedure, fluoroscopy, ablation (time from first RF to last RF application), and balloon (time elapsing between catheter introduction to removal from the body) times, were 85 (interquartile range, 62-118), 14 (interquartile range, 9-23), 31 (interquartile range, 20-53), and 43 minutes (interquartile range, 32-70), respectively. The 12-month Kaplan-Meier estimates of freedom from any atrial arrhythmia (atrial fibrillation, atrial flutter, or atrial tachycardia) or atrial fibrillation alone were 77.5% (95% CI, 67.6%-84.7%) and 84.1% (95% CI, 74.9%-90.1%), respectively. There were no device-related serious adverse events. CONCLUSIONS: The novel radiofrequency balloon catheter allowed visually guided, directional titration of ablative energy to safely isolate PVs with short procedure times. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615001340527

Baseline clinical and echocardiographic characteristics of study population.

*<p>Categorical values are presented as number (percentage); continuous variables as mean ± standard deviation.</p>†<p>Echocardiographic data was available in 233 patients.</p><p>COPD = chronic obstructive pulmonary disease; LV = left ventricular; RLS = restless legs syndrome.</p

Polysomnographic variables of study population.

*<p>Categorical values are presented as number (percentage); continuous variables as mean ± standard deviation.</p><p>AHI = apnea-hypopnea index; REM = rapid eye movement; TST = total sleep time.</p

Univariate and multivariate predictors of atrial fibrillation progression.

<p>CI = confidence interval; OR = odds ratio.</p