Оцінка ефективності селективної артеріальної емболізації у хворих з доброякісною гіперплазією передміхурової залози та високим операційним ризиком

Мета. Покращити результати хірургічної реабілітації хворих з доброякісною гіперплазією передміхурової залози (ДГПЗ) та високим операційним ризиком, обгрунтувавши диференційований підхід до застосування селективної артеріальної емболізації (САЕ) та монополярної трансуретральної резекції передміхурової залози (ТУРПЗ). Матеріали і методи. Досліджено шляхом аналізу ефективність та безпечність САЕ передміхурової залози (ПЗ) як методу лікування симптомів нижніх сечовивідних шляхів (СНСШ) у хворих з ДГПЗ та високим операційним ризиком у порівнянні з ТУРПЗ. Аналіз базувався на систематичному вивченні функціональних результатів та ускладнень у 33 хворих основної групи, яким виконали САЕ, та у 39 хворих порівняльної групи, яким виконали ТУРПЗ. Результати. Хворі, яким виконали САЕ, не мали операційної травми, у них був низький ризик виникнення післяопераційних ускладнень, коротший післяопераційний період, покращились показники: Міжнародної шкали оцінки простатичних симптомів (IPSS) - на 47,8%, шкали оцінки якості життя (QoL) - на 53,3%, максимальної об’ємної швидкості струменя сечі (Qmax) - на 58,4% на фоні зменшення об’єму ПЗ на 28,6% та об’єму залишкової сечі на 55,3% протягом 24 міс спостереження, що є підставою вважати САЕ ПЗ ефективним та безпечним методом мініінвазивного лікування ДГПЗ у хворих з високим операційним ризиком. Після монополярної ТУРПЗ результати були подібні: покращення показників IPSS - на 50%, QoL - на 65,1%, Qmax - на 59,2%, зменшення об’єму ПЗ - на 31,6% та об’єму залишкової сечі - на 64,6%, але даний метод супроводжувався статистично більшою частотою післяопераційних ускладнень, що погіршувало рівень періопераційної безпеки. Висновки. Результати дослідження засвідчили, що САЕ є ефективним та безпечним методом лікування хворих з ДГПЗ та високим операційним ризиком, за результативністю порівнянним з ТУРПЗ, але з меншим ризиком виникнення післяопераційних ускладнень. САЕ може бути методом вибору у хворих похилого віку з вираженою супутньою патологією, які мають протипоказання до стандартного оперативного втручання або утримуються від нього з інших причин

Cardiopulmonary Test As A Component in the Diagnostic Algorithm for Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation

Background: Patients with heart failure with preserved ejection fraction account for more than half of all hospitalizations because of heart failure. On the other hand, atrial fibrillation and heart failure are quite often diagnosed together and one disease influences the development of the other. Timely and accurate diagnosis of heart failure with preserved ejection fraction is the basis for effective treatment of this category of patients. In 2019, the HFA-PEFF algorithm of diagnosis heart failure with preserved ejection fraction (including patients with atrial fibrillation) was proposed. However, the algorithm implies cardiac catheterization in patients at intermediate risk, which involves certain difficulties and cannot be used in routine practice. As an alternative to cardiac catheterization in the diagnosis of heart failure with preserved ejection fraction, we proposed a noninvasive diagnostic method cardiopulmonary test. However, the value of cardiopulmonary test technique has not been conclusively studied, especially in patients with a combination of chronic heart failure and atrial fibrillation. Aim: The aim of the study was to evaluate the role of the cardiopulmonary test in the diagnosis of heart failure with preserved ejection fraction in patients with atrial fibrillation. Methods: 138 patients with atrial fibrillation were included in our study. Using HFA-PEFF algorithm (algorithm for diagnosis of heart failure with preserved left ventricular ejection fraction) all patients were initially divided into 3 groups: low probability of heart failure 23 patients, intermediate probability 96 and high probability 19 patients. The stress-test allowed to precisely assess of patients at intermediate risk and finally form the groups: Group 1 without heart failure, 85 patients (61.6%); Group 2 patients with heart failure and preserved ejection fraction, 53 patients (38.4%). The next diagnostic stage was cardiopulmonary test. Results: During cardiopulmonary test, the anaerobic exercise threshold was 6.8 and 4.85 METs for the first and second groups, respectively (p 0.001), reflecting lower exercise tolerance in the second group of patients. Analysis of variance (ANOVA) demonstrated a statistically significant increase in pro-BNP levels with a decrease in peak VO2 (p 0.001). Also, analysis of variance demonstrated a significant statistical difference with respect to systolic pulmonary artery pressure in the subgroups with severely, moderately reduced oxygen consumption and in the group with normal peak VO2 (p=0.01). ROC analysis determined a peak VO2 of 20 ml/kg/min, above which the HFA-PEFF algorithm was unlikely to detect heart failure (AUC 0.73; confidence interval 0.650.82; p=0.043; sensitivity 85%; specificity 51%). Conclusion: The cardiopulmonary test is a reliable instrumental non-invasive method in the diagnosis of heart failure with preserved ejection fraction

Anticoagulation after typical atrial flutter ablation

The specifics of the anticoagulant therapy after radiofrequency ablation of the cavotricuspid isthmus have not been sufficiently studied, therefore, the recommendations for prescribing the anticoagulant therapy usually do not distinguish between atrial flutter and atrial fibrillation. In contrast to the case of atrial fibrillation, the effectiveness of the interventional treatment for typical atrial flutter reaches 90%. This procedure may save the patient from a long-term anticoagulant therapy in the absence of recurrence of typical atrial flutter. The decision to stop the anticoagulant therapy after successful radiofrequency ablation of the cavotricuspid isthmus should take into account the potential induction of atrial fibrillation in patients undergoing the interventional treatment. In addition to the CHA2DS2-VASc scale, which characterizes the patient's comorbidity, it is important to take into account the echocardiographic morphofunctional criteria to assess the risk of atrial fibrillation. Currently, this protocol is not regulated in the clinical guidelines. The analysis of the literature data and the authors' own experience allow us to conclude that the optimal time for stopping the anticoagulant therapy is a relapse-free period of 34 months after the radiofrequency ablation of the cavotricuspid isthmus, since it is at this time that the effectiveness of the interventional treatment can be objectified

Retraction notice on the article by A.S. Zotov et al. ‘Short-Term Results of Two Strategies in Thoracoscopic Ablation for Lone Atrial Fibrillation’ doi: 10.17816/clinpract110719

Editorial board of the journal informs authors about the retraction of the article Short-Term Results of Two Strategies in Thoracoscopic Ablation for Lone Atrial Fibrillation published in Journal of Clinical Practice 13(3) 2022 by A.S. Zotov, O.Yu. Pidanov, I.S. Osmanov, A.V. Troitsky, A.A. Silaev, E.R. Sakharov, V.N. Sukhotin, O.O. Shelest, R.I. Khabazov, D.A. Timashkov. The reason for the retraction is the publication ethics violation in terms of authorship criteria. Not all authors whose names appear on the article made substantial contributions to the study drafted/revised the manuscript and approved the version to be published. Retraction made on January 09, 2023 with approve from the Editor-in-Chief

The first experience of a hybrid approach in the surgical treatment of atrial fibrillation

Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results

The Repeating Flaring Activity of Blazar AO 0235+164

Context. Blazar AO 0235+164, located at redshift z = 0.94, has undergone several sharp multi-spectral-range flaring episodes during the last decades. In particular, the episodes peaking in 2008 and 2015, that received extensive multi-wavelength coverage, exhibited interesting behavior. Aims. We study the actual origin of these two observed flares by constraining the properties of the observed photo-polarimetric variability, those of the broad-band spectral energy-distribution and the observed time-evolution behavior of the source as seen by ultra-high resolution total-flux and polarimetric Very-long-baseline interferometry (VLBI) imaging. Methods. The analysis of VLBI images allows us to constrain kinematic and geometrical parameters of the 7 mm jet. We use the Discrete Correlation Function to compute the statistical correlation and the delays between emission at different spectral ranges. Multi-epoch modeling of the spectral energy distributions allows us to propose specific models of emission; in particular for the unusual spectral features observed in this source in the X-ray region of the spectrum during strong multi spectral-range flares. Results. We find that these X-ray spectral features can be explained by an emission component originating in a separate particle distribution than the one responsible for the two standard blazar bumps. This is in agreement with the results of our correlation analysis that do not find a strong correlation between the X-rays and the remaining spectral ranges. We find that both external Compton dominated and synchrotron self-Compton dominated models can explain the observed spectral energy distributions. However, synchrotron self-Compton models are strongly favored by the delays and geometrical parameters inferred from the observations

Extreme photometric and polarimetric variability of blazar S4 0954+65 at its maximum optical and γ-ray brightness levels

In 2022 the BL Lac object S4 0954+65 underwent a major variability phase, reaching its historical maximum brightness in the optical and γ -ray bands. We present optical photometric and polarimetric data acquired by the Whole Earth Blazar Telescope (WEBT) Collaboration from 2022 April 6 to July 6. Many episodes of unprecedented fast variability were detected, implying an upper limit to the size of the emitting region as low as 10−4 parsec. The WEBT data show rapid variability in both the degree and angle of polarization. We analyse different models to explain the polarization behaviour in the framework of a twisting jet model, which assumes that the long-term trend of the flux is produced by variations in the emitting region viewing angle. All the models can reproduce the average trend of the polarization degree, and can account for its general anticorrelation with the flux, but the dispersion of the data requires the presence of intrinsic mechanisms, such as turbulence, shocks, or magnetic reconnection. The WEBT optical data are compared to γ -ray data from the Fermi satellite. These are analysed with both fixed and adaptive binning procedures. We show that the strong correlation between optical and γ -ray data without measurable delay assumes different slopes in faint and high brightness states, and this is compatible with a scenario where in faint states we mainly see the imprint of the geometrical effects, while in bright states the synchrotron self-Compton process dominates

Multi-year characterisation of the broad-band emission from the intermittent extreme BL Lac 1ES 2344+514

Aims. The BL Lac 1ES 2344+514 is known for temporary extreme properties characterised by a shift of the synchrotron spectral energy distribution (SED) peak energy νsynch;p above 1 keV. While those extreme states have only been observed during high flux levels thus far, additional multi-year observing campaigns are required to achieve a coherent picture. Here, we report the longest investigation of the source from radio to very high energy (VHE) performed so far, focussing on a systematic characterisation of the intermittent extreme states. Methods.We organised a monitoring campaign covering a 3-year period from 2019 to 2021.Morethan ten instruments participated in the observations in order to cover the emission from radio to VHE. In particular, sensitive X-ray measurements by XMM-Newton, NuSTAR, and AstroSat took place simultaneously with multi-hour MAGIC observations, providing an unprecedented constraint of the two SED components for this blazar. Results. While our results confirm that 1ES 2344+514 typically exhibits νsynch;p > 1 keV during elevated flux periods, we also find periods where the extreme state coincides with low flux activity. A strong spectral variability thus happens in the quiescent state, and is likely caused by an increase in the electron acceleration efficiency without a change in the electron injection luminosity. On the other hand, we also report a strong X-ray flare (among the brightest for 1ES 2344+514) without a significant shift of νsynch;p. During this particular flare, the X-ray spectrum is among the softest of the campaign. It unveils complexity in the spectral evolution, where the common harder-when-brighter trend observed in BL Lacs is violated. By combining Swift-XRT and Swift-UVOT measurements during a low and hard X-ray state, we find an excess of the UV flux with respect to an extrapolation of the X-ray spectrum to lower energies. This UV excess implies that at least two regions significantly contribute to the infrared/optical/ultraviolet/X-ray emission. Using the simultaneous MAGIC, XMM-Newton, NuSTAR, and AstroSat observations, we argue that a region possibly associated with the 10 GHz radio core may explain such an excess. Finally, we investigate a VHE flare, showing an absence of simultaneous variability in the 0.3-2 keV band. Using time-dependent leptonic modelling, we show that this behaviour, in contradiction to single-zone scenarios, can instead be explained by a two-component model

Multi-year characterisation of the broad-band emission from the intermittent extreme BL Lac 1ES~2344+514

The BL Lac 1ES 2344+514 is known for temporary extreme properties (e.g., a shift of the synchrotron SED peak energy $\nu_{synch,p}$ above 1keV). While those extreme states were so far observed only during high flux levels, additional multi-year observing campaigns are required to achieve a coherent picture. Here, we report the longest investigation of the source from radio to VHE performed so far, focusing on a systematic characterisation of the intermittent extreme states. While our results confirm that 1ES 2344+514 typically exhibits $\nu_{synch,p}>$1keV during elevated flux periods, we also find periods where the extreme state coincides with low flux activity. A strong spectral variability thus happens in the quiescent state, and is likely caused by an increase of the electron acceleration efficiency without a change in the electron injection luminosity. We also report a strong X-ray flare (among the brightest for 1ES 2344+514) without a significant shift of $\nu_{synch,p}$. During this particular flare, the X-ray spectrum is among the softest of the campaign. It unveils complexity in the spectral evolution, where the common harder-when-brighter trend observed in BL Lacs is violated. During a low and hard X-ray state, we find an excess of the UV flux with respect to an extrapolation of the X-ray spectrum to lower energies. This UV excess implies that at least two regions contribute significantly to the infrared/optical/ultraviolet/X-ray emission. Using the simultaneous MAGIC, XMM-Newton, NuSTAR, and AstroSat observations, we argue that a region possibly associated with the 10 GHz radio core may explain such an excess. Finally, we investigate a VHE flare, showing an absence of simultaneous variability in the 0.3-2keV band. Using a time-dependent leptonic modelling, we show that this behaviour, in contradiction to single-zone scenarios, can instead be explained by a two-component model.Comment: Accepted for publication in Astronomy & Astrophysic

The variability patterns of the TeV blazar PG 1553 + 113 from a decade of MAGIC and multiband observations

PG 1553 + 113 is one of the few blazars with a convincing quasi-periodic emission in the gamma-ray band. The source is also a very high energy (VHE; >100 GeV) gamma-ray emitter. To better understand its properties and identify the underlying physical processes driving its variability, the MAGIC Collaboration initiated a multiyear, multiwavelength monitoring campaign in 2015 involving the OVRO 40-m and Medicina radio telescopes, REM, KVA, and the MAGIC telescopes, Swift and Fermi satellites, and the WEBT network. The analysis presented in this paper uses data until 2017 and focuses on the characterization of the variability. The gamma-ray data show a (hint of a) periodic signal compatible with literature, but the X-ray and VHE gamma-ray data do not show statistical evidence for a periodic signal. In other bands, the data are compatible with the gamma-ray period, but with a relatively high p-value. The complex connection between the low- and high-energy emission and the non-monochromatic modulation and changes in flux suggests that a simple one-zone model is unable to explain all the variability. Instead, a model including a periodic component along with multiple emission zones is required