Atrial fibrillation in chronic heart failure patients with reduced ejection fraction: The CHECK-HF registry

Background: Atrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy. Methods: We analyzed 8253 patients with chronic HF with reduced ejection fraction (HFrEF) from 34 Dutch outpatient clinics included in the period between 2013 and 2016 treated according to the 2012 ESC guidelines. Results: 2109 (25.6%) of these patients were in AF (mean age 76.8 ± 9.2 years, 65.0% were men) and 6.144 (74.4%) had no AF (mean age 70.7 ± 12.2 years, 63.6% were men). Patients with AF more often received beta-blockers (81.7% vs. 79.7%, p = 0.04), MRAs (57.1% vs. 51.7%, p < 0.01), diuretics (89.7% vs. 80.6%, p < 0.01) and digoxin (40.1% vs. 9.3%, p < 0.01) compared to patients without AF, whereas they less often receive renin-angiotensin-system (RAS)-inhibitors (76.1% vs. 83.1%, p < 0.01). The number of patients who received beta-blockers, RAS-inhibitor and MRA at ≥50% of the recommended target dose was comparable between those with and without AF (16.6% vs. 15.2%, p = 0.07). Conclusion: In this large cohort of chronic HFrEF patients, the prevalence of AF was high and we observed significant differences in prescription of both guideline-recommended HF between patients with and without AF

Peer influence on snacking behavior in adolescence

Item does not contain fulltextTo examine the association of adolescents' snack and soft drink consumption with friendship group snack and soft drink consumption, availability of snacks and soft drinks at school, and personal characteristics, snack and soft drink consumption was assessed in 749 adolescents (398 girls, 351 boys, age 12.4-17.6 years), and their friends, and snack and soft drink availability at schools was measured. In regression analysis, consumption by friends, snack and soft drink availability within school, and personal characteristics (age, gender, education level, body mass index) were examined as determinants of snack and drink consumption. Snack and soft drink consumption was higher in boys, soft drink consumption was higher in lower educated adolescents, and snack consumption was higher in adolescents with a lower body weight. Peer group snack and soft drink consumption were associated with individual intake, particularly when availability in the canteen and vending machines was high. The association between individual and peer snack consumption was strong in boys, adolescents with a lower education level, and adolescents with lower body weights. Our study shows that individual snack and soft drink consumption is associated with specific combinations of consumption by peers, availability at school, and personal characteristics

Toward 6 log10 pulsed electric field inactivation with conductive plastic packaging material

Generally, high grade products such as pulsed electric field (PEF) treated fruit juices are packaged after their preservative treatment. However, PEF treatment after packaging could avoid recontamination of the product and becomes feasible when electric field pulses of sufficient magnitude can be generated inside closed food containments. Microbial inactivation of 2 log10 was proved by using an electrically conductive plastic packaging material, and in this contribution it is shown that inactivation toward pasteurization level is achievable. Therefore, a series of microbial experiments with Lactobacillus plantarum at different energy levels were performed. The obtained microbial data with the plastic material have been compared with inactivation models from literature as well as with reference experiments. All treatments were done at ∼2.3 kV/mm, with treatment times between 10-600 μs, and the thermal load was below 38C. The maximum obtained microbial inactivation with the plastic packaging material was 5.9 log10 with a specific energy of 255 J/mL. PRACTICAL APPLICATIONS In order to further minimize the risk of contaminating microorganisms, e.g., introduced during the packaging process, this new technology of pulsed electric field (PEF) treatment after packaging can be beneficial in reducing food safety incidents. This technique also makes hygienic packaging machines superfluous, which will reduce operational and investment costs. By proving that PEF inactivation through a plastic packaging material is possible, the first step toward PEF treatment after packaging has been taken. Important next steps toward industrial realization are extensive research on food grade conductive packaging films, PEF in-pack processing methodologies and microbial investigation of different microorganisms. © 2011 Wiley Periodicals, Inc

Optoacoustic imaging of human vasculature: Feasibility by using a handheld probe.

Purpose To investigate whether multispectral optoacoustic tomography (MSOT) developed for deep-tissue imaging in humans could enable the clinical assessment of major blood vessels and microvasculature. Materials and Methods The study was approved by the Institutional Review Board of the University Medical Center Groningen (CCMO-NL-43587) and registered in the Dutch National Trial Registry (NTR4125). The authors designed a real-time handheld optoacoustic scanner for human use, based on a concave 8-MHz transducer array, attaining 135&deg; angular coverage. They applied a single-pulse-frame (SPF) sequence, which enabled motion insensitive optoacoustic imaging during handheld operation. SPF optoacoustic imaging was applied to imaging arteries and microvascular landmarks in the lower extremities of 10 healthy volunteers. The diameters selected microvessels were determined by measuring the full width at half maximum through the vessels in the MSOT images. Duplex ultrasonography was performed on the same landmarks in seven of the 10 volunteers for subjective comparison to the corresponding optoacoustic images. Results Optoacoustic imaging resolved blood vessels as small as 100 &micro;m in diameter and within 1 cm depth. Additionally, MSOT provided images reflecting hemoglobin oxygen saturation in blood vessels, clearly identifying arteries and veins, and was able to identify pulsation in arteries during imaging. Larger blood vessels, specifically the tibialis posterior and the dorsalis pedis arteries, were also visualized with MSOT. Conclusion Handheld MSOT was found to be capable of clinical vascular imaging, providing visualization of major blood vessels and microvasculature and providing images of hemoglobin oxygen saturation and pulsation

Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

Purpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dt(max,)) during CRT-implantation. The acute change in dP/dt(max), LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 +/- 18 to 27 +/- 11 and 23 +/- 12%, p < 0.001; SRS from 2.27 +/- 1.33 to 0.74 +/- 0.50 and 0.71 +/- 0.43%, p < 0.001) and improved LV function (dP/dt(max) 668 +/- 185 vs. 817 +/- 198 mmHg/s, p < 0.001; stroke volume 46 +/- 15 vs. 54 +/- 20 and 52 +/- 16 ml; LVEF 19 +/- 7 vs. 23 +/- 8 and 27 +/- 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored

Do the benefits of statins outweigh their drawbacks? Assessing patients' trade-off preferences with conjoint analysis.

Efficacious lowering of low-density lipoprotein cholesterol through prolonged statin therapy has become a major strategy for primary and secondary prevention of cardiovascular disease. From the perspective of patients, however, the prophylactic efficacy may be difficult to comprehend. It refers to prospective disease prevention at the population level and an uncertain risk reduction for individual patients. At the same time, actual side effects may occur and treatment entails a lifelong regimen. (aut. ref.

Conductive plastic film electrodes for Pulsed Electric Field (PEF) treatment : A proof of principle

Nowadays Pulsed Electric Field (PEF) treatment of food needs to be performed prior to packaging, either hygienic or aseptic packaging is necessary. New techniques for PEF treatment after packaging can be considered when plastic conductive (film) electrodes can be integrated within the package, so that the package and the product can be treated as a whole. This paper describes a newly developed treatment chamber, which can be used to test the ability of any arbitrary plastic packaging film to be used as electrodes for PEF treatment. Tests with a flexible commercially available electrically conductive copolymer film showed that reduction of Lactobacillus plantarum by PEF was possible. This heat sealable film obeys the mechanical properties of a polymer; however it has an electrical conductivity of 0.75 S m- 1 and approximately 2.3% of the surface area is electrically conductive. The maximum obtained inactivation was 2.1 log10 with a specific energy of 17 J ml- 1. The microbial experiments gave a consistent outcome compared with finite element simulations and with models from literature. Further research to reach real pasteurisation levels is needed as well as issues concerning utilisation of these film electrodes. Industrial relevance: Stainless steel electrodes, which are widely used as electrode material for Pulsed Electric Field (PEF) treatment systems, have as main disadvantage that they exhibit certain wear. This article showed that polymer composites can be considered as electrode material for newly to be developed PEF treatment concepts. With extensive research on food grade composite films the integration of cheap disposable plastic electrodes in food packages comes within reach. © 2010 Elsevier Ltd. All rights reserved