bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise intensity is associated with progression of coronary artery calcification in middle-aged and older athletes: findings from the MARC-2 study
Authors: Aengevaeren V , Mosterd A , Braber TL , Sharma S , Nathoe HM , Velthuis BK , Eijsvogels TMH
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation

Background 

Recent studies have reported increased coronary artery calcification (CAC) in middle-aged male athletes, which is related to the amount and intensity of lifelong exercise. However, previous studies are limited by their cross-sectional study design. 

Purpose 

We prospectively assessed progression of CAC and its association to exercise volume and intensity in middle-aged and older athletes.

Methods 

318 asymptomatic middle-aged and older men were recruited in the Measuring Athlete’s Risk of Cardiovascular events (MARC) study between 2012-2014 and invited for follow-up (MARC-2) between 2019-2020. During both study visits, computed tomography imaging was performed to assess CAC. Exercise characteristics during follow-up were used to calculate exercise volumes (Metabolic equivalent of task [MET]-hours/week), whereas intensities were classified as moderate (3-6 MET), vigorous (6-9 MET) and very vigorous (>9 MET). For linear regression analyses, CAC scores were transformed (Ln delta CAC score + 1) and analyses were adjusted for baseline confounders, CAC at baseline and time between CT scans. Exercise intensities were assessed as proportion of MET-hrs/week and separately included, while adjusting for exercise volume.

Results 

We included 289 men (54.9 ± 6.4 years) for MARC-2, with a follow-up of 6.3 ± 0.5 years. Participants exercised for 41 [25-57] MET-hrs/week, of which the median percentage was 0% [interquartile range 0-19] at moderate, 44% [0-84] at vigorous and 34% [0-80] at very vigorous intensity. At baseline, CAC was present in 151 (52%) men, and increased to 205 (71%) men at follow-up. CAC scores increased from 1 [0-32] to 31 [0-132]. Delta CAC score (26 [0-104]) was not associated with overall exercise volume. However, delta CAC score was negatively associated with vigorous intensity exercise and positively associated with very vigorous intensity exercise (Table).

Conclusion 

Progression of CAC was not associated with overall exercise volume during 6-year follow-up. However, the degree of vigorous intensity exercise was associated with attenuated CAC progression, whereas very vigorous intensity exercise was associated with accelerated CAC progression.

Linear regression analyses Progression of CAC (Ln Delta CAC score +1) B (95% CI) P-Value Exercise volume (MET-hours/week) .001 (-.005 - .008) .70 Exercise Intensity Moderate intensity (%) -.002 (-.009 - .005) .65 Vigorous intensity (%) -.005 (-.009 - .000) .03 Very vigorous intensity (%) .005 (.001 - .009) .02
Left ventricular remodelling in a large cohort of strength competitive athletes: not so common and differs by sex
Authors: Chumakova O , Isaeva M , Drobyazko O , Alekhin M , Zateyshchikov D
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research was supported by FMBA of Russia

Background. There are still very limited data about physiological cardiac adaptation in strength athletes. 

Purpose. To describe structural and functional features of left ventricular (LV) in a large cohort of healthy strength athletes.

Methods. A total of 673 Caucasian athletes (weight-lifting, males/females = 238/157, and Martial Arts, males/females = 200/78) competing in Russian National and International level events were recruited within 2010-2017. Data of standard 2D echocardiography (Echo) and comprehensive medical history were analyzed. Data are presented as median (IQR) and compared by nonparametric tests (table). To assess LV geometry all athletes were divided into 6 groups according to 4-tiered classification based on mass index, concentricity and end-diastolic volume (EDV) index of LV (Figure). 

Results. Both absolute and indexed values of LV structural features were higher in males. Females exhibited higher functional parameters. Only 54 (8%) athletes had elevated LV mass (no sex difference), 23 (3.4%) – LV wall ≥ 12mm (only males) and 78 (11.6%) – changes in LV geometry. There was a prevalence of females in eccentric non-dilated LV hypertrophy (LVH) group (p = 0.088), which was previously accepted as a benign pattern of LV remodelling in non-athlete populations. Males had more often concentric types of LV remodelling (36 of 54 athletes). Among dilated types of LVH, there was a prevalence of males (p = 0.070).

Conclusions. LV remodelling is not common in strength athletes and differs by sex with a more favourable profile in females.

Clinical and Echo parameters Total n = 673 males n = 438 females n = 235 males vs females p-value Age, years 20(4) 20(4) 20(5) 0.06 BSA, m² 1.84(0.39) 1.96(0.39) 1.66(0.25) <0.001 Sports practice, years 10(6) 10(7) 10(6) 0.12 LV EDD, mm 49(6) 50(5) 46(4) <0.001 LV EDD/(BSA)^0.5 35.8(3) 35.9(3) 35.6(3) 0.017 LV EDV, ml 108(38) 118(32) 92(24) <0.001 LV EDV/(BSA)^1.5 42.8(9) 42.9(10) 42.3(9) 0.14 Maximal LV WT, mm 10(1) 10(2) 9(1) <0.001 LV mass/BSA, g/m² 86(24) 91(22) 75(16) <0.001 LV Concentricity, g/(ml)^0.67 6.9(1.6) 7.4(1.6) 6.2(1.4) <0.001 LV EF, % 60(5) 60(4) 62(4) <0.001 Mitral E velocity, cm/sec 87(19) 85(19) 89(19) <0.001 BSA - body surface area; EDD - end-diastolic dimension; WT - wall thickness

Abstract Figure. Types of LV geometry in athletes
Cardiovascular risks awareness in coaches and amateur athletes
Authors: Markovich A , Mironova O
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Regular physical activity is an important component of therapy for most сardiovascular diseases and is associated with reduced cardiovascular and all-cause mortality. The promotion of the physical activity and regular exercise is an important preventive measure that affects the prognosis.

Purpose

To assess the awareness of the prevalence of cardiovascular disease in exercising population and its influence on the safety of the patients and healthy adults among coaches and people actively engaged in sports activities.

Methods

An open non-randomized observation was conducted. The questionnaire created by our team included 45 questions about cardiovascular diseases and sport. 111 athletes and coaches aged from 19 to 46 were enrolled in the study. 61,5% (68) are men and 38,5% (42) of the respondents are women.

30,3% (33) of the respondents are coaches. 45,5% (15) of them have over 5 years of coaching experience. 44% (48) of all respondents prefer endurance sport, 25,7% (28) train strength exercise.

63,6% (70) train 3-8 hours per week, 12,7% (14 [7 women and 7 men]) train more than 8 hours each week.

Results

18,5% (20 [6 women and 14 men]) think that ECG is enough for screening for cardiovascular diseases. 20% (4) of them are coaches. Only 69,5% (77) of all respondents know about treadmill test. And 41,6% (32/77) of them know about the necessary screening for arrhythmogenic condition. 13% (10/77) of them train more than 8 hours per week. And only 27,3% (21/77) of people who know about treadmill test, passed it themselves. Also 21,6% (24) of all respondents think that any episode of arrhythmia is the  contraindication for any sport. But 96,4% (107) of the respondents know that it is necessary to regularly screen the cardiovascular system, even in the absence of complaints. 9% (10) of the interviewed think that diet is not important for people with cardiovascular diseases. And 18,9% (21) of the respondents don’t know about the effect of electrolytes on the body and the work of the heart muscle. Only 53,2% (59 [21 women and 38 men]) of the respondents trust the doctors more than coaches or themselves. And this is one of the reasons why it is necessary to talk about the basic principles of sports cardiology not only to doctors. 8,1% (9) of the respondents have never heard about any cases of sudden death of an athlete during training or at competitions due to «heart problems». 63,6% (21) of the coaches would not train a person who has suffered a heart attack. 71,8% (56) of the sportsmen would like to return to training after a heart attack.

Conclusions

Despite the fact that most people prefer a sedentary lifestyle, high-intensity fitness and long-distance endurance sport is getting more popular. Our survey proves the relatively low level of education about the underlying health conditions and possible risks associated with sports not only among  athletes but  professional coaches as well.

There are no conflicts of interest to declare.
Communication based on partnership: experiences of lifestyle counselling by patients and caregivers in primary care
Authors: Loennberg L , Damberg M , Revenas A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Despite the knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. To enhance the care of patients at high cardiovascular risk we started a one-year, structured lifestyle program in primary care.

Purpose

To explore patients´ at high cardiovascular risk and community health nurses´ experiences of lifestyle counselling after participation in a lifestyle program.

Methods

A qualitative explorative design was used to collect data on participants ‘experiences and an inductive content analysis was performed. Sixteen patients (eight men and eight women, aged 51 – 75 years) diagnosed with either type 2 diabetes mellitus or hypertension and three community health nurses were interviewed.

Results

The participants emphasised that lifestyle counselling should be based on partnership where patients and community health nurses collaborates to reach the set treatment and behavioural goals. Five categories describe this partnership; "Collaboration based on respect and mutual interest", "Enable understanding of illness and lifestyle habits", "Measurements and goalsetting are valuable tools", "The value of continuous support" and "Organisation structure should support lifestyle counselling".

Conclusion

Our results indicate that a trustful relationship, increased knowledge on lifestyle habits and how they effect illness, repeated measurements and recurrent support are important for successful lifestyle counselling. Additionally, the organisation of the structured lifestyle counselling needs to be supported by the primary care unit.
Effectiveness of rehabilitation in post-COVID compared with post-cardiosurgery patients. A single Center experience
Authors: Villani GQ , Rosi A , Corbellini D , Schettino V , Bosoni A , Covini I , Ambiveri G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients.

The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3± 11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5± 10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment.

In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7 ± 20 vs discharge 72.7 ± 28.6 p <0.005, SMWT admission  146 ± 25 vs 318 ± 18 m, p <0.005) and in clinical complexity  (RCS admission 10.9 ± 1.1 vs discharge 5.3, p< 0.05)

Conclusions

Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative.

Group A vs Group B Group A Group B p pre-rehabilitation hospital stay (days) 31 ± 5 8 ± 2 0.005 RCS admission 10.9 ± 1.1 11.6 ± 1.2 ns BI admission 29.7 ± 20 47.7 ± 19 0.05 SMWT admission (m) 146 ± 25 255 ± 18 0.05 Rehabilitation duration (days) 29.7 ± 12.8 29.6 ± 10.1 ns RCS discharge 5.3 ± 2 6.5 ± 2 ns BI discharge 72.7 ± 28 71.5 ± 22.5 ns SMWT discharge (m) 385 ± 18 410 ± 25 ns RCS rehabilitation complexity scale, BI: Barthel Index, SMWT: six-minute walking test
Anxiety and depression in patients hospitalized in cardiology
Authors: Mzoughi K , Zairi I , Saadaoui A , Ben Mrad I , Kraiem S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Anxio-depressive disorders represent one of the psychiatric manifestations most frequently observed in hospitalized patients. Different factors can be involved in the onset or worsening of these disorders.

Purpose

The aim of our study was to evaluate the prevalence of of anxiety and depression in hospitalized cardiology patients and to determine their predictors.

Methods

This was a cross-sectional and descriptive study with a prospective data collection that included 150 patients hospitalized in the cardiology department of Habib Thameur hospital between November and December 2016. Anxiety and depression were assessed using the Hospital Anxiety Depression questionnaire validated in Arabic.

Results

Patients mean age was 60 ± 11.2 years with a gender ratio of 2.7. Seventy-nine percent of the patients had a school education, 85.3% were married and 46% were active workers.

Cardiovascular risk factors were dominated by arterial hypertension found in 56.7% of patients, followed by diabetes in 55.3%, dyslipidemia in 54.7% and active smoking in 43.3%. The most frequent reason for hospitalization was acute coronary syndrome, which was found in 52.7% of cases. The mean length of hospital stay was 13.7 ± 9.3 days.

The prevalence of anxiety symptoms and depression symptoms was 55.3% and 40%, respectively.

In multivariate analysis, age over 65 and active smoking were significantly associated with anxiety symptoms (OR = 0.345, 95% CI 0.150-0.790; p = 0.012 and OR = 0.44, 95% CI, respectively 0.194-0.90;

p = 0.045). Independent factors significantly associated with depression symptoms in hospitalized cardiology patients were age greater than 65 years and a hospital stay of more than 7 days (OR = 0.171, respectively, 95% CI 0.067-0.438; p = 0.0001 and OR = 0.462, 95% CI 0.08-0.466; p = 0.001).

Conclusion

Given the high prevalence of anxiety and depression in patients hospitalized in cardiology, the systematic identification of the factors associated with these disorders would facilitate screening and ensure their early management.
Factors associated with poor tensional control in the elderly
Authors: Bargaoui Z , Mzoughi K , Labbene S , Zairi I , Kraiem S , Aouina O
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertension is a major cardiovascular risk factor, responsible for significant morbidity and mortality. Despite therapeutic progress, blood pressure control remains insufficient.

Purpose

The aim of our study was to identify the factors associated with poor blood pressure control in the elderly.

Methods

This was a descriptive study with a prospective data collection including 101 hypertensive treated subjects, aged 65 years and over, followed on outpatient basis between November and December 2019 at the cardiology consultation either at the Habib Thameur hospital or at the Materi hospital.

Results

Median age was 73 and sex ratio 0.57. The major cardiovascular risk factor was diabetes in 60.4% of cases, followed by dyslipidaemia 48.5% and smoking 40.6%. A history of coronary syndrome was present in 36.6% of cases, followed by atrial fibrillation in 19.8% and 12.9% had a history of ischemic stroke. Thirty-three percent realized regular physical activity and 31% had a high-sodium diet. Four percent of our patients were completely dependent. Among our patients aged 80 and over, 68.2% were frail.

The prevalence of poor blood pressure control was 59%.

Adherence to treatment was satisfactory in 75.2% of cases.

Twelve percent of patients had information about their condition and 89% knew the dosage and schedule for their medication.

In multivariate analysis, the factors associated with poor blood pressure control were: non-compliance with treatment (adjusted OR = 0.19; p = 0.013), frailty (adjusted OR = 7.194; p = 0.004), the number of antihypertensive tablets (Adjusted OR = 0.382; p = 0.008), non-use of thiazide diuretics (adjusted OR = 25.903; p = 0.001) and the patient"s lack of knowledge of antihypertensive treatment (adjusted OR = 0.56; p = 0.008).

Conclusion

Detection of the risk of non-compliance, the use of thiazide diuretics, reducing the number of antihypertensive tablets, screening for frailty and informing the patient about his treatment are necessary to improve blood pressure control in the elderly.
The Pandora"s box of frailty assessments, which is the best for clinical purpose? A critical review
Authors: Baritello O , Salzwedel A , Suendermann S , Niebauer J , Voeller H
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Assessment of frailty is recommended for patients undergoing elective transcatheter aortic valve implantation (TAVI) to appreciate post-interventional prognosis. Several studies investigated frailty in this population using single markers (e.g. gait speed), clinical judgment scales (e.g. Rockwood) or composite indexes (e.g. Fried). However, there is a lack of consensus on the most appropriate tool for assessment of frailty in clinical practice.

Purpose

To evaluate which frailty assessment is the most used and meaningful for post-interventional prognosis in older TAVI patients.

Methods

A systematic search was performed in PubMed (May 2020). We included randomized controlled trials or observational studies (prospective or retrospective) without time restrictions investigating the association of frailty and 1-year all-cause mortality in older (≥70 years) TAVI-patients.

Results

60 studies (151,723 patients) were included. Studies heterogeneity (methods) was considerable. 40 different frailty assessments were identified. The most used single marker (Table) was gait speed (5-meter walk test), investigated in 16 observational studies (8/8 prospective/retrospective with 5,747/40,535 patients). 11 studies found mortality prediction by reduced gait speed, with hazard ratios (HR) between 1.36 (95% confidence interval (CI) 1.23-1.50) and 14.71 (95%CI 6.50-33.30) as well as an Odds Ratio (OR) of 2.34 (95%CI 1.03-5.32). Frailty in composite indexes (Table) predicted mortality in 10 of 11 observational studies 4-items index: HR 1.84 (95%CI 1.23-2.69) to 3.05 (95%CI 1.24-7.46), 5-items index: OR 1.63 (95 CI 1.12-2.37) to 2.75 (95%CI 1.55-4.87).

Conclusion

Predominantly, single markers, especially gait speed, are used to assess frailty in TAVI-patients. Composite indexes seem to be relieble as well and should be considered for prediction of 1-year mortality.

Review results Single marker of frailty Total studies Predictive for 1-y mortality Gait speed (GS) 16 (46582) 11 (41376) Activities of Daily Living (ADL) 14 (6600) 6 (1405) Serum albumin (SA) 15 (49334) 13 (48729) Handgrip strength 10 (5912) 5 (1105) Composite indexes 4-items (GS, HG, SA, ADL) 6 (1957) 6 (1957) 5-items (GS, HG, exhaustion, low PA, weight loss) 5 (3014) 5 (3014) Clinical judgment scale Clinical Frailty Scale (CFS) 9 (6415) 5 (4316) Numbers indicate number of studies and (number of patients)
Attainment of the 2019 ESC/EAS recommended LDL-C goal in Greek patients with established atherosclerotic cardiovascular disease
Authors: Ioannidis A , Pechlevanis A , Paraskelidou M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The novel 2019 ESC/EAS Guidelines on lipids recommend a more intensive reduction on LDL-C for patients with established atherosclerotic cardiovascular disease (ASCVD) in comparison with the 2016 edition.

Purpose

This cross-sectional observation study aims to assess whether patients on lipid lowering therapy, as a secondary prevention measure, are aware of the new set goals and if they achieved them.

Methods

Patients with known ASCVD, taking currently any statin, visiting the Emergency Department of a tertiary hospital in northern Greece were invited to participate by answering a short questionnaire followed by a phone call to provide the exact lab results or other details. Data were analyzed with the SPSS software version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA)

Results

In total 459 eligible patients (37.9% female) were enrolled from January to October 2020 (mean age 68 ± 12 years old). Mean duration of statin prescription was about 11 years (11.2 ± 6 years). The majority (431, 93.9%) of the patients reported lab tests yearly. The majority of the participants (406, 88.5%) were taking a statin as monotherapy of either low (11, 2.4%), medium (174, 37.9%) or high (221, 48.1%) potency. One tenth (50, 10.9%) were prescribed a combination of ezetimibe with a medium or high potency statin. Lastly, only three patients (0.7%) were prescribed a PCSK9 inhibitor. Approximately, one out of six patients had a LDL-C lower than 55mg/dL (78, 17.0%). As expected, the higher the potency of the statin, the higher the percentage of patients reaching the goal: low (1 of 11 patients, 9.1%), medium (21 of 174 patients, 12.1%) and high potency (45 of 221 patients, 20.4%). Moreover, nine out of the fifty the patients (18.0%) on ezetimibe combination therapy achieved the LDL-C goal. Lastly, two of the three patients (66.7%) on a PCSK9 inhibitor had attained the desired LDL-C level. No information could be collected regarding why patients not reaching the goal were not offered a statin of higher potency and/or dosing, a combination with ezetimibe or a PCSK9 inhibitor, accordingly. Disturbingly enough, none of the patient was aware that the LDL-C goals recommended by scientific societies had been lowered in 2019, although 71 patients (15.5%) could recall discussing LDL-C goals with their physician, even though none of the patients recalled the limit of 55mg/dL. The majority of the patients (427, 93.0%) reported that they would like to know their personal LDL-C goal.

Conclusions

Greek patients with established ASCVD taking statins are overall unaware of the novel set LDL-C goals. Hardly acceptable attainment of the LDL-C goal was observed. Further research is warranted to assess the barriers that obstruct a satisfactory goal achievement.

Abstract Figure. Patients achieving LDL-C goal
Post cardiac surgery Mediastinitis : Risk factors and therapeutic management
Authors: Mleyhi S , Messai M , Miri R , Ben Mrad M , Ziadi J , Ghedira F , Ben Omrane S , Kalfat T , Derbel B , Denguir R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background : Despite the progress in therapy and patient management in cardiac surgery, postoperative mediastinitis remains serious complication. Our study aims to study the incidence of mediastinitis after cardiac surgery and to identify the risk factors.

Methods

We conducted a retrospective, descriptive study including patients who had undergone cardiac surgery by sternotomy during a period of 5 years ( 2015 – 2019)and who meet the definition of mediastinitis proposed by the "Centers of disease control and disease". We collected the demographic characteristics of the patients and operative operative data of the first intervention as well as those relating to mediastinitis.

Results

 25 patients ( 2.93%)  among 1042 patients operated for cardiac surgery during the cited period presented mediastinitis. The main clinical signs were : surgical wound infection (80%), fever (40%) and sternal instability (30%). Biological tests showed : hyperleukocytosis and high C-Reactive Protein  in 22.7 % and 58.1 % of cases respectively. Gram-positive cocci are largely predominant and one case of Candida mediastinitis was found. type 1 diabetes and coronary artery bypass grafting were significantly associated with the occurrence of mediastinitis with P <0.01. The mean duration of intra venous antibiotic therapy was 21 days.

92 % of patients operated on for mediastinitis are cured, 4 % had a recurrence of infection and 4 % died.

CONCLUSION

Mediastinitis after heart surgery is rare but serious. The main risk factors are  insulin-dependent diabetes and coronary bypass surgery. The curative treatment is heavy and it is based on a rigorous and long medico-surgical care.
Impact of cardiac physiotherapy on the functional capacity of elderly people in primary care
Authors: Lopes Do Nascimento L , Viana DQO , Rodrigues LNTR
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Primary health care (PHC) is the first level of health care, and it includes health promotion and protection, as well as the prevention of aggravations from chronic diseases and comorbidities. The cardiovascular physiotherapy program in PHC is an important ally in prevention chronic diseases and maintaining functional capacity.  Purpose: to evaluate the impact of a cardiovascular physiotherapy program on a functional capacity of elderly people in primary care. Methods: This is a randomized clinical trial, carried out with 30 elderly people who attended the FISIOCAP (cardiovascular physiotherapy program in primary care) program for at least 6 months. The assessment of functional capacity was performed through the six-minute walk (6MWT) and 1-min sit-to-stand test (1-MSTS). The patients were submitted to a supervised exercise program lasting 90 minutes, twice a week, for a period of 16 weeks. Each session consisted of a warm-up phase (10 minutes), conditioning (60 minutes), calm down (10 minutes) and health education (10 minutes). At the end of 16 weeks, the elderly underwent a reassessment on the 1MSTS and 6MWT. Results: After the cardiovascular physiotherapy program, the participants increased the distance covered by the 6MWT by 19% (p = 0.002) and significantly exceeded the distance covered predicted for gender and age. In 1MSTS, the participants obtained a significant improvement in the number of repetitions in the test (25.25 ± 5.72 to 27.67 ± 5.55, p = 0.04). Conclusion: The cardiovascular physiotherapy program significantly benefited the functional capacity of elderly patients attending PHC.
Digital secondary prevention follow-up after percutaneous coronary intervention (PCI) at home: what are the users perspectives?
Authors: Elstad HL , Edvardsen A , Astin F , Steinsbekk A , Atar D , Lie I
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): LHL Hospital Gardermoen Bergesen Foundation

Digital Secondary Prevention Follow-up After Percutaneous Coronary Intervention (PCI) at Home:

What are the Users Perspectives?

Background

Secondary prevention for patients with established CHD is the mainstay of cardiovascular rehabilitation, but is not accessible to all eligible patients. Digital delivery offers a way to widen participation in secondary prevention to PCI patients, but little is known about users’ preferences.

Purpose

The purpose of this qualitative study was to explore service users, carers and health professionals views about potential challenges experienced in secondary prevention after PCI and preferences for support to inform the development of a digital home program.

Methods

A series of three focus group interviews were conducted in a broad user panel with former PCI patients (4), next-of-kin (1) and interdisciplinary health care professionals (4) between March 2017 and September 2019. Data was audiotaped, transcribed verbatim and analysed using content analysis.

Results

Three main themes and sub-themes on challenges and preferences for digital follow-up were identified: (1) Technology: feasibility including  safety, integration with known platforms, functionality, and user-friendly navigation were major assets, as well as the capability of monitoring medication adherence, smoking cessation and physical activity. (2) Communication: interactive, direct, clear, supportive, encouraging, visualizing, humorous, using virtual meeting rooms, as well as including direct responses on patients’ self-motivation and achieved goals and (3) Health information: basic step-by-step facts and questions-and-answers (FAQ), being practical, visual, and including side effects of medications and health services navigation.

Conclusion

User perspectives from former patients, next-of-kin and health care professionals reveal a preference for digital secondary prevention which offers functionality, communication, and health information during follow-up at home after a PCI.
Higher consumption of red and processed meat is associated with adverse cardiovascular magnetic resonance morpho-functional phenotypes: A study of 19,408 UK Biobank participants
Authors: Raisi-Estabragh Z , Mccracken C , Gkontra P , Jaggi A , Ardissino M , Cooper J , Biasiolli L , Aung N , Piechnik SK , Neubauer S , Munroe PB , Lekadir K , Harvey NC , Petersen SE
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship No. FS/17/81/33318 European Union’s Horizon 2020 research and innovation programme under grant agreement No 825903 (euCanSHare project).

Background

Multiple epidemiological studies link greater red and processed meat consumption with poorer cardiovascular outcomes. However, the impact of these exposures on directly measured cardiovascular phenotypes has not been examined in large cohorts. Limited existing studies suggest that the observed associations may be mediated by cardiometabolic diseases and/or novel mechanisms acting via the heart-gut axes. However, few studies systematically examine potential confounding and mediating mechanisms.

Purpose

We assessed, in the UK Biobank, the association between meat intake and cardiovascular structure and function incorporating a comprehensive range of confounders and mediators.

Methods

We studied 19,408 participants with cardiovascular magnetic resonance (CMR) data. We determined average daily red and processed meat intake using food frequency questionnaires. We used oily fish as a comparator linked to favourable cardiac health. We considered conventional CMR measures (ventricular volumes, left ventricular mass, ejection fraction, stroke volume), novel CMR radiomics features (shape, texture), and arterial stiffness metrics (arterial stiffness index, aortic distensibility). Multivariable linear regression models were used to investigate associations between meat/fish intake and cardiovascular phenotypes, adjusting for age, sex, deprivation, educational level, smoking, alcohol intake, and exercise. In separate models, we investigated the mediating role of cardiometabolic morbidities.

Results

Higher intake of red and processed meat was associated with an adverse overall pattern of right and left ventricular remodelling, poorer cardiac function, and higher arterial stiffness. Conversely, higher oily fish intake was associated with a healthy cardiovascular phenotype (better ventricular function, greater arterial compliance). Radiomics analysis showed association of the different dietary habits with unique overall geometry of the ventricles and myocardial texture. These associations were partially mediated by cardiometabolic morbidities.

Conclusions

Higher red and processed meat consumption is associated with adverse cardiovascular phenotypes. These relationships are not fully explained by mediation through cardiometabolic morbidities suggesting importance of alternative disease pathways. Understanding these potential novel disease mechanisms is important for optimising cardiovascular disease prevention strategies.
Cardiorespiratory fitness and left atrial strain in atrial fibrillation: A comparative study
Authors: Mishima RS , Ariyaratnam JP , Malik V , Pitman BM , Elliott AD , Sanders P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is the most common clinically relevant arrhythmia, and its occurrence is associated with pathological left atrial (LA) remodelling. In these patients, low cardiorespiratory fitness (CRF) is associated with increased AF recurrence. Speckle tracking derived LA strain (LAS) permits chamber function quantification and provides angle-independent and highly reproducible measurements of chamber deformation. However, the relationship between CRF and LA function, amongst AF patients is poorly understood. 

Purpose

To compare LA function amongst AF patients stratified by cardiorespiratory fitness. 

Methods

Consecutive AF patients referred for treadmill exercise stress test (EST) and transthoracic echocardiogram (TTE) between March and December 2020 were screened for inclusion. Treadmill EST was symptom limited and age and gender predicted CRF was calculated with conventional formulas. Speckle tracking software was used to obtain LAS from apical 4 and 2 chamber views and mean measurements for LASr and LASb were calculated. Those achieving <100% (low CRF) and ≥100% (high CRF) of predicted CRF were compared. 

Results

After exclusions, 141 patients in sinus rhythm were included in the analysis. Baseline characteristics were not significantly different between groups. Ejection fraction (63.6 ± 4.7% vs 64.8 ± 8.4%, p = 0.3) and LA volume index (33.1 ± 6.9 vs 31.4 ± 9.4 mL/m2, p = 0.3) were not different between groups. Both LASr (22.9% ± 7.4% vs 27.6% ± 11.4%, p = 0.02) and LASb (8.2% ± 4.7% vs 12.1% ± 6.8%, p = 0.004) (figure 1) were significantly higher in the fitter group. 

Conclusion

Patients with higher CRF showed improved LA function as per strain measurement in the absence of AF. The relationship between CRF and left atrial function warrants further research.

Abstract Figure. LASr and LASb by CRF
Tissue-specific regulation of epidermal contraction duringCaenorhabditis elegansembryonic morphogenesis
Authors: Drewnik Elizabeth D , Wiesenfahrt Tobias , Smit Ryan B , Park Ye-Jean , Pallotto Linda M , Mains Paul E
Published: May 2021

Actin and myosin mediate the epidermal cell contractions that elongate the Caenorhabditis elegans embryo from an ovoid to a tubular-shaped worm. Contraction occurs mainly in the lateral epidermal cells, while the dorsoventral epidermis plays a more passive role. Two parallel pathways trigger actinomyosin contraction, one mediated by LET-502/Rho kinase and the other by PAK-1/p21 activated kinase. A number of genes mediating morphogenesis have been shown to be sufficient when expressed either laterally or dorsoventrally. Additional genes show either lateral or dorsoventral phenotypes. This led us to a model where contractile genes have discrete functions in one or the other cell type. We tested this by examining several genes for either lateral or dorsoventral sufficiency. LET-502 expression in the lateral cells was sufficient to drive elongation. MEL-11/Myosin phosphatase, which antagonizes contraction, and PAK-1 were expected to function dorsoventrally, but we could not detect tissue-specific sufficiency. Double mutants of lethal alleles predicted to decrease lateral contraction with those thought to increase dorsoventral force were previously shown to be viable. We hypothesized that these mutant combinations shifted the contractile force from the lateral to the dorsoventral cells and so the embryos would elongate with less lateral cell contraction. This was tested by examining 10 single and double mutant strains. In most cases, elongation proceeded without a noticeable alteration in lateral contraction. We suggest that many embryonic elongation genes likely act in both lateral and dorsoventral cells, even though they may have their primary focus in one or the other cell type.
An age-downregulated ribosomal RpS28 protein variant regulates the muscle proteome
Authors: Jiao Jianqin , Kavdia Kanisha , Pagala Vishwajeeth , Palmer Lance , Finkelstein David , Fan Yiping , Peng Junmin , Demontis Fabio
Published: May 2021

Recent evidence indicates that the composition of the ribosome is heterogeneous and that multiple types of specialized ribosomes regulate the synthesis of specific protein subsets. In Drosophila, we find that expression of the ribosomal RpS28 protein variants RpS28a and RpS28-like preferentially occurs in the germline, a tissue resistant to aging and that it significantly declines in skeletal muscle during aging. Muscle-specific overexpression of RpS28a at levels similar to those seen in the germline decreases early mortality and promotes the synthesis of a subset of proteins with known anti-aging roles, some of which have preferential expression in the germline. These findings indicate a contribution of specialized ribosomal proteins to the regulation of the muscle proteome during aging.
Network-Exposure Severity and Self-Protective Behaviors: The Case of COVID-19
Authors: Litwin Howard , Levinsky Michal
Published: May 2021

Background and Objectives

To clarify whether awareness of the extent and severity of exposure to the coronavirus disease 2019 (COVID-19) in the social networks of older adults is related to the engagement by the latter in self-protective behaviors. The inquiry is guided by the Health Belief Model and by concepts from the domain of social networks.

Research Design and Methods

Data from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used, including the SHARE COVID-19 Survey executed in the summer of 2020. The study sample numbered 33,053 persons aged 50 and older in 26 countries. We regressed a logged count of self-protective behaviors on network-exposure severity, controlling for sociodemographic background, country, personality traits, and self-exposure severity. Age and network-exposure interaction terms were examined, as were “close family” and “other” network ties.

Results

Network-exposure severity was positively associated with the extent of engagement in self-protective behaviors among older adults, but mainly among the oldest group, aged 70 and older. Awareness of exposure severity in “close family” and “other” networks were similarly associated with self-protection. Respondents from countries with the lowest rates of COVID-19 infection at the time (Latvia, Finland, and Denmark) engaged in fewer self-protective behaviors, while those from countries with high infection rates (Spain, Italy, and Portugal) self-protected to a greater degree.

Discussion and Implications

The study findings point to the role of the social network, even if indirect, in promoting self-protective behaviors among the oldest segment of society. Policymakers should collaborate with the social networks of older adults in order to promote the adoption of self-protective behaviors. Such intervention might help to reduce the threat of infection among the most vulnerable age group.
BNT162b2 mRNA COVID-19 Vaccine Effectiveness in the Prevention of SARS-CoV-2 Infection: A Preliminary Report
Authors: Bianchi Francesco Paolo , Germinario Cinzia Annatea , Migliore Giovanni , Vimercati Luigi , Martinelli Andrea , Lobifaro Annamaria , Tafuri Silvio , Stefanizzi Pasquale ,   Control Room Working Group, Amoruso Fabio , Capodiferro Luca , De Crescenzio Irene , Furio Alessandro , Lattanzio Sabrina , Nozza Mirella , Parnoffi Nicole , Rella Michela , Riformato Giacomo , Spinelli Giuseppe , Manicone Annalucia
Published: May 2021

In the preregistration trial, data on efficacy of BNT162b2 mRNA vaccine against SARS-CoV-2 infection were not collected. This study aimed to evaluate vaccine effectiveness (VE) against documented infection. Bari Policlinico University Hospital health care workers (HCWs) who completed the vaccination schedule were matched with HCWs who had refused vaccination. VE for documented infection was 61.9% (95% confidence interval [CI], 19.2%–82.0%) 14–20 days after first dose, 87.9% (95% CI, 51.7%–97.0%) 21–27 days after first dose, and 96.0% (95% CI, 82.2%–99.1%) 7 or more days after second dose. Unvaccinated HCWs remain a concern in the context of the pandemic emergency.
MALDI-TOF Mass Spectrometry and 16S rRNA Gene Sequence Analysis for the Identification of Foodborne Clostridium Spp
Authors: Sulaiman Irshad M , Miranda Nancy , Simpson Steven
Published: May 2021

Background

Clostridium is a genus of Gram-positive, spore-forming, anaerobic bacteria comprising approximately 100 species. Some Clostridium spp. (C. botulinum, C. perfringens, C. tetani, and C. difficile) have been recognized to cause acute food poisoning, botulism, tetanus, and diarrheal illness in humans. Thus, rapid identification of Clostridium spp. is critical for source-tracking of contaminated food and to understand the transmission dynamics of these foodborne pathogens.

Objective

This study was carried out to rapidly identify Clostridium-like isolates by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) MS and rRNA sequencing methods.

Method

Thirty-three Clostridium-like isolates were recovered from various baby food and surveillance samples. Species identification of these isolates was accomplished using the VITEK MS system. Sequence characterization of the 16S rRNA region was done on an ABI 3500xL Genetic Analyzer.

Results

The VITEK MS system identified 28 of the 33 Clostridium-like isolates with a high confidence value (99.9%); no identification was observed for the remaining five isolates. Nucleotide sequencing of the 16S rRNA region identified all 33 Clostridium-like isolates. Furthermore, while characterizing the 16S rRNA gene, 11 distinct Clostridium spp. (Clostridium aciditolerans, Clostridium aerotolerans, Clostridium argentinense, Clostridium beijerinckii, Clostridium bifermentans, Clostridium butyricum, Clostridium cochlearium, Clostridium difficile, Clostridium perfringens, Clostridium sporogenes, and Clostridium subterminale) were recognized among the 33 Clostridium-like isolates. One of the Clostridium-like isolates was identified as Citrobacter amalonaticus by both diagnostic methods. The generated 16S rRNA sequences matched completely (100%) with sequences available in GenBank for Clostridium and Citrobacter species. Species identification attained using the VITEK MS for the Clostridium-like isolates was comparable to that from the 16S rRNA sequencing-based data.

Conclusions

The VITEK MS and 16S rRNA sequence analysis can be implemented in the species identification of Clostridium spp. isolates of public health importance.

Highlights

MALDI-TOF MS and 16S rRNA sequencing can be used in the species identification of Clostridium species.
In Vaccines We Trust? The Effects of the CIA’s Vaccine Ruse on Immunization in Pakistan
Authors: Martinez-Bravo Monica , Stegmann Andreas
Published: May 2021

In July 2011, the Pakistani public learnt that the Central Intelligence Agency (CIA) had used a vaccination campaign as cover to capture Osama Bin Laden. The Taliban leveraged on this information and launched an anti-vaccine propaganda campaign to discredit vaccines and vaccination workers. We evaluate the effects of these events on immunization by implementing a difference-in-differences strategy across cohorts and districts. We find that vaccination rates declined between 23% and 39% in districts in the 90th percentile of Islamist support relative to those in the 10th percentile. These results suggest that information discrediting vaccination campaigns can negatively affect trust in health services and demand for immunization.
Response to theJournal of ForestryArticle: “US Forest Service Implementation of the National Environmental Policy Act: Fast, Variable, Rarely Litigated, and Declining”
Authors: Morgan Todd A , Niccolucci Michael J , Berg Erik C
Published: May 2021

The Fleischman et al. (2020a) article on US Forest Service (FS) implementation of the National Environmental Policy Act (NEPA) correctly identified a decline in the number of NEPA analyses, but several conclusions were not supported by the data used. After analyzing their and other relevant data, we reached substantially different conclusions. Using FS budget data, we found budgets supporting NEPA analyses to be flat to increasing. Likewise, using FS accomplishment data, we found several FS land-management activities increased as others remained flat or decreased. The three types of NEPA analyses took statistically significant different times to complete, and time to complete analyses declined little over 15 years. We also found that litigation rates varied substantially by NEPA analysis type, resource purpose, and FS region. Conducting NEPA analyses is a necessary step in federal land management. However, resources invested in NEPA analyses represent an opportunity cost, and the success of the FS is better measured by on-the-ground accomplishments rather than number of NEPA analyses produced.
Local radiotherapy for pleural dissemination of thymic tumors after initial treatment
Authors: Okazaki Dai , Shibamoto Yuta , Yanagi Takeshi , Ishikura Satoshi , Kondo Takuhito , Yamada Yuki , Niwa Masanari
Published: May 2021

Pleural dissemination is a common pattern of failure after initial treatment of thymoma and thymic carcinoma, but there is no standardized treatment. As these tumors are relatively radiosensitive, we investigated the effectiveness of radiotherapy. Twenty patients underwent 33 series of local radiotherapy for 96 pleural dissemination lesions after initial treatment. Conventional radiotherapy (CRT), tomotherapy, and combination of the two were employed in 19, 13, and 1 series, respectively. The median follow-up period after the first irradiation for pleural dissemination was 46 months (range, 14–161). For all 20 patients, overall survival (OS) rates from initial radiotherapy for pleural dissemination were 100% at three years and 86% at five years. Progression-free survival (PFS) rates after 33 series of radiotherapy were 30% at three years and 16% at five years. Local control (LC) rates for 96 lesions were 98% at three years and 96% at five years. In-field recurrence was observed in only two among the 96 lesions. One patient (5%) developed grade 3 radiation pneumonitis and another (5%) developed grade 3 pericardial effusion. No other serious adverse events were observed. When disseminated nodules can be covered within localized fields, local radiotherapy may be a treatment option. Using tomotherapy, multiple lesions can be treated safely.