bluuebunny/crossref_metadata_2025 huggingface dataset:
P2836Role of pre-procedural CT-imaging on catheter ablation in patients with atrial fibrillation: procedural outcomes and radiological exposure
Authors: Di Cori A , Zucchelli G , Faggioni L , Segreti L , Barletta V , De Lucia R , Viani S , Paperini L , Della Tommasina V , Parollo M , Cellamaro T , Branchitta G , Soldati E , Caramella D , Bongiorni M G
Published: October 2019

Introduction

Cardiac computerized tomography (CT) is commonly used to study left atrial (LA) and pulmonary veins (PVs) anatomy before atrial fibrillation (AF) ablation. However, it remains unclear whether pre-procedural imaging actually is associated with an improvement of efficiency, efficacy, and safety.

Purpose

Aim of the the study was to determine the impact of pre-procedural imaging using CT with 3-D reconstruction on procedural outcomes and radiological exposure in patients who undergo radiofrequency catheter ablation (RFA) to eliminate AF.

Methods

In this registry, 493 consecutive patients (age 62±8 years, 70% male) with paroxysmal (316) or persistent (177) AF who underwent RFA were included. A CT scan was obtained in 324 (66%) patients (CT Group) prior to RFA, while 169 (34%) didn't have any pre-procedural imaging (No-CT Group). Antral PVs isolation was performed in all patients along using an open-irrigation-tip catheter with a 3-D electroanatomical navigation system. Additional ablation applications were targeted if required. Procedural outcome, including radiological exposure, and clinical outcomes were compared among patients who underwent RFA with (CT-Group) and without (No CT-Group) pre-procedural imaging.

Results

Acute PV isolation was obtained in all patients. Additional ablation targets were targeted along the CTI (71/324 [22%] vs. 40/169 [24%], P=NS), the roof line (74/324 [23%] vs. 40/169 [24%], P=NS), the mitral isthmus (33/324 [10%] vs. 12/169 [7%], P=NS) and CFAEs (28/324 [8.6%] vs. 12/169 [7.1%], P=NS), without significant differences among groups. Complication rate were comparable between CT and No CT patients (4.3% vs 3%, P=0.7). In one Redo procedure of the No-CT Group, for the impossibility of identifying left PVs, a 3D LA fluoro-angiography was performed, which confirmed a left PVs occlusion. (Figure) No differences were observed about mean duration of the procedure (231±60 vs 233±58 min, P=0.7) and fluoroscopy time (13±10 vs 13±8 min, P=0.6) between groups. Cumulative radiation dose resulted significantly higher in the CT-Group (8.9±24 vs 4.8±15 mSV, P=0.02). Compared to paroxistical AF, persistent AF patients showed a comparable procedural-ED (6.6±26 vs 6±19, P=0.8) but with an higher CT-ED (1.7±2.9 vs 1.1±1.9, P=0.01).At 1 year, 227/324 (70%) and 119/169 (70%) of the patients who did and did not have pre-procedural imaging were free from AF (P = NS).

Figure 1

Conclusions

Pre-procedural CT does not improve safety and efficacy of AF ablation, increasing significantly the cumulative radiological exposure. Considering that patients candidate to AF ablation are often young, the cumulative radiation dose per life span and radiation dose reduction strategies should remain a matter of concern for doctors.

Acknowledgement/Funding

None
P2838The impact of anesthesia depth on catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies
Authors: Li K H , Sang T , Chan C P , Gong M , Li G , Liu T , Wu W K K , Chan M , Tse G , Xia Y , Ho J
Published: October 2019

Objectives

This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of catheter ablation in patients under GA/deep sedation and mild/moderate sedation.

Background

Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to general anesthesia.

Methods

PubMed and Embase were searched up to July 2018 for randomized controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. 12 studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively.

Results

Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI: 0.56 to 1.13, P=0.20) and complications (RR: 0.95, 95% CI: 0.64 to 1.42, P=0.82), though statistically insignificant. In terms of procedural parameters, there was non-significant difference between the two groups when both procedural time (SMD: −0.13, 95% CI: −0.90 to 0.63, P=0.74) and fluoroscopy time (SMD: −0.41, 95% CI: −1.40 to 0.58, P=0.41) were considered. Multivariate meta-regression demonstrated hypertension as an independent moderating factor for complication risk.

Complications Comparison

Conclusion

Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.
P2841Atrial fibrillation ablation using ablation index guided high power (50W) smart touch technology for quantifiable and efficient circumferential pulmonary vein lesions (the FAFA power-touch study)
Authors: Chen S , Schmidt B , Bordignon S , Chun K R J
Published: October 2019

Background

High-power short-duration ablation appears a promising concept. The so-called ablation index (AI) integrating power, contact force and time have demonstrated increased pulmonary vein isolation (PVI) durability. However, feasibility and safety of AI guided high-power ablation is unknown.

Methods and results

Symptomatic AF patients (n=50) underwent circumferential PVI using AI guided high-power point-by-point ablation (CARTO Smart-Touch). Ablation was set to 50W targeting AI values (550: anterior wall/roof, 400: posterior wall) with an inter-lesion distance of 6mm using a non-steerable sheath. An esophageal probe monitored luminal temperature rises (limit: 39°C).

Acute PVI was obtained in all patients; first-pass efficacy was 92%. Mean ablation time per procedure was 11.2±2.2 min, mean procedure time was 55.6±6.6 min.

A total of 2105 lesions were analyzed, comparing left anterior wall vs. left posterior wall and right anterior wall vs. right posterior wall, the mean ablation time (sec.) was 20.5±8.2 vs. 8.6±3.2, and 12.2±4 vs 9.3±3.4; the mean contact force (g): 17.1±12 vs 25.4±14.2 and 33.7±13.1 vs 21.0±10.5, the mean AI: 546.8±48.2 vs 444.6±55 and 554.8±56 vs. 439.8±47.1 (all P<0.0001). Audible steam pops were noted in in 4 (8%) patients. Esophageal temperature rise >39°C were noted in 25 (50%) patients. In 1/50 (2%) patient a minor esophageal lesion after ablation was observed without requiring specific therapy. No major complications such as death, stroke, tamponade or atria-esophageal -fistula occurred.

Conclusion

The novel AI guided high power ablation appears to be a feasible, safe, quantifiable and efficient strategy for PVI.
P2850Time to isolation guided hot balloon ablation for pulmonary vein isolation
Authors: Chikata A , Kato T , Usuda K , Fujita S , Maruyama M , Otowa K , Takashima S , Murai H , Usui S , Furusho H , Kaneko S , Takamura M
Published: October 2019

Background

One disadvantage of hot balloon ablation (HBA) system is that real time monitoring of pulmonary vein (PV) potential is technically impossible. Therefore, the optimal radiofrequency-generated thermal energy application duration and application number are not completely established.

Purpose

The aim of this study is to evaluate the utility of 2Fr 4-electrode unidirectional catheter inserted into PV along with HB for real time monitoring of PV potential and investigate the time to isolation (TTI) guided optimal application strategy for HB based PV isolation in the acute phase.

Methods

We evaluated 23 consecutive patients who performed PV isolation using HBA system. Real time monitoring of PV potential was performed by 2Fr 4-electrode unidirectional catheter inserted into PV along with HB (Figure1A). After HBA applications, PV isolation was validated by high-resolution mapping with the 20-pole steerable mapping (PENTARAY) catheter as a standard. PV potentials during HBA application were categorized into five patterns. PV potentials disappeared during HBA applications and not emerged again (acute isolation), disappeared but verified by PENTARAY catheter (pseudo isolation), once disappeared but emerged again during the same application (acute reconnection), visible but not disappeared (ineffective application) and Invisible (Figure1B).

TTI, difference between TTI and time to reach target temperature (TTRT), balloon temperature at isolation and ablation time after isolation were examined for each applications.

Results

Out of 92 PVs, 69/92 (75.0%) PVs were isolated using HBA and 23/92 (25.0%) PVs required touch up ablation. In total, 120 applications were performed. Real time monitoring of the PV activity was obtained in 114 of 120 applications (95.0%). The distribution of PV potential patterns were 64/120 (53.3%), 2/120 (1.7%), 27/120 (22.5%), 23/120 (19.2%), for acute isolation, pseudo isolation, acute reconnection, ineffective application, respectively.

TTI and difference between TTI and TTRT were significantly shorter in the acute isolation group. Balloon temperature at isolation was significantly lower, TTRT and ablation time after isolation was significantly longer in the acute isolation group. Among them, TTI and difference between TTI and TTRT were highly predictive by receiver operation characteristics curve analysis. TTI <36.5s predicted successful application with sensitivity 83.9% and specificity 79.3%. Difference between TTI and TTRT <6.5s predicted with sensitivity 82.3% and specificity 89.7%.

Figure 1

Conclusions

In HBA system, real time monitoring of PV potentials can be obtained using 2Fr 4-electrode unidirectional catheter and accuracy to confirm an ostial PV isolation is relatively high.

TTI <36.5s and difference between TTI and TTRT <6.5s could be a suitable target for effective application.
P2853Contemporary reporting of acute complications from implantable cardioverter defibrillator surgery
Authors: Hassan A , Birnie D , Nery P , Nair G , Davis D , Green M , Sadek M , Golian M , Redpath C
Published: October 2019

Background

Defibrillator placement carries an inherent risk to the patient. Traditionally, major adverse events defined as cardiac arrest, tamponnade, pneumothorax, infection requiring re-operation, MI and CVA within 30 days are reported to occur between 3 and 4%. Minor complications such as heamatomae or lead dislodgement are reported between 8 and 13%. Novel lead technologies, protocolised programming and reduced use of Heparin bridging have been reported to reduce adverse outcomes. However, patients are still typically monitored in hospital for 24 hours to mitigate these risks. There is little evidence that discharge delay is effective yet incurs significant additional costs.

Purpose

We sought to evaluate the frequency and timing of adverse events relating to defibrillator surgery (ICD and CRT-D) at a large Canadian tertiary care center (UOHI).

Methods

We retrospectively reviewed all patients who received a defibrillator placed from 1st April 2013 to 31st March 2018 inclusive. Patient comorbidities were extracted from the hospital electronic medical record (EMR) system. Device related information and complications were extracted from UOHI PaceartTM system and EMR and cross referenced with physician remuneration databases.

Results

A total of 2221 procedures were performed on 2153 patients (78% male, mean age 65 years). The majority (60%) of defibrillator implants were de novo, with 884 (40%) pulse generator replacements/ upgrades and 868 (39%) defibrillators had CRT capability. Patients were routinely discharged within 24 hours of ICD surgery. Post-operative follow up ≥30 days was complete in 97% patients. Major adverse events occurred within 30 days in 9 patients (0.4%); 9 (100%) were infection requiring re-operation. An additional 32 patients (1.5%) required repeat interventions or readmission within 30 days of implant, most commonly due to lead dislodgement. Only 2 patients required readmission within 24 hours of surgery (0.1%). All procedure-related adverse events during clinical follow up (≤5 years) were 131 (5.9%) occurring in 122 patients. There were no apparent predictors of adverse events in this cohort.

Conclusion(s)

Contemporary risks to patients undergoing defibrillator surgery are considerably lower than that reported in 2010. The risk of infection appears constant despite increased antibiosis. Patients receiving an ICD or CRT-D can safely be discharged within 24 hours if no complications are apparent.

Acknowledgement/Funding

None
P2854Floating connecting tissue scars ghosts after transvenous lead extraction
Authors: Polewczyk A , Nowosielecka D , Tomaszewski A , Brzozowski W , Szczesniak Stanczyk D , Tulecki L , Tomkow K , Jachec W , Kutarski A
Published: October 2019

Background

The phenomenon of appearance of connecting tissue remnants floating in vena cava (VC), right atrium (RA) tricuspid valve (TV), right ventricle (RV) or coronary sinus (CS) was described recently. Frequency of occurrence and their significance remain unknown. Till now, our knowledge is limited due lack exact description in the literature.

Purpose

The goal of this study was analysis of the appearance of this phenomenon using trans-esophageal echocardiography.

Methods

Between 2006 and January 2018 we performed 2408 TLE procedures using conventional mechanical sheaths. 3836 leads (mean implant duration 96,13 months) were extracted, mainly due to non-infective indications in 64,2%. Results of exact TEE before and after the procedure were available in 2034 patients. All patients with incomplete ECHO/TEE evaluation were excluded from the analysis.

Results

Results are presented in the table

Conclusions

In about 25% of patients after TLE floating connecting tissue scars can be observed. Most frequently they can be noted in VC (33%) RA (28%) and RV (10%). In 23% ghosts has numerous location in different combinations. Mean size of “ghosts” is about 20x4 mm. This phenomenon should be known for doctors who perform transesophageal echocardiography to avoid faulty diagnosis.
P2865Mutation specific clinical characteristics in long QT syndrome type 8; severe phenotype in Timothy syndrome patients
Authors: Ohno S , Yoshinaga M , Ozawa J , Fukuyama M , Seiichi S , Kashiwa A , Yasuda K , Kaneko S , Nakau K , Inukai S , Sakazaki H , Makiyama T , Aiba T , Suzuki H , Horie M
Published: October 2019

Background

Long QT syndrome type 8 (LQT8) caused by mutations in CACNA1C has been classified as a very rare and severe type of long QT syndrome accompanied with Timothy syndrome (TS) with extra-cardiac phenotype. Recently, various mutations in CACNA1C have been identified in non-TS patients. However, mutation specific severity in LQT8 has not been elucidated yet, especially for non-TS patients.

Purpose

We aimed to clarify the clinical characteristics of LQT8 patients.

Methods

The study consists of 26 LQT8 patients (21 probands and 5 family members). We evaluated their phenotype.

Results

Table summarizes the clinical characteristics of LQT8 patients. TS patients diagnosed in younger age than those of non-TS. Four TS and one non-TS patients were diagnosed at the age of 0, though the non-TS patient was a son of a patient and asymptomatic. Nine patients suffered symptoms including 7 with cardiac arrest. We identified three TS mutations; classical p.G406R in two and p.G402S in two, and a new TS mutation, p.412M in one. Four of TS patients were symptomatic and two died suddenly at the age of 4 and 5. In contrast, no one died in non-TS patients. Five non-TS patients suffered symptoms in the age of 4,9,15,54 and 64, and the mutations were p.S643F, p.R858H (2 patients), p.K1518E and p.K1591T.

Characteristics of TS and non-TS patient TS Non-TS P N (male) 5 (2) 21 (9) Age (range) 0 (0–7) 12 (0–64) 0.004 Symptom Syncope 4 5 0.034 CPA 3 4 0.101 ECG characteristics   QT interval 603±40 507±14 0.011   T wave alternans 5 2 <0.001   AV Block 4 1 0.002 Therapy (4 unknown)   Beta-blocker 4 7 0.311   Mexiletine 3 1 0.024   ICD implantation 2 2 0.21

Conclusions

Although TS patients showed severe phenotype, most of the non-TS patients were asymptomatic. The phenotype in LQT8 are diversely different depend on the mutations, especially between patients with TS and non-TS.
P2874Predictors of Electrical Strom among ICD patients: the importance of the burden of non-sustained VTs
Authors: Jimenez-Candil J , Castro J C , Hernandez J , Nunez J , Morinigo J L , Bravo L , Sanchez P L
Published: October 2019

Background

Among ICD patients, the burden of non-sustained ventricular tachycardias (NSVT) occurring during the first 6 months after implant is associated independently with an increase in cardiac death. It is unknown whether there are differences between the incidence of Electrical Storm (ES) and the cause of cardiac mortality (CM) according to the burden of NSVT.

Purpose

To determine the relationship between the burden of NSVT occurring early after ICD implant and the risk of ES in the long-term among ICD patients with left ventricular dysfunction.

Methods

In this prospective study, 416 patients (age: 65±11; LVEF: 30±8; ischemic etiology: 62%, primary prevention: 63%) with LVEF <45% and ICD without cardiac resynchronization therapy were followed-up for 41±27 after implant. ICD programming was standardized. NSVT was defined as any ventricular tachyarrhythmia with >5 beats at ≥150 bpm terminating spontaneously before therapy that occurred within the first six months after ICD implant.

Results

A total of 31 patients (7.5%) presenting with ES during the follow-up. After classifying the subjects into three groups according to the burden of NSVT (tertiles): no NSVT (N=166, group 1); 1–5 NSVT (n=130, group 2) and >5 NSVT (n=120, group 3), the cumulative incidence of ES was higher in group 3: 2.4% vs. 3.1% vs. 19.2%, with an average of time from implant to ES significantly shorter (mean [95% CI, months]): 97 (94–100) vs. 103 (99–106) vs. 86 (79–93); p<0.001 for groups 1–2 vs. 3 (log-rank test). Figure. All ESs were due to monomorphic VT in individuals with ≤5 NSVT; however, 19% of ESs were caused by polymorphic VT or VF among patients with >5 NSVT (p<0.05). By multivariate analysis (Cox-regression), LVEF, % (HR=1.06; p=0.026) and >5 TVNS (HR=4.66; p=0.001) were identified as independent predictors of ES. Cardiac mortality (CM) was independently higher in subjects with >5 NSVT (HR=1.7; p=0.03). The most frequent cause of CM was cardiac failure irrespective of NSVT burden (93% in patients with ≤5 NSVT and 79% in >5 NSVT); however CM due to ES was exclusive of individuals with >5 NSVT: 15% vs. 0% (p<0.05).

Figure 1

Conclusions

1. The burden of NSVT occurring during the first 6 months after an ICD implant is associated independently with a higher risk of ES in the long-term. 2. The adjusted risk of ES is 4-fold higher in individuals with >5 NSVT. 3. The most frequent etiology of CM is heart failure; CM due to ES is exclusive of patients with >5 NSVT causing the 15% of deaths in such population.
P2878Higher all-cause mortality in patients with implanted dual-chamber cardioverter-defibrillators for secondary prevention: an analysis from the Polish ICD Registry
Authors: Warchol I , Lubinski A , Sterlinski M , Kowalski O , Goscinska-Bis K , Pytkowski M , Mitkowski P , Kazmierczak J , Szwed H , Przybylski A , Trusz-Gruza M , Kempa M , Zienciuk A , Sielski S , Pazdyga A
Published: October 2019

Background

In the Polish ICD Registry population secondary prevention recipients account for over 27%. Despite the evolution of indications for secondary prevention implantable cardioverter defibrillators (ICDs), recommendations regarding the use of ICDs for secondary prevention of sudden cardiac death (SCD) rely on information from a small number of randomized controlled trials that were performed decades ago, with mixed results. Moreover, research on the outcomes after implantations for secondary prevention of ICDs is limited. While dual-chamber devices offer theoretical advantage over single-chamber devices, dual-chamber ICDs (DC-ICDs) were announced not superior to single-chamber (SC-ICDs) in some research.

Purpose

Therefore, the aim of the study was to evaluate the all-cause mortality among patients from the Polish ICD Registry receiving either a single- or a dual-chamber device for secondary prevention in contemporary clinical practice.

Methods

All patients enrolled in the Polish ICD Registry from 1995 to 2016 were identified. Patients were included in the study if they were designated as receiving an ICD for secondary prevention of SCD after documented tachycardic arrest, sustained ventricular tachycardia (VT), or syncope. Kaplan-Meier survival analysis was used to assess all-cause mortality.

Results

In the study population of 3596 ICD recipients (mean age 69±12 years, 81% male, SC-ICD 61%, DC-ICD 39%), during mean follow-up of 79±43 months all-cause mortality rate was higher in the dual-chamber group than in the single chamber group, with a significant difference between the two groups as depicted in Kaplan-Meier curve (p<0,05). The median survival time was 98 months versus 110 months for SC and DC-ICD, respectively.

Conclusions

This study is the first to describe the characteristics of a national cohort of patients receiving a secondary prevention ICD in such a long follow-up period in contemporary practice. Implantation of a dual-chamber ICD was associated with higher all-cause mortality compared with single chamber devices.
P2879Effectiveness of first versus subsequentes ATP attemps: predictors and clinical consequences
Authors: Jimenez-Candil J , Perez J , Morinigo J L , Hernandez J , Bravo Calero L , Sanchez P L
Published: October 2019

Introduction

Antitachycardia pacing (ATP) terminates the majority (but not all) of slow VTs (S-VT) with a cycle length (CL) >320 ms.

Purpose

To analyze the efficacy, safety and predictors of ATP, comparing the first (ATP-1) to the second (ATP-2) and third (ATP-3) attempts.

Methods

We studied 556 S-VT (CL=354±18 ms; range: 321–415 ms; 1.6% syncopes) occurring in 67 patients. ATP programming was standardized, including three consecutive bursts of 15 pulses at 91% of VT CL.

Results

ATP effectiveness declined significantly from ATP-1 (436/556: 78%) compared to ATP-2 (24/103: 23%) and ATP-3 (10/79: 13%), p<0.01 for all comparisons. The percentage of variation of RR intervals (P-RR, %) was significantly higher prior to effective ATP-1 (2.73±1.45 vs 1.23±0.9; p<0.001). After an ineffective ATP-1, the P-RR decreased dramatically, with no differences between episodes terminated or not at ATP-2 (0.6±0.14 vs 0.44±0.16; p=0.6) or ATP-3 (0.54±0.15 vs. 0.52±0.14; p=0.7). The postpacing interval – CL difference (PPI-CLd) after an unsuccessful ATP-1 was shorter in episodes terminating at ATP-2 or ATP-3 (180±24 vs 211±15 ms; p<0.001) being 200 ms the cut-off point with the best sensitivity and specificity for non-effective ATP-2 and ATP-3 (93% and 74%, respectively). By multivariate analysis, the duration of native QRS complex (dQRS) (ms) was found the only independent predictor of a PPI-CLd ≥200 ms (OR=1.04; p=0.003). The best cutoff point of dQRS for PP-CLd ≥200 ms was 120 ms (sensitivity and specificity of 66% and 79%, respectively).

Several predictors of ATP efficacy were found by logistic regression: a) ATP-1: P-RR (OR=7.3; p<0.001), beta-blockers (OR=4.1; p<0.001) and dQRS (OR=0.95; p<0.001); b) ATP-2: PPI-CLd (OR=0.94; p=0.001) and dQRS (OR=0.96; p=0.04); c) ATP-3: PPI-CLd (OR=0.93; p=0.009).

Patients with a dQRS≥120 ms had a lower adjusted effectiveness of ATP and a higher proportion of S-VT causing syncope. Table.

Table 1 Patients with QRS <120 ms Patients with QRS ≥120 ms p value Adjusted effectiveness of ATP-1 89% (82–96) 70% (59–80) 0.008 Adjusted effectiveness of ATP-2 47% (32–63) 23% (11–35) 0.036 Adjusted effectiveness of ATP-3 18% (3–33) 3% (0–6) 0.003 Adjusted incidence of syncope due to S-VT 0.18% (0–0.6) 4.1% (2.1–6.1) 0.025 Values are expressed as mean (95% CI). Generalized Estimating Equations Method.

Conclusions

The efficacy of ATP in terminating S-VT is mainly due to the ATP-1. The regularization of RR intervals after ineffective ATP-1 underlies the lower efficacy of ATP-2 and ATP-3. Since the dQRS correlated significantly with the PPI-CLd, patients with a dQRS≥120 ms had a lower ATP-1, ATP-2 and ATP-3 effectiveness, leading to a higher incidence of syncope.
An allometric area-based approach—a cost-effective method for stand volume estimation based on ALS and NFI data
Authors: Socha Jarosław , Hawryło Paweł , Pierzchalski Marcin , Stereńczak Krzysztof , Krok Grzegorz , Wężyk Piotr , Tymińska-Czabańska Luiza
Published: October 2019

Reliable information concerning stand volume is fundamental to making strategic decisions in sustainable forest management. A variety of remotely sensed data and different inventory methods have been used for the estimation of forest biometric parameters. Particularly, airborne laser scanning (ALS) point clouds are widely used for the estimation of stand volume and forest biomass using an area-based approach (ABA) framework. This method relies on the reference measurements of field plots with the necessary prerequisite of a precise co-registration between ground reference plots and the corresponding ALS samples. In this research, the allometric area-based approach (AABA) is proposed in the context of stand volume estimation of Scots pine (Pinus sylvestris L.) stands. The proposed method does not require detailed information about the coordinates of the field plots. We applied Polish National Forest Inventory data from 9400 circular field plots (400 m2) to develop a plot level stand volume allometric model using two independent variables: top height (TH) and relative spacing index (RSI). The model was developed using the multiple linear regression method with a log–log transformation of variables. The hypothesis was that, the field measurements of TH and RSI could be replaced with corresponding ALS-derived metrics. It was assumed that TH could be represented by the maximum height of the ALS point cloud, while RSI can be calculated based on the number of tree crowns delineated within the ALS-derived canopy height model. Performance of the developed AABA model was compared with the semi-empirical ABASE (with two predictors: TH and RSI) and empirical ABAE (several point cloud metrics as predictors). The models were validated at the plot level using 315 forest management inventory plots (400 m2) and at the stand level using the complete field measurements from 42 Scots pine dominated forest stands in the Milicz forest district (Poland). The AABA model showed a comparable accuracy to the traditional ABA models with relatively high accuracy at the plot (relative root mean square error (RMSE) = 22.8 per cent; R2 = 0.63) and stand levels (RMSE = 17.8 per cent, R2 = 0.65). The proposed novel approach reduces time- and cost-consuming field work required for the classic ABA method, without a significant reduction in the accuracy of stand volume estimations. The AABA is potentially applicable in the context of forest management inventory without the necessity for field measurements at local scale. The transportability of the approach to other species and more complex stands needs to be explored in future studies.
Retrieving lithospheric magnetisation distribution from magnetic field models
Authors: Lesur V , Vervelidou F
Published: October 2019

We investigate to which extent the radially averaged magnetisation of the lithosphere can be recovered from the information content of a spherical harmonic model of the generated magnetic field when combined with few simple hypotheses. The results obtained show firstly that a hypothesis of magnetisation induced by a field of internal origin, even over a localised area, is not sufficient to recover uniquely the radially averaged magnetisation and, secondly, that this magnetisation can be recovered when a constant magnetisation direction is assumed. An algorithm to recover the magnetisation direction and distribution is then described and tested over a synthetic example. It requires to introduce a cost function that vanishes when estimated in a system of coordinates with its Z axis aligned with the magnetisation direction. Failing to find a vanishingly small value for the cost function is an indication that a constant magnetisation direction is not a valid hypothesis for the studied magnetic field model. The range of magnetisation directions that are compatible with the magnetic field model and a given noise level, can also be estimated. The whole process is illustrated by analysing a local, isolated maximum of the Martian magnetic field.
The short-term seismicity of the Central Ionian Islands (Greece) studied by means of a clustering model
Authors: Mangira Ourania , Console Rodolfo , Papadimitriou Eleftheria , Murru Maura , Karakostas Vasilios
Published: October 2019

Earthquake clustering in the area of Central Ionian Islands (Greece) is statistically modelled by means of the Epidemic Type Aftershock Sequence (ETAS) branching model, which is the most popular among the short-term earthquake clustering models. It is based upon the assumption that an earthquake is not fully related to any other one in particular, but rather to both all previous events, and the background seismicity. The close temporal proximity of the strong ($M \ge 6.0$) events in the study area offers the opportunity to retrospectively test the validity of the ETAS model through the 2014 Kefalonia doublet (Mw 6.1 and Mw 6.0) and the 2015 Lefkada aftershock sequences. The application of a physics-based earthquake simulator to the local fault system produced a simulated catalogue with time, space and magnitude behaviour in line with the observed seismicity. This catalogue is then used for the detection of short-term interactions between both strong and smaller events and the comparison between the two cases. The results show that the suggested clustering model provides reliable forecasts of the aftershock activity. Combining the ETAS model and the simulator code, though, needs to be more deeply examined since the preliminary results show some discrepancy between the estimated model parameters.
Improving Quality of Care in Inflammatory Bowel Disease Through Patients’ Eyes: IQCARO Project
Authors: Calvet Xavier , Saldaña Roberto , Carpio Daniel , Mínguez Miguel , Vera Isabel , Juliá Berta , Marín Laura , Casellas Fransesc
Published: October 2019

Background

Quality improvement is a major topic in inflammatory bowel disease (IBD) care, and measuring quality of care (QoC) is necessary for QoC improvement. Most QoC projects or consensus statements are designed from the health care professional point of view. Having QoC indicators designed for and fully evaluable by patients may provide a key tool for external evaluation of QoC improvement measures. The aim of the IQCARO project was to identify indicators to measure QoC from the IBD patient’s point of view.

Methods

An extensive review of the literature to identify indicators of QoC was performed; first the identified indicators were reviewed by a steering committee including patients, nurses, IBD specialists, and methodologists. Then 2 focus groups of IBD patients analyzed the QoC indicators to determine whether they could be understood and evaluated by patients. The final QoC indicators were selected by a group of IBD patients using a Delphi consensus methodology.

Results

An initial list of 54 QoC indicators was selected by the steering committee. The QoC indicators were evaluated by 16 patients who participated in 2 focus groups. They identified 21 indicators that fulfilled the understandability and evaluability requirements. The 10 most relevant QoC indicators were selected by 26 patients with IBD using a Delphi consensus. The selected items covered important aspects of QoC, including professionalism, patients’ autonomy, information, accessibility, and continuity of care.

Conclusions

The present Delphi consensus identified QoC indicators that are useful for developing and measuring improvement strategies in the management of IBD.
All-trans Retinoic Acid Counteracts Diarrhea and Inhibition of Downregulated in Adenoma Expression in Gut Inflammation
Authors: Priyamvada Shubha , Anbazhagan Arivarasu N , Kumar Anoop , Chatterjee Ishita , Borthakur Alip , Saksena Seema , Gill Ravinder K , Alrefai Waddah A , Dudeja Pradeep K
Published: October 2019

Background

Intestinal epithelial apical membrane Cl-/HCO3- exchanger DRA (downregulated in adenoma, SLC26A3) has emerged as an important therapeutic target for diarrhea, emphasizing the potential therapeutic role of agents that upregulate DRA. All-trans retinoic acid (ATRA), a key vitamin A metabolite, was earlier shown by us to stimulate DRA expression in intestinal epithelial cells. However, its role in modulating DRA in gut inflammation has not been investigated.

Aims

Our aim was to analyze the efficacy of ATRA in counteracting inflammation-induced decrease in DRA in vitro and in vivo.

Methods

Interferon-γ (IFN-γ)-treated Caco-2 cells and dextran sulfate sodium (DSS)-treated C57BL/6J mice served as in vitro and in vivo models of gut inflammation, respectively. The effect of ATRA on IFN-γ-mediated inhibition of DRA function, expression, and promoter activity were elucidated. In the DSS colitis model, diarrheal phenotype, cytokine response, in vivo imaging, myeloperoxidase activity, and DRA expression were measured in the distal colon.

Results

All-trans retinoic acid (10 μM, 24 h) abrogated IFN-γ (30 ng/mL, 24 h)-induced decrease in DRA function, expression, and promoter activity in Caco-2 cells. All-trans retinoic acid altered IFN-γ signaling via blocking IFN-γ-induced tyrosine phosphorylation of STAT-1. All-trans retinoic acid cotreatment (1 mg/kg BW, i.p. daily) of DSS-treated mice (3% in drinking water for 7 days) alleviated colitis-associated weight loss, diarrheal phenotype, and induction of IL-1β and CXCL1 and a decrease in DRA mRNA and protein levels in the colon.

Conclusion

Our data showing upregulation of DRA under normal and inflammatory conditions by ATRA demonstrate a novel role of this micronutrient in alleviating IBD-associated diarrhea.
Excisional Hemorrhoidectomy: Safe in Patients With Crohn’s Disease?
Authors: Lightner Amy L , Kearney David , Giugliano Danica , Hull Tracy , Holubar Stefan D , Koh Sharon , Zaghiyan Karen , Fleshner Phillip R
Published: October 2019

Introduction

Due to concerns over wound healing, hemorrhoidectomy in patients with Crohn’s disease (CD) remains controversial. We sought to ascertain safety and efficacy of excisional hemorrhoidectomy in CD.

Methods

A retrospective review of all adult CD patients undergoing excisional hemorrhoidectomy between January 1, 1995, and January 1, 2019, at 2 IBD referral centers was performed. Data collected included patient demographics, clinical characteristics of CD (anorectal symptoms; prior nonoperative hemorrhoidal therapy; presence of other perianal disease; and activity, duration, and anatomic location of CD), and postoperative complications including bleeding, wound healing, and need for further therapy or surgical intervention after surgery.

Results

A total of 36 adult patients with Crohn’s disease with symptomatic hemorrhoidal disease were included. The study cohort included 16 males (44%), and median age was 49 (range, 21 to 77) years. Predominant symptoms included pain (n = 16; 44%), prolapse (n = 8; 22%), and bleeding (n = 12; 33%). Sixteen patients (44%) had nonoperative therapy before surgery. Twenty-four patients (67%) had other perianal disease. At the time of hemorrhoidectomy, 9 patients (25%) were exposed to corticosteroids, 8 patients (25%) to immunomodulators, and 9 patients (25%) to biologics. During a median follow-up time of 31.5 (range, 1 to 255) months after hemorrhoidectomy, 4 patients (11%) had complications (1 developed a stricture, 1 developed a perianal abscess/fistula, 1 had a nonhealing wound, and 1 had hemorrhoidal recurrence).

Conclusion

Our data suggest that excisional hemorrhoidectomy may be performed safely in CD patients who have failed nonoperative hemorrhoidal therapy without concern for de novo perianal disease or need for proctectomy.

Hemorrhoidal disease is common in patients with Crohn’s disease. This study sought to understand the outcomes of surgically treating hemorrhoids in patients with Crohn’s disease.
Evaluation of Piper marginatum (Piperales: Piperaceae) Oil and Geraniol on the Embryonic Development of Spodoptera frugiperda (Lepidoptera: Noctuidae) in Comparison to Formulated Products
Authors: Guedes Carolina A , Teixeira Valeria Wanderley , Dutra Kamila A , Navarro Daniela M A F , Cruz Glaucilane S , Lapa Neto Clóvis J C , Correia Alicely A , Sandes Jana M , Brayner Fábio A , Alves Luiz C , Teixeira Álvaro A C
Published: October 2019

Essential oils and their isolated constituents are constantly being studied for the control of insect pests. In this context, the present research reports the chemical composition of Piper marginatum (Jacq.) oil aiming to: 1) establish lethal concentrations LC30 and LC50 for this oil and the compound geraniol, 2) histologically examine the embryonic development of Spodoptera frugiperda (J.E. Smith) through light microscopy and scanning electron microscopy (SEM), as well as 3) compare the efficacy of the P. marginatum oil with that of the botanical insecticide azadirachtin, the synthetic insecticide deltamethrin, and acetone as a negative control. Semithin sections of S. frugiperda eggs revealed that the oil, geraniol, azadirachtin, and deltamethrin affected embryonic development at both concentrations. However, geraniol and the oil were more efficient because they caused more significant damage, even at lower concentrations. SEM revealed that all products altered the morphology of the eggs, modifying the structure of the chorion and making the eggs nonviable. Thus, this work demonstrates that P. marginatum oil is effective in the control of S. frugiperda because it results in embryonic damage even at the lowest concentrations.
Combustion of pneumoperitoneum: a rare danger in the operating room
Authors: McSweeney William T , Kirkby Brian
Published: October 2019

Fire or combustion occurring during laparotomy is an uncommon and potentially hazardous event that can be precipitated by the use of surgical energy devices in the presence of enteric gases or exogenous materials present in the abdomen such as alcohol. Oxygen necessary for a combustive event can be increased in the setting of a proximal enteric injury and with higher concentrations of inspired oxygen during anaesthesia. We report on a case of combustion on entry to the abdomen using monopolar diathermy during exploratory laparotomy for gastric antral perforation in the presence of alcohol and enteric gases.
Combining phenotype, genotype and environment to uncover genetic components underlying water use efficiency in Persian walnut
Authors: Arab Mohammad Mehdi , Marrano Annarita , Abdollahi-Arpanahi Rostam , Leslie Charles A , Cheng Hao , Neale David B , Vahdati Kourosh
Published: October 2019

Walnut production is challenged by climate change and abiotic stresses. Elucidating the genomic basis of adaptation to climate is essential to breeding drought tolerant cultivars for enhanced productivity in arid and semi-arid regions. Here, we aimed to identify loci potentially involved in water use efficiency (WUE) and adaptation to drought in Persian walnut using a diverse panel of 95 walnut families (950 seedlings) from Iran, which show contrasting levels of water availability in their native habitats. We analyzed associations between phenotypic, genotypic, and environmental variables from datasets of 609 K high-quality single-nucleotide polymorphisms (SNPs), three categories of phenotypic traits (WUE related traits under drought, their drought stress index and principal components), and 21 climate variables and combination of them (first three PCs). Our genotype-phenotype analysis identified 22 significant and 266 suggestive associations, some of which were identified for multiple traits, suggesting their correlation and a possible common genetic control. Also, genotype-environment association analysis found 115 significant and 265 suggestive SNP loci that displayed potential signals of local adaptation. Several sets of stress-responsive genes were found in the genomic regions significantly associated with the aforementioned traits. Most of the candidate genes identified are involved in abscisic acid signaling, stomatal regulation, transduction of environmental signals, antioxidant defense system, osmotic adjustment, and leaf growth and development. Upon validation, the marker-trait associations identified for drought tolerance-related traits would allow the selection and development of new walnut rootstocks or scion cultivars with superior water use efficiency.
Analysis of potential redundancy among Arabidopsis 6-phosphogluconolactonase isoforms in peroxisomes
Authors: Lansing Hannes , Doering Lennart , Fischer Kerstin , Baune Marie-Christin , Schaewen Antje Von
Published: October 2019

Recent work revealed that PGD2, an Arabidopsis 6-phosphogluconate dehydrogenase (6-PGD) catalysing the third step of the oxidative pentose-phosphate pathway (OPPP) in peroxisomes, is essential during fertilization. Earlier studies on the second step, catalysed by PGL3, a dually targeted Arabidopsis 6-phosphogluconolactonase (6-PGL), reported the importance of OPPP reactions in plastids but their irrelevance in peroxisomes. Assuming redundancy of 6-PGL activity in peroxisomes, we examined the sequences of other higher plant enzymes. In tomato, there exist two 6-PGL isoforms with the strong PTS1 motif SKL. However, their analysis revealed problems regarding peroxisomal targeting: reporter–PGL detection in peroxisomes required construct modification, which was also applied to the Arabidopsis isoforms. The relative contribution of PGL3 versus PGL5 during fertilization was assessed by mutant crosses. Reduced transmission ratios were found for pgl3-1 (T-DNA-eliminated PTS1) and also for knock-out allele pgl5-2. The prominent role of PGL3 showed as compromised growth of pgl3-1 seedlings on sucrose and higher activity of mutant PGL3-1 versus PGL5 using purified recombinant proteins. Evidence for PTS1-independent uptake was found for PGL3-1 and other Arabidopsis PGL isoforms, indicating that peroxisome import may be supported by a piggybacking mechanism. Thus, multiple redundancy at the level of the second OPPP step in peroxisomes explains the occurrence of pgl3-1 mutant plants.
Probing primordial 3He from hyperfine line afterglows around supercritical black holes
Authors: Vasiliev Evgenii O , Sethi Shiv K , Shchekinov Yuri A
Published: October 2019

We consider the possibility of the detection of 3HeII hyperfine line (rest frequency, $8.67 \, \rm GHz$) emission from ionized zones around accreting black holes (BHs) formed at high redshifts, z = 15–30. We show that the brightness temperature in 8.67GHz line increases and reaches a peak value after the accretion onto the BH exhausts and HeIII recombines into HeII. This period of brightening last up to 40 million years. We find that during this period the maximum brightness temperature reaches ≃ 0.2–0.5μK, depending on the epoch when such a black hole starts growing. The maximum angular size of the region emitting in the hyperfine line is around 0.5′. The flux from such a region ($\simeq 0.3 \, \rm nJy$) is too small to be detected by SKA1-MID. The RMS of the collective flux from many emitting regions from a volume bounded by the synthesized beam and the band-width of SKA1-MID might reach 100 nJy, which is potentially detectable by SKA1-MID.
Asymmetric Distribution of Gene Trees Can Arise under Purifying Selection If Differences in Population Size Exist
Authors: He Chong , Liang Dan , Zhang Peng
Published: October 2019

Incomplete lineage sorting (ILS) is an important factor that causes gene tree discordance. For gene trees of three species, under neutrality, random mating, and the absence of interspecific gene flow, ILS creates a symmetric distribution of gene trees: the gene tree that accords with the species tree has the highest frequency, and the two discordant trees are equally frequent. If the neutral condition is violated, the impact of ILS may change, altering the gene tree distribution. Here, we show that under purifying selection, even assuming that the fitness effect of mutations is constant throughout the species tree, if differences in population size exist among species, asymmetric distributions of gene trees will arise, which is different from the expectation under neutrality. In extremes, one of the discordant trees rather than the concordant tree becomes the most frequent gene tree. In addition, we found that in a real case, the position of Scandentia relative to Primate and Glires, the symmetry in the gene tree distribution can be influenced by the strength of purifying selection. In current phylogenetic inference, the impact of purifying selection on the gene tree distribution is rarely considered by researchers. This study highlights the necessity of considering this impact.
DrLLPS: a data resource of liquid–liquid phase separation in eukaryotes
Authors: Ning Wanshan , Guo Yaping , Lin Shaofeng , Mei Bin , Wu Yu , Jiang Peiran , Tan Xiaodan , Zhang Weizhi , Chen Guowei , Peng Di , Chu Liang , Xue Yu
Published: October 2019

Here, we presented an integrative database named DrLLPS (http://llps.biocuckoo.cn/) for proteins involved in liquid–liquid phase separation (LLPS), which is a ubiquitous and crucial mechanism for spatiotemporal organization of various biochemical reactions, by creating membraneless organelles (MLOs) in eukaryotic cells. From the literature, we manually collected 150 scaffold proteins that are drivers of LLPS, 987 regulators that contribute in modulating LLPS, and 8148 potential client proteins that might be dispensable for the formation of MLOs, which were then categorized into 40 biomolecular condensates. We searched potential orthologs of these known proteins, and in total DrLLPS contained 437 887 known and potential LLPS-associated proteins in 164 eukaryotes. Furthermore, we carefully annotated LLPS-associated proteins in eight model organisms, by using the knowledge integrated from 110 widely used resources that covered 16 aspects, including protein disordered regions, domain annotations, post-translational modifications (PTMs), genetic variations, cancer mutations, molecular interactions, disease-associated information, drug-target relations, physicochemical property, protein functional annotations, protein expressions/proteomics, protein 3D structures, subcellular localizations, mRNA expressions, DNA & RNA elements, and DNA methylations. We anticipate DrLLPS can serve as a helpful resource for further analysis of LLPS.
Tobacco 21 Laws in Europe: A Policy Whose Time Has Come
Authors: Levy David T , Meza Rafael
Published: October 2019

Introduction

A 21 tobacco age of sale has been proposed for European nations.

Methods

We briefly review past studies of underage purchase policies and their enforcement.

Results

Past evaluations and modeling studies indicate important public health gains from 21 tobacco age of sale laws. However, further attention should be given to issues of compliance, the availability of social sources, and the breadth of coverage. In particular, the application of the law to e-cigarettes merits further attention.

Conclusions

Past literature indicates potential benefits of a 21 tobacco age of sale in terms of reducing tobacco use in European nations.

Implications

We review past studies of underage purchase laws, and the potential implications of applying that law to e-cigarettes. Past studies indicate the effectiveness of raising tobacco age of sale laws to 21. This law should be implemented and enforced in Europe.