bluuebunny/crossref_metadata_2025 huggingface dataset:
Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation
Authors: Rizza V , Maranta F , Cianfanelli L , Grippo R , Meloni C , Avitabile M , Castiglioni A , De Bonis M , Alfieri O , Cianflone D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes.

Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS).

Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR).

Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p < 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p < 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p < 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p < 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin > 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period.

Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.
Impact of an online cardiac rehabilitation program after an acute coronary syndrome during SARS-CoV-2 pandemic
Authors: Severo Sanchez A , Rivero Santana B , Arbas Redondo E , Juarez Olmos VM , Poveda Pinedo D , Tebar Marquez D , Dalmau Gonzalez-Galarza R , Castro Conde A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario La Paz

Introduction

The SARS-CoV-2 pandemic has overloaded health care systems at several fields. Spanish COVID-19 first wave led to the interruption of most cardiac rehabilitation (CRH) programs in our country. Resume activity without compromising patient"s safety has been a challenge. At our centre (a third-level hospital), we modified our routine clinical practice from face-to-face interviews to a complete online CRH program since July 1st 2020.

Purpose

The aim of this study is to analyse the impact of an online CRH program after hospital discharge for an acute coronary syndrome in health goals and adherence to secondary prevention measures at the end of the program.

Methods

This is a retrospective study made up of patients who, after suffering an acute myocardial infarction, followed an online CRH program from June to November 2020. A first online assessment is made by a cardiology consultant. Then, it is followed by ten online group interviews of up to three patients and a health care proffesional: either a nurse or a physiotherapist. These interviews last around ninety minutes. Four weeks after, an online follow-up interview is made by a cardiology consultant. These interviews focus either on physical exercise instructions (aerobical exercise and endurance exercise) or educational interviews (ischemic cardiomyopathy, Mediterranean diet, pharmacological treatment, sexual dysfunction, stress management techniques and solution of questions).

Results

Up to eighty-four patients were included in our CRH program (this means 83% of patients discharged from our hospital after an acute coronary event). Median of time from discharge to first online interview was 8"79 days and from this last one to program beginning, 3"67 days. Four weeks after the beginning of the program, 82% of the patients presented with a LDL-cholesterol level below aim level (< 55 mg/dL). Workout, Mediterranean diet and tobacco abstinence observance rates were over 90%. There were just three patients who gave up or did not complete the program.

Conclusion

Despite the fact that SARS-CoV-2 pandemic has arisen a huge challenge for ongoing CRH programs in Spain, the benefit that has been showed by them on cardiovascular health, makes it necessary to develop new tools to allow them going on. New technologies are an opportunity for us to keep on following these patients, moreover showing good results as for adherence, availability and patient and operator assesssment.
Effectiveness of cardiac telerehabilitation with relapse prevention compared to centre-based cardiac rehabilitation: results from the SmartCare-CAD randomised controlled trial
Authors: Brouwers R , Kraal JJ , Regis M , Spee RF , Kemps HMC
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was part of the SmartCare project, which was partially funded under the ICT Policy Support Programme (ICT PSP), grant agreement number 325158.

Background

Most studies failed to show superiority of cardiac telerehabilitation (CTR) over traditional, centre-based cardiac rehabilitation (CR).

Purpose

To evaluate the effectiveness of a novel CTR intervention on the adherence to a physically active lifestyle in patients with coronary artery disease (CAD).

Methods

We randomised patients with CAD entering phase II outpatient CR to either CTR with relapse prevention by on-demand coaching (intervention group), or centre-based CR with supervised exercise training (control group). The primary outcome measure was objectively assessed physical activity level (PAL), secondary outcome measures included physical fitness and quality of life (QoL).

Results

A total of 300 patients (89% male, mean age 60.7 ± 9.5 years) participated in the trial. Both groups significantly improved their PAL at 12 months follow-up (p < 0.01), but without a significant between-group difference in the response over time (p = 0.73). Similarly, we observed sustained increases in physical fitness and QoL, but without significant between-group differences in responses over time.

Conclusions

In patients with CAD who had low residual cardiovascular risk, CTR with relapse prevention resulted in a sustained increase in PAL, physical fitness and QoL, but without differences in responses over time as compared to centre-based CR. For this reason, future CTR interventions should be directed specifically to patients who are at risk for relapse into unhealthy lifestyle behaviour.

Main outcome measures Control (centre-based CR) Intervention (CTR) Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months PAL † 1.40 (0.45) 1.53 (0.48) 1.55 (0.46) <0.001 0.001 1.44 (0.50) 1.67 (0.50) 1.61 (0.46) <0.001 <0.001 Workload (% of expected) * 92.1 ± 19.3 103.6 ± 19.5 104.8 ± 21.0 <0.001 <0.001 91.3 ± 18.6 101.2 ± 18.8 102.5 ± 19.6 <0.001 <0.001 KVL-H total † 5.3 (1.4) 6.1 (1.0) 6.3 (0.9) <0.001 <0.001 5.4 (1.8) 6.0 (1.0) 6.2 (1.0) <0.001 <0.001 CR cardiac rehabilitation; CTR: cardiac telerehabilitation; KVL-H: Kwaliteit van Leven bij Hartpatiënten (quality of life in cardiac patients); PAL: physical activity level. †Values reported as median (interquartile range). Within-groups differences assessed by Wilcoxon signed-rank test. *Values reported as mean ± standard deviation. Within-groups differences assessed by paired samples T-test.
Natural history of right ventricle: longitudinal study in veteran athletes
Authors: Ferrara R , Serdoz A , Egisto G , Zuccaro M , Di Giacinto B , Maestrini V , Cavarretta E , Spataro A , Pelliccia A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Right ventricular (RV) enlargement is a physiologic adaptation to long lasting athletic training. Its clinical implications for veteran athletes are poorly understood. In recent years, controversial data suggest an association between ultra-endurance exercise and a RV cardiomyopathy similar to arrhythmogenic cardiomyopathy (ACM). In this context, the effects of exercise detraining have not been extensively studied yet.

PURPOSE

The aim of this study was to assess the morphological and functional RV changes in veteran athletes and to evaluate the effect of a long period of detraining.

METHODS

This is a longitudinal study including 22 veteran rowers with at least 10 years of competitive career. We evaluated them with an echocardiographic assessment at baseline and after a minimum of 3 years of detraining (age: 23.2 ± 4.4 and 43 ± 7.4 years), by reducing the weekly training volume from 26 ± 0.7 to 3 ± 2 hours. In this second evaluation we also performed an RV strain analysis and a cardiac magnetic resonance (CMR) study.

RESULTS

RV end diastolic (ED) areas significantly reduced after detraining (31.48 ± 5.8 versus 28.59 ± 6.8; p = 0.001), although remaining larger than normal. RV enlargement was balanced: the ratio between inflow (IT) and outflow tract (OT) (RVIT/RVOT = 1.4 ± 0.1) and the ratio between RV and left ventricle (LV) (RV/LV = 0.81 ± 0.1) were within normal limits. The fractional area change (FAC%) was normal at baseline and increased significantly (41.5 ± 6% versus 45.8 ± 7%; p = 0.011). After detraining, RV longitudinal strain was normal (-19.7 ± 2.7%). CMR assessment showed enlarged RVED volumes (97.9 ± 14 ml/m2) but normal RV ejection fraction (55.5 ± 4.1%).

CONCLUSIONS

RV enlargement in endurance athletes persists after a long period of detraining. However, detraining results in a significant reduction of RV dimensions. Furthermore, the absence of RV dysfunction or disproportionate RV geometry are reassuring findings that suggest a physiological remodeling of the RV.

Significant echo findings. RV ECHO PARAMETERS BASELINE DETRAINING MEAN DIFF. (C.I. 95%) p VALUE RVOT plax (mm) 34.8 ± 4 33.7 ± 14 1.1 (0.18; 2.1) p = 0.011 RVOT psax (mm) 34.9 ± 3.3 33.09 ± 3.5 1.8 (0.9; 2.7) p < 0.001 RV basal diameter (mm) 47.31 ± 5.3 45.86 ± 6.4 1.4 (0.04; 2.8) p = 0.022 RV end-diastolic area (cm²) 31.48 ± 5.8 28.59 ± 6.8 2.8 (1.1; 4.6) p = 0.001 FAC% 41.5 ± 6 45.8 ± 7 0.04 (-0.07; -0.007) p = 0.011 RV inflow/outflow ratio 1.36 ± 0.1 1.36 ± 0.2 -0.003 (-0.06; 0.06) p = 0.454 RV/LV ratio 0.82 ± 0.07 0.81 ±0.1 0.01 (-0.01; 0.04) p = 0.219

Abstract Figure. Comparison in the same veteran athlete.
Sudden cardiac death related to physical exercise and sports in the young: a nationwide cohort study of Australia
Authors: Ha F , So J , Han HC , La Gerche A , Teh A , Sanders P , Farouque O , Lim H
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Sudden cardiac death (SCD) during physical exercise is uncommon but devastating.

Purpose

We aimed to determine risk factors, causes and circumstances of sports and exercise-related SCD in the young in Australia.

Methods

We retrospectively reviewed the National Coronial Information System (NCIS) registry for deaths in Australia relating to cardiovascular disease (CVD) in cases aged 10 to 35 years between 2000-2016. Included cases had been undertaking sports or physical exercise at time of event. We collected baseline demographics and circumstances of death including location, type of physical exercise, whether the event was witnessed, and engagement of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival.

Results

Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) related to sports/physical exercise were included in final analysis. Median age was 27 years (interquartile range [IQR] 21-32 years) with most being male (92%). Median BMI was 27 kg/m2 (IQR, 23-30) with 13 cases (12%) occurring in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequently practiced at time of event. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%.

Conclusions

This study demonstrates the high occurrence of CAD and SADS in exercise-related SCD in the young. Although events were commonly witnessed, an AED was seldom used prior to ambulance arrival highlighting an important opportunity to improve outcomes in the post-arrest chain of survival.
Clinical and genetic factors associated with mismanagement of dyslipidemia. Multiple cross-sectional analysis
Authors: Chekanova V , Marques-Vidal P , Abolhassani N
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Aims

Identify the clinical and genetic factors associated with poor control of high cholesterol in the Swiss population.

Methods

Data from three waves [baseline, N = 617; first, N = 844 and second, N = 798 follow-ups] of a population-based, prospective study conducted in Lausanne, Switzerland. Inadequate management of dyslipidemia was assessed according to the most common Swiss guideline. Genetic scores for lipid levels were computed based on the existing literature.

Results

Prevalence of inadequately managed dyslipidemia was 30%, 31.5% and 17.4% in the baseline, first and second follow-up. On multivariable analysis, participants at high risk of CVD had a lower likelihood of being adequately managed: odds ratio (OR) and (95% confidence interval) for high-risk relative to low-risk: 0.10 (0.06-0.18), 0.11 (0.07-0.17) and 0.15 (0.09-0.27) for the baseline, first and second follow-up (p for trend < 0.001). Use of more potent statins increased the likelihood of adequate management, OR and (95% CI) for third vs. first level: 2.89 (1.76-4.74) and 5.17 (2.51-10.6) in the first and second follow-up (p for trend < 0.001). No differences in total cholesterol, LDL and HDL genetic scores were found between adequately and inadequately managed participants: for the total cholesterol, -3.7 ± 9.6 vs. -2.7 ± 9.4; -3.5 ± 8.9 vs. -3.7 ± 9.5 and -3.8 ± 8.9 vs. -3.3 ± 9.4 in the baseline, first and second follow-up, p = NS. Those findings were replicated when the thresholds for adequate control were relaxed.

Conclusion

Management of dyslipidemia is suboptimal in Switzerland. Use of newer, more potent statins in high-risk patients could improve this status. The use of genetic scores appears to be of little interest.

Multivariate Analysis First FUOR (95% CI) p-value Second FUOR (95% CI) p-value CVD risk Intermediate 0.18 (0.10 - 0.32) <0.001 0.22 (0.09 - 0.55) 0.001 High 0.07 (0.04 - 0.12) <0.001 0.09 (0.04 - 0.2) <0.001 p-value for trend <0.001 <0.001 Swiss vs Non-Swiss 1.34 (0.87 - 2.05) 0.181 0.79 (0.43 - 1.43) 0.428 FH dyslipidemia (yes/no) 1.02 (0.63 - 1.63) 0.948 0.55 (0.29 - 1.03) 0.060 Statins potency First 1 (ref.) 1 (ref.) Second 2.00 (1.22 - 3.27) 0.006 2.59 (1.23 - 5.44) 0.012 Third 2.89 (1.76 - 4.74) <0.001 5.17 (2.51 - 10.6) <0.001 p-value for trend <0.001 <0.001
Conventional cardiac risk factors associated with Trastuzumab induced cardio-toxicity in breast cancer: a meta-analysis
Authors: Koulaouzidis G , Charisopoulou D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2(HER-2) positive breast cancer patients. However, it is associated with cardiotoxicity, expressed as an asymptomatic decrease in LVEF and less often as clinical HF. Published studies have tried to identify risk factors predisposing to cardiotoxicity but the results are not uniform. 

The aim of this meta-analysis is to identify the association of the conventional cardiovascular risk factors:age, smoking, hypertension, hyperlipidaemia, obesity, diabetes mellitus, family history of cardiac disease and the previous history of coronary artery disease (CAD), with the development of Trastuzumab induced cardiotoxicity (TIC).

Methods

A literature search of PubMed was conducted to identify studies examining the association between cardiovascular risk factors and TIC. The primary outcome of interest was the development of cardiotoxicity manifested as heart failure or deterioration in LVEF based on the criteria presented within each study. We included prospective and retrospective studies of patients with HER2 positive breast cancer who were treated with Trastuzumab. Data were extracted and pooled odds ratios (ORs) with 95% confidence intervals (Cis) were calculated examining the odds of developing TIC for each of the risk factors.

Results

A total of 35 studies were included in the analysis. Age > 60 years old (OR: 0.7; 95% CI: 0.318-1.09; p = 0.0004), hypertension (OR: 0.69; 95% CI: 0.26-1.12; p = 0.001), smoking (OR: 0.35; 95% CI: 0.01- 0.69; p = 0.038), diabetes mellitus (OR: 0.44; 95% CI: 0.24- 0.68; p = 0.0001) and family history of CAD (OR: 5.51, 95%CI 1.76-17.25; p< 0.00001) were significantly associated with the development of cardiotoxicity. Known history of CAD (OR: 3.72; 95%CI 2.11-6.57; p = 0.0005) was also associated with the development of TIC. On the other hand, obesity (OR: 2.47; 95% CI: 0.93- 6.55; p= 0.07) and hyperlipidaemia (OR: 1.32, 95% CI: 0.71- 2.46; p = 0.38) did not meet statistical significance for association with TIC.

Conclusion

Identifying women at risk for TIC have several important potential applications. Clinicians may decide to assess LVEF more frequently in patients at highest risk for TIC in order to detect LV systolic dysfunction earlier. Identifying high risk patients may play a role for recognition which individuals would obtain the most benefit from prophylactic therapy for preventing TIC. 

this could help identify patients who would benefit most from prophylactic therapy for preventing TIC. Finally, these factors could in the future form the basis of a risk model for TIC.
Aspirin in the primary prevention of cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis
Authors: Pallikadavath S , Ashton L , Burton J , Brunskill N , Gray L , Major R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in individuals with chronic kidney disease (CKD). Aspirin is widely used in secondary prevention of cardiovascular disease. Its use in primary prevention, particularly in CKD, is less clear. Previous reviews have offered inconclusive findings for the benefit of aspirin in CKD. Recent trials have been completed that may help provide more conclusive answers in CKD.

Purpose

This study aimed to assess the role of aspirin in the primary prevention of CVD and its associated adverse events in individuals with CKD.

Methods

A pre-defined protocol registered with PROSPERO (CRD42014008860) was used. The OVID Medline and EMBASE databases were searched for studies from 1996 to the 15th September 2020. Abstracts and full-texts were screened independently by two reviewers. Randomised controlled trials that compared aspirin to placebo in individuals with non-endstage CKD without CVD nor primary renal disease were included. The primary outcomes of interests were: CVD, major and minor bleeding events. Secondary outcomes of interest were: all-cause mortality, coronary artery disease and stroke. A meta-analysis was conducted using a random-effects model to calculate a pooled relative risk (RR).

Results

Five trials were included with 434 CVD events in 7,825 individuals with CKD. Aspirin offered no statistically significant benefit in reduction of CVD events (RR = 0.79, 95%CI: 0.57, 1.09) but significantly increased both minor (RR = 2.62, 95%CI: 1.64, 4.20) and major bleeding (RR= 1.51, 95%CI: 1.13, 2.02) events compared to placebo. Aspirin conferred no benefit for all-cause mortality (RR= 0.89, 95%CI: 0.64, 1.22), coronary heart disease (RR= 0.66, 95%CI: 0.27, 1.63) and stroke (RR= 0.94, 95%CI: 0.55, 1.58).

Conclusion

Aspirin cannot be recommended for the primary prevention of CVD in individuals with CKD as it offers no conclusive benefit and increases the risk of bleeding. Other strategies to optimise CVD primary prevention in individuals with CKD should be prioritised.
Adherence to remote cardiac rehabilitation during the coronavirus pandemic
Authors: Nabutovsky I , Klempfner Y , Nachshon A , Yeshayahu S , Breitner D , Heller A , Klempfner R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The global crisis of COVID-19 has highlighted how the health care system needs to adapt. With the announcement of a partial lockdown, cardiac rehabilitation centers in Israel were closed and patients were left without regular training and risk factor management. However, the Remote Cardiac Rehabilitation Programs (RCRP), which had been previously developed, continued to function. The purpose of this study was to evaluate the performance of RCRP during the pandemic.

Methods

We compared retrospective cohort data on the performance of RCRP patients and care teams over two time periods: (P1) nine weeks before lockdown; and (P2) seven weeks during the lockdown. Included in the analysis were parameters of exercise adherence, objective training efficacy, and satisfaction.

Results

The analysis included 38 patients, 92% male, age 58 ± 11 enrolled in the RCRP predominantly following myocardial infarction or coronary interventions (57%). Patient activity during the lockdown period increased with higher average exercise minutes per week as well as higher exercise minutes performed at the designated target heart rate (all P for trend < 0.05). In a mid-study survey, over 86% of patients responded that they felt safe and satisfied with the RCRP. 

Conclusions

The RCRP has proven to be reliable and effective in maintaining the mental and physical health of patients in the face of a national crisis, even with a substantial reduction in staff. Automation by flexible rules, incorporated in the system, resolved numerous time-consuming tasks, thus allowing for more time to be dedicated to human interaction.

Assessed parameter Entire study duration Period 1 Period 2 P value Aerobic minutes per week, average 221.1 205.5 241.7 0.01 Number of Aerobic sessions per week, median 3.8 3.6 4 NA Average number of Minutes at Target HR per session, per week (% of session time at target HR) 116.2 (52.5%) 107.7 (52.4%) 127.2 (52.6%) < 0.001 The average %HRR during aerobic session, per week 75.7 75.4 76.1 0.47 Steps per day, average 8,830 9,000 8,600 0.06 Mobile application entries per week, average 4.43 4.3 4.6 0.50 Patients activity before (P1) and during (P2) the lockdown

Abstract Figure. The clinical program management center a
Smartphone app-guided secondary prevention in patients with coronary heart disease
Authors: Eckardt I , Buschhaus C , Nickenig G , Jansen F
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Deutsche Forschungsgemeinschaft

Background 

Coronary artery disease (CAD) is the leading cause of death worldwide. Lifestyle change is a crucial part of secondary prevention. Only 30% of CAD patients follow the corresponding guideline recommendations. The widespread adoption of smartphones offers the opportunity to integrate secondary prevention into the daily routine of CAD patients.

Purpose 

The purpose of this study was to show that smartphone-guided secondary prevention (SGSP) could achieve lifestyle changes and a gain of disease specific knowledge among CAD patients. 

Methods 

We developed an app to integrate secondary prevention into CAD patients’ everyday life. The app provided a daily 15-minute program that included video-guided exercises, video sessions with background information about CAD, and a tool to record blood pressure and heart rate once a day.

The SGSP app was tested with the primary outcome of 28-day adherence. The secondary outcome was a composite of self-reported behavioural changes, gain of knowledge about cardiovascular risk factors and an increase in quality of life.

Results 

Of the 66 patients screened, 43 (65%) were included into the study and, of those, 17 (40%) used the app continuously for 28 days. From this group, 14 (82%) were physically more active and ten (59%) improved their dietary habits. Usage of the SGSP app was also associated with a gain of knowledge about cardiovascular risk factors (70% physical activity, 59% healthy diet).

Conclusion 

The regular use of a SGSP app appears to support lifestyle changes in patients with CAD.

Primary and secondary endpoints Results Overall(n = 17) P-Value Adherence (28 days) 17 (39.5) 0.34 Behavioural change Significantly increased physical activity no. (%) 14 (82.4) 0.08 Implemented a healthier diet no. (%) 10 (58.8) 0.64 Relevant gain of knowledge about CVRF Physical activity no. (%) 12 (70.6) 0.13 Unhealthy diet no. (%) 10 (58.8) 1.00 Smoking no. (%) 1 (5.9) 0.47 Stress no. (%) 7 (41.2) 0.13 Potential for long-term use Willingness to use the App over a long time period (>28 days), no. (%) 15 (88.2) 1.00

Abstract Figure.
Aging is accompanied by a decrease in the number of naive Tregs
Authors: Filatova A , Potekhina A , Radyukhina N , Ruleva N , Arefieva T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Age-related changes in the immune system are an important factor contributing to the maintenance of chronic inflammatory status. There are undoubted data on the decrease of the number of T-lymphocytes with age caused by thymus involution, but there are currently no unambiguous data on changes of minor T-cell subpopulations, in particular, regulatory T-cells (Treg). The aim of this study was to analyze the content of effector and regulatory CD4+ T cell subsets in patients with coronary and/or carotid atherosclerosis depending on age.

Methods. 111 patients (men, median age 63 (55;69)) with coronary and/or carotid atherosclerosis, without smoking anamnesis, were enrolled.  Mononuclear leuocytes were isolated from blood by gradient centrifugation, and CD4 + CD25high and CD4 + Foxp3+ Treg, CD4 + IL17+ T-helpers (Th) 17 and CD4 + INFγ Th1 were evaluated by direct immunofluorescence and flow cytometry. For intracellular cytokine detection cells were pre-activated in vitro in the presence of PMA/ionomycin/brefeldin A. In 74 patients cells were additionally stained with CD39, CD278, CD45RA Mabs to reveal naïve and primed T-cells.

Results. According to age the patients formed three groups: I – <55 y.o. (n = 23), II – 55-64 y.o. (n = 42), III - ≥65 y.o. (n = 46). All patients were taking statins at baseline. The groups were comparable in traditional risk factors of CVD (BMI, arterial hypertension, diabetes mellitus, previous myocardial infarction anamnesis). The absolute content of CD4+ T cells was lower in group III (646.3 (516.0;806.4)) compared to groups I (903.0 (585.6;1113.8), p = 0.03) and II (745.4 (502.2;924.0), p = 0.06). The absolute content of CD4 + CD25high Treg was lower in group III (24.2 (18.4;35.2)) compared to groups I (35.0 (28.7;54.4), p = 0.01) and II (31.0 (21.1;43.6), p = 0.03). There were no differences in Th1, Th17, CD39 + CD45RA- and CD278+ Treg content between groups. A negative correlation was found between age and the content of CD4+ T cells (r= -0.28), CD4 + CD25high Treg (r= -0.27), p < 0.05. A negative correlation was found between age and CD4 + CD25highCD45RA+ Treg (r= -0.24) and CD4 + CD45RA+ T cells (r= -0.36), CD4 + CD45RA+/CD4 + CD45RA- T-cells ratio (r= -0.24), p < 0.05.

Conclusion. Here we demonstrate an age-dependent decrease of total CD4+ T cell population and Treg subset in patients with atherosclerosis. The changes observed were primary due to the deficiency of CD45RA+ naïve T cells. The effector cell Th1 and Th17 quantities were at the same levels. Future research will show whether the identified immunological patterns can contribute to the progression of atherosclerosis and other chronic inflammatory diseases.
Analysis of cardiac rhythm reported to ABO blood group
Authors: Choukrani H , Abouradi S , Kherraf A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

ABO blood groups have been associated with various diseases , particularly cardiovascular diseases which are the most common causes of death in developed countries and their prevalence rate is rapidly growing in developing countries.  Cardiac arrhythmias in particular, atrial fibrillation are frequents .

The aim of this study was to research if there is a relationship between cardiac rhythm and ABO blood group.

METHODS : We included in this retrospective study patients who were hospitalized in the cardiology department of the university hospital center between 2018 and 2020 with  blood group phenotype.

RESULTS :

The study includes 90 patients, mean age was 58.86 ±14.03 years old, sex ratio 1.09 (52.2% men 47.8 % women), blood group included A 45.5 % ; AB 1.1%. B 20% O 33.3%.  On the electrocardiogram, atrial fibrillation was found in 23% of the cases, 57% related to mitral stenosis. while 77 % of the cases were in sinus rhythm.  A significant relation was found between blood group type A+ and  atrial fibrillation  (p =0.026 ; OR : 3.06 (95%CI: 1.17–6.8) ; no significant relation was found between other types of blood group and cardiac rhythm neither between blood type A and particular atrial fibrillation etiology.

CONCLUSION :

Blood group A may be a risk factor for atrial fibrillation.

Larger studies may support this finding. Understanding the physiopathology will orient towards new possible therapies.
Evidence for reactivation of new faults and seismicity migration away from the causative fault of the 2001 MW 7.7 Bhuj earthquake, western India
Authors: Paul Himangshu , Ravi Kumar M , Kumar Santosh
Published: May 2021

The Kachchh Rift Basin of western India that hosted the devastating 2001 MW 7.7 Bhuj earthquake has been witnessing minor to moderate seismicity since then. The genesis of these intraplate earthquakes and geometry of the causative faults is still elusive. In this study, we relocated all the earthquakes recorded between 2006 and 2018 and utilized a set of 4285 best located earthquakes to provide rare insights into the orientation and depth distribution of the currently active faults. We also analysed previously computed source mechanisms, in perspective of our location results. It is revealed that the present seismic activity is primarily aligned along two planes—one steeply dipping (∼60°) to the northeast with a NW–SE strike and the other gently (∼34°) dipping to the SSW, striking WNW–ESE. The traces of these fault surfaces coincide with the Kachchh Mainland fault (KMF) and the North Wagad Fault (NWF) when extrapolated to the surface, respectively. Activity along the NWF has been shown in earlier studies, however, clear evidence of activity along the steep north-dipping KMF is presented for the very first time. Thrust earthquakes dominate the NWF while strike-slip earthquakes are seen across the KMF. Our results show that the two fault surfaces converge between 70.30°E and 70.43°E longitudes in the depth range 22–32 km, however, there is large E–W offset between the northern and southern extremities of the fault-system. This convergence zone hosted the largest earthquakes (ML 4.7–5.1) between 2006 and 2018 and the hypocentre of 2001 main shock also coincide with it. The earthquakes occurring in the interfault region show major strike-slip motion and are probably influenced by the relative motion between the NWF and KMF. Consistent seismicity, assisted probably by high conducting material, is seen across the NWF while intermittent seismicity is revealed along the KMF. Scrutiny of earlier studies revealed that the 2001 main shock and first few weeks of aftershocks were hosted on another south-dipping fault, the South Wagad Fault (SWF), however, activity along the SWF is found to be meagre during 2006–2018. Instead, seismicity has currently migrated to faults north and south of the SWF. These currently active faults most likely were reactivated during/after the 2001 main shock.
On magnetic disturbances induced by rotation of coil-type magnetometer driven by seismic waves
Authors: Gao Yongxin , Jiang Peng , Xu Yixian , Jiang Li , Cheng Chieh-Hung , Zhao Guoze , Tang Ji , Chen Xiaobin , Han Bin , Chong Jiajun , Yao Cheng
Published: May 2021

Rotation of coil-type magnetometers caused by seismic waves can change the magnetic flux of the earth's magnetic field through the coils and thereby give rise to rotation-induced magnetic fields (RIMFs), which have contribution to so-called coseismic magnetic disturbances during earthquake events. In this study, we present a method to numerically calculate the rotational motion and RIMFs excited by a seismic source in a horizontally layered model. Like computing synthetic seismograms, this method allows calculating the full response of magnetic disturbances during an earthquake event. Numerical examples are conducted to investigate characters of the magnetic fields under excitation of different kinds of sources. The results show that the P-SV-mode waves mainly contribute to radial and vertical magnetic disturbances, while the SH-mode waves dominate tangential magnetic disturbances. We also apply this method to the 2017 Jiuzhaigou earthquake. The synthetic magnetic signals explain well the observed data, suggesting that the coseismic magnetic fields observed during this earthquake are mainly caused by the rotation of the magnetometers.
Cell dynamics in human villous trophoblast
Authors: Aplin John D , Jones Carolyn J P
Published: May 2021

BACKGROUND

Villous cytotrophoblast (vCTB) is a precursor cell population that supports the development of syncytiotrophoblast (vSTB), the high surface area barrier epithelium of the placental villus, and the primary interface between maternal and fetal tissue. In light of increasing evidence that the placenta can adapt to changing maternal environments or, under stress, can trigger maternal disease, we consider what properties of these cells empower them to exert a controlling influence on pregnancy progression and outcome.

OBJECTIVE AND RATIONALE

How are cytotrophoblast proliferation and differentiation regulated in the human placental villus to allow for the increasing demands of the fetal and environmental challenges and stresses that may arise during pregnancy?

SEARCH METHODS

PubMed was interrogated using relevant keywords and word roots combining trophoblast, villus/villous, syncytio/syncytium, placenta, stem, transcription factor (and the individual genes), signalling, apoptosis, autophagy (and the respective genes) from 1960 to the present. Since removal of trophoblast from its tissue environment is known to fundamentally change cell growth and differentiation kinetics, research that relied exclusively on cell culture has not been the main focus of this review, though it is mentioned where appropriate. Work on non-human placenta is not systematically covered, though mention is made where relevant hypotheses have emerged.

OUTCOMES

The synthesis of data from the literature has led to a new hypothesis for vCTB dynamics. We propose that a reversible transition can occur from a reserve population in G0 to a mitotically active state. Cells from the in-cycle population can then differentiate irreversibly to intermediate cells that leave the cycle and turn on genes that confer the capacity to fuse with the overlying vSTB as well as other functions associated with syncytial barrier and transport function. We speculate that alterations in the rate of entry to the cell cycle, or return of cells in the mitotic fraction to G0, can occur in response to environmental challenge. We also review evidence on the life cycle of trophoblast from the time that fusion occurs, and point to gaps in knowledge of how large quantities of fetal DNA arrive in maternal circulation. We critique historical methodology and make a case for research to re-address questions about trophoblast lifecycle and dynamics in normal pregnancy and the common diseases of pre-eclampsia and fetal growth restriction, where altered trophoblast kinetics have long been postulated.

WIDER IMPLICATIONS

The hypothesis requires experimental testing, moving research away from currently accepted methodology towards a new standard that includes representative cell and tissue sampling, assessment of cell cycle and differentiation parameters, and robust classification of cell subpopulations in villous trophoblast, with due attention to gestational age, maternal and fetal phenotype, disease and outcome.
Validation of stock assessment methods: is it me or my model talking?
Authors: Kell Laurence T , Sharma Rishi , Kitakado Toshihide , Winker Henning , Mosqueira Iago , Cardinale Massimiliano , Fu Dan
Published: May 2021

The adoption of the Precautionary Approach requires providing advice that is robust to uncertainty. Therefore, when conducting stock assessment alternative, model structures and data sets are commonly considered. The primary diagnostics used to compare models are to examine residuals patterns to check goodness-of-fit and to conduct retrospective analysis to check the stability of estimates. However, residual patterns can be removed by adding more parameters than justified by the data, and retrospective patterns removed by ignoring the data. Therefore, neither alone can be used for validation, which requires assessing whether it is plausible that a system identical to the model generated the data. Therefore, we use hindcasting to estimate prediction skill, a measure of the accuracy of a predicted value unknown by the model relative to its observed value, to explore model misspecification and data conflicts. We compare alternative model structures based on integrated statistical and Bayesian state-space biomass dynamic models using, as an example, Indian Ocean yellowfin tuna. Validation is not a binary process (i.e. pass or fail) but a continuum; therefore, we discuss the use of prediction skill to identify alternative hypotheses, weight ensemble models and agree on reference sets of operating models when conducting Management Strategy Evaluation.
Metrics on a Surface with Bounded Total Curvature
Authors: Li Yuxiang , Sun Jianxin , Tang Hongyan
Published: May 2021

Let $g=e^{2u}g_{euc}$ be a conformal metric defined on the unit disk of ${{\mathbb{C}}}$. We give an estimate of $\|\nabla u\|_{L^{2,\infty }(D_{\frac{1}{2}})}$ when $\|K(g)\|_{L^1}$ is small and $\frac{\mu (B_r^g(z),g)}{\pi r^2}<\Lambda $ for any $r$ and $z\in D_{\frac{3}{4}}$. Then we use this estimate to study the Gromov–Hausdorff convergence of a conformal metric sequence with bounded $\|K\|_{L^1}$ and give some applications.
Hypergeometric Functions of Type BC and Standard Multiplicities
Authors: Narayanan Eravimangalam Krishnan , Pasquale Angela
Published: May 2021

We study the Heckman–Opdam hypergeometric functions associated with a root system of type $BC$ and a multiplicity function that is allowed to assume some nonpositive values (a standard multiplicity function). For such functions, we obtain positivity properties and sharp estimates that imply a characterization of the bounded hypergeometric functions. As an application, our results extend the known properties of Harish-Chandra’s spherical functions on Riemannian symmetric spaces of the non-compact type $G/K$ to spherical functions over homogeneous vector bundles on $G/K$, which are associated with certain small $K$-types.
Classification of Simply-Transitive Levi Non-Degenerate Hypersurfaces in ℂ3
Authors: Doubrov Boris , Merker Joël , The Dennis
Published: May 2021

Holomorphically homogeneous Cauchy–Riemann (CR) real hypersurfaces $M^3 \subset \mathbb{C}^2$ were classified by Élie Cartan in 1932. In the next dimension, we complete the classification of simply-transitive Levi non-degenerate hypersurfaces $M^5 \subset \mathbb{C}^3$ using a novel Lie algebraic approach independent of any earlier classifications of abstract Lie algebras. Central to our approach is a new coordinate-free formula for the fundamental (complexified) quartic tensor. Our final result has a unique (Levi-indefinite) non-tubular model, for which we demonstrate geometric relations to planar equi-affine geometry.
Lack of Commitment, Retroactive Taxation, and Macroeconomic Instability
Authors: Ortigueira Salvador , Pereira Joana
Published: May 2021

Retroactive tax legislation is constitutional in most high-income countries. In this paper, we are concerned with the fiscal and macroeconomic consequences stemming from retroactive income taxation. Within the context of a real neoclassical economy, we find that if the government can set taxes retroactively within the fiscal year—or if there is a positive probability that a future government will be able to use retroactive taxation—then there exists a multiplicity of expectations-driven equilibria. In this case, neither fiscal policy nor macroeconomic aggregates are uniquely pinned down by economic fundamentals. Rather, they are determined by expectations about current and future fiscal policies. This implies that the government is a source of macroeconomic instability. In contrast, a constitutional reform banning the government from using retroactive tax legislation would yield a unique equilibrium, thus removing the possibility of expectations-driven fluctuations.
Crowdsourced Tick Image-Informed Updates to U.S. County Records of Three Medically Important Tick Species
Authors: Kopsco Heather L , Duhaime Roland J , Mather Thomas N
Published: May 2021

Burgeoning cases of tick-borne disease present a significant public health problem in the United States. Passive tick surveillance gained traction as an effective way to collect epidemiologic data, and in particular, photograph-based tick surveillance can complement in-hand tick specimen identification to amass distribution data and related encounter demographics. We compared the Federal Information Processing Standards (FIPS) code of tick photos submitted to a free public identification service (TickSpotters) from 2014 to 2019 to published nationwide county reports for three tick species of medical concern: Ixodes scapularis Say (Ixodida: Ixodidae), Ixodes pacificus Cooley and Kohls (Ixodida: Ixodidae), and Amblyomma americanum Linneaus (Ixodida: Ixodidae). We tallied the number of TickSpotters submissions for each tick species according to “Reported” or “Established” criteria per county, and found that TickSpotters submissions represented more than half of the reported counties of documented occurrence, and potentially identified hundreds of new counties with the occurrence of these species. We detected the largest number of new county reports of I. scapularis presence in Michigan, North Carolina, and Texas. Tick image submissions revealed potentially nine new counties of occurrence for I. pacificus, and we documented the largest increase in new county reports of A. americanum in Kentucky, Illinois, Indiana, and Ohio. These findings demonstrate the utility of crowdsourced photograph-based tick surveillance as a complement to other tick surveillance strategies in documenting tick distributions on a nationwide scale, its potential for identifying new foci, and its ability to highlight at-risk localities that might benefit from tick-bite prevention education.
Brahms’s Hungarian Dances and the Early ‘Csárdás’ Recordings
Authors: Banks Jon
Published: May 2021

The relationship of Brahms’s Hungarian Dances to their origins has been a subject of enquiry ever since they were first published. This article extends previous investigations of Brahms’s written sources to include the many 78rpm recordings of ‘traditional’ Hungarian music made shortly after his death. It establishes that nearly half of the Brahms melodies appear in the repertory of popular recording artists such as the so-called ‘Gypsy bands’, and that many of these artists had been active in Vienna during Brahms’s lifetime. It identifies other performing contexts—military bands, popular songs, salon pieces—and argues that the ‘Hungarian Dances’ are an invented amalgamation of several distinct genres, reflecting Brahms’s urban experience and musical interests. The article compares Brahms’s arrangements with the same tunes in oral tradition where possible and considers the wider implications of the recorded legacy for our understanding of the ‘style hongrois’ and Brahms’s appropriation of it.
Hamilton’s Object – a clumpy galaxy straddling the gravitational caustic of a galaxy cluster: constraints on dark matter clumping
Authors: Griffiths Richard E , Rudisel Mitchell , Wagner Jenny , Hamilton Timothy , Huang Po-Chieh , Villforth Carolin
Published: May 2021

We report the discovery of a ‘folded’ gravitationally lensed image, ‘Hamilton’s Object’, found in a HST image of the field near the active galactic nucleus SDSS J223010.47-081017.8 (which has redshift 0.62). The lensed images are sourced by a galaxy at a spectroscopic redshift of 0.8200 ± 0.0005 and form a fold configuration on a caustic caused by a foreground galaxy cluster at a photometric redshift of 0.526 ± 0.018 seen in the corresponding Pan-STARRS PS1 image and marginally detected as a faint ROSAT All-Sky Survey X-ray source. The lensed images exhibit properties similar to those of other ‘folds’ where the source galaxy falls very close to or straddles the caustic of a galaxy cluster. The folded images are stretched in a direction roughly orthogonal to the critical curve, but the configuration is that of a tangential cusp. Guided by morphological features, published simulations and similar ‘fold’ observations in the literature, we identify a third or ‘counter’-image, confirmed by spectroscopy. Because the fold-configuration shows highly distinctive surface brightness features, follow-up observations of microlensing or detailed investigations of the individual surface brightness features at higher resolution can further shed light on kpc-scale dark matter properties. We determine the local lens properties at the positions of the multiple images according to the observation-based lens reconstruction of Wagner. The analysis is in accordance with a mass density which hardly varies on an arcsecond scale (6 kpc) over the areas covered by the multiple images.