CHADS2 and CHA2DS2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation

Aim: To evaluate the role of CHADS₂ and CHA₂DS₂-VASc scores in predicting the risk of ischemic stroke or transient ischemic attack (TIA) outcomes in patients with interatrial block (IAB) without a history of atrial fibrillation (AF).

Methods: A retrospective study was conducted, including 1,046 non-anticoagulated inpatients (612 males, 434 females; mean age: 63 ± 10 years) with IAB and without AF. IAB was defined as P-wave duration > 120 ms using a 12-lead electrocardiogram. CHADS₂ and CHA₂DS₂-VASc scores were retrospectively calculated. The primary outcomes evaluated were ischemic stroke or TIA.

Results: During the mean follow-up period of 4.9 ± 0.7 years, 55 (5.3%) patients had an ischemic stroke or TIA. Receiver operating characteristic (ROC) curve analysis showed that the CHADS₂ score [area under the curve (AUC), 0.638; 95% confidence interval (CI), 0.562–0.715; P = 0.001] and the CHA₂DS₂-VASc score (AUC, 0.671; 95% CI, 0.599–0.744; P <0.001) were predictive of ischemic strokes or TIA. Cut-off point analysis showed that a CHADS₂ score ≥ 3 (sensitivity = 0.455 and specificity = 0.747) and a CHA₂DS₂-VASc score ≥ 4 (sensitivity = 0.564 and specificity = 0.700) provided the highest predictive value for ischemic stroke or TIA. The multivariate Cox regression analysis showed that CHADS₂ [hazard ratio (HR), 1.442; 95% CI, 1.171–1.774; P = 0.001] and CHA₂DS₂-VASc (HR, 1.420; 95% CI, 1.203–1.677; P <0.001) scores were independently associated with ischemic stroke or TIA following adjustment for smoking, left atrial diameter, antiplatelet agents, angiotensin inhibitors, and statins.

Conclusions: CHADS₂ and CHA₂DS₂-VASc scores may be predictors of risk of ischemic stroke or TIA in patients with IAB without AF.

[Application of swallow tail appearance in patients with Parkinson's disease]

OBJECTIVE

To evaluate the clinical value of swallow tail appearance in detecting the patient with Parkinson's disease at 3.0 T MRI.

METHODS

A total of 42 patients with clinical diagnosis of Parkinson's disease(PD) and 27 age-matched normal controls underwent the brain MR examination with conventional and E-SWAN sequences. Patients were divided into 4 groups based on Hoehn-Yahr stage and 2 groups according the treatment condition (treated, untreated). Substantia nigra (SN) was selected as region of interest (ROI) and observed the swallow tail appearance on magnitude imagines of E-SWAN sequence. Nonparametric test was used for comparison between patients groups and normal controls. There was statistically difference if the P value was lower than 0.05.

RESULTS

The swallow tail appearance lost was significantly correlated with Parkinson's disease (P=0.000). The swallow tail appearance lost was not correlated with the usage of drugs(P=0.833) and Hoehn-Yahr stage(P=0.189). The sensitivity of diagnosis of PD by using the swallow tail disappearance was 95.5% (42/44), the specificity was 83.3% (25/30), the accuracy was 90.5%(67/74).

CONCLUSIONS

Assessing the substantia nigra on E-SWAN for the typical swallow tail appearance has potential to become a new and easy applicable 3.0 T MRI diagnostic tool for PD, however, it was meaningless for prognosis and staging.

Mineralization of sulfamethizole in photo-Fenton and photo-Fenton-like systems

In this investigation, UV/H2O2, UV/H2O2/Fe(2+) (photo-Fenton) and UV/H2O2/Fe(3+) (photo-Fenton-like) systems were used to mineralize sulfamethizole (SFZ). The optimal doses of H2O2 (1-20 mM) in UV/H2O2 and iron (0.1-1 mM) in photo-Fenton and photo-Fenton-like systems were determined. Direct photolysis by UV irradiation and direct oxidation by added H2O2, Fe(2+) and Fe(3+) did not mineralize SFZ. The optimal dose of H2O2 was 10 mM in UV/H2O2 and that of iron (Fe(2+) or Fe(3+)) was 0.2 mM in both UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems. Under the best experimental conditions and after 60 min of reaction, the SFZ mineralization percentages in UV/H2O2, UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems were 16, 90 and 88%, respectively. The UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems effectively mineralized SFZ.

Effect of atorvastatin on plasma NT-proBNP and inflammatory cytokine expression in patients with heart failure

The aim of this study was to explore the effect of atorvastatin intervention on plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and inflammatory cytokine levels in patients with heart failure (HF). One hundred and twenty-three HF patients were selected from our hospital and randomly divided into control (N = 61) and observation (N = 62) groups; the former received conventional treatment, while the latter were given conventional treatment combined with atorvastatin. Plasma NT-proBNP, inflammatory cytokines [high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10] and cardiac function [left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), end-diastolic maximum flow rate ratio (E/A)] were compared among groups. The effective rate of treating HF significantly increased after atorvastatin treatment. The plasma NT-proBNP, IL-6, IL-10, hs-CRP, and LVEDD levels significantly decreased (P < 0.05), while the LVEF and E/A levels significantly increased (P < 0.05) in the observation group compared to the control group and before intervention. The NT-proBNP and cytokine levels significantly differed among patients with different classes of heart function (P < 0.05); the NT-proBNP and cytokine levels increased with the severity of heart function. Pearson's correlation analysis revealed a negative correlation between the NT-proBNP and inflammatory cytokine levels and LVEF and E/A values, and a positive correlation between these factors and LVEDD (P < 0.05). In conclusion, atorvastatin significantly improves cardiac function; the mechanism atorvastatin action was related to the decrease in plasma NT-proBNP and inflammatory cytokine levels.

Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation

BACKGROUND

It has been demonstrated that advanced interatrial block (IAB) is associated with an increased risk of atrial fibrillation (AF); however, the impact of advanced IAB on recurrence of paroxysmal AF after catheter ablation is not clear.

METHODS

204 consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. In all patients, a resting electrocardiogram in sinus rhythm was evaluated for the presence of advanced IAB, defined as a P-wave duration >120ms and biphasic (±) morphology in the inferior leads. Advanced IAB was detected in 20.1% of patients. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30s beyond 3 months after the catheter ablation in the absence of any antiarrhythmic treatment.

RESULTS

During the mean follow-up period of 13.9±6.2 months (range, 3-27 months), 62 patients (30.4%) developed recurrence of AF. The recurrence rate was higher in patients with advanced IAB than those without advanced IAB (46.3% vs. 26.4%, p=0.006). Cox regression analysis with adjustment for age, P-wave duration, CHADS2 score, and PV isolation identified advanced IAB (hazard ratio, 2.111; 95% confidence interval, 1.034-4.308; p=0.040) and left atrial diameter (hazard ratio, 1.051; 95% confidence interval, 1.004-1.100; p=0.034) as two independent predictors of recurrence of AF.

CONCLUSIONS

Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.

Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea, May to June 2015

South Korea is experiencing the largest outbreak of Middle East respiratory syndrome coronavirus infections outside the Arabian Peninsula, with 166 laboratory-confirmed cases, including 24 deaths up to 19 June 2015. We estimated that the mean incubation period was 6.7 days and the mean serial interval 12.6 days. We found it unlikely that infectiousness precedes symptom onset. Based on currently available data, we predict an overall case fatality risk of 21% (95% credible interval: 14–31).

Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea, May to June 2015

South Korea is experiencing the largest outbreak of Middle East respiratory syndrome coronavirus infections outside the Arabian Peninsula, with 166 laboratory-confirmed cases, including 24 deaths up to 19 June 2015. We estimated that the mean incubation period was 6.7 days and the mean serial interval 12.6 days. We found it unlikely that infectiousness precedes symptom onset. Based on currently available data, we predict an overall case fatality risk of 21% (95% credible interval: 14–31).

Regeneration of magnetic biochar derived from eucalyptus leaf residue for lead(II) removal

Regeneration of Pb-loaded magnetic biochar prepared with eucalypts leaf residue was studied by using EDTA-2Na as a regenerant. The desorption efficiency was found to be 84.1% in 120 min with iron leaching amount of 1.1 mg g(-1). Higher SBET and pore volume were observed in regenerated magnetic biochars and no significant band shifts occurred in FTIR spectra during 6 regeneration cycles. The decrease of Pb(II) adsorption capacity (from 52.4 to 41.5 mg g(-1)) was only found in the first regeneration cycle. Magnetic separation performance of adsorbents was not significantly affected by multiple regeneration cycles.

Photodegradation of sulfonamide antimicrobial compounds (sulfadiazine, sulfamethizole, sulfamethoxazole and sulfathiazole) in various UV/oxidant systems

This study used Na₂S₂O₈, NaBrO8 and H₂O₂to degrade sulfadiazine (SDZ), sulfamethizole (SFZ), sulfamethoxazole (SMX) and sulfathiazole (STZ) under ultraviolet (UV) irradiation. The initial concentration of sulfonamide and oxidant in all experiments was 20 mg/L and 5 mM, respectively. The degradation rate for sulfonamides satisfies pseudo-first-order kinetics in all UV/oxidant systems. The highest degradation rate for SDZ, SFZ, SMX and STZ was in the UV/Na₂S₂O₈, UV/NaBrO₃, UV/Na₂S₂O₈ and UV/H₂O₂ system, respectively. In the UV/Na₂S₂O₈ system, the photodegradation rate of SDZ, SFZ, SMX and STZ was 0.0245 min⁻¹, 0.0096 min⁻¹, 0.0283 min⁻¹ and 0.0141 min⁻¹, respectively; moreover, for the total organic carbon removal rate for SDZ, SFZ, SMX and STZ it was 0.0057 min⁻¹, 0.0081 min⁻¹, 0.0130 min⁻¹ and 0.0106 min⁻¹, respectively. Experimental results indicate that the ability of oxidants to degrade sulfonamide varied with pollutant type. Moreover, UV/Na₂S₂O₈ had the highest mineralization rate for all tested sulfonamides.

Clinical severity of human infections with avian influenza A(H7N9) virus, China, 2013/14

Assessing the severity of emerging infections is challenging because of potential biases in case ascertainment. The first human case of infection with influenza A(H7N9) virus was identified in China in March 2013; since then, the virus has caused two epidemic waves in the country. There were 134 laboratory-confirmed cases detected in the first epidemic wave from January to September 2013. In the second epidemic wave of human infections with avian influenza A(H7N9) virus in China from October 2013 to October 2014, we estimated that the risk of death among hospitalised cases of infection with influenza A(H7N9) virus was 48% (95% credibility interval: 42-54%), slightly higher than the corresponding risk in the first wave. Age-specific risks of death among hospitalised cases were also significantly higher in the second wave. Using data on symptomatic cases identified through national sentinel influenza-like illness surveillance, we estimated that the risk of death among symptomatic cases of infection with influenza A(H7N9) virus was 0.10% (95% credibility interval: 0.029-3.6%), which was similar to previous estimates for the first epidemic wave of human infections with influenza A(H7N9) virus in 2013. An increase in the risk of death among hospitalised cases in the second wave could be real because of changes in the virus, because of seasonal changes in host susceptibility to severe infection, or because of variation in treatment practices between hospitals, while the increase could be artefactual because of changes in ascertainment of cases in different areas at different times.

High-precision distribution of highly stable optical pulse trains with 8.8 × 10⁻¹⁹ instability

The high-precision distribution of optical pulse trains via fibre links has had a considerable impact in many fields. In most published work, the accuracy is still fundamentally limited by unavoidable noise sources, such as thermal and shot noise from conventional photodiodes and thermal noise from mixers. Here, we demonstrate a new high-precision timing distribution system that uses a highly precise phase detector to obviously reduce the effect of these limitations. Instead of using photodiodes and microwave mixers, we use several fibre Sagnac-loop-based optical-microwave phase detectors (OM-PDs) to achieve optical-electrical conversion and phase measurements, thereby suppressing the sources of noise and achieving ultra-high accuracy. The results of a distribution experiment using a 10-km fibre link indicate that our system exhibits a residual instability of 2.0 × 10⁻¹⁵ at1 s and8.8 × 10⁻¹⁹ at 40,000 s and an integrated timing jitter as low as 3.8 fs in a bandwidth of 1 Hz to 100 kHz. This low instability and timing jitter make it possible for our system to be used in the distribution of optical-clock signals or in applications that require extremely accurate frequency/time synchronisation.

Unusual perforation of the left ventricle during radiofrequency catheter ablation for ventricular tachycardia

Cardiac perforation during catheter-based radiofrequency ablation procedures is relatively uncommon but potentially fatal if tamponade ensues. This complication should be promptly recognised. We present a case of incomplete perforation of the left ventricle with transient ST-segment elevation in leads V1 to V3 during catheter ablation of ventricular tachycardia. Complete perforation was avoided because of rapid diagnosis by the detection of subtle changes in electrode potentials and by performing angiography via an externally irrigated ablation catheter lumen.

Prolonged PR interval and risk of recurrence of atrial fibrillation after catheter ablation

It has been demonstrated that a prolonged PR interval is associated with an increased risk of AF. However, the impact of a prolonged PR interval on recurrence of paroxysmal atrial fibrillation (AF) after catheter ablation is not clear. A total of 112 patients with a prolonged PR interval (PR > 200 ms) (PPR group) and 112 age- and gender-matched control patients (on a 1:1 basis) with a normal PR interval (NPR group) were included in this study. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30 seconds beyond 3 months after catheter ablation in the absence of any antiarrhythmic treatment. During a mean follow-up period of 10.9 ± 5.5 months (range, 3-18 months), 61 patients (27.2%) developed recurrence of AF. The recurrence rate was higher in the PPR group than in the NPR group (33.9% versus 20.5%, respectively; P = 0.018). Cox regression analysis with adjustment for age, body mass index, valvular heart disease, left atrial diameter, and pulmonary vein isolation identified only a prolonged PR interval as an independent predictor of recurrence of AF (hazard ratio, 1.81; 95% confidence interval, 1.07-3.05; P = 0.027). Patients with a prolonged PR interval were at an increased risk of AF recurrence after catheter ablation.

Preparation of immobilized Cu2O using microwave irradiation and its catalytic activity for bisphenol A: comparisons of Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems

This study produced immobilized Cu2O via microwave irradiation. The surface properties of Cu2O were assessed by X-ray diffraction, scanning electron microscopy, and UV-vis spectroscopy. The catalytic activity of the generated Cu2O was examined for bisphenol (BPA) degradation in Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems under various H2O2 concentrations. Cu2O can decompose H2O2 to generate radicals, similar to the Fenton-like process. The BPA degradation rate followed pseudo-first-order kinetics. The optimal H2O2 concentration was 30 mM and the BPA degradation rate under 30 mM H2O2 in the Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems was 1.43 and 2.69 h(-1), respectively. The original Cu2O partly oxidized into CuO in the visible-light/Cu2O/H2O2 system and the BPA degradation percentage declined to 51% from 100% after the fifth cycle.

Highly stable wideband microwave extraction by synchronizing widely tunable optoelectronic oscillator with optical frequency comb

Optical frequency combs (OFCs), based on mode-locked lasers (MLLs), have attracted considerable attention in many fields over recent years. Among the applications of OFCs, one of the most challenging works is the extraction of a highly stable microwave with low phase noise. Many synchronisation schemes have been exploited to synchronise an electronic oscillator with the pulse train from a MLL, helping to extract an ultra-stable microwave. Here, we demonstrate novel wideband microwave extraction from a stable OFC by synchronising a single widely tunable optoelectronic oscillator (OEO) with an OFC at different harmonic frequencies, using an optical phase detection technique. The tunable range of the proposed microwave extraction extends from 2 GHz to 4 GHz, and in a long-term synchronisation experiment over 12 hours, the proposed synchronisation scheme provided a rms timing drift of 18 fs and frequency instabilities at 1.2 × 10⁻¹⁵/1 s and 2.2 × 10⁻¹⁸/10000 s.

Kinetics of serological responses in influenza A(H7N9)-infected patients correlate with clinical outcome in China, 2013

The novel avian influenza A(H7N9) infection has recently emerged to cause severe respiratory illness in China. The objectives of this study were to define the kinetics of the antibody responses in patients with influenza A(H7N9) disease and to correlate these kinetics with clinical outcome. Serial serum samples were obtained at intervals of three to four days from 18 patients with virologically confirmed A(H7N9) disease in Shanghai. We determined the kinetics of the haemagglutination inhibition (HI) and A(H7H9) pseudotype neutralisation antibody (Nab) responses and correlated these with clinical outcomes. Most patients had robust serological responses by both HI and Nab tests. Taking into account censoring due to time of testing and death, the median time from onset of illness to Nab titre ≥1:40 was 14 days (95% confidence interval (CI): 11–18 days) in the fatal cases and 10.5 days (95% CI: 7–12) in the survivors (p=0.003). The two groups did not differ in initial Nab titres, but the rate of increase in Nab titres was significantly faster for survivors by approximately 10-fold per 15 days (p=0.007). Early and rapid induction of Nab was correlated significantly with better clinical outcome.

Genetic diversity of Saccharum spontaneum from geographical regions of China assessed by simple sequence repeats

Saccharum spontaneum is the most variable wild relative of sugarcane with potential for use in sugarcane improvement programs. In order to help preserve and exploit this species, 152 accessions from eight major geographical regions in China, including Hainan, Guangdong, Guangxi, Yunnan, Sichuan, Guizhou, Fujian, and Jiangxi provinces, were investigated by analyzing 20 simple sequence repeats (SSRs), including 11 genomic SSRs (gSSRs) and nine SSRs developed from expressed sequence tags (EST-SSRs). A total of 454 alleles were generated by the 20 SSRs, with 295 and 159 alleles detected by gSSRs and EST-SSRs respectively. The Mantel test showed significant correlation between genetic matrixes among the studied accessions revealed by gSSRs versus EST-SSRs, although the average polymorphism of EST-SSRs (17.7) was much lower than that of gSSRs (26.8). Among the eight provinces, collections from Guizhou were the most diverse and those from Guangdong were the most distinct. Clustering analysis and principal component analysis accordantly classified the accessions into four groups, which were "Southwest group", "Hainan group", "Guangdong group", and "Guangxi group", based on the geographical origin of the major accessions in each group, demonstrating that geographical factors play an important role in the pattern of genetic structure of Chinese S. spontaneum. As two (Guizhou and Yunnan) of the three provinces with highest genetic diversity are located in southwest China, we concluded that southwest China is the region with the highest genetic diversity of S. spontaneum.

Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013

Binary file ES_Abstracts_Final_ECDC.txt matches

Preliminary inferences on the age-specific seriousness of human disease caused by avian influenza A(H7N9) infections in China, March to April 2013

Between 31 March and 21 April 2013, 102 laboratory-confirmed influenza A(H7N9) infections have been reported in six provinces of China. Using survey data on age-specific rates of exposure to live poultry in China, we estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages. Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date.

Efficacy of catheter ablation for atrial fibrillation in patients with a permanent pacemaker for sick sinus syndrome

OBJECTIVE

To study the clinical efficacy of catheter ablation for paroxysmal atrial fibrillation (AF) in patients with a permanent pacemaker (PM) for sick sinus syndrome (SSS).

METHODS

Our prospectively established database of patients who underwent circumferential pulmonary vein (PV) ablation for paroxysmal AF was retrospectively reviewed. A total of 41 patients with a permanent PM for the treatment of SSS (SSS+PM group) and 123 age- and gender-matched control subjects (on a 1: 3 basis) without SSS or a permanent PM (no-SSS+no-PM group) were included in this study. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30 seconds beyond three months after catheter ablation in the absence of any antiarrhythmic treatment.

RESULTS

During a mean follow-up period of 18.3±10.6 months (range 3-30 months), 50 patients (30.5%) developed recurrence of AF. The recurrence rate was higher in the SSS+PM group than in the no-SSS+no-PM group (43.9% vs. 26.3%, p=0.011). A Cox regression analysis adjusted for age, valvular heart disease, left atrial (LA) diameter and PV isolation identified only SSS and the use of a PM together as an independent predictor of recurrence of AF (hazard ratio 2.02, 95% confidence interval 1.10-3.69, p=0.023).

CONCLUSION

Patients with a permanent PM for SSS are at an increased risk of recurrence of AF after catheter ablation.

Seroprevalence of antibody to pandemic influenza A (H1N1) 2009 among healthcare workers after the first wave in Hong Kong

During the first wave of an influenza pandemic prior to the availability of an effective vaccine, healthcare workers (HCWs) may be at particular risk of infection with the novel influenza strain. We conducted a cross-sectional study of the prevalence of antibody to pandemic influenza A (H1N1) 2009 (pH1N1) among HCWs in Hong Kong in February–March 2010 following the first pandemic wave. Sera collected from HCWs were tested for antibody to pH1N1 influenza virus by viral neutralisation (VN). We assessed factors associated with higher antibody titres, and we compared antibody titres in HCWs with those in a separate community study. In total we enrolled 703 HCWs. Among 599 HCWs who did not report receipt of pH1N1 vaccine, 12% had antibody titre ≥1:40 by VN. There were no significant differences in the age-specific proportions of unvaccinated HCWs with antibody titre ≥1:40 compared with the general community following the first wave of pH1N1. Under good adherence to infection control guidelines, potential occupational exposures in the hospital setting did not appear to be associated with any substantial excess risk of pH1N1 infection in HCWs. Most HCWs had low antibody titres following the first pandemic wave.

Reducing the impact of the next influenza pandemic using household-based public health interventions

Household-based public health interventions can effectively mitigate the impact of influenza pandemic, and the resources and compliance requirement are realistic and feasible.