High intensity focused ultrasound ablation for atrial fibrillation: results from the National Spanish Registry

BACKGROUND

A National Spanish Registry to compile all patients treated with high intensity focused ultrasound (HIFU) energy for atrial fibrillation (AF) was created to evaluate the safety and efficacy of AF surgical ablation.

METHODS

A national Spanish registry was created, and ten hospitals using HIFU to ablate AF joined it. A total of 412 patients undergoing cardiac surgery between 2006 and February 2013 were included. AF was divided between paroxysmal AF (33%) and persistent AF (67%) with a mean AF duration of 29.3±108.2 months. Mean left atrial diameter was 51.2±6.5 mm. Mean underlying heart disease were aortic valve disease (49.3%), ischemic disease (25.2%) and mitral disease (33.2%) Clinical follow-up of patients and a 6 months postoperative echocardiogram were performed in all patients.

RESULTS

A pacemaker implantation was needed in 4.9% of patients with a perioperative stroke in 2.5%. Rhythm at discharge from hospital was sinus rhythm in 58%, AF in 35.9% and atrial flutter in 0.8% of patients. Sinus rhythm restoration at 6, 12, 24 and 36 months follow-up was achieved in 66.1%, 63.8%, 63.9% and 45.9% of patients respectively. Multivariate analysis showed paroxysmal AF and sinus rhythm restoration in the operating theatre as factors related to sinus rhythm long term restoration.

CONCLUSIONS

The Spanish national registry showed an efficacy of AF ablation with the HIFU Epicor system of 66.1%, 63.8%, 63.9% and 45.9% at 6, 12, 24 and 36 months follow-up. There were no device-related complications.

How 'ground-picked' olive fruits affect virgin olive oil ethanol content, ethyl esters and quality

BACKGROUND

Olives dropped on the ground naturally sometimes are not separated from those fresh and healthy collected from the tree for harvest and processing. In this work we compared the quality, ethanol content and bioactive components of virgin olive oils from ground-picked olives, tree-picked fruits and their mixture.

RESULTS

Ground-picked olives produced 'Lampante' virgin olive oils; these are of a lower quality category, because of important alterations in chemical and sensory characteristics. Ethyl esters showed the highest values, although under the regulated limit. The mixture of ground and tree-picked olives gave oils classified as 'virgin' because of sensory defects, although the quality parameters did not exceed the limits for the 'extra' category. Ethanol content showed a significant increase in the oils from ground- picked olives and their mixture with respect to those from tree-picked fruits. Furthermore, bioactive compounds showed a significant decrease as fruit quality was poorer.

CONCLUSION

Ground-picked olives must be harvested and processed separately since they produce low-quality virgin olive oils with sensory defects and lower concentrations of bioactive compounds. The higher acidity and ethanol concentration observed in oils from ground-picked fruits or their mixture may help ethyl ester synthesis during storage. © 2015 Society of Chemical Industry.

Determination of metabolic equivalents during low- and high-intensity resistance exercise in healthy young subjects and patients with type 2 diabetes

The purpose of this study was to quantify the metabolic equivalents (METs) of resistance exercise in obese patients with type 2 diabetes (T2DM) and healthy young subjects and to evaluate whether there were differences between sessions executed at low- versus high-intensity resistance exercise. Twenty obese patients with T2DM (62.9±6.1 years) and 22 young subjects (22.6±1.9 years) performed two training sessions: one at vigorous intensity (80% of 1-repetition maximum (1RM)) and one at moderate intensity (60% of 1RM). Both groups carried out three strength exercises with a 2-day recovery between sessions. Oxygen consumption was continuously measured 15 min before, during and after each training session. Obese T2DM patients showed lower METs values compared with young healthy participants at the baseline phase (F= 2043.86; P<0.01), during training (F=1140.59; P<0.01) and in the post-exercise phase (F=1012.71; P<0.01). No effects were detected in the group x intensity analysis of covariance. In this study, at both light-moderate and vigorous resistance exercise intensities, the METs value that best represented both sessions was 3 METs for the obese elderly T2DM patients and 5 METs for young subjects.

A randomized trial comparing standard outcomes in two treatment models for substance users with tuberculosis

SETTING

Chicago Department of Public Health (CDPH), TB Control Program.

OBJECTIVES

To compare anti-tuberculosis treatment outcomes using two different types of directly observed therapy (DOT) outreach workers.

METHODS

Substance users diagnosed with TB from October 1996 to July 2000 were randomized to DOT administered by either 1) CDPH personnel (standard arm) or 2) previous substance-using human immunodeficiency virus/acquired immune-deficiency syndrome outreach workers (enhanced arm). Treatment completion was physician-determined, and adherence was estimated based on risk of missed DOT appointments.

RESULTS

Of 94 patients, 46 were randomized to the standard and 48 to the enhanced arm. The standard arm had a significantly higher risk of non-completion of treatment (39% vs. 15%, RR 2.7, 95%CI 1.2-5.8), and a significantly higher risk of missing DOT appointments (RR 2.6, 95%CI 1.4-4.8). For both outcomes, housing instability was a significant predictor in multivariate analyses.

CONCLUSIONS

TB treatment completion and adherence among substance users was improved by the enhanced intervention; the familiarity of enhanced-arm DOT workers with the patients' social norms due to their own previous substance use may have made them more effective. Successful DOT in hard-to-reach populations may require strategies that directly address the population's circumstances and utilize DOT workers who are intimately familiar with patients' life situations.

Treatment with Hypomethylating Agents before Allogeneic Stem Cell Transplant Improves Progression-Free Survival for Patients with Chronic Myelomonocytic Leukemia

The treatment of patients with chronic myelomonocytic leukemia (CMML) with transplant has not been optimized. We retrospectively reviewed the data for 83 consecutive patients with CMML (47 with CMML-1/2 and 36 with CMML progressed to acute myeloid leukemia) who received an allogeneic stem cell transplant (allo-SCT) at our institution between April 1991 and December 2013 to identify factors associated with improved survival and determine whether treatment with hypomethylating agents before transplant improves progression-free survival (PFS). The median age of the cohort was 57 years. Seventy-eight patients received induction treatment before transplant, with 37 receiving hypomethylating agents and 41 receiving cytotoxic chemotherapy. Patients treated with a hypomethylating agent had a significantly lower cumulative incidence of relapse at 3 years post-transplant (22%) than those treated with other agents (35%; P = .03), whereas treatment-related mortality at 1 year post-transplant did not significantly differ between the groups (27% and 30%, respectively; P = .84). The lower relapse rate resulted in a significantly higher 3-year PFS rate in patients treated with a hypomethylating agent (43%) than in those treated with other agents (27%; P = .04). Our data support the use of hypomethylating agents before allo-SCT for patients with CMML to achieve morphologic remission and improve PFS of these patients. Future studies are needed to confirm these findings.

Ethanol in Olive Fruit. Changes during Ripening

Ethanol is one of the precursors of ethyl esters, the virgin olive oil quality parameter for the "extra" category recently adopted by the European Union and International Olive Oil Council. Although ethyl ester content has great importance for virgin olive oil classification, the origin of ethanol is not clear. A possible source of ethanol may be the olive fruit itself while it remains on the tree. Variation of fruit ethanol content during ripening was studied for three different olive cultivars: 'Picual', 'Hojiblanca', and 'Arbequina'. Ethanol was measured in fruit homogenates by HS-SPME-GC-FID. The ethanol content varied between 0.56 and 58 mg/kg. 'Hojiblanca' fruits showed the highest ethanol concentration. For all of the cultivars, ethanol content of fruit increased during the ripening process, although a clear cultivar-dependent effect was observed because 'Hojiblanca' fruits showed the most significant raise. Therefore, results indicated that ethanol can be accumulated during fruit maturation on the olive tree.

Head-to-head comparison between two screening systems for HBsAG, anti-HBc, anti-HCV and HIV combination immunoassays in an international, multicentre evaluation study

BACKGROUND

Mandatory screening of blood donations for hepatitis B and hepatitis C viruses and human immunodeficiency viruses 1 and 2 requires assays with exceptional sensitivity and specificity. This study reports the results from a direct head-to-head comparison of the Elecsys HBsAG II, Elecsys Anti-HBc, Elecsys Anti-HCV II and Elecsys HIV combi PT immunoassays with the respective ABBOTT PRISM/Architect instrument immunoassays in a multicentre blood bank evaluation study.

STUDY DESIGN AND METHODS

Assay validation was performed in the blood screening laboratories of four blood bank centres in Austria, Germany, Spain and Thailand, where both first-time donor samples (approximately 6000 donors) and repeat donor samples (approximately 14,000 donors) were screened.

RESULTS

Of all screened donor samples, 93 (0.46%) were confirmed to be positive using assays from both manufacturers. The specificity of all immunoassays was >99.5% and was comparable between first-time and multiple-time donors. A direct comparison between the assays from Roche and ABBOTT according to Bland and Altman analysis demonstrated equivalent quality.

CONCLUSIONS

These results suggest that the Elecsys immunoassays for HBV, HCV and HIV infection, with a comparative sensitivity of 100% and a specificity exceeding the common technical specification threshold of >99.5%, meet the stringent performance criteria stipulated for blood donor screening for these infectious agents. Significant differences in the specificity between first-time and repeat donors were not detectable.

Interference of l,2,3,4-Tetramethoxy-5-(2-propenyl)benzene with Photosynthetic Electron Transport

The effect of 1,2,3,4-tetramethoxy-5-(2-propenyl)benzene, the major phytogrowth-inhibitory agent isolated from the leaves, stem bark and wood of Malmea depressa (Annonaceae), on several photosynthetic activities has been investigated using freshly lysed spinach chloroplasts. The results indicate that this compound inhibits proton-uptake, ATP synthesis and electron flow (basal, phosphorylating and uncoupled) in a concentration dependent manner, therefore acting as a Hill reaction inhibitor. Uncoupled electron transport through photosystem I from reduced dichlorophenol-indophenol to methylviologen is unaffected by this compound. On the other hand, uncoupled electron transport through photosystem II from water to dichlorophenol-indophenol, from water to silicomolibdate and from diphenylcarbazide to dichlorophenol-indophenol is inhibited by this phenylpropanoid, suggesting that the site of inhibition is located in the span from P680 to QA.

Changes in insulin sensitivity in response to different modalities of exercise: a review of the evidence

Type 2 diabetes is an increasingly prevalent condition with complications including blindness and kidney failure. Evidence suggests that type 2 diabetes is associated with a sedentary lifestyle, with physical activity demonstrated to increase glucose uptake and improve glycaemic control. Proposed mechanisms for these effects include the maintenance and improvement of insulin sensitivity via increased glucose transporter type four production. The optimal mode, frequency, intensity and duration of exercise for the improvement of insulin sensitivity are however yet to be identified. We review the evidence from 34 published studies addressing the effects on glycaemic control and insulin sensitivity of aerobic exercise, resistance training and both combined. Effect sizes and confidence intervals are reported for each intervention and meta-analysis presented. The quality of the evidence is tentatively graded, and recommendations for best practice proposed.

Macroautophagic process was differentially modulated by long-term moderate exercise in rat brain and peripheral tissues

The autophagic process is a lysosomal degradation pathway, which is activated during stress conditions, such as starvation or exercise. Regular exercise has beneficial effects on human health, including neuroprotection. However, the cellular mechanisms underlying these effects are incompletely understood. Endurance and a single bout of exercise induce autophagy not only in brain but also in peripheral tissues. However, little is known whether autophagy could be modulated in brain and peripheral tissues by long-term moderate exercise. Here, we examined the effects on macroautophagy process of long-term moderate treadmill training (36 weeks) in adult rats both in brain (hippocampus and cerebral cortex) and peripheral tissues (skeletal muscle, liver and heart). We assessed mTOR activation and the autophagic proteins Beclin 1, p62, LC3B (LC3B-II/LC3B-I ratio) and the lysosomal protein LAMP1, as well as the ubiquitinated proteins. Our results showed in the cortex of exercised rats an inactivation of mTOR, greater autophagy flux (increased LC3-II/LC3-I ratio and reduced p62) besides increased LAMP1. Related with these effects a reduction in the ubiquitinated proteins was observed. No significant changes in the autophagic pathway were found either in hippocampus or in skeletal and cardiac muscle by exercise. Only in the liver of exercised rats mTOR phosphorylation and p62 levels increased, which could be related with beneficial metabolic effects in this organ induced by exercise. Thus, our findings suggest that long-term moderate exercise induces autophagy specifically in the cortex.

Microbial examination of anaerobic sludge adaptation to animal slurry

The objective of this study was to evaluate changes in the microbial population of anaerobic sludge digesters during the adaptation to pig slurry (PS) using quantitative real-time polymerase chain reaction (qPCR) and qualitative scanning electron microscopy (SEM). Additionally, the relationship between microbial parameters and sludge physicochemical composition and methane yield was examined. Results showed that the addition of PS to an unadapted thermophilic anaerobic digester caused an increase in volatile fatty acids (VFA) concentration, a decrease in removal efficiency and CH4 yield. Additionally, increases in total bacteria and total archaea were observed using qPCR. Scanning electron micrographs provided a general overview of the sludge's cell morphology, morphological diversity and degree of organic matter degradation. A change in microbial morphotypes from homogeneous cell morphologies to a higher morphological diversity, similar to that observed in PS, was observed with the addition of PS by SEM. Therefore, the combination of qPCR and SEM allowed expanding the knowledge about the microbial adaptation to animal slurry in thermophilic anaerobic digesters.

High agreement between laboratory and field estimates of critical power in cycling

The purpose of this study was to investigate the level of agreement between laboratory-based estimates of critical power (CP) and results taken from a novel field test. Subjects were fourteen trained cyclists (age 40±7 yrs; body mass 70.2±6.5 kg; VO2max 3.8±0.5 L · min-1). Laboratory-based CP was estimated from 3 constant work-rate tests at 80%, 100% and 105% of maximal aerobic power (MAP). Field-based CP was estimated from 3 all-out tests performed on an outdoor velodrome over fixed durations of 3, 7 and 12 min. Using the linear work limit (Wlim) vs. time limit (Tlim) relation for the estimation of CP1 values and the inverse time (1/t) vs. power (P) models for the estimation of CP2 values, field-based CP1 and CP2 values did not significantly differ from laboratory-based values (234±24.4 W vs. 234±25.5 W (CP1); P<0.001; limits of agreement [LOA], -10.98-10.8 W and 236±29.1 W vs. 235±24.1 W (CP2); P<0.001; [LOA], -13.88-17.3 W. Mean prediction errors for laboratory and field estimates were 2.2% (CP) and 27% (W'). Data suggest that employing all-out field tests lasting 3, 7 and 12 min has potential utility in the estimation of CP.

The spatial statistics formalism applied to mapping electromagnetic radiation in urban areas

Determining the electromagnetic radiation levels in urban areas is a complicated task. Various approaches have been taken, including numerical simulations using different models of propagation, sampling campaigns to measure field values with which to validate theoretical models, and the formalism of spatial statistics. In the work, we present here that this latter technique was used to construct maps of electric field and its associated uncertainty from experimental data. For this purpose, a field meter and a broadband probe sensitive in the 100-kHz-3-GHz frequency range were used to take 1,020 measurements around buildings and along the perimeter of the area. The distance between sampling points was 5 m. The results were stored in a geographic information system to facilitate data handling and analysis, in particular, the application of the formalism of spatial statistical to the analysis of the distribution of the field levels over the study area. The spatial structure was analyzed using the variographic technique, with the field levels at non-sampled points being interpolated by kriging. The results indicated that, in the urban area analyzed in the present work, the linear density of sampling points could be reduced to a distance which coincides with the length of the blocks of buildings without the statistical parameters varying significantly and with the field level maps being reproduced qualitatively and quantitatively.