Acute Phase Research Articles

Comparison of inebilizumab or rituximab in addition to glucocorticoid therapy for neuromyelitis optica spectrum disorders

AIM: To investigate the short-term efficacy and safety of inebilizumab for neuromyelitis optica spectrum disorders (NMOSD). METHODS: A total of 33 patients with NMOSD treated with inebilizumab (Group INB, n=15) or rituximab (Group RTX, n=18) in addition to high-dose glucocorticoids were included. Both groups underwent hormone shock therapy during the acute phase. Subsequently, Group INB received inebilizumab injections during the remission phase, while Group RTX received rituximab injections. A comparison of aquaporins 4 (AQP4) titer values, peripheral blood B lymphocyte counts, and visual function recovery was conducted before and 8wk after treatment. Additionally, adverse reactions and patient tolerability were analyzed after using inebilizumab treatment regimes. RESULTS: Following inebilizumab treatment, there was a significantly improvement in the visual acuity of NMOSD patients (P<0.05), accompanied by a notable decrease in AQP4 titer values and B lymphocyte ratio (P<0.05). Moreover, inebilizumab treatment showed a partial effect in preventing optic nerve atrophy (P<0.05). However, there were no significant differences in other therapeutic effects compared to rituximab, which has previously demonstrated substantial therapeutic efficacy (P>0.05). Furthermore, inebilizumab exhibited higher safety levels than that of rituximab injections. CONCLUSION: The combination of inebilizumab and high-dose glucocorticoids proves to be effective. In comparison to rituximab injections, inebilizumab displays better tolerance and safety. Moreover, it demonstrates a partial effect in preventing optic nerve atrophy. Thus, it stands as an effective method to reduce the disability rates and improve the daily living ability of patients with NMOSD.

Pathophysiology, Diagnosis, Prognosis, and Prevention of Poststroke Epilepsy: Clinical and Research Implications.

Poststroke epilepsy (PSE) is associated with higher mortality and poor functional and cognitive outcomes in patients with stroke. With the remarkable development of acute stroke treatment, there is a growing number of survivors with PSE. Although approximately 10% of patients with stroke develop PSE, given the significant burden of stroke worldwide, PSE is a significant problem in stroke survivors. Therefore, the attention of health policymakers and significant funding are required to promote PSE prevention research. The current PSE definition includes unprovoked seizures occurring more than 7 days after stroke onset, given the high recurrence risks of seizures. However, the pathologic cascade of stroke is not uniform, indicating the need for a tissue-based approach rather than a time-based one to distinguish early seizures from late seizures. EEG is a commonly used tool in the diagnostic work-up of PSE. EEG findings during the acute phase of stroke can potentially stratify the risk of subsequent seizures and predict the development of poststroke epileptogenesis. Recent reports suggest that cortical superficial siderosis, which may be involved in epileptogenesis, is a promising marker for PSE. By incorporating such markers, future risk-scoring models could guide treatment strategies, particularly for the primary prophylaxis of PSE. To date, drugs that prevent poststroke epileptogenesis are lacking. The primary challenge involves the substantial cost burden due to the difficulty of reliably enrolling patients who develop PSE. There is, therefore, a critical need to determine reliable biomarkers for PSE. The goal is to be able to use them for trial enrichment and as a surrogate outcome measure for epileptogenesis. Moreover, seizure prophylaxis is essential to prevent functional and cognitive decline in stroke survivors. Further elucidation of factors that contribute to poststroke epileptogenesis is eagerly awaited. Meanwhile, the regimen of antiseizure medications should be based on individual cardiovascular risk, psychosomatic comorbidities, and concomitant medications. This review summarizes the current understanding of poststroke epileptogenesis, its risks, prognostic models, prophylaxis, and strategies for secondary prevention of seizures and suggests strategies to advance research on PSE.

Higher Neck Pain Intensity and Pain Catastrophizing Soon After A Whiplash Injury Partially Explain the Presence of Persistent Headache: A Prospective Study.

To understand whether pain-related factors soon after a whiplash injury can explain the presence of chronic headache. A prospective study with a follow-up of 6 months was performed, including 42 patients with acute whiplash-associated disorders. Neck pain intensity, the Neck Disability Index, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale, and the Anxiety State-Trait Scale were assessed at baseline. Differences in clinical characteristics between those with and without headache at 6 months were determined. The relative risk of presenting with headache was evaluated. A logistic regression model was performed to assess which factors at baseline could explain the presence of headache at 6 months. At 6 months, one-third of the sample presented with chronic headache. Significant differences were found for several outcome measures when people with and without headache were compared ( P <0.001). The highest relative risk of presenting with headache was found for moderate/severe levels of pain catastrophizing during the acute phase (RR=15.00, 95% CI=3.93, 57.22). The level of neck pain intensity and pain catastrophizing at baseline partially explained the presence of headache at 6 months ( R2 =0.627). The risk of presenting with persistent headache attributed to a whiplash injury is increased when people present with higher neck pain intensity and pain catastrophizing soon after a whiplash injury. Evaluating neck pain intensity and pain catastrophizing at baseline may assist in identifying those more likely to develop chronic headache, potentially providing an opportunity for early targeted interventions.

The effects of nutritional support and inflammation on plasma thiamine and erythrocyte thiamine pyrophosphate concentrations in the acute phase of critical illness: A pioneer study

The effects of nutritional support and inflammation on plasma thiamine and erythrocyte thiamine pyrophosphate concentrations in the acute phase of critical illness: A pioneer study

Antiepileptic and antioxidant effects of aqueous extract of Lippia multiflora Moldenke (Verbenaceae) on pilocarpine-induced seizures in Mus musculus Swiss mice

Epilepsy is a chronic neurological disorder that affects the central nervous system. Approximately 3% of the population at some point in their lives would be affected by epileptic disorders in the world, that is to say nearly 70 million people and therefore about 85% live in developing countries. The objective of this study is to determine the anticonvulsant effects of Lippia multiflora on the animal model of epileptogenesis induced by pilocarpine injection in mice during the acute phase. Mice were treated with different doses of the aqueous extract of L. multiflora or sodium valproate. The anticonvulsant effects were evaluated 24 after the injection of pilocarpine by referring to the Racine scale. Then a daily treatment was done for one week corresponding to the acute stage of the disease. Oxidative stress parameters were measured from brain samples taken on the last day of treatment. The injection of pilocarpine induced the Status epilepticus, which is translated by the appearance of convulsive seizures while the administration of different doses of the aqueous extract of L. multiflora led to a significant decrease of the seizures induced by pilocarpine in mice. In addition, L. multiflora extract restored endogenous levels of oxidative stress markers (MDA and NO) and increased the activity of oxidative stress enzymes (SOD, CAT and GSH). L. multiflora possesses anticonvulsant properties mediated by the involvement of GABAA receptors and antioxidants.

SARS-CoV-2 infection induces adaptive NK cell responses by spike protein-mediated induction of HLA-E expression

ABSTRACT HLA-E expression plays a central role for modulation of NK cell function by interaction with inhibitory NKG2A and stimulatory NKG2C receptors on canonical and adaptive NK cells, respectively. Here, we demonstrate that infection of human primary lung tissue with SARS-CoV-2 leads to increased HLA-E expression and show that processing of the peptide YLQPRTFLL from the spike protein is primarily responsible for the strong, dose-dependent increase of HLA-E. Targeting the peptide site within the spike protein revealed that a single point mutation was sufficient to abrogate the increase in HLA-E expression. Spike-mediated induction of HLA-E differentially affected NK cell function: whereas degranulation, IFN-γ production, and target cell cytotoxicity were enhanced in NKG2C+ adaptive NK cells, effector functions were inhibited in NKG2A+ canonical NK cells. Analysis of a cohort of COVID-19 patients in the acute phase of infection revealed that adaptive NK cells were induced irrespective of the HCMV status, challenging the paradigm that adaptive NK cells are only generated during HCMV infection. During the first week of hospitalization, patients exhibited a selective increase of early NKG2C+CD57- adaptive NK cells whereas mature NKG2C+CD57+ cells remained unchanged. Further analysis of recovered patients suggested that the adaptive NK cell response is primarily driven by a wave of early adaptive NK cells during acute infection that wanes once the infection is cleared. Together, this study suggests that NK cell responses to SARS-CoV-2 infection are majorly influenced by the balance between canonical and adaptive NK cells via the HLA-E/NKG2A/C axis.

A prospective randomized controlled clinical trial investigating the efficacy of low-dose olanzapine in preventing nausea and vomiting associated with oxaliplatin-based and irinotecan-based chemotherapy

ObjectiveThe aim of this study is to assess the clinical efficacy of a 5 mg dosage of olanzapine in preventing chemotherapy-induced nausea and vomiting (CINV) associated with moderately emetogenic chemotherapy (MEC) among female patients diagnosed with gastrointestinal tract tumors.MethodsPatients undergoing the oxaliplatin/irinotecan chemotherapy regimen were enrolled in this prospective controlled study. The olanzapine group received a 5 mg dosage of olanzapine along with palonosetron and dexamethasone, while the control group received a standard two-combination regimen consisting of dexamethasone and palonosetron. The primary endpoints included the total protection (TP) rates for the entire age group and the subgroup aged 60 years and above. Secondary endpoints encompassed the total protection rates during the acute and delayed phases within the two age brackets, as well as the total control (TC) rates and complete remission (CR) rates across all three phases (total, acute, and delayed). Additionally, the study involved the assessment of quality of life and the collection of adverse events associated with the interventions.Results1) Regarding the primary endpoint, the total phase TP rates within both the entire age group and the age group exceeding 60 years demonstrated superiority in the olanzapine group when compared to the control group (66.7% vs 37.25%, P = 0.003; 68.8% vs 44.4%, P = 0.044). 2) In terms of secondary endpoints, the olanzapine group exhibited superior acute phase TP rates in both age brackets when compared to the control group (P < 0.05). The olanzapine group also demonstrated higher delayed-phase TP rates, TC rates across all three phases, and CR rates within the two age brackets, although the differences were not statistically significant (P > 0.05). Furthermore, the quality of life in the olanzapine group surpassed that of the control group for both age brackets (P < 0.05), characterized by enhanced appetite and a higher incidence of drowsiness in the patients treated with olanzapine when compared to those in the control group (P < 0.05).ConclusionOlanzapine can enhance CINV induced by MEC regimen in female patients across all age groups, including the elderly, and therefore improve the quality of life for these patients.Clinical Trial Registration:https://www.chictr.org.cn/index.html, identifier: ChiCTR20000368269, 25/08/2020.

Peripheral inflammatory response in people after acute ischaemic stroke and isolated spontaneous cervical artery dissection.

The systemic inflammatory response following acute ischaemic stroke remains incompletely understood. We characterised the circulating inflammatory profile in 173 acute ischaemic stroke patients by measuring 65 cytokines and chemokines in plasma. Participants were grouped based on their inflammatory response, determined by high-sensitivity C-reactive protein levels in the acute phase. We compared stroke patients' profiles with 42 people experiencing spontaneous cervical artery dissection without stroke. Furthermore, variations in cytokine levels among stroke aetiologies were analysed. Follow-up samples were collected in a subgroup of ischaemic stroke patients at three and twelve months. Ischaemic stroke patients had elevated plasma levels of HGF and SDF-1α, and lower IL-4 levels, compared to spontaneous cervical artery dissection patients without stroke. Aetiology-subgroup analysis revealed reduced levels of nine cytokines/chemokines (HGF, SDF-1α, IL-2R, CD30, TNF-RII, IL-16, MIF, APRIL, SCF), and elevated levels of IL-4 and MIP-1β, in spontaneous cervical artery dissection (with or without ischaemic stroke as levels were comparable between both groups) compared to other aetiologies. The majority of cytokine/chemokine levels remained stable across the study period. Our research indicates that stroke due to large artery atherosclerosis, cardioembolism, and small vessel occlusion triggers a stronger inflammatory response than spontaneous cervical artery dissection.

Anti-ferroptosis exosomes engineered for targeting M2 microglia to improve neurological function in ischemic stroke.

Stroke is a devastating disease affecting populations worldwide and is the primary cause of long-term disability. The inflammatory storm plays a crucial role in the progression of stroke. In the acute phase of ischemic stroke, there is a transient increase in anti-inflammatory M2 microglia followed by a rapid decline. Due to the abundant phospholipid in brain tissue, lipid peroxidation is a notable characteristic of ischemia/reperfusion (I/R), constituting a structural foundation for ferroptosis in M2 microglia. Slowing down the decrease in M2 microglia numbers and controlling the inflammatory microenvironment holds significant potential for enhancing stroke recovery. We found that the ferroptosis inhibitor can modulate inflammatory response in MCAO mice, characterizing that the level of M2 microglia-related cytokines was increased. We then confirmed that different subtypes of microglia exhibit distinct sensitivities to I/R-induced ferroptosis. Adipose-derived stem cells derived exosome (ADSC-Exo) effectively decreased the susceptibility of M2 microglia to ferroptosis via Fxr2/Atf3/Slc7a11, suppressing the inflammatory microenvironment and promoting neuronal survival. Furthermore, through plasmid engineering, a more efficient M2 microglia-targeted exosome, termed M2pep-ADSC-Exo, was developed. In vivo and in vitro experiments demonstrated that M2pep-ADSC-Exo exhibits significant targeting specificity for M2 microglia, further inhibiting M2 microglia ferroptosis and improving neurological function in ischemic stroke mice. Collectively, we illustrated a novel potential therapeutic mechanism that Fxr2 in ADSC-Exo could alleviate the M2 microglia ferroptosis via regulating Atf3/Slc7all expression, hence inhibiting the inflammatory microenvironment, improving neurofunction recovery in cerebral I/R injury. We obtained a novel exosome, M2pep-ADSC-Exo, through engineered modification, which exhibits improved targeting capabilities toward M2 microglia. This provides a new avenue for the treatment of stroke.

Clinical characteristics and factors affecting disease severity in hospitalized tick-borne encephalitis patients in Norway from 2018 to 2022.

To describe the clinical characteristics and factors associated with disease severity in a Norwegian cohort of hospitalized patients with tick-borne encephalitis (TBE). This observational multicenter study included hospitalized patients with TBE in the endemic area in the southeastern region of Norway from 2018 to 2022. Clinical signs and findings from laboratory tests, EEG, CT and MRI scans were recorded. Patient characteristics were compared among those with mild, moderate, and severe TBE, and factors associated with disease severity were identified. Nearly all eligible patients were included in the final cohort (153/189 participants, 81%). The median age was 56 years, 63% were men, and 7% were vaccinated against TBE; no participants were fully vaccinated. TBE presented as mild (meningeal) disease in 31% of patients and as moderate or severe (encephalitic) disease in 54% and 14% of patients, respectively. We found that 46% of the patients had a monophasic course, 64% had hyponatremia, and 7% presented with central nervous system (CNS) symptoms without pleocytosis in cerebrospinal fluid (CSF). Dysesthesia, a symptom previously not described, was reported in 10% of the patients. Most objective findings were related to the CNS. Preexisting comorbidities, CRP and CSF protein levels were predictors of more severe disease. This novel presentation of a large Norwegian cohort supports TBE as a serious disease in the southeastern region of Norway. The majority of hospitalized patients presented with encephalitis, and fewer presented with meningitis. Comorbidities, CRP and CSF protein levels were associated with more severe disease. Prosjekt #2,296,959 - The Norwegian Tick-borne Encephalitis Study - NOTES. Acute phase characteristics and long-term outcomes. - Cristin.

Metabolic and productive parameters of lactating dairy cows under heat stress conditions supplemented with plant polyphenol extract.

The impact of heat stress on dairy cattle leads to significant economic losses and a negative impact on the welfare of the animals. The objective of this research was to evaluate the effect of the nutritional additive (Thermoplus®) in dairy cows under postpartum heat stress conditions, and its effects on the metabolic profile, production and quality of milk. Eighteen lactating Holstein cows (8 multiparous and ten primiparous), in a free-stall system, with a mean body condition score (BCS) of 3.14 ± 0.05, live weight of 624.55 ± 18, 61kg, with initial mean days in milk (DIM) of 90 ± 10.11, were selected. The animals were grouped into a control (CG, n = 9) and a treatment (TG, n = 9). Both groups underwent 14days of diet adaptation, the TG received the basal diet supplemented with 50g of the additive, once a day, individually, while the control group received only the total diet. Data collection of metabolic and productive parameters were evaluated on days -14 (before adaptation), 1 (after the diet adaptation period), 16, 30, and 44. Milk, blood, and body condition score (BCS) were collected once a day, and heart rate, respiratory rate, and rectal temperature were collected twice a day. Serum concentrations of albumin, calcium, magnesium, glucose, gamma-glutamyl transferase (GGT), beta-hydroxybutyrate (BHBA), non-esterified fatty acids (NEFAs), and paraoxonase-1 (PON-1) were evaluated. In the milk, the percentage of fat, protein, lactose, and total solids were determined in each sampling. Milk yield was measured daily. Humidity and ambient temperature values were collected on the days of the collection every 30min, from 5:30 am to 5:00pm, to calculate the temperature-humidity index (THI). Statistical analyzes were performed using the SAS software (version 9.3, SAS Institute Inc., Cary, NC, USA). The THI ranged from 62.22 to 79.47. Our findings showed that when the THI was greater than 72, the animals in the TG were able to maintain milk yield (Odds ratio (OD) = -0.0577,), and the animals in the CG had a greater chance of reducing it (OD = -0.2301). Multiparous cows in the TG had higher milk yield than CG (32.57 ± 0.34 vs 30.50 ± 0.36kg per day; P = 0.0078) and lower SCC (34.110 ± 6,940 vs 665.50 ± 214.41 cells per ml; P = 0.03), with the same percentages of total solids (P > 0.05). In multiparous metabolic markers, TG when compared CG had higher albumin concentrations (2.50 ± 0.07 vs 2.12 ± 0.07g/dl; < 0.001), equal PON-1 (P > 0.05), and higher BHBA levels (0.49 ± 0.03 vs 0.39 ± 0.04mmol/l). Primiparous from the CG had higher concentrations of NEFA (0.18 ± 0.02mmol/l) than multiparous from the same group (0.09 ± 0.02mmol/l) P = 0.0265. The use of the plant polyphenol extract in postpartum Holstein cows challenged by heat stress had beneficial effects on the production and health of the mammary gland in multiparous cows without decreasing milk solids. The non-reduction of the activities of the acute phase proteins indicates an immunomodulatory and inflammatory-reducing effect of the product used.

Time-dependent activation and repolarization changes following left bundle branch area pacing versus conventional biventricular pacing in patients with dyssynchronous heart failure

Abstract Background Cardiac Resynchronization Therapy (CRT) is the standard treatment for patients with dyssynchronous heart failure. Despite the effectiveness of conventional biventricular pacing (BiVP), 6-16% of patients develop ventricular tachyarrhythmias (VTAs) within a year of implantation. The relationship between BiVP and the development of VTAs is still under debate. During BiVP, the left-sided epicardium-to-endocardium activation creates a non-physiological activation and hence a non-physiological repolarization, which might trigger VTAs. A novel alternative treatment option to BiVP that on the contrary induces a left ventricular endocardium-to-epicardium activation, is left bundle branch area pacing (LBBAP). We hypothesized that LBBAP leads to a more homogenous repolarization than conventional BiVP. Purpose To compare time-dependent activation and repolarization changes in patients with dyssynchronous heart failure receiving LBBAP versus BiVP. Methods Patients eligible for CRT who underwent LBBAP (n=21) or BiVP (n=94) were retrospectively included. Standard 12-lead electrocardiograms obtained prior to implantation [baseline], shortly following implantation (0-2 days, [acute phase]), and after prolonged pacing during follow-up (31-180 days, [chronic phase]) were analyzed. QRS duration and QRS area were calculated through reconstruction of the vectorcardiogram and further analyzed together with corrected QT (QTc) and corrected Tpeak-Tend (Tp-e,c) intervals using a semi-automatic approach in MATLAB. Differences between LBBAP and BiVP patients were determined using the Mann-Whitney U-test. Time-dependent changes within groups were determined using the Wilcoxon signed-rank tests. Significance was defined as a p-value ≤0.05. Results (see figure): Compared to baseline, QRS duration and QRS area decreased significantly during the acute phase (both p &amp;lt; 0.01) and stabilized during chronic pacing for both BiVP and LBBAP patients. Differences in QRS duration or QRS area between LBBAP and BiVP were not significant at any of the time points. In the acute phase, BiVP resulted in a temporary and significant prolongation of both QTc and Tp-e,c compared to baseline (both p &amp;lt; 0.01). However, there was a subsequent shortening observed between the acute and chronic phases for both QTc and Tp-e,c (both p &amp;lt; 0.01). Compared to baseline, LBBAP acutely shortened Tp-e,c (p = 0.02) and tended to shorten QTc. During chronic pacing, LBBAP shortened QTc and Tp-e,c compared to baseline (p = 0.01 and p &amp;lt; 0.01). The decreases in QTc and Tp-e,c were larger in LBBAP than in BiVP patients in the acute and chronic pacing phase (all p &amp;lt;0.01). Conclusion CRT induces activation changes in both BiVP and LBBAP patients to a comparable extent. While BiVP leads to an acute increase in repolarization dispersions, LBBAP reduces markers of repolarization dispersion compared to baseline. The diminished dispersion of repolarization might contribute to an antiarrhythmic effect with LBBAP.

Cognitive and emotional empathy in acute and remitted anorexia nervosa: a systematic review

BackgroundImpairments in empathy are well established in anorexia nervosa (AN). It is unclear, however, whether these deficits only occur in the acute phases of AN due to neurocognitive impacts of starvation (often referred to as context-dependent, or state-like), or if deficits remain once remission has been achieved (trait-like). This debate is commonly referred to as the ‘state vs trait’ debate.ObjectiveThis systematic review aims to summarise existing literature regarding empathy in AN, and to investigate whether empathy deficits in AN are state- or trait-based.MethodA total of 1014 articles were identified, and seven articles remained after the screening process. These seven articles, comparing empathy across three groups (acute AN, remission of AN, and non-clinical controls), were evaluated and summarised in accordance with PRISMA guidelines. Articles were required to have included all three groups and report on either cognitive empathy and/or emotional empathy.ResultsThe majority of studies were of satisfactory quality. The results identified were inconsistent, with few articles lending some support to the ‘state’ hypothesis and others producing nonsignificant results.ConclusionsThere is minimal literature comparing empathy in acute and remission phases of AN. While there were some inconsistencies in included articles, some data indicate that there may be slight improvements to emotional and cognitive empathy following recovery of AN. Further research is needed to better enrich knowledge regarding the role of state vs trait with regard to neurocognitive difficulties experienced by individuals with AN.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335669, identifier CRD42022335669.

Infantile pyknocytosis, a neonatal hemolytic anemia with Heinz bodies: A cohort study.

Infantile pyknocytosis (IP) is a rare, probably misestimated, cause of non-immune neonatal hemolytic anemia evolving in two phases: an initial phase with severe jaundice, followed by a second phase with hemolytic anemia, which may require neonatal intensive care. The diagnosis of IP is based on the transient presence on blood smear of hyperdense, contracted, and/or spiculated red blood cells (pyknocytes), associated with the spontaneous resolution of clinico-biological features and the exclusion of other causes. If the etiology remains undetermined, some contributing factors, such as oxidative stress, have been proposed. We report the description of 16 patients with IP aiming at clarifying the circumstances associated with the development of this acquired disorder. In the acute phase, the mean hemoglobin nadir and pyknocyte count were 7.8g/dL and 11%, respectively, and strikingly, Heinz bodies were evident in 50% of the newborns, but in 100% after prolonged incubation (4hours). A high proportion of Mediterranean or African ancestry was noted in newborns, as well as a significant number of peripartum events, such as respiratory distress. If the etiology of IP is certainly multifactorial, our series reinforces the role of oxidative stress, which may, at least in part, find origin in desaturation episodes in newborns.

Catheter ablation of premature ventricle complex from multiples site of origin guided by an ultra-high density mapping system in a single-center

Abstract Background Frequent premature ventricle complex (PVC) could induce cardiomyopathy in some patient. PVC ablation by radiofrequency (RF) is a well-stablished procedure in high density PVC patients and results are consistent and robust in literature, with somewhat differing success rates reported. Catheter ablation of radiofrequency guided by ultra-high density mapping systems (UHDMS), enable a much more accurate reconstruction of the site of origin (SOO). Furthermore, we obtained this anatomic recreation with the analysis of a few number of beats. The UHDMS have demonstrated to be feasible and safe in a wide range / large spectrum of arrhythmic substrates, however, there is lack of evidence of its usefulness in the ablation of PVC. Purpose To determine the safety and utility, both in the acute phase and in the short-medium term, of employing a UHDMS in PVC catheter ablation in a retrospective cohort of patients treated at a single centre. Methods Catheter ablation procedures guided by an UHDMS carried out from July 2015 to January 2021 in a single-center of Spain were retrospectively included. The primary outcomes analyzed were: acute success rate, short-medium success rate (6-month efficacy after ablation), and complication rate related to the procedure. Results One hundred and two procedures, corresponding to 92 patients (mean age 59 ± 14 years, 63% male, 74% without cardiomyopathy, mean LVEF of 60%), were analyzed. The acute success rate was 93%. According the SOO, the lowest acute success rate was PVC from epicardial level (LV Summit) (75%). At 6-month follow-up after the first procedure, the short-medium success rate was up to 84% (no recurrence of the PVC ablated). There were three acute complications related to the procedure (complication rate 2,94%). In 19% (21 out 102) of the procedures, at least two arrhythmic substrates were successfully ablated in a single intervention. Conclusion Catheter ablation guided by an UHDMS showed an excellent safety profile in PVC ablation procedures. Beyond this minor complication rate, this type of technique has improved acute and short-term success rates. This allows us to assert that this type of technique grants a very high success rate and improves previously results. Last but not least, this new approach was useful and accurate in complex patients, providing good results in ablation procedures of two or more arrhythmic substrates without altering the safety profile.

Effectiveness of a stepwise approach for screening of atrial fibrillation after stroke: insights from the SAFAS study

Abstract Background Detection of atrial fibrillation (AF) is critical after ischemic stroke, providing information regarding the mechanism of the event and leading to modification in the antithrombotic strategy. While most guidelines recommend screening patients for AF with 12-lead ECG, telemetry, long-duration Holter monitoring and implantable cardiac monitor (ICM), the optimal timing and combination of such screening tools remain unclear. Objective This study aimed at investigating the suitability of a sequential combination of screening techniques (12-lead ECG, telemetry, in hospital long-lasting Holter monitoring, and ICM in the detection of AF after stroke. Methods Patients without previously known AF admitted to the Dijon University Hospital stroke unit for acute ischemic stroke were prospectively enrolled. After a stepwise screening approach for AF based on admission ECG, telemetry monitoring during the stroke unit stay and long-duration Holter monitoring during hospital stay, cryptogenic stroke patients were implanted of an ICM. Primary endpoint was the presence of AF detected during the 3-year period after stroke based on this sequential screening approach. Results A total of 240 patients were included. Among them, 104 (43.3%) patients had a documented cause of stroke non-related to AF. Among the remaining 136 patients (53.7% male, 70.8±13.7 yo), AF was detected in 82 (60%) patients over the acute screening phase or the 3-year follow-up with ICM. AF was diagnosed using 12-lead ECG, in-hospital telemetry, and in hospital long-lasting Holter monitoring in 17 (13%), 25 (18%), and 18 (13%) patients, respectively. AF was detected after the first 24 hours on the long-lasting Holter monitoring in 66% of patients. Among the 76 (56%) patients classified as cryptogenic after the complete stroke work-up and implanted from an ICM, AF was detected in 22 (29%) patients. AF occurred during the first, second, and third years of implantable monitoring in 14 (18.4%), 5 (6.6%), and 3 (3.9%) patients, respectively (Figure 1). Mean time from ICM implantation to AF diagnosis was 308+/-279 days. Finally, among all AF detected, 72% (60/83) were found during the initial intensive in-hospital screening. Conclusion A stepwise approach for AF screening after ischemic stroke allows the early detection of AF in a substantial number of patients during hospital stay. Even with such proactive initial monitoring strategy, invasive monitoring remains complementary to non-invasive screening tools not to overlook more distant AF episodes. Studies focusing on the relative risk of ischemic stroke recurrence according to AF timing and burden are needed.Figure 1

New-onset atrial fibrillation in patients with ST-elevation myocardial infarction

Abstract Background New-onset atrial fibrillation (NOAF) complicating ST-elevation myocardial infarction (STEMI) remains clinically challenging. Little is known regarding the long-term clinical impact of NOAF in the acute STEMI phase compared to a prior diagnosis of AF before the onset of STEMI. Methods We retrospectively reviewed consecutive patients undergoing percutaneous coronary intervention (PCI) for STEMI between May 2015 and September 2023. Patients were stratified based on NOAF diagnosis during the index-hospitalization vs. preexisting AF prior to the onset of STEMI. Long-term follow-up was obtained for stroke, major bleeding, or death. Results We analyzed 1327 consecutive patients undergoing PCI for STEMI. NOAF was detected in 117 patients (9%) and 69 patients (5%) had prior AF. Patients with NOAF and prior AF had similar baseline characteristics. NOAF patients were 65% males, with a mean age of 69 ± 13 years. All patients were treated with enoxaparin, but only 30% of patients with NOAF and 65% with prior AF were discharged with triple therapy, p&amp;lt;0.05. During a median follow-up of 696 days, the rates of stroke were 11% in patients with NOAF compared to 6% (p= 0.03) in patients with prior AF. Major bleeding occurred in 7% vs. 9%, p= 0.59, and death in 19% vs. 22%, p= 0.25 of patients with NOAF vs. prior AF. Conclusion NOAF was detected in almost 1 out of 10 STEMI patients and was associated with a similar rate of major bleeding and death as in patients with prior AF. The risk of NOAF for stroke might be higher than that of prior AF. These finding warrant confirmation in larger data sets.Central illustration

Combined effects of ambient temperature and food availability on induced innate immune response of a fruit-eating bat (Carollia perspicillata).

Resilience of mammals to anthropogenic climate and land-use changes is associated with the maintenance of adequate responses of several fitness-related traits such as those related to immune functions. Isolated and combined effects of decreased food availability and increased ambient temperature can lead to immunosuppression and greater susceptibility to disease. Our study tested the general hypothesis that decreased food availability, increased ambient temperature and the combined effect of both factors would affect selected physiological and behavioral components associated with the innate immune system of fruit-eating bats (Carollia perspicillata). Physiological (fever, leukocytosis and neutrophil/lymphocyte ratio) and behavioral (food intake) components of the acute phase response, as well as bacterial killing ability of the plasma were assessed after immune challenge with lipopolysaccharide (LPS: 10 mg/kg) in experimental groups kept at different short-term conditions of food availability (ad libitum diet or 50% food-deprived) and ambient temperature (27 and 33°C). Our results indicate that magnitude of increase in body temperature was not affected by food availability, ambient temperature or the interaction of both factors, but the time to reach the highest increase took longer in LPS-injected bats that were kept under food restriction. The magnitude of increased neutrophil/lymphocyte ratio was affected by the interaction between food availability and ambient temperature, but food intake, total white blood cell count and bacterial killing ability were not affected by any factor or interaction. Overall, our results suggest that bacterial killing ability and most components of acute phase response examined are not affected by short-term changes in food availability and ambient temperature within the range evaluated in this study, and that the increase of the neutrophil/lymphocyte ratio when bats are exposed to low food availability and high ambient temperature might represent an enhancement of cellular response to deal with infection.

Rest and stress aortic flow analysis by CMR in MyoFit46

Abstract Background Aortic stiffness is a strong predictor of future cardiovascular events and all-cause mortality. Aortic stiffness has never been measured during adenosine stress perfusion before, and may provide valuable relationship about this relationship. Aim To investigate if there are differences between aortic stiffness and conditions of rest and stress perfusion, in an older age-homogenous population-based cohort. Methods 203 participants from the longitudinal 1946 Medical Research Council National Survey of Health and Development British birth cohort were included. Cardiovascular Magnetic Resonance (CMR) imaging was performed at rest and during adenosine stress perfusion. 3 established and validated biomarkers of aortic stiffness were reported - pulse wave velocity, distensibility and beta stiffness, at rest and stress perfusion. All variables were non-normally distributed, therefore the Wilcoxon signed-rank test was used to look for significant differences between rest and stress. Results Aortic stiffness increased significantly during adenosine stress perfusion, shown by all biomarkers of aortic stiffness used: pulse wave velocity (p = &amp;lt;0.001), distensibility (p = &amp;lt;0.001), and beta stiffness (p = &amp;lt;0.001). However, the aortas of participants with a higher resting aortic stiffness at baseline were less dynamic (little if any aortic stiffness change with stress) when compared to those with low resting aortic stiffness. Conclusion It is feasible to measure aortic stiffness during adenosine stress perfusion. In healthy aortas, aortic stiffness increases in the acute phase of adenosine stress suggesting a new potential mechanism for the body response to adenosine – peripheral chemoreceptor reflex activation. Stiffer arteries at baseline are less modifiable and stress aortic flow CMR has the potential to identify these persons permitting early targeted therapy. Change in aortic stiffness, measured by stress aortic flow CMR is therefore a potential non-invasive biomarker of aortic health.

Complications Linked to Acute COVID-19 Phase during its Second Wave Era

Numerous global studies have documented the multi-systemic complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, there is a scarcity of research exploring SARS-CoV-2-related complications in Libya, specifically in Zawia city. Therefore, this study aimed to screen and identify complications of acute COVID-19 in 176 SARS-CoV-2 infected patients in Zawia city, Libya. As part of a past retrospective cohort study, 176 randomly selected volunteers who tested positive for SARS-CoV-2 between December 1, 2020, and February 28, 2021, in Zawia city participated in this research. Participants completed a questionnaire designed for COVID-19 patients, and the collected data were analyzed to achieve the objectives of this study. In the current study, we found that 73.9% of the COVID-19 patients were mild to moderate cases, while 26.1% were severe cases. Moreover, our recent research revealed that 90.9% of the COVID-19 patients experienced complications during the acute phase of the disease. The reported complications during this phase included psychological disorders (90%), pneumonia (35.6%), brain fog (19.4%), multi-joint pain (18.8%), hearing deficit (8.1%), acute respiratory failure (5.6%), acute cardiac injury (3.8%), thrombotic lesions (1.9%), and vision impairment (1.9%). Overall, our findings indicate that most of COVID-19 participants had mild to moderate disease, with approximately one quarter experiencing severe illness. Furthermore, the vast majority of patients had complications during the acute COVID-19 phase, with psychological disorders being the most commonly reported, followed by pneumonia. While rare, fatal complications such as acute respiratory failure, acute cardiac injury, and thrombotic lesions were observed in some participants.