The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively

BACKGROUND: Diabetes (DM) deteriorates the prognosis in patients with coronary heart disease. However, the prognostic value of different glucose abnormalities (GA) other than DM in subjects with acute myocardial infarction (AMI) treated invasively remains unclear. AIMS: To assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI). METHODS: A single-center, prospective registry encompassed 2733 consecutive AMI subjects treated with PCI. In all in-hospital survivors (n = 2527, 92.5%) without the history of DM diagnosed before or during index hospitalization standard oral glucose tolerance test (OGTT) was performed during stable condition before hospital discharge and interpreted according to WHO criteria. The mean follow-up period was 37.5 months. RESULTS: The incidence of GA was as follows: impaired fasting glycaemia - IFG (n = 376, 15%); impaired glucose tolerance - IGT (n = 560, 22%); DM (n = 425, 17%); new onset DM (n = 384, 15%); and normal glucose tolerance – NGT (n = 782, 31%). During the long-term follow-up, death rate events for previously known DM, new onset DM and IGT were significantly more frequent than those for IFG and NGT (12.3; 9.6 and 9.4 vs. 5.6 and 6.4%, respectively, P < 0.05). The strongest and common independent predictors of death in GA patients were glomerular filtration rate < 60 ml/min/1,73 m^2 (HR 2.0 and 2.8) and left ventricle ejection fraction < 35% (HR 2.5 and 1.8, all P < 0.05) respectively. CONCLUSIONS: Glucose abnormalities are very common in AMI patients. DM, new onset DM and IGT increase remote mortality. Impaired glucose tolerance bears similar long-term prognosis as diabetes

Browsers, grazers or mix-feeders? Study of the diet of extinct Pleistocene Eurasian forest rhinoceros Stephanorhinus kirchbergensis (J¨ager, 1839) and woolly rhinoceros Coelodonta antiquitatis (Blumenbach, 1799)

The wooly rhinoceros (Coelodonta antiquitatis) and forest rhinoceros (Stephanorhinus kirchbergensis) were prominent representatives of the Middle and Late Pleistocene glacial and interglacial faunas of Eurasia. Their diet has traditionally been inferred on functional morphology of the dentition and skull. In rare cases, food remains are preserved in the fossas of the teeth or as gut content. New approaches to infer diet include the study of isotopes and mesowear. Here we apply all four methods to infer the diet of these emblematic rhinoceros’ species and compare the food actually taken with the food available, as indicated by independent botanical data from the localities where the rhinoceros’ fossils were found: Gorz´ow Wielkopolski (Eemian) and Starunia (Middle Vistulian) as well as analysis of literature data. We also made inferences on the season of death of these individuals. Our results indicate that the woolly rhino in both Europe and Asia (Siberia) was mainly a grazer, although at different times of the year and depending on the region its diet was also supplemented by leaves of shrubs and trees. According to the results of isotope studies, there were important individual variations. The data show a clear seasonal variation in the isotope composition of this rhino’s diet. In contrast, Stephanorhinus kirchbergensis was a browser, though its diet included low-growing vegetation. Its habitat consisted of various types of forests, from riparian to deciduous and mixed forests, and open areas. The diet of this species consisted of selected items of vegetation, also including plants growing near both flowing and standing waters. The food remains from the fossae of the teeth indicated flexible browsing, confirming the previous interpretations based on functional morphology and stable isotopes. Long-term data from mesowear and microwear across a wider range of S. kirchbergensis fossils indicate a more mixed diet with a browsing component. The different diets of both of rhinoceros reflect not only the different habitats, but also climate changes that occurred during the Late Pleistocene

Patterns of pre‐Islamic settlement in the Qumayrah microregion, northern Oman: First results of an archaeological and geological survey

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Małoinwazyjna hybrydowa ablacja przetrwałego i długotrwającego przetrwałego migotania przedsionków: roczne wyniki obserwacji

Background: The concept of a hybrid approach, combining the most effective techniques of surgical and endocardial catheter ablation has resulted in the creation of the convergent ablation procedure. This novel, pericardioscopic, hybrid approach can be an effective option for highly symptomatic patients with persistent atrial fibrillation (PSAF) and longstanding persistent atrial fibrillation (LSPAF) for whom standalone surgical or endocardial ablation procedures offer sometimes unsatisfactory outcomes. Aim: To assess the safety, efficacy and effectiveness of a hybrid epicardial and endocardial radiofrequency ablation for the treatment of PSAF and LSPAF. Methods: Single-centre, prospective, non-randomised clinical study. Between August 2009 and December 2011, 27 patients with PSAF (n = 5) and LSPAF (n = 22) underwent hybrid ablation (HABL). Mean age was 52.52 &#177; 11.27 years, and the mean EHRA class was 2.5; 14 (51.8%) patients had a history of electrical cardioversion (n = 6) or catheter ablation (n = 8). Five patients had left ventricular ejection fraction (LVEF) of less than 35%. Mean AF duration for all patients was 3.46 &#177; 2.5 years. All patients were on antiarrhythmic drugs (AAD) and oral anticoagulation. Patients were scheduled for three, six and 12 month follow-up with seven day Holters, REVEAL&#174; XT and ECHO measurements. Results: The HABL procedure was feasible in all patients. At six months post procedure, 72.2% (13/18) of patients were in SR, and 66.5% (12/18) were off class I/III AADs. Four patients were in AF and one patient developed right atrial flutter. At one year post procedure, 80% (8/10) of patients were in SR and off class I/III AADs. At two year post procedure, 100% (6/6) of patients were in SR and off class I/III AADs. Rapid change in left ventricular function was noted in patients with low LVEF (&#8804; 35%) prior to the procedure. Patients with LVEF +40% had less apparent improvement. Conclusions: Hybrid, epicardial and endocardial, radiofrequency ablation is feasible and safe, effectively restoring sinus rhythm in the vast majority of patients with PSAF and LSPAF.Wstęp: Wciąż brakuje skutecznego sposobu leczenia objawowych chorych z przetrwałą i długotrwającą przetrwałą formą migotania przedsionków (AF). Połączenie wysiłków kardiochirurga i elektrofizjologa w postaci hybrydowej endo- i epikardialnej ablacji struktur obu przedsionków jest obiecującą opcją dla tych chorych, u których inne formy terapii zawiodły. Cel: Celem niniejszego badania było określenie bezpieczeństwa, możliwość i efektywności hybrydowego leczenia przetrwałego AF. Metody: Badanie ma charakter jednoośrodkowy, nierandomizowany. W okresie od 08.2009 do 12.2011 r. zabiegowi hybrydowej ablacji poddano 27 chorych (obecnie, do dnia 05.07.2012 n = 43). Z opisanych w niniejszej pracy 27 pacjentów, 5 miało przetrwałe AF (PAF), a 22 długotrwające przetrwałe AF (LSPAF). Średni wiek wynosił 52,52 &#177; 11,27 roku, średnia klasa EHRA 2,5. U 6 osób w przeszłości wykonano elektryczną kardiowersję, natomiast 8 przeszło &#8805; 1 ablację endokardialną. U 5 chorych stwierdzono upośledzoną funkcję skurczową lewej komory (LVEF < 35%). Średni czas trwania AF wynosił 3,46 &#177; 2,5 roku. Wszyscy pacjenci stosowali maksymalnie tolerowaną farmakoterapię oraz doustne leki przeciwzakrzepowe. Okres obserwacji po zabiegu zakładał wykonanie 7-dniowego badania EKG metodą Holtera oraz badanie echokardiograficzne w 3., 6. i 12. miesiącu po zabiegu. U części pacjentów implantowano stały rekorder EKG REVEAL&#174; XT. Wyniki: Procedurę przeprowadzono u wszystkich chorych. Sześć miesięcy po ablacji 72,2% (13/18) pacjentów pozostało na rytmie zatokowym (SR), a u 66,5% (12/18) było możliwe odstąpienie od leczenia antyarytmicznego (leki klas I/III). U 4 osób stwierdzono AF, natomiast u 1 wykryto trzepotanie przedsionków. Rok po zabiegu 80% (8/10) osób pozostało na SR bez stosowania leków klasy I/III (wg danych z dnia publikacji manuskryptu, gdy n = 43: wyniki dotyczące SR w 3., 6. i 12. miesiącu wynosiły odpowiednio: 75,8%, 76,9% i 84%). Wnioski: Małoinwazyjna, hybrydowa ablacja, łącząca zalety endo- i epikardialnej ablacji prądem o wysokiej częstotliwości jest bezpieczna i skuteczna w przywróceniu SR u większości chorych z objawowym, przetrwałym i długotrwającym przetrwałym AF