Potential role for clinical calibration to increase engagement with and application of home telemonitoring: a report from the HeartCycle programme

Aims: There is a need for alternative strategies that might avoid recurrent admissions in patients with heart failure. Home Telemonitoring (HTM) to monitor patient’s symptoms from a distance may be useful. This study attempts to assess changes in HTM vital signs in response to daily life activities (variations in medication, salt intake, exercise and stress) and to stablish which variations affect weight, blood pressure (BP) and heart rate (HR). Methods and results: We assessed 76 patients with heart failure (mean age 76 ± 10.8 years, 75% male, mainly in NYHA class II/III and from ischaemic etiology cause). Patients were given a calendar of interventions scheduling activities approximately twice-a-week before measuring their vital signs. Eating salty food or a large meal were the activities that had a significant impact on weight gain (+0.3 kg; p<0.001 and p=0.006, respectively). Exercise and skipping a dose of medication other than diuretics increased heart rate (+3 bpm, p=0.001 and almost +2 bpm, p=0.016, respectively). Conclusions: Our HTM system was able to detect small changes in vital signs related to these activities. Further studies should assess if providing such a schedule of activities might be useful for patient education and could improve long-term adherence to recommended lifestyle changes

Planetary science and exploration in the deep subsurface: results from the MINAR Program, Boulby Mine, UK

The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining

Les bolcheviks au Guilan

L’arrivée des bolcheviks au nord de la Perse et le renversement du gouvernement de Koutchek Khan, en juin et juillet 1920, comptent parmi les épisodes les plus dramatiques de la révolution au Guilan de 1920-1921. L’envoi d’une escadre rouge dans le port caspien d’Anzali et l’évacuation de la garnison britannique de Rasht, capitale de la province du Guilan, avaient abouti, dans un premier temps, à la proclamation, le 4 juin 1920, de la « République soviétique de Perse » avec à sa tête le chef des partisans nationalistes djangali, Mirza Koutchek Khan. Moscou avait l’intention d’installer un gouvernement de « type soviétique » mais sans imposer de révolution sociale car elle voulait éviter que les djangali ne se retirent du combat pour la libération nationale. Ainsi, en apportant son soutien à cette révolution, le gouvernement de la RSFSR, cherchait moins à soviétiser l’empire du shah qu’à exercer, en agitant la menace de l’« expansion rouge » en Asie, une pression sur le gouvernement britannique afin d’aboutir à un « marchandage diplomatique » entre Moscou et Londres. Il s’agissait d’obtenir des Anglais la levée du blocus économique de la RSFSR en échange de l’arrêt de l’offensive russe en Orient. Toutefois, les communistes locaux étaient opposés à cette « soviétisation de façade » et ils fomentèrent un complot contre le « démocrate bourgeois » Koutchek Khan. Ils réussirent à renverser son gouvernement et à le remplacer par un Revkom fantoche qui tenta de mettre en place une politique d’expropriation des terres. Seul le renfort en troupes russes et azerbaïdjanaises permit à ce Revkom de se maintenir, pour un temps, au pouvoir. L’occupation de fait du Guilan, l’hostilité de la population et les défaites sur le front obligèrent Moscou à entamer des pourparlers avec le gouvernement du shah. Ils conduisirent à l’accord soviéto-perse du 26 février 1921, à l’évacuation des troupes russes et à la fin de la république du Guilan.The Bolsheviks in Gilan: the overthrow of Kuchek Khan’s government. – The Bolsheviks’ arrival in northern Persia and the overthrow of Kuchek Khan’s government in June and July 1920 are among the most dramatic episodes of the Gilan revolution of 1920-1921. First, the stationing of a red squadron in the Caspian sea port of Anzali together with the evacuation of the British garrison from Rasht, the capital of the Gilan province, had led to the proclamation on June 14, 1920 of the “Soviet Republic of Persia,” whose head was Mirza Kuchek Khan, the leader of the Jangali nationalist partisans group. Moscow’s intention was to set up a “Soviet-type” government without imposing a social revolution because it wanted to avoid the Jangalis’ withdrawal from the struggle for national liberation. Thus, by supporting this revolution, the government of the RSFSR was seeking less a sovietization of the shah’s empire than a way of pressuring the British government with the threat of a “red expansion” in Asia in order to bring Moscow and London to the negotiating table. At stake was the raising of the British embargo on the RSFSR in exchange for the cessation of the Russian offensive in the East. However, local communists opposed this “façade Sovietization” and fomented a plot against the “bourgeois democrat” Kuchek Khan. They successfully overthrew his government and replaced it with a puppet Revkom which attempted to set up a land expropriation policy. This Revkom was able temporarily to remain in power thanks only to reinforcements in Russian and Azerbaijanian troops. The de facto occupation of Gilan, the population’s hostility as well as a series of defeats on the front obliged Moscow to start negotiations with the shah’s government. These negotiations led to the Soviet-Persian agreement of February 26, 1921, the evacuation of Russian troops, and the end of the Gilan Republic

Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting

Author Manuscript: 2011 April 14Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis in patients with DM modifies the response to arterial injury, with profound clinical consequences for patients undergoing percutaneous coronary intervention (PCI). Multiple studies have shown that DM is a strong risk factor for restenosis following successful balloon angioplasty or coronary stenting, with greater need for repeat revascularization and inferior clinical outcomes. Early data suggest that drug eluting stents reduce restenosis rates and the need for repeat revascularization irrespective of the diabetic state and with no significant reduction in hard clinical endpoints such as myocardial infarction and mortality. For many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy. PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with medical therapy. However, selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial. Randomized trials comparing multivessel PCI with balloon angioplasty or bare metal stents to coronary artery bypass grafting (CABG) consistently demonstrated the superiority of CABG in patients with treated DM. In the setting of diabetes CABG had greater survival, fewer recurrent infarctions or need for re-intervention. Limited data suggests that CABG is superior to multivessel PCI even when drug-eluting stents are used. Several ongoing randomized trials are evaluating the long-term comparative efficacy of PCI with drug-eluting stents and CABG in patients with DM. Only further study will continue to unravel the mechanisms at play and optimal therapy in the face of the profoundly virulent atherosclerotic potential that accompanies diabetes mellitus.National Institutes of Health (U.S.) (GM 49039

Omics phenotyping in heart failure:The next frontier

This state-of-the-art review aims to provide an up-to-date look at breakthrough omic technologies that are helping to unravel heart failure (HF) disease mechanisms and heterogeneity. Genomics, transcriptomics, proteomics, and metabolomics in HF are reviewed in depth. In addition, there is a thorough, expert discussion regarding the value of omics in identifying novel disease pathways, advancing understanding of disease mechanisms, differentiating HF phenotypes, yielding biomarkers for diagnosis or prognosis, or identifying new therapeutic targets in HF. The combination of multiple omics technologies may create a more comprehensive picture of the factors and physiology involved in HF than achieved by either one alone and provides a rich resource for predictive phenotype modelling. However, the successful translation of omics tools as solutions to clinical HF requires that the observations are robust and reproducible and can be validated across multiple independent populations to ensure confidence in clinical decision-making.</p

Is urinary incontinence associated with lichen sclerosus in females? A systematic review and meta‐analysis

Background Lichen sclerosus (LS) is a scarring chronic inflammatory disease with a predilection for genital skin in both sexes. The aetiology of LS is controversial, but evidence increasingly suggests that the occluded exposure of susceptible epithelium to urine is involved in the pathogenesis of genital LS in males. This theory has not yet been robustly investigated in females. Objectives This review and meta-analysis examined whether there is an association between urinary incontinence (UI) and genital lichen LS in females.Methods We performed a comprehensive search of MEDLINE, Embase and CINAHL to identify observational studies assessing the prevalence of UI in females with LS. DerSimonian and Laird random‐effects models were used to estimate the overall pooled prevalence and risk ratio compared to controls. Heterogeneity was assessed.ResultsIn total, eight studies met the inclusion criteria and five studies were included in a meta-analysis. Three studies were graded as moderate quality and five were poor. The pooled prevalence for UI in LS was 0.35 (95% CI 0.13-0.58, I2=98.4%). The risk ratio of UI in LS was 0.97 (95% CI 0.53-1.75, I2=87.5%). ConclusionThere appears to be no difference between patients with LS and those without LS in terms of UI. Studies are limited by clinical and methodological quality and heterogeneity is high. Well-designed prospective studies are needed

The 25in25 initiative : A novel transformative project to reduce mortality due to heart failure by 25% in the next 25 years

No abstract available

Soluble ST2 is a marker for acute cardiac allograft rejection

©2011. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Accepted version of a Published Work that appeared in final form in The Annals of Thoracic Surgery. To access the final edited and published work see https://doi.org/10.1016/j.athoracsur.2011.07.048Background: Soluble ST2 (sST2), an interleukin (IL)-1 receptor family member, has a role in immunologic tolerance and has also emerged as a biomarker of cardiac stretch and remodeling. The sST2 role in heart transplantation is still unknown. Methods: From the heart transplantation population at our institution (n = 74), we selected a subset of 26 patients who had an acute rejection episode in the first year after transplantation (35%; 52 ± 14 years; 76% men). Endomyocardial biopsy (EMB) results obtained at the time of the first rejection episode represented the rejection cohort (n = 26). Each patient served as a control to himself or herself, with EMB without rejection obtained before and after the rejection episode (n = 52). All laboratory measurements and blood samples were obtained at the time of EMB. Results: sST2 concentrations rose significantly in the context of acute rejection (130 [60 to 238] versus 51 ng/mL [28 to 80]; p = 0.002). Tertile analyses of sST2 concentrations revealed a graded association with rejection (p = 0.002) and repeated measurement analyses showed that sST2 concentrations were significantly modulated by the presence of rejection (p = 0.001). In receiver operator characteristic (ROC) analysis, sST2 had an area under the curve (AUC) of 0.72; the optimal cutoff point was 68 ng/mL (positive predictive value of 53%, negative predictive value of 83%), which predicted acute cellular rejection (odds ratio [OR] 4.9; 95% confidence interval [CI], 1.7 to 14.5; p = 0.004). The addition of sST2 values to those for the N-terminal pro B-type natriuretic peptide (NT-proBNP) resulted in a significant improvement on the integrated discrimination index (IDI) for rejection (relative improvement of 24%; p = 0.021). Conclusions: sST2 concentrations are modulated by the presence of acute rejection and provide complementary predictive ability to NT-proBNP for the biochemical identification of rejection

Suspected de novo heart failure in outpatient care: the REVOLUTION HF study.

BACKGROUND AND AIMS: Ambulatory patients presenting with signs or symptoms of heart failure (HF) should undergo natriuretic peptide testing. Rates of death, HF hospitalization, and healthcare costs were examined in patients thus identified with suspected de novo HF. METHODS: This population-based study (REVOLUTION HF) encompassing two large healthcare regions in Sweden examined patients who presented to outpatient care for the first time between 1 January 2015 and 31 December 2020, who had a recorded sign (peripheral oedema) or symptom (dyspnoea) of HF, and whose N-terminal pro-B-type natriuretic peptide (NT-proBNP) measured >300 ng/L within ±30 days of that sign or symptom. Characteristics, outcomes, healthcare patterns, and healthcare costs for these patients were followed for 1 year. Comparisons were made with matched controls without history of HF, its signs, its symptoms, or elevated NT-proBNP. RESULTS: Overall, 5942 patients (median age 78.7 years; 54% women) presented with suspected de novo HF. Within 1 year, 29% had received a HF diagnosis. Patients with suspected de novo HF had higher rates of all-cause death (11.7 vs. 6.5 events/100 person-years) and HF hospitalizations (12.5 vs. 2.2 events/100 person-years) than matched controls (n = 2048), with the highest event rates in the weeks after presentation. Rates were higher with higher NT-proBNP levels. Although some patients already used HF guideline-directed medical therapies for other indications, initiation of new medications was variable. Healthcare costs were higher in patients with suspected de novo HF than in matched controls, driven mostly by HF and chronic kidney disease. CONCLUSIONS: Patients with suspected HF and elevated NT-proBNP had high mortality and morbidity in the weeks after presentation, and accrued substantial healthcare costs, highlighting an urgent need for prompt identification, evaluation, and treatment of HF

Circulating linoleic acid at the time of myocardial infarction and risk of primary ventricular fibrillation

Primary ventricular fibrillation (PVF) is a major driver of cardiac arrest in the acute phase of ST-segment elevation myocardial infarction (STEMI). Enrichment of cardiomyocyte plasma membranes with dietary polyunsaturated fatty acids (PUFA) reduces vulnerability to PVF experimentally, but clinical data are scarce. PUFA status in serum phospholipids is a valid surrogate biomarker of PUFA status in cardiomyocytes within a wide range of dietary PUFA. In this nested case-control study (n = 58 cases of STEMI-driven PVF, n = 116 control non-PVF STEMI patients matched for age, sex, smoking status, dyslipidemia, diabetes mellitus and hypertension) we determined fatty acids in serum phospholipids by gas-chromatography, and assessed differences between cases and controls, applying the Benjamini-Hochberg procedure on nominal P-values to control the false discovery rate (FDR). Significant differences between cases and controls were restricted to linoleic acid (LA), with PVF patients showing a lower level (nominal P = 0.002; FDR-corrected P = 0.027). In a conditional logistic regression model, each one standard deviation increase in the proportion of LA was related to a 42% lower prevalence of PVF (odds ratio = 0.58; 95% confidence interval, 0.37, 0.90; P = 0.02). The association lasted after the inclusion of confounders. Thus, regular consumption of LA-rich foods (nuts, oils from seeds) may protect against ischemia-driven malignant arrhythmias