Harmonising Individual Patient Level Cardiac Registry Data Across the Asia Pacific Region-A Feasibility Study of In-Hospital Outcomes of STEMI Patients From the Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Network.

OBJECTIVE: The Asia-Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration was established to inform on percutaneous coronary intervention (PCI) in the Asia-Pacific Region. Our aims were to (i) determine the operational requirements to assemble an international individual patient dataset and validate the processes of governance, data quality and data security, and subsequently (ii) describe the characteristics and outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing PCI in the ASPECT registry. METHODS: Seven (7) ASPECT members were approached to provide a harmonised anonymised dataset from their local registry. Patient characteristics were summarised and associations between the characteristics and in-hospital outcomes for STEMI patients were analysed. RESULTS: Six (6) participating sites (86%) provided governance approvals for the collation of individual anonymised patient data from 2015 to 2017. Five (5) sites (83%) provided >90% of agreed data elements and 68% of the collated elements had <10% missingness. From the registry (n=12,620), 84% were male. The mean age was 59.2±12.3 years. The Malaysian cohort had a high prevalence of previous myocardial infarction (34%), almost twice that of any other sites (p<0.001). Adverse in-hospital outcomes were the lowest in Hong Kong whilst in-hospital mortality varied from 2.7% in Vietnam to 7.9% in Singapore. CONCLUSIONS: Governance approvals for the collation of individual patient anonymised data was achieved with a high level of data alignment. Secure data transfer process and repository were established. Patient characteristics and presentation varied significantly across the Asia-Pacific region with this likely to be a major predictor of variations in the clinical outcomes observed across the region.

Hyper-Angle Exploitative Searching for Enabling Multi-Objective Optimization of Fog Computing.

Fog computing is an emerging technology. It has the potential of enabling various wireless networks to offer computational services based on certain requirements given by the user. Typically, the users give their computing tasks to the network manager that has the responsibility of allocating needed fog nodes optimally for conducting the computation effectively. The optimal allocation of nodes with respect to various metrics is essential for fast execution and stable, energy-efficient, balanced, and cost-effective allocation. This article aims to optimize multiple objectives using fog computing by developing multi-objective optimization with high exploitive searching. The developed algorithm is an evolutionary genetic type designated as Hyper Angle Exploitative Searching (HAES). It uses hyper angle along with crowding distance for prioritizing solutions within the same rank and selecting the highest priority solutions. The approach was evaluated on multi-objective mathematical problems and its superiority was revealed by comparing its performance with benchmark approaches. A framework of multi-criteria optimization for fog computing was proposed, the Fog Computing Closed Loop Model (FCCL). Results have shown that HAES outperforms other relevant benchmarks in terms of non-domination and optimality metrics with over 70% confidence of the t-test for rejecting the null-hypothesis of non-superiority in terms of the domination metric set coverage.

Anti-inflammatory and anti-oxidant effects of combination between sulforaphane and acetaminophen in LPS-stimulated RAW 264.7 macrophage cells.

Objectives: Accumulating evidence indicates that combination of therapeutic agents may increase their pharmacological properties with fewer undesired side effects. Acetaminophen (APAP) has been widely used to treat pain and fever in many countries. However, APAP only possesses a weak anti-inflammatory property at therapeutic dose, and exhibits hepatotoxicity at high dose. On other hand, sulforaphane (SFN) has been well-known as a potential anti-inflammatory and antioxidant agent. In this study, we investigated the anti-inflammatory and antioxidant effects of combination between APAP and SFN in LPS-stimulated RAW 264.7 macrophage cells. Methods: Nitric oxide (NO) assay was determined using the Griess assay. Reactive oxygen species (ROS) formation was measured using an ROS-sensitive fluorescence indicator, DCFH-DA. The protein expression was determined by western blot analysis. Results: Our results showed that the combination of SFN and APAP exhibited an inhibitory effect on inflammatory markers such as NO, iNOS, COX-2, and IL-1ß, and this effect was more pronounced than the compound was used alone. In addition, the combination of SFN and APAP at low doses decreased intracellular ROS formation and increased the protein levels of CAT, GPx, Nrf2, NQO1, and HO-1, which were much better than APAP alone and were equivalent to SFN at full dose. Conclusions: Our findings suggest that the combination of APAP and SFN enhanced anti-inflammatory and anti-oxidant activities in stimulated macrophages, which provide an important rationale to utilize drug and food in combination for prevention and/or treatment inflammation-related diseases.

A Novel Four Single-Sideband M-QAM Modulation Scheme Using a Shadow Equalizer for MIMO System Toward 5G Communications.

Single-sideband (SSB) modulation through Hilbert transformation has successfully transmitted data using only half the bandwidth of the traditional scheme for the same amount of contained information. Toward this end, the four single-sideband (4-SSB) approach for high order modulation is a promising approach for the next-generation communications by applying soft-input soft-output (SISO) equalizer algorithms over orthogonal frequency division multiplexing (OFDM). However, OFDM is challenging for realizing the feasible 5G communications, compared to the emerging techniques, e.g., non-orthogonal multiple access (NOMA), orthogonal multiple access (OMA) or multiple-input multiple-output (MIMO). Since the 4-SSB is an orthogonal modulation which was successfully applied over the traditional OFDM, in this article, we propose a novel 4-SSB modulation scheme over OFDM Guard Interval (GI) and massive MIMO. Besides the carrier signal, from the receiver side, we also apply the shadow equalizer algorithm in the uncoded and coded environment using turbo codes to achieve the 4-SSB with high efficiency from low complexity and energy consumption for 5G. The evaluation results validate that our system consumes lower energy due to low complexity gained from same number of iterations without the heavy decoding as of the 4-SSB SISO based on the turbo equalizer. In addition, the 4-SSB over the OFDM GI achieves the best performance among the relevant approaches conducted in 4-SSB. The proposal then acts as a practical communication system designed to solve the inter-symbol interference (ISI) induced by additional Hilbert transform in the wireless environment toward fifth generation (5G), given that turbo code is considered as a potential channel coding scheme for 5G radio specification.

Using Linguistic Properties of Place Specification for Network Naming to Improve Mobility Performance.

By considering the definitions and properties from the field of linguistics regarding place specification, a questionnaire that can be used to improve naming in networks is obtained. The questionnaire helps introduce the idea of place specification from linguistics and the concept of metric spaces into network naming schemes. The questionnaire results are used to improve the basic Information-Centric Networking (ICN) architecture's notoriously lax network naming structure. The improvements are realized by leveraging components from the Named-Node Network Architecture, a minor ICN design, to supply the resulting network architecture with the properties the questionnaire highlights. Evaluation results from experiments demonstrate that modifying the network architecture so that the proposed questionnaire is satisfied results in achieving high mobility performance. Specifically, the proposed system can obtain mean application goodput at above 88 % of the ideal result, with a delay below 0.104 s and with the network time-out Interest ratio below 0.082 for the proposed single mobile push producer, single mobile consumer scenario, even when the nodes reach the maximum tested speed of 14 m/s.

PPCS: A Progressive Popularity-Aware Caching Scheme for Edge-Based Cache Redundancy Avoidance in Information-Centric Networks.

This article proposes a novel chunk-based caching scheme known as the Progressive Popularity-Aware Caching Scheme (PPCS) to improve content availability and eliminate the cache redundancy issue of Information-Centric Networking (ICN). Particularly, the proposal considers both entire-object caching and partial-progressive caching for popular and non-popular content objects, respectively. In the case that the content is not popular enough, PPCS first caches initial chunks of the content at the edge node and then progressively continues caching subsequent chunks at upstream Content Nodes (CNs) along the delivery path over time, according to the content popularity and each CN position. Therefore, PPCS efficiently avoids wasting cache space for storing on-path content duplicates and improves cache diversity by allowing no more than one replica of a specified content to be cached. To enable a complete ICN caching solution for communication networks, we also propose an autonomous replacement policy to optimize the cache utilization by maximizing the utility of each CN from caching content items. By simulation, we show that PPCS, utilizing edge-computing for the joint optimization of caching decision and replacement policies, considerably outperforms relevant existing ICN caching strategies in terms of latency (number of hops), cache redundancy, and content availability (hit rate), especially when the CN's cache size is small.

Human Papillomavirus Infection, p16INK4a Expression and Genetic Alterations in Vietnamese Cervical Neuroendocrine Cancer.

Neuroendocrine cervical cancer is a rare subtype of cervical cancer with a highly aggressive malignancy. This study was conducted to analyse the human papillomavirus (HPV) infection and molecular abnormalities in Vietnamese neuroendocrine carcinomas of the uterine cervix. HPV genotyping and p53 mutations were examined using polymerase chain reaction (PCR)-based direct sequencing. Mutations of epidermal growth factor receptor (EGFR), Kirsten rat sarcoma (KRAS), neuroblastoma RAS viral oncogene homolog (NRAS) and v-Raf murine sarcoma viral oncogene homolog B (BRAF) were identified using commercial kits. Four high-risk HPV genotypes were identified in 26 (86.7%) out of a total of 30 tumours. The prevalence of HPV 16, 18, 31 and 45 was 20.0%, 50.0%, 20.0% and 36.7%, respectively. Overexpression of p16INK4a was observed in 93.3% of cases and was significantly correlated with high-risk HPV infections. Furthermore, p53 and NRAS mutations were detected in five (16.7%) and one (3.3%) cases, respectively, whereas no EGFR, KRAS or BRAF mutations were observed. These results demonstrate that high-risk HPV infection may be an important oncogenic factor for the development and progression of cervical neuroendocrine carcinoma.

A Smart Congestion Control Mechanism for the Green IoT Sensor-Enabled Information-Centric Networking.

Information-Centric Networking (ICN) is a new Internet architecture design, which is considered as the global-scale Future Internet (FI) paradigm. Though ICN offers considerable benefits over the existing IP-based Internet architecture, its practical deployment in real life still has many challenges, especially in the case of high congestion and limited power in a sensor enabled-network for the Internet of Things (IoT) era. In this paper, we propose a smart congestion control mechanism to diminish the network congestion rate, reduce sensor power consumptions, and enhance the network performance of ICN at the same time to realize a complete green and efficient ICN-based sensor networking model. The proposed network system uses the chunk-by-chunk aggregated packets according to the content popularity to diminish the number of exchanged packets needed for data transmission. We also design the sensor power-based cache management strategy, and an adaptive Markov-based sensor scheduling policy with selective sensing algorithm to further maximize power savings for the sensors. The evaluation results using ndnSIM (a widely-used ICN simulator) show that the proposed model can provide higher network performance efficiency with lower energy consumption for the future Internet by achieving higher throughput with higher cache hit rate and lower Interest packet drop rate as we increase the number of IoT sensors in ICN.

Unique characteristics of Asians with hypertension: what is known and what can be done?

Hypertension remains the leading modifiable risk factor for cardiovascular disease worldwide. Over the past 30 years, the prevalence of hypertension has been increasing in East and Southeast Asia to a greater extent as compared with other Western countries. Asians with hypertension have unique characteristics. This can be attributed to increased impact of obesity on Asians with hypertension, excessive salt intake and increased salt sensitivity, loss of diurnal rhythm in blood pressure and primary aldosteronism. The impact of hypertension on cardiovascular (particularly strokes) and chronic kidney disease is greater in Asians. These unique characteristics underpinned by the diverse socioeconomic backgrounds pose its own challenges in the diagnosis and management of hypertension in Asia.

Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention.

The aim of this study was to compare the efficacy and safety of transradial approach (TRA) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with the efficacy and safety of transfemoral approach (TFA). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) reporting the outcomes of TRA versus TFA in CTO PCI. The primary end point was procedural success. Secondary end points included access-site complications, in-hospital adverse events, procedural efficacy outcomes, and 30-day all-cause mortality. A total of 28,754 CTO PCI cases from 19 studies were included (2 RCTs and 17 OS). The pooled mean J-CTO score is 2.3. The main analysis showed a trend toward a higher success rate for TRA (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.00 to 1.38), but this was not the case in the secondary analysis, which included only RCTs and OS with moderate risk of bias (OR 0.99, 95% CI 0.81 to 1.22). TRA was associated with significant reductions in access-site complications (OR 0.33, 95% CI 0.24 to 0.45) and major bleeding (OR 0.34, 95% CI 0.20 to 0.59), and a similar risk of other in-hospital adverse events and 30-day mortality (p >0.05) to that of TFA. Moreover, there was less fluoroscopy time (minutes) and contrast volume use (ml) in the transradial CTO PCI (mean difference: -6.19 [-10.98 to -1.40] and -22.14[-34.56 to -9.72], respectively). In conclusion, the transradial PCI in appropriate CTO lesions was associated with a lower incidence of access-site complications/major bleeding than was TFA and a similar other periprocedural complications rate, without compromising procedural success.

Myocardial fibrosis in rheumatic heart disease: emerging concepts and clinical implications.

Rheumatic heart disease (RHD) remains a significant cardiovascular burden in the world even though it is no longer common in affluent countries. Centuries of history surrounding this disease provide us with a thorough understanding of its pathophysiology. Infections in the throat, skin, or mucosa are the gateway for Group A Streptococcus (GAS) to penetrate our immune system. A significant inflammatory response to the heart is caused by an immunologic cascade triggered by GAS antigen cross-reactivity. This exaggerated immune response is primarily responsible for cardiac dysfunction. Recurrent inflammatory processes damage all layers of the heart, including the endocardium, myocardium, and pericardium. A vicious immunological cycle involving inflammatory mediators, angiotensin II, and TGF-ß promotes extracellular matrix remodeling, resulting in myocardial fibrosis. Myocardial fibrosis appears to be a prevalent occurrence in patients with RHD. The presence of myocardial fibrosis, which causes left ventricular dysfunction in RHD, might be utilized to determine options for treatment and might also be used to predict the outcome of interventions in patients with RHD. This emerging concept of myocardial fibrosis needs to be explored comprehensively in order to be optimally utilized in the treatment of RHD.

Intermediate outcome for the single-stage surgical repair of aortopulmonary window associated with interrupted aortic arch.

OBJECTIVES: Aortopulmonary window (APW) associated with an interrupted aortic arch (IAA) is a rare cardiac malformation with significant mortality and morbidity. The goal of this study was to report the intermediate outcomes of single-stage repair concentrating on the surgical techniques and postoperative reintervention for this rare cardiac lesion. METHODS: Eleven patients were diagnosed with IAA-associated APW and underwent single-stage surgical repair at Vietnam National Children's Hospital. RESULTS: The APW anatomy types were types I, II and III in 1, 4 and 6 patients, respectively. The IAA morphology was type A in 9 patients and type B in 2 patients. The median age was 27 [interquartile range (IQR) 6-79] days, and the median weight was 3.5 (IQR 2.8-4.5) kg. The aortic arch was repaired using direct end-to-side tissue anastomosis in 7 patients, and patch aortoplasty was performed in 4 patients. Six patients underwent APW closure with an intra-aortic baffle, and 5 patients required right pulmonary artery detachment and reimplantation. One early death occurred. Four patients required reinterventions: 1 patient required reoperation due to aortic stenosis and 3 required balloon angioplasty for either recurrent aortic arch stenosis (n = 1) or right pulmonary stenosis (n = 2) with a mean follow-up time of 3.1 years (IQR 0.5-4.3 years). CONCLUSIONS: Single-stage repair of IAA-associated APW can be achieved with good survival outcomes in children. However, the need for repeat reintervention or reoperation remains high, and the growth of both the aorta and pulmonary arteries should follow carefully as the patient grows. CLINICAL REGISTRATION NUMBER: VNCH-RICH-18-96.

The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome.

Purpose: The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods: This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results: Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion: This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.

Effectiveness of community-based comprehensive healthy lifestyle promotion on cardiovascular disease risk factors in a rural Vietnamese population: a quasi-experimental study.

BACKGROUND: Health promotion is a key component for primary prevention of cardiovascular disease (CVD). This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors (CVDRF) in the general population in the context of a community-based programme on hypertension management. METHODS: A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009. In the intervention commune, a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated, while no new programme, apart from conventional healthcare services, was provided in the reference commune. Health promotion campaigns focused on smoking cessation, reducing alcohol consumption, encouraging physical activity and reducing salty diets. Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure (BP) and behavioural CVDRFs (smoking, alcohol consumption, physical inactivity and salty diet) in both communes before and after the 3-year intervention. RESULTS: Overall 4,650 adults above 25 years old were surveyed, in four randomly independent samples covering both communes at baseline and after the 3-year intervention. Although physical inactivity and obesity increased over time in the intervention commune, there was a significant reduction in systolic and diastolic BP (3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively) in the general population at the intervention commune. Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption. CONCLUSION: Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span. Limited effects on a context-bound CVDRF like smoking suggested that higher intensity of intervention, a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention.

An enhanced two-dimensional hole gas (2DHG) C-H diamond with positive surface charge model for advanced normally-off MOSFET devices.

Though the complementary power field effect transistors (FETs), e.g., metal-oxide-semiconductor-FETs (MOSFETs) based on wide bandgap materials, enable low switching losses and on-resistance, p-channel FETs are not feasible in any wide bandgap material other than diamond. In this paper, we propose the first work to investigate the impact of fixed positive surface charge density on achieving normally-off and controlling threshold voltage operation obtained on p-channel two-dimensional hole gas (2DHG) hydrogen-terminated (C-H) diamond FET using nitrogen doping in the diamond substrate. In general, a p-channel diamond MOSFET demonstrates the normally-on operation, but the normally-off operation is also a critical requirement of the feasible electronic power devices in terms of safety operation. The characteristics of the C-H diamond MOSFET have been analyzed with the two demonstrated charge sheet models using the two-dimensional Silvaco Atlas TCAD. It shows that the fixed-Fermi level in the bulk diamond is 1.7 eV (donor level) from the conduction band minimum.  However, the upward band bending has been obtained at Al2O3/SiO2/C-H diamond interface indicating the presence of inversion layer without gate voltage. The fixed negative charge model exhibits a strong inversion layer for normally-on FET operation, while the fixed positive charge model shows a weak inversion for normally-off operation.  The maximum current density of a fixed positive interface charge model of the Al2O3/C-H diamond device is - 290 mA/mm, which corresponds to that of expermental result of Al2O3/SiO2/C-H diamond - 305 mA/mm at a gate-source voltage of - 40 V. Also, the threshold voltage Vth is relatively high at Vth = - 3.5 V, i.e., the positive charge model can reproduce the normally-off operation. Moreover, we also demonstrate that the Vth and transconductance gm  correspond to those of the experimental work.

Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam.

BACKGROUND: Costly efforts have been invested to control and prevent cardiovascular diseases (CVD) and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam. METHODS: In a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme. RESULTS: Both top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme. CONCLUSION: Our model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac care network, led by an outstanding cardiac referral centre.

Depression Among Patients with Type 2 Diabetes Mellitus: Prevalence and Associated Factors in Hue City, Vietnam.

BACKGROUND AND AIMS: Depression is common in people with type 2 diabetes mellitus. The association of depression and diabetes has negative effects on patients. This study investigated the prevalence of depression in individuals with type 2 diabetes mellitus and examined the social, psychological and clinical factors associated with depression. PATIENTS AND METHODS: The study included 216 inpatients with type 2 diabetes mellitus at the Department of Endocrinology and Neurology, Hue Central Hospital and the Department of General Internal Medicine, Hue University Hospital. This descriptive cross-sectional study evaluated depression using the Patient Health Questionnaire-9 (PHQ-9). Data were collected on patients' socio-demographic factors such as sex, age, marital and economic status, level of education and clinical factors including duration of type 2 diabetes mellitus, fasting blood glucose, HbA1C, comorbidities or complications as well as health behavior including alcohol consumption, smoking and physical activities. Logistic regression was used to analyze the factors associated with depression in patients with type 2 diabetes mellitus. RESULTS: 23.2% of the patients had depression. The rates of severe, moderate and mild depression were 0.5, 0.9 and 21.8%, respectively. Multivariate logistic regression analysis indicated several factors associated with depression in participants, including age under 60 years, poor economic status, unstable or part-time work, having stress during the past year, without/poor treatment adherence to type 2 diabetes mellitus, and engaging in heavy physical activity or physical activity less than three days per week. CONCLUSION: The prevalence of depression among patients with type 2 diabetes mellitus is high. Endocrinologists should be made aware of the increased risk of depression in this patient population and screening individuals for relevant risk factors is highly recommended.

2020 Asian Pacific Society of Cardiology Consensus Recommendations on Antithrombotic Management for High-risk Chronic Coronary Syndrome.

The unique characteristics of patients with chronic coronary syndrome (CCS) in the Asia-Pacific region, heterogeneous approaches because of differences in accesses and resources and low number of patients from the Asia-Pacific region in pivotal studies, mean that international guidelines cannot be routinely applied to these populations. The Asian Pacific Society of Cardiology developed these consensus recommendations to summarise current evidence on the management of CCS and provide recommendations to assist clinicians treat patients from the region. The consensus recommendations were developed by an expert consensus panel who reviewed and appraised the available literature, with focus on data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting recommendations provide guidance on the assessment and management of bleeding and ischaemic risks in Asian CCS patients. Furthermore, the selection of long-term antithrombotic therapy is discussed, including the role of single antiplatelet therapy, dual antiplatelet therapy and dual pathway inhibition therapy.

Asian Pacific Society of Cardiology Consensus Recommendations on the Use of MitraClip for Mitral Regurgitation.

Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted 'agree' or 'neutral'. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.

Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes.

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease.