The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive guidelines for the management of Atrial Fibrillation

The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.

Le programme de lignes directrices de la Société canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a été élaboré pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les décideurs politiques et les systèmes de soins de santé sur des questions connexes. La dernière édition complète des lignes directrices de la SCC en matière de FA a été publiée en 2010. Depuis lors, des mises à jour périodiques ont été publiées, traitant de domaines en évolution rapide. Cependant, en 2020, un grand nombre de développements s'y étaient ajoutés, couvrant un large éventail de domaines, ce qui a motivé le comité à créer une refonte complète des lignes directrices. L'édition 2020 des lignes directrices de la SCC en matière de FA représente un renouvellement complet qui intègre, met à jour et remplace les lignes directrices, les recommandations et les conseils pratiques des dix dernières années. Elle est destinée à être utilisée par les cliniciens praticiens de toutes les disciplines qui s'occupent de patients souffrant de FA. L'approche GRADE (Gradation des Recommandations, de l'Appréciation, du Développement et des Évaluations) a été utilisée pour évaluer la pertinence des recommandations et la qualité des résultats. Les domaines d'intérêt incluent : la classification et les définitions de la FA, son épidémiologie, sa physiopathologie, l'évaluation clinique, le dépistage de la FA, la détection et la gestion des facteurs de risque modifiables, l'approche intégrée de la gestion de la FA, la prévention des accidents vasculaires cérébraux, la gestion de l'arythmie, les différences entre les sexes et la FA dans des populations particulières. Des tableaux et figures ont été largement utilisés pour synthétiser les éléments importants et présenter les concepts clés. Ce document devrait représenter une aide importante pour l'intégration des connaissances et un outil pour aider à améliorer la gestion clinique de cette arythmie importante et difficile à traiter.

2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation

The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update

Trade-off of ovarian lipids and total body lipids for fecundity and starvation resistance in tropical populations of Drosophila melanogaster.

In Drosophila melanogaster, clines of starvation resistance along a latitudinal gradient (south to north) have been reported in India, which matched with their cline for total body lipids (TL ). Nevertheless, producing too many reserves is likely to be costly and a trade-off might exist with life-history traits. Previous studies on starvation resistance and life-history traits of D. melanogaster have mainly focused on quantification of total body lipids, instead of separating ovarian lipids from total body lipids. In the present study, we have quantified absolute ovarian lipids (OL ) versus absolute body lipids excluding ovarian lipids (BL ) and examined associations with fecundity as well as starvation resistance in two latitudinal populations (8.34 vs. 32.43°N) of D. melanogaster. Firstly, we observed a trade-off between BL and OL that matched the trade-off of starvation resistance, longevity versus fecundity and development time in latitudinal populations of D. melanogaster. Southern populations had higher starvation resistance, more BL and lesser OL, whereas northern populations had enhanced fecundity, OL and lesser BL . Secondly, within population, starvation resistance also correlated with BL , and fecundity with OL . However, there was no correlation between starvation resistance and OL . Moreover, there was utilization of BL and nonutilization of OL under starvation stress. Therefore, resources invested for fecundity in the form of OL were independent of evolved starvation resistance in D. melanogaster. Our results suggest that a common pool of energy storage compounds (lipids) are allocated differentially between fecundity and starvation resistance and are consistent with Y-model of resource allocation.

Thermal developmental plasticity affects body size and water conservation of Drosophila nepalensis from the Western Himalayas.

In the Western Himalayas, Drosophila nepalensis is more abundant during the colder and drier winter than the warmer rainy season but the mechanistic bases of such adaptations are largely unknown. We tested effects of developmental plasticity on desiccation-related traits (body size, body melanization and water balance traits) that may be consistent with changes in seasonal abundance of this species. D. nepalensis grown at 15°C has shown twofold higher body size, greater melanization (∼15-fold), higher desiccation resistance (∼55 h), hemolymph as well as carbohydrate content (twofold higher) as compared with corresponding values at 25°C. Water loss before succumbing to death was much higher (∼16%) at 15°C than 25°C. Developmental plastic effects on body size are associated with changes in water balance-related traits (bulk water, hemolymph and dehydration tolerance). The role of body melanization was evident from the analysis of assorted darker and lighter flies (from a mass culture of D. nepalensis reared at 21°C) which lacked differences in dry mass but showed differences in desiccation survival hours and rate of water loss. For adult acclimation, we found a slight increase in desiccation resistance of flies reared at lower growth temperature, whereas in flies reared at 25°C such a response was lacking. In D. nepalensis, greater developmental plasticity is consistent with its contrasting levels of seasonal abundance. Finally, in the context of global climate change in the Western Himalayas, D. nepalensis seems vulnerable in the warmer season due to lower adult as well as developmental acclimation potential at higher growth temperature (25°C).

Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease.

BACKGROUND: Standard perfusion imaging may underestimate the extent of disease in 3-vessel coronary atherosclerosis. This study determined whether positron emission tomography quantification of perfusion reserve by use of rubidium 82 net retention defined a greater extent of disease than the standard approach in patients with 3-vessel disease. METHODS AND RESULTS: Rb-82 net retention was quantified as an estimation of absolute perfusion at rest and with dipyridamole stress by use of dynamic positron emission tomography imaging. The percent of abnormal myocardial sectors, as compared with a normal database, for a standard and quantification approach was determined. Twenty-three patients were evaluated. Defect sizes were larger in patients with 3-vessel disease (n = 13) by use of quantification methods: 44% +/- 18% of the myocardial sectors were abnormal by use of the standard approach versus 69% +/- 24% of sectors when measured by quantification of the stress-rest perfusion difference (P =.008). In patients with single-vessel disease (n = 10), defect sizes were smaller with quantification methods. CONCLUSIONS: Quantification of Rb-82 net retention to measure the stress-rest perfusion difference in the myocardium defined a greater extent of disease than the standard approach in this group of patients with triple-vessel disease. More accurate measurement of the extent of coronary artery disease could facilitate better risk stratification and identify more high-risk patients in whom aggressive intervention is required.

Geographical clines for quantitative traits in natural populations of a tropical drosophilid: Zaprionus indianus.

We analyzed natural populations of Zaprionus indianus in 10 Indian localities along a south-north transect (latitude: 10-31 degrees 3 N). Size traits (body weight, wing length and thorax length) as well as a reproductive trait (ovariole number) followed a pattern of clinal variation, that is, trait value increased with latitude. Wing/thorax ratio, which is inversely related to wing loading, also had a positive, but non-significant correlation with latitude. By contrast, bristle numbers (sternopleural and abdominal) exhibited a non-significant but negative correlation with latitude. Sex dimorphism, estimated as the female/male ratio, was very low in Z. indianus, contrasting with results already published in other species. Genetic variations among populations were also analyzed according to other geographic parameters (altitude and longitude) and to climatic conditions from each locality. A significant effect of altitude was found for size traits. For abdominal bristles, a multiple regression technique evidenced a significant effect of both latitude and altitude, but in opposite directions. Genetic variations were also correlated to climate, and mainly with average year temperature. Taking seasonal variations into account failed however to improve the predictability of morphometrical variations. The geographic differentiation of Z. indianus for quantitative traits suggests adaptive response to local conditions, especially to temperature, but also reveals a complex situation according to traits investigated and to environmental parameters, which does not match results on other drosophilid species.

Microspatial genetic differentiation for tolerance and utilization of various alcohols and acetic acid in Drosophila species from India.

In five Indian localities, it was possible to collect D. melanogaster in two different types of habitats, namely ordinary domestic and alcohol rich ones. Tolerance and utilization capacity of several alcohols and of acetic acid were analyzed in a total of 10 local populations. Results on two other species (D. repleta and D. immigrans) were also available from one place. In each locality, the population from alcohol rich habitat proved to be more tolerant to all the investigated products and also to be more capable of using them as a resource. Alcohols toxicity increased with increasing carbon chain length and secondary alcohols were more toxic than primary ones. Utilization capacity of all products was relatively independent of their toxicity. Especially acetic acid, the toxicity of which was low and similar to that of ethanol, was always a fairly poor resource. From a genetic point of view, tolerance and utilization capacity appeared as two relatively independent traits. Natural selection, which is responsible for the genetic differentiation of local populations, is likely to act simultaneously on both traits.

Geographical divergence for quantitative traits in colonising populations of Drosophila kikkawai from India.

There are significant geographical variations for four quantitative traits among eight natural populations of Drosophila kikkawai along the Indian latitudinal transect (8.29 to 33 degrees N). Body weight, wing length, thorax length, and ovariole number exhibit significant clinal variation with increase in latitutde. Genetic correlations between all the four traits are significantly higher. Slope values for body weight and wing length are higher (2.32 per degree latitude) while lower for thorax length (0.70) and ovariole number (0.56). South Indian populations are characterised by lower mean values but higher variances as well as CV values as compared with northern populations. Multiple regression analyses (on the basis of temperature related climatic variables) evidence significantly higher association between all the four traits and coefficient of variation of mean annual temperature (seasonal thermal amplitude; TCV). Thus, genetic differentiations for quantitative traits in D. kikkawai are due to selective pressure from variable seasonal environmental conditions occurring on the southern tropical versus northern subtropical regions of the Indian subcontinent.

Latitudinal clines for morphometrical traits in Drosophila kikkawai: a study of natural populations from the Indian subcontinent.

Natural populations of Drosophila kikkawai were collected in India and Sri Lanka, along a latitudinal transect ranging from 6.8 degrees to 31.8 degrees N latitude. Six morphometrical traits were analysed: wing and thorax length, body weight, ovariole number, and abdominal and sternopleural bristle numbers. Significant clines were observed for the three-size related traits and for ovariole number, corresponding to a regular increase in the mean value with latitude, but not for bristle numbers. Due to the utilization of two types of laboratory food, data were distributed into two separate data sets. A low-nutrient food produced smaller flies on average because of more intense crowding. The two rearing conditions produced significant clines but with significantly different slopes. The wing/thorax ratio, which is inversely related to wing loading, also increased with latitude. The analysis of Indian climatic conditions suggested that winter temperature, decreasing from south to north, could be more efficient than summer temperature, which varies in an opposite way, as a selective factor for inducing the clinal variations. The sibling species D. leontia, which is known only from the humid tropics, was found to be much smaller than D. kikkawai and did not fit the clinal regressions. Such morphological differences should help to identify the two species when found in sympatry.

Detection and spectrophotometric determination of EDTA with cobalt(II) and phosphomolybdic acid in urine and detergents.

A simple, rapid, sensitive and selective method for the microgram detection and spectrophotometric determination of EDTA in water, human urine and detergents, based on its reaction with Co(II) and phosphomolybdic acid at pH 0.5-2.0 is reported. Absorbance is measured against Co(II)-phosphomolybdic acid reference solution at 750 nm. The effect of time, temperature, pH and Co(II) or phosphomolybdic acid concentration is studied, and optimum operating conditions are established. Beer's law is applicable in the concentration range 0.3-1.9 mug ml(-1) of 10(-5)M EDTA. Its detection limit is 0.14 mug in the solution phase and 0.03 mug in the resin phase. The relative standard deviation is +/-0.13 mug. Ag(I), Zn(II), Cu(II), Ni(II), Pb(II), Cd(II), Ca(II), Mg(II), Fe(III), Cr(III), U(VI), chloride, nitrite, phosphate, oxalate, borate and amino acids do not interfere.

The family's perspective on issues of hydration in terminal care.

We identified issues that are important to family caregivers when deciding whether or not artificial hydration should be provided to patients with advanced cancer. A qualitative study using semi-structured interviews was carried out in the home support and inpatient divisions of a palliative care program in Halifax, Nova Scotia. Participants included children and spouses of terminally ill patients who had dealt with or would soon deal with issues of hydration. Factors influencing caregivers included issues of symptom distress, ethical and emotional considerations, information exchange between health professionals and family, and culture. The perceived benefits of artificial hydration by the caregivers were central to the ethical, emotional, and cultural considerations involved in their decision making. Discussions with caregivers should attempt to (a) discover the patient's wishes and attitudes concerning the procedure; (b) provide as accurate information as is available about advantages and disadvantages; and (c) recognize and explore caregivers' concerns that may or may not have been expressed.

REACTION NORMS OF MORPHOLOGICAL TRAITS IN DROSOPHILA: ADAPTIVE SHAPE CHANGES IN A STENOTHERM CIRCUMTROPICAL SPECIES?

Reaction norms of wing length, thorax length, and ovariole number were studied according to growth temperature in the circumtropical Drosophila ananassae, and compared to similar data from the cosmopolitan D. melanogaster. In the two species convex reaction norms were observed, but they were not parallel and sometimes exhibited intersections either at high (wing) or at low (thorax) temperature. On average, D. ananassae may be considered as a species with a bigger thorax but shorter wings than D. melanogaster. The shapes of reaction norms were analyzed and compared after quadratic polynomial adjustments. Significant differences were observed, in several cases between polynomial parameters, and in all cases between characteristic points that is, Maximum Value (MV) and Temperature of Maximum Value (TMV). The wing/thorax ratio may also be considered as a specific trait related to wing loading. Major differences were observed between the two species for the mean value and the shape of the response curves of this trait. The main observation of this work was however a shift of TMVs for wing and thorax length and ovariole number in D. ananassae toward higher temperatures. These variations in the reaction norms corresponded to a shift in the species thermal range, suggesting that temperature adaptation was accompanied by a modification of the shape of the response curves.

Geographical differentiation of allozymic variability in natural Indian populations of Drosophila melanogaster.

Fourteen Indian populations of D. melanogaster collected along a 22 degrees latitudinal range were analyzed electrophoretically to compare the geographical patterns of allozymic variation at 13 loci. The data show higher genetic differentiation on the basis of moderate to higher FST values and significant statistical correlation of allelic frequencies at six polymorphic loci with latitude. The results add support to the hypothesis that the occurrence of parallel or complementary latitudinal clines across different continental populations provides evidence of natural selection maintaining such clinal variation.

Latitudinal allozymic variability in natural populations of Zaprionus indianus from India.

Twelve natural populations of Z. indianus from India, collected along lines of latitude, were analyzed electrophoretically and the geographical pattern of variation was compared at 15 allozyme loci. Except for Mdh-2, all the loci revealed extensive polymorphism. The allele frequency variation revealed a statistically significant correlation as well as regression coefficients with the latitude. The populations revealed extensive clinical variation at all the polymorphic loci, which depicted moderate to higher FST values. Thus, the observed genetic divergence in colonizing populations of Z. indianus shows the role of natural selection that varies spatially along the north-south axis of the Indian subcontinent.

Geographical clinal variation at seven esterase-coding loci in Indian populations of Zaprionus indianus.

Twelve Indian natural populations of Zaprionus indianus, collected along 22 degrees latitudinal range, were analysed electrophoretically for allozymic variation of esterase gene-enzyme system. Interestingly, all the seven Est loci were found to be highly polymorphic in all the populations of Z. indianus. The genetic structure of Z. indianus populations was characterized by extensive inter-populational genotypic as well as allelic frequency heterogeneity and higher genic differentiation at all the esterase-coding loci. All the polymorphic loci in geographical populations of Z. indianus revealed latitudinal clines, and changes in allelic frequencies were found to correlate with latitude. The occurrence of higher genetic variability in Z. indianus populations was in agreement with its habitat-generalist or broad niche-width characteristics, i.e., the species populations utilized diverse food resources and displayed adaptation to variable climatic conditions. Thus, the observed genic divergence patterns in colonizing populations of Z. indianus could be maintained by balancing natural selection varying spatially along the north-south axis of the Indian sub-continent.

Malachite green as a reagent for detection and spectrophotometric determination of chromium(VI).

A sensitive and inexpensive method of spectrophotometric determination of chromium(VI), based on the absorbance of its complex with malachite green and acetic acid at pH 2.5 is reported. The complex shows a molar absorptivity of 8 x 10(4) l.mole(-1) cm(-1) at 560 nm, using malachite green and acetic acid as reference solution. The effect of time, temperature, pH and reagent concentration is studied and optimum operating conditions are established. Beer's law is applicable in the concentration range 2.0-22.8 mug/ml chromium(VI). The resin beads act as a catalyst and as little as 1.6 mug of chromium(VI) is detected in the resin phase as compared to 4.1 mug in the solution phase. The standard deviation in the determinations is +/-0.40 mug/ml for a 10.35 mug/ml solution.

Titrimetric determination of vanadium(IV) with DCTA.

Vanadium(IV) has been determined by DCTA titration conductometrically, spectrophotometrically and visually (with Alizarin Red S, Gallein and Catechol Violet as indicators at pH 4.0, 4.2 and 4.5-4.6 respectively). The interference of nickel, copper, lead, aluminium and thorium can be removed, and the method utilized for the analysis of binary mixtures of vanadium(IV) with nickel, copper or thorium.

Esterase polymorphism in a population of Zaprionus paravittiger.

Esterase isozyme variation in Zaprionus paravittiger is controlled by multiple alleles at 2 autosomal loci (Est-1 and Est-3). Est-1 codes for dimeric esterases while Est-3 codes for monomeric esterases. The degree and pattern of esterase polymorphism have been described.