Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria.

INTRODUCTION: The diagnosis of acute myocarditis (AM) is complex due to its heterogeneity and typically is defined by either Electronic Healthcare Records (EHRs) or advanced imaging and endomyocardial biopsy, but there is no consensus. We aimed to investigate the diagnostic accuracy of these approaches for AM. METHODS: Data on ICD 10th Revision(ICD-10) codes corresponding to AM were collected from two hospitals and compared to CMR-confirmed or clinically suspected(CS) AM cases with respect to diagnostic accuracy, clinical characteristics, and all-cause mortality. Next, we performed a review of published AM studies according to inclusion criteria. RESULTS: We identified 291 unique admissions with ICD-10 codes corresponding to AM in the first three diagnostic positions. The positive predictive value(PPV) of ICD-10 codes for CMR-confirmed or CS-AM was 36%, and patients with CMR-confirmed or CS AM had a lower all-cause mortality than those with a refuted diagnosis (P = 0.019). Using an unstructured approach, patients with CMR-confirmed and CS AM had similar demographics, comorbidity profiles and survival over a median follow-up of 52 months (P = 0.72). Our review of the literature confirmed our findings. Outcomes for patients included in studies using CMR-confirmed criteria were favourable compared to studies with EMB-confirmed AM cases. CONCLUSION: ICD-10 codes have poor accuracy in identification of AM cases and should be used with caution in clinical research. There are important differences in management and outcomes of patients according to the selection criteria used to diagnose AM. Potential selection biases must be considered when interpreting AM cohorts and requires standardisation of inclusion criteria for AM studies.

Prognostic relevance of demographic factors in cardiac magnetic resonance-proven acute myocarditis: A cohort study.

Aim: Acute myocarditis (AM) is a heterogeneous condition with variable estimates of survival. Contemporary criteria for the diagnosis of clinically suspected AM enable non-invasive assessment, resulting in greater sensitivity and more representative cohorts. We aimed to describe the demographic characteristics and long-term outcomes of patients with AM diagnosed using non-invasive criteria. Methods and results: A total of 199 patients with cardiac magnetic resonance (CMR)-confirmed AM were included. The majority (n = 130, 65%) were male, and the average age was 39 ± 16 years. Half of the patients were White (n = 99, 52%), with the remainder from Black and Minority Ethnic (BAME) groups. The most common clinical presentation was chest pain (n = 156, 78%), with smaller numbers presenting with breathlessness (n = 25, 13%) and arrhythmias (n = 18, 9%). Patients admitted with breathlessness were sicker and more often required inotropes, steroids, and renal replacement therapy (p < 0.001, p < 0.001, and p = 0.01, respectively). Over a median follow-up of 53 (IQR 34-76) months, 11 patients (6%) experienced an adverse outcome, defined as a composite of all-cause mortality, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) therapy. Patients in the arrhythmia group had a worse prognosis, with a nearly sevenfold risk of adverse events [hazard ratio (HR) 6.97; 95% confidence interval (CI) 1.87-26.00, p = 0.004]. Sex and ethnicity were not significantly associated with the outcome. Conclusion: AM is highly heterogeneous with an overall favourable prognosis. Three-quarters of patients with AM present with chest pain, which is associated with a benign prognosis. AM presenting with life-threatening arrhythmias is associated with a higher risk of adverse events.

[Manejo de la cesación tabáquica entre residentes de cardiología de Iberoamérica]. / Smoking cessation management among Iberoamerica's cardiology residents

Introduction and objectives: Although cardiologists frequently assist patients who suffer damage from smoking, the degree of training they receive to manage this problem during their residency is unknown. Because of this, we'd proposed to ­evaluate the preferences and practices of cardiology residents for smoking cessation of the attending patients. Materials and methods: Closed, prefixed, voluntary and anonymous survey among doctors who carried out the specialty of cardiology in 5 countries of Latin America and Spain. Results: 716 residents were surveyed; 62.4% from Argentina, 19% from Mexico, 6.8% from Spain, 6.7% from Chile, 3.2% from Uruguay, and 1.9% from Paraguay. When asked about the importance they assigned to this problem (using a scale of 1-10), 85.8% assigned this question a score of 8 or higher. While 80.5% of the participants expressed giving short anti-tobacco advice routinely, only 27.7% used pharmacological therapy for this purpose. Among those who did not use pharmacological therapy, 58.3% said that the reason was not being familiar with the treatments; 62.9% of the surveyed said they had not received any type of training in this problem. Those residents who received some type of training reported feeling more prepared for this (p < 0.0001). Conclusion: We found that cardiology residents have a low knowledge of pharmacological treatment and relatively low confidence to provide assistance in smoking cessation. This topic should be included in the training of future cardiologists in order to achieve a more comprehensive cardiovascular prevention.

Introducción y objetivos: Si bien los cardiólogos asisten cotidianamente a pacientes que sufren daño por el tabaquismo, no se conoce el grado de formación que reciben sobre esta problemática durante su residencia. Debido a ello nos propusimos evaluar las preferencias y prácticas de los residentes de cardiología para la cesación tabáquica de los pacientes que asisten. Materiales y métodos: Encuesta cerrada, prefijada, voluntaria y anónima entre médicos que realizaban la especialidad de cardiología en cinco países de Latinoamérica y España. Resultados: Se encuestaron 716 residentes: un 62.4% de Argentina, un 19% de México, un 6.8% de España, un 6.7% de Chile, un 3.2% de Uruguay y un 1.9% de Paraguay. Con respecto a la importancia que asignaban a esta problemática (empleando una escala de 1-10), el 85.8% le asignó a esta pregunta una puntuación de 8 o mayor. Mientras el 80.5% de los participantes expresó dar consejo breve antitabáquico sistemáticamente, solamente un 27.7% empleaban terapia farmacológica con este fin. Entre quienes no empleaban terapia farmacológica, el 58.3% manifestó que el motivo era no encontrarse familiarizados con los tratamientos. El 62.9% de los encuestados dijo no haber recibido ningún tipo de formación en esta problemática. Aquellos residentes que recibieron algún tipo de formación manifestaron sentirse más preparados (p < 0.0001). Conclusión: Encontramos un bajo conocimiento sobre el tratamiento farmacológico y relativamente poca seguridad por parte de los residentes de cardiología para brindar asistencia en cesación tabáquica. Consideramos esencial incluir este tópico en la formación de los futuros cardiólogos a fin de lograr una prevención cardiovascular más integral.

Fire effects on C and H isotopic composition in plant biomass and soil: Bulk and particle size fractions.

This work studies carbon (C) and hydrogen (H) isotope composition of plant biomass and soil organic matter (SOM) in an attempt to assess both, changes exerted by fire and possible inputs of charred materials to the soil after a wildfire. Isotope composition of bulk soil, soil particle size fractions and biomass of the dominant standing vegetation in the area (Quercus suber) from Doñana National Park (SW-Spain) were studied by isotope ratio mass spectrometry (IRMS). SOM C isotope composition indicates the occurrence of two SOM pools with different degree of alteration. Coarse soil fractions (>0.5 mm) were found 13C depleted with δ13C values close to those in leaf biomass, pointing to a predominance of poorly transformed SOM. Conversely, fine fractions (<0.1 mm) were found enriched in 13C as corresponds to a more humified SOM. The fire produced no changes in this trend, although a consistent 13C enrichment (c. 1‰) was observed in all soil fractions with decreasing size. Concerning H isotopes, the coarse fractions (>0.5 mm) displayed significant lower δ2H values than the intermediate and fine ones (<0.5 mm), again similar to those in leaf biomass (c. -80‰), whereas the fine fractions were found deuterium (2H)-enriched with significant higher δ2H values (c. 50‰), suggesting physical speciation of H depending on soil particle size. The fire produced a significant 2H depletion (Δ2H c. -10‰) in the finer fractions (<0.1 mm). The study of stable isotope analysis added new information and complements the results obtained by other proxies to better understand the effect of fire on SOM.

Effect of a wildfire and of post-fire restoration actions in the organic matter structure in soil fractions.

The impact of wildfires and of restoration actions on soil organic matter (SOM) content and structure was studied in a soil under pine (Pinus pinea) from Doñana National Park (SW Spain). Samples were collected from burnt areas before (B) and after post-fire restoration (BR) and compared with an unburnt (UB) site. Analytical pyrolysis (Py-GC/MS) was used to investigate SOM molecular composition in whole soil samples and in coarse (CF) and fine (FF) fractions. The results were interpreted using a van Krevelen graphical-statistical method. Highest total organic carbon (TOC) was found in UB soil and no differences were found between B and BR soils. The CF had the highest TOC values and FF presented differences among the three scenarios. Respect to SOM structure, the B soil was depleted in lignin and enriched in unspecific aromatics and polycyclic aromatic hydrocarbons, and in all scenarios, CF SOM consisted mainly of lignocellulose derived compounds and fatty acids. In general, FF SOM was found more altered than CF. High contribution of unspecific aromatic compounds and polycyclic aromatic hydrocarbons was observed in B-FF whereas BR-FF samples comprised considerable proportions of compounds from labile biomass, possibly due to soil mixing during rehabilitation actions. The fire caused a defunctionalisation of lignin-derived phenolics and the formation of pyrogenic compounds. The van Krevelen diagram was found useful to-at first sight-differentiate between chemical processes caused by fire and of the rehabilitation actions. Fire exerted SOM demethoxylation, dealkylation and dehydration. Our results indicate that soil management actions after the fire lead to an increase in aromaticity corresponding to the accumulation of lignin and polycyclic aromatic compounds. This suggests additional inputs from charred lignocellulosic biomass, including black carbon, that was incorporated into the soil during rehabilitation practices.

Ultra-high resolution mass spectrometry of physical speciation patterns of organic matter in fire-affected soils.

Fire is one of the most important modulating factors of the environment and the forest inducing chemical and biological changes on the most reactive soil component, the soil organic matter (SOM). Assuming the complex composition of the SOM, we used an ultra-high resolution mass spectrometry analysis technique to assess the chemical composition and fire-induced alterations in soil particle size fractions (coarse and fine) from a sandy soil in a Mediterranean oak forest at Doñana National Park (Southwest Spain). Electrospray ionization-Fourier transform ion cyclotron resonance mass spectrometry (ESI-FTICRMS) showed that the coarse fraction of soils not affected by fires consisted mainly of polyphenolic compounds consistent with little-transformed SOM and fresh biomass, whereas the fine fraction was enriched in protein and lipid like homologues suggesting microbially reworked SOM. In fire-affected SOM, the coarse fraction contained a high proportion of aromatic compounds, consistent with inputs of charred litter or in situ chemical transformation of the SOM. Analysis of the fine fraction revealed two differentiated chemical families pointing to the existence of two carbon pools; a native microbial-derived moiety composed of lipids and polypeptide compounds, and a secondary, pyrogenic or thermally-altered moiety rich in aromatic compounds. This work represents the first application of ultra-high resolution mass spectrometry to study the chemical composition of SOM in different particle size fractions.

Wildfire effects on lipid composition and hydrophobicity of bulk soil and soil size fractions under Quercus suber cover (SW-Spain).

Soil water repellency (hydrophobicity) prevents water from wetting or infiltrating soils, triggering changes in the ecosystems. Fire may develop, enhance or destroy hydrophobicity in previously wettable or water-repellent soils. Soil water repellency is mostly influenced by the quality and quantity of soil organic matter, particularly the lipid fraction. Here we report the results of a study on the effect of fire on the distribution of soil lipids and their role in the hydrophobicity grade of six particle size fractions (2-1, 1-0.5, 0.5-0.25, 0.25-0.1, 0.1-0.05 and <0.05mm) of an Arenosol under Quercus suber canopy at the Doñana National Park (SW-Spain). Hydrophobicity was determined using water drop penetration time test. Field emission scanning electron microscopy (FESEM) was used to assess the presence and morphology of the inorganic and organic soil components in the particle size fractions. Soil lipids were Soxhlet extracted with a dichloromethane-methanol mixture. Fatty acids (FAs) and neutral lipids were separated, derivatized, identified and quantified by gas chromatography/mass spectrometry and gas chromatography/flame ionization detection. The hydrophobicity values of soil samples and fractions were statistically different (P < 0.05), for both, the unburnt and burnt soils, and particle size fractions. All samples displayed a similar distribution of FAs, straight-chain saturated acids in the C14-C32 range, and neutral lipids (n-alkan-1-ols, n-alkanes), only differing in their relative abundances. Among possible biogeochemical mechanisms responsible for the changes in soil lipids, the observed depletion of long chain FAs (C≥24) in the coarse fraction is best explained by thermal cracking caused by the heat of the fire. The enrichment of long chain FAs observed in other fractions suggests possible exogenous additions of charred, lipid-rich, material, like cork suberin or other plant-derived macromolecules (cutins). Principal component analysis was used to study the relationships between hydrophobicity with soil organic matter and its different components. Extractable organic matter (EOM) and specifically long chain FAs content were positively correlated to soil hydrophobicity. Therefore, the latter could be used as biomarkers surrogated to hydrophobicity in sandy soils.

Effects of soil management techniques on soil water erosion in apricot orchards.

Soil erosion is extreme in Mediterranean orchards due to management impact, high rainfall intensities, steep slopes and erodible parent material. Vall d'Albaida is a traditional fruit production area which, due to the Mediterranean climate and marly soils, produces sweet fruits. However, these highly productive soils are left bare under the prevailing land management and marly soils are vulnerable to soil water erosion when left bare. In this paper we study the impact of different agricultural land management strategies on soil properties (bulk density, soil organic matter, soil moisture), soil water erosion and runoff, by means of simulated rainfall experiments and soil analyses. Three representative land managements (tillage/herbicide/covered with vegetation) were selected, where 20 paired plots (60 plots) were established to determine soil losses and runoff. The simulated rainfall was carried out at 55mmh(-1) in the summer of 2013 (<8% soil moisture) for one hour on 0.25m(2) circular plots. The results showed that vegetation cover, soil moisture and organic matter were significantly higher in covered plots than in tilled and herbicide treated plots. However, runoff coefficient, total runoff, sediment yield and soil erosion were significantly higher in herbicide treated plots compared to the others. Runoff sediment concentration was significantly higher in tilled plots. The lowest values were identified in covered plots. Overall, tillage, but especially herbicide treatment, decreased vegetation cover, soil moisture, soil organic matter, and increased bulk density, runoff coefficient, total runoff, sediment yield and soil erosion. Soil erosion was extremely high in herbicide plots with 0.91Mgha(-1)h(-1) of soil lost; in the tilled fields erosion rates were lower with 0.51Mgha(-1)h(-1). Covered soil showed an erosion rate of 0.02Mgha(-1)h(-1). These results showed that agricultural management influenced water and sediment dynamics and that tillage and herbicide treatment should be avoided.

The immediate effectiveness of barley straw mulch in reducing soil erodibility and surface runoff generation in Mediterranean vineyards.

Soil and water loss in agriculture is a major problem throughout the world, and especially in Mediterranean areas. Non-conservation agricultural practices have further aggravated the situation, especially in vineyards, which are affected by one of the highest rates of soil loss among cultivated lands. Therefore, it is necessary to find the right soil practices for more sustainable viticulture. In this regard, straw mulching has proven to be effective in other crop and fire affected soils, but, nonetheless, little research has been carried out in vineyards. This research tests the effect of barley straw mulching on soil erosion and surface runoff on vineyards in Eastern Spain where the soil and water losses are non-sustainable. An experiment was setup using rainfall simulation tests at 55 mm h(-1) over 1h on forty paired plots of 0.24 m(2): twenty bare and twenty straw covered. Straw cover varied from 48 to 90% with a median value of 59% as a result of the application of 75 g of straw per m(2). The use of straw mulch resulted in delayed ponding and runoff generation and, as a consequence, the median water loss decreased from 52.59 to 39.27% of the total rainfall. The straw cover reduced the median sediment concentration in runoff from 9.8 to 3.0 g L(-1) and the median total sediment detached from 70.34 to 15.62 g per experiment. The median soil erosion rate decreased from 2.81 to 0.63 Mg ha(-1)h(-1) due to the straw mulch protection. Straw mulch is very effective in reducing soil erodibility and surface runoff, and this benefit was achieved immediately after the application of the straw.