Who is open to change after the COVID-19 pandemic? Some insights from Germany.

The COVID-19 pandemic as a disruptive event was initially considered an opportunity for a transformation towards more sustainable lifestyles. In two telephone surveys with more than 1000 participants each, this study explored in October 2020 and May 2021 how people in Germany experienced the COVID-19 related lockdown restrictions. Specifically, the study investigated how the respondents felt their lives had been impaired during the pandemic, which changes they had experienced as particularly bothersome and which ones they perceived to be beneficial. A second objective was to analyze how these perceptions related to either the respondents' urge to return to "normal" or, in contrast, to their openness towards lifestyle changes. A third objective was to identify structural characteristics that would explain differences in perception and assessment of lifestyle changes. Overall, the study found that by 2021, the pandemic had impacted people more negatively than in 2020. Most respondents missed social contacts, traveling and cultural events. Among the positive changes, working from home and spending less money for useless things were particularly prominent. A third of the participants agreed that they would like to question their behavior before the pandemic and live more consciously. Apart from slight differences in gender, age and, most importantly, academic background, socio-economic characteristics hardly help explain why some people were more open to change than others. Therefore, a cluster analysis was conducted with the result that respondents with stronger pro-environmental attitudes were more open to change, no matter how much they felt affected by the pandemic. These findings indicate that when routines are disrupted, pro-environmental personal values and education contribute to the openness for alternative lifestyle choices.

Validation of a Skin Calorimeter to Determine the Heat Capacity and the Thermal Resistance of the Skin.

In vivo determination of the skin's thermal properties is of growing interest. Several types of sensors are being designed and tested. In this field, we have developed a skin calorimeter for the determination of the heat flow, the heat capacity and the thermal resistance of the skin. The calorimeter calibration consists of the determination of the parameters of the model we have chosen to represent the behavior of the device. This model considers the heat capacity and the thermal resistance of the skin, which depend on the case (body zone, subject, physical state, etc.) and also have a strong time dependence. Therefore, this work includes a validation study with reference materials. Finally, it is concluded that the heat capacity determined is a function of the thermal penetration depth of the measurement characteristics. In the case of high thermal conductivity materials in which the thermal penetration is nearly total, the heat capacity obtained coincides with that of the reference material sample.

The effects of temperature and salinity on the blood chemistry and survival of juvenile Atlantic tarpon Megalops atlanticus.

Atlantic tarpon Megalops atlanticus are highly migratory sportfish that support recreational fisheries throughout their range. In US waters, juveniles can be found in coastal and estuarine habitats along the Gulf of Mexico and Atlantic seaboard, with temperature limiting their northern latitudinal distribution. Juveniles may overwinter in these areas during the first several years of life. Low temperatures are known to cause mortality in adults, but the challenges of temperature are less understood for juveniles. Furthermore, salinity, which can change dramatically in these habitats, may have a synergistic effect with temperature. To examine the physiological effects of temperature and salinity on juvenile tarpon, wild fish were acclimated to a range of conditions that potentially occur in the northern range of their estuarine habitats. The haematology of juvenile tarpon was examined in two salinity (≤2 and ≥30 ppt) and temperature (15 and 25°C) treatments, followed by a low-temperature tolerance test. After 2 weeks in treatment conditions, blood samples were analysed for haematocrit, pH, red blood cell concentration, haemoglobin content and plasma osmolality. Increased plasma osmolality was observed in fish at low temperature (15°C compared to 25°C) and at high salinity (≥30 ppt compared to ≤2 ppt). Blood pH was increased at 15°C compared to 25°C, with the highest pH at 15°C and low salinity. Haemoglobin, haematocrit and red blood cell concentration were higher at 25°C than 15°C, with haemoglobin lowest at 15°C and low salinity. For the low-temperature tolerance test, all fish were acclimated to 15°C for 2 weeks, then transferred to separate tanks where temperature was gradually decreased at 0.9 ± 0.1°C/h until fish lost equilibrium. Fish at low salinity lost equilibrium more rapidly (1 ppt, 12.65 ± 0.46°C) than fish at high salinity (30 ppt, 11.26 ± 0.14°C). The results indicate juvenile tarpon are susceptible to low temperature, which is exacerbated by low salinity, findings useful in the assessment of juvenile tarpon overwintering habitat.

Effects of temperature on metabolic rate and lower dissolved oxygen tolerance of juvenile speckled peacock bass Cichla temensis.

The speckled peacock bass Cichla temensis is a popular sport and food fish that generates substantial angling tourism and utilitarian harvest within its range. Its popularity and value make this species important for management and a potential aquaculture candidate for both fisheries enhancement and food fish production. However, little is known of optimal physiochemical conditions in natural habitats, which also are important for the development of hatchery protocols for handling, spawning and grow-out. Speckled peacock bass have been documented to have high sensitivity to extreme temperatures, but the metabolic underpinnings have not been evaluated. In this study, the effects of temperature (25, 30 and 35°C) on the standard metabolic rate (SMR) and lower dissolved oxygen tolerance (LDOT) of juvenile speckled peacock bass (mean ± standard error total length 153 ± 2 mm and wet weight 39.09 ± 1.37 g) were evaluated using intermittent respirometers after an acclimation period of 2 weeks. Speckled peacock bass had the highest SMR at 35°C (345.56 ± 19.89 mgO2  kg-1 h-1 ), followed by 30°C (208.16 ± 12.45 mgO2  kg-1 h-1 ) and 25°C (144.09 ± 10.43 mgO2  kg-1 h-1 ). Correspondingly, the Q10 , or rate of increase in aerobic metabolic rate (MO2 ) relative to 10°C, for 30-35°C was also greater (2.76) than from 25 to 30°C (2.08). Similarly, speckled peacock bass were the most sensitive to hypoxia at the warmest temperature, with an LDOT at pO2 of 90 mmHg (4.13 mg l-1 ) at 35°C compared to pO2 values of 45 mmHg (2.22 mg l-1 ) and 30 mmHg (1.61 mg l-1 ) at 30 and 25°C, respectively. These results indicate that speckled peacock bass are sensitive to temperatures near 35°C, therefore we recommend managing and rearing this species at 25-30°C.

Long-term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established. OBJECTIVES: To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD. METHODS: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I2 = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I2 = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I2 = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I2 = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I2 = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I2 = 0%). CONCLUSION: In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.

Covid-19 and small lodging establishments: A break-even calibration analysis (CBA) model.

The COVID-19 pandemic foiled the hospitality industry offering no clear insight as to what to expect regarding the emergence of possible new industry standards as likely corollaries of the pandemic. The accommodation sector is one of the most affected sectors in the hospitality industry, especially small lodging establishments incurring the most dramatic brunt of the pandemic's long-tail effects. This study employed a breakeven (BC) analysis to examine the pandemic's opportunity cost and the financial resilience efforts that SLEs should undertake to bounce back or bounce forward. The case study centers on the Superior Small Lodgings (SSL) of Florida, USA. The results suggest that the opportunity cost varies depending on the SLE profiles, and hence resilience approaches should consider heterogeneous business responses.

The relationship between career adaptability, hope, resilience, and life satisfaction for hospitality students in times of Covid-19.

This study investigates the antecedents and effects of hospitality students' coping mechanisms during the COVID-19 pandemic. The relationship between career adaptability, hope, resilience, and life satisfaction are explored to unveil students' adaptability during times of crisis. The findings confirmed that hope is an important driver of resilience and life satisfaction. Despite all the negativity and uncertainty about jobs and careers during the COVID-19 pandemic, resilience has a double acting effect on the students' life satisfaction via individual and community resilience. Critical implications for academic institutions and the hospitality industry are presented. As the industry recovers from the pandemic and moves toward normality, the potential impact of career adaptability, hope, resilience, and life satisfaction on future job pursuit and career magnetism towards particular industry or organizations should be considered.

Meta-Analysis of Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome Treated With Coronary Stenting.

We aimed to evaluate if a shorter course of DAPT followed by P2Y12 inhibitor monotherapy is as effective as a 12-month course with fewer bleeding events. PubMed, Scopus, and Cochrane Central were searched for randomized controlled trials of ACS patients comparing dual antiplatelet therapy (DAPT) for 1 to 3 months followed by a P2Y12 inhibitor to 12-month DAPT. Quality assessment was performed with the Cochrane Collaboration risk of bias assessment tool. Five randomized clinical trials were included, with a total of 18,046 participants. Antiplatelet strategies were aspirin and P2Y12 inhibitor for 12 months compared with aspirin and P2Y12 inhibitor for 1 to 3 months followed by P212 inhibitor alone. Patients randomized to 1 to 3 months of DAPT followed by P2Y12 inhibitor monotherapy had lower rates of major bleeding (1.42% vs 2.53%; OR 0.53; 95% CI 0.42-0.67; p < 0.001; I2 = 0%) and all-cause mortality (1.00% vs 1.42%; OR 0.71; 95% CI 0.53-0.95; p = 0.02; I2=0%) with similar major adverse cardiac events (MACE) (2.66% vs 3.11%; OR 0.86; 95% CI 0.71 - 1.03; p = 0.10; I2 = 0 %) compared to 12 months of DAPT. In conclusion, shorter course of DAPT for 1 to 3 months followed by P2Y12 inhibitor monotherapy reduces major bleeding and all course mortality without increasing major adverse cardiac events compared with traditional DAPT for 12 months.

Rivaroxaban versus warfarin in patients with atrial fibrillation enrolled in Latin America: Insights from ROCKET AF.

BACKGROUND: ROCKET AF demonstrated the efficacy and safety of rivaroxaban compared with warfarin for the prevention of stroke and systemic embolism (SE) in patients with atrial fibrillation (AF). We examined baseline characteristics and outcomes in patients enrolled in Latin America compared with the rest of the world (ROW). METHODS: ROCKET AF enrolled 14,264 patients from 45 countries. Of these, 1,878 (13.2%) were from 7 Latin American countries. The clinical characteristics and outcomes (adjusted by baseline characteristics) of these patients were compared with 12,293 patients from the ROW. Treatment outcomes of rivaroxaban compared with warfarin were also stratified by region. RESULTS: The annual rate of stroke/SE was similar in those from Latin American and ROW (P= .63), but all-cause and vascular death were significantly higher than in ROW (HR 1.40, 95% CI 1.20-1.64; HR 1.38, 95% CI 1.14-1.68; P< .001). Rates of major or nonmajor clinically relevant bleeding tended to be lower in Latin America (HR 0.89, 95% CI 0.80-1.0; P= .05). Rates of stroke and/or SE were similar with rivaroxaban and warfarin in patients from Latin America and ROW (HR 0.83, 95% CI 0.54-1.29 vs HR 0.89, 95% CI 0.75-1.07; interaction P= .77). CONCLUSIONS: Patients with AF in Latin America had similar rates of stroke and/or SE, higher rates of vascular death, and lower rates of bleeding compared with patients in the ROW. The effect of rivaroxaban compared with warfarin in Latin America was similar to the ROW. Further studies analyzing patient- and country-specific determinants of these regional differences in Latin America are warranted.

Dipyridamole Inhibits Lipogenic Gene Expression by Retaining SCAP-SREBP in the Endoplasmic Reticulum.

Sterol regulatory element-binding proteins (SREBPs) are master transcriptional regulators of the mevalonate pathway and lipid metabolism and represent an attractive therapeutic target for lipid metabolic disorders. SREBPs are maintained in the endoplasmic reticulum (ER) in a tripartite complex with SREBP cleavage-activating protein (SCAP) and insulin-induced gene protein (INSIG). When new lipid synthesis is required, the SCAP-SREBP complex dissociates from INSIG and undergoes ER-to-Golgi transport where the N-terminal transcription factor domain is released by proteolysis. The mature transcription factor translocates to the nucleus and stimulates expression of the SREBP gene program. Previous studies showed that dipyridamole, a clinically prescribed phosphodiesterase (PDE) inhibitor, potentiated statin-induced tumor growth inhibition. Dipyridamole limited nuclear accumulation of SREBP, but the mechanism was not well resolved. In this study, we show that dipyridamole selectively blocks ER-to-Golgi movement of the SCAP-SREBP complex and that this is independent of its PDE inhibitory activity.

Brain morphology of Gymnura lessae and Gymnura marmorata (Chondrichthyes: Gymnuridae) and its implications for batoid brain evolution.

Although skeletal and muscle anatomy has supported Gymnuridae as the sister group of the most derived myliobatoids, recent studies based on molecular characters suggest that the family branches into a more basal position than previously thought. This study aims to understand the brain anatomy of the genus Gymnura and its importance in the evolution of the batoid brain. The brain anatomy of Gymnura lessae and Gymnura marmorata is relatively simple. They exhibit a small brain and telencephalon (T), where the latter is wider than it is longer, and the division of the posterior central nucleus is poorly developed. The cerebellum (C) is symmetrical and is not highly foliated. Unlike other species, the brain auricles are smooth, and the posterior auricles exhibit a diagonal arrangement, not always forming a bridge over the fourth ventricle. These auricles are larger in G. marmorata. A principal component analysis based on 20 morphological variables, revealed a separation between species, and multivariate analysis of variance identified significant differences. The most important variables in species segregation were a deeper olfactory bulb in G. lessae and a greater distance between the bulbs in G. marmorata. Contrary to the body anatomy, the brain anatomy reveals that Gymnura has a simpler and more primitive brain than most derived myliobatoids. Our results are consistent with the evidence from phylogenies developed with molecular data, where gymnurids are a basal group within myliobatoids.

COVID-19 fulminant myocarditis: a case report.

BACKGROUND: Fulminant myocarditis is a catastrophic disease with high mortality and complications. A viral aetiology is frequent and the implication of SARS-CoV-2 is not yet known. CASE SUMMARY: A 38-year-old woman who recently arrived from Spain presented with palpitations that started suddenly 3 days prior to presentation and were associated with haemodynamic instability, without dyspnoea or chest pain. We found features of myopericarditis on the electrocardiogram and severe systolic dysfunction on the echocardiogram. The chest tomography showed findings which suggested COVID-19 infection, and PCR for SARS-CoV-2 was positive. The cardiac magnetic resonance image showed Lake Louise criteria for myocarditis. The patient was treated with immunomodulatory, steroid, and immunoglobulin therapy, with a favourable clinical response. DISCUSSION: The importance of this case lies in highlighting the severe cardiac involvement in a young patient, without previous risk factors, positive for COVID-19, and the favourable response to the medical treatment given.

A Method to Determine Human Skin Heat Capacity Using a Non-Invasive Calorimetric Sensor.

A calorimetric sensor has been designed to measure the heat flow dissipated by a 2 x 2 cm2 skin surface. In this work, a non-invasive method is proposed to determine the heat capacity and thermal conductance of the area of skin where the measurement is made. The method consists of programming a linear variation of the temperature of the sensor thermostat during its application to the skin. The sensor is modelled as a two-inputs and two-outputs system. The inputs are 1) the power dissipated by the skin and transmitted by conduction to the sensor, and 2) the power dissipated in the sensor thermostat to maintain the programmed temperature. The outputs are 1) the calorimetric signal and 2) the thermostat temperature. The proposed method consists of a sensor modelling that allows the heat capacity of the element where dissipation takes place (the skin) to be identified, and the transfer functions (TF) that link the inputs and outputs are constructed from its value. These TFs allow the determination of the heat flow dissipated by the surface of the human body as a function of the temperature of the sensor thermostat. Furthermore, as this variation in heat flow is linear, we define and determine an equivalent thermal resistance of the skin in the measured area. The method is validated with a simulation and with experimental measurements on the surface of the human body.

Developmental and epileptic encephalopathy due to SZT2 genomic variants: Emerging features of a syndromic condition.

Seizure threshold 2 (SZT2) gene mutations have been associated with developmental and epileptic encephalopathies (DEEs). Following a literature review, we collected 22 patients and identified the main clinical features related to SZT2 variants that are epilepsy with onset within the first years of life, intellectual disability (ID), macrocephaly with dysmorphic facial features, corpus callosum (CC) shape abnormalities, and cortical migration disorders. Moreover, we identified the c.7825T>G homozygous missense variant in SZT2 in two female siblings presenting with focal seizures, mild-moderate ID, behavioral disturbances, and facial dysmorphisms. Interictal Electroencephalogram (EEG) and ictal EEG were both informative and revealed, respectively, temporal bilateral asynchronous slow and epileptiform abnormalities and a focal onset in both of them. Neuroimaging study revealed a thick and abnormally shaped CC. Seizure threshold 2 has been identified as a component of the KICSTOR complex, a newly recognized protein complex involved in the mammalian target of rapamycin (mTOR) pathway. mTOR signaling dysregulation represents common pathogenetic mechanisms that can explain the presence of both epileptogenesis and ID. Even if few cases had been reported, a new clinical phenotype is emerging, and recent hypothesis of hyperactivation of mTORC1 signaling might also open to targeted treatments, challenging an early diagnosis as of paramount importance.

Network meta-analysis of His bundle, biventricular, or right ventricular pacing as a primary strategy for advanced atrioventricular conduction disease with normal or mildly reduced ejection fraction.

INTRODUCTION: Although right ventricular pacing (RVP) may impair ventricular function, it is commonly used for advanced atrioventricular block (AVB) and normal or mildly reduced ejection fraction (EF). We aimed to compare His bundle pacing (HBP), biventricular pacing (BiVP), and RVP for advanced AVB in patients with normal or mildly reduced EF. METHODS AND RESULTS: MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, Scopus, and Web of Science were searched. Outcomes were all-cause death, heart failure hospitalizations (HFH), EF, left ventricular volumes, 6-minute walk test, and QRS duration. HBP or BiVP was compared with RVP. Subsequently, network meta-analysis compared the three pacing options. Our protocol was registered in PROSPERO (CRD42018094132). Six studies compared BiVP and RVP (704 vs 614 patients) and four compared HBP and RVP (463 vs 568 patients). Follow-up was 6 months to 5 years. There was significantly lower mortality and HFH with HBP or BiVP as compared with RVP (odds ratio [OR], 0.66, [0.51-0.85], P = .002; OR, 0.61 [0.45-0.82], P < .001, respectively]. HBP or BiVP also showed significant increase in EF and decrease in QRS duration (mean difference [MD], 5.27 [3.86-6.69], P < .001; MD -42.2 [-51.2 to -33.3], P < .001, respectively). In network meta-analysis, HBP and BiVP were associated with significantly improved survival compared to RVP, with surface under the cumulative ranking curve (SUCRA) probability of 79.4%, 69.4%, and 1.2% for HBP, BiVP, and RVP, respectively. For HFH, SUCRA probability was 91.5%, 57.2%, and 1.3%, respectively. CONCLUSION: HBP or BiVP were the superior strategies to reduce all-cause death and HFH for advanced AVB with normal or mildly reduced EF, with no significant difference between BiVP and HBP.

Neuroanatomy of two species of genus Myliobatis (Chondrichthyes: Myliobatoidea) / Neuroanatomía de dos especies del género Myliobatis (Chondrichthyes: Myliobatoidea)

Several studies on the elasmobranchs neuroanatomy have shown that their brain is more complex than previously thought, and had significant intra and interspecific variations. The objective of this work was conducting a comparative encephalic neuroanatomy study of two species of genus Myliobatis. In total, 16 organisms of genera Myliobatis californica and Myliobatis longirostris, collected in the coasts of Kino Bay, Sonora, Mexico, were used. In Myliobatis, the brain has a long telencephalon and the posterior central nucleus is poorly developed. Their cerebellum is asymmetric, has several sulci, most of which are transversally oriented, with four lobes (anterior, medium and two posterior), a condition which has not been reported for any other species. It was observed that, despite the morphology of M. californica and M. longirostris is similar, there are some significant differences. Both species have moderate foliation, but M. californica has more sulci. In the diencephalon of M. californica, it was observed that the lobes of the infundibulum are oval-shaped and separated, while in M. longirostris, such lobes are rounded and near the medium line. It has to be highlighted that Myliobatis belongs to the most derived batoid group; nevertheless, its brain is considerably less complex, as compared to what has been reported for the most derived milyobatoids species.

Diversos estudios sobre la neuroanatomía de los elasmobranquios han demostrado que el cerebro es más complejo de lo que se pensaba y presenta considerables variaciones tanto intra como interespecíficas. El objetivo de este trabajo fue realizar un estudio de neuroanatomía comparada del encéfalo de dos especies del género Myliobatis. Se utilizaron un total de 16 organismos de Myliobatis californica y Myliobatis longirostris, los cuales fueron colectados en las costas de Bahía Kino, Son., México. El cerebro de Myliobatis tiene un telencéfalo largo, el núcleo central posterior está poco desarrollado; el cerebelo es asimétrico, presenta surcos que en su mayoría están orientados transversalmente, con cuatro lóbulos (anterior, medio y dos posteriores), condición que no ha sido reportada para otra especie. Se observó que, aunque M. californica y M. longirostris presentan una morfología similar existen ciertas diferencias. En ambas especies presentan una foliación moderada; sin embargo, en M. californica se observan más surcos. En el diencéfalo de M. californica se observa que los lóbulos del infundíbulo son ovalados y están separados, mientras que en M. longirostris son redondeados y se encuentran próximos a la línea media. Es importante señalar que, pese a que Myliobatis pertenece al grupo de batoideos más derivado, su cerebro es considerablemente menos complejo de lo que se ha reportado para las especies de miliobatoideos más derivadas.

In-Hospital Management and Outcomes of Patients With Acute Myocardial Infarction and Influenza.

Patients with influenza infection are at increased risk of acute myocardial infarction (AMI). There are limited data on the short-term prognosis and management of patients with AMI and concomitant influenza. We examined the National Inpatient Sample from 2010 to 2014 for adult patients with a diagnosis of AMI. Patients were stratified into those with or without concomitant influenza. In-hospital therapies and outcomes were compared between groups in unadjusted and adjusted analyses. Standardized differences of >10% and p values <0.05 were considered significant. Propensity matching was performed using a caliper radius of 0.01*sigma. Of 4,285,641 patients with a discharge diagnosis of AMI, 12,830 had concomitant influenza. Patients with influenza were older, had a higher burden of co-morbidities, and more often presented with non-ST elevation AMI (90% vs 74%) as compared with those without influenza. Coronary angiography (23% vs 54%) and revascularization (11% vs 41%) were less often pursued in AMI patients with influenza. Patients with AMI and influenza had elevated in-hospital mortality (14%) and multiorgan failure (33%). In a propensity-matched analysis of 23,415 patients, in-hospital mortality (odds ratio [OR] 1.26; p = 0.01), acute kidney injury (OR 1.36; p <0.01), multiorgan failure (OR 1.81; p <0.01), length-of-stay, and hospital costs were significantly higher in those with influenza. In conclusion, patients with AMI and concomitant influenza have an adverse in-hospital prognosis as compared with those without influenza.

A meta-analysis of arrhythmia endpoints in randomized controlled trials of transendocardial stem cell injections for chronic ischemic heart disease.

INTRODUCTION: The electrophysiologic impact of cell-based therapy on the injured myocardium remains highly controversial. We aimed to perform a meta-analysis of studies comparing arrhythmia burden following transendocardial stem cell therapy vs placebo in patients with chronic ischemic heart disease (CIHD). METHODS AND RESULTS: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched. No restriction of stem cell type was specified. The outcomes included sustained supraventricular or ventricular arrhythmias (VAs), sudden cardiac death (SCD), and resuscitated sudden cardiac arrest (SCA). Effect sizes were reported as odds ratio (OR) and 95% CI. Poisson regression was used to account for zero-events data. Twelve randomized trials that included 736 patients (384 in the cell therapy group and 352 in the placebo group) were analyzed. Six different cell types were used. Follow-up ranged from 6 to 12 months. There was a significant decrease in risk of SCD in the cell therapy group, (FE OR, 0.19 [0.04, 0.93]; P = .04). In subgroup analysis, there was a significantly lower risk of SCD or resuscitated SCA in the cell therapy group limited to studies that did not use skeletal myoblasts, (FE OR, 0.23 [0.06, 0.83]; P = .03). There was no significant difference in the incidence of sustained VA between groups (FE OR, 0.91 [0.47, 1.77]; P = .8), even after stratifying by cell type. There was no difference in supraventricular arrhythmias between groups. CONCLUSION: Nonskeletal myoblast transendocardial cell therapy was associated with a significantly lower risk of SCD or resuscitated SCA compared to control, with no proarrhythmic effects.

Prevention of Stroke in Atrial Fibrillation After Coronary Stenting.

Background and Purpose- The optimal antithrombotic strategy to balance thromboembolic and bleeding events, especially acute stroke, for patients with atrial fibrillation following coronary stenting remains a matter of debate. We conducted a network meta-analysis to identify the antithrombotic regimen associated with the lowest rate of bleeding and thromboembolic events in atrial fibrillation after coronary stenting. Methods- PubMed, Scopus, and Cochrane Central were searched for randomized controlled trials and observational studies of patients with atrial fibrillation after coronary stenting. The outcomes of interest were stroke, myocardial infarction, major adverse cardiac events, mortality, and major bleeding. A network meta-analysis was performed comparing the available antithrombotic regimens in the literature. Results- Three randomized and 15 observational studies were included, with a total of 23 478 participants. Median follow-up was 2 years. Network meta-analysis demonstrated that vitamin K antagonist plus single antiplatelet therapy or direct-acting oral anticoagulant plus single antiplatelet therapy were the most effective regimens in preventing stroke. Direct-acting oral anticoagulant regimens were associated with lower major bleeding rates than vitamin K antagonist regimens. Regimens with dual antiplatelet therapy were associated with lower rates of myocardial infarction. Vitamin K antagonist plus dual antiplatelet therapy was associated with a lower mortality and low-dose direct-acting oral anticoagulants with decreased major cardiovascular adverse events. Conclusions- Direct-acting oral anticoagulant regimens were associated with less major bleeding and major cardiovascular adverse events, but vitamin K antagonists were associated with decreased mortality and stroke. These results suggest that the decision of antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention needs to be individualized.