Anticoagulant cessation following atrial fibrillation ablation: limits of the ECG-guided approach

Introduction: Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management.

Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation.

Expert commentary: The present clinical perspective suggests that, at least within patients with severely enlarged left atrium, previous cardiac surgery and catheter or surgical AF ablation, especially if repeated, assessment of atrial contractility by transthoracic echocardiography should be performed before discontinuing OAC in patients who maintain sinus rhythm, confirmed by serial ECG or Holter monitorings.     

Patterns of cortical thickness associated with impulse control disorders in Parkinson's disease

Previous functional neuroimaging studies in Parkinson's disease (PD) patients with impulse control disorders (ICDs) demonstrated dysfunction of the reward network, although the extent of anatomical changes is unclear. The aim of this study was to measure brain cortical thickness and subcortical volumes, and to assess their relationship with presence and severity of symptoms, in PD patients with and without ICDs. We studied 110 PD patients (N = 58 with ICDs) and 33 healthy controls (all negative for ICDs) who underwent an extensive neurological, neuropsychological, and behavioral assessment as well as structural 1.5 Tesla magnetic resonance imaging (MRI). Between‐group differences in brain cortical thickness and subcortical volumes, assessed with the FreeSurfer 5.1 tool, were analyzed. In patients with ICDs, we found significant cortical thinning in fronto‐striatal circuitry, specifically in the right superior orbitofrontal, left rostral middle frontal, bilateral caudal middle frontal region, and corpus callosum, as well as volume reduction in the right accumbens and increase in the left amygdala. Finally, we observed a positive association relationship between severity of impulsive symptoms and left rostral middle frontal, inferior parietal, and supramarginal areas. These results support the involvement of both reward and response inhibition networks in PD patients with ICDs. Moreover, their severity is associated with alterations in brain regions linked with reward and top‐down control networks. Increased understanding of the mechanisms underlying impulsive and compulsive behaviors might help improve therapeutic strategies for these important disorders. © 2015 International Parkinson and Movement Disorder Society     

Possible prognostic role of IL-17R in osteosarcoma

Purpose An intense vascularization of primary tumor mass is associated with a fatal outcome in various types of invasive solid tumors. Interleukin 17 (IL-17), a CD4+ T-cell-derived cytokine, stimulates some tumor cells to secrete angiogenic factors, among which venous endothelial growth factor (VEGF). We assessed whether the expression of IL-17 receptor (IL-17R) represents a marker for the metastasizing ability of osteosarcoma (OS), a very malignant bone tumor. Methods We immunoassayed the amount of VEGF secreted by three OS cell lines expressing IL-17R in differing amounts: HOS, MG63 and U-2 OS, and their sensitivity to IL-17 stimulation to secrete VEGF. Results U-2 OS, which best expresses IL-17R, secreted the highest amounts of VEGF and was the most sensitive to IL-17, whereas MG63 expressed the lowest level of IL-17R, secreted the lowest amount of VEGF and was not sensitive to IL-17. IL-17R expression correlated with VEGF secretion and IL-17 sensitivity. U-2 OS expressed the most dedifferentiated phenotype, which is associated with tumor malignancy. Conclusions These results suggest that IL-17R in OS might represent a marker of tumor metastasis potential.     

Family Functioning and Dysfunctional Eating Among Italian Adolescents: The Moderating Role of Gender

The first aim of this study was to examine the association between different dimensions of family functioning and dysfunctional eating in a sample of Italian adolescent boys and girls. The second aim was to investigate whether gender moderates the relationship between family functioning and dysfunctional eating. Seven hundred and twenty seven adolescents (500 boys and 227 girls) with ages ranging from 15 to 18 years completed a survey of self-report measures. Findings from hierarchical multiple regression analysis suggested that aspects of family functioning such as flexibility, cohesion, disengagement, enmeshment, rigidity and chaotic were related to dysfunctional eating in adolescents. Additionally the results indicated differences between boys and girls, in particular dysfunctional eating in adolescent boys seemed to be more affected by dimensions of enmeshment and disengagement than dysfunctional eating in girls. This research highlights the important role of various aspects of family functioning in relation to dysfunctional eating in adolescents.     

Silk Fibroin Processing from CeCl3 Aqueous Solution: Fibers Regeneration and Doping with Ce(III)

Silk fibroin (SF) obtained from Bombyx mori cocoon is a very promising biopolymer. It can be processed from aqueous solutions to obtain many versatile scaffolds useful in optoelectronics, photonics, and biomedicine. Aqueous solutions are prepared by dissolving degummed fibroin with chaotropic agents and then purifying by dialysis. This work presents, for the first time, a solubilization protocol, involving CeCl₃·7H₂O as chaotropic salt in water and ethanol, that allows to regenerate SF under a fibrous form, unlike the standard Ajisawa’s method, which uses CaCl₂ and allows to obtain aqueous gels. All the experimental analyses performed (SEM, XPS, WAXS, ATR‐FTIR, NMR) suggest that the fiber recovered preserves most of the morphological and structural features of the pristine SF and is doped with Ce(III) ions, that interact mainly with the oxygen atoms of C?O moieties and side‐chains of amino acids. Ce(III) doped SF could be the base for new luminescent materials.     

Relationships between blood pressure,anthropometric characteristics and blood lipids in high- and low-altitude populations from Central Asia

We studied the relationships between blood pressure, anthropometric characteristics and blood lipids in 72 low altitude (LA) Uighurs (600m), 91 LA-Kirghizs (900 m), 117 medium altitude (MA) Kazakhs (2100m) and 94 high altitude (HA) Kirghizs (3200 m). All subjects were male and had a similar age (p = ns, ANOVA; range for all 374 subjects: 18-66 yr). Body weight (Wt), body mass index (BMI) and the sum of four skinfolds (4SF) were significantly lower in HA-Kirghizs than the remaining groups (p < 0:0005, p < 0:0005 and p < 0:05 respectively, ANOVA). However, no difference was found in body fat distribution as detected by waist: hip circumference (WHR) and triceps : subscapular skinfold ratios (TSR; p = ns, ANOVA). Stage 1 hypertension was detected in 18% of LA-Uighurs, 2% of LA-Kirghizs, 4% of MA-Kazakhs and 1% of HA-Kirghizs; stage 2 hypertension was detected in 2% of LA-Uighurs and none of the remaining groups; no subject had stage 3 hypertension (The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure 1997). Blood cholesterol (CH) and triglycerides (TG) did not differ between groups (p = ns, ANOVA). The relationships between systolic (SBP) or diastolic (DBP) blood pressure and age, Wt, BMI, 4SF, WHR, TSR, CH and TG were independent from altitude (p = ns, ANCOVA). In the pooled sample (n = 374), age explained 1 and 3% of SBP (p < 0:05) and DBP (p < 0:005) variance respectively, Wt was the best predictor of SBP and DBP explaining 11 and 10% of their variance respectively (p < 0:0001) and CH explained 5% of DBP variance (p < 0:0001). In conclusion, hypertension is more frequent in LA- than MA- and HA-subjects from Central Asia. However, anthropometric characteristics and blood lipids do similarly contribute to explain blood pressure in these subjects.

An Bewohnern des Tieflandes (LA), mittlerer Hohen (MA) und an Hochlandbevolkerungen (HA) wurde der Zusammenhang zwischen dem Blutdruck, anthropometrischen Charakteristika und Blutlipiden untersucht. Im einzelnen handelt es sich bei den untersuchten Bevolkerungen um 72 LA-Uiguren (600m), 91 LA-Kirgis (900 m), 117 MA-Kasaks (2100 m) und 94 HA-Kirgis (3200 m). Es handelt sich ausschliesslich um mannliche Probanden ahnlichen Alters (p = ns, ANOVA; Variationsbreite fur alle 374 Probanden: 18-66 Jahre). Das Korpergewicht (Wt), der Body Mass Index (BMI) und die Summe von vier Hautfaltendicken (4SF) war bei den HA-Kirgis signifikant niedriger als in den ubrigen Gruppen (p < 0:0005; p < 0:0005 bzw. p < 0:05, ANOVA). In der Verteilung des Korperfetts, die uber das Verhaltnis von Taillen- zu Huftumfang (WHR) sowie das Verhaltnis von Trizeps-Hautfaltendicke zur Dicke der subskapularen Hautfalte (TSR; p = ns, ANOVA) erfasst wurde, liessen sich jedoch keine Unterschiede beobachten. Ein Bluthochdruck im Stadium 1 liess sich bei 18% der LA-Uiguren, 2% der LA.Kirgis 4% der MA-Kasaks und 1% der HA-Kirgis beobachten; ein Bluthochdruck des Stadiums 2 wurde lediglich bei 2% der LA-Uiguren beobachtet, wahrend er in den ubrigen Bevolkerungen nicht vorkam; ein Bluthochdruck des Stadiums 3 wurde in keiner Bevolkerung beobachtet (The Joint National Committee on Prevention, Detection, Evaluation and Treatment of Hypertension 1997). In den Blutkonzentrationen von Cholesterin (CH) und Triglyzeriden (TG) wurden keine Unterschiede zwischen den Gruppen beobachtet (p = ns, ANOVA). Der Zusammenhang zwischen dem systolischen (SBP) bzw. dem diastolischen Blutdruck (DBP) und dem Alter, Wt, BMI, 4SF, WHR, TSR, CH und TG war von der Hohenlage des Wohnortes unabhangig (p = ns; ANCOVA). In der gepoolten Stichprobe (n = 374), erklarte das Alter 1 bzw. 3% der Varianz des SBP (p < 0:05) bzw. des DBP (p < 0:005). Das Gewicht erwies sich als bester Pradiktor des SBP und DBP, es erklarte 11 bzw. 10% der Varianz (p < 0:0001). CH erklarte 5% der Varianz des DBP (p < 0:0001). Zusammenfassend lasst sich festhalten, dass Bluthochdruck in Zentralasien bei LA-Bevolkerungen haufiger vorkommt als in MA- und HA-Bevolkerungen. Anthropometrische Charakteristika und Blutfette tragen jedoch in ahnlicher Weise zur Erklarung des Blutdruckes bei allen Probanden bei.

On a etudie les associations entre la pression arterielle, les caracteristiques anthropometriques et les lipides sanguins chez 72 Ouigour d'altitude basse (AB) (600 m), 91 AB-Khirghiz (900 m), 117 Kazakhs d'altitude moyenne (AM) (2100m) et 94 Kirghiz d'altitude haute (AH) (3200 m). Tous les sujets etaient des hommes adultes de moyenne d'age similaire (p = ns, ANOVA; etendue de variation pour l'ensemble des 374 sujets: 18-66 ans). Le poids corporel (Pds), l'indice de masse corporelle (IMC) et la somme des quatre plis cutanes (S4PC) etaient significativement plus bas chez les AH-Kirghiz que dans les autres groupes (respectivement p < 0:0005, p < 0:0005 et p < 0:05 ANOVA). Cependant, on n'a pas trouve de difference dans la distribution de la graisse corporelle telle que determinee par les rapports des circonferences taille/hanches (RTH) et par le rapport des plis cutanes triceps/sous-scapulaire (RTS; p = ns, ANOVA). L'hypertension de niveau 1 est presente chez 18% des AB-Ouigour, 2% des AB-Kirghiz, 4% des AMKazakh et 1% des AH-Kirghiz. Le niveau 2 d'hypertension a ete detecte chez 2% des AB-Ouigour seulement. Aucun des sujets n'avait atteint le niveau 3 d'hypertension (Comite de Prevention, Detection, Evaluation et Traitement de la Haute Pression Arterielle, 1997). Le cholesterol sanguin (CS) et les triglycerides (TG) ne differaient pas entre groupes (p = ns, ANOVA). Les associations entre pressions arterielle systolique (PAS), diastolique (PAD) et l'age, le Pds, l'IMC, la S4PC, le RTH, le RTS, le CS et les TG sont independantes de l'altitude (p = ns, ANCOVA). L'age expliquait respectivement 1 et 3% des variances de la PAS (p < 0:05) et de la PSD (p < 0:005), le Pds etant le meilleur predicteur de la PAS et de la PAD, expliquant respectivement 11% et 10% de leur variance (p, < 0:0001), le CS expliquant 5% de la variance en PAD (p < 0:0001). En conclusion, l'hypertension est plus frequente chez les sujets d'AB- que d'AM- et d'AH- en Asie Centrale. Les caracteristiques anthropometriques et les lipides sanguins contribuent demaniere semblable a expliquer la pression arterielle chez les sujets examines.     

Dual Vulnerability of Being Both a Teen and an Immigrant Parent: Illustrations from an Italian Context

Italy has experienced a recent surge in immigration, which has led to an increase in the country’s birth rate. Many immigrant mothers are adolescent parents. 30 adolescent mothers (17 recent immigrants and 13 adolescents of Italian descent) completed measures of adolescent self-development and motherhood, perceived availability and satisfaction with social support, and emotional and behavioral characteristic of their children. Findings suggest that immigrant teen mothers show more difficulties related to parenting than do Italian born teen mothers. In particular, immigrant teen mothers report lower levels of social support satisfaction and availability, higher levels of parent–child dysfunction, and experience motherhood and child behavior as more problematic. The findings highlight and confirm the need for well-designed, specific supportive services for adolescent immigrant mothers.