Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Microplastic pollution in fragile coastal ecosystems with special reference to the X-Press Pearl maritime disaster, southeast coast of India

Microplastics (MPs) are a global environmental concern and pose a serious threat to marine ecosystems. This study aimed to determine the abundance and distribution of MPs in beach sediments (12 beaches), marine biota (6 beaches) and the influence of microbes on MPs degradation in eco-sensitive Palk Bay and Gulf of Mannar coast. The mean MP abundance 65.4 ± 39.8 particles/m² in beach sediments; 0.19 ± 1.3 particles/individual fish and 0.22 ± 0.11 particles g^-1 wet weight in barnacles. Polyethylene fragments (33.4%) and fibres (48%) were the most abundant MPs identified in sediments and finfish, respectively. Histopathological examination of fish has revealed health consequences such as respiratory system damage, epithelial degradation and enterocyte vacuolization. In addition, eight bacterial and seventeen fungal strains were isolated from the beached MPs. The results also indicated weathering of MPs due to microbial interactions. Model simulations helped in tracking the fate and transboundary landfall of spilled MPs across the Indian Ocean coastline after the X-Press Pearl disaster. Due to regional circulations induced by the monsoonal wind fields, a potential dispersal of pellets has occurred along the coast of Sri Lanka, but no landfall and ecological damage are predicted along the coast of India.

Global popularization of CuNiO2 and their rGO nanocomposite loveabled to the photocatalytic properties of methylene blue

New advancements of photocatalytic activity with higher efficiency, low price are most important, which is challenging in industrialized and many fields. We have introduced CuNiO₂ and CuNiO₂/rGO nanocomposite was generally prepared by the hydrothermal treatment and tested to the photocatalytic studies. Photocatalytic measurements of CuNiO₂ with different weight percentages CuNiO₂/rGO (25/75), (50/50), and (75/25) are achieved to the efficiency under visible light, in this case, CuNiO₂/rGO (50/50) composite have the highest performance is scrutinized. This was obeyed for a synergistic effect between CuNiO₂ nanoparticles and rGO composites. Furthermore, the CuNiO₂, CuNiO₂/rGO (25/75), (50/50), and (75/25) nanocomposite were tested by several analyses like XRD, FT-IR, DRS UV Visible spectroscopy, Raman spectroscopy, and FESEM & HRTEM investigations. In this regard all measurements are very clear and satisfied; therefore we are encouraged for future developing environmental applications.

Hybrid machine learning classification scheme for speaker identification

Motivated by the requirement to prepare for the next generation of "Automatic Spokesperson Recognition" (ASR) system, this paper applied the fused spectral features with hybrid machine learning (ML) strategy to the speech communication field. This strategy involved the combined spectral features such as mel-frequency cepstral coefficients (MFCCs), spectral kurtosis, spectral skewness, normalized pitch frequency (NPF), and formants. The characterization of suggested classification method could possibly serve in advanced speaker identification scenarios. Special attention was given to hybrid ML scheme capable of finding unknown speakers equipped with speaker id-detecting classifier technique, known as "Random Forest-Support Vector Machine" (RF-SVM). The extracted speaker precise spectral attributes are applied to the hybrid RF-SVM classifier to identify/verify the particular speaker. This work aims to construct an ensemble decision tree on a bounded area with minimal misclassification error using a hybrid ensemble RF-SVM strategy. A series of standard, real-time speaker databases, and noise conditions are functionally tested to validate its performance with other state-of-the-art mechanisms. The proposed fusion method succeeds in the speaker identification task with a high identification rate (97% avg) and lower equal error rate (EER) (<2%), compared with the individual schemes for the recorded experimental dataset. The robustness of the classifier is validated using the standard ELSDSR, TIMIT, and NIST audio datasets. Experiments on ELSDSR, TIMIT, and NIST datasets show that the hybrid classifier produces 98%, 99%, and 94% accuracy, and EERs were 2%, 1%, and 2% respectively. The findings are then compared with well-known other speaker recognition schemes and found to be superior.

Antidiabetic potential of Andrographis echioides Nees. leaf extract on high fat diet-fed C57BL/6J diabetic mice

The present study validates the antidiabetic potential of Andrographis echioides leaf extract (AeLE) on high fat diet-fed diabetic C57BL/6J mice. The male C57BL/6J mouse (age 6-8 weeks) were divided into 2 groups (lean control group and diabetic group). The lean control group (6 animals) was fed with standard diet pellets. The diabetic group animals (24 animals) were made diabetic by feeding a high-fat diet for 12 weeks. This group was then further divided into 4 groups of 6 animals each and treated orally (for 28 days) with vehicle (0.5%carboxymethyl cellulose), metformin 100mg/kg body weight and 2 different concentrations of test drug viz., 100mg/kg and 200mg/kg body weight. The results show a significant reduction in blood glucose and other biochemical parameters. After 28 days, the metformin and AeLE (200 mg/kg b.w) treated animals had an average serum glucose value of 129.69±1.97 mg/dl and 109.6±3.92 mg/dl, respectively. Also, the liver markers were positively affected by AeLE. In conclusion, A. echioides leaf extract was found to reduce hyperglycemia and significantly improve the biochemical profile of the mice.

Enhanced Photocatalytic Performance of Sn6SiO8 Nanoparticles and Their Reduced Graphene Oxide (rGO) Nanocomposite

Photocatalysts provide excellent potential for the full removal of organic chemical pollutants as an environmentally friendly technology. It has been noted that under UV-visible light irradiation, nanostructured semiconductor metal oxides photocatalysts can degrade different organic pollutants. The Sn₆SiO₈/rGO nanocomposite was synthesized by a hydrothermal method. The Sn₆SiO₈ nanoparticles hexagonal phase was confirmed by XRD and functional groups were analyzed by FT-IR spectroscopy. The bandgap of Sn₆SiO₈ nanoparticles (NPs) and Sn₆SiO₈/GO composites were found to be 2.7 eV and 2.5 eV, respectively. SEM images of samples showed that the flakes like morphology. This Sn₆SiO₈/rGO nanocomposite was testing for photocatalytic dye degradation of MG under visible light illumination and excellent response for the catalysts. The enhancement of photocatalytic performance was mainly attributed to the increased light absorption, charge separation efficiency and specific surface area, proved by UV-vis DRS. Further, the radical trapping experiments revealed that holes (h⁺) and superoxide radicals (·O^-₂) were the main active species for the degradation of MG, and a possible photocatalytic mechanism was discussed.

Visible-Light Driven Effective Photocatalytic Degradation of Methylene Blue Dye Using Perforated Curly Zn0.1Ni0.9O Nanosheets

Herein, we report the facile synthesis, characterization and visible-light-driven photocatalytic degradation of perforated curly Zn_0.1Ni_0.9O nanosheets synthesized by hydrothermal process. The X-ray diffraction (XRD) and scanning electron microscopy (SEM) studies confirmed the cubic phase crystalline structure and growth of high density perforated curly Zn_0.1Ni_0.9O nanosheets, respectively. As a photocatalyst, using methylene blue (MB) as model pollutant, the synthesized nanosheets demonstrated a high degradation efficiency of ~76% in 60 min under visible light irradiation. The observed results suggest that the synthesized Zn_0.1Ni_0.9O nanosheets are attractive photocatalysts for the degradation of toxic organic waste in the water under visible light.

Binary Mixture of Lanthanide Metal Doped ZnO Nanorod: f-MWCNT Nanocomposite for Simultaneous and Selective Determination of Vitamins B² and B6

An electrochemical sensor using lanthanide element Gadolinium doped Zinc oxide and functionalized Multiwalled Carbon Nanotube (Gd-ZnO:f-MWCNT) fabricated electrode was presented for the simultaneous determination of vitamins (Riboflavin (VB₂) and Pyridoxine (VB₆)). The nanocomposite was characterized by FESEM, EDS, XRD and FTIR techniques. The CV, EIS and DPV techniques were used to evaluate the electrochemical properties of the nanocomposite. Under optimum conditions, the peak current of VB₂ and VB₆ are linearly proportional to its concentration in the range from 0.05 to 10 μM and the estimated detection limits were 0.009 and 0.001 μM for VB₂ and VB₆ respectively. The sensitivities calculated were 0.94 μA nM_-1 cm_-2 (VB₂) and 1.43 μA nM_-1 cm_-2 (VB₆). In addition, the proposed electrode was exhibited high selectivity, reproducibility, as well as long-term stability for the determination of vitamins. Finally, the vitamins contained in pharmaceutical formulation and commercial orange juice has been determined by the proposed sensor and the obtained results were validated with HPLC.

The neuropathological signature of bulbar-onset ALS: A systematic review

ALS is a multisystem disorder affecting motor and cognitive functions. Bulbar-onset ALS (bALS) may be preferentially associated with cognitive and language impairments, compared with spinal-onset ALS (sALS), stemming from a potentially unique neuropathology. The objective of this systematic review was to compare neuropathology findings reported for bALS and sALS subtypes in studies of cadaveric brains. Using Cochrane guidelines, we reviewed articles in MEDLINE, Embase, and PsycINFO databases using standardized search terms for ALS and neuropathology, from inception until July 16th 2016. 17 studies were accepted for analysis. The analysis revealed that both subtypes presented with involvement in motor and frontotemporal cortices, deep cortical structures, and cerebellum and were characterized by neuronal loss, spongiosis, myelin pallor, and ubiquitin+ and TDP43+ inclusion bodies. Changes in Broca and Wernicke areas - regions associated with speech and language processing - were noted exclusively in bALS. Further, some bALS cases presented with atypical pathology such as neurofibrillary tangles and basophilic inclusions, which were not found in sALS cases. Given the limited number of studies, all with methodological biases, further work is required to better understand neuropathology of ALS subtypes.

Incidence of contrast-induced nephropathy in kidney transplant recipients

Contrast-induced nephropathy (CIN) is responsible for one-third of acute kidney injuries (AKI) in the hospital setting. The incidence of CIN varies from 3% to 30%, depending on the preexisting risk factors, with higher incidence noted with diabetes mellitus, chronic kidney disease, and older age. Though CIN risk factors are common in kidney transplant recipients (KTRs), data about incidence of CIN in this population are sparse.

METHODS

We retrospectively analyzed 124 consecutive patients transplanted at our center between January 2002 and December 2013 and received iodinated intravascular contrast with stable kidney function prior to contrast administration. CIN was defined as either an absolute rise in serum creatinine of ≥ 0.5 mg/dL or a ≥ 25% drop in estimated glomerular filtration rate (eGFR) after contrast administration.

RESULTS

Seven of 124 (5.64%) patients developed CIN. Kidney function returned to baseline in 5 of the 7 patients within 3 weeks. In 2 patients serum creatinine remained elevated due to recurrent AKI episodes from other causes. Dialysis was not required in any patient. Calcineurin inhibitors (CNIs) were being used in 95% patients at the time of contrast administration. Diabetes mellitus, baseline serum creatinine, age, race, gender, and the use of ACE inhibitor, angiotensin receptor blocker, diuretic, or prophylaxis with intravenous hydration ± N-acetylcysteine did not affect the incidence of CIN.

CONCLUSION

Incidence of CIN in KTRs was low in our study (5.6%), much less than previously reported. This low incidence may be related to the high baseline eGFR (>70 mL/min/1.73 m(2)) and use of hypo-osmolar contrast in our patients. In KTRs with baseline eGFR >70 mL/min, the incidence of CIN is low despite the concurrent use of nephrotoxic CNI.

Occurrence of isopod Nerocila phaiopleura infestation on Whitefin wolf-herring (Chirocentrus nudus) from Southeast coast of India

The present study reported the first observation of isopod parasite, Nerocila phaiopleura infestation on Chirocentrus nudus an economically important fish from Cuddalore coast, Southeast coast of India. The maximum prevalence of 6.3 % and mean intensity of 3.2 were observed during pre-monsoon 2010 and monsoon 2010 respectively. The highest intensity 7 was observed in the single host during monsoon. The site of attachment leads to wound and offer the secondary infection. Two pathogenic bacteria Streptococcus aureus and E. coli were isolated from the wound.

1'-Allyl-1-(3,4-di-methyl-benzo-yl)-2-(4-methyl-1,3-thia-zol-5-yl)-1,2,5,6,7,7a-hexa-hydro-spiro-[pyrrolizine-3,3'-indolin]-2'-one

In the title compound, C₃₀H₃₁N₃O₂S, the fused pyrrolidine ring bearing three substituents adopts an envelope conformation with the C atom bearing the benzoyl group as the flap. The other fused pyrrolidine ring adopts a twisted conformation about one of its C—C bonds. The dihedral angle between the isatin ring system and the methyl­thia­zole ring is 25.95 (8)°. An intra­molecular C—H⋯O inter­action closes an S(8) ring. In the crystal, mol­ecules are linked by C—H⋯O inter­actions, generating C(11) chains propagating in [001].

Ethyl 2-amino-4-(4-methyl-1,3-thia-zol-5-yl)-5-oxo-4H,5H-pyrano[3,2-c]chromene-3-carboxyl-ate

There are two independent mol-ecules in the asymmetric unit of the title compound, C19H16N2O5S, in which the thia-zole rings make dihedral angles of 80.89 (11) and 84.81 (11)° with the pyrano[3,2-c]chromene ring systems. An intra-molecular N-H⋯O hydrogen bond involving the amino group occurs in each independent mol-ecule. In the crystal, the amino groups are involved in N-H⋯O and N-H⋯N hydrogen bonds.

Comparing the efficacy of plasmid curing agents in Lactobacillus acidophilus

This study was mainly focused on plasmid profiling and plasmid characterisation of Lactobacillus acidophilus isolated from molasses. The secondary objective was to observe the efficacy of the plasmid curing agents acriflavine, ethidium bromide, novobiocin and SDS on L. acidophilus. Plasmid-free strains and cured derivatives harbouring only a single plasmid (6.2 kbp) were also obtained. Treatment of L. acidophilus with novobiocin at concentrations of 2.4 µg/ml could produce a large number of chloramphenicol- variants at a very high frequency (4.6%). These curing data confirmed that novobiocin acts as an effective curing agent for L. acidophilus.

Giant left atrium secondary to tight mitral stenosis leading to acquired Lutembacher syndrome: a case report with emphasis on role of echocardiography in assessment of Lutembacher syndrome

Lutembacher syndrome is an unusual clinical entity of congenital secundum atrial septal defect in combination with rheumatic mitral stenosis. Although this classic form is seldom seen by the adult cardiologist, spontaneous Lutembacher syndrome as discussed later or the iatrogenic variant is not infrequently encountered. The pathophysiologic, clinical, and hemodynamic differences of mitral valve disease in the presence of atrial septal defect compared with isolated mitral stenosis are highlighted in this case review. Special emphasis has also been given to echocardiographic evaluation of this syndrome complex, particularly in the setting of percutaneous mitral valvuloplasty, which produces the iatrogenic form of Lutembacher syndrome.

Abnormal implantation of permanent pacemaker lead in the left ventricle via a patent foramen ovale: clinical and echocardiographic recognition of a rare complication

An 84-year-old man with a history of permanent pacemaker placement had a preoperative cardiac evaluation for prostate cancer surgery. The patient was asymptomatic, and the results of a physical examination were consistent with a right bundle branch block, which was confirmed by electro-cardiogram as his paced rhythm. A chest radiograph raised the possibility of an abnormal lead location, and transthoracic echocardiography confirmed the mechanism of an abnormal placement of the pacemaker lead. Left ventricular location of pacemaker is rare, and awareness of its clinical and imaging findings, complications, and management options is important for clinicians involved in the care of patients with pacemakers.