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.

Effects of Modified Hatha Yoga in Industrial Rehabilitation on Physical Fitness and Stress of Injured Workers

PURPOSE

The purpose of this study was to assess the effects of 8 weeks of modified hatha yoga training on physical fitness and stress level in injured workers.

METHODS

Eighteen male and female injured workers, age between 18 and 55 years, participated in this study. They were divided into two groups: an additive hatha yoga training to routine industrial rehabilitation program group (HYG: n = 9) and a control group with no yoga training (CG: n = 9). A modified hatha yoga protocol was designed for this population by two certified yoga instructors, approved by a physical therapist, and conducted for 1 h, three times weekly for 8 weeks. Physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and lung capacity and scores of sensitivity to stress were evaluated at the time of recruitment and after 8 weeks of intervention.

RESULTS

The values of all physical fitness variables and stress scores were no significant difference between the two groups at baseline. Significant post-yoga improvements for HYG group were noted in flexibility, hand grip strength, and vital capacity (p < 0.05). In contrast, there was no significant change in the CG group. Stress scores did not change as a result of hatha yoga training.

CONCLUSION

An 8-week modified hatha yoga training experience exerted therapeutic effects on physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and vital capacity, but not on stress level in injured workers. These findings indicate that hatha yoga can be a beneficial adjunct to routine physical therapy treatment in industrial rehabilitation programs.

Coherence between tissue oxygen indexes in vastus lateralis and gastrocnemius in repetition of impulse exercise with high intensity

The purpose of this study was to determine whether tissue oxygen indices (TOIs) in two muscle groups oscillated and were synchronized in repetition of impulse exercise with high intensity. Five impulse exercises of 400 watts for 10 s were repeated with intervals of 6 min. During this period, TOI was determined by near-infrared spectroscopy in the vastus lateralis and gastrocnemius muscles. TOIs in the two muscles oscillated at rest. The TOIs rapidly decreased during each impulse exercise and then recovered and overshot after each impulse. The TOIs oscillated during each interval period. During this test period, coherent and phase differences were determined. There was high coherence between TOIs in the two muscles with a peak value at 0.019 Hz. There was a phase difference of -45 ± 32.4 degrees between TOIs in the two muscles. This phase difference corresponded to about 6 s in time scale. It seemed from this time delay that impulse exercise was not a trigger factor for the starting point of TOIs in the two muscles. It has been concluded that TOIs oscillate and are synchronized between two muscles in repetition of impulse exercise with high intensity.

The Role of Oestradiol in the Uterine Peristalsis in the Perfused Swine Uterus

This study was designed to examine the effects of oestradiol (E2) on sperm transport in the swine uterus. The bicornuate swine uterus is optimal for the study of the uterine transport and peristalsis because the influence of various factors can be examined on each uterine horn independently. Forty swine uteri (with or without ovarectomy) were perfused for a period of up to 7 h. Two different E2 concentrations (3 or 30 pg/ml) in the perfusion medium were administered for 30 min unilaterally. Through an intracervical catheter 1 ml of a high concentrated dextran blue solution was administered directly in the upper part of the cervix. After bilateral perfusion of the swine uterus with a bolus of 0.3 IU oxytocin the distribution of coloured particles was assessed macroscopically before and after incision of the uterine horns. Coloration was evaluated by two observers blinded to the site-specific administration of E2. In the 10 ovarectomized uteri with the 3 pg/ml E2 concentration a unilateral distribution towards the side of oestradiol administration was observed in six uteri, in four it was a bilateral distribution. In the 10 non-ovarectomized uteri with the 3 pg/ml E2 concentration a uni- and ipsilateral coloration was observed in five uteri, in five it was a bilateral distribution. In the 20 uteri with 30 pg/ml E2, a unilateral coloration of the uterus horns was observed in all uteri. Oestradiol is one of the main factors, which influences the direction of the sperm transport in a dose-dependent manner, in the perfused swine uterus.

[Biomechanical studies and finite element analysis of a bone-implant interface]

In the present study, the fixation system of a femoral medullary nail connection was investigated. In surgical treatment of fractured femurs, the fracture is bridged by a medullary nail that is fixed by interlocking screws in the bone. Bone failure around these screws is the most common complication associated with the treatment of fractures of osteoporotic bone. The present study analyses the stresses present in the region of the implant/bone system. Three-dimensional finite element models were generated, a nonlinear structure analysis performed, and the stresses at material interfaces investigated. The highest concentration of stresses is to be found in the middle of the interlocking screws and the holes drilled in the bone. This is in agreement with the results of experimental investigations.

Biomechanical comparison of different fixations of femur-interlocking-nails

OBJECTIVE

A new design of intra-medullary nailing fixation is investigated in this study. The strength properties of the new design are compared to the standard fixation method.

DESIGN

The bone-implant-compound is examined by using experimental methods.

BACKGROUND

Failure of bone substance in the region of the interlocking screws is a complication in particular in treating fractures of osteoporotic bone. A new additional implant is investigated, which should improve the fracture fixation of the bone-implant-compound.

METHODS

The experiments were performed by using an universal testing machine. The bone-implant-compound was loaded by different compressive forces and the stiffness of the bone-implant-compound was measured. The maximum force to failure was also determined by a destructive test.

RESULTS

The experimental results indicate that the additional implant increases the stiffness of the bone-implant-compound. The highest stress concentrations occur at the drill holes of the interlocking screws. Failure of the bone-implant-compound occurs at higher maximum forces by using the additional implant.

CONCLUSIONS

The additional implant improves the strength of the bone-implant-compound. In the case of osteoporotic bone, the use of the additional implant is recommended.

RELEVANCE

In surgical treatment of fractured femurs, the fracture is bridged by a medullary nail fixed with interlocking screws. Failure of bone substance in the region of the interlocking screws is the most common complication in the treatment of osteporotic bone. With the aim of preventing this complication, a new additional implant is developed and investigated.

[Finite element analysis of an additional implant for intramedullary nailing]

In the surgical treatment of fractured femurs, the fracture is bridged by a medullary nail fixed in the bone with interlocking screws. Failure of bone substance in the region of the interlocking screws is the most common complication in the treatment of osteoporotic bone. With the aim of preventing this complication, an additional implant was developed. A finite element analysis of an ideal bone/implant system was carried out to investigate the role of the additional implant. Three defined finite element models were generated, and the associated stress situations compared. The first model is a standard fixation without the additional implant. In the second model, the additional implant is integrated within the bone/implant system. The third model uses a modified form of the additional implant. The results show that both additional implants reduce the stresses occurring, both in the bone substance and at the screws. The modified form of the additional implant proved to be the most favorable version. In the case of the original additional implant, the negative effect of the sharp edges of the thread was demonstrable.

Megakaryocytes in chronic myeloproliferative disorders: numerical density correlated between different entities

A morphometric evaluation of number and grouping of megakaryocytes (MK) in five different groups of chronic myeloproliferative disorders (CMPD) was performed by counting 60 high power fields equaling approximately 14.28 mm2 of haematopoiesis in each case. Twenty-one up to 29 cases were evaluated for each of five categories of CMPD and one control group; a total of 132 cases of CMPD and 33 control cases were used. The mean number of MK per square millimetre was 15.54 +/- 1.53 in chronic myeloid leukaemia of common or granulocytic type (CML.CT), 69.91 +/- 5.85 in CML with megakaryocytic increase (CML.MI), 59.59 +/- 3.27 in polycythaemia vera (P. vera), 59.85 +/- 4.59 in primary thrombocythaemia (PTH), 67.58 +/- 4.11 in chronic megakaryocytic granulocytic myelosis (CMGM), and 19.7 +/- 3.07 in controls. The distinction between free or isolated MK, and between clustered or grouped MK corresponds to the total cell counts of MK in the various groups of CMPD. Clustering of MK was significantly higher in CMGM and PTH compared to other groups, but the difference between them was not statistically significant. Significant differences in the mean number of MK were obtained between controls and CML.CT on the one hand and all other groups of CMPD on the other. The results further support the histological sub-classification of CMPD according to the primary disorders of the Hannover classification (not advanced by sclerosis, fibrosis or excess of blasts, respectively).