Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Predicting spring migration of two European amphibian species with plant phenology using citizen science data

Habitat fragmentation is one of the drivers for amphibian population declines globally. Especially in industrialized countries roads disrupt the seasonal migration of amphibians between hibernation and reproduction sites, often ending in roadkills. Thus, a timely installing of temporary mitigation measures is important for amphibian conservation. We wanted to find out if plant phenology can be a proxy in advance to determine the start of amphibian migration, since both phenomena are triggered by temperature. We analysed data of 3751 amphibian and 7818 plant phenology observations from citizen science projects in Austria between 2000 and 2018. Using robust regression modelling we compared the migration of common toads (Bufo bufo) and common frogs (Rana temporaria) with the phenology of five tree, one shrub, and one herb species. Results showed close associations between the migration of common frogs and phenological phases of European larch, goat willow and apricot. Models based on goat willow predict migration of common frog to occur 21 days after flowering, when flowering was observed on 60th day of year; apricot based models predict migration to occur 1 day after flowering, observed on the 75th day of year. Common toads showed weaker associations with plant phenology than common frogs. Our findings suggest that plant phenology can be used to determine the onset of temporary mitigation measures for certain amphibian species to prevent roadkills.

Cannabis-Associated Psychotic-like Experiences Are Mediated by Developmental Changes in the Parahippocampal Gyrus

OBJECTIVE

Cannabis consumption during adolescence has been reported as a risk factor for psychotic-like experiences (PLEs) and schizophrenia. However, brain developmental processes associated with cannabis-related PLEs are still poorly described.

METHOD

A total of 706 adolescents from the general population who were recruited by the IMAGEN consortium had structural magnetic resonance imaging scans at both 14 and 19 years of age. We used deformation-based morphometry to map voxelwise brain changes between the two time points, using the pairwise algorithm in SPM12b. We used an a priori region-of-interest approach focusing on the hippocampus/parahippocampus to perform voxelwise linear regressions. Lifetime cannabis consumption was assessed using the European School Survey Project on Alcohol and other Drugs (ESPAD), and PLEs were assessed with the Comprehensive Assessment Psychotic-like experiences (CAPE) tool. We first tested whether hippocampus/parahippocampus development was associated with PLEs. Then we formulated and tested an a priori simple mediation model in which uncus development mediates the association between lifetime cannabis consumption and PLEs.

RESULTS

We found that PLEs were associated with reduced expansion within a specific region of the right hippocampus/parahippocampus formation, the uncus (p = .002 at the cluster level, p = .018 at the peak level). The partial simple mediation model revealed a significant total effect from lifetime cannabis consumption to PLEs (b = 0.069, 95% CI = 0.04-0.1, p =2 × 10^-16), as well as a small yet significant, indirect effect of right uncus development (0.004; 95% CI = 0.0004-0.01, p = .026).

CONCLUSION

We show here that the uncus development is involved in the cerebral basis of PLEs in a population-based sample of healthy adolescents.

Neural Correlates of Failed Inhibitory Control as an Early Marker of Disordered Eating in Adolescents

BACKGROUND

Binge eating and other forms of disordered eating behavior (DEB) are associated with failed inhibitory control. This study investigated the neural correlates of failed inhibitory control as a potential biomarker for DEB.

METHODS

The study used prospective longitudinal data from the European IMAGEN study adolescent cohort. Participants completed baseline assessments (questionnaires and a brain scan [functional magnetic resonance imaging]) at 14 years of age and a follow-up assessment (questionnaires) at 16 years of age. Self-reported binge eating and/or purging were used to indicate presence of DEB. Neural correlates of failed inhibition were assessed using the stop signal task. Participants were categorized as healthy control subjects (reported no DEB at both time points), maintainers (reported DEB at both time points), recoverers (reported DEB at baseline only), and developers (reported DEB at follow-up only). Forty-three individuals per group with complete scanning data were matched on gender, age, puberty, and intelligence (N = 172).

RESULTS

At baseline, despite similar task performance, incorrectly responding to stop signals (failed inhibitory control) was associated with greater recruitment of the medial prefrontal cortex and anterior cingulate cortex in the developers compared with healthy control subjects and recoverers.

CONCLUSIONS

Greater recruitment of the medial prefrontal and anterior cingulate regions during failed inhibition accords with abnormal evaluation of errors contributing to DEB development. As this precedes symptom onset and is evident despite normal task performance, neural responses during failed inhibition may be a useful biomarker of vulnerability for DEB. This study highlights the potential value of prospective neuroimaging studies for identifying markers of illness before the emergence of behavior changes.

Farmland biodiversity and agricultural management on 237 farms in 13 European and two African regions

Farmland is a major land cover type in Europe and Africa and provides habitat for numerous species. The severe decline in farmland biodiversity of the last decades has been attributed to changes in farming practices, and organic and low-input farming are assumed to mitigate detrimental effects of agricultural intensification on biodiversity. Since the farm enterprise is the primary unit of agricultural decision making, management-related effects at the field scale need to be assessed at the farm level. Therefore, in this study, data were collected on habitat characteristics, vascular plant, earthworm, spider, and bee communities and on the corresponding agricultural management in 237 farms in 13 European and two African regions. In 15 environmental and agricultural homogeneous regions, 6-20 farms with the same farm type (e.g., arable crops, grassland, or specific permanent crops) were selected. If available, an equal number of organic and non-organic farms were randomly selected. Alternatively, farms were sampled along a gradient of management intensity. For all selected farms, the entire farmed area was mapped, which resulted in total in the mapping of 11 338 units attributed to 194 standardized habitat types, provided together with additional descriptors. On each farm, one site per available habitat type was randomly selected for species diversity investigations. Species were sampled on 2115 sites and identified to the species level by expert taxonomists. Species lists and abundance estimates are provided for each site and sampling date (one date for plants and earthworms, three dates for spiders and bees). In addition, farmers provided information about their management practices in face-to-face interviews following a standardized questionnaire. Farm management indicators for each farm are available (e.g., nitrogen input, pesticide applications, or energy input). Analyses revealed a positive effect of unproductive areas and a negative effect of intensive management on biodiversity. Communities of the four taxonomic groups strongly differed in their response to habitat characteristics, agricultural management, and regional circumstances. The data has potential for further insights into interactions of farmland biodiversity and agricultural management at site, farm, and regional scale.

Common neural correlates of intertemporal choices and intelligence in adolescents

Converging behavioral evidence indicates that temporal discounting, measured by intertemporal choice tasks, is inversely related to intelligence. At the neural level, the parieto-frontal network is pivotal for complex, higher-order cognitive processes. Relatedly, underrecruitment of the pFC during a working memory task has been found to be associated with steeper temporal discounting. Furthermore, this network has also been shown to be related to the consistency of intertemporal choices. Here we report an fMRI study that directly investigated the association of neural correlates of intertemporal choice behavior with intelligence in an adolescent sample (n = 206; age 13.7-15.5 years). After identifying brain regions where the BOLD response during intertemporal choice was correlated with individual differences in intelligence, we further tested whether BOLD responses in these areas would mediate the associations between intelligence, the discounting rate, and choice consistency. We found positive correlations between BOLD response in a value-independent decision network (i.e., dorsolateral pFC, precuneus, and occipital areas) and intelligence. Furthermore, BOLD response in a value-dependent decision network (i.e., perigenual ACC, inferior frontal gyrus, ventromedial pFC, ventral striatum) was positively correlated with intelligence. The mediation analysis revealed that BOLD responses in the value-independent network mediated the association between intelligence and choice consistency, whereas BOLD responses in the value-dependent network mediated the association between intelligence and the discounting rate. In summary, our findings provide evidence for common neural correlates of intertemporal choice and intelligence, possibly linked by valuation as well as executive functions.

N,N,N′,N′,N′,N″,N‴,N‴-Octamethyl-[bi-2,4,6-cycloheptatrien-1-yl]- 3,3′-dicarboxamidinium-Salze: Struktur der meso-Verbindung in Lösung und im Kristall [1] / N,N,N′,N′,N′,N″,N‴,N‴-Octamethyl-[bi-2,4,6-cycloheptatriene-1-yl]- 3,3′-dicarboxamidinium Salts: Structure of the meso-Compound in Solution and in Solid State [1]

3,3′-Bicycloheptatrienylamidinium salts 3 have been prepared by oxidative dimerization of 8 ,8 -bis(dimethylamino)heptafulvene (1). An X-ray structure analysis of the meso-octamethyl[bi-2,4,6-cycloheptatrienyl]3,3'-dicarboxamidinium-bis(triiodide) (3b) has been carried out. The dication 3 is centrosymmetric (Ci-symmetry) with boat shaped cycloheptatriene rings. The amidinium groups are twisted out of the plane of the C3(C3′)-C2(C2′) double bonds. The structure of the dication in the solid state is discussed in comparison with the structure in solution by aid of 1H NMR techniques. The N-methyls within one amidinium group show temperature dependent 1H NMR spectra and are chemically nonequivalent (anisochronous).

Ru2(CO)6(ButNS) − Ein tert-Butylschwefelimid-Komplex mit Ru2NS-Tetrahedrangerüst / Ru2(CO)6(BUtNS) - A tert-Butyl Sulfur Imide Complex Containing a Ru2NS Tetrahedrane Skeleton

Fragmentation of bis(rm-butyl) sulfur diimide, S(NBut)2 (1a), in the presence of Ru3(CO)12 leads to a yellow tetrahedrane-type complex Ru2(CO)6(ButNS) (3a) containing tert-butyl sulfur imide as a six-electron ligand. According to the X-ray structure determination the N−S bond (1.716 Å) is arranged perpendicular to the Ru−Ru axis (2.661 Å).

(Dimethylphosphito-P){tris[2-(diphenylphosphino)ethyl]-phosphine-P,P′,P″,P″′}platinum(II)-chloride: Synthesis and Structural Characterization

Controlled hydrolysis at low temperatures of (trimethylphosphito-P){tris[2-(diphenylphosphino)ethyl]phosphine-P,P′,P″,P″′}platinum(II)-dichloride, [Pt(PP3)(P(OMe)3)]Cl2 (2), leads to the title compound (1) in nearly quantitative yield. The 31P NMR spectrum of 1 shows an AMX3 pattern consistent with the formulation as [Pt(P(O)(OMe)2)(PP3)]Cl. 1 has been further characterized by an X-ray structure analysis, which shows a trigonal-bipyramidal stereochemistry with the (dimethylphosphito)-ligand occupying an axial position. NMR and X-ray results of 1 and [PtH(PP3)](BPh4) (3) are compared.

Die Kristallstrukturen des Benzo[1.2-c:3.4-cʹ]bis[1.2.5]thiadiazols und des semihomologen [1.2.5]Selenadiazolo[3.4-e]-2.1.3-benzothiadiazols [1]/The Crystal Structures of the Benzo [1,2-c : 3,4-cʹ]bis[1,2,5]thiadiazole and of the Semihomologous [1,2,5]Selenadiazolo[3,4-e]-2,1,3-benzothiadiazole [1]

The X-ray structure analyses of the title compounds 1 and 2 were performed. 1: monoclinic, C 2/c, a = 9.532(2), b = 11.469(2), c = 7.030(3) Å, β = 110.58(2)°, Z = 4; 2: monoclinic, P21/a, a = 7.650(2), b = 7.729(2), c = 12.948(3) Å, β = 74.26(2)°, Z = 4. The structure of 1 was solved by direct methods, that of 2 by Patterson- and successive Fourier-synthesis techniques. The least squares refinement converged for 894 independent reflections with I > 2δI to an R-value of 0.032 (Rw = 0.035) in the case of 1 and for 1440 independent reflections to an R-value of 0.045 (Rw = 0.045) in the case of 2. The bond lengths in the [1,2,5]thiadiazole rings in 1 and 2 and also in the Se-homologous ring in 2 indicate to a quasi-aromatic π-system, whereas the aromatic character of the central benzene ring in 1 and 2 is strongly disturbed. The substitution of one S by the homologous Se in 2 induces significant changes of comparable bond lengths in 1 and 2. In the crystal structures of both compounds molecular layers and columnar stacks are formed. Quasipolymers in form of ribbon like structures are established in 1 by short S···N contacts and in 2 by short Se···N contacts. In 2 (SeN2)x-chains are formed.

Amygdala-function perturbations in healthy mid-adolescents with familial liability for depression

OBJECTIVE

Functional magnetic resonance imaging (fMRI) studies have identified increased amygdala responses to negative stimuli as a risk marker of depression in adults, and as a state marker of depression in adults and adolescents. Hyperreactivity of the amygdala has been linked to negatively biased emotional processing in depression. However, no study has elucidated whether similar amygdala perturbations can be found in healthy mid-adolescents with familial liability for depression. We hypothesized that healthy 14-year-olds with relatives with depression would demonstrate increased amygdala responses to negative stimuli, as compared with their peers with no family history of mental disorders.

METHOD

We investigated a community-based sample of 164 typically developing 14-year-olds without record of past or current mental disorders. Of these individuals, 28 fulfilled criteria for family history of depression, and 136 served as controls. Groups did not differ with regard to cognitive ability, depressive symptomatology, and anxiety. During fMRI they performed a perceptual discrimination task in which visual target and distractor stimuli varied systematically with regard to emotional valence.

RESULTS

Both a hypothesis-driven region-of-interest analysis and a whole-brain analysis of variance revealed that negative distractors elicited greater amygdala activation in adolescents with a family history of depression compared to controls. Amygdala responses also differed during the processing of negative target stimuli, but effects were reversed.

CONCLUSION

Our study demonstrates that familial liability for depression is associated with correlates of negatively biased emotional processing in healthy adolescents. Amygdala perturbations during the processing of negative stimuli might reflect an early and subtle risk marker for depression.

Interindividual differences in mid-adolescents in error monitoring and post-error adjustment

A number of studies have concluded that cognitive control is not fully established until late adolescence. The precise differences in brain function between adults and adolescents with respect to cognitive control, however, remain unclear. To address this issue, we conducted a study in which 185 adolescents (mean age (SD) 14.6 (0.3) years) and 28 adults (mean age (SD) 25.2 (6.3) years) performed a single task that included both a stimulus-response (S-R) interference component and a task-switching component. Behavioural responses (i.e. reaction time, RT; error rate, ER) and brain activity during correct, error and post-error trials, detected by functional magnetic resonance imaging (fMRI), were measured. Behaviourally, RT and ER were significantly higher in incongruent than in congruent trials and in switch than in repeat trials. The two groups did not differ in RT during correct trials, but adolescents had a significantly higher ER than adults. In line with similar RTs, brain responses during correct trials did not differ between groups, indicating that adolescents and adults engage the same cognitive control network to successfully overcome S-R interference or task switches. Interestingly, adolescents with stronger brain activation in the bilateral insulae during error trials and in fronto-parietal regions of the cognitive control network during post-error trials did have lower ERs. This indicates that those mid-adolescents who commit fewer errors are better at monitoring their performance, and after detecting errors are more capable of flexibly allocating further cognitive control resources. Although we did not detect a convincing neural correlate of the observed behavioural differences between adolescents and adults, the revealed interindividual differences in adolescents might at least in part be due to brain development.

Diagnosing aortic valve stenosis by parameter extraction of heart sound signals

The objective of this study was to develop an automatic signal analysis system for heart sound diagnosis. This should support the general practitioner in discovering aortic valve stenoses at an early stage to avoid or decrease the number of surgical interventions. The applied analysis method is based on classification of heart sound signals utilising parameter extraction. From the wavelet decomposition of a representative heart cycle as well as from the Short Time Fourier Transform (STFT) and the Wavelet Transform (WT) spectra new time series were derived. In several segments, parameters were extracted and analysed. In addition, features of the Fast Fourier Transform (FFT) of the raw signal were examined. In this study, 206 patients were enrolled, 159 with no heart valve disease or any other heart valve disease but aortic valve stenosis and 47 suffering from aortic valve stenosis in a mild, moderate or severe stage. To separate the groups, a linear discriminant function analysis was applied leading to a reduced parameter set. The introduced two classification stage (CS) system for automatic detection of aortic valve stenoses achieves a high sensitivity of 100% for moderate and severe aortic valve stenosis and a sensitivity of 75% for mild aortic valve stenosis. A specificity of 93.7% for patients without aortic valve stenosis is provided. The developed method is robust, cost effective and easy to use, and could, therefore, be a suitable method to diagnose aortic valve stenosis by general practitioners.

[Knotting of a catheter in the plexus brachialis. A rare complication]

For the repair of an open injury to the hand, a continuous axillary block was performed in a 40- year-old male patient. Slight resistance was experienced during advancement of the catheter. Adequate surgical anaesthesia developed after the injection of 40 ml of a bupivacaine/prilocaine mixture. For postoperative analgesia an infusion of bupivacaine 0.25% was started. Three days later the removal of the catheter proved to be difficult due to a knot in the distal part of the catheter. This seems to be the first report of a knot in a catheter used for continuous axillary plexus block.

Matrix-metalloproteinases and their inhibitors in plasma and tumor tissue of patients with renal cell carcinoma

Matrix-metalloproteinases (MMPs) are associated with invasive and metastatic behavior of several human malignant tumors. We have determined MMP-2 and MMP-9 and tissue inhibitors of MMPs (TIMP-1 and TIMP-2) in blood plasma and in renal tissue samples of patients with renal cell carcinoma (RCC) from cancerous and non-cancerous parts of the same kidney. In tumor tissue, MMP-9 and TIMP-1 were significantly higher than in normal counterparts. MMP-2 was not different between tumor tissue and normal counterparts. TIMP-2 values could not be measured. In plasma, MMP-9 concentrations were significantly higher in RCC patients than in healthy controls, MMP-2 and TIMP-2 concentrations were higher in healthy controls and TIMP-1 concentrations were not different.

Kupplungsreaktionen von Diazoniumsalzen mit 3-tert-Butoxy- 1,6-methano[10]annulen und Röntgenstrukturanalyse eines Vertreters /Coupling Reactions of Diazonium Salts with 3-tert-Butoxy-1,6-methano[10]annulene and X-Ray Structure Analysis of one Compound

The syntheses of 5a-c by coupling reactions of 3-tert-butoxy-1,6-methano[10]annulene with different aryldiazonium salts as well as their spectroscopic properties are described; an X-ray structure analysis of 5c is reported.