Search Results (101)

Background and Objectives: The perioperative use of beta-blockers remains controversial due to conflicting evidence of their risks and benefits. The aim of this study was to evaluate the association between chronic beta-blocker (bb) therapy and perioperative cardiac events in non-cardiac surgeries using 24 h continuous Holter monitoring. Materials and Methods: A prospective observational study was conducted on patients undergoing elective or emergency non-cardiac surgery at a Romanian tertiary care hospital. The patients were divided into two groups: G1 (not receiving Bb) and G2 (on chronic Bb). The incidences of perioperative cardiac events, such as severe bradycardia (<40 b/min), new-onset atrial fibrillation (AF), extrasystolic arrhythmia (Ex), and sustained ventricular tachycardia (sVT) and arterial hypotension, were compared between the two groups using clinical, electrocardiography (ECG), and Holter ECG data. Beta-blocker indications, complications, and outcomes were analyzed using chi-squared tests and logistic regression. Results: A total of 100 consecutive patients (63% men, mean age of 53.7 years) were enrolled in the study. G2 included 30% (n = 30) of patients on chronic beta-blocker therapy. The indications included atrial fibrillation (46.7%, n = 14), arterial hypertension (36.7%, n = 11), extrasystolic arrhythmias (10%, n = 3), and chronic coronary syndrome (6.6%, n = 2). Beta-blocker use was significantly associated with severe bradycardia (n = 6; p < 0.001) in G2, whereas one patient in G1 had bradycardia, and 15 and 1 patients had hypotension (p < 0.001) in G1 and G2, respectively. The bradycardia and arterial hypotension cases were promptly treated and did not influence the patients’ prognoses. The 14 patients with AF in G2 had a 15-fold higher odds of requiring beta-blockers (p < 0.001, odds ratio (OR) = 15.145). No significant associations were found between beta-blocker use and the surgery duration (p = 0.155) or sustained ventricular tachycardia (p = 0.857). Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related to longer surgery durations (165 (150–180) vs. 120 (90–150) minutes; p = 0.002) and postoperative anemia [hemoglobin (Hg): 10.4 (9.37–12.6) vs. 12.1 (11–13.2) g/dL; p = 0.041]. Conclusions: Patients under chronic beta-blocker therapy undergoing non-cardiac surgery have a higher risk of perioperative bradycardia and hypotension. Continuous Holter monitoring proved effective in detecting transient arrhythmic events, emphasizing the need for careful perioperative surveillance of these patients, especially the elderly, in order to prevent cardiovascular complications These findings emphasize the necessity of tailored perioperative beta-blocker strategies and support further large-scale investigations to optimize risk stratification and management protocols. Full article

Background: Epicardial adipose tissue (EAT) may contribute to the pathogenesis of atrial fibrillation (AF). The attenuation of EAT assessed by means of computed tomography (CT) may reflect the severity of local tissue inflammation. This study aimed to systematically analyze the relationship between the attenuation of EAT surrounding the left atrium (LA-EAT) and AF recurrence after catheter ablation (CA). Methods: Five databases were searched up to April 10, 2025. Original studies involving adult patients with paroxysmal or persistent AF undergoing CA were included if they provided quantitative measurements of LA-EAT attenuation on cardiac CT before ablation. Results: A total of seven retrospective observational studies with 2440 patients were included in the analysis. The percentage of male participants ranged from 60.9% to 73.0%, and the mean or median age of patients varied from 57.5 to 68.2 years. The mean body mass index across studies ranged from 24.0 to 32.4 kg/m². A pooled analysis of all included trials demonstrated that the mean LA-EAT attenuation in the AF recurrence group was −78.97 ± 15.34 HU, which was less negative compared to the non-recurrence group (−81.37 ± 15.46 HU; mean difference [MD] = 2.22; 95% confidence interval [CI]: 0.84 to 3.61; p = 0.002). Conclusions: LA-EAT attenuation is significantly more positive in patients experiencing AF recurrence compared to those without recurrence following CA procedures. Full article

Background/Objectives: Pulmonary vein isolation (PVI) is the standard treatment for atrial fibrillation (AF), but medium-term success rates remain suboptimal. Non-pulmonary vein triggers, particularly from the superior vena cava (SVC), contribute to AF recurrence. Empirical SVC isolation (SVCi) in addition to standard PVI may improve outcomes. This study evaluated the acute procedural efficacy and safety of PVI with adjunctive SVCi versus PVI alone in patients with paroxysmal AF (PAF). Methods: In this randomized, controlled, single-center study, 149 patients with PAF were assigned to either standard PVI (n = 74) or PVI with adjunctive empirical SVCi (n = 75) using a fourth-generation CB. Primary endpoints were acute procedural success and the incidence of procedure-related complications, particularly phrenic nerve injury (PNI) and sinus node dysfunction. Results: Acute PVI was achieved in all patients; SVCi was successful in 84.9% of the PVI + SVCi group. Major complication rates were low and comparable between groups (0% vs. 2.6%, p = 0.157). However, the overall complication rate was significantly higher in the PVI + SVCi group (50.6% vs. 6.8%, p < 0.001), driven primarily by transient or impending right PNI (38.6% vs. 6.8%, p < 0.001) and sinus node dysfunction. All PNI events resolved before the end of the procedure. Conclusions: Empirical SVCi using a fourth-generation CB is feasible and generally safe, but carries a higher risk of transient PNI and reversible sinus node dysfunction. Therefore, CB SVCi should be approached with caution. Further studies are needed to evaluate long-term outcomes and assess whether the potential benefits outweigh these procedural risks. Full article

Background and clinical significance: Functional/dissociative seizures (FDSs) in adolescents are paroxysmal events which superficially resemble epileptic seizures or syncope. This study evaluated the effectiveness of brief cognitive analytic therapy (CAT). Case presentation: The patient was a 17-year-old white cisgender male with a diagnosis of non-epileptic attack disorder. The functional/dissociative seizures were treated with 8-session CAT, with follow-up at 5 weeks. Two target problems (TPs) and associated target problem procedures (TPPs) were rated for recognition and revision at each session and at follow-up. An A-B-C-FU single-case experimental evaluation of the TP/TPPs was conducted. Nomothetic outcome measures (DES-2 and RCADS) were administered at session 1, session 8, and at follow-up, and the YP-CORE and the Session Rating Scale were completed at each session. The patient was independently interviewed using the Change Interview 13 weeks after completing therapy. The results show that CAT effectively increased the recognition and revision of TPs/TPPs, four specific changes occurred (including cessation of functional seizures). There were pre–post reliable and clinically significant improvements to psychological wellbeing, but these were not maintained at follow-up. Conclusions: This study indicates that CAT was a partially effective intervention. The use of CAT as a treatment for FND in adolescents holds promise, but more research is needed. Full article

Background: Inflammation plays an important role in the initiation of atrial fibrillation (AF) and the development of fibrosis following pulmonary vein isolation (PVI). We aimed to investigate whether early post-PVI levels of C-reactive protein (CRP), white blood cells, tumour necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-ß1) are associated with long-term arrhythmia recurrence. Methods: This prospective observational study included 48 patients with paroxysmal AF undergoing PVI. Peripheral venous blood samples were collected on the day of hospitalisation (T0), immediately after the procedure (T1) and after 24 h (T2), seven days (T3) and one month (T4) following the procedure. Blood samples were obtained from the coronary sinus (CS) before and after PVI. CRP levels, leukocyte (LKc) and neutrophile (Neu) counts were determined. TGF-β1 and TNF-α were analysed using the enzyme-linked immunosorbent assay (ELISA). After discharge, follow-up visits were scheduled at seven days and one-, three-, six-, nine- and twelve-months post-ablation, with 24 h Holter monitoring at each visit. Results: Patients were allocated into a recurrent and a non-recurrent group. Baseline characteristics did not differ between the groups, except for the duration of AF, which was found to be a significant arrhythmia recurrence predictor. Patients in the non-recurrent group had statistically significantly higher LKc at all time points, and Neu at T2 and T3. CRP and TGF-β1 concentrations were significantly higher in the non-recurrent group, while TNF-α concentration was significantly higher in the recurrent group at the T2 time point. Significantly higher concentrations of CS TNF-α at T1 and TGF-β1 at T0 and T1 were documented in the non-recurrent group. Conclusions: The study shows that an enhanced inflammatory response early after PVI, characterised by increased CRP, WBC and TGF-β1 levels, may play a protective role against late arrhythmia recurrence. Full article

Background: Patients with arrhythmias, particularly paroxysmal supraventricular tachycardia (PSVT), face an increased risk of cardiac complications. Currently, non-parenteral medications for rapid PSVT cessation are lacking. Etripamil, a novel intranasal, short-acting calcium channel blocker, offers a rapid onset and the potential for unsupervised PSVT management. However, data on its use in arrhythmia management remain limited. Aims: We aimed to assess the efficacy and safety of 70 mg of etripamil compared with placebo in the treatment of PSVT. Methods: We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) from inception to April 2025. We calculated pooled risk ratios (RRs) with 95% confidence intervals (CIs) using random or common effects models, depending on the heterogeneity. Results: Four RCTs including 540 patients were analyzed. Etripamil demonstrated higher conversion rates to the sinus rhythm at 15 min (RR 1.84 [95% CI: 1.32–2.48]), 30 min (RR 1.80 [95% CI: 1.38–2.35]), and 60 min (RR 1.24 [95% CI: 1.04–1.48]). PSVT recurrence rates were similar between groups (RR 0.52 [95% CI: 0.20–1.34]). Adverse events (AEs) and severe AEs were comparable between etripamil and the placebo. Etripamil was associated with higher rates of nasal discomfort, nasal congestion, rhinorrhea, and epistaxis but not with increased bradyarrhythmia, atrial fibrillation, or non-sustained ventricular tachycardia. Conclusions: Etripamil appears to be a promising treatment for cardiac arrhythmias. Larger long-term RCTs are needed to confirm its safety and efficacy in clinical practice. Full article

Atrial fibrillation (AF) is a leading cause of stroke, heart failure, and cardiovascular morbidity, yet its pathophysiology remains incompletely understood. Among various molecular regulators, microRNAs (miRNAs) have emerged as promising biomarkers for AF detection and burden monitoring. However, the optimal sample type for miRNA analysis remains unclear, posing a challenge for biomarker standardization. This study aimed to assess whether miRNA expression profiles remain consistent across plasma and blood cells, with a focus on identifying miRNAs with a strong predictive potential for AF burden. This exploratory study recruited patients diagnosed with sick sinus syndrome who had undergone permanent pacemaker implantation. Participants were stratified into three groups based on AF status: no AF (n = 2), paroxysmal AF (PaAF; n = 2), and persistent AF (PerAF; n = 2) for white blood cell (WBC) samples, and pooled plasma samples from no AF (n = 3 pools) and PerAF (n = 3 pools). Using an miRNA microarray analysis, miR-1-3p was consistently downregulated in both WBC and plasma samples of patients with AF, showing significant decreases (fold-change in WBC: PaAF 0.22, PerAF 0.20; plasma PerAF 0.28) and highlighting its potential as a circulating biomarker for AF burden. Additional differentially expressed miRNAs, including miR-451a and miR-382-5p, exhibited sample-dependent variations, underscoring the importance of validating miRNA expression across multiple biological compartments. The study highlights the need for mechanistic investigations to determine whether miR-1-3p directly contributes to AF pathogenesis or serves as a downstream consequence of atrial remodeling. These findings reinforce the potential of miR-1-3p as a reliable circulating biomarker for AF, offering new avenues for non-invasive monitoring and risk stratification. Future research should explore the role of miR-1-3p in AF-related molecular pathways and its applicability as a therapeutic target. Full article

Background: This paper will identify the potential genetic causes of multimorbidity associated with autosomal dominant congenital cataract (ADCC). Methods: Whole exome sequencing (WES) was performed on 13 individuals affected with ADCC. Subsequent bioinformatic analyses identified variants with deleterious pathogenicity scores. Results: Disease-causing variants were identified in 8 genes already linked to cataract (CHMP4B, CRYAA, CRYBA1, CRYGD, CYP21A2, GJA8, OPA1, and POMGNT1), but variants previously associated with systemic disorders were also found in a further 11 genes (ACTL9, ALDH18A1, CBS, COL4A3, GALT, LRP5, NOD2, PCK2, POMT2, RSPH4A, and SMO). All variants were identified via pipeline data analysis, prioritising rare coding variants using Kaviar and the Genome Aggregation Database. The following ADCC-associated non-ocular phenotypes were identified in four patients in the cohort: (i) Horner’s pupils, vaso-vagal syncope, and paroxysmal orthostatic tachycardia syndrome; (ii) reduced kidney function and high cholesterol; (iii) hypertension, high cholesterol, and kidney stones; and (iv) grade 1 spondylolysis. Conclusions: We report 11 novel genes identified in an ADCC patient cohort associated with systemic disorders found, along with 8 known cataract-causing genes. Our findings broaden the spectrum of potentially cataract-associated genes and their related lens phenotypes, as well as evidence multimorbidities in four patients, highlighting the importance of careful multisystem phenotyping following genetic analysis. Full article

Background/Objectives: Parkinson’s disease (PD) and benign paroxysmal positional vertigo (BPPV) are both prevalent in the geriatric population. While dizziness is a common non-motor symptom in PD, the relationship between PD and incident BPPV remains unclear. Limited data suggest potential shared mechanisms, including mitochondrial dysfunction and oxidative stress, but large-scale epidemiological evidence is lacking. This investigation focused on assessing the incidence of BPPV in patients with PD compared to matched controls using a nationwide cohort. Methods: Data from the Korean National Health Insurance Service–Health Screening Cohort were used to perform a retrospective cohort analysis. We identified 8232 newly diagnosed PD patients and matched them 1:4 with 32,928 controls based on age, sex, income, and residential region. Stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident BPPV. Subgroup and Kaplan–Meier analyses were also performed. Results: Over 220,151 person-years of follow-up revealed a lower incidence of BPPV in the PD group relative to the control group (4.98 vs. 5.95 per 1000 person-years); the corresponding adjusted HR was 0.77 (95% CI: 0.66–0.90; p = 0.001), indicating a 23% reduced risk. The inverse association remained consistent across most subgroups, including older adults and rural residents. Kaplan–Meier analysis further illustrated a significant decline in the cumulative incidence of BPPV in PD patients (p = 0.007). Conclusions: PD may contribute to a lower incidence of BPPV, which could be explained by reduced mobility, altered vestibular function, or diagnostic challenges. Clinicians should consider BPPV in PD patients presenting with dizziness. Full article

Thromboembolism (TE) is a major cause of morbidity and mortality in patients with paroxysmal nocturnal hemoglobinuria (PNH). This narrative review summarizes available evidence on TE in Asian patients with PNH and discusses practical considerations and challenges for preventing and managing PNH-associated TE in Asian populations. Evidence suggests that, compared with non-Asians, fewer Asian patients have a history of TE (3.6% vs. 8.9%, p < 0.01), receive anticoagulants (8.5% vs. 16.2%, p = 0.002), or die from TE (6.9% vs. 43.7%, p = 0.000). Independent predictors of TE include lactate dehydrogenase ≥ 1.5 × upper limit of normal, pain, and male sex. Clone size alone does not appear to be a reliable estimate of TE risk. D-dimer levels are a useful marker of hemostatic activation, although they are not specific to PNH. Complement inhibition reduces the incidence of TE, although it does not wholly eliminate TE risk. Eligibility criteria and access to complement inhibitors vary across Asia, with limited availability in some countries. Anticoagulation is required to treat acute TE events and for primary or secondary prophylaxis in selected patients. Physicians and patients must stay alert to the signs and symptoms of TE to ensure prompt and appropriate treatment. Full article

Background/Objectives: Pediatric migraine is a prevalent neurological disorder that significantly impacts children’s quality of life, academic performance, and social interactions. Unlike migraines in adults, pediatric migraines often present differently and involve unique underlying mechanisms, making diagnosis and treatment more complex. Methods: This review discusses the clinical phases of pediatric migraine, key trigger factors, sex- and age-related differences, and the role of childhood maltreatment in migraine development. We also discuss episodic syndromes such as cyclic vomiting syndrome, abdominal migraine, benign paroxysmal vertigo, and benign paroxysmal torticollis, along with comorbidities such as psychiatric disorders, sleep disturbances, and epilepsy. Results: The underlying pathophysiological mechanisms for pediatric migraines, including genetic predispositions, neuroinflammation, and gut microbiota dysbiosis, are summarized. Current therapeutic strategies, including conventional and emerging pharmacological treatments, nutraceuticals, and non-pharmacological approaches, are evaluated. Non-pharmacological strategies, particularly evidence-based lifestyle interventions such as stress management, diet, hydration, sleep, exercise, screen time moderation, and cognitive behavioral therapy, are highlighted as key components of migraine prevention and management. The long-term prognosis and follow-up of pediatric migraine patients are reviewed, emphasizing the importance of early diagnosis, and tailored multidisciplinary care to prevent chronic progression. Conclusions: Future research should focus on novel therapeutic targets and integrating gut–brain axis modulation, with a need for longitudinal studies to better understand the long-term course of pediatric migraine. Full article

Sulfur dioxide (SO₂) is sourced by degassing magma in the shallow crust; hence its monitoring provides information on the rates of magma ascent in the feeding conduit and the style and intensity of eruption, ultimately contributing to volcano monitoring and hazard assessment. Here, we present a new algorithm to extract SO₂ data from the TROPOMI imaging spectrometer aboard the Sentinel-5 Precursor satellite, which delivers atmospheric column measurements of sulfur dioxide and other gases with an unprecedented spatial resolution and daily revisit time. Specifically, we automatically extract the volcanic clouds by introducing a two-step approach. Firstly, we used the Simple Non-Iterative Clustering segmentation method, which is an object-based image analysis approach; secondly, the K-means unsupervised machine learning technique is applied to the segmented images, allowing a further and better clustering to distinguish the SO₂. We implemented this algorithm in the open-source Google Earth Engine computing platform, which provides TROPOMI imagery collection adjusted in terms of quality parameters. As case studies, we chose three volcanoes: Mount Etna (Italy), Taal (Philippines) and Sangay (Ecuador); we calculated sulfur dioxide mass values from 2018 to date, focusing on a few paroxysmal events. Our results are compared with data available in the literature and with Level 2 TROPOMI imagery, where a mask is provided to identify SO₂, finding an optimal agreement. This work paves the way to the release of SO₂ flux time series with reduced delay and improved calculation time, hence contributing to a rapid response to volcanic unrest/eruption at volcanoes worldwide. Full article

Atrial fibrillation (AF), a prevalent cardiac arrhythmia and a major contributor to stroke risk, is anticipated to increase in incidence with the aging global population. For effective AF management, particularly for paroxysmal AF (PAF), long-term and accurate monitoring is essential. However, traditional monitoring methods, including Holter ECGs and implantable cardiac monitors (ICMs), present limitations in comfort, compliance and extended monitoring capabilities. Recent advancements in wearable technology have introduced smart textile-based ECG devices, which incorporate electrochemical sensors into fabrics, enabling non-invasive, continuous monitoring while enhancing user comfort. This review evaluates textile-based ECG devices by comparing their performance—assessed through AF detection rates, signal-to-noise ratio (SNR) and total analysis time—against conventional Holter monitoring and the 12-lead ECG. Furthermore, this review examines user acceptability factors, including patient-reported comfort, usability during resting and physical activities and skin-related adverse effects. The findings aim to provide insights for future device development and facilitate their integration into clinical practice. Full article

Chronic coughing is a common complaint in small animal medicine and it has an extensive differential diagnosis with very different treatment and prognosis. Coughing is considered chronic when it lasts at least 8 weeks. This retrospective study aimed to describe the most common causes of chronic coughing in a population of dogs that presented to a referral hospital in England between January 2012 and December 2021. In addition, we aimed to evaluate if an association with signalment, weight, coughing characteristics, and/or concomitant clinical signs could be identified. A total of 329 dogs met the inclusion criteria. The most frequent diagnoses were airway collapse (102/329, 30.7%), chronic bronchitis (80/329, 24.3%), neoplasia (62/329, 18.8%), and infectious bronchopneumonia (54/329, 16.4%). Other diagnoses were also identified in a lower number of cases. Pomeranian, Chihuahua, and Yorkshire Terrier were over-represented breeds for airway collapse. No predictive factors were identified for chronic bronchitis. Lower body weight (odds ratio [OR] 0.92, 95% confidence interval [CI]: 0.90–0.95), non-productive (OR 14.3 CI 3.44–50) paroxysmal coughing (OR 4.9, 95%, CI: 2.2–11.0), and exercise intolerance (OR 3.3, 95%, CI: 1.7–6.3) increased the odds of airway collapse. Older dogs (OR 1.025, 95%, CI: 1.014–1.036), higher body weight (OR 1.048, 95%, CI: 1.018–1.080), lethargy (OR 5.1, 95%, CI: 1.5–17.7), haemoptysis (OR 8.6, 95%, CI: 1.9–38.4), weight loss (OR 4.0, 95%, CI: 1.1–15.3), and inappetence (OR 6.5, 95%, CI: 1.9–22.1) increased the odds of neoplasia. Productive coughing (OR 3.0, 95%, CI: 1.5–6) and nasal discharge (OR 4.1, 95%, CI: 1.4–11.9) were predictive factors of infectious bronchopneumonia. Younger age (OR 0.96, 95%, CI: 1.061–1.150), higher body weight (OR 1.097, 95%, CI: 1.037–1.161), and haemoptysis (OR 11.8, 95%, CI: 1.8–78.5), increased the odds of airway foreign body. Higher body weight (OR 1.105, 95%, CI: 1.061–1.150), older age (OR 1.041, 95%, CI: 1.022–1.061), and regurgitation were predictive factors of laryngeal paralysis. Epiglottic retroversion was associated with younger age (OR 0.969, 95%, CI: 0.943–0.994), dysphagia (OR 42.5, 95%, CI: 4.7–382.7), and regurgitation (OR 11.6, 95%, CI: 1.2–113.1). All the aforementioned findings are valuable for prioritising differential diagnoses and consequently increasing the efficacy of the diagnostic plan and prioritising tests, which becomes even more important in cases where financial constraints are present. Finally, an appropriate selection of diagnostics tools helps optimise veterinary resources. Full article

Background/Objectives: The present study introduces our targeted approach for concomitant surgical ablation (CSA) using non-invasive phase mapping (NIPM) and describes its effectiveness regarding freedom from atrial fibrillation (AF). Methods: This retrospective study included cardiac surgical patients undergoing preoperative NIPM for CSA guidance. The primary outcome was freedom from AF six months after surgery. Key secondary outcomes were freedom from AF at hospital discharge and three months, frequency of biatrial ablation, feasibility and safety, the rate of CSA, complications, and levels of biomarkers. The control group consisted of patients undergoing CSA without NIPM. Results: Forty-four patients (Control: n = 31/NIPM: n = 13) were included. The NIPM group was younger (64 vs. 71 years [p = 0.044]), had a lower EuroSCORE II (2.6 vs. 3.4 [p = 0.041]), and a smaller left atrial size (46 mm vs. 54 mm [p = 0.025]). Surgery duration was longer in the NIPM group (285 vs. 230 min [p = 0.037]) with similar aortic cross-clamp times. Preoperative NIPM resulted in an effective frequency of CSA of 93%. CSA was more extensive in the NIPM group, with biatrial ablation performed in 54% vs. 26% of patients (p = 0.09). Conclusions: Routine preoperative NIPM in patients with non-paroxysmal atrial fibrillation might aid in increasing the number of patients receiving concomitant surgical ablation and developing a personalized CSA approach for every patient. Full article