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H. Maaroos [1] R. Keevallik [2] H. Kolk [1] I. Kull [1] K. Labotkin [1] R. Tammur [3] [11/12] Long-term Endoscopic Follow-up of Peptic Ulcer (PU): Clinical Course, Endoscopic Finding, [...]

T. Vorobjova [1] O. Ananieva [1] H. Maaroos [2] P. Sipponen [3] G. Faller [4] M. Utt [5] I. Nilsson [5] T. Wadstrom [5] K. Villako [2] R. Uibo [1] [...]

Background:The association of apoptosis was analysed in three different compartments (foveolar cells- FC, proliferating zone-PZ and glandular part-GP) of antrum and corpus mucosa specimens with development of atrophy and the extent of apoptosis as depending on grade of chronic inflammation, activity of gastritis and Helicobacter pyloricolonization at two time points of an 18-year follow-up in an adult population from Saaremaa, Estonia, with a high prevalence of H. pyloriinfection were compared. Methods:A total of 68 persons (31 men, 37 women; median age, 39 years in 1979) from a primary sample of 304 subjects, endoscoped in 1979 and reinvestigated by endoscopy and biopsy in 1997, were included in the study. The state of the gastric mucosa and the presence of H. pyloriin the antrum and corpus mucosa were assessed in accordance with the Sydney system. The dynamics of apoptotic index (AI) between two time points in 1979 and 1997 was evaluated in antrum biopsies of 49 persons and in corpus biopsies of 64 persons. Apoptosis was measured using terminal deoxyuridine nucleotide nick end labelling (TUNEL) histochemistry. Results:The antrum as well as the corpus of 2/68 persons were H. pylorinegative at both time points. Atrophy developed in 9/68 persons in the antrum and in 23/68 in the corpus. In PZ and GP of the corpus mucosa as well as in GP of the antrum mucosa, AI decreased significantly during 18 years compared with initial values (P< 0.05), which was not associated with development of atrophy. In all compartments of the antrum and corpus mucosa, studied at the initial and end points of observation, AI did not reveal a difference in persons with and without development of atrophy (P> 0.05). In the samples of 1979 the highest independent effect on the value of AI in the FC compartment for the antrum was exerted by grade of activity of gastritis (P= 0.01) and in GP by degree of chronic inflammation (P= 0.03), while in the samples of 1997 the highest effec... [ABSTRACT FROM AUTHOR]

In 30% of H. pylori-infected patients a certain type of antigastric autoantibodies, reacting against canalicular structures within human parietal cells, is detectable. Furthermore, it has been shown that these autoantibodies are correlated with atrophy of the mucosa in the corpus. The aim of this study was to analyse the prevalence of these anticanalicular autoantibodies (ACAB) and their significance for development of gastric mucosa atrophy in a 12-year follow-up period. Gastric biopsy specimens from 62 persons in Saaremaa Island, Estonia, were collected in 1997 and assessed independently by two pathologists in accordance with the updated Sydney system. The sera of these persons were immunohistochemically screened for ACAB and for classic parietal cell antibodies (PCA). In addition, for 37 of the 62 persons, gastric biopsies and sera collected 12 years earlier (1985) were investigated in an analogous manner. ACAB increased significantly, from 8 out of 37 in 1985 to 17 out of 37 in 1997 (P=0.004; McNemar test). In 1997 a significant correlation existed between the presence of ACAB and corpus mucosa atrophy (19 out of 30 versus 10 out of 32 without atrophy; P=0.01; odds ratio (OR)=3.8, 95% CI 1.4-10.6). However, no correlation was found between ACAB and development of atrophy in the period from 1985 to 1997. All 37 persons were PCA negative in 1985, whereas in 1997, 2 turned out to be PCA positive. ACAB increased significantly with duration of H. pylori gastritis. The correlation between ACAB and presence of gastric corpus atrophy was confirmed. However, it is possible that ACAB are the consequence of and not a causative factor in gastric mucosa atrophy, insofar as the association of ACAB with progression of corpus atrophy was not significant. [ABSTRACT FROM AUTHOR]

Evaluates the course of chronic gastritis and its association with Helicobacter pylori and CagA seroposivity. Correlation between intestinal metaplasia and gastritis; Effect of atrophy on epithelial cells; Prevalence of antibodies on CagA.

Helicobacter pylori (Hp) infection is very common in Estonia. The data about reinfection rate in children in communities with a high prevalence of Hp are scarce. Aim: To evaluate the reinfection rate after Hp treatment in a cohort of children followed up for a mean 6.5 years. Patients and Methods: 29 children with a mean age of 12.9 years (range 7 - 17 years) with recurrent abdominal pain and with Hp positive gastritis, 6 of them with simultaneous duodenal ulcer, received triple treatment for Hp infection. Four weeks after treatment Hp status was assessed by the histological and bacteriological evaluations of both the antrum and corpus mucosa. All treated patients were invited for the follow-up: the first follow-up took place during the 2nd post-treatment year (mean 19 months after treatment), and the second follow-up took place during the 7th post-treatment year (mean 6.5 years after treatment). The patients were interviewed and [sup 13]C-urea breath tests were performed to determine Hp-status. Results: 4 weeks after treatment 23 of 29 (79.3%) patients were Hp-negative. Twenty-two patients attended the first follow-up. One of 17 previously Hp-negative patients turned to be Hp-positive (follow-up 27 person-years). Thus the reinfection rate was 3.7% per person-year. One out of 5 previously Hp-positive children turned out to be Hp-negative (follow-up 7.9 person-years). Twenty patients attended the second follow-up: 4 of 15 previously Hp-negative patients turned out to be Hp-positive (follow-up 95.1 personyears). Thus the reinfection rate for the second follow-up was 4.2% per person-year. All 5 patients who had been Hp-positive during the first follow-up remained Hp-positive. The cumulative reinfection rate for the whole follow-up was 31.2%. Conclusions: Majority of the patients in whom eradication was attained remained Hp-negative during long-term follow-up. The reinfection rate calculated per person-year was quite stable during whole follow-up. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is often asymptomatic and intermittent making its detection challenging. A photoplethysmography (PPG) provides a promising option for atrial fibrillation detection. However, the shapes of pulse waves vary in atrial fibrillation decreasing pulse and atrial fibrillation detection accuracy. This study evaluated ten robust photoplethysmography features for detection of atrial fibrillation. The study was a national multi-center clinical study in Finland and the data were combined from two broader research projects (NCT03721601, URL: https://clinicaltrials.gov/ct2/show/NCT03721601 and NCT03753139, URL: https://clinicaltrials.gov/ct2/show/NCT03753139). A photoplethysmography signal was recorded with a wrist band. Five pulse interval variability, four amplitude features and a novel autocorrelation-based morphology feature were calculated and evaluated independently as predictors of atrial fibrillation. A multivariate predictor model including only the most significant features was established. The models were 10-fold cross-validated. 359 patients were included in the study (atrial fibrillation n = 169, sinus rhythm n = 190). The autocorrelation univariate predictor model detected atrial fibrillation with the highest area under receiver operating characteristic curve (AUC) value of 0.982 (sensitivity 95.1%, specificity 93.7%). Autocorrelation was also the most significant individual feature ( p < 0.00001) in the multivariate predictor model, detecting atrial fibrillation with AUC of 0.993 (sensitivity 96.4%, specificity 96.3%). Our results demonstrated that the autocorrelation independently detects atrial fibrillation reliably without the need of pulse detection. Combining pulse wave morphology-based features such as autocorrelation with information from pulse-interval variability it is possible to detect atrial fibrillation with high accuracy with a commercial wrist band. Photoplethysmography wrist bands accompanied with atrial fibrillation detection algorithms utilizing autocorrelation could provide a computationally very effective and reliable wearable monitoring method in screening of atrial fibrillation., Competing Interests: JL, TR, TM, HJ, JH, and MT are shareholders of Heart2Save company that designs ECG-based software for medical equipment. JL, MT, and HJ have a patent pending. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Väliaho, Kuoppa, Lipponen, Hartikainen, Jäntti, Rissanen, Kolk, Pohjantähti-Maaroos, Castrén, Halonen, Tarvainen, Santala and Martikainen.)

Background: Atrial fibrillation (AF) is the major cause of stroke since approximately 25% of all strokes are of cardioembolic-origin. The detection and diagnosis of AF are often challenging due to the asymptomatic and intermittent nature of AF., Hypothesis: A wearable electrocardiogram (ECG)-device could increase the likelihood of AF detection. The aim of this study was to evaluate the feasibility and reliability of a novel, consumer-grade, single-lead ECG recording device (Necklace-ECG) for screening, identifying and diagnosing of AF both by a cardiologist and automated AF-detection algorithms., Methods: A thirty-second ECG was recorded with the Necklace-ECG device from two positions; between the palms (palm) and between the palm and the chest (chest). Simultaneously registered 3-lead ECGs (Holter) served as a golden standard for the final rhythm diagnosis. Two cardiologists interpreted independently in a blinded fashion the Necklace-ECG recordings from 145 patients (66 AF and 79 sinus rhythm, SR). In addition, the Necklace-ECG recordings were analyzed with an automatic AF detection algorithm., Results: Two cardiologists diagnosed the correct rhythm of the interpretable Necklace-ECG with a mean sensitivity of 97.2% and 99.1% (palm and chest, respectively) and specificity of 100% and 98.5%. The automatic arrhythmia algorithm detected the correct rhythm with a sensitivity of 94.7% and 98.3% (palm and chest) and specificity of 100% of the interpretable measurements., Conclusions: The novel Necklace-ECG device is able to detect AF with high sensitivity and specificity as evaluated both by cardiologists and an automated AF-detection algorithm. Thus, the wearable Necklace-ECG is a new, promising method for AF screening., Clinical Trial Registration: Study was registered in the ClinicalTrials.gov database (NCT03753139)., (© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Background:: Pharmacological cardioversion of atrial fibrillation is a reasonable alternative for electrical cardioversion in acute atrial fibrillation. We compared the efficacy and safety of intravenous vernakalant and intravenous flecainide in patients with recent-onset (< 48 h) atrial fibrillation., Methods:: A total of 200 consecutive patients, 100 patients undergoing cardioversion with intravenous vernakalant and 100 patients undergoing cardioversion with intravenous flecainide, were included in this single centre non-randomized retrospective study. The primary endpoint was conversion to sinus rhythm within 120 minutes from the drug administration., Results:: Cardioversion was successful in 67% of patients treated with vernakalant and in 46% of patients treated with flecainide ( p=0.003). Vernakalant (odds ratio 1.99, 95% confidence interval 1.08-3.69, p=0.029) and female gender (odds ratio 2.48, 95% confidence interval 1.22-15.05, p=0.012) were significant predictors of successful cardioversion. The success rate of cardioversion was lowest among men treated with flecainide (36.9%). Patients treated with vernakalant were discharged earlier from the emergency department compared with those treated with flecainide (8.2 ± 4.7 h vs. 12.0 ± 6.0 h, p < 0.001). There was no difference in the complication rate between the groups. Vernakalant treated patients were older (59.3 ± 12.5 vs. 55.4 ± 13.0 years, p=0.03), had higher CHA 2 DS 2 -VASc score (1.4 ± 1.3 vs. 0.9 ± 1.2, p = 0.002) and were more often on beta-blocker medication (59% vs. 42%, p= 0.016) than flecainide treated patients., Conclusion:: Vernakalant was safe, more effective and faster than flecainide in the cardioversion of recent-onset atrial fibrillation. The difference in efficacy was especially apparent among men.