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Hepatobiliary cancers share risk factors with colorectal cancer (CRC), but there are no combined screening programs for these conditions. The aim of this study was to assess whether patients with high-risk colonic polyps are more likely to die from liver related tumors than patients with a negative colonoscopy. In this retrospective analysis of mortality data, Austrian screening participants were included. The absolute risk for hepatobiliary cancer death was calculated using the cumulative incidence method. We aimed to identify an association with time to death of hepatobiliary cancer by Cox proportional hazards model. 343,838 colonoscopies performed between 01/2007 and 12/2020 were included in the analysis, of which 17,678 (5.14%) revealed high-risk polyps. Overall hepatobiliary cancer mortality was more than twice as high in patients with high risk polyps (cumulative incidence 0.39%, 95% CI 0.37–0.41%) compared to patients with a negative colonoscopy (cumulative incidence 0.17%, 95% CI 0.17–0.17%). When adjusting for age and sex, having high-risk polyps at screening colonoscopy was significantly associated with hepatobiliary cancer death (HR 1.83, 95% CI 1.29- 2.59, p < 0.001). Patients with certain colonic polyp characteristics are at increased risk for mortality of liver malignancies. Further studies are needed to determine whether a structured additional screening for liver diseases and consecutive malignancies might be beneficial in these patients. [ABSTRACT FROM AUTHOR]

Patients with repaired tetralogy of Fallot (TOF) are at risk for ventricular tachycardia (VT) related to well-described anatomical isthmuses. The purpose of this study was to explore QRS morphology as an indicator of anatomical isthmus conduction. Patients with repaired TOF and complete right bundle branch block referred for transcatheter pulmonary valve replacement (PVR) or presenting with sustained VT underwent comprehensive 3-dimensional mapping in sinus rhythm. Electrocardiographic characteristics were compared to right ventricular (RV) activation and anatomical isthmus conduction properties. Twenty-two patients (19 pre–pulmonary valve replacement and 3 clinical VT) underwent comprehensive 3-dimensional mapping (median 39 years; interquartile range [IQR] 27–48 years; 12 [55%] male). Septal RV activation (median 40 ms; IQR 34–46 ms) corresponded to the nadir in lead V 1 and free wall activation (median 71 ms; IQR 64–81 ms) to the transition point in the upstroke of the Rʹ wave. Patients with isthmus block between the pulmonary annulus and the ventricular septal defect patch and between the ventricular septal defect patch and the tricuspid annulus (when present), were more likely to demonstrate lower amplitude Rʹ waves in lead V 1 (5.8 mV vs 9.4 mV; P =.005), QRS fragmentation in lead V 1 (15 [94%] vs 2 [13%]; P <.001), and terminal S waves in lead aVF (15 [94%] vs 6 [40%]; P <.001) than those with intact conduction. During catheter ablation, these QRS changes developed during isthmus block. For patients with repaired TOF, the status of septal isthmus conduction was evident from sinus rhythm QRS morphology. Low-amplitude, fragmented Rʹ waves in lead V 1 and terminal S waves in the inferior leads were related to septal isthmus conduction abnormalities, providing a mechanistic link between RV activation and common electrocardiographic findings. [ABSTRACT FROM AUTHOR]

Harmful algal blooms (HABs) have impaired Lake Erie's western basin water quality since the 1960s. Though scientists agree that eutrophication is a key driver of HABs in Lake Erie, the role of nitrogen is still the subject of debate. The problem is twofold: (1) uncertainty in the specific causes of HABs can lead to inappropriate management solutions, and (2) managing a cross-boundary watershed requires collaboration and agreement on apt solutions from multiple stakeholders as well as many U.S. states and Canadian provinces. In our study, we interviewed 29 stakeholders actively involved in western Lake Erie's watershed. We analyzed the stakeholders' values, attitudes, and policy preferences to understand their differences, similarities, and their effects on management decisions. We found that stakeholders agree on the urgency of the problem and the necessity for increased nutrient management in Lake Erie's western basin. Furthermore, we found that stakeholders can be represented as distinct clusters based on their values, and these value-based clusters are associated with different policy preferences. The different opinions and preferences of these value clusters span across stakeholder sectors and may affect efforts toward policy change. Stakeholders often question the feasibility and effectiveness of existing policies and policy plans. The findings shed new light on the relationship between stakeholder type and environmental values, attitudes, and policy preferences. Collaboration on HABs in Lake Erie will require open lines of communication both to improve policy and to cultivate trust among the multiple parties in this diverse watershed. [ABSTRACT FROM AUTHOR]

• Significant platelet activation is a hallmark of severe COVID-19. • Platelet activation biomarkers are associated with COVID-19 in-hospital mortality. • After adjustment for confounding factors, only coagulopathy was linked to mortality. • Antiplatelet agents were not a protective factor against COVID-19 mortality. Coronavirus disease 2019 (COVID-19) is associated with an inflammatory cytokine burst and a prothrombotic coagulopathy. Platelets may contribute to microthrombosis, and constitute a therapeutic target in COVID-19 therapy. To assess if platelet activation influences mortality in COVID-19. We explored two cohorts of patients with COVID-19. Cohort A included 208 ambulatory and hospitalized patients with varying clinical severities and non-COVID patients as controls, in whom plasma concentrations of the soluble platelet activation biomarkers CD40 ligand (sCD40L) and P-selectin (sP-sel) were quantified within the first 48 hours following hospitalization. Cohort B was a multicentre cohort of 2878 patients initially admitted to a medical ward. In both cohorts, the primary outcome was in-hospital mortality. In cohort A, median circulating concentrations of sCD40L and sP-sel were only increased in the 89 critical patients compared with non-COVID controls: sP-sel 40,059 (interquartile range 26,876–54,678) pg/mL; sCD40L 1914 (interquartile range 1410–2367) pg/mL (P < 0.001 for both). A strong association existed between sP-sel concentration and in-hospital mortality (Kaplan-Meier log-rank P = 0.004). However, in a Cox model considering biomarkers of immunothrombosis, sP-sel was no longer associated with mortality, in contrast to coagulopathy evaluated with D-dimer concentration (hazard ratio 4.86, 95% confidence interval 1.64–12.50). Moreover, in cohort B, a Cox model adjusted for co-morbidities suggested that prehospitalization antiplatelet agents had no significant impact on in-hospital mortality (hazard ratio 1.05, 95% CI 0.80–1.37; P = 0.73). Although we observed an association between excessive biomarkers of platelet activation and in-hospital mortality, our findings rather suggest that coagulopathy is more central in driving disease progression, which may explain why prehospitalization antiplatelet drugs were not a protective factor against mortality in our multicentre cohort. [ABSTRACT FROM AUTHOR]

Mobile (m) Health technology is well-suited for Remote Patient Monitoring (RPM) in a patient's habitual environment. In recent years there have been fast-paced developments in mHealth-enabled pediatric RPM, especially during the COVID-19 pandemic, necessitating evidence synthesis. To this end, we conducted a scoping review of clinical trials that had utilized mHealth-enabled RPM of pediatric asthma. MEDLINE, Embase and Web of Science were searched from September 1, 2016 through August 31, 2021. Our scoping review identified 25 publications that utilized synchronous and asynchronous mHealth-enabled RPM in pediatric asthma, either involving mobile applications or via individual devices. The last three years has seen the development of evidence-based, multidisciplinary, and participatory mHealth interventions. The quality of the studies has been improving, such that 40% of included study reports were randomized controlled trials. In conclusion, there exists high-quality evidence on mHealth-enabled RPM in pediatric asthma, warranting future systematic reviews and/or meta-analyses of the benefits of such RPM. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is the most common cause of death in childhood hypertrophic cardiomyopathy (HCM). Recently, two risk scores have been developed to estimate the 5-year risk of SCD. We aimed to assess their respective performances in an independent cohort of primary prevention children with HCM. All patients with HCM < 18-year-old from a single-center were retrospectively included between 2003 and 2023. Secondary and syndromic causes of HCM were excluded as well as children with inaugural sustained ventricular arrythmias. HCM Risk-Kids and PRIMaCY risk scores were calculated at diagnosis and during follow-up. The primary composite outcome included sustained ventricular arrhythmia, appropriate ICD therapy, aborted cardiac arrest, or SCD. Hundred primary prevention children were included (mean age 7.1 ± 5.6 years, 59.0% males), with a mean follow-up of 8.6 ± 5.5 years.13 (13.0%) patients experienced the primary composite outcome. When only considering events during the 5 first years, Harrel's C index was 0.52 (95% CI: 0.27–0.77) for HCM Risk-Kids (≥ 6%) and 0.70 (95% CI: 0.59–0.80) for PRIMaCY (> 8.3%), with 1 patient potentially treated by ICD for every 25 ICDs implanted for HCM Risk Kids and 1 for every 14 ICDs implanted for PRIMaCY. When risk scores were repeated and all primary outcomes during follow-up considered, all events except one (93.2%) were correctly identified using both risk scores, with 1 patient potentially treated by ICD for every 5.6 ICDs implanted for HCM Risk Kids and 1 for every 5.3 ICDs implanted for PRIMaCY. Among 44 (44.0%) patients implanted with an ICD, all primary prevention patients who had ≥ one appropriate ICD therapy during follow-up had HCM Risk-Kids ≥ 6% and PRIMaCY > 8.3% at implantation. Our findings suggest imperfect discrimination between low and high-risk HCM patients using these two risk scores. The performance or risk scores was substantially improved by periodic re-assessment during follow-up. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is the leading cause of death in adults with a systemic right ventricle (sRV). Dapagliflozin has been shown to reduce hospitalization for HF and all-cause death in patients with HF and reduced ejection fraction. The impact of dapagliflozin in patients with a sRV remains unknown. We aimed to evaluate the efficacy and safety of dapagliflozin in patients with sRV. This was a prospective, observational, single-center study. All symptomatic (NYHA ≥ 2) patients with a sRV dysfunction despite optimal medical treatment were included from March 2023 to March 2024. Patients were assessed at baseline and 3, 6 and 12 months after dapagliflozin introduction. The primary endpoint was the 6-minute walk distance. Secondary endpoints included NT-proBNP, quality of life (KCCQ-12), NYHA class, systemic and sub-pulmonary ventricular systolic function, and potential treatment-related side effects. A total of 32 patients were included. Mean age was 48 years (range: 19–79), 20 (62%) of patients were male, 12 (38%) had congenitally corrected transposition of the great arteries and 20 (62%) had transposition of the great arteries with atrial switch. Preliminary results at 6 months were available in 20 patients. There was no statistically significant improvement in 6-minute walk distance (558.0 m vs. 599.5, P = 0.11) nor NT-proBNP (355.5 pg/mL vs. 293.5, P = 0.81). However, the quality of life of patients (80.5 vs. 92.0, P < 0.01) and the right ventricle global longitudinal strain (−11.2% vs. −12.9, P < 0.01) significantly improved. The drug was well tolerated with no side effects reported (Fig. 1). These preliminary results suggest that dapagliflozin is well tolerated and associated with improved quality of life and right ventricle global longitudinal strain in patients with sRV dysfunction. Final results will bring important data on long-term outcomes associated with dapagliflozin use in this population. [ABSTRACT FROM AUTHOR]

Women aged 55 to 59 years have a similar prevalence rate and number needed to screen for colorectal adenomas as men at a 10-year younger age. The aim of this study was to determine sex-specific differences in colorectal cancer mortality and estimate the association with adenomas at screening colonoscopy. This retrospective study analyzed 323,139 individuals who underwent colonoscopy within a national colorectal cancer screening program in Austria between January 2007 and December 2020. Median patient age was 60 years (interquartile range, 54-67), and the sex distribution in all age groups was nearly identical. Men had significantly higher odds of having an adenoma or serrated polyp, low-risk polyp, high-risk polyp, or colorectal cancer detected at colonoscopy than women (odds ratio [OR] 1.83; 95% confidence interval [CI], 1.80-1.86; OR, 1.46; 95% CI, 1.44-1.49; OR, 1.74; 95% CI, 1.69-1.80; and OR, 1.87; 95% CI, 1.70-2.05, respectively). Strikingly, male sex, when compared with female sex, was associated with an almost 2-fold (hazard ratio, 1.67; 95% CI, 1.05-2.67) increased risk to die from colorectal cancer when an adenoma or serrated polyp was found at the screening colonoscopy and a 4-fold (hazard ratio, 4.14; 95% CI, 2.72-6.3) increased risk when a high-risk polyp was found at the screening colonoscopy. The cumulative incidence for death of colorectal cancer for 60-year-old individuals was 8.5-fold higher in men as compared with women. Markedly, this sex gap narrowed with increasing age, whereas the difference in deaths of other causes remained similar in all age groups. Our findings strengthen the necessity of sex-specific screening recommendations. Importantly, further prospective studies should focus on sex differences in tumor biology to propose personalized surveillance guidelines. [ABSTRACT FROM AUTHOR]

Background: Although patients with systemic right ventricle (SRV) represent a significant proportion of patients with congenital heart disease (CHD) implanted with cardiac resynchronization therapy (CRT), there are limited and conflicting data in this specific patient group.Objective: We aimed to analyze outcomes of patients with SRV implanted with a CRT device.Methods: Data were analyzed from an observational, retrospective, multicenter cohort study including all patients with CHD implanted with a CRT device from 6 French centers from 2004 to 2020. Response to CRT was defined as an increase in systemic ventricular ejection fraction of ≥10% and/or an improvement in New York Heart Association functional class by at least 1 grade.Results: A total of 85 patients with CHD were enrolled (mean age 39.8 ± 20.0 years; 55 [64.7%] males; 25 defibrillators [29.4%]), including 31 patients with SRV (36.5%) (mean age 43.9 ± 19.8 years; 16 [51.6%] males). The mean change in QRS duration after implantation was similar as compared with patients with systemic left ventricle (-46 ± 26 ms vs -35 ± 32 ms; P = .16). During a mean follow-up of 5.1 ± 3.5 years, late complications included 2 lead dysfunctions (6.5%), 3 CRT-related infections (9.7%), and 1 inappropriate implantable cardioverter-defibrillator shock (3.2%). The proportion of CRT responders at 6, 12, and 24 months were 82.6%, 80.0%, and 77.8% in patients with SRV vs 66.7%, 64.3%, and 69.6% in patients with systemic left ventricle (P = NS).Conclusion: In this multicenter cohort, one-third of patients with CHD implanted with a CRT device had SRV. CRT in patients with SRV was associated with a high rate of responders, comparable to that of patients with systemic left ventricle. [ABSTRACT FROM AUTHOR]

The risk of cancer in adults with congenital heart disease (ACHD) is 23% higher than in the general population. The objective of our study was to assess cancer screening coverage in ACHD. This was a prospective, observational, bicentric study of ACHD patients. Data were collected through a self-questionnaire proposed to all consecutive patients over 25 years from September 2022 to March 2023. Information on cervical, breast and colorectal cancer screening was collected and compared with screening data provided by Santé Publique France. A total of 263 patients were included. The mean age was 44 years (range, 25–78), 122 (46%) patients were male, and 99 (38%) patients had a complex CHD. Eleven (4%) patients had a history of cancer. The screening participation rate for breast cancer was higher in ACHD patients (72%) compared to the general population from Ile de France region (39%, p < 0.001) and from the whole French population (51%, p = 0.002). For colorectal and cervical cancers, the screening participation rate were 36% and 65%, compared to 31% and 51% in Île de France region and 34% and 59% in the whole French population, respectively with no statistically significant difference (Figure 1). Cancer screening coverage in ACHD patients was greater than non-congenital patients for breast cancer, but comparable for colorectal and cervical cancers. The screening participation rate remained however lower than European objectives for all cancers. Our data call for specific actions to better screen this aging population at high risk for cancer. [ABSTRACT FROM AUTHOR]

Ventricular arrhythmias and sudden death are recognized complications of tetralogy of Fallot (TOF). Electrophysiological study (EPS) is increasingly performed prior to pulmonary valve replacement (PVR) in these patients to evaluate and treat the arrhythmic substrate. We aimed to assess the value of cardiac magnetic resonance (CMR) to refine pre-operative risk stratification in this population. A prospective multicenter study was conducted to systematically assess EPS in patients with TOF referred for PVR from January 2020 to December 2021 in 5 tertiary centers in France. CMR parameters including right ventricular (RV) - left ventricular (LV) volumes, function, and as well as pulmonary regurgitant fraction and pulmonary annulus diameter were assessed. A positive EPS was defined as inducibility of a sustained ventricular arrhythmia (VA). A total of 120 patients were enrolled. Among the 108 (90.0%) patients who had a CMR prior to EPS, 24 (22.2%) had a VA inducible. Clinical characteristics of patients associated with EPS results are presented in table1. Concerning CMR variables, mean RV end-diastolic volume index was 157 ± 39 ml and was not statistically different in patients with positive vs. negative EPS (164 ± 49 vs. 155 ± 35, p = 0.395). However, a RV/LV end-diastolic volume index ratio > 2.4 was significantly associated with a higher likelihood of inducibility (OR 3.10, 95%CI 1.14–8.74, p = 0.040). Mean RV end-systolic volume index tended to be upper in patient with positive EPS (101 ± 35 vs. 86 ± 26, p = 0.072). The RV ejection fraction (RVEF) measured on CMR also tended to be slightly lower in patients with positive EPS (40 ± 7 vs. 43 ± 9, p = 0.069) unlike the LV ejection fraction (LVEF) (p = 0.600). Mean pulmonary annulus diameter were significantly associated with positive EPS (31 ± 8 vs. 26 ± 7, OR 1.10 [1.02–1.18], p = 0.012) and also with a cut-off > 28 mm (60.9% vs 34.4%, OR 2.92 [1.10–8.11] p = 0.047). Others non-CMR factors associated with inducible VA are presented in Table 1. In patients with TOF prior to PVR, RV/LV end-diastolic volume index ratio and pulmonary annulus diameter are associated with ventricular arrhythmia inducibility during EPS. CMR parameters, in combination with other clinical factors, may be useful to improve pre-operative risk stratification. [ABSTRACT FROM AUTHOR]

The adenoma detection rate (ADR) and characteristics of previously resected adenomas are associated with colorectal cancer (CRC) incidence and mortality. However, the combined effect of both factors on CRC mortality is unknown. Using data of the Austrian quality assurance program for screening colonoscopy, we evaluated the combined effect of ADR and lesion characteristics on subsequent risk for CRC mortality. We analyzed mortality rates for individuals with low-risk adenomas (1–2 adenomas <10 mm), individuals with high-risk adenomas (advanced adenomas or ≥3 adenomas), and after negative colonoscopy (negative colonoscopy or small hyperplastic polyps) performed by endoscopists with an ADR <25% compared with ≥25%. Cox regression was used to determine the association of combined risk groups with CRC mortality, adjusted for age and sex. We evaluated 259,885 colonoscopies performed by 361 endoscopists. A total of 165 CRC-related deaths occurred during the follow-up period, up to 12.2 years. In all risk groups, CRC mortality was higher when colonoscopy was performed by an endoscopist with an ADR <25%. Compared with negative colonoscopy with an ADR ≥25%, CRC mortality was similar for individuals with low-risk adenomas irrespective of ADR (for ADR ≥25%: adjusted hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.59–2.49; for ADR <25%: adjusted HR, 1.25; 95% CI, 0.64–2.43) and after negative colonoscopy with ADR <25% (adjusted HR, 1.27; 95% CI, 0.81–2.00). Individuals with high-risk adenomas were at significantly higher risk for CRC death if colonoscopy was performed by an endoscopist with an ADR <25% (adjusted HR, 2.25; 95% CI, 1.18–4.31) but not if performed by an endoscopist with an ADR ≥25% (adjusted HR, 1.35; 95% CI, 0.61–3.02). Our study adds important evidence for mandatory assessment and monitoring of performance quality in screening colonoscopy. High-quality colonoscopy was associated with a lower risk for CRC death, and the impact of ADR was strongest for individuals with high-risk adenomas. [Display omitted] [ABSTRACT FROM AUTHOR]

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A confluence of clinical and epidemiologic factors has provoked a steep increase in the prevalence of atrial fibrillation in adults with congenital heart disease. Atrial fibrillation is the most common presenting arrhythmia. Much remains to be unraveled about the mitigating role congenital heart disease, residual hemodynamic defects, surgical ramifications, and shunts and cyanosis on new-onset and recurrent atrial fibrillation in this population. Catheter ablation is increasingly performed for atrial fibrillation. This synopsis provides an overview of current knowledge on atrial fibrillation in adults with congenital heart disease, addresses clinical management, and discusses knowledge gaps and areas for future research. [ABSTRACT FROM AUTHOR]

Background: While outcomes of intra-atrial reentrant/focal atrial tachycardia (IART/FAT) catheter ablation have considerably improved in adult congenital heart disease (ACHD), recurrences remain common with different circuits frequently encountered.Objective: We aimed to assess the value of programmed atrial stimulation after successful clinical IART/FAT catheter ablation in patients with ACHD.Methods: This is a retrospective study including all patients with ACHD undergoing IART/FAT catheter ablation in a tertiary center. After successful catheter ablation of clinical arrhythmia, survival free from arrhythmia recurrence was analyzed according to whether all inducible IARTs/FATs were targeted.Results: From 2004 to 2020, 238 IART/FAT catheter ablation procedures were performed (mean age 44.1 ± 15.0 years; 61.3% men). Acute procedural success of clinical arrhythmia was achieved in 208 procedures (87.4%). Among 122 procedures with programmed atrial stimulation (58.7%), at least 1 other IART/FAT was induced in 61 patients (50%). All inducible IARTs/FATs were ablated in 54 patients (88.5%), whereas 7 patients (11.5%) presented with at least 1 nontargeted inducible IART/FAT. Patients with nontargeted inducible IART/FAT had a higher risk of atrial arrhythmia episodes than did inducible patients treated with ablation of all IARTs/FATs (hazard ratio 5.7; 95% confidence interval 1.7-18.4; P = .004), with 12-month atrial arrhythmias recurrence rates of 22.9% and 77.7%, respectively. Inducible patients with successful ablation of all IARTs/FATs had a risk of recurrence similar to that of noninducible patients (hazard ratio 0.6; 95% confidence interval 0.3-1.3; P = .215).Conclusion: Beyond clinical IART/FAT catheter ablation in patients with ACHD, our findings suggest the interest of systematically targeting all remaining inducible arrhythmias, irrespective of whether previously documented. [ABSTRACT FROM AUTHOR]

Adenoma detection rate (ADR) is the best established quality parameter for screening colonoscopy. Guidelines recommend a target ADR >25% because previous studies have shown that patients of endoscopists with higher ADRs have a lower risk of postcolonoscopy interval cancers. However, studies have shown that improvement in ADR mainly results in increased detection of clinically irrelevant nonadvanced adenomas (NAAs). The impact of ADR on the detection of advanced adenomas (AAs) as well as adverse event rates has yet to be determined. A total of 218,193 screening colonoscopies performed between 2007 and 2010 by 262 endoscopists within the Austrian quality assurance program were analyzed. We divided endoscopists into quintiles based on ADRs and calculated mean advanced ADRs (AADRs), NAA detection rates (NAADRs), and adverse event rates for each quintile. Spearman rank-order was used to calculate overall correlations between ADRs and AADRs as well as adverse event rates. Endoscopists with an ADR <25% were compared with those with an ADR >25%. Fifty-one percent of patients were women. Mean ADR was 23.03% (95% confidence interval [CI], 21.93-24.13), AADRs 7.72% (95% CI, 7.19-8.25), and NAADRs 15.31% (95% CI, 14.36-16.27). Overall, there was a significant correlation between ADR and AADR (rho =.51; P <.001). When ADR was divided into quintiles, mean AADR increased with increasing ADR. Even in the highest ADR group (ADR, 31.36%-52.27%) there was a further increase in AADR with a mean of 10.75% (95% CI, 9.31-12.19). Importantly, NAADRs increased continuously with improvement in ADRs but never dissociated from a simultaneous improvement in AADRs. However, there was also a significant correlation of ADRs and endoscopic adverse events (rho =.26, P <.001), even if the perforation rate of.028% (95% CI,.004-.052) in the highest ADR group still remained within the accepted limits based on guidelines. Increasing ADR is associated with improved detection of AAs and therefore is likely to prevent more cases of colorectal cancer. However, higher ADR was also associated with a higher rate of adverse events, although the adverse event rate was low. [ABSTRACT FROM AUTHOR]

Background: Differences in relative survival (RS) of melanoma between histologic subtypes were discussed to be mainly caused by tumor thickness.Objective: To investigate RS of melanoma, stratified by tumor thickness for each histologic subtype, and identify survival trends.Methods: With use of cancer registry data on melanoma cases (International Classification of Diseases, 10th Revision, codes C43.0-C43.9) diagnosed in Germany in 1997-2013, 5- and 10-year age-standardized RS stratified by histologic subtype and stratified or standardized by T stage was estimated by standard and modeled period analyses. We restricted 10-year RS analyses to patients younger than 75 years.Results: We analyzed 82,901 cases. Overall, the 5- and 10-year RS rates were 91.7% and 90.8%, respectively. Prognosis worsened with increasing T stage for all histologic subtypes, but T-stage distribution varied substantially. Survival differences by histologic subtype were strongly alleviated after adjustment for T stage but remained significant. Overall, 5-year RS increased significantly (by 3.8 percentage points) between the periods 2002-2005 and 2010-2013. This increase was no longer seen after adjustment for T stage.Limitations: Exclusion of cases on account of missing information on T stages, changes in the definition of T stages, and lack of information on screening and treatment limit our analyses.Conclusion: Differences in RS between histologic subtypes were strongly mediated by tumor thickness. Over time, RS of melanoma increased as a result of changes in T-stage distribution. [ABSTRACT FROM AUTHOR]

Abstract Background and aims Hot snare (HS) is widely used for the resection of adenomas >5 mm. The cold snare (CS) has a better safety profile and is more cost-effective. The aims of this study were to evaluate effectiveness and safety of CS polypectomy (CSP) compared to HS polypectomy (HSP) for adenomas sized 5–10 mm and 11–20 mm. Methods 4018 colonoscopies performed within "quality certificate for screening colonoscopy" with one polypectomy of an adenoma sized 5–20 mm each were included. Retrieval rates, complete resection rates and complication rates were assessed and compared between CSP and HSP for adenomas sized 5–10 mm and 11–20 mm. Histologic subgroups were additionally assessed. Results Complete resection rates (5–10 mm: CSP: 89.4% vs. HSP: 87.9%, p = 0.33; 11–20 mm: CSP: 81.8% vs. 80.9%; p = 1), retrieval rates (5–10 mm: CSP: 99.5% vs. HSP: 99.4%, p = 0.76; 11–20 mm: CSP: 100% vs. HSP: 99%, p = 1) and complication rates (5–10 mm: CSP: 0.2% vs. HSP: 0.2%; p = 1; 11–20 mm: CSP: 0% vs. HSP: 1%, p = 1) were equal between CSP and HSP for adenomas sized 5–10 mm as well as 11–20 mm. For serrated adenomas sized 5–10 mm, HSP was superior to CSP (88.7% vs. 77.2%, p < 0.05) regarding the complete resection rate, but not for advanced adenomas (HSP: 89.1% vs. 87.3%, p = 0.69) or adenomas with high-grade dysplasia (HSP: 76.7% vs. 75%, p = 1). Conclusion This study further supports the use of CSP for polyps sized 5–10 mm and additionally suggests also using CSP for polyps sized 11–20 mm. These findings, as well as the best method for resection of serrated polyps should be validated in further studies. [ABSTRACT FROM AUTHOR]

Background and Aims The primary aim of this study was to evaluate adenomas per positive participant (APP) and adenomas per colonoscopy (APC) as new quality parameters in screening colonoscopy. Furthermore, we wanted to assess whether these parameters differ depending on the setting or profession. Methods Colonoscopy records were obtained from the database of the Austrian certificate of quality for screening colonoscopy. The Spearman correlation was calculated to compare the adenoma detection rate (ADR), APC, APP, and advanced ADR. The parameters were compared between surgeons and internists and between private practices and hospitals by using the t test. Results A total of 44,142 colonoscopies performed by 202 endoscopists were included. APC showed a strong correlation with ADR (r = 0.94; P <.01), and both showed a similar correlation with the advanced ADR (ADR: r = 0.47; P < 0.01, APC: r = 0.46; P <.01). APP showed weaker correlations compared with all other parameters (ADR: r = 0.36; P <.01; advanced ADR: r = 0.19; P <.01). Private practices did not differ in ADR, APP or APC from hospitals. Among endoscopists with ADRs of ≥25%, 7 (10.3%) had an APP in the lowest quartile, whereas no endoscopists had an APC in the lowest quartile. Conclusions APC did not reveal additional information to ADR, and thus there is no need to use it instead of or additionally to ADR. Although the APP identifies endoscopists who find few adenomas per procedure despite acceptable ADRs, this additional information might not be important in regard to sufficient colorectal cancer prevention, because these endoscopists still had high advanced ADRs. [ABSTRACT FROM AUTHOR]

Abstract Process mining offers the potential for internal logistics process improvement using data. While there exists a massive amount of data, identifying and understanding relevant data across different information systems and complex data models is difficult. To address this issue, ontologies can be used to formalize a shared understanding. This paper aims to provide an extended internal logistics ontology focusing the process perspective. Existing internal ontologies are reviewed, compared and merged. Additionally, related resources such as products and packaging is integrated. In conclusion, this paper proposes a domain ontology to support process mining within internal logistics. [ABSTRACT FROM AUTHOR]

The risk of cancer in adults with congenital heart disease (ACHD) is 23% higher than in the general population. The objective of our study was to assess cancer screening coverage in ACHD. This was a prospective, observational, bicentric study of ACHD patients. Data were collected through a self-questionnaire proposed to all consecutive patients over 25 years from September 2022 to March 2023. Information on cervical, breast and colorectal cancer screening was collected and compared with screening data provided by Santé Publique France. A total of 263 patients were included. The mean age was 44 years (range, 25–78), 122 (46%) patients were male, and 99 (38%) patients had a complex CHD. Eleven (4%) patients had a history of cancer. The screening participation rate for breast cancer was higher in ACHD patients (72%) compared to the general population from Ile de France region (39%, P < 0.001) and from the whole French population (51%, P = 0.002). For colorectal and cervical cancers, the screening participation rate were 36% and 65%, compared to 31% and 51% in Île de France region and 34% and 59% in the whole French population, respectively with no statistically significant difference (Figure 1). Cancer screening coverage in ACHD patients was greater than non-congenital patients for breast cancer, but comparable for colorectal and cervical cancers. The screening participation rate remained however lower than European objectives for all cancers. Our data call for specific actions to better screen this aging population at high risk for cancer. [ABSTRACT FROM AUTHOR]

Polyp size and high-grade dysplasia in polyps at screening colonoscopy are considered risk factors for post-colonoscopy colorectal cancer (PCCRC) development and death, which might be averted by surveillance colonoscopy. However, robust evidence backing these risk factors is lacking. We aimed to investigate whether polyp size or dysplasia grade is associated with PCCRC mortality. This was a retrospective study including individuals of the Austrian Quality Certificate for Screening Colonoscopy who underwent a colonoscopy between January 2007 and December 2020. We investigated the association of polyp size and dysplasia in polyps with PCCRC mortality according to Cox regression analysis. In addition, whether patients with certain polyp characteristics had similar risk for CRC death compared with the Austrian population was assessed by calculating standardized mortality ratios (SMRs). A total of 316,001 individuals were included. After a median follow-up time of 5.27 years (95% confidence interval [CI], 5.25-5.29), a significant association of polyps 10 to 20 mm (hazard ratio, 4.00; 95% CI, 2.46-6.50; P <.001) as well as high-grade dysplasia (hazard ratio, 6.61; 95% CI, 3.31-13.2; P <.001) with PCCRC death was observed. PCCRC mortality was significantly lower than the expected CRC mortality in the general population in patients with polyps <10 mm and without high-grade dysplasia (SMR,.27; 95% CI,.21-.33; P <.001), which was not observed for patients with polyps ≥10 mm or with high-grade dysplasia (SMR, 2.05; 95% CI, 1.64-2.57; P <.001). Polyp size ≥10 mm and high-grade dysplasia are associated with PCCRC mortality in screening patients. The data suggest that these patients might benefit most from surveillance colonoscopy. [ABSTRACT FROM AUTHOR]

Natural products have been an excellent and abundant source of therapeutics for many decades. To expand on their success, and explore areas of chemical space not covered by biosynthesis, the synthesis of natural product-inspired compound collections has emerged as a viable strategy. Herein we describe the principles behind biology-oriented synthesis and related approaches, the requirements for development of novel chemistry and how phenotypic screens are a very fruitful way to explore the bioactivity of compounds made using these approaches. Finally, we summarize state-of-the-art techniques to identify the biological targets of any hits identified. [ABSTRACT FROM AUTHOR]

The presence of an implantable cardioverter-defibrillator (ICD) in the paediatric population is marked by the occurrence of more frequent complications compared to the adult population, such as lead failure, infections and inappropriate shocks. The objectives of the iChildren study is to carry out an inventory of French practices and to compare the three available defibrillation methods (endovascular, surgical, subcutaneous S-ICD) in terms of effectiveness and safety. We retrospectively included 274 children aged 16 years or younger at the time of the first implantation of an ICD, from most of the major French implanting centres since 2005. Data were collected in an eCRF. The primary composite outcome (PCO) associates the occurrence of lead failure or device infection. We also analyse the rate of appropriate and inappropriate shocks. An endovascular ICD was implanted in 103 patients (38%), a subcutaneous ICD (S-ICD) in 55 patients (20%), a surgical ICD in 116 patients (42%). During a mean follow-up time of 5.7 years, the occurrence of PCO was found in 21% of patients, 5% of the S-ICD patients, 19% of the endovascular patients, 29% of the surgical patients. In univariate analysis, the factors associated with PCO were: young age group, type of ICD. In multivariate analysis, after adjustment, the surgical ICD was associated with the highest risk of PCO (P < 0.05). In the total population, the rate of appropriate shocks was 30%, the rate of inappropriate shocks was 11%, with no statistically significant difference between ICD types at implantation. Surgical implantation of an ICD is associated with more long-term complications, such as lead failure and device infection. There was no statistically significant difference in the occurrence of inappropriate shocks between the 3 defibrillation approaches. [ABSTRACT FROM AUTHOR]

CO 2 streams captured from power stations or industrial plants may contain impurities that impact the consecutive steps of the CO 2 capture and storage (CCS) chain. As the basis for an optimization of CO 2 purity over the whole CCS chain, impacts of different impurities were investigated at key steps including studies on (i) corrosion of metallic materials in CO 2 streams and brine, (ii) fluid and interfacial properties as a function of pressure, temperature and CO 2 stream composition and their implications for CO 2 transport, injection and geological storage, (iii) costs of different pipeline design options, (iv) geochemical alterations at typical reservoir conditions and their implications for geomechanical rock properties. Major findings are synthesized for two exemplary single source-single sink CCS chain scenarios involving CO 2 stream compositions typical for pre-combustion capture and oxyfuel combustion. Recommendations for material selection for compression, transport and injection were derived for various CO 2 stream compositions. To reliably control corrosion, a limitation of water contents to 50 ppm v is recommended for pipeline transportation of all CO 2 streams. At geological storage conditions, the presence of either O 2 , NO x or SO 2 only weakly affected fluid-mineral/rock interactions that still impacted geomechanical rock properties. [ABSTRACT FROM AUTHOR]

Geological storage of captured CO 2 , which typically will contain certain amounts of impurities, in saline aquifers is of potential to reduce greenhouse gas emissions into the atmosphere. The co-injection of the impurity SO 2 has an effect on the chemical reactivity of the fluid and solid phases as well as on the physical behaviour of the CO 2 plume. To address these influences we assessed the impact of SO 2 on the physicochemical behaviour of the CO 2 phase by pressure-volume-temperature calculations and geochemical modelling of fluid-rock interactions. As case study, the Ketzin pilot site in Germany was chosen. The results reveal that the presence of SO 2 causes a greater porosity decrease compared to pure CO 2 during the injection period. Certainly, any textural changes that occur in the vicinity of the injection well are of importance for selecting the right injection strategy and to reduce operational costs. We further assessed the impact of SO 2 on the overall CO 2 storage capacity at different depth. Particularly, there is a maximum reduction of the storage capacity at low depth, but the general impact of SO 2 concentrations <1% is comparatively low. Furthermore, short-term porosity changes that are induced by chemical reactions beyond the dry-out zone will reduce the pore spaces available for storage. [ABSTRACT FROM AUTHOR]

Drilling operations require the usage of drilling fluids to perform not only cleaning and cooling functions, but also to control the hydraulic pressure inside the oil well. Monitoring the quantity of solids suspended in such fluid is important because it is related to density and apparent viscosity. Both physicochemical data influence the determination of the frictional pressure loss in annuli, which is the first step of calculation while determining the hydraulic pressure. Automating the measurement of solids may not only improve drilling performance but also mark the initial steps toward attaining a fully automated drilling operation. This work measured real-time data of ultrasonic attenuation, velocity of sound, density and apparent viscosity in several distinct suspensions. Such data was used to determine the content of solids in water-based drilling fluids. The results showed that ultrasonic attenuation and density were proportional to the quantity of solids suspended (The largest density range evaluated was from 0.98 to 1.6 kg/l, water to heavy slurry; the concentration of solids suspended varied from zero to 1000 g per liter of suspension, which caused the ultrasonic attenuation range from 6 to 32 dB). The apparent viscosity appears to impact ultrasonic attenuation (1 cP to 135 cP caused the ultrasonic attenuation to vary from 6 to 22 dB, approximately). The velocity of sound was proportional to the quantity of dissolved solids (1500 m/s were raised to 1750 m/s, approximately, when 300 g/l of sodium chloride was added in water.) Results also showed that Newtonian and non-Newtonian suspensions vary due to the fact that the shear rate must be known for non-Newtonian fluids in order to correctly determine the solids content. To predict the solids content of water-based drilling fluids from real time data, the study successfully implements a statistical model. When the predicted and experimental values were compared in a case study, the proposed model presented accuracy of ±10%. [ABSTRACT FROM AUTHOR]

Geochemical modeling was used to assess the impact of sulfur dioxide (SO 2 ) in impure carbon dioxide (CO 2 ) streams on fluid–rock interaction during storage in siliciclastic rocks of Permian age (Rotliegend). We focused on the impact of SO 2 on the porosity evolution, as well as on the trapping of CO 2 as solid mineral phase. Due to the lack of a validated approach to calculate SO 2 solubility in highly saline brine at CO 2 storage conditions, different calculation approaches were tested against experimental literature data. Our novel approach employs a pressure and temperature adjusted Henry's constant with salinity correction. Depending on the solubility calculation approach and on the consecutive reactions of dissolved SO 2 , different SO 2 concentrations in the brine were calculated. Based on the results of these solubility calculations, a low and a high SO 2 concentration case were defined for geochemical modeling to assess the impact of different SO 2 concentrations on fluid–rock interactions in a CO 2 storage reservoir. An exemplary Rotliegend sandstone composition was chosen reflecting compositions of potential target horizons in the North German Basin. Short-term dissolution of carbonates and, in the presence of SO 2 , subsequent precipitation of sulfur-bearing minerals results in a decrease in porosity. A precipitation of sulfates near the injection well may lower injectivity. With time, dissolution of alumosilicates further provides cations to the aqueous solution for a precipitation of secondary carbonates. The presence of SO 2 modifies this long-term interplay between silicate and carbonate minerals. The higher the SO 2 concentration in the brine, the lower the amounts of newly formed carbonates, i.e. the mineral trapping of CO 2 , and the lower the overall porosity decrease. Hence, the assessment of SO 2 dissolution in the formation brine at subsurface conditions is crucial for predicting mineral reactions and porosity evolution during geological storage of impure CO 2 . [ABSTRACT FROM AUTHOR]

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce. We aimed to describe long-term follow-up of TOF patients implanted with ICD through a nationwide French registry. Nationwide French Registry including all TOF patients with an ICD initiated in 2010 by the French Institute of Health and Medical Research. The primary time to event endpoint was the time from ICD implantation to first appropriate ICD therapy. Clinical events were centrally adjudicated by a blinded committee. A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (IQR) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least one appropriate ICD therapy. The annual incidence of the primary outcome was 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively, P = 0.03). Overall, 71 (43.0%) patients presented with at least one ICD complication, including inappropriate shocks in 42 (25.5%) patients and lead dysfunction in 36 (21.8%) patients. Among 61 (37.0%) primary prevention patients, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with respectively no, one, two, or ≥ three guideline-recommended risk factors. QRS fragmentation was the only independent predictor of appropriate ICD therapies (HR 3.47, 95% CI 1.19–10.11), and its integration in a model with current criteria increased the 5-year time-dependent area under the curve from 0.68 to 0.81 (P = 0.006) (Fig. 1). Patients with TOF and an ICD experience high rates of appropriate therapies, including those implanted in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria including QRS fragmentation might improve risk stratification. [ABSTRACT FROM AUTHOR]

The idea of adapting the air supply rate to the actual demand in a building is not a new one. In commercial buildings it is already state-of-the-art to establish a demand controlled ventilation, where the level of air flow is based on sensors or time control. In residential buildings however, mechanical ventilation systems, whether centralized or decentralized, are in most cases operated in a constant modus, providing fresh air regardless if the fresh air is needed or not, even though the technology and the components needed for demand controlled ventilation exist and can be purchased at reasonable prices. In this article, results of field tests with a semi-centralized demand feedback-controlled ventilation system are shown and compared to outcomes with other demand controlled systems. The semi-centralized prototype includes decentralized fans per ventilation zone, making a room-wise ventilation possible and valves to balance the system hydraulically unnecessary. It is shown that each presented concept of demand controlled ventilation can save energy by decreasing the operational time or the mean air flow rate without compromising air quality. Concepts which make a zone- or even a room-wise control of air flow possible, showed the highest energy saving potential of up to two-thirds compared to a system operating at constant flow rates. In addition to the energy savings due to decreased operational time, the maintenance and filter costs are decreased while the user comfort is increased, as natural ventilation in spring, summer and autumn may easily be added when ΔT between inside and outside is small. [ABSTRACT FROM AUTHOR]

Background & Aims Various types of liver disease are associated with an increased prevalence of colorectal adenomas. We investigated whether cirrhosis is a risk factor for colorectal neoplasia by analyzing colonoscopy findings from 2 cohorts of patients awaiting liver transplantation. Methods We performed a retrospective analysis to compare findings from colorectal cancer screenings of 567 adult patients with cirrhosis placed on the waitlist for liver transplantation with those from controls (matched for age, sex, body mass index, smoking, and diabetes). Rates of adenoma and advanced adenoma detection were adjusted owing to differences in rates of polypectomies performed in the 2 cohorts. Results Adenomas were detected in a significantly higher percentage of patients with cirrhosis (29.3%) than in controls (21.5%) ( P = .0057; relative risk [RR], 1.36; 95% confidence interval [CI], 1.09–1.69); and patients with cirrhosis had a higher rate of advanced adenoma detection than controls (13.9% vs 7.7%; P = .0015; relative risk, 1.82; 95% CI, 1.25–2.64). A greater percentage of patients with alcoholic cirrhosis had neoplasias (34.3%) than controls (25.3%; P = .0350; RR, 1.36), and rates of advanced adenoma detection were 16.7% vs 10.2% ( P = .0409; RR, 1.63). Adenomas were detected in 27.8% of patients with viral cirrhosis vs 15.9% of controls ( P = .0061; RR, 1.74), with rates of advanced adenoma detection of 13.6% vs 5.0% ( P = .0041; RR, 2.73). Similar proportions of patients with cirrhosis of other etiologies and controls were found to have colorectal neoplasias. Conclusions Based on a retrospective analysis of colonoscopy findings from patients awaiting liver transplantation, those with alcoholic or viral cirrhosis are at higher risk of developing colorectal neoplasia and should be considered for earlier colonoscopy examination. [ABSTRACT FROM AUTHOR]

Objectives Oral and pharyngeal cancer is still a serious health problem with an annual incidence of about 13,000 in Germany. This study aimed at describing trends of incidence and mortality in Germany by age, sex, and sub-site as a baseline for an oral cancer prevention campaign. Methods Using data from the National Association of Population-based Cancer Registries, incidence rates for oral and pharyngeal cancer (ICD-10, C00–C14) from 2003 to 2011 and mortality rates from 1990 to 2012 were analysed by age, sex, and sub-site (C00–C06, C07–C08, C09–C14). Trends were described by annual percentage changes. Results Men are 2.5-times more likely than women to be diagnosed and 3-times more likely to die from this tumour. Incidence and mortality in women increased slightly during the last decade, while incidence and mortality in men remained stable at a high level. While a decline was observed for younger age groups, an increase was seen in the elderly. For some sub-sites a deviation from this overall pattern was observed. Conclusions The decrease in this tumour in younger age groups is pleasing and may be attributed to public efforts in non-smoker protection in recent years. Further efforts are needed to counteract the increasing burden of disease in older age groups and in men. [ABSTRACT FROM AUTHOR]

A recent investigation of bacterioplankton communities in the German Bight towards the end of a diatom-dominated spring phytoplankton bloom revealed pronounced successions of distinct bacterial clades. A combination of metagenomics and metaproteomics indicated that these clades had distinct substrate spectra and consumed different algal substrates. In this study we re-analyzed samples from the initial study by total community RNA (metatranscriptomics) and 16S rRNA gene amplicon sequencing. This complementary approach provided new insights into the community composition and expressed genes as well as the assessment of metabolic activity levels of distinct clades. Flavobacteria (genera Ulvibacter , Formosa , and Polaribacter ), Alphaproteobacteria (SAR11 clade and Rhodobacteraceae ) and Gammaproteobacteria (genus Reinekea and SAR92 clade) were the most abundant taxa. Mapping of the metatranscriptome data on assembled and taxonomically classified metagenome data of the same samples substantiated that Formosa and Polaribacter acted as major algal polymer degraders, whereas Rhodobacteraceae and Reinekea spp. exhibited less specialized substrate spectra. In addition, we found that members of the Rhodobacteraceae and SAR92 clade showed high metabolic activity levels, which suggests that these clades played a more important role during the bloom event as indicated by their in situ abundances. [ABSTRACT FROM AUTHOR]

Background: Walnut consumption is associated with reduced risk of coronary heart disease (CHD). Objective: We assessed the effect of walnuts on lipid and glucose metabolism, adipokines, inflammation and endothelial function in healthy Caucasian men and postmenopausal women ≥50years old. Design: Forty subjects (mean±SEM: age 60±1years, BMI 24.9±0.6kg/m2; 30 females) were included in a controlled, cross-over study and randomized to receive first a walnut-enriched (43g/d) and then a Western-type (control) diet or vice-versa, with each lasting 8weeks and separated by a 2-week wash-out. At the beginning and end of each diet phase, measurements of fasting values, a mixed meal test and an assessment of postprandial endothelial function (determination of microcirculation by peripheral artery tonometry) were conducted. Area under the curve (AUC), incremental AUC (iAUC) and treatment×time interaction (shape of the curve) were evaluated for postprandial triglycerides, VLDL-triglycerides, chylomicron-triglycerides, glucose and insulin. Results: Compared with the control diet, the walnut diet significantly reduced non-HDL-cholesterol (walnut vs. control: −10±3 vs. −3±2mg/dL; p=0.025) and apolipoprotein-B (−5.0±1.3 vs. −0.2±1.1mg/dL; p=0.009) after adjusting for age, gender, BMI and diet sequence. Total cholesterol showed a trend toward reduction (p=0.073). Fasting VLDL-cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and glucose, insulin, HOMA-IR, and HbA1c did not change significantly. Similarly, fasting adipokines, C-reactive protein, biomarkers of endothelial dysfunction, postprandial lipid and glucose metabolism and endothelial function were unaffected. Conclusion: Daily consumption of 43g of walnuts for 8weeks significantly reduced non-HDL-cholesterol and apolipoprotein-B, which may explain in part the epidemiological observation that regular walnut consumption decreases CHD risk. [ABSTRACT FROM AUTHOR]

With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in ACHD patients, over a significant period of time, remain scarce. We aimed to describe temporal trends in volume and outcomes of catheter ablation in ACHD patients. Retrospective observational study including all consecutive ACHD patients undergoing attempted catheter ablation in a large tertiary referral center over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 months were analyzed. From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6 ± 15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 cases per year (P < 0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n = 217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P < 0.001). Use of irrigated catheters (OR = 4.03, 95% CI: 1.86–8.55), 3D-mapping system (OR = 3.70, 95% CI: 1.72–7.74), contact force catheters (OR = 3.60, 95% CI: 1.81–7.38), and high-density mapping (OR = 3.69, 95% CI: 1.82–8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P = 0.001). Seven (2.3%) non-fatal complications occurred (Fig. 1). The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and midterm outcomes. [ABSTRACT FROM AUTHOR]

While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Heart transplant recipients are at high-risk of sudden cardiac death (SCD). However, risk factors of SCD in heart recipients remained poorly described. To assess the predictors of SCD beyond the first-year post-transplant. We enrolled consecutive patients transplanted between 2004 and 2017 in two French referral centres. We excluded patients deceased during the first year. Patients underwent an evaluation at the day of transplantation and during the first year, comprising clinical, biological, histological, immunological (circulating anti-HLA DSA) and interventional (cardiac allograft vasculopathy assessment) parameters. According to the last consensus, SCD was defined as an unexpected out-of-hospital cardiac arrest without obvious non-cardiac cause, in the first hour after initiation of symptoms. A total of 913 patients were included. The median follow-up post-HT was 5.9 years (IQR = 2.9–8.5). Among the 60 parameters tested in univariate analysis, we identified 4 independent factors independently associated with sudden death after 1 year post-HT: donor age (HR = 1.55; 95% CI: 1.14–2.11; P = 0.005), recipient age (HR = 0.74; 95% CI: 0.59–0.93; P = 0.011), ventricular ejection fraction (LVEF) < 55% any time after transplantation (HR: 3.95; 95% CI: 1.95–8.02; P < 0.001), the presence of circulating anti-HLA DSA at the time of transplantation (HR: 2.18; 95% CI: 1.15–4.11; P = 0.017). The incidence rate of SCD was 2.17 per 100 person-year (95% CI: 1.42–4.60) and 1.21 per 100 person-year (95% CI: 0.80–2.58) in patients with FEVG < 55% (n = 73) and in patients with pre-formed DSA (n = 260), respectively (Table 1). In a large multicentric and highly phenotyped cohort of heart transplant recipients, we identified four independent factors associated with SCD beyond the first year. This study provides fresh evidence of SCD assessment for improving risk stratification of HT recipients. [ABSTRACT FROM AUTHOR]

Background: The incidence of skin cancer is increasing worldwide. For decades, opportunistic melanoma screening has been carried out to respond to this burden. However, despite potential positive effects such as reduced morbidity and mortality, there is still a lack of evidence for feasibility and effectiveness of organized skin cancer screening. Objective: The main aim of the project was to evaluate the feasibility of systematic skin cancer screening. Methods: In 2003, the Association of Dermatological Prevention was contracted to implement the population-based SCREEN project (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany) in the German state of Schleswig-Holstein. A two-step program addressing malignant melanoma and nonmelanocytic skin cancer was implemented. Citizens (aged ≥20 years) with statutory health insurance were eligible for a standardized whole-body examination during the 12-month study period. Cancer registry and mortality data were used to assess first effects. Results: Of 1.88 million eligible citizens, 360,288 participated in SCREEN. The overall population-based participation rate was 19%. A total of 3103 malignant skin tumors were found. On the population level, invasive melanoma incidence increased by 34% during SCREEN. Five years after SCREEN a substantial decrease in melanoma mortality was seen (men: observed 0.79/100,000 and expected 2.00/100,000; women: observed 0.66/100,000 and expected 1.30/100,000). Limitations: Because of political reasons (resistance as well as lack of support from major German health care stakeholders), it was not possible to conduct a randomized controlled trial. Conclusions: The project showed that large-scale systematic skin cancer screening is feasible and has the potential to reduce skin cancer burden, including mortality. Based on the results of SCREEN, a national statutory skin cancer early detection program was implemented in Germany in 2008. [ABSTRACT FROM AUTHOR]

Background: Neuroendocrine tumors of the thymus (NETT) are a rare tumor entity of the anterior mediastinum. They belong to the category of foregut carcinoids and are often associated with the multiple endocrine neoplasia type 1 (MEN1) syndrome. Approximately 180 cases have been reported since their first description. NETT reveal an aggressive behavior leading to rapid local invasion and metastatic spread. An aggressive surgical approach may achieve long-term survival. Methods: Patients presenting from 1990 to 2005 at the Department of Surgery and the Department of Gastroenterology of the Philipps-University Marburg with neuroendocrine tumors were enrolled in a prospective database with a follow-up until 2005. Fifty MEN1-patients were enrolled in a study and screening program. These databases were retrospectively reviewed identifying all patients with NETT. The clinical features, therapeutical approaches and the outcome were analyzed. Results: Six patients were found with NETT, 4 patients suffered from metastases at the time of presentation. All patients were male, with a median age of 41.3 years at presentation. Four out of these 6 patients revealed MEN1 syndrome. All patients underwent tumor resection via sternotomy. Three patients underwent parathyreoidectomy and transcervical thymectomy before the NETT was diagnosed. Median survival was 53 months (range, 24–109). Conclusion: Given a frequent association between MEN1 and NETT, all patients with NETT should be screened for MEN1. Since transcervical thymectomy does not prevent all MEN1 patients from developing NETT, existing surveillance guidelines for MEN1 should consider CT scan of the thorax on a regular basis. [Copyright &y& Elsevier]

Summary: Purpose: To compare the incidence and magnitude of weight gain associated with valproic acid (VPA) monotherapy in male and female epilepsy patients and to determine possible gender-specific differences in frequency of carbohydrate craving, body-composition, glucose homeostasis and lipid metabolism. Methods: Epilepsy patients on VPA monotherapy were consecutively recruited at the outpatient clinic of the Department of Neurology, Innsbruck Medical University. Weight gain during VPA-therapy, frequency of carbohydrate craving and physical exercise, sociopsychological problems and family history for diabetes were obtained from all patients. Clinical data also comprised body-impedance analysis, body mass index and waist-to-hip ratio. Morning fasting blood samples were drawn to determine serum leptin, glucose and lipid concentrations, as well as insulin, C-reactive protein and TNF-α. Results: One hundred and six patients (55 women) were enrolled in the study. Significant weight gain was seen during VPA-therapy in both genders (each p <0.001) with women experiencing increment of weight more frequently and more pronounced than did men. Analyses of patients who gained weight during VPA-therapy revealed significantly higher serum leptin concentrations in women than in men (p <0.001). Women also revealed significantly higher high-density lipoprotein-cholesterol and lower triglyceride concentrations than men (p =0.004 and 0.014, respectively). Frequency of carbohydrate craving was 25.8% in women and 14.3% in men. More women tried to lose or control weight through diet than did men (22.6% versus 7.1%). Moreover, weight gain as a sociopsychological problem was more numorous in women than in men. Conclusion: Women are more prone to gain weight during VPA therapy though higher frequency of diet and sociopsychological burden than men, which might possibly be related to leptin-resitance and a higher frequency of carbohydrate craving. [Copyright &y& Elsevier]