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• Approximately 1 in 20 patients with STEMI had CID. • A history of CID did not affect long-term survival after STEMI. • Corticosteroids appear associated with higher death rates during follow-up in CID. Patients with chronic inflammatory diseases (CIDs) are at increased risk of cardiovascular events. However, the prognostic impact of CID after an acute coronary event has been poorly studied. To examine the effect of history of CID on long-term outcome in patients with ST-segment elevation myocardial infarction (STEMI). We analysed data from SCALIM, a regional registry that prospectively enrolled patients with STEMI between June 2011 and May 2019. The presence of CID (including inflammatory bowel diseases, rheumatic conditions, inflammatory skin diseases, multiple sclerosis, vasculitis and autoimmune diseases) was identified. The primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction, ischaemic stroke, peripheral vascular events and rehospitalization for cardiovascular conditions. Data from 1941 patients with STEMI (mean age 64.8 ± 14.1 years, 75.1% men) were analyzed. The prevalence of any CID was 4.6% (n = 89). After a mean follow-up of 3.4 ± 2.6 years, the overall death rate was 16.2%, with similar 5-year survival between patients with and without CID (74.2% vs. 81.9%, respectively; P = 0.121), with no significant mortality excess (hazard ratio: 1.15, 95% confidence interval: 0.73 − 1.82; P = 0.55). However, among CID patients, 35 (39.3%) were on corticosteroid therapy and showed decreased 5-year survival (52.8% vs. 89.5% without corticosteroids; P = 0.001). We found no increased rate of secondary endpoints, except for peripheral vascular events (5-year survival free of peripheral events: 93.3% vs. 98.6% in those without CID; P = 0.005). Approximately 1 in 20 patients with STEMI has CID. We found no effect of CID on long-term survival. However, patients on corticosteroid therapy appeared to have higher rates of death during follow-up. Whether this finding is related to the use of corticosteroids or to the more progressive nature of their condition warrants further investigation. [ABSTRACT FROM AUTHOR]

In patients with ST-elevation myocardial infarction (STEMI), white blood cell count (WBCC) is associated with infarct size and cardiovascular outcome. We sought to determine the impact of WBBC variation (ΔWBCC) during hospital stay on the long-term outcome after STEMI. From June 2011 to December 2019, consecutive patients referred for STEMI were enrolled. Those with at least two WBCC during hospitalization were included in this study. ΔWBCC was calculated as: [WBCC (admission) – WBCC (before discharge)]. The population was divided into 3 groups according to ΔWBCC tertiles. The primary outcome was all-cause mortality. A total of 1782 patients (mean age 64.5 ± 14.1 years, 75.7% males), were included and divided in 3 groups: group 1 (ΔWBCC < 880/mm3); group 2 (ΔWBCC 880-3265/mm3); and group 3 (ΔWBCC > 3265/mm3). Patients in group 1 were the oldest (67.9 ± 13.8, vs. 65.1 ± 13.9 and 60.5 ± 13.7 years in groups 2 and 3 respectively, P < 0.001). Hypertension, prior coronary artery bypass and cancer were more prevalent in groups 1 and 2. Troponin peak was the highest in group 3 (3601 ± 563, vs. 2810 ± 439 and 2451 ± 467 ng/mL in groups 1 and 2, respectively; P < 0.001). The 5-year survival was the lowest in group 1 (78.5% vs. 87.4% and 87.5% in group 2 and 3, respectively; P < 0.001) (Figure 1). Adjusted to age, gender, cardiovascular risk factors, MI territory and left ventricular ejection fraction, ΔWBCC < 0.880/mm3 was independently associated with all-cause mort. [ABSTRACT FROM AUTHOR]

A comprehensive database of detonation run-up distances (x DDT) in unobstructed tubes/channels is compiled. Eight fuels are included, i.e. , hydrogen, methane, ethane, ethylene, acetylene, propane, butane and carbon monoxide. Oxygen is used as oxidizer with different diluents under a wide range of tube/channel sizes. In total 559 points are collected and analyzed. The global x DDT trends observed in the data as a function of the initial conditions (i.e. , fuel type, equivalence ratio (ϕ), hydraulic diameter (D h), and pressure (p)) reveal that x DDT decreases with increasing p , decreasing D h , and ϕ → 1. The correlation of the normalized run-up distance x DDT / D h with geometrical parameters and fundamental combustion properties shows that most of the variance in the experimental data can be captured by the ratio of D h to the flame thickness ( D h / δ f ), the expansion ratio (σ − 1) and that of the Chapman–Jouguet to the laminar flame speed ( V CJ / σ s L ). With these, a non-linear (NLM) and a logarithmic model (LM) are proposed using a non-linear least squares regression to fit a user-defined function. The NLM and LM are shown to outperform the widely used Silvestrini and Dorofeev models by a large margin since they are capable of explaining ∼ 70 – 80 % of the variance in the experimental x DDT / D h data in contrast to only ∼ 20 % of the original Silvestrini and Dorofeev models. The poor performance of the original models is due to the limited amount of data used to determine the models constants. An update to these constants is also carried out using the database collected in this work resulting in a notable improvement of their predictive capabilities over the original models. The database is publicly available so that it can be used freely to guide future research in the combustion community (e.g. , by identifying conditions where there is a lack of data), and as a test bed for further data-driven model development. [ABSTRACT FROM AUTHOR]

Prognostic markers are needed to identify patients at higher risk for adverse events in patients with acute coronary syndrome. Complete blood count (CBC) is routinely performed and included several parameters and ratios that could provide such a prognostic information. We sought to investigate the prognostic value of different CBC parameters and ratios in patients with ST-segment elevation myocardial infarction (STEMI). We retrospectively analysed admission CBC (the first within the first 24 hours) in STEMI patients enrolled in SCALIM registry between June 2011 and December 2019, Investigated CBC parameters were the following: white blood cell count (WBCC), neutrophil, lymphocyte (LC), monocyte, eosinophil counts, haemoglobin (Hb), haematocrit (HC), red cell distribution width, platelet count (PC), and mean platelet volume (MPV). The following CBC ratios were calculated: neutrophil to lymphocyte (NLR), platelet to lymphocyte (PLR), lymphocyte to monocyte (LMR) ratios, MPV/LC and MPV/PC. Adjustment for age, gender, risk factors, prior revascularization, coronary status, left ventricular function and troponin level was performed. The primary outcome was all-cause mortality during in-hospital stay and at follow-up. A total of 1910 patients (mean age 64.4 ± 14.1 years, 75.6% males) were included. In-hospital mortality rate was 5.7%. After adjustment, WBCC (per 1Giga/L increment OR = 1.06, CI 95% [1.02–1.12], P = 0.009), neutrophil count (per 1Giga/L increment OR = 1.12, CI 95% [1.05–1.20], P = 0.001) and LMR (per 1unit decrement OR = 1.12, CI95% [1.05–1.19], P < 0.001) independently predicted in-hospital mortality. The mean follow-up period was 3.4 ± 2.6 years. Mortality rate was 3.83 per 100 patient-year. After adjustment, WBCC (per 1Giga/L increment HR = 1.03, CI 95% [1.01–1.04], P = 0.002), neutrophil count (per 1Giga/L increment HR = 1.05, CI 95% [1.01–1.09], P = 0.005), NLR (per 1unit increment HR = 1.04, CI 95% [1.02–1.06], P < 0.001) and LMR (per 1unit decrement HR = 1.06, CI 95% [1.03–1.09], P = 0.001) independently predicted long-term mortality. Among CBC parameters and ratios, WBCC, neutrophil count, NLR and LMR were shown to have prognostic value in STEMI patients. [ABSTRACT FROM AUTHOR]

The article informs about archives of French departments published between 2017-2018 on several topics including interregional management of companies, economic competition and public finance.

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic inflammatory diseases (CID) are common and affect 5 to 7% of the general population. In primary prevention the presence of CID increases the risk of cardiovascular disease (e.g. ST-segment elevation myocardial infarction or STEMI), but the prognosis after the occurrence of STEMI in these patients is poorly studied. The objective of our study is to determine the prognostic impact related to the presence of a MIC on mortality in patients with STEMI. Single-centre cohort including patients managed at the University Hospital of Limoges for STEMI from June 2011 to May 2019 and included in the SCALIM registry. The presence of any MIC defined the CID+ group, compared to other patients (CID-). The primary endpoint was mortality. Secondary endpoints included cardiovascular mortality, recurrent coronary events, new cardiac hospitalizations, occurrence of acute peripheral arterial events and ischemic stroke, and all of those combined. Our study included 1941 patients aged 65 ± 14 years, 75% of whom were men. The prevalence of CID in the SCALIM registry was 4.6% (including 22% rhumatoid arthritis, 19% psoriasis and 16% ankylosing spondylitis) and 40% were on corticosteroid therapy and 20% on biotherapy at STEMI. Over a mean follow-up of 3.4 ± 2.6 years after STEMI, we found no significant difference in mortality in the CID+ and CID- groups respectively (22.5% vs. 15.9% P = 0.14) or in the combined secondary endpoint (29% vs. 49% P = 0.11). Long-term corticosteroid therapy was associated with excess mortality in the CID+ group (39% vs. 12%, P < 0.01). Despite the cardiovascular excess risk described in the literature related to the presence of a MIC, we did not show mortality excess related to these conditions after a STEMI. The mortality risk excess in patients under corticosteroids suggests a multidisciplinary discussion on their management. Further analysis is needed to confirm our results. [ABSTRACT FROM AUTHOR]

To determine whether the participation to a medical hypnosis training program reduces the levels of burnout in healthcare providers. Survey study. Study conducted from 2014 to 2018 using the MBI-HSS questionnaire assessing three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). Healthcare providers in particular anesthesiologists participating to a one-year medical hypnosis training program. All participants were asked to fill the MBI-HSS on the first day before the training program had begun, then on the last day of the program once the entire training was completed. The EE, DP and PA scores and their grade (high, average and low) were compared before and after training and between physicians and caregivers. In total, 1850 persons participated to the training sessions, with 1366 participants enrolled before the first session (74%) and 1407 (76%) after the fourth. On the 1366 persons enrolled before training, 1139 (83%) completed the survey and on the 1407 enrolled after training, 1194 (85%) completed the survey. The scores were significantly smaller after training for EE and DP and significantly greater for PA. Before training, EE was significantly greater in physicians than in caregivers as well as DP, with no difference for PA. After training, DP was significantly greater in physicians than in caregivers and PA was smaller, with no difference for EE. Before training, there was high rates of burnout in both healthcare providers but there was a significant trend to smaller rates of burnout after training. This study shows that healthcare providers who participated to a medical hypnosis training program presented improvements in the three dimensions of burnout. Further study is required to investigate and recommend this type of continuous medical education to improve professional satisfaction and wellbeing in healthcare providers. • Participating to a full medical hypnosis training program improves the three dimensions of burnout in healthcare providers. • This study was performed among 1850 anesthesiologists and other caregivers and comprised more than 2000 MBI questionnaires. • The limits are selection bias of the participants, lack of control group and anonymous nature of the questionnaire. [ABSTRACT FROM AUTHOR]

The patient delay between the occurrence of symptoms and call for seeking medical assistance is an important component of the pain-to-balloon delay in patients with ST-elevated myocardial infarction (STEMI). Factors affecting this delay have been poorly studied, and awareness campaigns regarding the emergency call have barely been evaluated. We evaluated the factors related to the patient delay and the effects of public awareness campaigns undertaken in our region. Data from the regional registry of STEMI in Limousin, France, were analyzed and we performed a survey to assess medical history, clinical signs, context, socio-economic situation, perception and behavior of the patient. "Late callers" (i.e. 3rd tertile, > 154 min) were compared to "early callers" (i.e. first and 2nd tertile, ≤ 154 min) using univariate and multivariate statistical methods. The influence of public awareness campaigns was studied by comparing the delays before and after a regional campaign. Among 481 patients, the median patient delay was 87 min. "Late callers" were older (OR = 1.02 per year, 95%CI = [1.00–1.12]), had more often symptoms onset between 00:00 and 05:59am (OR = 1.86, [1.10–3.12]), seeked more often general practitioners' assistance (OR = 2.58, [1.66–4.04]) or attended the emergency room (OR = 4.10, [2.04-8.32]). Sweats and the feeling of a severe situation were associated with a reduced delay. After awareness campaigns, there was no change in the patient's delay but the proportion of patients calling Emergency Medical Service increased from 55% to 62% (P < 0.001). The patient delay is multifactorial. The impact of previous campaigns is mixed. Psychological and behavioral aspects are determinant and should be taken into consideration for targeted awareness messages to specific groups. [ABSTRACT FROM AUTHOR]

The relationship between short-term variations of air pollutants concentrations and occurrence of ST-elevated myocardial infarction (STEMI) remains controversial. Most studies have been performed in highly polluted areas. To analyze the association between air pollutant concentrations and admission for STEMI in a low-to-average polluted urban area. We reviewed the medical data of the prospective SCALIM registry to identify all patients (n = 631) admitted between 06/2011 and 12/2018 for STEMI in our department living in the urban area of Limoges, France, and matched them with daily and hourly averaged concentrations of air pollutants (particulate matter ≤ 2.5 μm, PM 2.5 , and ≤ 10 μm PM 10 , nitrogen dioxide, NO 2 , and ozone, O 3) monitored in the same area. Each patient was his/her own control in this study with four control periods in the past month preceding the STEMI case. The risk of STEMI was 30.5% higher with every 10-units PM 10 peak concentration increase in the two hours preceding STEMI symptoms (P < 0.001). This association remained valid despite adjustment for every cardiovascular risk factor, as well as in patients without severe coronary artery disease, or those with ≤ 2 cardiovascular risk factors and those with history of MI. A 10-unit increase in PM 2.5 median concentration in the six hours preceding symptoms was also significatively associated with STEMI but only for patients with ≤ 2 cardiovascular risk factors. The O 3 and NO 2 concentrations were not associated with STEMI. The PM 10 pollution level was associated with the risk of STEMI, even in an area not considered as highly polluted. [ABSTRACT FROM AUTHOR]

A man aged 41 years with a clinical diagnosis of cardiomyopathy and hepatic insufficiency was found, on angiocardiography, to have a mass, presumably a thrombus, within the left ventricle. A second angiocardiogram performed five days later showed that the thrombus had disappeared. The mechanism invoked was more probably an increase of spontaneous fibrinolysis as described in cirrhotic patients, perhaps helped by heparin, rather than ejection of the mass from the ventricle with silent embolisation somewhere in the systemic circulation. [ABSTRACT FROM PUBLISHER]