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Background: Coronavirus disease 2019 (COVID-19) may be associated with cardiac arrhythmias in hospitalized patients, but data from the ICU setting are limited. We aimed to describe the epidemiology of cardiac arrhythmias in ICU patients with COVID-19.Methods: We conducted a multicenter, retrospective cohort study including all ICU patients with an airway sample positive for severe acute respiratory syndrome corona-virus 2 from March 1st to June 1st in the Capital Region of Denmark (1.8 million inhabitants). We registered cardiac arrhythmias in ICU, potential risk factors, interventions used in ICU and outcomes.Results: From the seven ICUs we included 155 patients with COVID-19. The incidence of cardiac arrhythmias in the ICU was 57/155 (37%, 95% confidence interval 30-45), and 39/57 (68%) of these patients had this as new-onset arrhythmia. Previous history of tachyarrhythmias and higher disease severity at ICU admission were associated with cardiac arrhythmias in the adjusted analysis. Fifty-four of the 57 (95%) patients had supraventricular origin of the arrhythmia, 39/57 (68%) received at least one intervention against arrhythmia (eg amiodarone, IV fluid or magnesium) and 38/57 (67%) had recurrent episodes of arrhythmia in ICU. Patients with arrhythmias in ICU had higher 60-day mortality (63%) as compared to those without arrhythmias (39%).Conclusion: New-onset supraventricular arrhythmias were frequent in ICU patients with COVID-19 and were related to previous history of tachyarrhythmias and severity of the acute disease. The mortality was high in these patients despite the frequent use of interventions against arrhythmias. [ABSTRACT FROM AUTHOR]

Real-world experiments have become a common method for testing and developing new technologies to decarbonize the energy system. The significance of the site of such experiments is evident yet elusive. A case in point is the Danish island Bornholm, test site for a smart grid experiment involving more than 800 private households. The object of intervention of this experiment is the so-called flexible electricity consumer; a means for countering radical increases in fluctuating, renewable energy that challenges the stability of the electricity system. A flexible consumer adjusts consumption to production rather than the other way. Accordingly, the experiment seeks to knit together the electricity system infrastructure and its users in new ways. The island provides the boundaries for this experiment, all the while it is endowed with multiple politics by its various participants. To the scientists running the experiment, Bornholm is their living laboratory: it provides a partly controllable electricity system upon which to test their reorganized energy system. To local participants, however, the experiment is above all a demonstration of their commitment to the island and its role in a green transition. Finally, during the experiment, the local energy supplier begins to frame the island's energy system and its users as assets; a test island for future participatory experiments. Eventually, the site of this real-world experiment makes a flexible consumer possible as object of intervention, yet at the same time, it transforms the scientific results produced and the identity of the island. [ABSTRACT FROM AUTHOR]

Introduction: Patients with COPD are vulnerable to workforce detachment. Better knowledge of features associated with paid work loss might be of help to design and select appropriate interventions.Method: This cross-sectional study aimed to explore the presence of treatable traits in COPD patients without paid work. Patients with COPD below 65 years at first referral to a hospital-based patient clinic were included. Using binary logistic regression analysis, the relationship between paid work and the following characteristics was explored: low daily physical activity, exercise, active smoking, Medical Research Council dyspnea scale (MRC), poor nutritional status, exacerbations, and fatigue (checklist individual strength (CIS)). Variables were adjusted for age, sex, forced expiratory volume in 1 s (FEV 1), and education level.Results: In total, 191 patients (47.3%) were without paid work. The following treatable traits were related to not being in paid work: < 5000 steps/day (OR 2.36, 95% CI (1.52-3.68)), MRC ≥ 3 (OR 1.78, 95%CI (1.14-2.77)), CIS ≥ 36 points (OR 1.78, 95% CI (1.10-2.87)), six-minute walk distance (6MWD) < 70% of predicted (OR 2.62, 95% CI (1.69-4.06)), and ≥ 2 exacerbations per year (OR 1.80, 95% CI (1.12-2.92)). Significant differences were also seen in age (OR 1.06, 95% CI (1.02-1.10) per year), FEV 1% predicted (OR 0.98, 95% CI (0.97-1.00) per % predicted increase), and medium/high education level (OR 0.62, 95% CI (0.41-0.93)). When adjusting for all variables the only treatable trait that remained significant was 6MWD.Conclusion: Patients without paid work are more likely to have treatable traits with 6MWD revealing the most significant association. [ABSTRACT FROM AUTHOR]

Organisational research positions design as complex and open-ended. We contribute to research on design and the organisation of competition by conceptualising design as redesign and as a collective 'thing' consisting of an interconnected and dynamically evolving set of new design issues and matters of concern that blur actors' professional roles. Our approach builds on actor-network theory using an ethnographic study to follow architects' design work in a commercial case of a dialogue-based architectural competition. Building scales and design concepts were translated and inscribed into different forms of design visualisations and circulated amongst the client, the architect office, and the workshop during the encounter between the team of architects and the jury. As circulating references, design visualisations retain and transform the design and give rise to new contradictory design issues during the actors' verbal dialogue. [ABSTRACT FROM AUTHOR]

The many stakeholders in the food industry with their diverse interests make this industry complex and interesting to work with. There are four main stakeholders; 1) The customers with their increased demand for customized products, quick delivery times and increased responsiveness, 2) The authorities with increased legislations, 3) Employees with salary demands and 4) Owners/shareholders with profit wishes add to the complexity. Furthermore, markets are getting bigger and the competition harder. The profit margin for many companies is getting smaller. There are a demand for quantifying this complexity and finding a method for using these complexity factors in economic calculations. The research question this paper seeks to address is therefore "Which complexity factors can be quantified in the food industry and how can they be used in economic calculations?" A case study of a SME Danish bread producer will address the research question due to the explorative nature of this study and the limited amount of previous research within this field. [ABSTRACT FROM AUTHOR]

The article presents guidelines for safe and responsible use of antibiotics in dental practice. Topics include the discovery of penicillin by Alexander Fleming, Nobel Lecture warning on dangers of over-reliance with antibiotics due to threat of resistance development of bacteria as well as data on antibiotic-related adverse events in the U.S. Also mentioned are dentists' confusion on prescriptions in Canada as per survey published in "The Journal of the American Dental Association."

The article discusses the mechanisms of the Safety in Numbers for bicyclists and walkers. Topics covered include the changes in behavior of people bicycling or walking. Also mentioned is the goal of reducing the conflict between encouraging bicycling and walking for the health benefits of physical activity and discouraging bicycling and walking to prevent injuries.

Background: Low plasma 25-hydroxyvitamin D [p-25(OH)D] is associated with increased risk of ischaemic heart disease and with the subgroup myocardial infarction. However, whether this association is causal or due to confounding or reverse causation is presently unknown. We tested the hypothesis that genetically reduced plasma 25(OH)D is associated with increased risk of ischaemic heart disease and myocardial infarction.Methods: We used a Mendelian randomization design in the Copenhagen City Heart Study, the Copenhagen General Population Study, and the Copenhagen Ischaemic Heart Disease Study. Two 25(OH)D reducing genetic variants in the DCHR7 gene (rs7944926 and rs11234027) and two in the CYP2R1 gene (rs10741657 and rs12794714) were genotyped in 92 416 participants of Danish descent, of whom 14 455 developed ischaemic heart disease (ICD-8:410-414; ICD-10:I20-I25) and 7061 myocardial infarction (ICD-8:410: ICD-10:I21-I22) from 1977 through 2011. P-25(OH)D was measured in 36,089 participants. APOE genotype was included as a positive control for risk of ischaemic heart disease.Results: The multivariable adjusted hazard ratios for lowest vs highest quartile of 25(OH)D were 1.82 [95% confidence interval (CI): 1.42-2.32] for ischaemic heart disease. Each allele increase in a combined allele score was associated with a 1.9-nmol/l decrease in p-25(OH)D (P = 7 × 10(-55); R(2) = 0.9%). The genetic variants were, however, not associated with increased risk of ischaemic heart disease. In instrumental variable analysis, the odds ratio for ischaemic heart disease for a genetically 25-nmol/l decrease in p-25(OH)D was 0.98 (95% CI: 0.76-1.26), with a corresponding observational hazard ratio by Cox regression of 1.07 (1.01-1.13). Similarly, with myocardial infarction as the outcome, observational analyses suggested an increased risk with lower 25(OH)D, whereas genetic analyses suggested no causal effect. For APOE genotype, the odds ratio for ischaemic heart disease for a 1-mmol/l genetic increase in plasma total cholesterol concentrations was 1.23 (1.08-1.41), with a corresponding observational hazard ratio of 1.08 (1.04-1.14).Conclusion: We found no evidence to suggest that genetically reduced p-25(OH)D is associated with increased risk of ischaemic heart disease or myocardial infarction. [ABSTRACT FROM AUTHOR]

Background Catheter ablation with remote magnetic navigation (RMN) can offer some advantages compared to manual techniques. However, the relevant clinical evidence for how RMN-guided ablation affects electrical storm (ES) due to ventricular tachycardia (VT) in patients with severe ischemic heart failure (SIHF) is still limited. Methods Forty consecutive SIHF patients (left ventricular ejection fraction, 21 ± 6.9%) presenting with ES underwent ablation using RMN. All the patients received implantable cardioverter-defibrillators (ICDs) either before or after ablation. Acute ablation success was defined as noninducibility of any sustained monophasic VT at the end of the procedure. Long-term analysis addressed VT recurrence, ICD therapies and all-cause death. ES was acutely suppressed by ablation in all patients. Results Acute ablation success was obtained in 32 of 40 (80%) patients. The procedure time and fluoroscopy time were 105 ± 27 min and 7.5 ± 4.8 min respectively. No major complications occurred during procedures. During a mean follow-up of 17.4 months, 19 patients (47.5%) remained free of VT recurrence. The percentage of patients receiving ICD shocks after ablation was lower than before ablation (30% vs 69%,P < 0.01). The mean number of ICD shocks per individual per year was reduced from 4.3 before ablation to 1.9 after ablation (P < 0.05). Ten patients died during follow-up. Conclusions Acute catheter ablation with RMN is safe and effective to suppress ES in SIHF patients. RMN-guided catheter ablation can prevent VT recurrence and significantly reduce ICD shocks, suggesting that this strategy can be used as an alternative therapy for VT storm in SIHF patients with ICDs. [ABSTRACT FROM AUTHOR]

Background Sun exposure is the single most important risk factor for skin cancer, but sun exposure may also have beneficial effects on health. We tested the hypothesis that individuals with skin cancer (non-melanoma skin cancer and cutaneous malignant melanoma) have less myocardial infarction, hip fracture and death from any cause, compared with general population controls.Methods We examined the entire Danish population above age 40 years from 1980 through 2006, comprising 4.4 million individuals. Diagnoses of non-melanoma skin cancer (n = 129 206), cutaneous malignant melanoma (n = 22107), myocardial infarction (n = 327 856), hip fracture (n = 129 419), and deaths from any cause (n = 1 629 519) were drawn from national registries.Results In individuals with vs without non-melanoma skin cancer, multifactorially adjusted odds ratios were 0.96 (95% confidence interval: 0.94–0.98) for myocardial infarction and 1.15 (1.12–1.18) for hip fracture, and the multifactorially adjusted hazard ratio was 0.52 (0.52–0.53) for death from any cause. Risk of hip fracture was reduced (odds ratios were below 1.0) in individuals below age 90 years. In individuals with vs without cutaneous malignant melanoma, corresponding odds ratios were 0.79 (0.74–0.84) for myocardial infarction and 0.84 (0.76–0.93) for hip fracture, and the corresponding hazard ratio for death from any cause was 0.89 (0.87–0.91); however, cutaneous malignant melanoma was associated positively with death from any cause in some individuals.Conclusions In this nationwide study, having a diagnosis of skin cancer was associated with less myocardial infarction, less hip fracture in those below age 90 years and less death from any cause. Causal conclusions cannot be made from our data. A beneficial effect of sun exposure per se needs to be examined in other studies. [ABSTRACT FROM AUTHOR]

Using simulation as an approach to display and improve internal logistics at hospitals has great potential. This study shows how a simulation model displaying the morning blood-taking round at a Danish public hospital can be developed and utilized with the aim of improving the logistics. The focus of the simulation was to evaluate changes made to the transportation of blood samples between wards and the laboratory. The average- (AWT) and maximum waiting time (MWT) from a blood sample was drawn at the ward until it was received at the laboratory, and the distribution of arrivals of blood samples in the laboratory were used as the evaluation criteria. Four different scenarios were tested and compared with the current approach: (1) Using AGVs (mobile robots), (2) using a pneumatic tube system, (3) using porters that are called upon, or (4) using porters that come to the wards every 45 minutes. Furthermore, each of the scenarios was tested in terms of what amount of resources would give the optimal result. The simulations showed a big improvement potential in implementing a new technology/mean for transporting the blood samples. The pneumatic tube system showed the biggest potential lowering the AWT and MWT with approx. 36% and 18%, respectively. Additionally, all of the scenarios had a more even distribution of arrivals except for porters coming to the wards every 45 min. As a consequence of the results obtained in the study, the hospital decided to implement a pneumatic tube system. [ABSTRACT FROM AUTHOR]

Abstract: The spatial distribution of β-cyclodextrin grafted to a range of porous materials was investigated. (3-glycidyloxypropyl)trimethoxysilane was used to facilitate the covalent grafting of β-cyclodextrin. The spatial distribution was analysed by combining results from confocal laser scanning microscopy and electron microscopy fitted with a focused ion beam and an energy-dispersive X-ray detector. Three materials were analysed: Two types of silica gel and one calcium phosphate. The results show that by combining the two methods it is possible to deduce the spatial distribution of the grafted cyclodextrins. Silica gel with small pores could be grafted to a depth of approximately 10μm, whereas calcium phosphate with larger pores indicated a penetration depth larger than 30μm. [Copyright &y& Elsevier]

Objective: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. Methods: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. Results: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D ( p for trend ≤ 2 × 10−3). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D concentrations between the 1st and 4th percentiles to individuals with 25-hydroxyvitamin D concentrations between the 50th and 100th percentiles, multivariate adjusted hazard ratio of ischemic stroke was 1.82 (95% confidence interval, 1.41-2.34). Comparing individuals with clinical categories of severe vitamin D deficiency (<25.0nmol/l [<10.0ng/ml]) to individuals with optimal vitamin D status (≥75.0nmol/l [≥30.0ng/ml]), the multivariate adjusted hazard ratio of ischemic stroke was 1.36 (1.09-1.70). 25-Hydroxyvitamin D concentrations were not associated with risk of hemorrhagic stroke. In a meta-analysis comparing lowest versus highest quartile of 25-hydroxyvitamin D concentrations, the multivariate adjusted odds ratio of ischemic stroke was 1.54 (1.43-1.65) with a corresponding hazard ratio of 1.46 (1.35-1.58) in prospective general population studies. Interpretation: In this large population-based prospective study, we observed stepwise increasing risk of symptomatic ischemic stroke with decreasing plasma 25-hydroxyvitamin D concentrations. This finding was substantiated in a meta-analysis. ANN NEUROL 2013. [ABSTRACT FROM AUTHOR]

Aim: To study poisoning mortality from birth to the end of teenage. Methods: Registry study within the Danish population including all deaths from poisoning in the 0-19-year age groups for the years 1970-2006. Results: Poisoning mortality was age dependent with a modest peak in preschool children because of accidents and a very steep increase from 0.1/105 person years (p.y.) at 12 years to 6.1/105 p.y. at 19 years. Accidents, suicide and undetermined manner of death all contributed to the increase. A significant proportion of accidental and undetermined manner of death was caused by opioides and probably abuse related. During the study period, mortality decreased by more than 50% with all manners of death contributing significantly to the decline. Carbon monoxide poisoning was the overall dominating cause of death and contributed most to reduction in mortality. Poisoning death caused by opioides and unspecified drugs was unchanged over time. Conclusion: Poisoning mortality among the youngest Danish children was dominated by accidental poisonings. During teenage, the level and pattern of adults was approached with respect to suicidal and abuse related deaths. A fall in mortality since mid-eighties was explained by fewer deaths from carbon monoxide poisoning. [ABSTRACT FROM AUTHOR]

Voltage-Guided Ablation Technique for Cavotricuspid Isthmus-Dependent Atrial Flutter. Ablation of the cavotricuspid isthmus has become first-line therapy for 'isthmus-dependent' atrial flutter. The goal of ablation is to produce bidirectional cavotricuspid isthmus block. Traditionally, this has been obtained by creation of a complete ablation line across the isthmus from the ventricular end to the inferior vena cava. This article describes an alternative method used in our laboratory. There is substantial evidence that conduction across the isthmus occurs preferentially over discrete separate bundles of tissue. Consequently, voltage-guided ablation targeting only these bundles with large amplitude atrial electrograms results in a highly efficient alternate method for the interruption of conduction across the cavotricuspid isthmus. Understanding the bundle structure of conduction over the isthmus facilitates more flexible approaches to its ablation and targeting maximum voltages in our hands has resulted in reduction of ablation time and fewer recurrences. (J Cardiovasc Electrophysiol, Vol. 23, pp. 672-676, June 2012) [ABSTRACT FROM AUTHOR]

The article presents the result of a cohort study on the predictors of herniated lumbar disc disease (HLDD). The study is a 33-year follow-up in the Copenhagen Male Study which was established in 1970 to 1971. It examines the relation between self-reported physical workload and HLDD. The study concludes that frequent exposure to strenuous physical activity at work is a strong risk factor for HLDD.

A decrease in the number and dysfunction of endothelial progenitor cells (EPC) may increase the risk for progression of cardiovascular disease (CVD) in type 1 diabetic patients with diabetic nephropathy (DN). Our aim was to evaluate EPC numbers in asymptomatic CVD type 1 diabetic patients with or without DN and to study the effect of CVD and medication on EPC numbers. Methods: We examined EPC numbers in 37 type 1 diabetic patients with DN and 35 type 1 diabetic patients with long-standing normoalbuminuria. Patients were without symptoms of CVD and the prevalence of CVD was previously shown to be very low. EPC number was assessed in in vitro cultures by fluorescent staining of attached cells. Results: There was no difference in EPC numbers between patients with DN (mean ± SD 120 ± 49 cells/field) and normoalbuminuria (108 ± 41 cells/field; p = 0.25). Furthermore, EPC number was not associated with CVD (p > 0.05). Conventional risk factors were significantly higher in patients with DN and they received more CVD-preventive treatment. All patients receiving simvastatin or calcium-channel blockers had higher numbers of EPC compared to patients not treated with these drugs. Conclusions: Asymptomatic patients with DN had EPC numbers similar to normoalbuminuric patients, which was related to aggressive CVD intervention therapy. This may have contributed to the low prevalence of CVD. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: We evaluated the renoprotective effects as reflected by short-term changes in albuminuria of dual blockade of the renin-angiotensin system (RAS) by adding an angiotensin II receptor blocker (ARB) to treatment with maximal recommended doses of an ACE inhibitor (ACEI) in patients with type 2 diabetes and nephropathy.Research Design and Methods: A total of 20 patients (17 men and 3 women) with type 2 diabetes along with hypertension and nephropathy were enrolled in this double-blind, randomized, two-period, crossover trial of 8 weeks of treatment with the ARB candesartan 16 mg daily and placebo added in random order to existing treatment with lisinopril/enalapril 40 mg daily or captopril 150 mg daily. At the end of each treatment period, we evaluated albuminuria in three 24-h urinary collections by turbidimetry, 24-h ambulatory blood pressure (ABP) using the Takeda-TM2420, and glomerular filtration rate (GFR) by the (51)Cr-EDTA plasma-clearance technique.Results: During monoblockade of the RAS by ACEI treatment, albuminuria was 706 (349-1,219) mg/24 h [geometric mean (IQR)]; 24-h ABP was 138 +/- 3/72 +/- 2 mmHg (mean +/- SE); and GFR was 77 +/- 6 ml x min(-1) x 1.73 m(-2) (mean +/- SE). During dual blockade of the RAS by addition of candesartan 16 mg daily, there was a mean (95% CI) reduction in albuminuria of 28 (17-38) compared with ACEI alone (P < 0.001). There was a modest reduction in systolic/diastolic 24-h ABP of 3/2 mmHg (-2 to 8 systolic, -2 to 5 diastolic; NS). Changes in albuminuria did not correlate to changes in ABP. Addition of candesartan 16 mg daily induced a small, insignificant decrease in GFR of 4 (-1 to 9) ml x min(-1) x 1.73 m(-2).Conclusions: Dual blockade of the RAS provides superior short-term renoprotection independent of systemic blood pressure changes in comparison with maximally recommended doses of ACEI in patients with type 2 diabetes as well as nephropathy. [ABSTRACT FROM AUTHOR]

Background: Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in diabetic patients. We tested whether dual blockade of the renin-angiotensin system (RAS) with both an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) is superior to maximal recommended dose of ACE inhibitor in type 1 diabetic patients with diabetic nephropathy (DN).Methods: We performed a randomized, double-blind, crossover trial with 8 weeks treatment with placebo and irbesartan 300 mg (once daily), added on top of enalapril 40 mg (once daily). We included 24 type 1 patients with DN. At the end of each treatment period, albuminuria, 24-hour blood pressure, and glomerular filtration rate (GFR) were measured.Results: Values on ACE inhibitors + placebo were: albuminuria [mean (95% CI)], 519 (342 to 789) mg/24 hours; blood pressure [mean (SEM)], 131 (3)/74 (1) mm Hg, and GFR [mean (SEM)], 65 (5) mL/min/1.73 m2. Dual blockade of the RAS induced a reduction in albuminuria [mean (95% CI)] of 25% (15, 34) (P < 0.001), a reduction in systolic blood pressure of 8 mm Hg (4, 12) (P = 0.002), and a reduction of 4 mm Hg (2, 7) (P = 0.003) in diastolic blood pressure. GFR and plasma potassium remained unchanged during both treatment regimes. Dual blockade was safe and well tolerated.Conclusion: Dual blockade of the RAS is superior to maximal recommended dose of ACE inhibitors with regard to lowering of albuminuria and blood pressure in type 1 patients with DN. Long-term trials are needed to further establish the role of dual blockade of the RAS in renal and cardiovascular protection. [ABSTRACT FROM AUTHOR]

Presents a study which evaluated the possible impact of poison center advice on physicians' treatment and referral of nondrug exposures. Review of related literature; Methodology; Results and discussion.

Describes the natural history of diabetic nephropathy in normotensive type 1 diabetic patients. Evaluation of the genetic and nongenetic progression promoters; Measurement of the Cr-EDTA plasma clearance at yearly intervals; Factors enhancing the decline in the glomerular filtration rate.

The hypothesis that income distribution follows an inverted-U pattern with respect to economic growth has been tested against US time-series data by several authors, and rejected. We reconsider this issue, paying special attention to data non-stationarity, and the use of 'unbalanced' Seemingly Unrelated Regressions estimation. We also reject the hypothesis, but find that minimum income inequality occurred at different times for different ethnic groups, and at later dates than suggested by previous studies. [ABSTRACT FROM AUTHOR]

Investigates angiotensin converting enzyme (ACE) in diabetic nephropathy. Association between albuminuria and ACE/insulin-dependent (ID) polymorphism; Influence of the mean arterial blood pressure on the reduction of albuminuria; Susceptibility of hypertensive albuminuric ID diabetes mellitus patients to renoprotective treatment.

Presents a study of patients with insulin dependent diabetes and nephropathy who have been treated with captopril for a median of seven years. Direct correlation between initial loss and decline in glomerular filtration rate; Factors influencing the sustained rate of decline in glomerular filtration rate.

Background: This research is focused on robotic magnetic navigation (RMN) when used in conjunction with a non-integrated 3D mapping system to perform catheter ablation. Currently, only CARTO and AcQMap mapping system are fully integrated with RMN for performing catheter ablation. This study aimed to evaluate the efficacy of combining the not yet integrated mapping system EnSite Precision with RMN for atrial fibrillation (AF) ablation. Methods: A total of 103 consecutive patients with AF (paroxysmal, 61.2%) underwent catheter ablation with EnSite Precision and RMN. Left atrial (LA) mapping data was acquired using a circular mapping catheter and pulmonary vein isolation (PVI) was performed with magnetic RMN navigated catheter in all cases. The procedural data, procedure-related complications and AF free recurrence rates were analyzed between paroxysmal and persistent AF groups. Cox regression was performed to analyze the recurrence risk factors. Results: There were no significant differences in the total procedure time, fluoroscopy time, LA mapping time and radiofrequency energy. Ablation and mapping times were longer in the persistent AF group than in the paroxysmal AF group (P = 0.028). More complex fractionated atrial electrograms were ablated in the persistent AF group than in the paroxysmal AF group (P = 0.008). No major complications occurred in either group. After 11.3 ± 5.3 months of follow-up, the AF-free rates were 79.0% for paroxysmal AF and 61.0% for persistent AF, respectively. Cox-regression analysis demonstrated that female gender (HR: 3.029, 95% CI: 1.315-6.976, P = 0.009) and left ventricular ejection fraction (LVEF) = 40% (HR: 4.250, 95% CI: 1.639-11.019, P = 0.003) were factors associated with a higher AF recurrence. Conclusions: Collaboration of EnSite Precision and RMN is effective in patients with both paroxysmal and persistent AF. Female gender and low LVEF were two significant predictors of AF recurrence. [ABSTRACT FROM AUTHOR]

A letter to the editor regarding lung function in the elderly is presented.

To investigate the association between diabetic retinopathy (DR) and coronary artery disease (CAD) using coronary angiotomography (CCTA) and multimodal retinal imaging (MMRI) with ultra-widefield retinography and optical coherence tomography angiography and structural domain. Single-center, cross-sectional, single-blind. Patients with diabetes who had undergone CCTA underwent MMRI. Uni and multivariate analysis were used to assess the association between CAD and DR and to identify variables independently associated with DR. We included 171 patients, 87 CAD and 84 non-CAD. Most CAD patients were males (74 % vs 38 %, P < 0.01), insulin users (52 % vs 38 %, p < 0.01) and revascularized (64 %). They had a higher prevalence of DR (48 % vs 22 %, p = 0.01), microaneurysms (25 % vs 13 %, p = 0.04), intraretinal cysts (22 % vs 8 %, p = 0.01) and areas of reduced capillary density (46 % vs 20 %, p < 0.01). CAD patients also had lower mean vascular density (MVD) (15.7 % vs 16.5,%, p = 0.049) and foveal avascular zone (FAZ) circularity (0.64 ± 0.1 vs 0.69 ± 0.1, p = 0.04). There were significant and negative correlations between Duke coronary score and MVD (r = −0.189; p = 0.03) and FAZ circularity (r = −0,206; p = 0.02). CAD, DM duration and insulin use independently associated with DR. CAD patients had higher prevalence of DR and lower MVD. CAD, DM duration and insulin use were independently associated with DR. • Coronary artery disease (CAD) and diabetic retinopathy are associated. • Multimodal retinal imaging and coronary angiotomography reveal novel findings. • Mean vascular density and circularity of the FAZ are lower in CAD patients. • Severity of macrovascular and microvascular complications correlated positively. • Cardiovascular stratification and artificial intelligence are promising uses. [ABSTRACT FROM AUTHOR]

Introduction: Prediction of recurrent ventricular arrhythmia (VA) in survivors of an out‐of‐hospital cardiac arrest (OHCA) is important, but currently difficult. Risk of recurrence may be related to presence of myocardial scarring assessed with late gadolinium enhancement cardiac magnetic resonance (LGE‐CMR). Our study aims to characterize myocardial scarring as defined by LGE‐CMR in survivors of a VA‐OHCA and investigate its potential role in the risk of new VA events. Methods: Between 2015 and 2022, a total of 230 VA‐OHCA patients without ST‐segment elevation myocardial infarction had CMR before implantable cardioverter‐defibrillator implantation for secondary prevention at Copenhagen University Hospital, Rigshospitalet, and Hospital Clínic, University of Barcelona, of which n = 170 patients had a conventional (no LGE protocol) CMR and n = 60 patients had LGE‐CMR (including LGE protocol). Scar tissue including core, border zone (BZ) and BZ channels were automatically detected by specialized investigational software in patients with LGE‐CMR. The primary endpoint was recurrent VA. Results: After exclusion, n = 52 VA‐OHCA patients with LGE‐CMR and a mean left ventricular ejection fraction of 49 ± 16% were included, of which 18 (32%) patients reached the primary endpoint of VA. Patients with recurrent VA in exhibited greater scar mass, core mass, BZ mass, and presence of BZ channels compared with patients without recurrent VA. The presence of BZ channels identified patients with recurrent VA with 67% sensitivity and 85% specificity (area under the ROC curve (AUC) 0.76; 95% CI: 0.63–0.89; p <.001) and was the strongest predictor of the primary endpoint. Conclusions: The presence of BZ channels was the strongest predictor of recurrent VA in patients with an out of‐hospital cardiac arrest and LGE‐CMR. [ABSTRACT FROM AUTHOR]

Background: Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness.Case Report: Four of seven staff members in an emergency department became acutely ill with nonspecific symptoms. After uneventful observation they were discharged, but symptoms worsened at reassembly for debriefing. Poisoning with hydrogen sulfide was suspected, and the victims were transferred by helicopter for hyperbaric oxygen (HBO) treatment. During the following 9 days, 14 possible poisoning victims were identified, 6 of whom were transferred for HBO. After hospital stays with repeated HBO treatment and examinations without identification of significant physical disease, the majority of the 10 HBO-treated victims remained symptomatic, some on prolonged sick leave. The ward was closed for several weeks during comprehensive but negative investigations for toxic chemicals. Clinical data and lack of indication of chemical exposure, together with an attack pattern with only some individuals becoming ill in a shared environment, suggest MPI. Iatrogenic influence from dramatic intervention was probably a strong driving force in the outbreak. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of MPI may prevent unnecessary and potentially harmful treatment as well as improve health care resilience, particularly with respect to preparedness. Outbreaks of illness in a group of symptomatic victims without indication of significant physical disease should be managed by observation and limited intervention. [ABSTRACT FROM AUTHOR]

Investigates the effects of angiotensin II receptor blockade in hypertensive type 1 diabetic patients with diabetic nephropathy homozygous for the insertion or deletion allele of the angiotensin converting enzyme (ACE)/ID polymorphism. Interaction between ACE/ID genotypes and ACE inhibition.

The article presents a study that used the mendelian randomisation approach in determining the association between genetically low 25-hydroxyvitamin D concentrations and increased mortality in white participants of Danish descent. The results of the study showed that low vitamin D concentrations increased all cause mortality, including cancer mortality, but not cardiovascular mortality. Also mentioned is the impact of sun exposure and skin colour on 25-hydroxyvitamin D concentrations.

Background There have been advancements of sophisticated mapping systems used for ablation procedures over the last decade. Utilization of these novel mapping systems in combination with remote magnetic navigation (RMN) needs to be established. We investigated the new EnSite Precision mapping system (St. Jude Medical, Inc., St. Paul, MN, USA), which collects magnetic data for checking navigation field stability and is built on an open platform, allowing physicians to choose diagnostic and ablation catheters. We address its compatibility with RMN. Objective To assess the clinical utility of a novel 3D mapping system (EnSite Precision mapping system) combined with RMN (Niobe ES, Stereotaxis, Inc., St. Louis, MO, USA) for atrial fibrillation (AF) ablation. Methods In this prospective nonrandomized study, two groups of patients were treated in our center for drug refractory AF. Patients were consecutively enrolled in each group. Group A (n = 35, 14 persistent AF [PsAF]) was treated using the novel 3D mapping system combined with RMN. Group B (n = 38, 16 PsAF) was treated using Carto®3 (Biosense Webster, Inc., Diamond Bar, CA, USA) combined with RMN. In Group A, the left atrium (LA) was mapped with a circular magnetic catheter manually and was then replaced by a RMN ablation catheter. At the end of the procedures in Group A, the circular catheter was used for confirming field stability. In Group B, an ablation catheter was controlled by RMN to perform both LA mapping and ablation. All patients underwent pulmonary vein antrum isolation. Additional complex fractionated atrial electrograms (CFAEs) ablation was performed for PsAF. Procedural, ablation, and fluoroscopy times were recorded and complications were assessed. Results Electrophysiological end points were achieved in all patients. Using the novel mapping system, LA mapping time was fast (308 ± 60 seconds) with detailed anatomy points (178,831 ± 70,897) collected and magnetic points throughout LA. At the end of the procedures in Group A, the LA model was confirmed to be stable and its location was within the distance threshold (1 mm). Procedure time (117.9 ± 29.6 minutes vs. 119.2 ± 29.7 minutes, P = 0.89), fluoroscopy time (6.1 ± 2.4 minutes vs. 4.8 ± 2.2 minutes, P = 0.07), and ablation time (28.0 ± 12.9 minutes vs. 27.9 ± 15.8 minutes, P = 0.98) were similar in Group A versus Group B, respectively. No complications occurred in either group. Conclusions LA mapped by the novel system is stable and reliable. Combined with RMN, it could be effectively used for AF ablation without impacting overall procedural times. [ABSTRACT FROM AUTHOR]

Background: Diabetic kidney disease is a major cause of morbidity and mortality. Dysregulated turnover of collagen type III is associated with development of kidney fibrosis. We investigated whether a degradation product of collagen type III (C3M) was a risk marker for progression of chronic kidney disease (CKD), occurrence of cardiovascular disease (CVD), and mortality during follow up in people with type 2 diabetes (T2D) and microalbuminuria. Moreover, we investigated whether C3M was correlated with markers of inflammation and endothelial dysfunction at baseline. Methods: C3M was measured in serum (sC3M) and urine (uC3M) in 200 participants with T2D and microalbuminuria included in an observational, prospective study at Steno Diabetes Center Copenhagen in Denmark from 2007–2008. Baseline measurements included 12 markers of inflammation and endothelial dysfunction. The endpoints were CVD, mortality, and CKD progression (>30% decline in eGFR). Results: Mean (SD) age was 59 (9) years, eGFR 90 (17) ml/min/1.73m2 and median (IQR) urine albumin excretion rate 102 (39–229) mg/24-h. At baseline all markers for inflammation were positively correlated with sC3M (p≤0.034). Some, but not all, markers for endothelial dysfunction were correlated with C3M. Median follow-up ranged from 4.9 to 6.3 years. Higher sC3M was associated with CKD progression (with mortality as competing risk) with a hazard ratio (per doubling) of 2.98 (95% CI: 1.41–6.26; p = 0.004) adjusted for traditional risk factors. uC3M was not associated with CKD progression. Neither sC3M or uC3M were associated with risk of CVD or mortality. Conclusions: Higher sC3M was a risk factor for chronic kidney disease progression and was correlated with markers of inflammation. [ABSTRACT FROM AUTHOR]

The author discusses the article "Treatment of Herpes Labialis: Comparison of Two OTC Drugs and Untreated Controls," by James P. McCarthy and colleagues. The author mentions that the study provides an over-the-counter (OTC) medication and management on secondary extraoral herpes simplex infections (herpes liabisis). He also features various types of herpes viruses, and its connections on aphthous ulcers.

The author comments on the article "A Case Series: Herpes Simplex Virus as an Occupational Hazard." The author is critical on the conclusions made in the article's case reports on herpetic whitlow and ophthalmic herpetic keratitis. Moreover, the author stresses the importance of safety procedures in dental practice.

The article presents a letter to the editor in response to the article "Unsafe driving behaviour and four wheel drive vehicles: observational study," by Walker et al.

Beneficial impact on cardiovascular risk factors by dual blockade of the rennin-angiotensin system in diabetic nephropathy. Background Patients with diabetic nephropathy have a high risk of cardiovascular disease and end-stage renal disease. Dual blockade of the renin-angiotensin system (RAS) with both ACE inhibitors (ACE-I) and angiotensin II receptor blockers may offer therapeutic advantages. Methods Based on three double-blind randomized cross-over trials, we analyzed the short-term effects of dual blockade of the RAS on cardiovascular surrogate end points in 51 type 1 diabetic patients with diabetic nephropathy. Results Compared to ACE-I, dual blockade of the RAS decreased albuminuria 37% from 558 mg/24 hour, and lowered 24-hour blood pressure 7/5 mm Hg from 137/76 mm Hg ( P < 0.01). In addition, dual blockade lowered total and LDL-cholesterol 0.3 from 5.4 mmol/L and 3.1 mmol/L, respectively ( P ≤ 0.01). The antialbuminuric response to dual blockade of the RAS was influenced by the insertion (I)/deletion (D) polymorphism in the ACE gene. Conclusion Dual blockade of the RAS may offer additional cardiovascular and renal protection in type 1 diabetic patients with diabetic nephropathy. Determination of the ACE/ID genotype may help identify patients particularly sensitive to such therapy. [ABSTRACT FROM AUTHOR]

Beneficial impact on cardiovascular risk factors by dual blockade of the rennin-angiotensin system in diabetic nephropathy.Background.Patients with diabetic nephropathy have a high risk of cardiovascular disease and end-stage renal disease. Dual blockade of the renin-angiotensin system (RAS) with both ACE inhibitors (ACE-I) and angiotensin II receptor blockers may offer therapeutic advantages.Methods.Based on three double-blind randomized cross-over trials, we analyzed the short-term effects of dual blockade of the RAS on cardiovascular surrogate end points in 51 type 1 diabetic patients with diabetic nephropathy.Results.Compared to ACE-I, dual blockade of the RAS decreased albuminuria 37% from 558 mg/24 hour, and lowered 24-hour blood pressure 7/5 mm Hg from 137/76 mm Hg (P<0.01). In addition, dual blockade lowered total and LDL-cholesterol 0.3 from 5.4 mmol/L and 3.1 mmol/L, respectively (P≤ 0.01). The antialbuminuric response to dual blockade of the RAS was influenced by the insertion (I)/deletion (D) polymorphism in the ACE gene.Conclusion.Dual blockade of the RAS may offer additional cardiovascular and renal protection in type 1 diabetic patients with diabetic nephropathy. Determination of the ACE/ID genotype may help identify patients particularly sensitive to such therapy. [ABSTRACT FROM AUTHOR]

Aim. To validate the National Danish Ablation Database (NDAD) by investigating to what extent data in NDAD correspond to medical records. Type of study. Non-blinded, registry-based, retrospective, validation study. Material and methods. A sample of patients who underwent ablation for atrial fibrillation in Denmark between 1 January 2016 and 31 December 2016 were included. By utilizing medical records as gold standard, positive predictive (PPV) and negative predictive values (NPV) for NDAD were assessed and presented as five main categories: arrhythmia characteristics, demographics, cardiac history, complications, and medication. PPV's and NPV's exceeding 90% were considered as high agreement. Results. 597 patients (71.0% males) were included in the study. Median age was 63.1 (IQR: 54.9–68.4) years. The median PPV and NPV estimates across all variables were respectively 90.4% (95% CI: 68%–95.2%) (PPV) and 99.4% (95% CI: 98.4%–99.8%) (NPV) at baseline, and 91.7% (95% CI: 67.4%–95.4%) (PPV) and 99.3% (98.2%–99.3%) (NPV) at follow-up. Conclusion. The data registered in NDAD agrees to a great extent with the patients' medical records, suggesting NDAD is a database with high validity. As a result of low complication rate, the PPV- and NPV-estimates among complication variables were prone to somewhat greater uncertainty compared to the rest. [ABSTRACT FROM AUTHOR]

Aim: Treatment with certain drugs can augment the risk of developing malignant arrhythmias (e.g. torsades de pointes [TdP]). Hence, we examined the overall TdP risk drug use before out-of-hospital cardiac arrest (OHCA) and possible association with shockable rhythm and return of spontaneous circulation (ROSC).Methods: Patients ≥18 years with an OHCA of cardiac origin from the Danish Cardiac Arrest Registry (2001-2014) and TdP risk drug use according to www.CredibleMeds.org were identified. Factors associated with TdP risk drug use and secondly how use may affect shockable rhythm and ROSC were determined by multivariable logistic regression.Results: We identified 27,481 patients with an OHCA of cardiac origin (median age: 72 years [interquartile range 62.0, 80.0 years]). A total of 37% were in treatment with TdP risk drugs 0-30 days before OHCA compared with 33% 61-90 days before OHCA (p < 0.001). Most commonly used TdP risk drugs were citalopram (36.1%) and roxithromycin (10.7%). Patients in TdP risk drug treatment were older (75 vs 70 years) and more comorbid compared with those not in treatment. Subsequently, TdP risk drug use was associated with less likelihood of the presenting rhythm being shockable (odds ratio [OR] = 0.63, 95% confidence interval [CI]:0.58-0.69) and ROSC (OR = 0.73, 95% CI:0.66-0.80).Conclusion: TdP risk drug use increased in the time leading up to OHCA and was associated with reduced likelihood of presenting with a shockable rhythm and ROSC in an all-comer OHCA setting. However, patients in TdP risk drug treatment were older and more comorbid than patients not in treatment. [ABSTRACT FROM AUTHOR]